An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada

PubMed Central

2014-01-01

Background Interest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is to estimate the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. Methods Using an economic model, the costs related to early retirement and reduction in clinical hours of physicians were compared for those who were experiencing burnout against a scenario in which they did not experience burnout. The January 2012 Canadian Medical Association Masterfile was used to determine the number of practicing physicians. Transition probabilities were estimated using 2007–2008 Canadian Physician Health Survey and 2007 National Physician Survey data. Adjustments were also applied to outcome estimates based on ratio of actual to planned retirement and reduction in clinical hours. Results The total cost of burnout for all physicians practicing in Canada is estimated to be $213.1 million ($185.2 million due to early retirement and $27.9 million due to reduced clinical hours). Family physicians accounted for 58.8% of the burnout costs, followed by surgeons for 24.6% and other specialists for 16.6%. Conclusion The cost of burnout associated with early retirement and reduction in clinical hours is substantial and a significant proportion of practicing physicians experience symptoms of burnout. As health systems struggle with human resource shortages and expanding waiting times, this estimate sheds light on the extent to which the burden could be potentially decreased through prevention and promotion activities to address burnout among physicians. PMID:24927847

Special Analysis of Migrant Education Even Start Data. Even Start Information System.

ERIC Educational Resources Information Center

Tao, Fumiyo; Arriola, Christine

This report analyzes data submitted by 11 of 14 state Migrant Education Even Start (MEES) projects operating in 1994-95. These projects provide migrant families with an integrated program of early childhood education, adult education, and parenting education. The data were drawn from the Even Start Information System (ESIS), which collected…

Periodic self-rostering in shift work: correspondence between objective work hours, work hour preferences (personal fit), and work schedule satisfaction.

PubMed

Ingre, Michael; Åkerstedt, Torbjörn; Ekstedt, Mirjam; Kecklund, Göran

2012-07-01

The main objective of the present study was to investigate relative personal fit as the association between rated needs and preferences for work hours, on the one hand, and actual work hours, on the other hand, in three groups (hospital, call-center, and police) working with periodic self-rostering. We also examined the association between personal fit and satisfaction with the work schedule and preference for a fixed and regular shift schedule, respectively. We collected questionnaire data and objective work hour data over 6-12 months from the computerized self-rostering system. The response rate of the questionnaire was 69% at the hospital and call-center and 98% among the police. In total, 29 433 shifts for 285 shift workers were included in the study. Data was analyzed by means of mixed ANOVA, Kendal tau correlations and ordinal (proportional odds) logistic regression. The results show that evening types worked relatively more hours during the evening and night hours compared to morning types as an indication of relative personal fit. Relative personal fit was also found for long shift, short rest, and morning-, evening- and night-shift frequency, but only personal fit related to morning, evening and night-shift was associated with satisfaction with work hours. Reported conflicts at the workplace about work hours and problems with lack of predictability of time for family/leisure activities, was associated with poor satisfaction and a preference for a fixed shift schedule. The present study shows that periodic self-rostering is associated with relative personal fit, in particular with respect to night, evening, and morning work. Personal fit seems to be associated with satisfaction with work hours and may be a moderator of tolerance to shift work exposure.

Social optimum for evening commute in a single-entry traffic corridor with no early departures

NASA Astrophysics Data System (ADS)

Li, Chuan-Yao; Xu, Guang-Ming; Tang, Tie-Qiao

2018-07-01

In this paper, we investigate the evening commute behaviors on the social optimum (SO) state in a single-entry traffic corridor with no early departures. Differing from the previous studies on evening commute, the dynamic properties of traffic flow are analyzed with the LWR (Lighthill-Whitham-Richards) model. The properties of optimum cumulative inflow curve with general desired departure time distribution curve are deduced, and then the analytic solutions for common desired departure time in SO are obtained. Three numerical examples are carried out to capture the characteristics of evening commuting behaviors under different values of time. The analytic and numerical results both indicate that the rarefaction wave originating from the first entry point influences the whole or part of the outflow curve. No shock wave exists through the commuting process. In addition, the cost curves show that the trip cost increases and the departure delay cost decreases with departure time, whereas the travel time cost first increases then decreases with departure time under the SO principle.

29 CFR 785.21 - Less than 24-hour duty.

Code of Federal Regulations, 2014 CFR

2014-07-01

... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes no...

29 CFR 785.21 - Less than 24-hour duty.

Code of Federal Regulations, 2012 CFR

2012-07-01

... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes no...

29 CFR 785.21 - Less than 24-hour duty.

Code of Federal Regulations, 2011 CFR

2011-07-01

... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes no...

29 CFR 785.21 - Less than 24-hour duty.

Code of Federal Regulations, 2010 CFR

2010-07-01

... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes no...

29 CFR 785.21 - Less than 24-hour duty.

Code of Federal Regulations, 2013 CFR

2013-07-01

... be on duty for less than 24 hours is working even though he is permitted to sleep or engage in other... specified hours is working even though she is permitted to sleep when not busy answering calls. It makes no...

Has the 80-hour work week increased faculty hours?

PubMed

Winslow, Emily R; Berger, Lisa; Klingensmith, Mary E

2004-01-01

The 80-hour work week has affected not only surgical residents but also faculty. The aim of this study was to determine the effect of resident hour restrictions on faculty hours and attitudes. Anonymous survey. A single, large academic medical center. All faculty in the Departments of Surgery, Neurosurgery, Orthopedics, and Otolaryngology. Faculty were surveyed 6 months before and 6 months after the institution of the resident 80-hour work week. Surgeons detailed hours worked over 1 week and answered yes/no questions about changes in patient care and resident education. P values were determined by Chi-square tests or Student t-tests as appropriate. Of the 118 surveys distributed, 88 were returned (75%). Respondents were evenly divided between general surgeons (GS) and subspecialists (SS). Initially, 70% of faculty predicted that resident work-hour restrictions would increase faculty hours; however, only 47% of faculty felt that this had occurred. When current faculty work hours were compared with previously collected data, no differences were found. Faculty reported working an average of 69.9 +/- 12.2 hours per week this year, compared with 70.4 +/- 12.5 hours last year. When asked about the global impact of the 80-hour work week on faculty, 46% viewed the changes as harmful to the faculty. More concerning, 50% of all faculty felt the care their patients received was worse than previously, with only 2% feeling patient care had improved. This perception was significantly more common among GS faculty (70% GS vs 37% SS; p < 0.01), 94% of whom felt that the current lack of continuity compromises patient care. When the data were stratified by faculty work hours, interesting differences are seen. Of those faculty with work weeks less than 60 hours, only 6% thought the changes were harmful to patients and 64% thought resident training had suffered. In contrast, of those faculty who worked greater than 80 hours per week, 56% thought patients were harmed (p = 0.03) and 100

National Evaluation of the Even Start Family Literacy Program: Report on Migrant Even Start Projects.

ERIC Educational Resources Information Center

Levin, Marjorie; Gamse, Beth; Swartz, Janet; Tao, Fumiyo; Tarr, Hope

In fall 1994, 14 state Migrant Education Programs were receiving direct federal grants to administer Migrant Even Start projects. These projects provide migrant families with an integrated program of early childhood education, adult education, and parenting education. As part of the national evaluation of the Even Start Family Literacy Program,…

New Approach To Hour-By-Hour Weather Forecast

NASA Astrophysics Data System (ADS)

Liao, Q. Q.; Wang, B.

2017-12-01

Fine hourly forecast in single station weather forecast is required in many human production and life application situations. Most previous MOS (Model Output Statistics) which used a linear regression model are hard to solve nonlinear natures of the weather prediction and forecast accuracy has not been sufficient at high temporal resolution. This study is to predict the future meteorological elements including temperature, precipitation, relative humidity and wind speed in a local region over a relatively short period of time at hourly level. By means of hour-to-hour NWP (Numeral Weather Prediction)meteorological field from Forcastio (https://darksky.net/dev/docs/forecast) and real-time instrumental observation including 29 stations in Yunnan and 3 stations in Tianjin of China from June to October 2016, predictions are made of the 24-hour hour-by-hour ahead. This study presents an ensemble approach to combine the information of instrumental observation itself and NWP. Use autoregressive-moving-average (ARMA) model to predict future values of the observation time series. Put newest NWP products into the equations derived from the multiple linear regression MOS technique. Handle residual series of MOS outputs with autoregressive (AR) model for the linear property presented in time series. Due to the complexity of non-linear property of atmospheric flow, support vector machine (SVM) is also introduced . Therefore basic data quality control and cross validation makes it able to optimize the model function parameters , and do 24 hours ahead residual reduction with AR/SVM model. Results show that AR model technique is better than corresponding multi-variant MOS regression method especially at the early 4 hours when the predictor is temperature. MOS-AR combined model which is comparable to MOS-SVM model outperform than MOS. Both of their root mean square error and correlation coefficients for 2 m temperature are reduced to 1.6 degree Celsius and 0.91 respectively. The

New Plans for Evening and Correspondence School Students.

ERIC Educational Resources Information Center

Lebedev, I.I.

A general discussion is given concerning revisions in hours and schedules for evening and correspondence school students engaged in higher technical education. The teaching plan for the evening system consists of two parts: one for instruction in the first three years, and the other for the next three. The plan for correspondence study provides…

The First Hours of the GW170817 Kilonova and the Importance of Early Optical and Ultraviolet Observations for Constraining Emission Models

NASA Astrophysics Data System (ADS)

Arcavi, Iair

2018-03-01

The kilonova associated with GW170817 displayed early blue emission, which has been interpreted as a signature of either radioactive decay in low-opacity ejecta, relativistic boosting of radioactive decay in high-velocity ejecta, the cooling of material heated by a wind or by a “cocoon” surrounding a jet, or a combination thereof. Distinguishing between these mechanisms is important for constraining the ejecta components and their parameters, which tie directly into the physics we can learn from these events. I compile published ultraviolet, optical, and infrared light curves of the GW170817 kilonova and examine whether the combined data set can be used to distinguish between early-emission models. The combined optical data show an early rise consistent with radioactive decay of low-opacity ejecta as the main emission source, but the subsequent decline is fit well by all models. A lack of constraints on the ultraviolet flux during the first few hours after discovery allows for both radioactive decay and other cooling mechanisms to explain the early bolometric light curve. This analysis demonstrates that early (few hours after merger) high-cadence optical and ultraviolet observations will be critical for determining the source of blue emission in future kilonovae.

Payroll data based description of working hours in the Danish regions.

PubMed

Garde, Anne Helene; Hansen, Johnni; Kolstad, Henrik A; Larsen, Ann Dyreborg; Pedersen, Jacob; Petersen, Jindong Ding; Hansen, Åse Marie

2018-05-15

The aim was to describe the organization of working hours in the Danish regions according to sex, age and calendar year. Based on the Danish Working Hour Database (DWHD), individuals were classified according to schedules: Permanent day (57.8%), evening (1.7%), or night (1.2%); day/evening (22.0%); day/night (6.6%); evening/night (0.6%); and day/evening/night (10.2%). More men (9.1%) than women (5.9%) worked day/night, whereas more women (10.9%) than men (7.4%) worked day/evening/night. More young than older employees worked day/evening/night, and fewer worked permanent day or night. From 2008 to 2015 we observed a trend towards more employees working permanent day and fewer employees working other schedules. Altogether DWHD provides a strong tool in research on working hours.

What children eat during afternoons and evenings: is it important?

PubMed

Rockell, Jennifer E; Skidmore, Paula M L; Parnell, Winsome R; Wilson, Noela

2011-03-01

To complete a description of the dietary intakes of New Zealand schoolchildren by describing afternoon and evening foods and nutrients. Twenty-four hour dietary recall data from the 2002 Children's Nutrition Survey were analysed to describe food and nutrient intakes during the afternoon (14.00 to 16.59 hours) and evening (17.00 to 23.59 hours). New Zealand homes and schools. Children (n 2875) aged 5-14 years. Most children consumed something during the afternoon (79 %) and evening (98 %). Children were less likely to consume something during non-school day afternoons; if 11-14 years of age; and when of Pacific ethnicity. Afternoon food consumers had higher daily intakes for most nutrients. Afternoon intake accounted for much of this difference. In the afternoon, children consumed fruit (26 %) and biscuits/crackers (21 %). Evening eating contributed to daily intakes of energy (40 %), fat (43 %), carbohydrate (35 %), sucrose (20 %), glucose (24 %), vitamin A (47 %), Ca (26 %) and Fe (40 %). Children aged 5-6 years consumed a lower proportion of their daily energy intake during the evening than older children. In the evening, just one-third of children consumed vegetables (45 % if including potato/kumara/taro), 19 % fruit and 17 % ate hot chips. Children were more likely to consume vegetables if they also consumed potato/kumara/taro. Twenty-three per cent of children had powdered drinks/cordials, 21 % had soft drinks and 19 % had milk. Consuming foods/drinks in the afternoon positively influenced macronutrient distribution, increasing the carbohydrate proportion. During the evening 40 % of energy intake was consumed but less than one-half of children consumed vegetables; thus inclusion of vegetables in the evening is important, particularly in meals without potato/kumara/taro.

Weed presence altered biotic stress and light signaling in maize even when weeds were removed early in the critical weed-free period

USDA-ARS?s Scientific Manuscript database

Weeds reduce crop yield even when there is no competition for resources. A phenomena known as the critical weed-free period (CWFP), which occurs early in the crop’s life cycle, is the essential interval when weed presence can reduce crop growth and yield. Even when weeds are removed after the CWFP, ...

Infant self-regulation and early childhood media exposure.

PubMed

Radesky, Jenny S; Silverstein, Michael; Zuckerman, Barry; Christakis, Dimitri A

2014-05-01

Examine prospective associations between parent-reported early childhood self-regulation problems and media exposure (television and video viewing) at 2 years. We hypothesized that children with poor self-regulation would consume more media, possibly as a parent coping strategy. We used data from 7450 children in the Early Childhood Longitudinal Study-Birth Cohort. When children were 9 months and 2 years old, parents completed the Infant Toddler Symptom Checklist (ITSC), a validated scale of self-regulation. With daily media use at 2 years as our outcome, we conducted weighted multivariable regression analyses, controlling for child, maternal, and household characteristics. Children watched an average of 2.3 hours per day (SD 1.9) of media at age 2 years. Infants with poor self-regulation (9-month ITSC score ≥3) viewed 0.23 hour per day (95% confidence interval [CI] 0.12-0.35) more media at 2 years compared with those with 9-month ITSC score of 0 to 2; this remained significant in adjusted models (0.15 hour per day [95% CI 0.02-0.28]). Children rated as having persistent self-regulation problems (ITSC ≥3 at both 9 months and 2 years) were even more likely to consume media at age 2 (adjusted β 0.21 hour per day [95% CI 0.03-0.39]; adjusted odds ratio for >2 hours per day 1.40 [95% CI 1.14-1.71]). These associations were slightly stronger in low socioeconomic status and English-speaking households. Early childhood self-regulation problems are associated with mildly increased media exposure, even after controlling for important confounding variables. Understanding this relationship may provide insight into helping parents reduce their children's screen time. Copyright © 2014 by the American Academy of Pediatrics.

Regulatory effects on particulate pollution in the early hours of Chinese New Year, 2015.

PubMed

Lai, Yonghang; Brimblecombe, Peter

2017-08-23

Human activities are a key driver of air pollution, so it is hardly surprising that celebrations affect air quality. The use of fireworks contributes to high particulate concentrations in many parts of the world, with the Chinese Lunar New Year (spring festival) particularly noticeable, as firecrackers are traditionally used to drive off evil spirits. Fireworks lead to short-term peaks in the concentration of PM10, PM2.5 and SO 2 . Regulatory actions that restrict the use of fireworks have been evident in China since the 1990s. This paper investigates the particulate concentrations in nine Chinese cities (Beijing, Chengdu, Chongqing, Tianjin, Xi'an, Nanjing, Shanghai, Guangzhou and Shenzhen, along with Hong Kong (a Special Administrative Region) and Taipei and Kaohsiung (Taiwan) with a particular focus on the celebrations of 2015. Extremely high concentrations of particulate matter were observed, with some sites revealing peak PM10 concentrations in excess of 1000 μg m -3 in the early hours of the New Year. In Beijing, Tianjin and Chongqing, the activities caused high particulate matter concentrations at most sites throughout the city. These peaks in particulate load in the early hours of Chinese New Year do not appear to be closely related to meteorological parameters. However, in cities where fireworks appear to be better regulated, there are fewer sharp pollution peaks just after midnight, although lowered air quality can still be found in the outer parts of some cities, remote from regulatory pressures. A few cities seem to have been effective at reducing the impact of the celebrations on air quality, with Nanjing a recent example. An increasing focus on light displays and electric lanterns also seems to offer a sense of celebration with much reduced impacts on air quality.

Early effects of resident work-hour restrictions on patient safety: a systematic review and plea for improved studies.

PubMed

Baldwin, Keith; Namdari, Surena; Donegan, Derek; Kamath, Atul F; Mehta, Samir

2011-01-19

since the inception of the eighty-hour work week, work hour restrictions have incited considerable debate. Work hour policies were designed to prevent medical errors and to reduce patient morbidity and mortality. It is unclear whether work hour restrictions have been helpful in medicine in general and in orthopaedic surgery specifically. This systematic review of the literature was designed to determine the success of these restrictions in terms of patient mortality, medical errors, and complications. a systematic review of the literature was performed to determine if work hour rules have improved patient and systems-based outcomes and reduced physician errors as measured by mortality, medical errors, and complications. A random effects model was utilized to determine whether patient mortality rates were improved under the new rules. the odds of patient death before implementation of the work hour rules were 1.12 (95% confidence interval, 1.07 to 1.17) times those after implementation. These differences were consistent across disciplines. The data concerning medical or surgical complications before and after the institution of the work hour rules were mixed. There was little information in these studies concerning direct medical errors. The odds of death in nonteaching cohorts were not significantly different from that in teaching cohorts. there appears to be a decrease in mortality following the institution of work hour rules. The difference seen in teaching cohorts is not significantly different from that in nonteaching cohorts. It is unclear whether this difference would have been observed even without work hour restrictions. No study has shown a reduction in mortality for orthopaedic patients in teaching cohorts that was greater than that observed in nonteaching cohorts. Because of methodological concerns and the lack of current literature linking physician fatigue and physician underperformance with patient mortality, it is unclear whether the goals of the

The effects of 72 hours of sleep loss on psychological variables.

PubMed

Mikulincer, M; Babkoff, H; Caspy, T; Sing, H

1989-05-01

A study was conducted on the effects of 72 hours of sleep loss and modified continuous operations on performance and psychological variables. This paper presents the results of self-report data of 12 subjects for the following psychological variables: sleepiness, affect, motivation, cognitive difficulties, and waking dreams. The relationship between the self-report measures and performance in a visual search and memory task is also examined. Most of the psychological variables are significantly affected by the number of days of sleep deprivation, all are significantly affected by hour of day; but only sleepiness, affect and motivation are also significantly affected by the interaction between these variables. The peak hours for self-reported psychological complaints are generally between 0400 and 0800, while the lowest number of complaints are usually reported in the afternoon/early evening, between 1600 and 2000. In addition, the results showed that (a) the amplitude of the circadian component of the psychological data increased over the period of sleep loss, and (b) psychological data were more highly correlated with a measure of general performance than with accuracy. The mechanisms of sleep deprivation underlying its effects on psychological and performance measures are discussed.

Even Start Projects Serving Migrant Families: Resource Guide.

ERIC Educational Resources Information Center

Gonzales, Miriam; Goldstein, David; Stief, Elizabeth; Fiester, Leila; Weiner, Lisa; Waiters, Katrina

Even Start was created by federal legislation to address poverty and illiteracy among low-income families by integrating early childhood education, adult literacy or adult basic education, and parenting education into a unified family literacy program. Migrant Education Even Start (MEES) projects resemble other Even Start projects but are affected…

National Evaluation of the Even Start Family Literacy Program. Report on Even Start Projects for Indian Tribes and Tribal Organizations.

ERIC Educational Resources Information Center

Levin, Marjorie; Moss, Marc; Swartz, Janet; Khan, Sherry; Tarr, Hope

The tribal Even Start program is one of the set-aside components of the U.S. Department of Education's Even Start Family Literacy Program. Even Start combines adult literacy, early childhood education, and parenting education services for parents eligible for adult education and their children from birth to age 7. In 1994-95, nine Indian tribes…

Relation of cardiac troponin I measurements at 24 and 48 hours to magnetic resonance-determined infarct size in patients with ST-elevation myocardial infarction.

PubMed

Hallén, Jonas; Buser, Peter; Schwitter, Jürg; Petzelbauer, Peter; Geudelin, Bernard; Fagerland, Morten W; Jaffe, Allan S; Atar, Dan

2009-12-01

Levels of circulating cardiac troponin I (cTnI) or T are correlated to extent of myocardial destruction after an acute myocardial infarction. Few studies analyzing this relation have employed a second-generation cTnI assay or cardiac magnetic resonance (CMR) as the imaging end point. In this post hoc study of the Efficacy of FX06 in the Prevention of Mycoardial Reperfusion Injury (F.I.R.E.) trial, we aimed at determining the correlation between single-point cTnI measurements and CMR-estimated infarct size at 5 to 7 days and 4 months after a first-time ST-elevation myocardial infarction (STEMI) and investigating whether cTnI might provide independent prognostic information regarding infarct size at 4 months even taking into account early infarct size. Two hundred twenty-seven patients with a first-time STEMI were included in F.I.R.E. All patients received primary percutaneous coronary intervention within 6 hours from onset of symptoms. cTnI was measured at 24 and 48 hours after admission. CMR was conducted within 1 week of the index event (5 to 7 days) and at 4 months. Pearson correlations (r) for infarct size and cTnI at 24 hours were r = 0.66 (5 days) and r = 0.63 (4 months) and those for cTnI at 48 hours were r = 0.67 (5 days) and r = 0.65 (4 months). In a multiple regression analysis for predicting infarct size at 4 months (n = 141), cTnI and infarct location retained an independent prognostic role even taking into account early infarct size. In conclusion, a single-point cTnI measurement taken early after a first-time STEMI is a useful marker for infarct size and might also supplement early CMR evaluation in prediction of infarct size at 4 months.

Morning versus evening induction of labour for improving outcomes.

PubMed

Bakker, Jannet J H; van der Goes, Birgit Y; Pel, Maria; Mol, Ben Willem J; van der Post, Joris A M

2013-02-28

Induction of labour is a common intervention in obstetric practice. Traditionally, in most hospitals induction of labour with medication starts early in the morning, with the start of the working day for the day shift. In human and animal studies spontaneous onset of labour is proven to have a circadian rhythm with a preference for start of labour in the evening. Moreover, when spontaneous labour starts in the evening, the total duration of labour and delivery shortens and fewer obstetric interventions are needed. Based on these observations one might assume that starting induction of labour in the evening, in harmony with the circadian rhythm of natural birth, is more beneficial for both mother and child. To assess whether induction of labour starting in the evening, coinciding with the endogenous circadian rhythm, improves the outcome of labour compared with induction of labour starting in the early morning, organised to coincide with office hours. We contacted the Trials Search Co-ordinator to search the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012). In addition, we searched MEDLINE (1966 to 16 February 2012) and EMBASE (1980 to 16 February 2012). We included all published and unpublished randomised controlled trials. We excluded trials that employed quasi-random methods of treatment allocation. Two review authors independently assessed trials for inclusion and risk of bias. Two review authors independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. The search resulted in 2693 articles that we screened on title and abstract for eligibility.Thirteen studies were selected for full text assessment. We included three randomised trials involving 1150 women. Two trials compared the administration of prostaglandins in the morning versus the evening in women with an unfavourable cervix, and one trial compared induction of labour in the morning versus the evening

Colorado Even Start. 1998-1999 Progress Report.

ERIC Educational Resources Information Center

Anderson, Beckie

Even Start programs integrate early childhood education, adult literacy or basic education, parenting education and support, and parent and child time to help break the cycle of poverty and illiteracy. This report describes the Even Start program in Colorado, and includes evaluation questions and methods. The report presents evaluation findings…

Colorado Even Start. 1997-1998 Progress Report.

ERIC Educational Resources Information Center

Anderson, Beckie

Even Start programs integrate early childhood education, adult literacy or basic education, parenting education and support, and parent and child time together to help break the cycle of poverty and illiteracy. This report describes the Even Start program in Colorado, including evaluation questions and methods. The report also presents evaluation…

Sensors Provide Early Warning of Biological Threats

NASA Technical Reports Server (NTRS)

2009-01-01

Early Warning Inc. of Troy, New York, licensed powerful biosensor technology from Ames Research Center. Incorporating carbon nanotubes tipped with single strands of nucleic acid from waterborne pathogens, the sensor can detect even minute amounts of targeted, disease causing bacteria, viruses, and parasites. Early Warning features the NASA biosensor in its water analyzer, which can provide advance alert of potential biological hazards in water used for agriculture, food and beverages, showers, and at beaches and lakes -- within hours instead of the days required by conventional laboratory methods.

Colorado Even Start Progress Report, 2001-2002.

ERIC Educational Resources Information Center

Anderson, Beckie

Even Start programs integrate early childhood education, adult literacy or basic education, parenting education and support, and parent and child time together to help break the cycle of poverty and illiteracy. This progress report describes the Even Start program in Colorado and presents evaluation findings from the 2001-2002 implementation year,…

Early prediction of post-thyroidectomy hypocalcemia by early parathyroid hormone measurement.

PubMed

Yetkin, Gurkan; Citgez, Bulent; Yazici, Pinar; Mihmanli, Mehmet; Sit, Erhan; Uludag, Mehmet

2016-01-01

Hypoparathyroidism is the most common complication of total thyroidectomy (TT). Postthyroidectomy hypocalcemia occurs 24 to 48 hours after the operation. It prolongs the length of hospital stay, even though transient in most cases. The aim of this study was to predetermine the patients who may develop postthyroidectomy hypocalcemia by using early postoperative serum intact parathormone (iPTH) and calcium (Ca2+) measurements, and to investigate the effects of early initiated oral calcium and vitamin D treatments on the development of transient hypocalcemia. Patients who underwent TT after initiation of the early iPTH measurement protocol in January 2013 were included into the study group (Group 1, n=202). The control group (Group 2) was composed of 72 patients who underwent TT before the protocol. Prior to the initiation of the protocol, Ca2+ was measured instead of iPTH. In the study group, the serum Ca2+ and iPTH levels were measured before surgery, and 1 and 24-hours after. A calcium level below 8 mg/dL was accepted as biochemical hypocalcaemia, and a iPTH level under 15pg/mL was accepted as hypoparathyroidism. In the study group, patients with below normal iPTH levels were treated with prophylactic oral calcium and vitamin D. In Group 1, 15.8% (n=32) of the patients had hypoparathyroidism on the 1h and 24 h iPTH measurements. There was no statistically difference with regard to PTH levels measured in the postoperative 1st hour and at the 24th hour (p= 0.078). Biochemical hypocalcaemia developed in 16 (7.9%) and 13 (18%) patients in Groups 1 and 2, respectively, 24 hours after thyroidectomy (p<0.05). Mean length of hospital stay was 2.17 and 3.26 days in the study and control groups (p<0.001). We believe that the measurement of iPTH levels one hour after thyroidectomy, when compared to levels at 24 hours after procedure, is a safe, reliable, and adequate method for the effective management of plausible postthyroidectomic hypocalcemia. It yields significantly

Work shift duration: a review comparing eight hour and 12 hour shift systems.

PubMed

Smith, L; Folkard, S; Tucker, P; Macdonald, I

1998-04-01

Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative effects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. The research findings are largely equivocal. The bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. There can be considerable extension of the person's time awake either side of the shift. However, the effects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed.

Morning and Evening Blue-Enriched Light Exposure Alters Metabolic Function in Normal Weight Adults.

PubMed

Cheung, Ivy N; Zee, Phyllis C; Shalman, Dov; Malkani, Roneil G; Kang, Joseph; Reid, Kathryn J

2016-01-01

Increasing evidence points to associations between light-dark exposure patterns, feeding behavior, and metabolism. This study aimed to determine the acute effects of 3 hours of morning versus evening blue-enriched light exposure compared to dim light on hunger, metabolic function, and physiological arousal. Nineteen healthy adults completed this 4-day inpatient protocol under dim light conditions (<20lux). Participants were randomized to 3 hours of blue-enriched light exposure on Day 3 starting either 0.5 hours after wake (n = 9; morning group) or 10.5 hours after wake (n = 10; evening group). All participants remained in dim light on Day 2 to serve as their baseline. Subjective hunger and sleepiness scales were collected hourly. Blood was sampled at 30-minute intervals for 4 hours in association with the light exposure period for glucose, insulin, cortisol, leptin, and ghrelin. Homeostatic model assessment of insulin resistance (HOMA-IR) and area under the curve (AUC) for insulin, glucose, HOMA-IR and cortisol were calculated. Comparisons relative to baseline were done using t-tests and repeated measures ANOVAs. In both the morning and evening groups, insulin total area, HOMA-IR, and HOMA-IR AUC were increased and subjective sleepiness was reduced with blue-enriched light compared to dim light. The evening group, but not the morning group, had significantly higher glucose peak value during blue-enriched light exposure compared to dim light. There were no other significant differences between the morning or the evening groups in response to blue-enriched light exposure. Blue-enriched light exposure acutely alters glucose metabolism and sleepiness, however the mechanisms behind this relationship and its impacts on hunger and appetite regulation remain unclear. These results provide further support for a role of environmental light exposure in the regulation of metabolism.

Morning and Evening Blue-Enriched Light Exposure Alters Metabolic Function in Normal Weight Adults

PubMed Central

Cheung, Ivy N.; Zee, Phyllis C.; Shalman, Dov; Malkani, Roneil G.; Kang, Joseph; Reid, Kathryn J.

2016-01-01

Increasing evidence points to associations between light-dark exposure patterns, feeding behavior, and metabolism. This study aimed to determine the acute effects of 3 hours of morning versus evening blue-enriched light exposure compared to dim light on hunger, metabolic function, and physiological arousal. Nineteen healthy adults completed this 4-day inpatient protocol under dim light conditions (<20lux). Participants were randomized to 3 hours of blue-enriched light exposure on Day 3 starting either 0.5 hours after wake (n = 9; morning group) or 10.5 hours after wake (n = 10; evening group). All participants remained in dim light on Day 2 to serve as their baseline. Subjective hunger and sleepiness scales were collected hourly. Blood was sampled at 30-minute intervals for 4 hours in association with the light exposure period for glucose, insulin, cortisol, leptin, and ghrelin. Homeostatic model assessment of insulin resistance (HOMA-IR) and area under the curve (AUC) for insulin, glucose, HOMA-IR and cortisol were calculated. Comparisons relative to baseline were done using t-tests and repeated measures ANOVAs. In both the morning and evening groups, insulin total area, HOMA-IR, and HOMA-IR AUC were increased and subjective sleepiness was reduced with blue-enriched light compared to dim light. The evening group, but not the morning group, had significantly higher glucose peak value during blue-enriched light exposure compared to dim light. There were no other significant differences between the morning or the evening groups in response to blue-enriched light exposure. Blue-enriched light exposure acutely alters glucose metabolism and sleepiness, however the mechanisms behind this relationship and its impacts on hunger and appetite regulation remain unclear. These results provide further support for a role of environmental light exposure in the regulation of metabolism. PMID:27191727

Review shows that early foetal alcohol exposure may cause adverse effects even when the mother consumes low levels.

PubMed

Sarman, Ihsan

2018-06-01

Studies are increasingly focusing on the effects of prenatal alcohol exposure (PAE) on child health. The aim of this review was to provide paediatricians with new insights to help them communicate key messages about avoiding alcohol during pregnancy. Inspired by the 7th International Conference on Fetal Alcohol Spectrum Disorder, which focused on integrating research, policy and practice, we studied English language papers published since 2010 on how early PAE triggered epigenetic mechanisms that had an impact on the development of some chronic diseases. We also report the findings of a human study using three-dimensional photography of the face to explore associations between PAE and craniofacial phenotyping. Animal models with different alcohol exposure patterns show that early PAE may lead to long-term chronic effects, due to developmental programming for some adult diseases in cardiovascular, metabolic and renal systems. The study with three-dimensional photographing is very promising in helping paediatricians to understand how even small amounts of PAE can affect craniofacial phenotyping. Even low levels of PAE can cause adverse foetal effects and not just in the brain. It is not currently possible to determine a safe period and level when alcohol consumption would not affect the foetus. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Reduced Contact Hour Accelerated Courses and Student Learning

ERIC Educational Resources Information Center

Thornton, Barry; Demps, Julius; Jadav, Arpita

2017-01-01

Undergraduate instruction in the Davis College of Business at Jacksonville University utilizes two course delivery methods. Traditional daytime classes are 15 weeks long and have approximately 40 contact hours, while evening courses are offered in the Accelerated Degree program in a compressed 8-week format with 24 contact hours. The curriculum is…

Work shift duration: a review comparing eight hour and 12 hour shift systems

PubMed Central

Smith, L.; Folkard, S.; Tucker, P.; Macdonald, I.

1998-01-01

OBJECTIVES: Shiftwork is now a major feature of working life across a broad range of industries. The features of the shift systems operated can impact on the wellbeing, performance, and sleep of shiftworkers. This paper reviews the current state of knowledge on one major characteristic of shift rotas-namely, shift duration. Evidence comparing the relative effects of eight hour and 12 hour shifts on fatigue and job performance, safety, sleep, and physical and psychological health are considered. At the organisational level, factors such as the mode of system implementation, attitudes towards shift rotas, sickness absence and turnover, overtime, and moonlighting are discussed. METHODS: Manual and electronic searches of the shiftwork research literature were conducted to obtain information on comparisons between eight hour and 12 hour shifts. RESULTS: The research findings are largely equivocal. The bulk of the evidence suggests few differences between eight and 12 hour shifts in the way they affect people. There may even be advantages to 12 hour shifts in terms of lower stress levels, better physical and psychological wellbeing, improved durations and quality of off duty sleep as well as improvements in family relations. On the negative side, the main concerns are fatigue and safety. It is noted that a 12 hour shift does not equate with being active for only 12 hours. CONCLUSIONS: There can be considerable extension of the person's time awake either side of the shift. However, the effects of longer term exposure to extended work days have been relatively uncharted in any systematic way. Longitudinal comparative research into the chronic impact of the compressed working week is needed.   PMID:9624275

Did liberalising bar hours decrease traffic accidents?

PubMed

Green, Colin P; Heywood, John S; Navarro, Maria

2014-05-01

Legal bar closing times in England and Wales have historically been early and uniform. Recent legislation liberalised closing times with the object of reducing social problems thought associated with drinking to "beat the clock." Indeed, using both difference in difference and synthetic control approaches we show that one consequence of this liberalisation was a decrease in traffic accidents. This decrease is heavily concentrated among younger drivers. Moreover, we provide evidence that the effect was most pronounced in the hours of the week directly affected by the liberalisation: late nights and early mornings on weekends. This evidence survives a series of robustness checks and suggests at least one socially positive consequence of extending bar hours. Copyright © 2014 Elsevier B.V. All rights reserved.

Off-Hour Admission and Outcomes in Patients with Acute Intracerebral Hemorrhage in the INTERACT2 Trial.

PubMed

Sato, Shoichiro; Arima, Hisatomi; Heeley, Emma; Hirakawa, Yoichiro; Delcourt, Candice; Lindley, Richard I; Robinson, Thompson; Huang, Yining; Morgenstern, Lewis; Stapf, Christian; Wang, Jiguang; Chalmers, John; Anderson, Craig S

2015-01-01

Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country. Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity). Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours. © 2015 S. Karger AG, Basel.

City-level variations in NOx emissions derived from hourly monitoring data in Chicago

NASA Astrophysics Data System (ADS)

de Foy, Benjamin

2018-03-01

Control on emissions of nitrogen oxides (NOx) in the United States of America have led to reductions in concentrations in urban areas by up to a factor of two in the last decade. The Air Quality System monitoring network provides surface measurements of concentrations at hourly resolution over multiple years, revealing variations at the annual, seasonal, day of week and diurnal time scales. A multiple linear regression model was used to estimate the temporal profiles in the NOx concentrations as well as the impact of meteorology, ozone concentrations, and boundary layer heights. The model is applied to data from 2005 to 2016 available at 6 sites in Chicago, Illinois. Results confirm the 50% decrease in NOx over the length of the time series. The weekend effect is found to be stronger in more commercial areas, with 32% reductions on Saturdays and 45% on Sundays and holidays; and weaker in more residential areas with 20% reductions on Saturdays and 30% reductions on Sundays. Weekday diurnal profiles follow a double hump with emission peaks during the morning and afternoon rush hours, but only a shallow drop during the middle day. Difference in profiles from the 6 sites suggest that there are different emission profiles within the urban area. Diurnal profiles on Saturdays have less variation throughout the day and more emissions in the evening. Sundays are very different from both weekdays and Saturdays with a gradual increase until the early evening. The results suggest that in addition to vehicle type and vehicle miles traveled, vehicle speed and congestion must be taken into account to correctly quantify morning rush hour emissions and the weekend effect.

An Hour in History

NASA Image and Video Library

2011-03-22

John C. Stennis Space Center historian Marco Giardino speaks to center employees during the first An Hour in History session March 22. The Stennis History Office launched the series as part of the rocket engine test facility's yearlong 50th anniversary celebration. The inaugural session focused on Stennis history during the early 1960s. Subsequent sessions will focus on other aspects of Stennis history as part of the '50 Years of Powering Dreams' anniversary theme.

The Functional and Clinical Significance of the 24-Hour Rhythm of Circulating Glucocorticoids

PubMed Central

Oster, Henrik; Challet, Etienne; Ott, Volker; Arvat, Emanuela; de Kloet, E. Ronald; Dijk, Derk-Jan; Lightman, Stafford; Vgontzas, Alexandros

2017-01-01

Adrenal glucocorticoids are major modulators of multiple functions, including energy metabolism, stress responses, immunity, and cognition. The endogenous secretion of glucocorticoids is normally characterized by a prominent and robust circadian (around 24 hours) oscillation, with a daily peak around the time of the habitual sleep-wake transition and minimal levels in the evening and early part of the night. It has long been recognized that this 24-hour rhythm partly reflects the activity of a master circadian pacemaker located in the suprachiasmatic nucleus of the hypothalamus. In the past decade, secondary circadian clocks based on the same molecular machinery as the central master pacemaker were found in other brain areas as well as in most peripheral tissues, including the adrenal glands. Evidence is rapidly accumulating to indicate that misalignment between central and peripheral clocks has a host of adverse effects. The robust rhythm in circulating glucocorticoid levels has been recognized as a major internal synchronizer of the circadian system. The present review examines the scientific foundation of these novel advances and their implications for health and disease prevention and treatment. PMID:27749086

Impact of new duty-hour rules on residency training.

PubMed

Duran-Nelson, Alisa; Van Camp, Joan; Ling, Louis

2010-11-01

On the surface, changing the rules related to the number of hours residents work per day and per week sounds like a good idea. Theoretically, residents who work fewer hours would be less tired and provide better patient care. But even small changes in residency training programs have implications for the quality of the educational experience and the cost of training, as well as patient care. This article highlights the challenges that two Minnesota residency programs are facing as they adapt to the new rules around residents' work hours.

[The Psychotherapeutic Evening Clinic: Concept and First Results].

PubMed

Dinger, Ulrike; Komo-Lang, Miriam; Schauenburg, Henning; Herzog, Wolfgang; Nikendei, Christoph

2018-05-30

This article reports about a new treatment setting, the Psychotherapeutic Evening Clinic at the University Hospital Heidelberg. The treatment intensity is ranked between intensive, full-day inpatient and day-clinic programs in hospitals and less frequent outpatient psychotherapy according to the Germany Psychotherapy Guideline. Patients attend the Evening Clinic on 3 evenings per week for 3 hours each. During this time, they receive group therapy, individual therapy, mindfulness exercises and psychotherapeutic ward rounds. The first experiences with the new setting are positive, a specific advantage is the possibility to include daily hassles and everyday stressors as well as patients' strengths and resources into the treatment. Therapeutic challenges are the potential of overburdening patients with an already high impairment. On the structural and political level it will be important to ensure funding for the new treatment setting. © Georg Thieme Verlag KG Stuttgart · New York.

Intensive Evening Outpatient Treatment for Patients With Personality Dysfunction: Early Group Process, Change in Interpersonal Distress, and Longer-Term Social Functioning.

PubMed

Joyce, Anthony S; Ogrodniczuk, John S; Kealy, David

2017-01-01

Entrenched interpersonal difficulties are a defining feature of those with personality dysfunction. Evening treatment-a comprehensive and intensive group-oriented outpatient therapy program-offers a unique approach to delivering mental health services to patients with chronic personality dysfunction. This study assessed change in interpersonal problems as a key outcome, the relevance of such change to future social functioning, and the influence of early group processes on this change. Consecutively admitted patients (N = 75) to a group-oriented evening treatment program were recruited; the majority were diagnosed with personality disorder. Therapy outcome was represented by scores on the Inventory of Interpersonal Problems. Follow-up outcome was represented by the global score of the Social Adjustment Scale. Group climate, group cohesion, and the therapeutic alliance were examined as process variables. Patients experienced substantial reduction in distress associated with interpersonal problems; early process factors that reflected a cohesive and engaged group climate and stronger therapeutic alliance were predictive of this outcome. Improvement in interpersonal distress was predictive of global social functioning six months later. The therapeutic alliance most strongly accounted for change in interpersonal problems at posttreatment and social functioning at follow-up. A comprehensive and integrated outpatient group therapy program, offered in the evening to accommodate patients' real-life demands, can facilitate considerable improvement in interpersonal problems, which in turn influences later social functioning. The intensity and intimacy of peer interactions in the therapy groups, and a strong alliance with the program therapists, are likely interacting factors that are particularly important to facilitate such change.

The Associations Between Long Working Hours, Physical Inactivity, and Burnout.

PubMed

Hu, Nien-Chih; Chen, Jong-Dar; Cheng, Tsun-Jen

2016-05-01

To examine the correlations between long working hours, physical activity, and burnout. A cross-sectional survey was administered to 1560 full-time employees, who underwent periodic health examinations in the year 2013. The subjects were divided into upper, middle, and lower tertiles according to the Copenhagen Burnout Inventory (CBI) score. The comparison of the high- and low-burnout groups revealed that long working hours were significantly correlated with burnout in a dose-dependent manner. Long working hours were more significantly associated with burnout among individuals younger than 50 years, females, and physically inactive employees. Long working hours are correlated with burnout when working over 40 hours per week and is even stronger when working over 60 hours per week. Limiting working hours to 40 weekly may be beneficial for the prevention of burnout. Physical activity helps reduce the risk of burnout.

Unrestricted evening use of light-emitting tablet computers delays self-selected bedtime and disrupts circadian timing and alertness.

PubMed

Chinoy, Evan D; Duffy, Jeanne F; Czeisler, Charles A

2018-05-01

Consumer electronic devices play an important role in modern society. Technological advancements continually improve their utility and portability, making possible the near-constant use of electronic devices during waking hours. For most people, this includes the evening hours close to bedtime. Evening exposure to light-emitting (LE) devices can adversely affect circadian timing, sleep, and alertness, even when participants maintain a fixed 8-hour sleep episode in darkness and the duration of evening LE-device exposure is limited. Here, we tested the effects of evening LE-device use when participants were allowed to self-select their bedtimes, with wake times fixed as on work/school days. Nine healthy adults (3 women, 25.7 ± 3.0 years) participated in a randomized and counterbalanced study comparing five consecutive evenings of unrestricted LE-tablet computer use versus evenings reading from printed materials. On evenings when using LE-tablets, participants' self-selected bedtimes were on average half an hour later (22:03 ± 00:48 vs. 21:32 ± 00:27 h; P = 0.030), and they showed suppressed melatonin levels (54.17 ± 18.00 vs. 9.75 ± 22.75%; P < 0.001), delayed timing of melatonin secretion onset (20:23 ± 01:06 vs. 19:35 ± 00:59 h; P < 0.001), and later sleep onset (22:25 ± 00:54 vs. 21:54 ± 00:25 h; P = 0.041). When using LE-tablets, participants rated themselves as less sleepy in the evenings (P = 0.030) and less alert in the first hour after awakening on the following mornings (P < 0.001). These findings demonstrate that evening use of LE-tablets can induce delays in self-selected bedtimes, suppress melatonin secretion, and impair next-morning alertness, which may impact the health, performance, and safety of users. © 2018 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T.

PubMed

Mueller, Christian; Giannitsis, Evangelos; Christ, Michael; Ordóñez-Llanos, Jorge; deFilippi, Christopher; McCord, James; Body, Richard; Panteghini, Mauro; Jernberg, Tomas; Plebani, Mario; Verschuren, Franck; French, John; Christenson, Robert; Weiser, Silvia; Bendig, Garnet; Dilba, Peter; Lindahl, Bertil

2016-07-01

We aim to prospectively validate the diagnostic accuracy of the recently developed 0-h/1-h algorithm, using high-sensitivity cardiac troponin T (hs-cTnT) for the early rule-out and rule-in of acute myocardial infarction. We enrolled patients presenting with suspected acute myocardial infarction and recent (<6 hours) onset of symptoms to the emergency department in a global multicenter diagnostic study. Hs-cTnT (Roche Diagnostics) and sensitive cardiac troponin I (Siemens Healthcare) were measured at presentation and after 1 hour, 2 hours, and 4 to 14 hours in a central laboratory. Patient triage according to the predefined hs-cTnT 0-hour/1-hour algorithm (hs-cTnT below 12 ng/L and Δ1 hour below 3 ng/L to rule out; hs-cTnT at least 52 ng/L or Δ1 hour at least 5 ng/L to rule in; remaining patients to the "observational zone") was compared against a centrally adjudicated final diagnosis by 2 independent cardiologists (reference standard). The final diagnosis was based on all available information, including coronary angiography and echocardiography results, follow-up data, and serial measurements of sensitive cardiac troponin I, whereas adjudicators remained blinded to hs-cTnT. Among 1,282 patients enrolled, acute myocardial infarction was the final diagnosis for 213 (16.6%) patients. Applying the hs-cTnT 0-hour/1-hour algorithm, 813 (63.4%) patients were classified as rule out, 184 (14.4%) were classified as rule in, and 285 (22.2%) were triaged to the observational zone. This resulted in a negative predictive value and sensitivity for acute myocardial infarction of 99.1% (95% confidence interval [CI] 98.2% to 99.7%) and 96.7% (95% CI 93.4% to 98.7%) in the rule-out zone (7 patients with false-negative results), a positive predictive value and specificity for acute myocardial infarction of 77.2% (95% CI 70.4% to 83.0%) and 96.1% (95% CI 94.7% to 97.2%) in the rule-in zone, and a prevalence of acute myocardial infarction of 22.5% in the observational zone. The hs

Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study.

PubMed

Pflug, Christina; Bihler, Moritz; Emich, Katharina; Niessen, Almut; Nienstedt, Julie Cläre; Flügel, Till; Koseki, Jana-Christiane; Plaetke, Rosemarie; Hidding, Ute; Gerloff, Christian; Buhmann, Carsten

2018-02-01

To assess the prevalence of dysphagia and its typical findings in unselected "real-world" Parkinson patients using an objective gold-standard method. This was a prospective, controlled, cross-sectional study conducted in 119 consecutive Parkinson patients of all stages independent of subjective dysphagia. Patients and 32 controls were clinically and endoscopically examined by flexible endoscopic evaluation of swallowing (FEES) to evaluate the deglutition with regard to three consistencies (water, biscuit, and bread). Typical findings of dysphagia like penetration and aspiration, residues, and leakage were assessed. Dysphagia was common in Parkinson patients and occurred in all, even early, disease stages. Only 5% (6/119) of patients showed a completely unremarkable deglutition. Aspiration was seen in 25% (30/119) of patients and always related to water. Residues occurred in 93% (111/119), most commonly for bread. Leakage was much less frequent and was found in only 3-18%, depending on consistency. In a significant fraction of patients, objective dysphagia was not subjectively perceived. A total of 16% of asymptomatic patients suffered from critical aspiration. Significant swallowing deficiencies already occurred in early disease. Aspiration was found in 4 of 20 (20%) patients with disease duration of less than 2 years. Seven of 57 patients (12%) with Hoehn and Yahr stage 2 suffered from severe aspiration. Given the high frequency of critical aspiration in Parkinson disease, these patients should be evaluated early for dysphagia to avoid complications and recommend an adequate therapy. FEES is a simple, cost efficient, minimally invasive method that is ideally suited for this purpose.

Effective implementation of work-hour limits and systemic improvements.

PubMed

Landrigan, Christopher P; Czeisler, Charles A; Barger, Laura K; Ayas, Najib T; Rothschild, Jeffrey M; Lockley, Steven W

2007-11-01

Sleep deprivation, ubiquitous among nurses and physicians, recently has been shown to greatly increase rates of serious medical errors and occupational injuries among health care workers in the United States. The Accreditation Council for Graduate Medical Education's current work-hour limits for physicians-in-training allow work hours well in excess of those proven safe. No regulations limit the work hours of other groups of health care providers in the United States. Consequently, nursing work shifts exceeding 12 hours remain common. Physician-in-training shifts of 30 consecutive hours continue to be endorsed officially, and data demonstrate that even the 30-hour limit is exceeded routinely. By contrast, European health care workers are limited by law to 13 consecutive hours of work and to 48-56 hours of work per week. Except for a few institutions that have eliminated 24-hour shifts, as a whole, the United States lags far behind other industrialized nations in ensuring safe work hours. Preventing health care provider sleep deprivation could be an extremely powerful means of addressing the epidemic of medical errors in the United States. Implementation of evidence-based work-hour limits, scientifically designed work schedules, and infrastructural changes, such as the development of standardized handoff systems, are urgently needed.

Time for Children, One's Spouse and Oneself among Parents Who Work Nonstandard Hours

ERIC Educational Resources Information Center

Wight, Vanessa R.; Raley, Sara B.; Bianchi, Suzanne M.

2008-01-01

Using data from the 2003 and 2004 American Time Use Surveys, this article examines nonstandard work hours and their relationship to parents' family, leisure and personal care time--informing the discussion of the costs and benefits of working nonstandard hours. The results suggest that parents who work nonstandard evening hours spend less time in…

Fatigue-related crashes involving express buses in Malaysia: will the proposed policy of banning the early-hour operation reduce fatigue-related crashes and benefit overall road safety?

PubMed

Mohamed, Norlen; Mohd-Yusoff, Mohammad-Fadhli; Othman, Ilhamah; Zulkipli, Zarir-Hafiz; Osman, Mohd Rasid; Voon, Wong Shaw

2012-03-01

Fatigue-related crashes have long been the topic of discussion and study worldwide. The relationship between fatigue-related crashes and time of day is well documented. In Malaysia, the possibility of banning express buses from operating during the early-hours of the morning has emerged as an important consideration for passenger safety. This paper highlights the findings of an impact assessment study. The study was conducted to determine all possible impacts prior to the government making any decision on the proposed banning. This study is an example of a simple and inexpensive approach that may influence future policy-making process. The impact assessment comprised two major steps. The first step involved profiling existing operation scenarios, gathering information on crashes involving public express buses and stakeholders' views. The second step involved a qualitative impact assessment analysis using all information gathered during the profiling stage to describe the possible impacts. Based on the assessment, the move to ban early-hour operations could possibly result in further negative impacts on the overall road safety agenda. These negative impacts may occur if the fundamental issues, such as driving and working hours, and the need for rest and sleep facilities for drivers, are not addressed. In addition, a safer and more accessible public transportation system as an alternative for those who choose to travel at night would be required. The proposed banning of early-hour operations is also not a feasible solution for sustainability of express bus operations in Malaysia, especially for those operating long journeys. The paper concludes by highlighting the need to design a more holistic approach for preventing fatigue-related crashes involving express buses in Malaysia. Copyright © 2011 Elsevier Ltd. All rights reserved.

Long working hours and pregnancy complications: women physicians survey in Japan.

PubMed

Takeuchi, Masumi; Rahman, Mahbubur; Ishiguro, Aya; Nomura, Kyoko

2014-07-23

Previous studies have investigated the impact of occupational risk factors on health outcomes among physicians. However, few studies have investigated the effects on pregnancy outcomes among physicians. In this study, we examined the association between working hours during pregnancy and pregnancy complications among physicians. A cross-sectional study was based on a survey conducted in 2009-2011 of 1,684 alumnae (mean age, 44 ± 8 years) who had graduated from 13 private medical schools in Japan. Data on threatened abortion (TA), preterm birth (PTB), and the number of working hours during the first trimester of pregnancy were obtained via retrospective assessments. Of the 939 physicians with a first pregnancy, 15% experienced TA and 12% experienced PTB. Women who experienced TA (mean weekly working hours: 62 h vs. 50 h, P < .0001) or PTB (62 h vs. 50 h, P < .0001) had longer weekly working hours during the first trimester than did those without pregnancy complications. Compared with women who worked 40 hours or less per week, women who worked 71 hours or more per week had a three-fold higher risk of experiencing TA (95% confidence interval (CI): 1.7-6.0) even after adjusting for medical specialty, maternal age, and current household income. The risk of experiencing PTB was 2.5 times higher (95% CI:1.2-5.2) in women who worked 51-70 hours and 4.2 times higher (95% CI: 1.9-9.2) in women who worked 71 hours or more even after adjusting for specialty, maternal age, and current household income. The trend in the P statistic reflecting the effect of the quartile of hours worked per week (40 hours, 41-50 hours, 51-70 hours, ≥ 71 hours) on TA or PTB was 0.0001 in the multivariate logistic regression models. These results suggest that working long hours during the first trimester of pregnancy is associated with TA and PTB.

29 CFR 778.421 - Offset hour for hour.

Code of Federal Regulations, 2010 CFR

2010-07-01

... hours standard, or in excess of the employees' normal working hours or regular working hours (as under... 29 Labor 3 2010-07-01 2010-07-01 false Offset hour for hour. 778.421 Section 778.421 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL...

Comparison of cardiovascular function during the early hours of bed rest and space flight

NASA Technical Reports Server (NTRS)

Lathers, C. M.; Charles, J. B.

1994-01-01

This paper reviews the cardiovascular responses of six healthy male subjects to 6 hours in a 5 degrees head-down bed rest model of weightlessness, and compares these responses to those obtained when subjects were positioned in head-up tilts of 10 degrees, 20 degrees, and 42 degrees, simulating 1/6, 1/3, and 2/3 G, respectively. Thoracic fluid index, cardiac output, stroke volume, and peak flow were measured using impedance cardiography. Cardiac dimensions and volumes were determined from two-dimensional guided M-mode echocardiograms in the left lateral decubitus position at 0, 2, 4, and 6 hours. Cardiovascular response to a stand test were compared before and after bed rest. The impedance values were related to tilt angle for the first 2 hours of tilt; however, after 3 hours, at all four angles, values began to converge, indicating that cardiovascular homeostatic mechanisms seek a common adapted state, regardless of effective gravity level (tilt angle) up to 2/3 G. Echocardiography revealed that left ventricular end-diastolic and end-systolic volume, stroke volume, ejection fraction, heart rate, and cardiac output had returned to control values by hour 6 for all tilt angles. The lack of a significant immediate change in left ventricular end-diastolic volume, despite decrements in stroke volume (P < .05) and heart rate (not significant), indicates that multiple factors may play a role in the adaptation to simulated hypogravity. The echocardiography data indicated that no angle of tilt, whether head-down or head-up for 4 to 6 hours, mimicked exactly the changes in cardiovascular function recorded after 4 to 6 hours of space flight. Changes in left ventricular end-diastolic volume during space flight and tilt may be similar, but follow a different time course. Nevertheless, head-down tilt at 5 degrees for 6 hours mimics some (stroke volume, systolic and diastolic blood pressure, mean arterial blood pressure, and total resistance), but not all, of the changes occurring

Semiclassical unified description of wobbling motion in even-even and even-odd nuclei

NASA Astrophysics Data System (ADS)

Raduta, A. A.; Poenaru, R.; Ixaru, L. Gr.

2017-11-01

A unitary description for wobbling motion in even-even and even-odd nuclei is presented. In both cases compact formulas for wobbling frequencies are derived. The accuracy of the harmonic approximation is studied for the yrast as well as for the excited bands in the even-even case. Important results for the structure of the wave function and its behavior inside the two wells of the potential energy function corresponding to the Bargmann representation are pointed out. Applications to 158Er and 163Lu reveal a very good agreement with available data. Indeed, the yrast energy levels in the even-even case and the first four triaxial superdeformed bands, TSD1, TSD2, TSD3, and TSD4, are realistically described. Also, the results agree with the data for the E 2 and M 1 intra- as well as interband transitions. Perspectives for the formalism development and an extensive application to several nuclei from various regions of the nuclides chart are presented.

Coupled nature of evening-time ionospheric electrodynamics

NASA Astrophysics Data System (ADS)

Joshi, L. M.; Tsai, L. C.

2018-04-01

The F region evening electrodynamics in the equatorial region is characterized by a pre-reversal enhancement (PRE) in the zonal eastward electric field. Although the theoretical mechanisms for PRE are known, its variability, particularly day-to-day variability is not fully resolved. PRE is a large scale phenomenon driven by the F region dynamo after the sunset hours. This paper investigates whether the variability of the E region conductivity (particularly the one associated with the sporadic E, Es) has any influence on the F region dynamo and hence on the PRE of zonal electric field. Interestingly, ionosonde observations have indicated a higher occurrence of the blanketing type Es (Esb) over the low latitude on days with highly suppressed PRE of zonal electric field in comparison with the days with significantly larger PRE. Observational evidences presented in this paper suggests that the formation of the Esb in the evening hours is a sovereign process, not always controlled by the sheared F region vertical electric field of equatorial origin, mapping along the magnetic field line on to the low latitude E region. Model computations of the PRE suppression based on the measured Es densities have further substantiated the observational findings presented in this paper. These results clearly indicate that the low latitude Es has the potential to suppress the PRE of zonal electric field and possibly can play a vital role in explaining the PRE variability, particularly the day-to-day variability. Results have been discussed in light of earlier reports on PRE mechanisms and E-F region coupling processes.

[EARLY IN-HOSPITAL MORTALITY IN INTERNAL MEDICINE WARDS (WITHIN 24 HOURS): A POTENTIAL QUALITY INDICATOR OR A VARIABLE AFFECTED BY MULTIPLE FACTORS?

PubMed

Niv, Yaron; Berkov, Evgeny; Kanter, Pazit; Abrahmson, Evgeny; Gabbay, Uri

2017-04-01

To evaluate in-hospital mortality rate within 24 hours in internal medicine wards and to evaluate if it may be used as quality indicator. In-hospital mortality rate is an outcome measure which apparently reflects quality of care. There are debates on whether it may be considered a quality indicator since it is difficult to compare different case-mixes between hospitals. Research on mortality within 24 hours had not been published. An historical prospective study was conducted including the entire internal wards admissions to the Rabin Medical Center between 1/7/14 and 30/6/15. We evaluated inhospital deaths and 7 days post discharge deaths. We focused on deaths within 24 hours, patients' characteristics, the primary diagnosis (which we assumed is the cause of death) and co-morbidity. The analysis includes descriptive statistics and mortality rates performed with SPSS version 22. Overall, 25,414 patients were admitted to internal wards during the study period. There were 1,620 in-hospitals deaths (6.37%) among which 164 deaths occurred within 24 hours (0.65%), which is 10.1% of in-hospital deaths. These patients were very old (median 82), many were residents of nursing homes and nearly all were brought to the hospital by ambulance. The most frequent primary diagnoses were sepsis (24%), pneumonia (22%), metastatic cancer (10%) and acute neurologic event (5%). The results exclude excessive inhospital mortality within 24 hours. The patients' characteristics enable researchers to assume that these deaths were expected and not preventable. There is no excessive mortality within 24 hours, the deaths were expected and a seasonal modifying effect was evident. All this and the different case mix in between hospitals suggest that early in-hospital mortality seems inadequate as a quality measure.

Building a dream: creating an oncology day/evening hospital.

PubMed

Fletcher, K; Painter, V

2002-01-01

The demand for inpatient beds has reached and often exceeds capacity producing waiting lists for cancer care. There is a need to explore alternative approaches to oncology treatment. The Oncology Day/Evening Hospital (ODEH), originally envisioned in 1995 as a joint project between an ambulatory cancer centre and a large teaching hospital, is an important cancer treatment initiative offering extended hours of ambulatory oncology treatment on days, evenings, weekends and statutory holidays. A review of current inpatient treatment modalities revealed that many patients receiving inpatient therapy could be safely and effectively managed in the ambulatory setting if treatment regimens were modified and if ambulatory hours of operation were extended. Healthcare improvements expected were: appropriate movement of inpatient activity to the ambulatory setting; more opportunities for patient choice in treatment time thereby allowing for maintenance of normal living; better quality of life for patients through prevention of hospitalization; decrease in treatment waiting times; consolidation of patients into an ambulatory oncology treatment setting as opposed to utilization of adult medicine units; and more rational inpatient bed utilization with reduction of admissions and intra-treatment transfers. This article describes our experience in building a dream, the challenges and lessons learned in implementing a better way to deliver oncology care in an environment of rapid change and staff shortages.

Chicago Mothers on Finding and Using Child Care during Nonstandard Work Hours

ERIC Educational Resources Information Center

Stoll, Marcia; Alexander, David; Nicpon, Christine

2015-01-01

Few issues confound child care policy more than the fact that very large numbers of mothers work evenings, overnight, or weekend hours when fewer child care programs operate. The authors interviewed 50 single Chicago mothers with nontraditional work hours about their experiences finding and using child care. Participants' responses addressed…

Cortical hypometabolism and hypoperfusion in Parkinson's disease is extensive: probably even at early disease stages.

PubMed

Borghammer, Per; Chakravarty, Mallar; Jonsdottir, Kristjana Yr; Sato, Noriko; Matsuda, Hiroshi; Ito, Kengo; Arahata, Yutaka; Kato, Takashi; Gjedde, Albert

2010-05-01

Recent cerebral blood flow (CBF) and glucose consumption (CMRglc) studies of Parkinson's disease (PD) revealed conflicting results. Using simulated data, we previously demonstrated that the often-reported subcortical hypermetabolism in PD could be explained as an artifact of biased global mean (GM) normalization, and that low-magnitude, extensive cortical hypometabolism is best detected by alternative data-driven normalization methods. Thus, we hypothesized that PD is characterized by extensive cortical hypometabolism but no concurrent widespread subcortical hypermetabolism and tested it on three independent samples of PD patients. We compared SPECT CBF images of 32 early-stage and 33 late-stage PD patients with that of 60 matched controls. We also compared PET FDG images from 23 late-stage PD patients with that of 13 controls. Three different normalization methods were compared: (1) GM normalization, (2) cerebellum normalization, (3) reference cluster normalization (Yakushev et al.). We employed standard voxel-based statistics (fMRIstat) and principal component analysis (SSM). Additionally, we performed a meta-analysis of all quantitative CBF and CMRglc studies in the literature to investigate whether the global mean (GM) values in PD are decreased. Voxel-based analysis with GM normalization and the SSM method performed similarly, i.e., both detected decreases in small cortical clusters and concomitant increases in extensive subcortical regions. Cerebellum normalization revealed more widespread cortical decreases but no subcortical increase. In all comparisons, the Yakushev method detected nearly identical patterns of very extensive cortical hypometabolism. Lastly, the meta-analyses demonstrated that global CBF and CMRglc values are decreased in PD. Based on the results, we conclude that PD most likely has widespread cortical hypometabolism, even at early disease stages. In contrast, extensive subcortical hypermetabolism is probably not a feature of PD.

Once-daily atomoxetine treatment for children with attention-deficit/hyperactivity disorder, including an assessment of evening and morning behavior: a double-blind, placebo-controlled trial.

PubMed

Kelsey, Douglas K; Sumner, Calvin R; Casat, Charles D; Coury, Daniel L; Quintana, Humberto; Saylor, Keith E; Sutton, Virginia K; Gonzales, Jill; Malcolm, Sandra K; Schuh, Kory J; Allen, Albert J

2004-07-01

Atomoxetine seems to be as effective for treating attention-deficit/hyperactivity disorder (ADHD) when the daily dose is administered once in the morning as when the dose is divided and administered in the morning and evening. In the present study, the efficacy of atomoxetine administered once daily among children with ADHD was assessed throughout the day, including the evening and early morning. Another goal was to determine how early in treatment it was possible to discern a specific effect of the drug on ADHD symptoms. This study was a randomized, multicenter, double-blind, placebo-controlled trial conducted at 12 outpatient sites in the United States. A total of 197 children, 6 to 12 years of age, who had been diagnosed as having ADHD, on the basis of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria, were randomized to receive 8 weeks of treatment with atomoxetine or placebo, dosed once daily in the mornings. ADHD symptoms were assessed with parent and investigator rating scales. The primary outcome measure was the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator-Administered and Scored total score. Daily parent assessments of children's home behaviors in the evening and early morning were recorded with an electronic data entry system. This instrument measures 11 specific morning or evening activities, including getting up and out of bed, doing or completing homework, and sitting through dinner. Seventy-one percent of the children enrolled were male, 69% met criteria for the combined subtype (both inattentive and hyperactive/impulsive symptoms), and the most common psychiatric comorbidity was oppositional defiant disorder (35%). Once-daily atomoxetine (final mean daily dose of 1.3 mg/kg) was significantly more effective than placebo in treating core symptoms of ADHD. Mean reductions in the Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent Version: Investigator-Administered and Scored

Long working hours and sleep disturbances: the Whitehall II prospective cohort study.

PubMed

Virtanen, Marianna; Ferrie, Jane E; Gimeno, David; Vahtera, Jussi; Elovainio, Marko; Singh-Manoux, Archana; Marmot, Michael G; Kivimäki, Mika

2009-06-01

To examine whether exposure to long working hours predicts various forms of sleep disturbance; short sleep, difficulty falling asleep, frequent waking, early waking and waking without feeling refreshed. Prospective study with 2 measurements of working hours (phase 3, 1991-1994 and phase 5, 1997-1999) and 2 measurements of subjective sleep disturbances (phase 5 and phase 7, 2002-2004). The Whitehall II study of British civil servants. Full time workers free of sleep disturbances at phase 5 and employed at phases 5 and 7 (n = 937-1594) or at phases 3, 5, and 7 (n = 886-1510). Working more than 55 hours a week, compared with working 35-40 hours a week, was related to incident sleep disturbances; demographics-adjusted odds ratio (95% CI) 1.98 (1.05, 3.76) for shortened sleeping hours, 3.68 (1.58, 8.58) for difficulty falling asleep; and 1.98 (1.04, 3.77) for waking without feeling refreshed. Repeat exposure to long working hours was associated with odds ratio 3.24 (1.45, 7.27) for shortened sleep, 6.66 (2.64, 16.83) for difficulty falling asleep, and 2.23 (1.16, 4.31) for early morning awakenings. Some associations were attenuated after adjustment for other risk factors. To a great extent, similar results were obtained using working hours as a continuous variable. Imputation of missing values supported the findings on shortened sleep and difficulty in falling asleep. Working long hours appears to be a risk factor for the development of shortened sleeping hours and difficulty falling asleep.

Neural reactivity to visual food stimuli is reduced in some areas of the brain during evening hours compared to morning hours: an fMRI study in women.

PubMed

Masterson, Travis D; Kirwan, C Brock; Davidson, Lance E; LeCheminant, James D

2016-03-01

The extent that neural responsiveness to visual food stimuli is influenced by time of day is not well examined. Using a crossover design, 15 healthy women were scanned using fMRI while presented with low- and high-energy pictures of food, once in the morning (6:30-8:30 am) and once in the evening (5:00-7:00 pm). Diets were identical on both days of the fMRI scans and were verified using weighed food records. Visual analog scales were used to record subjective perception of hunger and preoccupation with food prior to each fMRI scan. Six areas of the brain showed lower activation in the evening to both high- and low-energy foods, including structures in reward pathways (P < 0.05). Nine brain regions showed significantly higher activation for high-energy foods compared to low-energy foods (P < 0.05). High-energy food stimuli tended to produce greater fMRI responses than low-energy food stimuli in specific areas of the brain, regardless of time of day. However, evening scans showed a lower response to both low- and high-energy food pictures in some areas of the brain. Subjectively, participants reported no difference in hunger by time of day (F = 1.84, P = 0.19), but reported they could eat more (F = 4.83, P = 0.04) and were more preoccupied with thoughts of food (F = 5.51, P = 0.03) in the evening compared to the morning. These data underscore the role that time of day may have on neural responses to food stimuli. These results may also have clinical implications for fMRI measurement in order to prevent a time of day bias.

Meeting new Canadian 24-Hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada.

PubMed

Lee, Eun-Young; Hesketh, Kylie D; Hunter, Stephen; Kuzik, Nicholas; Rhodes, Ryan E; Rinaldi, Christina M; Spence, John C; Carson, Valerie

2017-11-20

Canada has recently released guidelines that include toddler-specific recommendations for physical activity, screen-based sedentary behaviour, and sleep. This study examined the proportions of toddlers meeting the new Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) and associations with body mass index (BMI) z-scores in a sample from Edmonton, Canada. Participants included 151 toddlers (aged 19.0 ± 1.9 months) for whom there was complete objectively measured physical activity data from the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) project. Toddlers' physical activity was measured using ActiGraph wGT3X-BT monitors. Toddlers' screen time and sleep were measured using the PREPS questionnaire. Toddlers' height and weight were objectively measured by public health nurses and BMI z-scores were calculated using World Health Organization growth standards. Meeting the overall 24-Hour Movement Guidelines was defined as: ≥180 min/day of total physical activity, including ≥1 min/day of moderate- to vigorous-intensity physical activity; no screen time per day (for those aged 12-23 months) or ≤1 h/day of screen time per day (ages 24-35 months); and 11-14 h of sleep per 24-h period. Frequency analyses and linear regression models were conducted. Only 11.9% of toddlers met the overall 24-Hour Movement Guidelines, but this finding was largely driven by screen time. The majority of toddlers met the individual physical activity (99.3%) and sleep (82.1%) recommendations, while only 15.2% of toddlers met the screen time recommendation. No associations were observed between meeting specific and general combinations of recommendations within the guidelines and BMI z-scores. Most toddlers in this sample were meeting physical activity and sleep recommendations but were engaging in more screen time than recommended. Consequently, only a small proportion of toddlers met the overall guidelines. Based on

Sensitive Troponin I and Stress Testing in the Emergency Department for the Early Management of Chest Pain Using 2-Hour Protocol.

PubMed

Dadkhah, Shahriar; Almuwaqqat, Zakaria; Sulaiman, Samian; Husein, Husein; Nguyen, Quang; Ali, Saad; Taskesen, Tuncay

2017-09-01

coronary angiography. One patient had severe tortuous coronaries but no significant obstructive lesion and one had a severe CAD who needed Coronary artery bypass grafting (CABG). Three of the six patients had a normal stress test and one patient decided to leave without further testing. None of the patients with a normal stress test had a major cardiac event or adverse cardiac outcome at six-month follow up. This study demonstrates that the 2 hours accelerated protocol using high sensitivity Troponin assay at 0 and 2 hours with comprehensive clinical evaluation and ECG followed by stress testing might be successful in identifying low-risk patient population who may benefit from early discharge from ED reducing associated costs and length of stay.

[Studies of termination of early pregnancy with Bromo-Geraminum].

PubMed

Hou, Z K; Liu, D G; Kao, F S; Chen, S L

1984-08-01

The authors introduced 3 ml of 2-3% Bromo-Geraminum (BG) solution into the uterine cavities to induce abortion in 356 early pregnant women from March 1979 through June 1980. The success rate in the termination of early pregnancy was 80.1% and even 96.5% in those who had been pregnant for less than 5 weeks. The mean abortion time was 40.9 porn 19.7 hours. It was noticed that the blood HCG level dropped dramatically after introducing into the uterine cavity. It has been demonstrated experimentally and clinically that this method is effective, safe, simple, and inexpensive and that the normal menstrual cycle recovers very soon without side effects.

The 100 ampere-hour nickel cadmium battery development program, volume 1

NASA Technical Reports Server (NTRS)

Gaston, S.

1974-01-01

A program to develop a long-life, reliable and safe 100 ampere-hour sealed nickel-cadmium cell and battery module with ancillary charge control and automated test equipment to fulfill the requirements of a large Manned Orbital Space Station which uses Solar Arrays as its prime source for 25 kW of electrical power was conducted. A sealed 100 ampere-hour cell with long life potential and a replaceable, space maintainable battery module has been developed for Manned Space Station applications. The 100 ampere-hour cell has been characterized for initial (early life) anticipated conditions.

Mortality and morbidities among very premature infants admitted after hours in an Australian neonatal intensive care unit network.

PubMed

Abdel-Latif, Mohamed E; Bajuk, Barbara; Oei, Julee; Lui, Kei

2006-05-01

To assess risk-adjusted early (within 7 days) mortality and major morbidities of newborn infants at < 32 weeks' gestation who are admitted after office hours to a regional Australian network of NICUs where statewide caseload is coordinated and staffed by on-floor registrars working in shift rosters. We hypothesize that adverse sequelae are increased in these infants. We conducted a database review of the records of infants (n = 8654) at < 32 weeks' gestation admitted to a network of 10 tertiary NICUs in New South Wales and the Australian Capital Territory from 1992 to 2002. Multivariate logistic regression analysis was performed to adjust for case-mix and significant baseline characteristics. Sixty-five percent of infants were admitted to the NICUs after hours. These infants did not have an increase in early neonatal mortality or major neonatal sequelae compared with their office-hours counterparts. Admissions during late night hours after midnight or fatigue risk periods before the end of a medical 12-hour shift were not associated with higher early mortality. Risk factors significantly predictive of early neonatal death were lack of antenatal steroid treatment, Apgar score < 7 at 5 minutes, male gender, gestation age, and being small for gestation. Current staffing levels, specialization, and networking are associated with lower circadian variation in adverse outcomes and after-hours admission to this NICU network and have no significant impact on early neonatal mortality and morbidity.

Health and psychosocial effects of flexible working hours.

PubMed

Janssen, Daniela; Nachreiner, Friedhelm

2004-12-01

To examine whether any impairments in health and social lives can be found under different kinds of flexible working hours, and whether such effects are related to specific characteristics of these working hours. Two studies -- a company based survey (N=660) and an internet survey (N=528) -- have been conducted. The first one was a questionnaire study (paper and pencil) on employees working under some 'typical' kinds of different flexible working time arrangements in different companies and different occupational fields (health care, manufacturing, retail, administration, call centres). The second study was an internet-based survey, using an adaptation of the questionnaire from the first study. The results of both studies consistently show that high variability of working hours is associated with increased impairments in health and well-being and this is especially true if this variability is company controlled. These effects are less pronounced if variability is self-controlled; however, autonomy does not compensate the effects of variability. Recommendations for an appropriate design of flexible working hours should be developed in order to minimize any impairing effects on health and psychosocial well-being; these recommendations should include -- besides allowing for discretion in controlling one's (flexible) working hours -- that variability in flexible working hours should be kept low (or at least moderate), even if this variability is self-controlled.

Improving health, safety, and profits in extended hours operations (shiftwork).

PubMed

Kerin, Alex; Aguirre, Acacia

2005-01-01

Circadian Technologies, Inc. (CIRCADIAN) is an international consulting firm that for over 20 yr has helped employees better cope with shiftwork, while ensuring their employers reduce costs and maximize profits. This paper describes two of the methods employed to reduce accidents, absenteeism, and turnover, while improving morale and productivity in extended hour operations (shiftwork). Shiftworkers rarely receive on-the-job training to help them cope better with the rigors of working nights, evenings, and early mornings. A pre- and post-training study by CIRCADIAN demonstrated improvements in health and fatigue indices, and an increase in daytime sleep length. Companies who provide shiftwork lifestyle training also have lower rates of absenteeism and turnover compared to companies that do not provide training. The second intervention described in this paper is a novel method of shift scheduling. There are thousands of potential schedules, so how does a company choose the best schedule for their facility? The answer lies in allowing employees to be involved in the process of selection. This results in a workforce that experiences less fatigue, turnover and absenteeism, and higher morale.

Caffeinated Gum Maintains Vigilance, Marksmanship, and PVT Performance During a 55 Hour Field Trial

DTIC Science & Technology

2004-01-01

effectively maintain vigilance for six hours in the early morning hours following a night without sleep (Kamimori et al., 2003) and have identified the...the significant correlations identified between marksmanship vigilance and the FIBUA task with the field laboratory task (PVT) will facilitate

Quality-control of an hourly rainfall dataset and climatology of extremes for the UK.

PubMed

Blenkinsop, Stephen; Lewis, Elizabeth; Chan, Steven C; Fowler, Hayley J

2017-02-01

Sub-daily rainfall extremes may be associated with flash flooding, particularly in urban areas but, compared with extremes on daily timescales, have been relatively little studied in many regions. This paper describes a new, hourly rainfall dataset for the UK based on ∼1600 rain gauges from three different data sources. This includes tipping bucket rain gauge data from the UK Environment Agency (EA), which has been collected for operational purposes, principally flood forecasting. Significant problems in the use of such data for the analysis of extreme events include the recording of accumulated totals, high frequency bucket tips, rain gauge recording errors and the non-operation of gauges. Given the prospect of an intensification of short-duration rainfall in a warming climate, the identification of such errors is essential if sub-daily datasets are to be used to better understand extreme events. We therefore first describe a series of procedures developed to quality control this new dataset. We then analyse ∼380 gauges with near-complete hourly records for 1992-2011 and map the seasonal climatology of intense rainfall based on UK hourly extremes using annual maxima, n-largest events and fixed threshold approaches. We find that the highest frequencies and intensities of hourly extreme rainfall occur during summer when the usual orographically defined pattern of extreme rainfall is replaced by a weaker, north-south pattern. A strong diurnal cycle in hourly extremes, peaking in late afternoon to early evening, is also identified in summer and, for some areas, in spring. This likely reflects the different mechanisms that generate sub-daily rainfall, with convection dominating during summer. The resulting quality-controlled hourly rainfall dataset will provide considerable value in several contexts, including the development of standard, globally applicable quality-control procedures for sub-daily data, the validation of the new generation of very high

Quality‐control of an hourly rainfall dataset and climatology of extremes for the UK

PubMed Central

Lewis, Elizabeth; Chan, Steven C.; Fowler, Hayley J.

2016-01-01

ABSTRACT Sub‐daily rainfall extremes may be associated with flash flooding, particularly in urban areas but, compared with extremes on daily timescales, have been relatively little studied in many regions. This paper describes a new, hourly rainfall dataset for the UK based on ∼1600 rain gauges from three different data sources. This includes tipping bucket rain gauge data from the UK Environment Agency (EA), which has been collected for operational purposes, principally flood forecasting. Significant problems in the use of such data for the analysis of extreme events include the recording of accumulated totals, high frequency bucket tips, rain gauge recording errors and the non‐operation of gauges. Given the prospect of an intensification of short‐duration rainfall in a warming climate, the identification of such errors is essential if sub‐daily datasets are to be used to better understand extreme events. We therefore first describe a series of procedures developed to quality control this new dataset. We then analyse ∼380 gauges with near‐complete hourly records for 1992–2011 and map the seasonal climatology of intense rainfall based on UK hourly extremes using annual maxima, n‐largest events and fixed threshold approaches. We find that the highest frequencies and intensities of hourly extreme rainfall occur during summer when the usual orographically defined pattern of extreme rainfall is replaced by a weaker, north–south pattern. A strong diurnal cycle in hourly extremes, peaking in late afternoon to early evening, is also identified in summer and, for some areas, in spring. This likely reflects the different mechanisms that generate sub‐daily rainfall, with convection dominating during summer. The resulting quality‐controlled hourly rainfall dataset will provide considerable value in several contexts, including the development of standard, globally applicable quality‐control procedures for sub‐daily data, the validation of the new

Impact of extended duty hours on medical trainees

PubMed Central

Weiss, Pnina; Kryger, Meir; Knauert, Melissa

2018-01-01

Many studies on resident physicians have demonstrated that extended work hours are associated with a negative impact on well-being, education, and patient care. However, the relationship between the work schedule and the degree of impairment remains unclear. In recent years, because of concerns for patient safety, national minimum standards for duty hours have been instituted (2003) and revised (2011). These changes were based on studies of the effects of sleep deprivation on human performance and specifically on the effect of extended shifts on resident performance. These requirements necessitated significant restructuring of resident schedules. Concerns were raised that these changes have impaired continuity of care, resident education and supervision, and patient safety. We review the studies on the effect of extended work hours on resident well-being, education, and patient care as well as those assessing the effect of work hour restrictions. Although many studies support the adverse effects of extended shifts, there are some conflicting results due to factors such as heterogeneity of protocols, schedules, subjects, and environments. Assessment of the effect of work hour restrictions has been even more difficult. Recent data demonstrating that work hour limitations have not been associated with improvement in patient outcomes or resident education and well-being have been interpreted as support for lifting restrictions in some specialties. However, these studies have significant limitations and should be interpreted with caution. Until future research clarifies duty hours that optimize patient outcomes, resident education, and well-being, it is recommended that current regulations be followed. PMID:29073389

"Rosetta" Mission's "7 Hours of Terror" and "Philae's" Descent

ERIC Educational Resources Information Center

Blanco, Philip

2015-01-01

In November 2014 the "Rosetta" mission to Comet 67P/Churyumov-Gerasimenko made the headlines when its "Philae" lander completed a successful unpowered descent onto the surface of the comet nucleus after "7 hours of terror" for the mission scientists. 67P's irregular shape and rotation made this task even more…

Effect of overtime work on 24-hour ambulatory blood pressure.

PubMed

Hayashi, T; Kobayashi, Y; Yamaoka, K; Yano, E

1996-10-01

Recently, the adverse effects of long working hours on the cardiovascular systems of workers in Japan, including "Karoshi" (death from overwork), have been the focus of social concern. However, conventional methods of health checkups are often unable to detect the early signs of such adverse effects. To evaluate the influence of overtime work on the cardiovascular system, we compared 24-hour blood pressure measurements among several groups of male white-collar workers. As a result, for those with normal blood pressure and those with mild hypertension, the 24-hour average blood pressure of the overtime groups was higher than that of the control groups; for those who periodically did overtime work, the 24-hour average blood pressure and heart rate during the busy period increased. These results indicate that the burden on the cardiovascular system of white-collar workers increases with overtime work.

Alcohol outlet business hours and violent crime in New York state.

PubMed

Schofield, Timothy P; Denson, Thomas F

2013-01-01

Alcohol-related harm places a significant strain on victims, perpetrators and society. The present research reports on how licensed alcohol outlet business hours may influence the reported incidence of interpersonal violence and the associated burden of disease. We examined the relationship between alcohol outlet business hours and violent crime in 2009 in New York State (excluding New York City). Regression analyses modeled the burden of disease for the violence associated with outlet business hours. Every 1 h increase in weekly outlet business hours was associated with a greater reported incidence of violent crimes generally, more reported aggravated assaults and more reported non-gun violence. The estimated cost from having licensed premises open after 1 a.m. was $194 million in 2009. The findings suggest that alcohol outlet business hours affect the incidence of reported violence even in regions that would not be considered to have severe problems with alcohol-fueled violence.

The influence of odd-even car trial on fine and coarse particles in Delhi.

PubMed

Kumar, Prashant; Gulia, Sunil; Harrison, Roy M; Khare, Mukesh

2017-06-01

The odd-even car trial scheme, which reduced car traffic between 08.00 and 20.00 h daily, was applied from 1 to 15 January 2016 (winter scheme, WS) and 15-30 April 2016 (summer scheme, SS). The daily average PM 2.5 and PM 10 exceeded national standards, with highest concentrations (313 μg m -3 and 639 μg m -3 , respectively) during winter and lowest (53 μg m -3 and 130 μg m -3 ) during the monsoon (June-August). PM concentrations during the trials can be interpreted either as reduced or increased, depending on the periods used for comparison purposes. For example, hourly average net PM 2.5 and PM 10 (after subtracting the baseline concentrations) reduced by up to 74% during the majority (after 1100 h) of trial hours compared with the corresponding hours during the previous year. Conversely, daily average PM 2.5 and PM 10 were higher by up to 3-times during the trial periods when compared with the pre-trial days. A careful analysis of the data shows that the trials generated cleaner air for certain hours of the day but the persistence of overnight emissions from heavy goods vehicles into the morning odd-even hours (0800-1100 h) made them probably ineffective at this time. Any further trial will need to be planned very carefully if an effect due to traffic alone is to be differentiated from the larger effect caused by changes in meteorology and especially wind direction. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Building a New Early Childhood Professional Development System Based on the 3 Rs: Research, Rigor, and Respect

ERIC Educational Resources Information Center

Karp, Naomi

2005-01-01

Professional development is a topic that is near and dear to the author's heart. The author has spent more hours than she can count trying to get her colleagues in the U.S. Department of Education to understand that early childhood professional development has to be part of the education continuum. She would argue that even if they had the luxury…

Septic shock with no diagnosis at 24 hours: a pragmatic multicenter prospective cohort study.

PubMed

Contou, Damien; Roux, Damien; Jochmans, Sébastien; Coudroy, Rémi; Guérot, Emmanuel; Grimaldi, David; Ricome, Sylvie; Maury, Eric; Plantefève, Gaëtan; Mayaux, Julien; Mekontso Dessap, Armand; Brun-Buisson, Christian; de Prost, Nicolas

2016-11-06

The lack of a patent source of infection after 24 hours of management of shock considered septic is a common and disturbing scenario. We aimed to determine the prevalence and the causes of shock with no diagnosis 24 hours after its onset, and to compare the outcomes of patients with early-confirmed septic shock to those of others. We conducted a pragmatic, prospective, multicenter observational cohort study in ten intensive care units (ICU) in France. We included all consecutive patients admitted to the ICU with suspected septic shock defined by clinical suspicion of infection leading to antibiotic prescription plus acute circulatory failure requiring vasopressor support. A total of 508 patients were admitted with suspected septic shock. Among them, 374 (74 %) had early-confirmed septic shock, while the 134 others (26 %) had no source of infection identified nor microbiological documentation retrieved 24 hours after shock onset. Among these, 37/134 (28 %) had late-confirmed septic shock diagnosed after 24 hours, 59/134 (44 %) had a condition mimicking septic (septic shock mimicker, mainly related to adverse drug reactions, acute mesenteric ischemia and malignancies) and 38/134 (28 %) had shock of unknown origin by the end of the ICU stay. There were no differences between patients with early-confirmed septic shock and the remainder in ICU mortality and the median duration of ICU stay, of tracheal intubation and of vasopressor support. The multivariable Cox model showed that the risk of day-60 mortality did not differ between patients with or without early-confirmed septic shock. A sensitivity analysis was performed in the subgroup (n = 369/508) of patients meeting the Sepsis-3 definition criteria and displayed consistent results. One quarter of the patients admitted in the ICU with suspected septic shock had no infection identified 24 hours after its onset and almost half of them were eventually diagnosed with a septic shock mimicker. Outcome did not differ

Clinical outcome of acute nonvariceal upper gastrointestinal bleeding after hours: the role of urgent endoscopy.

PubMed

Ahn, Dong-Won; Park, Young Soo; Lee, Sang Hyub; Shin, Cheol Min; Hwang, Jin-Hyeok; Kim, Jin-Wook; Jeong, Sook-Hyang; Kim, Nayoung; Lee, Dong Ho

2016-05-01

This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. A total of 158 patients visited the emergency unit for ANVUGIB after hours. Among them, 60 underwent urgent EGD (within 8 hours) and 98 underwent early EGD (8 to 24 hours) by experienced endoscopists. The frequencies of hemodynamic instability, fresh blood aspirate on the nasogastric tube, and high-risk endoscopic findings were significantly higher in the urgent EGD group. Primary hemostasis was achieved in all except two patients. There were nine cases of recurrent bleeding, and 30-day mortality occurred in three patients. There were no significant differences between the two groups in primary hemostasis, recurrent bleeding, and 30-day mortality. In a multiple linear regression analysis, urgent EGD significantly reduced the hospital stay compared with early EGD. In patients with a high clinical Rockall score (more than 3), urgent EGD tended to decrease the hospital stay, although this was not statistically significant (7.7 days vs. 12.0 days, p > 0.05). Urgent EGD after hours by experienced endoscopists had an excellent endoscopic success rate. However, clinical outcomes were not significantly different between the urgent and early EGD groups.

Associations between the macronutrient composition of the evening meal and average daily sleep duration in early childhood.

PubMed

Diethelm, Katharina; Remer, Thomas; Jilani, Hannah; Kunz, Clemens; Buyken, Anette E

2011-10-01

Short sleep duration in early childhood may increase the risk for chronic diseases in later life. Strategies to improve sleep duration are thus of interest. We investigated whether the nutritional composition of the evening meal is associated with children's sleep duration in the 2nd year of life. Multivariable regression models included 594 participants of the DONALD Study with 3-days weighed dietary records and average daily sleep duration at age 1.5 and 2 years. Higher energy intakes with the evening meal were associated with a longer sleep duration (1 min/10 kcal, p = 0,01). With respect to absolute intakes, carbohydrates (0.8 min/g, p < 0.0001), especially from high GI foods (1.3 min/g, p < 0.01), and a higher GL (1.5 min/g GL, p < 0.01) were accompanied by longer sleeping time. A qualitative exchange of energy from protein by energy from carbohydrates from high GI foods was only associated with increased sleep duration in toddlers without (1.9 min/%E, p < 0.05), but not with nightly eating occasions (p > 0.4). The observed associations are in line with suggested sleep-improving effects of carbohydrates. Effect sizes suggest that the clinical relevance of nutritional composition for sleep duration is limited in healthy young toddlers. These observations and their possible importance for more vulnerable groups need to be confirmed in clinical trials. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Comparison of patrons of hotels with early opening and standard hours.

PubMed

Smith, D I

1986-02-01

A comparison was made of 72 men who were patrons in hotels with 6 A.M. or 7 A.M. opening, with a control group of 87 men interviewed in nearby hotels with 10 A.M. opening. The two groups were very similar on biographical characteristics, yet the men in the early-opening group consumed significantly more alcohol, had more drinking sessions, spent longer in drinking, and had significantly higher SMAST scores. The early opening was apparently facilitating problem drinking.

Canadian 24-hour movement guidelines for the early years (0-4 years): exploring the perceptions of stakeholders and end users regarding their acceptability, barriers to uptake, and dissemination.

PubMed

Riazi, Negin; Ramanathan, Subha; O'Neill, Meghan; Tremblay, Mark S; Faulkner, Guy

2017-11-20

It is important to engage stakeholders and end users in the development of guidelines for knowledge translation purposes. The aim of this study was to examine stakeholders' (experts in pediatric and family medicine, physical activity knowledge translation, and research) and end users' (parents and early childhood educators) perceptions of the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years). Stakeholders (n = 10) engaged in telephone interviews and end users (n = 92) participated in focus groups (n = 14) to discuss perceived clarity and need for the guidelines, potential barriers to implementation, identification of credible messengers, and methods for dissemination of the guidelines. A thematic analysis was conducted. The proposed guidelines were very well received by both stakeholders and end users. A clear need for such guidelines was identified, and most believed the guidelines were achievable. Stakeholders and end users identified several potential barriers to uptake, including low awareness of current guidelines; 'daily challenges' such as allure of screen time, lack of time, and competing priorities; and challenges in the context of shifting social norms. A range of methods and messengers of dissemination were identified. Medical and child care settings were the most frequently cited places for dissemination, and physicians and early childhood educators were the most common suggestions for messengers. There was consistent support for the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) from both stakeholders and end users. Moving forward, it is important to dedicate appropriate support and funding toward dissemination efforts in order to reach end users, particularly parents and early childhood educators.

Sunlight Exposure, Work Hours, Caffeine Consumption, and Sleep Duration in the Naval Environment.

PubMed

Shattuck, Nita L; Matsangas, Panagiotis

2017-06-01

Sailors in the U.S. Navy are habitual shiftworkers, often experiencing circadian misalignment due to their irregular work/rest schedules. This study assessed the effect of sunlight exposure, work hours, and caffeinated beverage consumption on the daily sleep duration of crewmembers of a U.S. Navy ship during a 2-wk underway period. Working in an artificially lit area with no access to sunlight during work hours, U.S. Navy crew members (N = 91) used daily logs to report their daily activity, caffeinated beverage consumption, and exposure to sunlight while off-duty; sleep was assessed by wrist-worn actigraphy. Hours of sunlight exposure, work duration, and the amount of coffee/tea/soft drinks were statistically significant predictors of sleep duration. On average, crewmembers who reported more than one half-hour of sunlight each day slept on average ∼40 min (10%) less than their peers working the same shifts who received less than one half-hour of sunlight (on average 6.05 ± 0.90 h vs. 6.71 ± 0.91 h, respectively). Exposure to sunlight, work hours, and consumption of caffeinated beverages are important factors when planning watchstanding schedules at sea. Even though further research is needed, our results suggest that even brief exposure to sunlight may contribute to circadian misalignment that negatively affects sleep in the operational environment. Educating crewmembers about sleep hygiene, especially the important roles played by sunlight and caffeine, could potentially improve the sleep and fatigue levels of this population of maritime shiftworkers.Shattuck NL, Matsangas P. Sunlight exposure, work hours, caffeine consumption, and sleep duration in the naval environment. Aerosp Med Hum Perform. 2017; 88(6):579-585.

Impact of in or out of office hours at admission time on outcome in out-of-hospital cardiac arrest patients.

PubMed

Genbrugge, Cornelia; Viaene, Els; Meex, Ingrid; De Vadder, Katrien; Eertmans, Ward; Boer, Willem; Jans, Frank; De Deyne, Cathy; Dens, Jo; Ferdinande, Bert

2017-08-01

In out-of-hospital cardiac arrest (OHCA), neurological outcome is determined by the severity of neurological injury, early percutaneous coronary intervention, and application of neuroprotective temperature management. As this is a very time-intensive and manpower-intensive protocol, we hypothesized that there would be a difference in outcome between OHCA patients admitted during and out of office hours. We prospectively collected demographic data of OHCA patients in two hospitals. All patients included were treated at 33°C for 24 h, followed by a rewarming phase until 36.6°C. During office hours were defined as arriving between 8:00 a.m. and 5:00 p.m. on weekdays. Neurological outcome at 180 days was assessed following the Cerebral Performance Category scale. Forty-seven (31%) patients were admitted during office hours and 105 (69%) out of office hours (P=0.199). Patients admitted during office hours were significantly older, respectively, 66±14 and 59±15 years (P=0.014). There was no significant difference between both groups in the number of patients who underwent coronary angiography, door to angiography time, and number of affected vessels. The median time spent in the target range of PaO2, PaCO2, and lactate was also not significantly different. We found no significant difference in survival until 180 days between both groups (P=0.599), even after adjustment for age (95% confidence interval: 0.44-1.90, hazard ratio: 0.912). Survival until 180 days between OHCA patients admitted during office hours or out of office hours was not significantly different in two hospitals with a fixed protocol for neuroprotection and 24/7 streamlined access to coronary angiography.

Vaccinations Administered During Off-Clinic Hours at a National Community Pharmacy: Implications for Increasing Patient Access and Convenience

PubMed Central

Goad, Jeffery A.; Taitel, Michael S.; Fensterheim, Leonard E.; Cannon, Adam E.

2013-01-01

PURPOSE Approximately 50,000 adults die annually from vaccine-preventable diseases in the United States. Most traditional vaccine providers (eg, physician offices) administer vaccinations during standard clinic hours, but community pharmacies offer expanded hours that allow patients to be vaccinated at convenient times. We analyzed the types of vaccines administered and patient populations vaccinated during off-clinic hours in a national community pharmacy, and their implications for vaccination access and convenience. METHODS We retrospectively reviewed data for all vaccinations given at the Walgreens pharmacy chain between August 2011 and July 2012. The time of vaccination was categorized as occurring during traditional hours (9:00 am–6:00 pm weekdays) or off-clinic hours, consisting of weekday evenings, weekends, and federal holidays. We compared demographic characteristics and types of vaccine. We used a logistic regression model to identify predictors of being vaccinated during off-clinic hours. RESULTS During the study period, pharmacists administered 6,250,402 vaccinations, of which 30.5% were provided during off-clinic hours: 17.4% were provided on weekends, 10.2% on evenings, and 2.9% on holidays. Patients had significantly higher odds of off-clinic vaccination if they were younger than 65 years of age, were male, resided in an urban area, and did not have any chronic conditions. CONCLUSIONS A large proportion of adults being vaccinated receive their vaccines during evening, weekend, and holiday hours at the pharmacy, when traditional vaccine providers are likely unavailable. Younger, working-aged, healthy adults, in particular, a variety of immunizations during off-clinic hours. With the low rates of adult and adolescent vaccination in the United States, community pharmacies are creating new opportunities for vaccination that expand access and convenience. PMID:24019274

Comparison of early myocardial technetium-99m pyrophosphate uptake to early peaking of creatine kinase and creatine kinase-MB as indicators of early reperfusion in acute myocardial infarction

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

Kondo, M.; Yuzuki, Y.; Arai, H.

1987-10-01

The value of technetium-99m pyrophosphate (Tc-99m-PYP) scintigraphy as an indicator of reperfusion 2.8 to 8 hours after the onset of symptoms of acute myocardial infarction was compared with the value of early peak creatine kinase (CK) and CK-MB release within 16 hours after the onset of symptoms. In 29 patients who received thrombolytic therapy, recanalization was seen (group 1) and in 7 it was not (group 2). In 23 patients (79%) in group 1 scintigraphic findings were positive and in all 7 in group 2 they were negative. In 15 patients (52%) in group 1 and 1 patient (14%) inmore » group 2, CK reached its peak level within 16 hours. In 20 patients (69%) in group 1 and 3 (43%) in group 2 the CK-MB level reached a peak within 16 hours. The sensitivity, specificity and predictive accuracy of positive results of early Tc-99m-PYP scintigraphy in predicting the reperfusion were 79%, 100% and 83%. These values are significantly higher than or similar to those of early peaking of CK and CK-MB release. In contrast to measurements of enzyme release, reperfusion data for Tc-99m-PYP scintigraphy are available immediately after thrombolytic therapy. Therefore, early Tc-99m-PYP scintigraphy (3 to 8 hours after onset of symptoms) is valuable as a noninvasive technique for early diagnosis of reperfusion.« less

Investigation of Wind Conditions During Early Morning Hours at Los Angeles International Airport

DOT National Transportation Integrated Search

1977-10-01

Los Angeles International Airport (LAX) uses a unique runway utilization pattern to minimize noise pollution between midnight and 0600. During these hours, all approaches are conducted to the east, and all takeoffs are conducted to the west. The low-...

The evening versus morning polypill utilization study: the TEMPUS rationale and design.

PubMed

Lafeber, Melvin; Grobbee, Diederick E; Bots, Michiel L; Thom, Simon; Webster, Ruth; Rodgers, Anthony; Visseren, Frank L J; Spiering, Wilko

2014-04-01

In clinical practice, blood pressure (BP)-lowering agents are generally prescribed for use in the morning, whereas (short-acting) statins are recommended for use in the evening. There is evidence that the reduction in LDL cholesterol (LDL-c) achieved with short-acting statins is superior when taken in the evening and reported improvement in BP control when aspirin and BP-lowering agents are taken in the evening. However, it is unclear whether the additional reduction in LDL-c and BP is offset by a reduction in adherence, given that taking medication in the evening may be less typical or convenient. There is therefore uncertainty concerning the best timing of administration of a cardiovascular combination pill such as the polypill. The aim of TEMPUS (NCT01506505), a prospective randomized open blinded endpoint (PROBE) crossover trial, is to evaluate whether there is a difference in LDL-c levels or 24-hour ambulatory BP in individuals at increased risk of cardiovascular disease when the cardiovascular polypill is taken in the evening compared to the morning. An additional aim is to assess the effect of the polypill on LDL-c and BP compared to the administration of separate pills of identically dosed components of the polypill. In total 75 participants with established cardiovascular disease or an intermediate to high risk for cardiovascular disease are randomly allocated to the sequence of three different treatments of 6-8 weeks: (1) the cardiovascular polypill (aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg, and hydrochlorothiazide 12.5 mg) in the evening; (2) the polypill in the morning; and (3) the use of the identically dosed agents in separate pills taken at different time points during the day. The primary endpoint is the difference in LDL-c and mean 24-hour ambulatory systolic BP. Secondary outcomes are the difference in relative risk reduction, biochemistry, platelet function and pulse wave analysis, participants' adherence, and acceptability. TEMPUS will

Westward equatorial electrojet during daytime hours. [relation to geomagnetic horizontal field depression

NASA Technical Reports Server (NTRS)

Rastogi, R. G.

1974-01-01

The phenomenon of the depression of the geomagnetic horizontal field during the daytime hours of magnetically quiet days at equatorial stations is described. These events are generally seen around 0700 and 1600 LT, being more frequent during the evening than the morning hours. The evening events are more frequent during periods of low solar activity and in the longitude region of weak equatorial electrojet currents. The latitudinal extent of the phenomenon is limited to the normal equatorial electrojet region, and on some occasions the phenomenon is not seen at both stations, separated by only a few hours in longitude. During such an event, the latitudinal profile of the geomagnetic vertical field across the equator is reversed, the ionospheric drift near the equator is reversed toward the east, the q type of sporadic E layer is completely absent, and the height of the peak ionization in the F2 region is decreased. It is suggested that these effects are caused by a narrow band of current flowing westward in the E region of the ionosphere and within the latitude region of the normal equatorial electrojet, due to the reversal of the east-west electrostatic field at low latitudes.

Resident Physician Duty-hour Requirements: What Does the Public Think?

PubMed

Mercuri, John J; Okey, Neil E; Karia, Raj J; Gross, Richard H; Zuckerman, Joseph D

2016-11-01

To date, no study has reported on the public's opinion of orthopaedic resident duty-hour requirements (DHR). A survey was administered to people in orthopaedic waiting rooms and at three senior centers. Responses were analyzed to evaluate seven domains: knowledge of duty hours; opinions about duty hours; attitudes regarding shift work; patient safety concerns; and the effects of DHRs on continuity of care, on resident training, and on resident professionalism. Respondents felt that fatigue was unsafe and duty hours were beneficial in preventing resident physician fatigue. They supported the idea of residents working in shifts but did not support shifts for attending physicians. However, respondents wanted the same resident to provide continuity of care, even if that violated DHRs. They were supportive of increasing the length of residency to complete training. DHRs were not believed to affect professionalism. Half of the respondents believed that patient opinion should influence policy on this topic. Orthopaedic patients and those likely to require orthopaedic care have inconsistent opinions regarding DHRs, making it potentially difficult to incorporate their preferences into policy.

When Mothers' Work Matters for Youths' Daily Time Use: Implications of Evening and Weekend Shifts.

PubMed

Lee, Soomi; Davis, Kelly D; McHale, Susan M; Kelly, Erin L; Kossek, Ellen Ernst; Crouter, Ann C

2017-08-01

Drawing upon the work-home resources model, this study examined the implications of mothers' evening and weekend shifts for youths' time with mother, alone, and hanging out with peers unsupervised, with attention to both the amount and day-to-day consistency of time use. Data came from 173 mothers who worked in the long-term care industry and their youths who provided daily diaries. Multilevel modeling revealed that youths whose mothers worked more evening shifts on average spent less time with their mothers compared to youths whose mothers worked fewer evening shifts. Youths whose mothers worked more weekend shifts, however, spent more time with their mothers and exhibited less consistency in their time in all three activity domains compared to youths whose mothers worked fewer weekend shifts. Girls, not boys, spent less time alone on days when mothers worked weekend shifts than on days with standard shifts. Older but not younger adolescents spent more time hanging out with friends on evening and weekend shift days, and their unsupervised peer time was less consistent across days when mothers worked more evening shifts. These effects adjusted for sociodemographic and day characteristics, including school day, number of children in the household, mothers' marital status and work hours, and time with fathers. Our results illuminate the importance of the timing and day of mothers' work for youths' daily activities. Future interventions should consider how to increase mothers' resources to deal with constraints on parenting due to their work during nonstandard hours, with attention to child gender and age.

Assessment of early post-operative pain following septorhinoplasty.

PubMed

Szychta, P; Antoszewski, B

2010-11-01

To evaluate pain incidence and intensity in patients undergoing septorhinoplasty, and to assess analgesic treatment effectiveness, in the first 7 days after surgery. Prospective outcomes analysis using visual analogue scale assessment of pain intensity in the first 7 post-operative days. Fifty-seven patients were enrolled in the study, 29 women and 28 men, aged 18 to 51 years. All were treated for post-traumatic deformity of the external nose and/or nasal septum, with either septorhinoplasty or septoplasty. In the first 3 days after septorhinoplasty, patients' mean visual analogue scale pain score exceeded the range denoting 'analgesic success', and showed considerable exacerbation in the evening. Patients' pain decreased to a mean score of 15.4 one hour after administration of a nonsteroidal anti-inflammatory drug (metamizole). Analgesia is recommended for all patients in the first 3 days after septorhinoplasty, especially in the early evening.

Evaluation of the Monongalia County Schools, Even Start Family Literacy Program. Monongalia County Even Start Program. Parents Are Their Children's First and Most Important Teachers.

ERIC Educational Resources Information Center

Meehan, Merrill L.

The Monongalia County (West Virgina) Even Start Program begun in 1993 to address family literacy and to prepare children for entrance into school, consists of three interrelated approaches: adult education, parenting education, and early childhood education. In June 1996, the program was serving 62 families (mostly low-income) with an average of…

Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study.

PubMed

Miravitlles, Marc; Worth, Heinrich; Soler Cataluña, Juan José; Price, David; De Benedetto, Fernando; Roche, Nicolas; Godtfredsen, Nina Skavlan; van der Molen, Thys; Löfdahl, Claes-Göran; Padullés, Laura; Ribera, Anna

2014-10-21

Few studies have investigated the 24-hour symptom profile in patients with COPD or how symptoms during the 24-hour day are inter-related. This observational study assessed the prevalence, severity and relationship between night-time, early morning and daytime COPD symptoms and explored the relationship between 24-hour symptoms and other patient-reported outcomes. The study enrolled patients with stable COPD in clinical practice. Baseline night-time, early morning and daytime symptoms (symptom questionnaire), severity of airflow obstruction (FEV1), dyspnoea (modified Medical Research Council Dyspnoea Scale), health status (COPD Assessment Test), anxiety and depression levels (Hospital Anxiety and Depression Scale), sleep quality (COPD and Asthma Sleep Impact Scale) and physical activity level (sedentary, moderately active or active) were recorded. The full analysis set included 727 patients: 65.8% male, mean ± standard deviation age 67.2 ± 8.8 years, % predicted FEV1 52.8 ± 20.5%. In each part of the 24-hour day, >60% of patients reported experiencing ≥1 symptom in the week before baseline. Symptoms were more common in the early morning and daytime versus night-time (81.4%, 82.7% and 63.0%, respectively). Symptom severity was comparable for each period assessed. Overall, in the week before baseline, 56.7% of patients had symptoms throughout the whole 24-hour day (3 parts of the day); 79.9% had symptoms in ≥2 parts of the 24-hour day. Symptoms during each part of the day were inter-related, irrespective of disease severity (all p < 0.001). Early morning and daytime symptoms were associated with the severity of airflow obstruction (p < 0.05 for both). Night-time, early morning and daytime symptoms were all associated with worse dyspnoea, health status and sleep quality, and higher anxiety and depression levels (all p < 0.001 versus patients without symptoms in each corresponding period). In each part of the 24-hour day, there was also an association between

The hockey-stick method to estimate evening dim light melatonin onset (DLMO) in humans.

PubMed

Danilenko, Konstantin V; Verevkin, Evgeniy G; Antyufeev, Viktor S; Wirz-Justice, Anna; Cajochen, Christian

2014-04-01

The onset of melatonin secretion in the evening is the most reliable and most widely used index of circadian timing in humans. Saliva (or plasma) is usually sampled every 0.5-1 hours under dim-light conditions in the evening 5-6 hours before usual bedtime to assess the dim-light melatonin onset (DLMO). For many years, attempts have been made to find a reliable objective determination of melatonin onset time either by fixed or dynamic threshold approaches. The here-developed hockey-stick algorithm, used as an interactive computer-based approach, fits the evening melatonin profile by a piecewise linear-parabolic function represented as a straight line switching to the branch of a parabola. The switch point is considered to reliably estimate melatonin rise time. We applied the hockey-stick method to 109 half-hourly melatonin profiles to assess the DLMOs and compared these estimates to visual ratings from three experts in the field. The DLMOs of 103 profiles were considered to be clearly quantifiable. The hockey-stick DLMO estimates were on average 4 minutes earlier than the experts' estimates, with a range of -27 to +13 minutes; in 47% of the cases the difference fell within ±5 minutes, in 98% within -20 to +13 minutes. The raters' and hockey-stick estimates showed poor accordance with DLMOs defined by threshold methods. Thus, the hockey-stick algorithm is a reliable objective method to estimate melatonin rise time, which does not depend on a threshold value and is free from errors arising from differences in subjective circadian phase estimates. The method is available as a computerized program that can be easily used in research settings and clinical practice either for salivary or plasma melatonin values.

Late-seasonal activity and diet of the evening bat (Nycticeius humeralis) in Nebraska

USGS Publications Warehouse

Geluso, Keith; Damm, J.P.; Valdez, E.W.

2008-01-01

In North America, Nebraska represents part of the northwestern edge of the distribution for the evening bat (Nycticeius humeralis). To date, little information on this bat's natural history has been published from the state or from other parts of the Great Plains. Here we report on aspects of its natural history in Nebraska from 2 localities. In late summer and early autumn of 2006, we documented individuals farther west in Nebraska (Harlan County) than previously reported and determined that individuals fed mainly on Coleoptera and Hymenoptera. In 2006, evening bats appeared to migrate from Nebraska during late September-early October, and individuals were extremely fat, about 15 g, prior to migration. Evening bats likely are more widespread and common in south central Nebraska than previously documented. On 6 October 2005, we reported on an individual from eastern Nebraska (Douglas County), which represents the latest seasonal record of N. humeralis from the state.

A break-even analysis of major ear surgery.

PubMed

Wasson, J D; Phillips, J S

2015-10-01

To determine variables which affect cost and profit for major ear surgery and perform a break-even analysis. Retrospective financial analysis. UK teaching hospital. Patients who underwent major ear surgery under general anaesthesia performed by the senior author in main theatre over a 2-year period between dates of 07 September 2010 and 07 September 2012. Income, cost and profit for each major ear patient spell. Variables that affect major ear surgery profitability. Seventy-six patients met inclusion criteria. Wide variation in earnings, with a median net loss of £-1345.50 was observed. Income was relatively uniform across all patient spells; however, theatre time of major ear surgery at a cost of £953.24 per hour varied between patients and was the main determinant of cost and profit for the patient spell. Bivariate linear regression of earnings on theatre time identified 94% of variation in earnings was due to variation in theatre time (r = -0.969; P < 0.0001) and derived a break-even time for major ear surgery of 110.6 min. Theatre time was dependent on complexity of procedure and number of OPCS4 procedures performed, with a significant increase in theatre time when three or more procedures were performed during major ear surgery (P = 0.015). For major ear surgery to either break-even or return a profit, total theatre time should not exceed 110 min and 36 s. © 2015 John Wiley & Sons Ltd.

Patterns of morning and evening fatigue among adults with HIV/AIDS.

PubMed

Lerdal, Anners; Gay, Caryl L; Aouizerat, Bradley E; Portillo, Carmen J; Lee, Kathryn A

2011-08-01

Describe patterns of morning and evening fatigue in adults with HIV and examine their relationship to demographic and clinical factors and other symptoms. Most studies of HIV-related fatigue assess average levels of fatigue and do not address its diurnal fluctuations. Patterns of fatigue over the course of the day may have important implications for assessment and treatment. A cross-sectional, correlational design was used with six repeated measures over 72 hours. A convenience sample of 318 HIV-infected adults was recruited in San Francisco. Socio-demographic, clinical and symptom data were collected with questionnaires. CD4+ T-cell count and viral load were obtained from medical records. Participants completed a four-item version of the Lee Fatigue Scale each morning and evening for three consecutive days. Participants were grouped based on their diurnal pattern of fatigue (high evening only, high morning only, high morning and evening and low morning and evening). Group comparisons and logistic regression were used to determine the unique predictors of each fatigue pattern. The high evening fatigue pattern was associated with anxiety and the high morning pattern was associated with anxiety and depression. The morning fatigue pattern showed very little fluctuation between morning and evening, the evening pattern showed the largest fluctuation. The high morning and evening pattern was associated with anxiety, depression and sleep disturbance and this group reported the most fatigue-related distress and interference in functioning. These results provide initial evidence for the importance of assessing the patient's daily pattern of fatigue fluctuation, as different patterns were associated with different symptom experiences and perhaps different aetiologies. Different fatigue patterns may benefit from tailored intervention strategies. Management of depressive symptoms could be tested in patients who experience high levels of morning fatigue. © 2011 Blackwell

Patterns of Morning and Evening Fatigue Among Adults with HIV/AIDS

PubMed Central

Lerdal, Anners; Gay, Caryl L.; Aouizerat, Bradley E.; Portillo, Carmen J.; Lee, Kathryn A.

2011-01-01

Aims and objectives Describe patterns of morning and evening fatigue in adults with HIV and examine their relationship to demographic and clinical factors and other symptoms. Background Most studies of HIV-related fatigue assess average levels of fatigue and do not address its diurnal fluctuations. Patterns of fatigue over the course of the day may have important implications for assessment and treatment. Design A cross-sectional, correlational design was used with six repeated measures over 72 hours. Method A convenience sample of 318 HIV-infected adults was recruited in San Francisco. Socio-demographic, clinical and symptom data were collected with questionnaires. CD4+ T-cell count and viral load were obtained from medical records. Participants completed a four-item version of the Lee Fatigue Scale each morning and evening for three consecutive days. Participants were grouped based on their diurnal pattern of fatigue (high evening only, high morning only, high morning and evening and low morning and evening). Group comparisons and logistic regression were used to determine the unique predictors of each fatigue pattern. Results The high evening fatigue pattern was associated with anxiety and the high morning pattern was associated with anxiety and depression. The morning fatigue pattern showed very little fluctuation between morning and evening, the evening pattern showed the largest fluctuation. The high morning and evening pattern was associated with anxiety, depression and sleep disturbance and this group reported the most fatigue-related distress and interference in functioning. Conclusions These results provide initial evidence for the importance of assessing the patient’s daily pattern of fatigue fluctuation, as different patterns were associated with different symptom experiences and perhaps different etiologies. Relevance to clinical practice Different fatigue patterns may benefit from tailored intervention strategies. Management of depressive symptoms

Differences in Resident Perceptions by Postgraduate Year of Duty Hour Policies: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.

PubMed

Yang, Anthony D; Chung, Jeanette W; Dahlke, Allison R; Biester, Thomas; Quinn, Christopher M; Matulewicz, Richard S; Odell, David D; Kelz, Rachel R; Shea, Judy A; Lewis, Frank; Bilimoria, Karl Y

2017-02-01

In the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, there were several differences in residents' perceptions of aspects of their education, well-being, and patient care that differed between standard and flexible duty hour policies. Our objective was to assess whether these perceptions differed by level of training. A survey assessed residents participating in the FIRST trial's perceptions of the effect of duty hour policies on aspects of patient safety, continuity of care, resident education, clinical training, and resident well-being. Hierarchical logistic regression models were used to examine the association between residents' perceptions, study arm, and level of training (interns, junior residents, and senior residents). In the Standard Policy arm, as the PGY level increased, residents more frequently reported that duty hour policies negatively affected patient safety, professionalism, morale, and career choice (all interactions p < 0.001). However, in the Flexible Policy arm, as the PGY level increased, residents less frequently perceived negative effects of duty hour policies on resident health, rest, and time for family and friends and extracurricular activities (all interactions p < 0.001). Overall, there was an increase by PGY level in the proportion of residents expressing a preference for training in programs with flexible duty hour policies, and this preference for flexible duty hour policies was even more apparent among residents who were in the Flexible Policy arm (p < 0.001). As PGY level increased, residents had increasing concerns about patient care and resident education and training under standard duty hour policies, but they had decreasing concerns about well-being under flexible policies. When given the choice between training under standard or flexible duty hour policies, only 14% of residents expressed a preference for standard policies. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc

Giorgio Vasari and the Image of the Hour

NASA Astrophysics Data System (ADS)

Gahtan, M. W.

2011-06-01

Giorgio Vasari created the first allegories of the twenty-four hours in the mid-16th century. This essay explores Vasari's novel images in the context of his visual and literary sources, the rising importance of household timepieces, and the artist's other works and writings. Although a focused study of a single motif within Vasari's oeuvre, it has implications for the broader transformation time perception and its psychological dimensions then taking place in Early Modern Europe.

A break-even analysis of delivering a memory clinic by videoconferencing.

PubMed

Comans, Tracy A; Martin-Khan, Melinda; Gray, Leonard C; Scuffham, Paul A

2013-10-01

We analysed the costs of two kinds of dementia clinic. In the conventional clinic, held in a rural area, the specialist travels to the clinic from the city. In the videoconferencing clinic, patients are also seen in a rural area, but the specialist conducts the assessment by video from the city. The fixed costs common to both modalities, such as clinic infrastructure, were ignored. The total fixed cost of a monthly conventional clinic was $522 and the total fixed cost of a monthly videoconferencing clinic was $881. The additional variable cost of the specialist travelling to the conventional clinic was $2.62 per minute of the specialist's travelling time. The break-even point at which the cost of the two modalities is the same was just over two hours (138 min round trip). A sensitivity analysis showed that the break-even point was not particularly sensitive to changes in staff wages, but slightly more sensitive to the non labour costs of videoconferencing. Air travel is not an efficient alternative to travel by car. Reducing the number of clinics to six per year results in a much higher cost of running the videoconferencing service compared to the conventional service. Videoconferencing for the purpose of diagnosing dementia is both a reliable and cost effective method of health service provision when a specialist is required to drive for more than about two hours (round trip) to provide a memory disorder clinic service.

Change from slowly rotating 8-hour shifts to rapidly rotating 8-hour and 12-hour shifts using participative shift roster design.

PubMed

Smith, P A; Wright, B M; Mackey, R W; Milsop, H W; Yates, S C

1998-01-01

The study examined the impact of change, from slowly rotating continuous 8-hour shifts to more rapidly rotating continuous 8-hour and 12-hour shifts, on the health and quality of life of shift workers. Self-report survey data were collected from 72 shift workers at 3 sewage treatment plants before and several months after roster change. After the change 1 plant first worked a rapidly rotating, 8-hour shift roster and then worked a 12-hour shift roster, and the other 2 plants worked continuous 12-hour shift rosters. After the change the shift workers at each plant reported increased satisfaction with roster design, a decrease in physical and psychological circadian malaise associated with shift work, improved day sleep quality, less tiredness, and improvements in the quality of home, social and work life. A between-plant comparison of the rapidly rotating 8-hour and 12-hour shift rosters showed greater improvements had been obtained with the 12-hour shift roster, and no significant differences in tiredness or sleep quality between the redesigned 8- and 12-hour shift rosters. However, a within-plant matched-pairs comparison at the 1st plant of the rapidly rotating 8-hour shift roster and the 12-hour shift roster showed no significant differences. The results show that the prior level of support for change may best explain the impact of roster redesign on individual well-being. They lend further support to shift worker participation in roster design.

Herbage intake and ruminal digestion of dairy cows grazed on perennial ryegrass pasture either in the morning or evening.

PubMed

Ueda, Koichiro; Mitani, Tomohiro; Kondo, Seiji

2016-08-01

This study aimed to clarify diurnal fluctuations of herbage intake, ruminal fermentation of herbage carbohydrates and proteins, and digesta particulate weight in the rumen of grazing dairy cows. Six ruminally cannulated, non-lactating dairy cows were grazed on perennial ryegrass/white clover pasture either in the morning (04.00 to 08.00 hours) or the evening (16.00 to 20.00 hours). Cows grazed in the evening spent more time (P < 0.01) and consumed more herbage (P < 0.01) compared with cows grazed in the morning. Higher (P < 0.05) daily mean concentrations of total volatile fatty acid, propionate and n-butyrate in rumen fluid were observed for cows grazed in the evening compared with cows grazed in the morning. Although cows grazed in the evening ingested more crude protein compared with cows grazed in the morning, no significant difference in NH3 -N concentration in rumen fluid was observed between them. The ratio of purine-derivative concentration to creatinine concentrations was higher (P < 0.01) in the urine of cows grazed in the evening than in cows grazed in the morning. These results clearly indicated that evening grazing was advantageous for dairy cows compared with morning grazing, in terms of ruminal fermentable energy intake and nitrogen utilization efficiency. © 2015 Japanese Society of Animal Science.

Trends in the work hours of physicians in the United States.

PubMed

Staiger, Douglas O; Auerbach, David I; Buerhaus, Peter I

2010-02-24

Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed. To estimate trends in hours worked by US physicians and assess for association with physician fees. A retrospective analysis of trends in hours worked among US physicians using nationally representative workforce information from the US Census Bureau Current Population Survey between 1976 and 2008 (N = 116,733). Trends were estimated among all US physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001. Self-reported hours worked in the week before the survey. After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 54.9 hours per week in 1996-1998 to 51.0 hours per week in 2006-2008; 95% confidence interval [CI], 5.3%-9.0%; P < .001). Excluding resident physicians, whose hours decreased by 9.8% (95% CI, 5.8%-13.7%; P < .001) in the last decade due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7% (95% CI, 3.8%-7.7%; P < .001). The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%-10.2%; P < .001) and working outside of the hospital (6.4%; 95% CI, 4.1%-8.7%; P < .001), and the decrease was smallest for those aged 45 years or older (3.7%; 95% CI, 1.0%-6.5%; P = .008) and working in the hospital (4.0%; 95% CI, 0.4%-7.6%; P = .03). After adjusting for inflation, mean physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours. In 2001, mean physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52 hours per week elsewhere (P < .001 for difference). A steady decrease in hours

Childhood fever: a qualitative study on parents' expectations and experiences during general practice out-of-hours care consultations.

PubMed

de Bont, Eefje G P M; Loonen, Nicole; Hendrix, Dagmar A S; Lepot, Julie M M; Dinant, Geert-Jan; Cals, Jochen W L

2015-10-07

Fever in children is common and mostly caused by benign self-limiting infections. Yet consultation rates in primary care are high, especially during GP out-of-hours care. Therefore, we aimed to explore experiences of parents when having visited GP out-of-hours services with their febrile child. We performed a qualitative study using 20 semi-structured interviews among parents from different backgrounds presenting to GP out-of-hours care with a febrile child <12 years. Questions were directed at parental motivations, expectations and experiences when visiting the GP out-of-hours centre with a febrile child. Interviews were audio-recorded, transcribed and analysed using constant comparison technique. We identified four main categories emerging from the data; (1) cautiously seeking care, (2) discrepancy between rationality and emotion, (3) expecting reassurance from a professional and (4) a need for consistent, reliable information. Not one symptom, but a combination of fever with other symptoms, made parents anxious and drove care seeking. Although parents carefully considered when to seek care, they experienced increased anxiety with increases in their child's temperature. Because parents work during the day and fever typically rises during the early evening, the decision to seek care was often made during out-of-hours care. When parents consulted a GP they did not have any set expectations other than seeking reassurance, however a proper physical examination diminished their anxiety. Parents did not demand antibiotics, but trusted on the expertise of the GP to assess necessity. Parents requested consistent, reliable information on fever and self-management strategies. Parents were inexperienced in self-management strategies and had a subsequent desire for reassurance; this played a pivotal role in out-of-hours help seeking for childhood fever. These factors provide clues to optimise information exchange between GPs and parents, by providing written, tailored

Quartetting in even-even and odd-odd N=Z nuclei

NASA Astrophysics Data System (ADS)

Sambataro, M.; Sandulescu, N.

2018-02-01

We report on a microscopic description of even-even N = Z nuclei in a formalism of quartets. Quartets are four-body correlated structures characterized by isospin T and angular momentum J. We show that the ground state correlations induced by a realistic shell model interaction can be well accounted for in terms of a restricted set of T = 0 low-J quartets, the J = 0 one playing by far a leading role among them. A conceptually similar description of odd-odd self-conjugate nuclei is given in terms of two distinct families of building blocks, one formed by the same T = 0 quartets employed for the even-even systems and the other by collective pairs with either T = 0 or T = 1. Some applications of this formalism are discussed for nuclei in the sd shell.

Relationship between long working hours and periodontitis among the Korean workers.

PubMed

Lee, Wanhyung; Lim, Sung-Shil; Kim, Byurira; Won, Jong-Uk; Roh, Jaehoon; Yoon, Jin-Ha

2017-08-11

We aimed to investigate the association between long working hours and periodontitis, and whether such an association constitutes an exposure-response relationship. Data for this study were collected from the Korea National Health and Nutrition Examination Surveys conducted from 2007 to 2014; 17,533 workers (9,483 of men and 8,050 of women) were included. The odds ratios (OR) and 95% confidence intervals (CI) for the analysis of periodontitis defined as positive of Community Periodontal Index in relation to working hours were calculated using multiple logistic regression models with various stratifications. Compared to participants who worked ≤40 hours per week, the prevalence ratio (95% CI) for the periodontitis was 1.19 (1.14-1.24) and full adjusted OR (95% CI) was 1.09 (1.02-1.18) in participants who worked over 40 hours per week. The OR (95% CI) for periodontitis were 1.09 (0.99-1.19) in working group of 40< and ≥52 and 1.10 (1.01-1.20) in working group of >52 hours per week with a significant trend (p = 0.0233) even after adjusting for age, socioeconomic status, healthy behaviour, chronic disease, and dental care status. Long working hours are associated with periodontitis among Korean workers in an exposure-response manner.

Two- and 4-hour bright-light exposures differentially effect sleepiness and performance the subsequent night.

PubMed

Thessing, V C; Anch, A M; Muehlbach, M J; Schweitzer, P K; Walsh, J K

1994-03-01

The effect of two durations of bright light upon sleepiness and performance during typical night shift hours was assessed. Thirty normal, healthy young adults participated in a 2-night protocol. On the 1st night subjects were exposed to bright or dim light beginning at 2400 hours, under one of the following three conditions: bright light for 4 hours, dim light for 2 hours followed by bright light for 2 hours or dim light for 4 hours. Following light exposure, subjects remained awake until 0800 hours in a dimly lit room and slept in the laboratory between 0800 and 1600 hours, during which time sleep was estimated with actigraphy. Throughout the 2nd night, the multiple sleep latency test (MSLT), simulated assembly line task (SALT) performance, and subjective sleepiness were recorded. The single, 4-hour exposure to bright light was found to significantly increase MSLT scores and improve SALT performance during the early morning hours on the night following bright-light exposure. No significant effects were noted with a 2-hour exposure. The most likely explanation for these findings is a phase delay in the circadian rhythm of sleepiness-alertness.

The English Experiment: An Hour a Day Keeps Illiteracy at Bay

ERIC Educational Resources Information Center

Machin, Stephen; McNally, Sandra

2005-01-01

In developed countries like the United States and Britain, the continuing challenge for educators is to sort through the choices of an all-you-can-eat school system and teach the basic skills. Despite so-called universal education, an alarming number of people still fail to reach even basic levels of literacy. The "literacy hour" was…

[Differences in the reduction of blood pressure according to drug administration at activity hours or rest hours].

PubMed

Helena Ponte Márquez, Paola; José Solé, Maria; Arroyo, Juan Antonio; Matas, Laia; Benet, Maria Teresa; Roca-Cusachs, Àlex

2015-01-20

In this study, 123 recordings of blood pressure (BP) obtained by ambulatory BP monitoring were analyzed. These recordings were measured in 2011 in patients from a Spanish tertiary university hospital. All participating patients were treated with 2, 3 or 4 anti-hypertensive drugs. The main aim of this study was to determine differences in BP control, if any, depending on the medication schedule. Thus, BP levels were studied at 3 periods of the day: activity hours, rest hours and 24h. We compared subjects taking all anti-hypertensive agents during the day (n=70, group 1) with those taking at least one at night (n=53, group 2). Significant differences were found on diastolic BP, where group 2 patients had lower levels at activity, 24h periods and sleep-time. Even if it was not statistically significant, lower levels of systolic BP from group 2 were also observed at activity and 24h periods as well as lower levels of systolic, diastolic and mean BP at rest hours periods. There were also significant group differences in relation to the number of prescribed agents (with the mean being higher for group 2) and the type of agent (beta-blockers and calcium antagonists were more prevalent in group 2). Nevertheless, the multivariate regression analysis done taking into account these variables did not change the observed statistical significance. The administration of anti-hypertensive drugs at night could be associated with lower BP levels. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Improvement in Creatinine Clearance after Open Heart Surgery in Infants as an Early Indicator of Surgical Success.

PubMed

Dagan, Amit; Dagan, Ovadia

2016-12-01

Early surgical correction of congenital heart malformations in neonates and small infants may be complicated by acute kidney injury (AKI), which is associated with higher morbidity and mortality rates, especially in patients who require dialysis. Glomerular filtration rate (GFR) is considered the best measurement of renal function which, in neonates and infants, is highly dependent on heart function. To determine whether measurements of creatinine clearance after open heart surgery in neonates and young infants can serve as an early indicator of surgical success or AKI. We conducted a prospective observational study in 19 neonates and small infants (body weight < 5 kg) scheduled for open heart surgery with cardiopulmonary bypass. Urine collection measurement of creatinine clearance and albumin excretion was performed before and during surgery and four times during 48 hours after surgery. Mean creatinine clearance was lowest during surgery (25.2 ± 4. ml/min/1.73 m2) and increased significantly in the first 16 hours post-surgery (45.7 ± 6.3 ml/min/1.73 m2). A similar pattern was noted for urine albumin which was highest during surgery (203 ± 31 µg/min) and lowest (93 ± 20 µg/min) 48 hours post-surgery. AKI occurred in four patients, and two patients even required dialysis. All six showed a decline in creatinine clearance and an increase in urine albumin between 8 and 16 hours post-surgery. In neonates and small infants undergoing open heart surgery, a significant improvement in creatinine clearance in the first 16 hours postoperatively is indicative of a good surgical outcome. This finding has important implications for the early evaluation and treatment of patients in the intensive care unit on the first day post-surgery.

Optimizing Early Rule-Out Strategies for Acute Myocardial Infarction: Utility of 1-Hour Copeptin.

PubMed

Hillinger, Petra; Twerenbold, Raphael; Jaeger, Cedric; Wildi, Karin; Reichlin, Tobias; Rubini Gimenez, Maria; Engels, Ulrike; Miró, Oscar; Boeddinghaus, Jasper; Puelacher, Christian; Nestelberger, Thomas; Röthlisberger, Michèle; Ernst, Susanne; Rentsch, Katharina; Mueller, Christian

2015-12-01

Combined testing of high-sensitivity cardiac troponin T (hs-cTnT) and copeptin at presentation provides a very high-although still imperfect-negative predictive value (NPV) for the early rule-out of acute myocardial infarction (AMI). We hypothesized that a second copeptin measurement at 1 h might further increase the NPV. In a prospective diagnostic multicenter study, we measured hs-cTnT and copeptin concentrations at presentation and at 1 h in 1439 unselected patients presenting to the emergency department with suspected AMI. The final diagnosis was adjudicated by 2 independent cardiologists blinded to copeptin concentrations. We investigated the incremental value of 1-h copeptin in the rule-out setting (0-h hs-cTnT negative and 0-h copeptin negative) and the intermediate-risk setting (0-h hs-cTnT negative and 0-h copeptin positive). The adjudicated diagnosis was AMI in 267 patients (18.6%). For measurements obtained at presentation, the NPV in the rule-out setting was 98.6% (95% CI, 97.4%-99.3%). Whereas 1-h copeptin did not increase the NPV significantly, 1-h hs-cTnT did, to 99.6% (95% CI, 98.7%-99.9%, P = 0.008). Similarly, in the intermediate-risk setting (NPV 92.8%, 95% CI, 88.7%-95.8%), 1-h copeptin did not significantly increase the NPV (P = 0.751), but 1-h hs-cTnT did, to 98.6 (95% CI, 96%-99.7%, P < 0.001). One-hour copeptin increased neither the safety of the rule-out process nor the NPV in the intermediate-risk setting. In contrast, the incremental value of 1-h hs-cTnT was substantial in both settings. ClinicalTrials.gov/NCT00470587. © 2015 American Association for Clinical Chemistry.

Characteristics of worst hour rainfall rate for radio wave propagation modelling in Nigeria

NASA Astrophysics Data System (ADS)

Osita, Ibe; Nymphas, E. F.

2017-10-01

Radio waves especially at the millimeter-wave band are known to be attenuated by rain. Radio engineers and designers need to be able to predict the time of the day when radio signal will be attenuated so as to provide measures to mitigate this effect. This is achieved by characterizing the rainfall intensity for a particular region of interest into worst month and worst hour of the day. This paper characterized rainfall in Nigeria into worst year, worst month, and worst hour. It is shown that for the period of study, 2008 and 2009 are the worst years, while September is the most frequent worst month in most of the stations. The evening time (LT) is the worst hours of the day in virtually all the stations.

Association of Resident Duty Hour Restrictions, Level of Trainee, and Number of Available Residents with Mortality in the Neonatal Intensive Care Unit.

PubMed

Beltempo, Marc; Clement, Karin; Lacroix, Guy; Bélanger, Sylvie; Julien, Anne-Sophie; Piedboeuf, Bruno

2018-02-08

 This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU.  This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU ( N  = 185) and infants admitted to the NICU ( N  = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008-2011 [24-hour shifts] versus 2011-2014 [16-hour shifts]), level of trainee, and the number of residents present at admission.  The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, p  < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33-0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71-2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43-10.02, 5-8 residents vs. 0-2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50-1.07; after vs. before resident duty hour reform).  Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The impact of friends on young adults' drinking over the course of the evening--an event-level analysis.

PubMed

Thrul, Johannes; Kuntsche, Emmanuel

2015-04-01

To examine whether young adults' alcohol consumption during the course of an evening was affected by the number of friends present, and the interaction between participants' gender and number of friends present. Participants used the internet-based cellphone-optimized assessment technique (ICAT) to complete a series of cellphone questionnaires every Thursday, Friday and Saturday evening over five weekends. A multi-level growth curve model (hourly assessments, clustered within evenings, clustered within individuals) with time-invariant and time-varying covariates was estimated. French-speaking Switzerland. A total of 183 young adults (53.0% female, mean age = 23.1) who completed 7205 questionnaires on 1441 evenings. Alcohol consumption and number of friends present assessed at 8 p.m., 9 p.m., 10 p.m., 11 p.m. and midnight. Drinking pace accelerated notably over the course of the evening on Saturdays (b = 0.047; P < 0.01). Men consumed more alcohol than women, particularly at the beginning of the evening (b = 0.152; P < 0.05). However, this effect was no longer significant when the impact of friends was accounted for (b = 0.096; P = 0.139). The higher the number of friends present, the higher the number of drinks consumed at a given time during the course of the evening (b = 0.070; P < 0.001). Cross-level interaction effects indicated that this relationship was stronger for men than women (b = 0.027; P < 0.05). Among young adults in Switzerland, the number of friends present is associated positively with hourly drinking frequency during the course of weekend evenings. The impact of the drinking group size on alcohol use is stronger for men than women. © 2015 Society for the Study of Addiction.

Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

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

Seabold, J.E.; Conrad, G.R.; Ponto, J.A.

Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acutemore » DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.« less

Trends in the Work Hours of Physicians in the United States

PubMed Central

Staiger, Douglas O.; Auerbach, David I.; Buerhaus, Peter I.

2010-01-01

Context Recent trends in hours worked by physicians may affect workforce needs but have not been thoroughly analyzed. Objectives To estimate trends in hours worked by US physicians and assess for association with physician fees. Design, Setting, and Participants A retrospective analysis of trends in hours worked among US physicians using nationally representative workforce information from the US Census Bureau Current Population Survey between 1976 and 2008 (N=116 733). Trends were estimated among all US physicians and by residency status, sex, age, and work setting. Trends in hours were compared with national trends in physician fees, and estimated separately for physicians located in metropolitan areas with high and low fees in 2001. Main Outcome Measure Self-reported hours worked in the week before the survey. Results After remaining stable through the early 1990s, mean hours worked per week decreased by 7.2% between 1996 and 2008 among all physicians (from 54.9 hours per week in 1996–1998 to 51.0 hours per week in 2006–2008; 95% confidence interval [CI], 5.3%–9.0%; P<.001). Excluding resident physicians, whose hours decreased by 9.8% (95% CI, 5.8%–13.7%; P<.001) in the last decade due to duty hour limits imposed in 2003, nonresident physician hours decreased by 5.7% (95% CI, 3.8%–7.7%; P<.001). The decrease in hours was largest for nonresident physicians younger than 45 years (7.4%; 95% CI, 4.7%–10.2%; P<.001) and working outside of the hospital (6.4%; 95% CI, 4.1%–8.7%; P<.001), and the decrease was smallest for those aged 45 years or older (3.7%; 95% CI, 1.0%–6.5%; P=.008) and working in the hospital (4.0%; 95% CI, 0.4%–7.6%; P=.03). After adjusting for inflation, mean physician fees decreased nationwide by 25% between 1995 and 2006, coincident with the decrease in physician hours. In 2001, mean physician hours were less than 49 hours per week in metropolitan areas with the lowest physician fees, whereas physician hours remained more than 52

Non-linear relationship between maternal work hours and child body weight: Evidence from the Western Australian Pregnancy Cohort (Raine) Study.

PubMed

Li, Jianghong; Akaliyski, Plamen; Schäfer, Jakob; Kendall, Garth; Oddy, Wendy H; Stanley, Fiona; Strazdins, Lyndall

2017-08-01

Using longitudinal data from the Western Australia Pregnancy Cohort (Raine) Study and both random-effects and fixed-effects models, this study examined the connection between maternal work hours and child overweight or obesity. Following children in two-parent families from early childhood to early adolescence, multivariate analyses revealed a non-linear and developmentally dynamic relationship. Among preschool children (ages 2 to 5), we found lower likelihood of child overweight and obesity when mothers worked 24 h or less per week, compared to when mothers worked 35 or more hours. This effect was stronger in low-to-medium income families. For older children (ages 8 to 14), compared to working 35-40 h a week, working shorter hours (1-24, 25-34) or longer hours (41 or more) was both associated with increases in child overweight and obesity. These non-linear effects were more pronounced in low-to-medium income families, particularly when fathers also worked long hours. Copyright © 2017 Elsevier Ltd. All rights reserved.

Utility Of Heart Type Fatty Acid Binding Protein (H-Fabp) Point Of Care Test In The Early Hours Of Stemi Compared With Troponin-I In Pakistani Population.

PubMed

Abbasi, Walid Ahmad; Saleem, Muhammad; Rasheed, Shahid; Kiyani, Azhar Mahmood

2017-01-01

Acute coronary syndrome remains a dominant cause of high morbidity and mortality despite advancements in treatment This study was conducted to examine the utility of point-of-care test of heart-type fatty-acid binding protein (h-FABP) and compare it with the point-of-care test of cardiac troponin I (cTnI) in the first 06 hours of STEMI. This cross-sectional, comparative study which was conducted in Rawalpindi institute of cardiology, Rawalpindi, Pakistan, from January to June 2015. Serum samples of 125 patients with the diagnosis of STEMI, presenting with chest pain of less than 6 hours' duration, were analysed for quantitative and qualitative determination of h-FABP and cardiac troponin I (cTnI) using rapid immunochromatographic technique in the emergency department. Samples were taken at presentation and after 12 hours. Out of 125 patients, 112 were males and 13 were females with a mean age of 54.26±9.53 years. The average symptom-to-sample time was 3.19±1.44 hours (median 3 hours). Mean h-FABP levels were significantly higher than the mean cTnI levels (29.10±30.66 vs 0.94±2.02; p=0.000). Overall, HFABP was more sensitive than cTnI (72% vs 26.4%). The sensitivity of cTnI within 0-2, 2-4, and 4-6 hours of symptom onset was calculated to be 0%, 17.7%, and 75.9%, whereas sensitivity of HFABP was 35.3%, 79.03% and 100% respectively. There was not a single patient who was cTnI positive and H-FABP negative as compared to 57 patients who were FABP positive and cTnI negative. h-FABP is a promising cardiac biomarker for the early identification of myocardial ischemia and infarction. It could be a superior biomarker for earlier detection of ACS and screening of patients with non-cardiac chest pain.

Forecasting Kp from solar wind data: input parameter study using 3-hour averages and 3-hour range values

NASA Astrophysics Data System (ADS)

Wintoft, Peter; Wik, Magnus; Matzka, Jürgen; Shprits, Yuri

2017-11-01

We have developed neural network models that predict Kp from upstream solar wind data. We study the importance of various input parameters, starting with the magnetic component Bz, particle density n, and velocity V and then adding total field B and the By component. As we also notice a seasonal and UT variation in average Kp we include functions of day-of-year and UT. Finally, as Kp is a global representation of the maximum range of geomagnetic variation over 3-hour UT intervals we conclude that sudden changes in the solar wind can have a big effect on Kp, even though it is a 3-hour value. Therefore, 3-hour solar wind averages will not always appropriately represent the solar wind condition, and we introduce 3-hour maxima and minima values to some degree address this problem. We find that introducing total field B and 3-hour maxima and minima, derived from 1-minute solar wind data, have a great influence on the performance. Due to the low number of samples for high Kp values there can be considerable variation in predicted Kp for different networks with similar validation errors. We address this issue by using an ensemble of networks from which we use the median predicted Kp. The models (ensemble of networks) provide prediction lead times in the range 20-90 min given by the time it takes a solar wind structure to travel from L1 to Earth. Two models are implemented that can be run with real time data: (1) IRF-Kp-2017-h3 uses the 3-hour averages of the solar wind data and (2) IRF-Kp-2017 uses in addition to the averages, also the minima and maxima values. The IRF-Kp-2017 model has RMS error of 0.55 and linear correlation of 0.92 based on an independent test set with final Kp covering 2 years using ACE Level 2 data. The IRF-Kp-2017-h3 model has RMSE = 0.63 and correlation = 0.89. We also explore the errors when tested on another two-year period with real-time ACE data which gives RMSE = 0.59 for IRF-Kp-2017 and RMSE = 0.73 for IRF-Kp-2017-h3. The errors as function

Pre-dawn stomatal opening does not substantially enhance early-morning photosynthesis in Helianthus annuus.

PubMed

Auchincloss, Lisa; Easlon, Hsien M; Levine, Diedre; Donovan, Lisa; Richards, James H

2014-06-01

Most C3 plant species have partially open stomata during the night especially in the 3-5 h before dawn. This pre-dawn stomatal opening has been hypothesized to enhance early-morning photosynthesis (A) by reducing diffusion limitations to CO2 at dawn. We tested this hypothesis in cultivated Helianthus annuus using whole-shoot gas exchange, leaf level gas exchange and modelling approaches. One hour pre-dawn low-humidity treatments were used to reduce pre-dawn stomatal conductance (g). At the whole-shoot level, a difference of pre-dawn g (0.40 versus 0.17 mol m(-2) s(-1)) did not significantly affect A during the first hour after dawn. Shorter term effects were investigated with leaf level gas exchange measurements and a difference of pre-dawn g (0.10 versus 0.04 mol m(-2) s(-1)) affected g and A for only 5 min after dawn. The potential effects of a wider range of stomatal apertures were explored with an empirical model of the relationship between A and intercellular CO2 concentration during the half-hour after dawn. Modelling results demonstrated that even extremely low pre-dawn stomatal conductance values have only a minimal effect on early-morning A for a few minutes after dawn. Thus, we found no evidence that pre-dawn stomatal opening enhances A.

Vision, Training Hours, and Road Testing Results in Bioptic Drivers

PubMed Central

Dougherty, Bradley E.; Flom, Roanne E.; Bullimore, Mark A.; Raasch, Thomas W.

2015-01-01

Purpose Bioptic telescopic spectacles (BTS) can be used by people with central visual acuity that does not meet the state standards to obtain an unrestricted driver’s license. The purpose of this study was to examine the relationships among visual and demographic factors, training hours, and the results of road testing for bioptic drivers. Methods A retrospective study of patients who received an initial daylight bioptic examination at the Ohio State University and subsequently received a bioptic license was conducted. Data were collected on vision including visual acuity, contrast sensitivity, and visual field. Hours of driver training and results of Highway Patrol road testing were extracted from records. Relationships among vision, training hours, and road testing were analyzed. Results Ninety-seven patients who completed a vision examination between 2004 and 2008 and received daylight licensure with BTS were included. Results of the first Highway Patrol road test were available for 74 patients. The median interquartile range (IQR) hours of training prior to road testing was 21±17 hours, (range of 9 to 75 hours). Candidates without previous licensure were younger (p< 0.001) and had more documented training (p< 0.001). Lack of previous licensure and more training were significantly associated with having failed a portion of the Highway Patrol test and points deducted on the road test. Conclusions New bioptic drivers without previous non-bioptic driving experience required more training and performed more poorly on road testing for licensure than those who had previous non-bioptic licensure. No visual factor was predictive of road testing results after adjustment for previous experience. The hours of training received remained predictive of road testing outcome even with adjustment for previous experience. These results suggest that previous experience and trainer assessments should be investigated as potential predictors of road safety in bioptic drivers in

Realtime Hourly Data Table

Science.gov Websites

Tables View the latest hourly text summary CLICK ON UNDERLINED HOUR / SHADED BOX FOR THE LATEST CYCLE 00z Dump Tables View the latest rap text summary CLICK ON UNDERLINED HOUR / SHADED BOX FOR THE LATEST CYCLE Data Dump Tables View the latest model data text summary NAM GFS GDS CLICK ON UNDERLINED HOUR / SHADED

Adherence to 24-Hour Movement Guidelines for the Early Years and associations with social-cognitive development among Australian preschool children.

PubMed

Cliff, Dylan P; McNeill, Jade; Vella, Stewart A; Howard, Steven J; Santos, Rute; Batterham, Marijka; Melhuish, Edward; Okely, Anthony D; de Rosnay, Marc

2017-11-20

The new Australian 24-Hour Movement Guidelines for the Early Years recommend that, for preschoolers, a healthy 24-h includes: i) ≥180 min of physical activity, including ≥60 min of energetic play, ii) ≤1 h of sedentary screen time, and iii) 10-13 h of good quality sleep. Using an Australian sample, this study reports the proportion of preschool children meeting these guidelines and investigates associations with social-cognitive development. Data from 248 preschool children (mean age = 4.2 ± 0.6 years, 57% boys) participating in the PATH-ABC study were analyzed. Children completed direct assessments of physical activity (accelerometry) and social cognition (the Test of Emotional Comprehension (TEC) and Theory of Mind (ToM)). Parents reported on children's screen time and sleep. Children were categorised as meeting/not meeting: i) individual guidelines, ii) combinations of two guidelines, or iii) all three guidelines. Associations were examined using linear regression adjusting for child age, sex, vocabulary, area level socio-economic status and childcare level clustering. High proportions of children met the physical activity (93.1%) and sleep (88.7%) guidelines, whereas fewer met the screen time guideline (17.3%). Overall, 14.9% of children met all three guidelines. Children meeting the sleep guideline performed better on TEC than those who did not (mean difference [MD] = 1.41; 95% confidence interval (CI) = 0.36, 2.47). Children meeting the sleep and physical activity or sleep and screen time guidelines also performed better on TEC (MD = 1.36; 95% CI = 0.31, 2.41) and ToM (MD = 0.25; 95% CI = -0.002, 0.50; p = 0.05), respectively, than those who did not. Meeting all three guidelines was associated with better ToM performance (MD = 0.28; 95% CI = -0.002, 0.48, p = 0.05), while meeting a larger number of guidelines was associated with better TEC (3 or 2 vs. 1/none, p < 0.02) and ToM performance (3 vs. 2, p = 0.03). Strategies

[Economic assessment of low flow anesthesia with analysis of the break-even point. Experience at an underutilized operating room].

PubMed

Varesio, V; Agosta, I; Masullo, F; Malnati, R; Martegani, G M

1997-04-01

Many authors indicate the importance of economic saving obtained with the use of the inhalation rebreathing anaesthesia instead of non rebreathing anaesthesia, always referring to parameters which are the duration of anesthesia (1 hour) and the use of the operating theatre each year. It is presumed that the utilization of rebreathing system is at least a 1.000 hours/year. However it is not necessary that all the operating theatres employ 1.000 hours/year in rebreathing anesthesia. This method requires annual depreciation costs of the capital invested for the purchase of new adequate ventilators, to modificative those already existing and guarantee adequate monitoring and the maintenance of these equipment. The importance is stressed of individuating a method of economical evaluation comparing the effective savings obtained with the real utilization of rebreathing anesthesia for each operating theatre and the costs of purchasing and maintaining the equipment. From our point of view the break-even point analysis has demonstrated to be a consistent instrument for the evaluation of the real economic advantage of rebreathing system in each hospital. It is suggested to utilize a conventional formula for the determination of the break even point, which means the minimal number of hours for year that justifies economically the adoption of rebreathing anaesthesia. An example of this analysis has been applied for an operating theatre in the hospital of Morbegno, where the major utilization of regional anaesthesia leads to a reduced number hours/year of rebreathing anesthesia which remains anyhow economically advantageous.

Evidence of chiral bands in even-even nuclei

NASA Astrophysics Data System (ADS)

Petrache, C. M.; Lv, B. F.; Astier, A.; Dupont, E.; Wang, Y. K.; Zhang, S. Q.; Zhao, P. W.; Ren, Z. X.; Meng, J.; Greenlees, P. T.; Badran, H.; Cox, D. M.; Grahn, T.; Julin, R.; Juutinen, S.; Konki, J.; Pakarinen, J.; Papadakis, P.; Partanen, J.; Rahkila, P.; Sandzelius, M.; Saren, J.; Scholey, C.; Sorri, J.; Stolze, S.; Uusitalo, J.; Cederwall, B.; Aktas, Ö.; Ertoprak, A.; Liu, H.; Matta, S.; Subramaniam, P.; Guo, S.; Liu, M. L.; Zhou, X. H.; Wang, K. L.; Kuti, I.; Timár, J.; Tucholski, A.; Srebrny, J.; Andreoiu, C.

2018-04-01

Evidence for chiral doublet bands has been observed for the first time in the even-even nucleus 136Nd. One chiral band was firmly established. Four other candidates for chiral bands were also identified, which can contribute to the realization of the multiple pairs of chiral doublet bands (M χ D ) phenomenon. The observed bands are investigated by the constrained and tilted axis cranking covariant density functional theory (TAC-CDFT). Possible configurations have been explored. The experimental energy spectra, angular momenta, and B (M 1 )/B (E 2 ) values for the assigned configurations are globally reproduced by TAC-CDFT. Calculated results support the chiral interpretation of the observed bands, which correspond to shapes with maximum triaxiality induced by different multiquasiparticle configurations in 136Nd.

New ACGME Work-Hour Guidelines and Their Impact on Current Residency Training Practices

ERIC Educational Resources Information Center

Sattar, S. Pirzada; Basith, Fatima; Madison, James; Bhatia, Subhash C.

2005-01-01

Objective: Accreditation Council for Graduate Medical Education (ACGME) has introduced new work-hour guidelines for residents in ACGME accredited programs that were implemented in July 2003. The new ACGME policies impact several practices in various psychiatry residency programs across the U.S., even though psychiatry has not been at the forefront…

An hour of bright white light in the early morning improves performance and advances sleep and circadian phase during the Antarctic winter.

PubMed

Corbett, R W; Middleton, B; Arendt, J

2012-09-13

Previous work has demonstrated that exposure to an hour of bright light in the morning and the evening during the Polar winter has beneficial effects on circadian phase. This study investigated the effect of a single hour of bright white morning light on circadian phase, sleep, alertness and cognitive performance. Nine individuals (eight male, one female, median age 30 years), wintering at Halley Research Station (75°S), Antarctica from 7th May until 6th August 2007, were exposed to bright white light for a fortnight from 08:30 to 09:30 h, with two fortnight control periods on either side. This sequence was performed twice, before and following Midwinter. Light exposure, sleep and alertness were assessed daily by actigraphy, sleep diaries and subjective visual analogue scales. Circadian phase (assessed by urinary 6-sulphatoxymelatonin rhythm) and cognitive performance were evaluated at the end of each fortnight. During light exposure circadian phase was advanced from 4.97 ± 0.96 decimal hours (dh) (mean ± SD) to 4.08 ± 0.68 dh (p = 0.003). Wake-up time was shifted by a similar margin from 8.45 ± 1.83 dh to 7.59 ± 0.78 dh (p < 0.001). Sleep start time was also advanced (p = 0.047) but by a lesser amount, consequently, actual sleep time was slightly reduced. There was no change in objective or subjective measures of sleep quality or subjective measures of alertness. An improvement in cognitive performance was found with both the Single Letter Cancellation Test (p < 0.001) and the Digit Symbol Substitution Test (p = 0.026) with preserved circadian variation. These beneficial effects of a single short duration light treatment may have implications not only for the Antarctic but other remote environments where access to natural light and delayed circadian phase, is problematic. These results require validation in larger studies at varying locations. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Extended hours hemodialysis and survival: extended hours, extended evidence?

PubMed

Wald, Ron; Perl, Jeffrey

2016-12-01

Extended-hours hemodialysis presents another approach to the intensification of therapy for maintenance hemodialysis recipients. Smaller studies have demonstrated several potential benefits with this modality, but the impact on patient-centered outcomes has been unclear. We review the largest published study to compare survival among patients who received extended-hours hemodialysis with those who received conventional hemodialysis. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

A favorable outcome despite a 39-hour treatment delay for arterial gas embolism: case report.

PubMed

Covington, Derek; Bielawski, Anthony; Sadler, Charlotte; Latham, Emi

2016-01-01

Cerebral arterial gas embolism (CAGE) occurs when gas enters the cerebral arterial vasculature. CAGE can occur during sitting craniotomies, cranial trauma or secondary to gas embolism from the heart. A far less common cause of CAGE is vascular entrainment of gas during endoscopic procedures. We present the case of a 49-year-old male who developed a CAGE following an esophagoduodenoscopy (EGD) biopsy. Due to a delay in diagnosis, the patient was not treated with hyperbaric oxygen (HBO₂) therapy until 39 hours after the inciting event. Despite presenting to our institution non-responsive and with decorticate posturing, the patient was eventually discharged to a rehabilitation facility, with only mild left upper extremity weakness. This delay in HBO₂ treatment represents the longest delay in treatment to our knowledge for a patient suffering from CAGE secondary to EGD. In addition to the clinical case report, we discuss the etiology of CAGE and the evidence supporting early HBO₂ treatment, as well as the data demonstrating efficacy even after considerable treatment delay. Copyright© Undersea and Hyperbaric Medical Society.

29 CFR 553.225 - Early relief.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 3 2011-07-01 2011-07-01 false Early relief. 553.225 Section 553.225 Labor Regulations... Enforcement Employees of Public Agencies Tour of Duty and Compensable Hours of Work Rules § 553.225 Early... employees on the previous shift prior to the scheduled starting time. Such early relief time may occur...

29 CFR 553.225 - Early relief.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Early relief. 553.225 Section 553.225 Labor Regulations... Enforcement Employees of Public Agencies Tour of Duty and Compensable Hours of Work Rules § 553.225 Early... employees on the previous shift prior to the scheduled starting time. Such early relief time may occur...

Cost-effectiveness analysis of early versus non-early intervention in acute migraine based on evidence from the 'Act when Mild' study.

PubMed

Slof, John

2012-05-01

In spite of the important progress made in the abortive treatment of acute migraine episodes since the introduction of triptans, reduction of pain and associated symptoms is in many cases still not as effective nor as fast as would be desirable. Recent research pays more attention to the timing of the treatment, and taking triptans early in the course of an attack when pain is still mild has been found more efficacious than the usual strategy of waiting for the attack to develop to a higher pain intensity level. To investigate the cost effectiveness of early versus non-early intervention with almotriptan in acute migraine. An economic evaluation was conducted from the perspectives of French society and the French public health system based on patient-level data collected in the AwM (Act when Mild) study, a placebo-controlled trial that compared the response to early and non-early treatment of acute migraine with almotriptan. Incremental cost-effectiveness ratios (ICERs) were determined in terms of QALYs, migraine hours and productive time lost. Costs were expressed in Euros (year 2010 values). Bootstrapping was used to derive cost-effectiveness acceptability curves. Early treatment has shown to lead to shorter attack duration, less productive time lost, better quality of life, and is, with 92% probability, overall cost saving from a societal point of view. In terms of drug costs only, however, non-early treatment is less expensive. From the public health system perspective, the (bootstrap) mean ICER of early treatment amounts to €0.38 per migraine hour avoided, €1.29 per hour of productive time lost avoided, and €14,296 per QALY gained. Considering willingness-to-pay values of approximately €1 to avoid an hour of migraine, €10 to avoid the loss of a productive hour, or €30,000 to gain one QALY, the approximate probability that early treatment is cost effective is 90%, 90% and 70%, respectively. These results remain robust in different scenarios for the

First Hours of the GW170817 Kilonova: Why So Blue?

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2018-04-01

Now that the hubbub of GW170817 the first coincident detection of gravitational waves and an electromagnetic signature has died down, scientists are left with the task of taking the spectrum-spanning observations and piecing them together into a coherent picture. Researcher Iair Arcavi examines one particular question: what caused the blue color in the early hours of the neutron-star merger?Observations of the GW170817 kilonova by Hubble over a week-long span. [ESA/Hubble]Early ColorWhen the two neutron stars of GW170817 merged in August of last year, they produced not only gravitational waves, but a host of electromagnetic signatures. Chief among these was a flare of emission thought to be powered by the radioactive decay of heavy elements formed in the merger a kilonova.The emission during a kilonova can come from a number of different sources from the heavy-element-rich tidal tails of the disrupting neutron stars, or from fast, light polar jets, or from a wind or a disk outflow and each of these components could reveal different information about the original neutron stars and the merger.Its therefore important that we understand the sources of the emission that we observed in the GW170817 kilonova. In particular, wed like to know where the early blue emission came from that was spotted in the first hours of the kilonova.The combined ultravioletopticalinfrared light curve of the GW170817 kilonova. The rise in the emission occurs on roughly a day-long timescale. [Arcavi 2018]Comparing ModelsTo explore this question, Iair Arcavi (Einstein Fellow at University of California, Santa Barbara and Las Cumbres Observatory) compiled infrared through ultraviolet observations of the GW170817 kilonova from nearly 20 different telescopes. To try to distinguish between possible sources, Arcavi then compared the resulting combined light curves to a variety of models.Arcavi found that the light curves for the GW170817 kilonova indicate an initial 24-hour rise of emission. This

Early Ambulation Decreases Length of Hospital Stay, Perioperative Complications and Improves Functional Outcomes in Elderly Patients Undergoing Surgery for Correction of Adult Degenerative Scoliosis.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos

2017-09-15

Ambispective cohort review. To examine the effects of early mobilization on patient outcomes, complications profile, and 30-day readmission rates. Prolonged immobilization after surgery can result in functional decline and an increased risk of hospital-associated complications. We conducted an ambispective study of 125 elderly patients (>65 years) undergoing elective spinal surgery for correction of adult degenerative scoliosis. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. "Days of immobility" was defined as the number of days until a patient moved out of bed beyond a chair. Patients in the top and bottom quartiles were dichotomized into "early ambulators" and "late ambulators", respectively. Early ambulators were ambulatory within 24 hours of surgery, whereas late ambulators were ambulatory at a minimum of 48 hours after surgery. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between early ambulators and late ambulators. Baseline characteristics were similar between both cohorts. Compared with patients with a longer duration of immobility (i.e., late ambulators), the prevalence of at least one perioperative complication was significantly lower in the early ambulators cohort (30% vs. 54%, P = 0.06). The length of inhospital stay was 34% shorter in the early ambulators cohort (5.33 days vs. 8.11 days, P = 0.01). Functional independence was superior in the early ambulators cohort, with the majority of patients discharged directly home after surgery compared with late ambulators (71.2% vs. 22.0%, P = 0.01). Early ambulation after surgery significantly reduces the incidence of perioperative complications, shortens duration of inhospital stay, and contributes to improved perioperative functional status in elderly patients. Even a delay of 24 hours to ambulation is

The Effect of Fatherhood on Employment Hours: Variation by Birth Timing, Marriage and Coresidence.

PubMed

Weinshenker, Matthew

2015-01-01

Drawing on the life course paradigm, I assess how the effect of fatherhood on employment hours varies by age of becoming a parent and time elapsed since the birth. Using the National Longitudinal Survey of Youth - 1979 Cohort from 1979 to 2002 (N = 28,514 observations), separate effects are estimated based on fathers' marital status and co-residence with own children. Only unmarried men who became fathers before 24 work longer hours immediately after a first birth, but in the long run, most early fathers work fewer hours as a result of parenthood. Over time, unmarried but coresident men who became fathers between 24 and 29 increase their hours, as do married, coresident men who delayed fatherhood until 30 or older. However, the latter increase is moderated by support for egalitarian gender roles. The findings shed light on the contemporary transition to adulthood and on men's work-family balance.

The NASA POWER SSE: Deriving the Direct Normal Counterpart from the CERES SYN1deg Hourly Global Horizontal Irradiance during Early 2000 to Near Present

NASA Astrophysics Data System (ADS)

Zhang, T.; Stackhouse, P. W., Jr.; Westberg, D. J.

2017-12-01

The NASA Prediction of Worldwide Energy Resource (POWER) Surface meteorology and Solar Energy (SSE) provides solar direct normal irradiance (DNI) data as well as a variety of other solar parameters. The currently available DNIs are monthly means on a quasi-equal-area grid system with grid boxes roughly equivalent to 1 degree longitude by 1 degree latitude around the equator from July 1983 to June 2005, and the data were derived from the GEWEX Surface Radiation Budget (SRB) monthly mean global horizontal irradiance (GHI, Release 3) and regression analysis of the Baseline Surface Radiation Network (BSRN) data. To improve the quality of the DNI data and push the temporal coverage of the data to near present, we have applied a modified version of the DIRINDEX global-to-beam model to the GEWEX SRB (Release 3) all-sky and clear-sky 3-hourly GHI data and derived their DNI counterparts for the period from July 1983 to December 2007. The results have been validated against the BSRN data. To further expand the data in time to near present, we are now applying the DIRINDEX model to the Clouds and the Earth's Radiant Energy System (CERES) data. The CERES SYN1deg (Edition 4A) offers hourly all-sky and clear-sky GHIs on a 1 degree longitude by 1 degree latitude grid system from March 2000 to October 2016 as of this writing. Comparisons of the GHIs with their BSRN counterparts show remarkable agreements. Besides the GHIs, the inputs will also include the atmospheric water vapor and surface pressure from the Modern Era Retrospective-Analysis for Research and Applications (MERRA) and the aerosol optical depth from the Max-Planck Institute Climatology (MAC-v1). Based on the performance of the DIRINDEX model with the GEWEX SRB GHI data, we expect at least equally good or even better results. In this paper, we will show the derived hourly, daily, and monthly mean DNIs from the CERES SYN1deg hourly GHIs from March 2000 to October 2016 and how they compare with the BSRN data.

Impact of the recent reduction in working hours (the 80 hour work week) on surgical resident cancer education.

PubMed

Vetto, John T; Robbins, Debra

2005-01-01

Resident work hours were recently reduced to 80 hours per week by a mandate from the Accreditation Council for Graduate Medical Education and subsequent Federal law (HR 3236). This mandate became effective July 1st, 2003. We sought to determine any impact this change had on perceived and real resident cancer education and knowledge. Of the total 85 residents in our large, university-based surgical training program, we focused on the 40 who had been in the clinical program (rather than research) before and after the work hour reduction. Perceived impact on cancer education was determined by survey, and real impact by before (2002) and after (2004) scores on the overall and cancer-specific portion of the annual American Board of Surgery In-Training Examination (ABSITE). All eligible residents responded to the survey. The majority (83% to 85%) indicated that exposure to cancer patients on wards and in clinics remained the same. Thirty percent felt that their exposure to cancer operations and tumor boards had decreased; 60% to 65% felt that exposure to these activities were unchanged. Approximately half of residents reported an increase in their cancer-related reading and Internet learning activities--the other half felt they had not changed. The majority (88%) reported no change in their participation in extraprogrammatic cancer-related continuing medical education activities. Of the survey responders, 23 had completed the ABSITE in both 2002 and 2004; their mean scores between the 2 time periods increased by 7% for the overall test and decreased by 3% for the cancer-specific portion. Overall, the recent reduction in work hours does not appear to have changed residents' experience with cancer patient care, although possible early reductions in attendance at cancer operations and tumor boards merits further study and possibly future schedule changes. The reported perceived increase in cancer-related reading and Internet learning has not yet translated into improved

Early diagnosis and Early Start Denver Model intervention in autism spectrum disorders delivered in an Italian Public Health System service.

PubMed

Devescovi, Raffaella; Monasta, Lorenzo; Mancini, Alice; Bin, Maura; Vellante, Valerio; Carrozzi, Marco; Colombi, Costanza

2016-01-01

Early diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System. Twenty-one toddlers at risk for autism spectrum disorders, aged 20-36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents' and teachers' active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months). Children made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment. Our results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.

Proportion of infants meeting the Australian 24-hour Movement Guidelines for the Early Years: data from the Melbourne InFANT Program.

PubMed

Hesketh, Kylie D; Downing, Katherine L; Campbell, Karen; Crawford, David; Salmon, Jo; Hnatiuk, Jill A

2017-11-20

Little information is available on the movement behaviours of infants, despite evidence that these are important for development. The release of new Australian 24-hour Movement Guidelines provides an opportunity to document the current state of movement behaviours in infants relative to these guidelines. The aim of this study was to report the prevalence of 4 month old Australian infants meeting the 24-hour Movement Guidelines, individually, and in combination, and to describe associations with individual characteristics. Maternal report baseline data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program were used to determine prevalence of infants meeting physical activity (30 min of tummy time per day), sedentary behaviour (no more than 1 h at a time kept restrained; zero screen time), and sleep guidelines (14-17 h for 0-3 month olds or 12-16 h for 4-11 month olds). Prevalence of infants meeting combined guidelines was also described. The odds of meeting guidelines based on infant and family characteristics was determined. Data are reported for 455 infants with a mean age of 3.6 months (SD = 1.0). The proportion of infants meeting each of the guidelines was 29.7% for tummy time, 56.9% for kept restrained, 27.9% for screen time, 58.7% for sleep and 3.5% for the combined guidelines (i.e. meeting all four guidelines). A significantly higher proportion of girls than boys met the screen time guideline (32.5% versus 24.0%, p = 0.04) and the combined guidelines (5.7% versus 1.6%, p = 0.01). Few associations were observed between infant and family characteristics and proportion of infants meeting individual guidelines. Very few infants met all of the guidelines contained in the new Australian 24-hour Movement Guidelines suggesting there is much room for improvement in movement behaviours from early life. Fewer infants met the tummy time and screen time guidelines hence these appear to be the behaviours requiring most attention. Parents and

Evening Transition by a River Sampled Using a Remotely-Piloted Multicopter

NASA Astrophysics Data System (ADS)

Wrenger, B.; Cuxart, J.

2017-12-01

Measurements made with instruments aboard a remotely-piloted multicopter flying across the Weser river in Germany provide information on the thermal structure of the boundary layer over the river and adjacent land, in this case in summer for late afternoon, the evening transition and early night on a clear calm day. The river has a characteristic width of 100 m. The stratification over the land and river are of opposite signs at the lower levels, except during part of the evening transition. The multicopter allows to qualitatively estimate the evolution of the thermal contrast between both surfaces, showing that the river banks experience very significant daytime cooling and nocturnal warming due to river-bank circulations, with the change of sign taking place well before sunset.

Impact of states' nurse work hour regulations on overtime practices and work hours among registered nurses.

PubMed

Bae, Sung-Heui; Yoon, Jangho

2014-10-01

To examine the degree to which states' work hour regulations for nurses-policies regarding mandatory overtime and consecutive work hours-decrease mandatory overtime practice and hours of work among registered nurses. We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses. © Health Research and Educational Trust.

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis.

PubMed

Brotfain, Evgeni; Schwartz, Andrei; Boniel, Avi; Koyfman, Leonid; Boyko, Matthew; Kutz, Ruslan; Klein, Moti

2016-01-01

Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis. We analyzed the clinical data, including the outcome of critically ill ICU patients with severe sepsis who presented during a 5 year period with early hypophosphatemia and thrombocytopenia.This study was retrospective and single centre. All clinical and laboratory data was collected from the patients' ICU and hospital electronic records. All laboratory measurements were done on admission and during the ICU stay. The included patients were distributed into one of three study groups based on the presence of hypophosphatemia and/or thrombocytopenia during the first 24 hours of admission to the ICU: group 1 - early hypophosphatemia; group 2 - early hypophosphatemia and thrombocytopenia and group 3 - early thrombocytopenia. The ICU mortality rate was significantly higher in groups 2 and 3 (25.9% and 22% vs. 9.3%, respectively, P = 0.034). An APACHE II > 27, a TISS > 25 following the first 24 hours of ICU stay , an age higher than 70, male gender and total parenteral nutrition were independent predictors of ICU and hospital mortality in this study population. It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.

Effects of direction of rotation in continuous and discontinuous 8 hour shift systems

PubMed Central

Tucker, P.; Smith, L.; Macdonald, I.; Folkard, S.

2000-01-01

OBJECTIVES—Previous research has produced conflicting evidence on the relative merits of advancing and delaying shift systems. The current study assessed the effects of the direction of shift rotation within 8 hour systems, upon a range of measures including sleep, on shift alertness, physical health, and psychological wellbeing.
METHODS—An abridged version of the standard shiftwork index which included retrospective alertness ratings was completed by four groups of industrial shiftworkers on relatively rapidly rotating 8 hour systems (n=611). Two groups worked continuous systems that were either advancing or delaying; the other two groups worked discontinuous systems that were either advancing or delaying.
RESULTS—Few effects were found of direction of rotation on chronic measures of health and wellbeing, even when the systems incorporated "quick returns" (a break of only 8 hours when changing from one shift to another). This was despite the use of measures previously shown to be sensitive to the effects of a broad range of features of shift systems. However, advancing continuous systems seemed to be associated with marginally steeper declines in alertness across the shift (F (3,1080)=2.87, p<0.05). They were also associated with shorter sleeps between morning shifts (F (1,404)=4.01, p<0.05), but longer sleeps between afternoons (F (1,424)=4.16, p<0.05).
CONCLUSIONS—The absence of negative effects of advancing shifts upon the chronic outcome measures accorded with previous evidence that advancing shifts may not be as harmful as early research indicated. However, this interpretation is tempered by the possibility that difficult shift systems self select those workers most able to cope with their deleterious effects. The presence of quick returns in advancing continuous systems seemed to impact upon some of the acute measures such as duration of sleep, although the associated effects on alertness seemed to be marginal.


Keywords: shift

Tables of E2 transition probabilities from the first 2 + states in even-even nuclei [B(E2) evaluation for 0 + 1 → 2 + 1 transitions in even-even nuclei

DOE PAGES

Pritychenko, B.; Birch, M.; Singh, B.; ...

2015-11-03

A complete B(E2)↑ evaluation and compilation for even-even nuclei has been presented. The present paper is a continuation of P.H. Stelson and L. Grodzins, and S. Raman et al. nuclear data evaluations and was motivated by a large number of new measurements. It extends the list of evaluated nuclides from 328 to 452, includes an extended list of nuclear reaction kinematics parameters and comprehensive shell model analysis. Evaluation policies for analysis of experimental data have been discussed and conclusions are given. Moreover, future plans for B(E2)↑ systematics and experimental technique analyses of even-even nuclei are outlined.

Spin-dependent γ softness or triaxiality in even-even 132-138Nd nuclei

NASA Astrophysics Data System (ADS)

Chai, Qing-Zhen; Wang, Hua-Lei; Yang, Qiong; Liu, Min-Liang

2015-02-01

The properties of γ instability in rapidly rotating even-even 132-138Nd isotopes have been investigated using the pairing-deformation self-consistent total-Routhian-surface calculations in a deformation space of (β2, γ, β4). It is found that even-even 134-138Nd nuclei exhibit triaxiality in both ground and excited states, even up to high-spin states. The lightest isotope possesses a well-deformed prolate shape without a γ deformation component. The current numerical results are compared with previous calculations and available observables such as quadrupole deformation β2 and the feature of γ-band levels, showing basically a general agreement with the observed trend of γ correlations (e.g. the pattern of the odd-even energy staggering of the γ band). The existing differences between theory and experiment are analyzed and discussed briefly. Supported by National Natural Science Foundation of China (10805040,11175217), Foundation and Advanced Technology Research Program of Henan Province(132300410125) and S & T Research Key Program of Henan Province Education Department (13A140667)

The Effect of Fatherhood on Employment Hours: Variation by Birth Timing, Marriage and Coresidence

PubMed Central

Weinshenker, Matthew

2017-01-01

Drawing on the life course paradigm, I assess how the effect of fatherhood on employment hours varies by age of becoming a parent and time elapsed since the birth. Using the National Longitudinal Survey of Youth – 1979 Cohort from 1979 to 2002 (N = 28,514 observations), separate effects are estimated based on fathers’ marital status and co-residence with own children. Only unmarried men who became fathers before 24 work longer hours immediately after a first birth, but in the long run, most early fathers work fewer hours as a result of parenthood. Over time, unmarried but coresident men who became fathers between 24 and 29 increase their hours, as do married, coresident men who delayed fatherhood until 30 or older. However, the latter increase is moderated by support for egalitarian gender roles. The findings shed light on the contemporary transition to adulthood and on men’s work-family balance. PMID:28280281

Impact of States’ Nurse Work Hour Regulations on Overtime Practices and Work Hours among Registered Nurses

PubMed Central

Bae, Sung-Heui; Yoon, Jangho

2014-01-01

Objectives To examine the degree to which states’ work hour regulations for nurses—policies regarding mandatory overtime and consecutive work hours—decrease mandatory overtime practice and hours of work among registered nurses. Methods We analyzed a nationally representative sample of registered nurses from the National Sample Survey of Registered Nurses for years 2004 and 2008. We obtained difference-in-differences estimates of the effect of the nurse work hour policies on the likelihood of working mandatory overtime, working more than 40 hours per week, and working more than 60 hours per week for all staff nurses working in hospitals and nursing homes. Principal Findings The mandatory overtime and consecutive work hour regulations were significantly associated with 3.9 percentage-point decreases in the likelihood of working overtime mandatorily and 11.5 percentage-point decreases in the likelihood of working more than 40 hours per week, respectively. Conclusions State mandatory overtime and consecutive work hour policies are effective in reducing nurse work hours. The consecutive work hour policy appears to be a better regulatory tool for reducing long work hours for nurses. PMID:24779701

Study of Even-Even/Odd-Even/Odd-Odd Nuclei in Zn-Ga-Ge Region in the Proton-Neutron IBM/IBFM/IBFFM

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

Yoshida, N.; Brant, S.; Zuffi, L.

We study the even-even, odd-even and odd-odd nuclei in the region including Zn-Ga-Ge in the proton-neutron IBM and the models derived from it: IBM2, IBFM2, IBFFM2. We describe {sup 67}Ga, {sup 65}Zn, and {sup 68}Ga by coupling odd particles to a boson core {sup 66}Zn. We also calculate the beta{sup +}-decay rates among {sup 68}Ge, {sup 68}Ga and {sup 68}Zn.

Fixed Costs and Hours Constraints

ERIC Educational Resources Information Center

Johnson, William R.

2011-01-01

Hours constraints are typically identified by worker responses to questions asking whether they would prefer a job with more hours and more pay or fewer hours and less pay. Because jobs with different hours but the same rate of pay may be infeasible when there are fixed costs of employment or mandatory overtime premia, the constraint in those…

Registrar working hours in Cape Town.

PubMed

Vadia, S; Kahn, D

2005-08-01

The number of hours worked by general surgical registrars in Europe and the USA has been reduced so as to reduce fatigue and the possibility of errors. The impact of these restrictions on surgical training remains unresolved. To date there are no officially reported data on the number of hours worked by registrars in South Africa. The aim of this study was to document the hours worked by registrars in general surgery in Cape Town. Thirty-three general surgical registrars at the University of Cape Town were asked to complete a time sheet over a 2-week period, indicating hours spent in hospital as part of a normal working day, hours spent in hospital outside of a normal day, hours at home on 'cold call' and hours off duty. Of the 33 registrars, 25 completed the time sheet. Registrars at Groote Schuur Hospital worked an average of 105 hours per week (68 hours in hospital and 37 hours on call at home). Registrars at New Somerset Hospital worked 79 hours per week (70 hours on site), while registrars at Red Cross Children's Hospital, G. F. Jooste Hospital and the Trauma Unit worked 60 - 69 hours per week. In the Surgical Intensive Care Unit (SICU) registrars worked 75 hours per week. In conclusion, general surgical registrars at the University of Cape Town work hours in excess of European and American work-hour restrictions.

Gender differences in salary in a recent cohort of early-career physician-researchers.

PubMed

Jagsi, Reshma; Griffith, Kent A; Stewart, Abigail; Sambuco, Dana; DeCastro, Rochelle; Ubel, Peter A

2013-11-01

Studies have suggested that male physicians earn more than their female counterparts. The authors examined whether this disparity exists in a recently hired cohort. In 2010-2011, the authors surveyed recent recipients of National Institutes of Health (NIH) mentored career development (i.e., K08 or K23) awards, receiving responses from 1,275 (75% response rate). For the 1,012 physicians with academic positions in clinical specialties who reported salary, they constructed linear regression models of salary considering gender, age, race, marital status, parental status, additional doctoral degree, academic rank, years on faculty, specialty, institution type, region, institution NIH funding rank, K award type, K award funding institute, K award year, work hours, and research time. They evaluated the explanatory value of spousal employment status using Peters-Belson regression. Mean salary was $141,325 (95% confidence interval [CI] 135,607-147,043) for women and $172,164 (95% CI 167,357-176,971) for men. Male gender remained an independent, significant predictor of salary (+$10,921, P < .001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Peters-Belson analysis indicated that 17% of the overall disparity in the full sample was unexplained by the measured covariates. In the married subset, after accounting for spousal employment status, 10% remained unexplained. The authors observed, in this recent cohort of elite, early-career physician-researchers, a gender difference in salary that was not fully explained by specialty, academic rank, work hours, or even spousal employment. Creating more equitable procedures for establishing salary is important.

Comparison of population iodine estimates from 24-hour urine and timed-spot urine samples.

PubMed

Perrine, Cria G; Cogswell, Mary E; Swanson, Christine A; Sullivan, Kevin M; Chen, Te-Ching; Carriquiry, Alicia L; Dodd, Kevin W; Caldwell, Kathleen L; Wang, Chia-Yih

2014-04-01

Median urine iodine concentration (UIC; μg/L) in spot urine samples is recommended for monitoring population iodine status. Other common measures are iodine:creatinine ratio (I/Cr; μg/g) and estimated 24-hour urine iodine excretion (UIE; I/Cr × predicted 24-hour Cr; μg/day). Despite different units, these measures are often used interchangeably, and it is unclear how they compare with the reference standard 24-hour UIE. Volunteers aged 18-39 years collected all their urine samples for 24 hours (n=400). Voids from morning, afternoon, evening, overnight, and a composite 24-hour sample were analyzed for iodine. We calculated median observed 24-hour UIE and 24-hour UIC, and spot UIC, I/Cr, and two measures of estimated UIE calculated using predicted 24-hour Cr from published estimates by Kesteloot and Joosens (varies by age and sex) and published equations by Mage et al. (varies by age, sex, race, and anthropometric measures). We examined mean differences and relative difference across iodine excretion levels using Bland-Altman plots. Median 24-hour UIE was 173.6 μg/day and 24-hour UIC was 144.8 μg/L. From timed-spot urine samples, estimates were: UIC 147.3-156.2 μg/L; I/Cr 103.6-114.3 μg/g, estimated 24-hour UIE (Kesteloot and Joosens) 145.7-163.3 μg/day; and estimated 24-hour UIE (Mage) 176.5-187.7 μg/day. Iodine measures did not vary consistently by timing of spot urine collection. Compared with observed 24-hour UIE, on average, estimated (Mage) 24-hour UIE was not significantly different, while estimated 24-hour UIE (Kesteloot and Joosens) was significantly different for some ethnicity/sex groups. Compared with 24-hour UIC, on average, spot UIC did not differ. Estimates of UIC, I/Cr, and estimated 24-hour UIE (I/Cr × predicted 24-hour Cr) from spot urine samples should not be used interchangeably. Estimated 24-hour UIE, where predicted 24-hour Cr varies by age, sex, ethnicity, and anthropometric measures and was calculated with prediction

Severe community-acquired pneumonia: timely management measures in the first 24 hours.

PubMed

Phua, Jason; Dean, Nathan C; Guo, Qi; Kuan, Win Sen; Lim, Hui Fang; Lim, Tow Keang

2016-08-28

Mortality rates for severe community-acquired pneumonia (CAP) range from 17 to 48 % in published studies.In this review, we searched PubMed for relevant papers published between 1981 and June 2016 and relevant files. We explored how early and aggressive management measures, implemented within 24 hours of recognition of severe CAP and carried out both in the emergency department and in the ICU, decrease mortality in severe CAP.These measures begin with the use of severity assessment tools and the application of care bundles via clinical decision support tools. The bundles include early guideline-concordant antibiotics including macrolides, early haemodynamic support (lactate measurement, intravenous fluids, and vasopressors), and early respiratory support (high-flow nasal cannulae, lung-protective ventilation, prone positioning, and neuromuscular blockade for acute respiratory distress syndrome).While the proposed interventions appear straightforward, multiple barriers to their implementation exist. To successfully decrease mortality for severe CAP, early and close collaboration between emergency medicine and respiratory and critical care medicine teams is required. We propose a workflow incorporating these interventions.

Why do even satisfied newlyweds eventually go on to divorce?

PubMed

Lavner, Justin A; Bradbury, Thomas N

2012-02-01

Although divorce typically follows an extended period of unhappiness that begins early in marriage, some couples who are very happy throughout the first several years of marriage will also go on to divorce. This study aimed to identify risk factors early in marriage that distinguish initially satisfied couples who eventually divorce from those who remain married. We identified 136 couples reporting stably high levels of relationship satisfaction in the first 4 years of marriage. We compared the couples who went on to divorce by the 10-year follow-up with the couples who remained married on initial measures of commitment, observed communication, stress, and personality. Divorcing couples displayed more negative communication, emotion, and social support as newlyweds compared with couples who did not divorce. No significant differences were found in the other domains, in relationship satisfaction, or in positive behaviors. Overall, results indicate that even couples who are very successful at navigating the early years of marriage can be vulnerable to later dissolution if their interpersonal exchanges are poorly regulated. We speculate that, paradoxically, the many strengths possessed by these couples may mask their potent interpersonal liabilities, posing challenges for educational interventions designed to help these couples.

Effect of bed exercises and gum chewing on abdominal sounds, flatulence and early discharge in the early period after caesarean section.

PubMed

Çevik, Semra Akköz; Başer, Mürüvvet

2016-05-01

The purpose of this study was to determine the effects of bed exercises and gum chewing on abdominal sounds, flatulence and early discharge on women who have given birth at the Cengiz Gökçek Gynecology and Obstetrics Hospital surgery services in Gaziantep city centre. Caesarean operation is the most significant surgical intervention that affects central nervous system and decelerates bowel movements in the postoperative period. Conducted studies show that practices such as gum chewing ensure that bowel functions start in a short time through early feeding and mobilisation and shorten the duration of hospital stay. A randomised controlled experimental was used. A total of 120 women participated in the study in three groups of 40 for gum, exercise and control groups. Gum was given to the groups in the gum section two hours after the ceasarean, the women chewed gum for the first eight hours until flatulence for 15 minutes every two hours. However, the women in the exercise group started moving two hours after the caesarean for the first eight hours until flatulence for five minutes every two hours. The control group consisted of women under routine treatment and care of the hospital. All women were hourly evaluated in terms of abdominal sounds, flatulence and defaecation. It was determined that following caesarean, bowel functions started in three groups at the same time, there was no significant difference between three groups. It was determined that the gum group, exercise group and the control group were discharged earlier, there was no significant difference between three groups The study results show that spinal anaesthesia have positive effects on discharge time after caesarean section operation. This study provides useful information to clinician and researchers when determining practices such as postoperative standing up in early period, gum chewing and early liquid intake related to postoperative bowel functions after abdominal operations. © 2016 John

Hereditary Angioedema Attacks Resolve Faster and Are Shorter after Early Icatibant Treatment

PubMed Central

Maurer, Marcus; Kaplan, Allen; Investigators, on behalf of I. O. S.

2013-01-01

Background Attacks of hereditary angioedema (HAE) are unpredictable and, if affecting the upper airway, can be lethal. Icatibant is used for physician- or patient self-administered symptomatic treatment of HAE attacks in adults. Its mode of action includes disruption of the bradykinin pathway via blockade of the bradykinin B2 receptor. Early treatment is believed to shorten attack duration and prevent severe outcomes; however, evidence to support these benefits is lacking. Objective To examine the impact of timing of icatibant administration on the duration and resolution of HAE type I and II attacks. Methods The Icatibant Outcome Survey is an international, prospective, observational study for patients treated with icatibant. Data on timings and outcomes of icatibant treatment for HAE attacks were collected between July 2009–February 2012. A mixed-model of repeated measures was performed for 426 attacks in 136 HAE type I and II patients. Results Attack duration was significantly shorter in patients treated <1 hour of attack onset compared with those treated ≥1 hour (6.1 hours versus 16.8 hours [p<0.001]). Similar significant effects were observed for <2 hours versus ≥2 hours (7.2 hours versus 20.2 hours [p<0.001]) and <5 hours versus ≥5 hours (8.0 hours versus 23.5 hours [p<0.001]). Treatment within 1 hour of attack onset also significantly reduced time to attack resolution (5.8 hours versus 8.8 hours [p<0.05]). Self-administrators were more likely to treat early and experience shorter attacks than those treated by a healthcare professional. Conclusion Early blockade of the bradykinin B2 receptor with icatibant, particularly within the first hour of attack onset, significantly reduced attack duration and time to attack resolution. PMID:23390491

Rosetta Mission's "7 Hours of Terror" and Philae's Descent

NASA Astrophysics Data System (ADS)

Blanco, Philip

2015-09-01

In November 2014 the Rosetta mission to Comet 67P/Churyumov-Gerasimenko made the headlines when its Philae lander completed a successful unpowered descent onto the surface of the comet nucleus after "7 hours of terror" for the mission scientists. 67P's irregular shape and rotation made this task even more challenging. Philae fell almost radially towards 67P, as shown in an animation produced by the European Space Agency (ESA) prior to the event. Below, we investigate whether it is possible to model the spacecraft's descent time and impact speed using concepts taught in an introductory physics course.

A randomized trial of a three-hour protected nap period in a medicine training program: sleep, alertness, and patient outcomes.

PubMed

Shea, Judy A; Dinges, David F; Small, Dylan S; Basner, Mathias; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian J; Novak, Cristina; Bellini, Lisa M; Dine, C Jessica; Mollicone, Daniel J; Volpp, Kevin G

2014-03-01

Protected sleep periods for internal medicine interns have previously resulted in increased amount slept and improved cognitive alertness but required supplemental personnel. The authors evaluated intern and patient outcomes associated with protected nocturnal nap periods of three hours that are personnel neutral. Randomized trial at Philadelphia Veterans Affairs Medical Center (PVAMC) Medical Service and Hospital of the University of Pennsylvania (HUP) Oncology Unit. During 2010-2011, four-week blocks were randomly assigned to a standard intern schedule (extended duty overnight shifts of up to 30 hours), or sequential protected sleep periods (phone sign-out midnight to 3:00 AM [early shift] intern 1; 3:00 to 6:00 AM [late shift] intern 2). Participants wore wrist Actiwatches, completed sleep diaries, and performed daily assessments of behavioral alertness. Between-group comparisons of means and proportions controlled for within-person correlations. HUP interns had significantly longer sleep durations during both early (2.40 hours) and late (2.44 hours) protected periods compared with controls (1.55 hours, P < .0001). At PVAMC sleep duration was longer only for the late shift group (2.40 versus 1.90 hours, P < .036). Interns assigned to either protected period were significantly less likely to have call nights with no sleep and had fewer attentional lapses on the Psychomotor Vigilance Test. Differences in patient outcomes between standard schedule months versus intervention months were not observed. Protected sleep periods of three hours resulted in more sleep during call and reductions in periods of prolonged wakefulness, providing a plausible alternative to 16-hour shifts.

The Swedish duty hour enigma.

PubMed

Sundberg, Kristina; Frydén, Hanna; Kihlström, Lars; Nordquist, Jonas

2014-01-01

The Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this "the Swedish duty hour enigma." This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions? A case study was conducted at Karolinska University Hospital, Stockholm--an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research. The residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility. According to Swedish residents' conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice.

The Swedish duty hour enigma

PubMed Central

2014-01-01

Background The Swedish resident duty hour limit is regulated by Swedish and European legal frameworks. With a maximum average of 40 working hours per week, the Swedish duty hour regulation is one of the most restrictive in the world. At the same time, the effects of resident duty hour limits have been neither debated nor researched in the Swedish context. As a result, little is known about the Swedish conceptual framework for resident duty hours, their restriction, or their outcomes: we call this “the Swedish duty hour enigma.” This situation poses a further question: How do Swedish residents themselves construct a conceptual framework for duty hour restrictions? Methods A case study was conducted at Karolinska University Hospital, Stockholm – an urban, research-intensive hospital setting. Semi-structured interviews were carried out with 34 residents currently in training in 6 specialties. The empirical data analysis relied on theoretical propositions and was conducted thematically using a pattern-matching technique. The interview guide was based on four main topics: the perceived effect of duty hour restrictions on (1) patient care, (2) resident education, (3) resident well-being, and (4) research. Results The residents did not perceive the volume of duty hours to be the main determinant of success or failure in the four contextual domains of patient care, resident education, resident well-being, and research. Instead, they emphasized resident well-being and a desire for flexibility. Conclusions According to Swedish residents’ conceptual framework on duty hours, the amount of time spent on duty is not a proxy for the quality of resident training. Instead, flexibility, organization, and scheduling of duty hours are considered to be the factors that have the greatest influence on resident well-being, quality of learning, and opportunities to attain the competence needed for independent practice. PMID:25559074

A single-bout of one-hour spinning exercise increases troponin T in healthy subjects.

PubMed

Duttaroy, Smita; Thorell, Daniel; Karlsson, Lena; Börjesson, Mats

2012-02-01

While long-term endurance exercise is known to increase cardiac biomarkers, only a few studies on short-term exercise and these markers have been reported. The aim of this study was to investigate the acute effects of a one-hour bicycle spinning on cardiac biomarkers in healthy individuals. Serum levels of high-sensitive troponin T (TnT), creatinine kinase MB fraction (CK-MB), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatinine kinase (CK) and myoglobin were measured at baseline, 1 and 24 hour after one hour of spinning exercise in ten healthy and fit (age 31.0 ± 6.6 years) individuals. TnT doubled one hour post-exercise (All values ≤ 5 - 9.7 ± 6.0 ng/L, p < 0.001). Two individuals had TnT levels above upper reference limit, URL (20.7 and 20.2 ng/L, URL = 12 ng/L). Myoglobin levels increased 72% one hour post-exercise (38 ± 20 - 66 ± 41 mg/L, p < 0.02). TnT and myoglobin levels returned to baseline 24 hour post-exercise. Serum levels of CK-MB, NT-proBNP and CK were not significantly changed. A single-bout of one-hour bicycle spinning transiently increases TnT and myoglobin in healthy subjects. Some subjects even have TnT release above URL. Thus, recently performed exercise also of short duration should be taken into consideration in the evaluation of acute chest pain with release of cardiac TnT.

Early absorption of enteral ranitidine after major laparotomy.

PubMed

Kulber, D A; Bentt, L; Repique, E; Dubin, S B; Wittman, M; Treiman, R; Shabot, M M

1991-12-01

Thirty-six patients were studied following abdominal aortic surgery to determine if a commonly used medication could be absorbed from the gastrointestinal (GI) tract in the early postoperative period. Patients were randomized into two groups: Group I received ranitidine elixir 3 mg/kg via nasogastric tube every 12 hours; Group II received intravenous (IV) ranitidine 1 mg/kg every 8 hours. Ranitidine serum levels were measured with high performance liquid chromatography 1 hour after administration of the first three doses. Gastric pH was measured every 4 hours. It was found that serum ranitidine levels generally regarded as clinically effective were achieved in both groups. Although the levels were significantly higher following intravenous (IV) administration (Group II), there were no differences in average gastric pH. The authors conclude that within 24 hours of aortic surgery enterally administered ranitidine is effectively absorbed and provides prophylaxis equivalent to IV administration of the drug at lower cost. Other medications might be deliverable via the GI tract in the early postoperative period.

Effects of health care provider work hours and sleep deprivation on safety and performance.

PubMed

Lockley, Steven W; Barger, Laura K; Ayas, Najib T; Rothschild, Jeffrey M; Czeisler, Charles A; Landrigan, Christopher P

2007-11-01

There has been increasing interest in the impact of resident-physician and nurse work hours on patient safety. The evidence demonstrates that work schedules have a profound effect on providers' sleep and performance, as well as on their safety and that of their patients. Nurses working shifts greater than 12.5 hours are at significantly increased risk of experiencing decreased vigilance on the job, suffering an occupational injury, or making a medical error. Physicians-in-training working traditional > 24-hour on-call shifts are at greatly increased risk of experiencing an occupational sharps injury or a motor vehicle crash on the drive home from work and of making a serious or even fatal medical error. As compared to when working 16-hours shifts, on-call residents have twice as many attentional failures when working overnight and commit 36% more serious medical errors. They also report making 300% more fatigue-related medical errors that lead to a patient's death. The weight of evidence strongly suggests that extended-duration work shifts significantly increase fatigue and impair performance and safety. From the standpoint of both providers and patients, the hours routinely worked by health care providers in the United States are unsafe. To reduce the unacceptably high rate of preventable fatigue-related medical error and injuries among health care workers, the United States must establish and enforce safe work-hour limits.

29 CFR 553.225 - Early relief.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 3 2013-07-01 2013-07-01 false Early relief. 553.225 Section 553.225 Labor Regulations... FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire Protection and Law Enforcement Employees of Public Agencies Tour of Duty and Compensable Hours of Work Rules § 553.225 Early...

29 CFR 553.225 - Early relief.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 3 2012-07-01 2012-07-01 false Early relief. 553.225 Section 553.225 Labor Regulations... FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire Protection and Law Enforcement Employees of Public Agencies Tour of Duty and Compensable Hours of Work Rules § 553.225 Early...

29 CFR 553.225 - Early relief.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 3 2014-07-01 2014-07-01 false Early relief. 553.225 Section 553.225 Labor Regulations... FAIR LABOR STANDARDS ACT TO EMPLOYEES OF STATE AND LOCAL GOVERNMENTS Fire Protection and Law Enforcement Employees of Public Agencies Tour of Duty and Compensable Hours of Work Rules § 553.225 Early...

Effect of Lavender Oil Aroma in the Early Hours of Postpartum Period on Maternal Pains, Fatigue, and Mood: A Randomized Clinical Trial

PubMed Central

Vaziri, Farideh; Shiravani, Mahsa; Najib, Fatemeh Sadat; Pourahmad, Saeedeh; Salehi, Alireza; Yazdanpanahi, Zahra

2017-01-01

Background: Busy care providers focus on the serious complications of postpartum period. This issue causes the seemingly trivial complications, such as mother's pains, fatigue, and psychological status, to be less taken into account. The study aimed to determine the effect of lavender oil aroma in the early hours of postpartum period on maternal pains, fatigue, and mood in primiparous mothers. Methods: This randomized clinical trial was conducted on 56 participants; 29 in intervention group and 27 in control group. The intervention group received lavender oil in three doses during the first 24 h after delivery. Sesame oil was used in the control group. Intensity of pain, fatigue, and distress level was measured by visual analog scale before and after the interventions. Besides, mood status was assessed through the positive and negative affect schedule. Results: The mean age of all the participants was 23.88 ± 3.88 years. After the first intervention and also in the tomorrow morning assessment, significant differences were found between the two groups regarding perineal pain (P = 0.004, P < 0.001), physical pain (P < 0.001), fatigue (P = 0.02, P < 0.001), and distress scores (P < 0.001). In addition, significant differences were found concerning the mean scores of positive (P < 0.001) and negative (P = 0.007, P < 0.001) moods between the two groups after the interventions. Repeated measures analyses showed that the two groups were significantly different over time in all the evaluated variables. Conclusions: Lavender oil aromatherapy starting in the first hours of postpartum period resulted in better physical and mood status compared to nonaromatic group. PMID:28567231

Subjective and objective napping and sleep in older adults: are evening naps "bad" for nighttime sleep?

PubMed

Dautovich, Natalie D; McCrae, Christina S; Rowe, Meredeth

2008-09-01

To compare objective and subjective measurements of napping and to examine the relationship between evening napping and nocturnal sleep in older adults. For 12 days, participants wore actigraphs and completed sleep diaries. Community. One hundred individuals who napped, aged 60 to 89 (including good and poor sleepers with typical age-related medical comorbidities). Twelve days of sleep diary and actigraphy provided subjective and objective napping and sleep data. Evening naps (within 2 hours of bedtime) were characteristic of the sample, with peak nap time occurring between 20:30 and 21:00 (average nap time occurred between 14:30 and 15:00). Two categories of nappers were identified: those who took daytime and evening naps and daytime-only. No participants napped during the evening only. Day-and-evening nappers significantly underreported evening napping and demonstrated lower objectively measured sleep onset latencies (20.0 vs 26.5 minutes), less wake after sleep onset (51.4 vs 72.8 minutes), and higher sleep efficiencies (76.8 vs 82%) than daytime-only nappers. Day and evening napping was prevalent in this sample of community-dwelling good and poor sleepers but was not associated with impaired nocturnal sleep. Although the elimination or restriction of napping is a common element of cognitive-behavioral therapy for insomnia, these results suggest that a uniform recommendation to restrict or eliminate napping (particularly evening napping) may not meet the needs of all older individuals with insomnia.

Hourly pattern of allergenic alder and birch pollen concentrations in the air: Spatial differentiation and the effect of meteorological conditions

NASA Astrophysics Data System (ADS)

Borycka, K.; Kasprzyk, I.

2018-06-01

In temperate climate widespread alder and birch are an important source of strong aeroallergens. The diurnal pattern of airborne pollen concentrations depends on the rhythm of pollen release from anthers as well as weather conditions, convection air currents, long-distance transport, pollen trap location and local vegetation. The aim of the study was to present a diurnal pattern of Alnus (alder) and Betula (birch) pollen concentrations in the air in a horizontal and vertical gradient and examine the weather parameters that had the greatest impact on the pattern. The study was conducted in Rzeszów City, southeast Poland over three years. Pollen grains were collected using a Hirst volumetric spore trap at three sampling points: two at 12 m the agl, and one at 1.5 m agl. Data were analysed using circular statistics and a nonlinear function. For alder, three models of hourly patterns were elaborated and the most common presented early morning minimum and early afternoon maximum. For birch, the most common model has one peak at night and a marked decrease in concentrations in early morning, although a second model has peak during early afternoon. A model with 3 peaks is much less common. These models are characteristic for warm temperate climate regions, where alders and birches are common. The diurnal patterns did not depend on the localization of traps or proximity of the pollen source, although these factors influenced the hourly concentrations, with higher values observed at roof level. Significant relationships between the hourly pollen counts and meteorological parameters were observed only for alder. Three incidents of increasing birch pollen concentrations were observed during the first two hours of precipitation and linked to a convection effect. Unstable weather conditions caused by air convection might strongly modify the circadian pattern and cause the nightly peaks concentrations. The general results are that people suffering from allergies may be exposed

Hourly laying patterns of the Pearly-eyed Thrasher (Margarops fuscatus) in Puerto Rico

Treesearch

Wayne Arendt

2011-01-01

Temporal aspects of egg deposition are important factors governing avian reproductive success. I report hourly egg-laying patterns of the Pearly-eyed Thrasher (Margarops fuscatus) in the Luquillo Experimental Forest in northeastern Puerto Rico during 1979–2000. Initiatory eggs were laid by early morning (median 5 0642 hrs, AST) and almost half of the eggs were laid by...

Lifetime measurement of neutron-rich even-even molybdenum isotopes

NASA Astrophysics Data System (ADS)

Ralet, D.; Pietri, S.; Rodríguez, T.; Alaqeel, M.; Alexander, T.; Alkhomashi, N.; Ameil, F.; Arici, T.; Ataç, A.; Avigo, R.; Bäck, T.; Bazzacco, D.; Birkenbach, B.; Boutachkov, P.; Bruyneel, B.; Bruce, A. M.; Camera, F.; Cederwall, B.; Ceruti, S.; Clément, E.; Cortés, M. L.; Curien, D.; De Angelis, G.; Désesquelles, P.; Dewald, M.; Didierjean, F.; Domingo-Pardo, C.; Doncel, M.; Duchêne, G.; Eberth, J.; Gadea, A.; Gerl, J.; Ghazi Moradi, F.; Geissel, H.; Goigoux, T.; Goel, N.; Golubev, P.; González, V.; Górska, M.; Gottardo, A.; Gregor, E.; Guastalla, G.; Givechev, A.; Habermann, T.; Hackstein, M.; Harkness-Brennan, L.; Henning, G.; Hess, H.; Hüyük, T.; Jolie, J.; Judson, D. S.; Jungclaus, A.; Knoebel, R.; Kojouharov, I.; Korichi, A.; Korten, W.; Kurz, N.; Labiche, M.; Lalović, N.; Louchart-Henning, C.; Mengoni, D.; Merchán, E.; Million, B.; Morales, A. I.; Napoli, D.; Naqvi, F.; Nyberg, J.; Pietralla, N.; Podolyák, Zs.; Pullia, A.; Prochazka, A.; Quintana, B.; Rainovski, G.; Reese, M.; Recchia, F.; Reiter, P.; Rudolph, D.; Salsac, M. D.; Sanchis, E.; Sarmiento, L. G.; Schaffner, H.; Scheidenberger, C.; Sengele, L.; Singh, B. S. Nara; Singh, P. P.; Stahl, C.; Stezowski, O.; Thoele, P.; Valiente Dobon, J. J.; Weick, H.; Wendt, A.; Wieland, O.; Winfield, J. S.; Wollersheim, H. J.; Zielinska, M.; PreSPEC Collaboration

2017-03-01

Background: In the neutron-rich A ≈100 mass region, rapid shape changes as a function of nucleon number as well as coexistence of prolate, oblate, and triaxial shapes are predicted by various theoretical models. Lifetime measurements of excited levels in the molybdenum isotopes allow the determination of transitional quadrupole moments, which in turn provides structural information regarding the predicted shape change. Purpose: The present paper reports on the experimental setup, the method that allowed one to measure the lifetimes of excited states in even-even molybdenum isotopes from mass A =100 up to mass A =108 , and the results that were obtained. Method: The isotopes of interest were populated by secondary knock-out reaction of neutron-rich nuclei separated and identified by the GSI fragment separator at relativistic beam energies and detected by the sensitive PreSPEC-AGATA experimental setup. The latter included the Lund-York-Cologne calorimeter for identification, tracking, and velocity measurement of ejectiles, and AGATA, an array of position sensitive segmented HPGe detectors, used to determine the interaction positions of the γ ray enabling a precise Doppler correction. The lifetimes were determined with a relativistic version of the Doppler-shift-attenuation method using the systematic shift of the energy after Doppler correction of a γ -ray transition with a known energy. This relativistic Doppler-shift-attenuation method allowed the determination of mean lifetimes from 2 to 250 ps. Results: Even-even molybdenum isotopes from mass A =100 to A =108 were studied. The decays of the low-lying states in the ground-state band were observed. In particular, two mean lifetimes were measured for the first time: τ =29 .7-9.1+11.3 ps for the 4+ state of 108Mo and τ =3 .2-0.7+0.7 ps for the 6+ state of 102Mo. Conclusions: The reduced transition strengths B (E 2 ) , calculated from lifetimes measured in this experiment, compared to beyond

Vegetative conditions and management options in even-age stands on the Monongahela National Forest

Treesearch

Gary W. Miller; James N. Kochenderfer; James Knibbs; John E. Baumgras

2001-01-01

In 1998, personnel with the Northeastern Research Station and the Monongahela National Forest initiated a comprehensive survey of even-age stands that regenerated between 1964 and 1990. Preliminary results indicate that clearcutting was successful in regenerating these young stands with a variety of woody and herbaceous plant species. Early cleanings using crop-tree...

Plant based insect repellent and insecticide treated bed nets to protect against malaria in areas of early evening biting vectors: double blind randomised placebo controlled clinical trial in the Bolivian Amazon.

PubMed

Hill, N; Lenglet, A; Arnéz, A M; Carneiro, I

2007-11-17

To determine the effectiveness in reducing malaria of combining an insect repellent with insecticide treated bed nets compared with the nets alone in an area where vector mosquitoes feed in the early evening. A double blind, placebo controlled cluster-randomised clinical study. Rural villages and peri-urban districts in the Bolivian Amazon. 4008 individuals in 860 households. All individuals slept under treated nets; one group also used a plant based insect repellent each evening, a second group used placebo. Episodes of Plasmodium falciparum or P vivax malaria confirmed by rapid diagnostic test or blood slide, respectively. We analysed 15,174 person months at risk and found a highly significant 80% reduction in episodes of P vivax in the group that used treated nets and repellent (incidence rate ratio 0.20, 95% confidence interval 0.11 to 0.38, P<0.001). Numbers of P falciparum cases during the study were small and, after adjustment for age, an 82% protective effect was observed, although this was not significant (0.18, 0.02 to 1.40, P=0.10). Reported episodes of fever with any cause were reduced by 58% in the group that used repellent (0.42, 0.31 to 0.56, P<0.001). Insect repellents can provide protection against malaria. In areas where vectors feed in the early evening, effectiveness of treated nets can be significantly increased by using repellent between dusk and bedtime. This has important implications in malaria vector control programmes outside Africa and shows that the combined use of treated nets and insect repellents, as advocated for most tourists travelling to high risk areas, is fully justified. NCT 00144716.

β-Cell secretory defects are present in pancreatic insufficient cystic fibrosis with 1-hour oral glucose tolerance test glucose ≥155 mg/dL.

PubMed

Nyirjesy, Sarah C; Sheikh, Saba; Hadjiliadis, Denis; De Leon, Diva D; Peleckis, Amy J; Eiel, Jack N; Kubrak, Christina; Stefanovski, Darko; Rubenstein, Ronald C; Rickels, Michael R; Kelly, Andrea

2018-06-08

Patients with pancreatic insufficient cystic fibrosis (PI-CF) meeting standard criteria for normal glucose tolerance display impaired β-cell secretory capacity and early-phase insulin secretion defects. We sought evidence of impaired β-cell secretory capacity, a measure of functional β-cell mass, among those with early glucose intolerance (EGI), defined as 1-hour oral glucose tolerance test (OGTT) glucose ≥155 mg/dL (8.6 mmol/L). A cross-sectional study was conducted in the Penn and CHOP Clinical & Translational Research Centers. PI-CF categorized by OGTT as normal (PI-NGT: 1-hour glucose <155 mg/dL and 2-hour <140 mg/dL [7.8 mmol/L]; n = 13), PI-EGI (1-hour ≥155 mg/dL and 2-hour <140 mg/dL; n = 13), impaired (PI-IGT: 2-hour ≥140 and <200 mg/dL [11.1 mmol/L]; n = 8), and diabetic (cystic fibrosis-related diabetes, CFRD: 2-hour ≥200 mg/dL; n = 8) participated. Post-prandial glucose tolerance and insulin secretion, and β-cell secretory capacity and demand were derived from mixed-meal tolerance tests (MMTTs), and glucose-potentiated arginine (GPA) tests, respectively. PI-EGI had elevated post-prandial glucose with reduced early-phase insulin secretion during MMTT compared to PI-NGT (P < .05). PI-EGI also exhibited impaired acute insulin and C-peptide responses to GPA (P < .01 vs PI-NGT), measures of β-cell secretory capacity. Proinsulin secretory ratios were higher under hyperglycemic clamp conditions in PI-IGT and CFRD (P < .05 vs PI-NGT), and correlated with 1-hour glucose in PI-CF (P < .01). PI-CF patients with 1-hour OGTT glucose ≥155 mg/dL already manifest impaired β-cell secretory capacity with associated early-phase insulin secretion defects. Avoiding hyperglycemia in patients with EGI may be important for preventing excessive insulin demand indicated by disproportionately increased proinsulin secretion. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Subjective and Objective Napping and Sleep in Older Adults: Are Evening Naps ‘Bad’ for Nighttime Sleep?

PubMed Central

Dautovich, Natalie D.; McCrae, Christina S.; Rowe, Meredeth

2014-01-01

Objectives To compare objective and subjective measurements of napping, and to examine the relationship between evening napping and nocturnal sleep in older adults. Design For twelve days, participants wore actigraphs and completed sleep diaries. Setting Community Participants 100 individuals who napped, 60–89 years (including good and poor sleepers with typical age-related medical comorbidities). Measurements Twelve days of sleep diary and actigraphy provided subjective and objective napping and sleep data. Results Evening naps (within 2 hours of bedtime) were characteristic of the sample with peak nap time occurring between 20:30–21:00 (average nap time occurred between 14:30–15:00). Two categories of nappers were identified: 1) day/evening – those who took both daytime and evening naps, and 2) daytime-only. Interestingly, no participants napped during the evening only. Day/evening nappers significantly underreported evening napping and demonstrated lower objectively measured sleep onset latencies (20 vs 26.5 minutes), less wake after sleep onset (51.4 vs 72.8 minutes), and higher sleep efficiencies (76.8 vs 82%) than daytime-only nappers. Conclusion Day/evening napping was prevalent amongst this sample of community-dwelling good/poor sleepers, but was not associated with impaired nocturnal sleep. Although the elimination or restriction of napping is a common element of cognitive-behavioral therapy for insomnia (CBTi), these results suggest that a uniform recommendation to restrict/eliminate napping (particularly evening napping) may not meet the needs of all older individuals with insomnia. PMID:18691289

After-hours coverage

PubMed Central

Bordman, Risa; Wheler, David; Drummond, Neil; White, David; Crighton, Eric

2005-01-01

OBJECTIVE To determine the prevalence and content of existing or developing policies and guidelines of medical associations and colleges regarding after-hours care by family physicians and general practitioners, especially legal requirements. DESIGN Telephone survey in fall 2002, updated in fall 2004. SETTING Canada. PARTICIPANTS All national and provincial medical associations, Colleges of Family Physicians, Colleges of Physicians and Surgeons, local government offices for the north, and the Canadian Medical Protective Association (CMPA). MAIN OUTCOME MEASURE Response to the question: “Does your agency have a policy in place regarding after-hours health care coverage by FPs/GPs, or are there active discussions regarding such a policy?” RESULTS The College of Physicians and Surgeons of British Columbia was the first to institute a policy, in 1995, requiring physicians to make “specific arrangements” for after-hours care of their patients. The College of Physicians and Surgeons of Alberta adopted a similar policy in 1996 along with a guideline to aid implementation. In 2002, the College of Physicians and Surgeons of Nova Scotia approved a guideline on the Availability of Physicians After Hours. The Saskatchewan Medical Association and the College of Physicians and Surgeons of Saskatchewan formulated a joint policy on medical practice coverage that was released in 2003. Many agencies actively discussed the topic. Provincial and national Colleges of Family Physicians did not have any policies in place. The CMPA does not generate guidelines but released in an information letter in May 2000 a section entitled “Reducing your risk when you’re not available.” CONCLUSION There is increasing interest Canada-wide in setting policy for after-hours care. While provincial Colleges of Physicians and Surgeons have traditionally led the way, a trend toward more collaboration between associations was identified. The effect of policy implementation on physicians�

Gender Differences in Salary in a Recent Cohort of Early-Career Physician-Researchers

PubMed Central

Jagsi, Reshma; Griffith, Kent A.; Stewart, Abigail; Sambuco, Dana; DeCastro, Rochelle; Ubel, Peter A.

2013-01-01

Purpose Since prior studies have suggested that male physicians earn more than their female counterparts, the authors examined whether this disparity exists in a recently hired cohort. Method In 2010-11, the authors surveyed recent recipients of National Institutes of Health (NIH) mentored career development (i.e., K08 or K23) awards, receiving responses from 1,275 (75% response rate). For the 1,012 physicians with academic positions in clinical specialties who reported salary, they constructed linear regression models of salary considering gender, age, race, marital status, parental status, additional doctoral degree, academic rank, years on faculty, specialty, institution type, region, institution NIH funding rank, K-award type, K-award funding institute, K-award year, work hours, and research time. They evaluated the explanatory value of spousal employment status using Peters-Belson regression. Results Mean salary was $141,325 (95% confidence interval [CI] 135,607-147,043) for women and $172,164 (95% CI 167,357-176,971) for men. Male gender remained an independent, significant predictor of salary (+$10,921, P < 0.001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Peters-Belson analysis indicated that 17% of the overall disparity in the full sample was unexplained by the measured covariates. In the married subset, after accounting for spousal employment status, 10% remained unexplained. Conclusions The authors observed, in this recent cohort of elite, early-career physician researchers, a gender difference in salary that was not fully explained by specialty, academic rank, work hours, or even spousal employment. Creating more equitable procedures for establishing salary at academic institutions is important. PMID:24072109

Positioning and early mobilisation in stroke.

PubMed

Keating, Moira; Penney, Maree; Russell, Petra; Bailey, Emma

Stroke unit care, providing early rehabilitation, improves long-term outcomes for patients following a stroke. Early mobilisation and good positioning are recognised as key aspects of care in stroke units. Nurses working on stroke units have an important role because they are able to implement positioning and early mobilisation strategies 24 hours a day, reducing the risk of complications and improving functional recovery. Patients benefit if nurses work effectively with the therapy team in positioning and early mobilisation. Nurses also need appropriate training and expertise to make best use of specialist equipment.

Changes in Physical Activity in the School, Afterschool, and Evening Periods During the Transition From Elementary to Middle School.

PubMed

Lau, Erica Y; Dowda, Marsha; McIver, Kerry L; Pate, Russell R

2017-07-01

We examined longitudinal changes in children's physical activity during the school day, afterschool, and evening across fifth, sixth, and seventh grades. The analytical sample included children who had valid accelerometer data in fifth grade and at least one other time-point, and provided complete sociodemographic information (N = 768, 751, and 612 for the 3 time-periods studied). Accelerometer-derived total physical activity (TPA) and moderate-to-vigorous physical activity (MVPA) were expressed in minutes per hour for the school day (∼7:45 am to 3:30 pm), afterschool (∼2:25 to 6:00 pm), and evening (6:00 to 10:00 pm) periods. We used growth curve analyses to examine changes in TPA and MVPA. School day TPA and MVPA declined significantly; we observed a greater decrease from fifth to sixth grades than from sixth to seventh grades. Afterschool TPA declined significantly, but MVPA increased significantly among girls and remained stable for boys. Evening TPA decreased significantly and MVPA declined significantly in girls and remained stable among boys. To inform the development of effective intervention strategies, research should focus on examining factors associated with the decline in physical activity during the transition from elementary to middle school, particularly during the hours when children are in school. © 2017, American School Health Association.

Detection of vancomycin resistances in enterococci within 3 1/2 hours

NASA Astrophysics Data System (ADS)

Schröder, U. -Ch.; Beleites, C.; Assmann, C.; Glaser, U.; Hübner, U.; Pfister, W.; Fritzsche, W.; Popp, J.; Neugebauer, U.

2015-02-01

Vancomycin resistant enterococci (VRE) constitute a challenging problem in health care institutions worldwide. Novel methods to rapidly identify resistances are highly required to ensure an early start of tailored therapy and to prevent further spread of the bacteria. Here, a spectroscopy-based rapid test is presented that reveals resistances of enterococci towards vancomycin within 3.5 hours. Without any specific knowledge on the strain, VRE can be recognized with high accuracy in two different enterococci species. By means of dielectrophoresis, bacteria are directly captured from dilute suspensions, making sample preparation very easy. Raman spectroscopic analysis of the trapped bacteria over a time span of two hours in absence and presence of antibiotics reveals characteristic differences in the molecular response of sensitive as well as resistant Enterococcus faecalis and Enterococcus faecium. Furthermore, the spectroscopic fingerprints provide an indication on the mechanisms of induced resistance in VRE.

Morning-evening difference of team-handball-related short-term maximal physical performances in female team handball players.

PubMed

Mhenni, Thouraya; Michalsik, Lars Bojsen; Mejri, Mohamed Arbi; Yousfi, Narimen; Chaouachi, Anis; Souissi, Nizar; Chamari, Karim

2017-05-01

This study investigated the two different time-of-day effect on team-handball-related short-term maximal physical performances. At two different time-of-day, fifteen young female team handball players performed different physical tests: HandGrip (HG) test, Ball-Throwing Velocity (BTV) test, Modified Agility T-test (MAT) and Repeated Shuttle-Sprint and Jump Ability (RSSJA) test. Rating of perceived exertion (RPE) scale was determined following the termination of the last test. Measurements were performed at two separate testing sessions (i.e., in the morning (7:00-8:30 h) and in the early evening (17:00-18:30 h)) in a randomised and counter-balanced setting on non-consecutive days. The results showed that HG (P = 0.0013), BTV (P = 0.0027) and MAT (P < 0.001) performances were better in the evening compared with the morning. During RSSJA, both best and mean sprint times were shorter in the evening compared to the morning (P < 0.001). Moreover, during the latter test, mean jump performance was higher in the evening compared to the morning (P = 0.026). However, there was no morning-evening difference in the best jump performance during RSSJA. Likewise, jump performance decrement was not affected by the time-of-day of testing. On the other hand, RPE fluctuated, with morning nadirs and afternoon/early evening highest values. The findings suggest that in female team handball players, team-handball-related short-term maximal physical performances were better in the afternoon than in the morning.

Analysis of Office/Laboratory Staying Hour and Home Working Hour of Japanese Scientists and Engineers

NASA Astrophysics Data System (ADS)

Ejiri, A.

The second questionnaire for scientists and engineers was carried out in 2007, and status of Japanese scientists and engineers were analyzed and reported. A part of the data was reanalyzed from the viewpoint of work life balance. In particular, office/laboratory staying hour and home working hour were analyzed and dependences on various factors were investigated. It was found that these hours depend on gender, marital status, number of child, employment status and age. In addition, the total hours tend to be kept constant regardless of various factors.

Early-life sugar consumption has long-term negative effects on memory function in male rats.

PubMed

Noble, Emily E; Hsu, Ted M; Liang, Joanna; Kanoski, Scott E

2017-09-25

Added dietary sugars contribute substantially to the diet of children and adolescents in the USA, and recent evidence suggests that consuming sugar-sweetened beverages (SSBs) during early life has deleterious effects on hippocampal-dependent memory function. Here, we test whether the effects of early-life sugar consumption on hippocampal function persist into adulthood when access to sugar is restricted to the juvenile/adolescent phase of development. Male rats were given ad libitum access to an 11% weight-by-volume sugar solution (made with high fructose corn syrup-55) throughout the adolescent phase of development (post-natal day (PN) 26-56). The control group received a second bottle of water instead, and both groups received ad libitum standard laboratory chow and water access throughout the study. At PN 56 sugar solutions were removed and at PN 175 rats were subjected to behavioral testing for hippocampal-dependent episodic contextual memory in the novel object in context (NOIC) task, for anxiety-like behavior in the Zero maze, and were given an intraperitoneal glucose tolerance test. Early-life exposure to SSBs conferred long-lasting impairments in hippocampal-dependent memory function later in life- yet had no effect on body weight, anxiety-like behavior, or glucose tolerance. A second experiment demonstrated that NOIC performance was impaired at PN 175 even when SSB access was limited to 2 hours daily from PN 26-56. Our data suggest that even modest SSB consumption throughout early life may have long-term negative consequences on memory function during adulthood.

Chorioamnionitis and Culture-Confirmed, Early-Onset Neonatal Infections

PubMed Central

Hansen, Nellie I.; Schrag, Stephanie J.; Hale, Ellen; Van Meurs, Krisa; Sánchez, Pablo J.; Cantey, Joseph B.; Faix, Roger; Poindexter, Brenda; Goldberg, Ronald; Bizzarro, Matthew; Frantz, Ivan; Das, Abhik; Benitz, William E.; Shane, Andi L.; Higgins, Rosemary; Stoll, Barbara J.

2016-01-01

BACKGROUND: Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, early-onset infections can be asymptomatic at birth. METHODS: Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006–2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset. RESULTS: Early-onset infections were diagnosed in 389 of 396 586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P = .52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence. CONCLUSIONS: Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected

Antibiotic prescribing during office hours and out-of-hours: a comparison of quality and quantity in primary care in the Netherlands

PubMed Central

Debets, Vera EC; Verheij, Theo JM; van der Velden, Alike W

2017-01-01

Background Unnecessary and non-first-choice antibiotic prescribing is a significant problem in primary care. It is often argued that irrational prescribing is higher during out-of-hours (OOH) consultations. Aim To obtain insight into the quantity and quality of OOH antibiotic prescribing for commonly presented infectious diseases. Design and setting Two two-way comparisons of 1) nationally dispensed antibiotics during office hours and OOH care, using data from the Dutch Foundation of Pharmaceutical Statistics, and 2) regional prescribing quality data from 45 primary care practices from Utrecht and its vicinity, and two large OOH services in Utrecht and Woerden. Method From the national data, yearly dispensed antibiotics were analysed per prescriber type, with respect to time (office hours or OOH) of prescription, types of antibiotics, and patients’ age group. Regional prescribing rates, choice of antibiotic, and appropriateness of prescribing were compared for otitis media, sinusitis, tonsillitis, bronchitis, cystitis, and impetigo. Appropriateness was assessed by comparing all relevant information from medical files with the guideline recommendations. Results Only 6% of GP-prescribed antibiotics were prescribed OOH. OOH, cystitis and acute otitis media presented most often. First-choice prescribing was comparable for the two settings, whereas prescribing rates were higher OOH, with comparatively more amoxicillin(/clavulanate). The appropriateness evaluation, however, revealed that overprescribing was comparable, or even lower than, for daily practice. Conclusion The suggestion that OOH antibiotic prescribing quality is worse than in daily practice does not seem founded. The higher OOH prescribing rates can be explained by a different population of presenting patients. The appropriateness of prescribing rather than prescribing rates, therefore, should be used to determine quality. PMID:28232364

Rapamycin decreased blood-brain barrier permeability in control but not in diabetic rats in early cerebral ischemia.

PubMed

Chi, Oak Z; Kiss, Geza K; Mellender, Scott J; Liu, Xia; Weiss, Harvey R

2017-07-27

Diabetes causes functional and structural changes in blood-brain barrier (BBB). The mammalian target of rapamycin (mTOR) has been associated with glucose metabolism, diabetes, and altering BBB permeability. Since there is only a narrow therapeutic window (3h) for stroke victims, it is important to investigate BBB disruption in the early stage of cerebral ischemia. We compared the degree of BBB disruption in diabetic and in control rats at two hours of reperfusion after one hour of middle cerebral artery (MCA) occlusion with or without inhibition of mTOR. Two weeks after streptozotocin ip to induce diabetes, MCA occlusion was performed. In half of the rats, an mTOR inhibitor, rapamycin was given for 2days before MCA occlusion. After one hour of MCA occlusion and two hours of the reperfusion, the transfer coefficient (K i ) of 14 C-α-aminoisobutyric acid was determined to quantify degree of BBB disruption. Ischemia-reperfusion increased the K i in the control animals. Streptozotocin increased the K i in the ischemic-reperfused (IR-C, +22%) as well as in the contralateral cortex (CC, +40%). Rapamycin decreased the K i in the IR-C (-32%) as well as in the CC (-26%) in the control rats. However, rapamycin did not affect K i in the IR-C or in the CC in the diabetic rats. Our data demonstrated a greater BBB disruption in diabetes in the ischemic as well as non-ischemic cortex even in the early stage of cerebral ischemia-reperfusion and that acute administration of rapamycin did not significantly affect BBB permeability in diabetes. From our quantitative analysis of BBB disruption, the vulnerability of BBB in diabetes has been emphasized in the early stage of cerebral ischemia-reperfusion and a less important role of the mTOR pathway is suggested in altering BBB permeability in diabetes. Copyright © 2017 Elsevier B.V. All rights reserved.

Combination of 24-Hour and 7-Day Relative Neurological Improvement Strongly Predicts 90-Day Functional Outcome of Endovascular Stroke Therapy.

PubMed

Pu, Jie; Wang, Huaiming; Tu, Mingyi; Zi, Wenjie; Hao, Yonggang; Yang, Dong; Liu, Wenhua; Wan, Yue; Geng, Yu; Lin, Min; Jin, Ping; Xiong, Yunyun; Xu, Gelin; Yin, Qin; Liu, Xinfeng

2018-05-01

Early judgment of long-term prognosis is the key to making medical decisions in acute anterior circulation large-vessel occlusion stroke (LVOS) after endovascular treatment (EVT). We aimed to investigate the relationship between the combination of 24-hour and 7-day relative neurological improvement (RNI) and 90-day functional outcome. We selected the target population from a multicenter ischemic stroke registry. The National Institutes of Health Stroke Scale (NIHSS) scores at baseline, 24 hours, and 7 days were collected. RNI was calculated by the following equation: (baseline NIHSS - 24-hour/7-day NIHSS)/baseline NIHSS × 100%. A modified Rankin Scale score of 0-2 at 90 days was defined as a favorable outcome. Multivariable logistic regression analysis was used to evaluate the relationship between RNI and 90-day outcome. Receiver operator characteristic curve analysis was performed to identify the predictive power and cutoff point of RNI for functional outcome. A total of 568 patients were enrolled. Both 24-hour and 7-day RNI were independent predictors of 90-day outcome. The best cutoff points of 24-hour and 7-day RNI were 28% and 42%, respectively. Compared with those with 24-hour RNI of less than 28% and 7-day RNI of less than 42%, patients with 24-hour RNI of 28% or greater and 7-day RNI of 42% or greater had a 39.595-fold (95% confidence interval 22.388-70.026) increased probability of achieving 90-day favorable outcome. The combination of 24-hour and 7-day RNI very strongly predicts 90-day functional outcome in patients with acute anterior circulation LVOS who received EVT, and it can be used as an early accurate surrogate of long-term outcome. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

75 FR 2467 - Hours of Service

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... many hours per day and per week would be safe and healthy for a truck driver to work? 4. Would an hours... given scheduling flexibility--the ability to borrow an hour from another driving day once a week, for... No. FMCSA-2004-19608] RIN 2126-AB26 Hours of Service AGENCY: Federal Motor Carrier Safety...

75 FR 9376 - Hours of Service

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

... or adversely impact driver health? 3. How many hours per day and per week would be safe and healthy for a truck driver to work? 4. Would an hours-of-service rule that allows drivers to drive an hour... No. FMCSA-2004-19608] RIN 2126-AB26 Hours of Service AGENCY: Federal Motor Carrier Safety...

Every three-hour versus every six-hour oral feeding in preterm infants: a randomised clinical trial.

PubMed

Gray, Megan M; Medoff-Cooper, Barbara; Enlow, Elizabeth M; Mukhopadhyay, Sagori; DeMauro, Sara B

2017-02-01

This trial compares two oral feeding schedules, every three-hour and every six-hour oral feeding attempts, to determine which schedule allows for more rapid attainment of full oral feeding in preterm infants. Infants born at ≤33-week gestation were randomly assigned to receive oral feeding every three hours or every six hours if feeding cues were present. The primary outcome was time to full oral feeding; secondary outcomes include respiratory and apnoea rates, growth and length of stay. A total of 55 infants were recruited. There was no difference between the groups in the primary or secondary outcomes. For preterm infants fed when oral feeding cues are present, an every six-hour schedule did not alter the time to full oral feeding and had no effect on rates of tachypnoea, apnoea or length of hospital stay compared to every three-hour feeding schedule. An every six-hour oral feeding schedule led to only small reductions in number of oral feeding attempts per day. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

A comparison of graft and patient outcomes following kidney transplantation in extended hour and conventional haemodialysis patients.

PubMed

See, Emily J; Hawley, Carmel M; Cho, Yeoungjee; Toussaint, Nigel D; Agar, John Wm; Pascoe, Elaine M; Lim, Wai H; Francis, Ross S; Collins, Michael G; Johnson, David W

2018-01-08

Differences in early graft function between kidney transplant recipients previously managed with either haemodialysis (HD) or peritoneal dialysis are well described. However, only two single-centre studies have compared graft and patient outcomes between extended hour and conventional HD patients, with conflicting results. This study compared the outcomes of all extended hour (≥24 hours/week) and conventional HD patients transplanted in Australia and New Zealand between 2000 and 2014. The primary outcome was delayed graft function (DGF), defined in an ordinal manner as either a spontaneous fall in serum creatinine of less than 10% within 24 hours, or the need for dialysis within 72 hours following transplantation. Secondary outcomes included the requirement for dialysis within 72 hours post-transplant, acute rejection, estimated glomerular filtration rate at 12 months, death-censored graft failure, all-cause and cardiovascular mortality, and a composite of graft failure and mortality. A total of 4,935 HD patients (378 extended hour HD, 4,557 conventional HD) received a kidney transplant during the study period. Extended hour HD was associated with an increased likelihood of DGF compared with conventional HD (adjusted proportional odds ratio 1.33; 95% confidence interval 1.06-1.67). There was no significant difference between extended hour and conventional HD in terms of any of the secondary outcomes. Compared to conventional HD, extended hour HD was associated with DGF, although long-term graft and patient outcomes were not different. This article is protected by copyright. All rights reserved.

Even in early childhood offspring alcohol expectancies correspond to parental drinking.

PubMed

Kuntsche, Emmanuel; Kuntsche, Sandra

2018-02-01

Research has found that children as young as preschoolers have an idea about the valence (positive vs. negative) and activation (arousal vs. sedation) of emotional change when adults drink alcohol. The development of alcohol expectancies at such a young age may be due to observed parental alcohol use. Three measures of alcohol use (frequency, quantity and binge drinking) assessed among 115 fathers and 149 mothers were correlated with four alcohol expectancy factors (crossing valence and activation) of their offspring, aged three to six (70 boys and 82 girls). For both arousal and sedation expectancies and across alcohol use measures of both fathers and mothers, the greater parental alcohol use was, the higher their sons' negative and the lower positive alcohol expectancies were. For negative expectancies (particularly sedation, i.e., drinking when feeling sad or depressed), there was a stronger and more consistent association with paternal than with maternal drinking. For daughters, there was no consistent association between any expectancy factor and any parental drinking behavior. Already among preschoolers, parental drinking was found to be correlated with their sons' alcohol expectancies in the sense that they may observe and associate positive emotional consequences (feeling joyful, happy, calm, relaxed etc.) with moderate parental drinking and negative emotional consequences (feeling angry, nervous, sad, depressed etc.) with excessive drinking. This may be important for prevention, as expectancies have been found to be predominant predictors of early alcohol initiation and development of risky drinking in adolescence and beyond. Copyright © 2017 Elsevier B.V. All rights reserved.

Delay of constant light-induced persistent vaginal estrus by 24-hour time cues in rats.

PubMed

Weber, A L; Adler, N T

1979-04-20

The normal ovarian cycle of female rats is typically replaced by persistent estrus when these animals are housed under constant light. Evidence presented here shows that the maintenance of periodicity in the environment can at least delay (if not prevent) the photic induction of persistent vaginal estrus. Female rats in constant light were exposed to vaginal smearing at random times or at the same time every day. In another experiment, female rats were exposed to either constant bright light, constant dim light, or a 24-hour photic cycle of bright and dim light. The onset of persistent vaginal estrus was delayed in rats exposed to 24-hour time cues even though the light intensities were the same as or greater than those for the aperiodic control groups. The results suggest that the absence of 24-hour time cues in constant light contributes to the induction of persistent estrus.

Stress relaxation properties of four orthodontic aligner materials: A 24-hour in vitro study.

PubMed

Lombardo, Luca; Martines, Elisa; Mazzanti, Valentina; Arreghini, Angela; Mollica, Francesco; Siciliani, Giuseppe

2017-01-01

To investigate the stress release properties of four thermoplastic materials used to make orthodontic aligners when subjected to 24 consecutive hours of deflection. Four types of aligner materials (two single and two double layered) were selected. After initial yield strength testing to characterize the materials, each sample was subjected to a constant load for 24 hours in a moist, temperature-regulated environment, and the stress release over time was measured. The test was performed three times on each type of material. All polymers analyzed released a significant amount of stress during the 24-hour period. Stress release was greater during the first 8 hours, reaching a plateau that generally remained constant. The single-layer materials, F22 Aligner polyurethane (Sweden & Martina, Due Carrare, Padova, Italy) and Duran polyethylene terephthalate glycol-modified (SCHEU, Iserlohn, Germany), exhibited the greatest values for both absolute stress and stress decay speed. The double-layer materials, Erkoloc-Pro (Erkodent, Pfalzgrafenweiler, Germany) and Durasoft (SCHEU), exhibited very constant stress release, but at absolute values up to four times lower than the single-layer samples tested. Orthodontic aligner performance is strongly influenced by the material of their construction. Stress release, which may exceed 50% of the initial stress value in the early hours of wear, may cause significant changes in the behavior of the polymers at 24 hours from the application of orthodontic loads, which may influence programmed tooth movement.

Capturing Neutrinos from a Star's Final Hours

NASA Astrophysics Data System (ADS)

Hensley, Kerry

2018-04-01

What happens on the last day of a massive stars life? In the hours before the star collapses and explodes as a supernova, the rapid evolution of material in its core creates swarms of neutrinos. Observing these neutrinos may help us understand the final stages of a massive stars life but theyve never been detected.A view of some of the 1,520 phototubes within the MiniBooNE neutrino detector. Observations from this and other detectors are helping to illuminate the nature of the mysterious neutrino. [Fred Ullrich/FNAL]Silent Signposts of Stellar EvolutionThe nuclear fusion that powers stars generates tremendous amounts of energy. Much of this energy is emitted as photons, but a curious and elusive particle the neutrino carries away most of the energy in the late stages of stellar evolution.Stellar neutrinos can be created through two processes: thermal processesand beta processes. Thermal processes e.g.,pair production, in which a particle/antiparticle pair are created depend on the temperature and pressure of the stellar core. Beta processes i.e.,when a proton converts to a neutron, or vice versa are instead linked to the isotopic makeup of the stars core. This means that, if we can observe them, beta-process neutrinos may be able to tell us about the last steps of stellar nucleosynthesis in a dying star.But observing these neutrinos is not so easilydone. Neutrinos arenearly massless, neutral particles that interact only feebly with matter; out of the whopping 1060neutrinos released in a supernova explosion, even the most sensitive detectors only record the passage of just a few. Do we have a chance of detectingthe beta-process neutrinos that are released in the final few hours of a stars life, beforethe collapse?Neutrino luminosities leading up to core collapse. Shortly before collapse, the luminosity of beta-process neutrinos outshines that of any other neutrino flavor or origin. [Adapted from Patton et al. 2017]Modeling Stellar CoresTo answer this question, Kelly

Agreement between 24-hour salt ingestion and sodium excretion in a controlled environment.

PubMed

Lerchl, Kathrin; Rakova, Natalia; Dahlmann, Anke; Rauh, Manfred; Goller, Ulrike; Basner, Mathias; Dinges, David F; Beck, Luis; Agureev, Alexander; Larina, Irina; Baranov, Victor; Morukov, Boris; Eckardt, Kai-Uwe; Vassilieva, Galina; Wabel, Peter; Vienken, Jörg; Kirsch, Karl; Johannes, Bernd; Krannich, Alexander; Luft, Friedrich C; Titze, Jens

2015-10-01

Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed 2 independent ultralong-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 g/d and collected all urine. The subjects' daily menus consisted of 27 279 individual servings, of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady-state sodium balance in both studies. Even at fixed salt intake, 24-hour urine collection for sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-g difference in salt intake. Because of the biological variability in UNaV, only every other daily urine sample correctly classified a 3-g difference in salt intake (49%). By increasing the observations to 3 consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6 to 12 g salt per day were not suitable to detect a 3-g difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials. © 2015 American Heart Association, Inc.

Identifying Early Target Cells of Nipah Virus Infection in Syrian Hamsters

PubMed Central

Baseler, Laura; Scott, Dana P.; Saturday, Greg; Horne, Eva; Rosenke, Rebecca; Thomas, Tina; Meade-White, Kimberly; Haddock, Elaine; Feldmann, Heinz

2016-01-01

Background Nipah virus causes respiratory and neurologic disease with case fatality rates up to 100% in individual outbreaks. End stage lesions have been described in the respiratory and nervous systems, vasculature and often lymphoid organs in fatal human cases; however, the initial target organs of Nipah virus infection have not been identified. Here, we detected the initial target tissues and cells of Nipah virus and tracked virus dissemination during the early phase of infection in Syrian hamsters inoculated with a Nipah virus isolate from Malaysia (NiV-M) or Bangladesh (NiV-B). Methodology/Principal Findings Syrian hamsters were euthanized between 4 and 48 hours post intranasal inoculation and tissues were collected and analyzed for the presence of viral RNA, viral antigen and infectious virus. Virus replication was first detected at 8 hours post inoculation (hpi). Nipah virus initially targeted type I pneumocytes, bronchiolar respiratory epithelium and alveolar macrophages in the lung and respiratory and olfactory epithelium lining the nasal turbinates. By 16 hpi, virus disseminated to epithelial cells lining the larynx and trachea. Although the pattern of viral dissemination was similar for both virus isolates, the rate of spread was slower for NiV-B. Infectious virus was not detected in the nervous system or blood and widespread vascular infection and lesions within lymphoid organs were not observed, even at 48 hpi. Conclusions/Significance Nipah virus initially targets the respiratory system. Virus replication in the brain and infection of blood vessels in non-respiratory tissues does not occur during the early phase of infection. However, virus replicates early in olfactory epithelium and may serve as the first step towards nervous system dissemination, suggesting that development of vaccines that block virus dissemination or treatments that can access the brain and spinal cord and directly inhibit virus replication may be necessary for preventing central

Identifying Early Target Cells of Nipah Virus Infection in Syrian Hamsters.

PubMed

Baseler, Laura; Scott, Dana P; Saturday, Greg; Horne, Eva; Rosenke, Rebecca; Thomas, Tina; Meade-White, Kimberly; Haddock, Elaine; Feldmann, Heinz; de Wit, Emmie

2016-11-01

Nipah virus causes respiratory and neurologic disease with case fatality rates up to 100% in individual outbreaks. End stage lesions have been described in the respiratory and nervous systems, vasculature and often lymphoid organs in fatal human cases; however, the initial target organs of Nipah virus infection have not been identified. Here, we detected the initial target tissues and cells of Nipah virus and tracked virus dissemination during the early phase of infection in Syrian hamsters inoculated with a Nipah virus isolate from Malaysia (NiV-M) or Bangladesh (NiV-B). Syrian hamsters were euthanized between 4 and 48 hours post intranasal inoculation and tissues were collected and analyzed for the presence of viral RNA, viral antigen and infectious virus. Virus replication was first detected at 8 hours post inoculation (hpi). Nipah virus initially targeted type I pneumocytes, bronchiolar respiratory epithelium and alveolar macrophages in the lung and respiratory and olfactory epithelium lining the nasal turbinates. By 16 hpi, virus disseminated to epithelial cells lining the larynx and trachea. Although the pattern of viral dissemination was similar for both virus isolates, the rate of spread was slower for NiV-B. Infectious virus was not detected in the nervous system or blood and widespread vascular infection and lesions within lymphoid organs were not observed, even at 48 hpi. Nipah virus initially targets the respiratory system. Virus replication in the brain and infection of blood vessels in non-respiratory tissues does not occur during the early phase of infection. However, virus replicates early in olfactory epithelium and may serve as the first step towards nervous system dissemination, suggesting that development of vaccines that block virus dissemination or treatments that can access the brain and spinal cord and directly inhibit virus replication may be necessary for preventing central nervous system pathology.

Atrial Fibrillation Detection During 24-Hour Ambulatory Blood Pressure Monitoring: Comparison With 24-Hour Electrocardiography.

PubMed

Kollias, Anastasios; Destounis, Antonios; Kalogeropoulos, Petros; Kyriakoulis, Konstantinos G; Ntineri, Angeliki; Stergiou, George S

2018-07-01

This study assessed the diagnostic accuracy of a novel 24-hour ambulatory blood pressure (ABP) monitor (Microlife WatchBP O3 Afib) with implemented algorithm for automated atrial fibrillation (AF) detection during each ABP measurement. One hundred subjects (mean age 70.6±8.2 [SD] years; men 53%; hypertensives 85%; 17 with permanent AF; 4 paroxysmal AF; and 79 non-AF) had simultaneous 24-hour ABP monitoring and 24-hour Holter monitoring. Among a total of 6410 valid ABP readings, 1091 (17%) were taken in ECG AF rhythm. In reading-to-reading ABP analysis, the sensitivity, specificity, and accuracy of ABP monitoring in detecting AF were 93%, 87%, and 88%, respectively. In non-AF subjects, 12.8% of the 24-hour ABP readings indicated false-positive AF, of whom 27% were taken during supraventricular premature beats. There was a strong association between the proportion of false-positive AF readings and that of supraventricular premature beats ( r =0.67; P <0.001). Receiver operating characteristic curve revealed that in paroxysmal AF and non-AF subjects, AF-positive readings at 26% during 24-hour ABP monitoring had 100%/85% sensitivity/specificity (area under the curve 0.91; P <0.01) for detecting paroxysmal AF. These findings suggest that in elderly hypertensives, a novel 24-hour ABP monitor with AF detector has high sensitivity and moderate specificity for AF screening during routine ABP monitoring. Thus, in elderly hypertensives, a 24-hour ABP recording with at least 26% of the readings suggesting AF indicates a high probability for AF diagnosis and should be regarded as an indication for performing 24-hour Holter monitoring. © 2018 American Heart Association, Inc.

Cracking the Credit Hour

ERIC Educational Resources Information Center

Laitinen, Amy

2012-01-01

The basic currency of higher education--the credit hour--represents the root of many problems plaguing America's higher education system: the practice of measuring time rather than learning. "Cracking the Credit Hour" traces the history of this time-based unit, from the days of Andrew Carnegie to recent federal efforts to define a credit…

Efficacy of split hours part-time patching versus continuous hours part-time patching for treatment of anisometropic amblyopia in children: a pilot study.

PubMed

Sachdeva, Virender; Mittal, Vaibhev; Kekunnaya, Ramesh; Gupta, Amit; Rao, Harsha L; Mollah, Joseph; Sontha, Anand; Gunturu, Rekha; Rao, B Venkateshwar

2013-07-01

To compare efficacy of 'split hours part-time patching' and 'continuous hours part-time patching' for the treatment of anisometropic amblyopia. We designed a prospective, interventional, non-randomised, comparative pilot study involving children between 4 and 11 years of age with anisometropic amblyopia who were treated with either continuous wear (Group A) or split hours part-time patching (Group B) as per parents wish, after appropriate discussion with the parents. Children were followed-up for the improvement in visual acuity and the compliance at each follow-up visit. 44 and 24 children were recruited in Group A and Group B, respectively (mean ± SD baseline BCVA of the amblyopic eye: 0.99 ± 0.32 and 0.95 ± 0.23 logMAR, respectively). BCVA (adjusted for baseline BCVA and age) at 3 months in Group A (0.59 ± 0.24) was comparable (p=0.08) with that in Group B (0.71 ± 0.24). This was same even at 6 months (0.51 ± 0.25 in Group A and 0.59 ± 0.25 in Group B, p=0.25). The improvement in BCVA at 3 months was also comparable (p=0.06) in Group A (0.39 ± 0.23) and Group B (0.26 ± 0.23). The improvement in BCVA at 6 months was also comparable (p=0.14) in Group A (0.47 ± 0.26) and Group B (0.37 ± 0.26). Both patching regimens lead to significant and comparable improvement in BCVA in anisometropic amblyopia up to 6 months of follow-up.

Evaluation of the Fourth and Final Year of the Even Start--Padres y Progreso Program.

ERIC Educational Resources Information Center

Stevens, Carla J.; And Others

The Even Start--Padres y Progreso program was a nationally funded program in Houston (Texas) designed to prepare young children to enter school not only by offering early childhood education, but also assisting their families with adult literacy/English as a second language, parenting skills training, and employment skills training. The program…

Evaluation of the Even Start--Padres y Progreso Program in the Houston Independent School District.

ERIC Educational Resources Information Center

Stevens, Carla J.; And Others

The Even Start-Padres y Progreso program is a nationally funded program designed to prepare young children to enter school by not only offering early childhood education, but also assisting their families with adult literacy and English as a Second Language (ESL), parenting-skills training, and employment-skills training. An evaluation of the…

Intraocular Pressure Fluctuations and 24-Hour Continuous Monitoring for Glaucoma Risk in Wind Instrument Players.

PubMed

de Crom, Ronald M P C; Webers, Carroll A B; van Kooten-Noordzij, Marina A W; Michiels, Agnes C; Schouten, Jan S A G; Berendschot, Tos T J M; Beckers, Henny J M

2017-10-01

The purpose of this study is to investigate the influence of playing a wind instrument on intraocular pressure (IOP) and to monitor 24-hour (IOP) fluctuations in wind musicians of symphony and wind orchestras to compare IOP levels during normal daily activities with IOP levels during playing. Professional and amateur musicians of symphony and wind orchestras were invited to participate. A total of 42 participants, 9 with glaucoma, underwent a routine ophthalmologic examination. IOP measurements were taken before and immediately after 20 minutes of playing wind instruments. In addition, 6 participants underwent 24-hour IOP monitoring with the Triggerfish (Sensimed AG, Switzerland) sensing contact lens, during which they kept an activity logbook. Eleven professionals and 31 amateur musicians participated in the study. A total of 7 eyes of 6 patients underwent additional 24-hour IOP monitoring. Mean IOP before playing was 13.6±2.6 mm Hg, IOP change after playing was +1.5±2.2 mm Hg with a significant difference between professionals (2.5±1.5 mm Hg) and amateurs (1.1±2.3 mm Hg). There were no significant differences in IOP change between subjects with or without glaucoma. During 24-hour IOP monitoring there were slight increases in IOP while playing an instrument, but also during other activities and overnight. These latter IOP levels were similar or even higher than the IOP rise caused by playing a wind instrument. IOP often rises after playing wind instruments, but similar or even higher IOP levels seem to occur during common other daily activities or at night. These peaks may be relevant for glaucomatous field progression and treatment of glaucoma patients.

Break-Even Income Analysis of Pharmacy Graduates Compared to High School and College Graduates.

PubMed

Chisholm-Burns, Marie A; Gatwood, Justin; Spivey, Christina A; Dickey, Susan E

2016-04-25

Objective. To project the net cumulative income break-even point between practicing pharmacists and those who enter the workforce directly after high school graduation or after obtaining a bachelor's degree. Methods. Markov modeling and break-even analysis were conducted. Estimated costs of education were used in calculating net early career earnings of high school graduates, bachelor's degree holders, pharmacists without residency training, and pharmacists with residency training. Results. Models indicate that over the first 10 years of a pharmacist's career, they accumulate net earnings of $716 345 to $1 064 840, depending on cost of obtaining the PharmD degree and career path followed. In the break-even analysis, all pharmacy career tracks surpassed net cumulative earnings of high school graduates by age 33 and bachelor's degree holders by age 34. Conclusion. Regardless of the chosen pharmacy career track and the typical cost of obtaining a PharmD degree, the model under study assumptions demonstrates that pharmacy education has a positive financial return on investment, with a projected break-even point of less than 10 years upon career entry.

First observations of the midlatitude evening anomaly using Super Dual Auroral Radar Network (SuperDARN) radars

NASA Astrophysics Data System (ADS)

de Larquier, S.; Ruohoniemi, J. M.; Baker, J. B. H.; Ravindran Varrier, N.; Lester, M.

2011-10-01

Under geomagnetically quiet conditions, the daytime midlatitude ionosphere is mainly influenced by solar radiation: typically, electron densities in the ionosphere peak around solar noon. Previous observations from the Millstone Hill incoherent scatter radar (ISR) have evidenced the presence of evening electron densities higher than daytime densities during the summer. The recent development of midlatitude Super Dual Auroral Radar Network (SuperDARN) radars over North America and Japan has revealed an evening enhancement in ground backscatter during the summer. SuperDARN observations are compared to data from the Millstone Hill ISR, confirming a direct relation between the observed evening enhancements in electron densities and ground backscatter. Statistics over a year of data from the Blackstone radar show that the enhancement occurs during sunset for a few hours from April to September. The evening enhancement observed by both SuperDARN and the Millstone Hill ISR is shown to be related to recent satellite observations reporting an enhancement in electron densities over a wide range of longitudes in the Northern Hemisphere midlatitude sector during summer time. Finally, global results from the International Reference Ionosphere (IRI) and the horizontal wind model (HWM07) are presented in relation with previously published experimental results and proposed mechanisms of the evening enhancement, namely, thermospheric horizontal winds and geomagnetic field configuration. It is shown that the IRI captures the features of the evening enhancement as observed by SuperDARN radars and satellites.

Generalization of the NpNn scheme to nonyrast levels of even-even nuclei

NASA Astrophysics Data System (ADS)

Zhao, Y. M.; Arima, A.

2003-07-01

In this Brief Report we present the systematics of excitation energies for even-even nuclei in two regions: the 50even if one extends it to nonyrast levels, and thus can serve as a general tool to disclose new types of structural evolution for higher excitations, besides the yrast states which have been investigated extensively. It is highlighted that deformations in nonyrast quasibands of nuclei with Z˜80 and N˜104 are often very different from those in the ground bands.

Evening daylight may cause adolescents to sleep less in spring than in winter.

PubMed

Figueiro, Mariana G; Rea, Mark S

2010-07-01

Sleep restriction commonly experienced by adolescents can stem from a slower increase in sleep pressure by the homeostatic processes and from phase delays of the circadian system. With regard to the latter potential cause, the authors hypothesized that because there is more natural evening light during the spring than winter, a sample of adolescent students would be more phase delayed in spring than in winter, would have later sleep onset times, and because of fixed school schedules would have shorter sleep durations. Sixteen eighth-grade subjects were recruited for the study. The authors collected sleep logs and saliva samples to determine their dim light melatonin onset (DLMO), a well-established circadian marker. Actual circadian light exposures experienced by a subset of 12 subjects over the course of 7 days in winter and in spring using a personal, head-worn, circadian light measurement device are also reported here. Results showed that this sample of adolescents was exposed to significantly more circadian light in spring than in winter, especially during the evening hours when light exposure would likely delay circadian phase. Consistent with the light data, DLMO and sleep onset times were significantly more delayed, and sleep durations were significantly shorter in spring than in winter. The present ecological study of light, circadian phase, and self-reported sleep suggests that greater access to evening daylight in the spring may lead to sleep restriction in adolescents while attending school. Therefore, lighting schemes that reduce evening light in the spring may encourage longer sleep times in adolescents.

Evening daylight may cause adolescents to sleep less in spring than in winter

PubMed Central

Figueiro, Mariana G.; Rea, Mark S.

2012-01-01

Sleep restriction commonly experienced by adolescents can stem from greater sleep pressure by the homeostatic processes and from phase delays of the circadian system. With regard to the latter potential cause, we hypothesized that because there is more natural evening light during the spring than winter, a sample of adolescent students would be more phase delayed in spring than in winter, would have later sleep onset times and, because of fixed school schedules, would have shorter sleep durations. Sixteen eighth-grade subjects were recruited for the study. We collected sleep logs and saliva samples to determine their dim light melatonin onset (DLMO), a well-established circadian marker. Actual circadian light exposures experienced by a subset of twelve subjects over the course of seven days in winter and in spring using a personal, head-worn, circadian light measurement device are also reported here. Results showed that this sample of adolescents was exposed to significantly more circadian light in spring than in winter, especially in the evening hours when light exposure would likely delay circadian phase. Consistent with the light data, DLMO and sleep onset times were significantly more delayed, and sleep durations were significantly shorter in spring than in winter. The present ecological study of light, circadian phase, and self-reported sleep suggests that greater access to evening daylight in the spring may lead to sleep restriction in adolescents while attending school. Therefore, lighting schemes that reduce evening light in the spring may encourage longer sleep times in adolescents. PMID:20653452

12 hour shifts the Nambour Hospital experience.

PubMed

2007-08-01

Union members have a lengthy history of campaigning for fair working hours and conditions. The success of such campaigns has led to the implementation of the eight hour working day and the 40 hour and then 38 hour week as industrial standards. More recently though, calls for greater flexibility in their shift arrangements by nurses at Nambour Hospital have led to a voluntary 12 hour shift being implemented in their Intensive Care Unit. While union members are protective of their hard won gains in achieving reduced working hours through the 8 hour day--ICU nurses at Nambour Hospital say the voluntary 12 hour shift initiative goes a way in addressing their work/life balance issues.

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.

PubMed

Roy, Anil K; Chu, Jason; Bozeman, Caroline; Sarda, Samir; Sawvel, Michael; Chern, Joshua J

2017-06-01

OBJECTIVE Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery. METHODS Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations. RESULTS Cerebrospinal fluid shunt-and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43-2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32-2.96, p < 0.05]). CONCLUSIONS Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When

Early renal dysfunction after contrast media administration despite prophylactic hydration.

PubMed

Burchardt, Pawel; Guzik, Przemyslaw; Tabaczewski, Piotr; Synowiec, Tomasz; Bogdan, Monika; Faner, Paula; Chmielarz-Sobocińska, Anna; Palasz, Anna

2013-06-01

The actual incidence of renal dysfunction after contrast media administration seems to be underestimated, especially in the context of epidemiological data. There are only few data concerning the monitoring of impaired kidney function within a few hours after iodine contrast medium application. Hence, the purpose of this study is to observe the incidence of early renal function deterioration within 12-18 h after administration of iodine contrast media in patients scheduled for elective coronary angiography, who were intravenously and orally hydrated. In addition, the project aims to reclassify the contrast induced nephropathy phenomenon, by identification of early markers of renal dysfunction. Morphology, electrolytes, blood urea nitrogen (BUN), creatinine, low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein, and total cholesterol levels were assessed with the use of typical laboratory techniques in 319 patients referred for coronary angiography. We demonstrated that early deterioration of renal function in patients 12-18 h after administration of contrast during imaging tests (even when appropriate prophylactic hydration was used), may occurred just as an increase (or no change) of serum creatinine level and BUN level and a decrease of creatinine clearance and glomerular filtration rate. Depending on the parameter, the phenomenon can be found in 13-28 % of all respondents. Early renal function impairment defined as above was almost 2 and 2.22 × 10(3) times (respectively) more frequently observed in our study than contrast induced nephropathy defined by current definitions.

Do Financial Incentives Influence GPs' Decisions to Do After-hours Work? A Discrete Choice Labour Supply Model.

PubMed

Broadway, Barbara; Kalb, Guyonne; Li, Jinhu; Scott, Anthony

2017-12-01

This paper analyses doctors' supply of after-hours care (AHC), and how it is affected by personal and family circumstances as well as the earnings structure. We use detailed survey data from a large sample of Australian General Practitioners (GPs) to estimate a structural, discrete choice model of labour supply and AHC. This allows us to jointly model GPs' decisions on the number of daytime-weekday working hours and the probability of providing AHC. We simulate GPs' labour supply responses to an increase in hourly earnings, both in a daytime-weekday setting and for AHC. GPs increase their daytime-weekday working hours if their hourly earnings in this setting increase, but only to a very small extent. GPs are somewhat more likely to provide AHC if their hourly earnings in that setting increase, but again, the effect is very small and only evident in some subgroups. Moreover, higher earnings in weekday-daytime practice reduce the probability of providing AHC, particularly for men. Increasing GPs' earnings appears to be at best relatively ineffective in encouraging increased provision of AHC and may even prove harmful if incentives are not well targeted. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Subjective alertness and sleep quality in connection with permanent 12-hour day and night shifts.

PubMed

Gillberg, M

1998-01-01

The aim of this study was to compare permanent 12-hour day and night shifts (shift change over times at 0500 and 1700) in a shift system with 3 work periods followed by 4 free days. Sleep diaries were collected after main periods of sleep, and sleepiness ratings [Karolinska sleepiness scale (KSS)] were obtained 4 times during the last free day and also during the following 3 workshifts. Eighteen to twenty night workers and 8-10 day workers (depending on the instrument) participated. The day workers were significantly sleepier during their workdays. Times for going to bed and for rising differed between the groups. The amount of sleep per week did not differ between groups, but the pattern across days did in that the day workers had a short sleep (5 hours) before the first day and 6 hours of sleep after the other two. Night workers slept long (9 hours) before the first shift and had 6.5-hour sleep periods after the other shifts. During free time the day workers slept around 9 hours and the night workers around 8 hours. Sleep quality and ease of awakening showed no group differences in overall levels, but the day workers had difficulties awakening before their shifts. The night workers had little variation in sleep quality or difficulties awakening. The suggested explanation for the greater sleepiness and difficulties awakening among the day workers was the early start of the shift and the difficulties the workers had with phase advancing their sleep-wake rhythm.

GPs' experiences with out-of-hours GP cooperatives: a survey study from the Netherlands.

PubMed

Smits, Marleen; Keizer, Ellen; Huibers, Linda; Giesen, Paul

2014-09-01

Out-of-hours primary care has been provided by general practitioner (GP) cooperatives since the year 2000 in the Netherlands. Early studies in countries with similar organizational structures showed positive GP experiences. However, nowadays it is said that GPs experience a high workload at the cooperative and that they outsource a considerable part of their shifts. To examine positive and negative experiences of GPs providing out-of-hours primary care, and the frequency and reasons for outsourcing shifts. A cross-sectional observational survey among 688 GPs connected to six GP cooperatives in the Netherlands, using a web-based questionnaire. The response was 55% (n = 378). The main reasons for working in GP cooperatives were to retain registration as GP (79%) and remain experienced in acute care (74%). GPs considered the peak hours (81%) and the high number of patients (73%) as the most negative aspects. Most GPs chose to provide the out-of-hours shifts themselves: 85% outsourced maximally 25% of their shifts. The percentage of outsourced shifts increased with age. Main reasons for outsourcing were the desire to have more private time (76%); the high workload in daytime practice (71%); and less the workload during out-of-hours (46%). GPs are motivated to work in out-of-hours GP cooperatives, and they outsource few shifts. GPs consider the peak load and the large number of (non-urgent) help requests as the most negative aspects. To motivate and involve GPs for 7 × 24-h primary care, it is important to set limits on their workload.

Long hours in paid and domestic work and subsequent sickness absence: does control over daily working hours matter?

PubMed

Ala-Mursula, L; Vahtera, J; Kouvonen, A; Väänänen, A; Linna, A; Pentti, J; Kivimäki, M

2006-09-01

To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours. Prospective cohort study among 25 703 full-time public sector employees in 10 towns in Finland. A survey of working hours and control over working hours was carried out in 2000-01. The survey responses were linked with register data on the number of self-certified (< or =3 days) and medically certified (>3 days) sickness absences until the end of 2003. Poisson regression analyses with generalised estimating equations were used to take into account the fact that the employees were nested within work units. Adjustments were made for work and family characteristics and health behaviour. The mean follow-up period was 28.1 (SD 8.1) months. Long domestic and total working hours were associated with higher rates of medically certified sickness absences among both genders. In contrast, long paid working hours were associated with lower rates of subsequent self-certified sickness absences. Long commuting hours were related to increased rates of sickness absence of both types. Low control over daily working hours predicted medically certified sickness absences for both the women and men and self-certified absences for the men. In combinations, high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences. Employee control over daily working hours may protect health and help workers successfully combine a full-time job with the demands of domestic work.

24-hour urine copper test

MedlinePlus

... medlineplus.gov/ency/article/003604.htm 24-hour urine copper test To use the sharing features on this page, please enable JavaScript. The 24-hour urine copper test measures the amount of copper in ...

Long Working Hours and Cognitive Function

PubMed Central

Singh-Manoux, Archana; Ferrie, Jane E.; Gimeno, David; Marmot, Michael G.; Elovainio, Marko; Jokela, Markus; Vahtera, Jussi; Kivimäki, Mika

2009-01-01

This study examined the association between long working hours and cognitive function in middle age. Data were collected in 1997–1999 (baseline) and 2002–2004 (follow-up) from a prospective study of 2,214 British civil servants who were in full-time employment at baseline and had data on cognitive tests and covariates. A battery of cognitive tests (short-term memory, Alice Heim 4-I, Mill Hill vocabulary, phonemic fluency, and semantic fluency) were measured at baseline and at follow-up. Compared with working 40 hours per week at most, working more than 55 hours per week was associated with lower scores in the vocabulary test at both baseline and follow-up. Long working hours also predicted decline in performance on the reasoning test (Alice Heim 4-I). Similar results were obtained by using working hours as a continuous variable; the associations between working hours and cognitive function were robust to adjustments for several potential confounding factors including age, sex, marital status, education, occupation, income, physical diseases, psychosocial factors, sleep disturbances, and health risk behaviors. This study shows that long working hours may have a negative effect on cognitive performance in middle age. PMID:19126590

Heart Rate Variability in Obstetricians Working 14-Hour Call Compared to 24-Hour Call in Labour and Delivery.

PubMed

Thurman, Robin H; Yoon, Eugene; Murphy, Kellie E; Windrim, Rory; Farrugia, M Michéle

2017-12-01

Obstetricians have stressful and demanding jobs that may impact their health. A physiological measurement of cardiac function which varies with stress is heart rate variability (HRV). By measuring the cyclic variations in R-R intervals, or beat-to-beat differences, HRV reflects the continuous interplay of the controlling forces in the autonomic nervous system. Studies have shown HRV to be reduced during periods of work-induced stress, including 24-hour shifts. Our study aimed to determine if there was a correlation between length of shift worked and HRV. We hypothesised that working for a full 24-hour period is more stressful than a shorter, nighttime-only period, and HRV analyses were used to measure this objectively. Obstetricians wore an HRV monitor for 24 hours during both a regular day followed by a 14-hour night shift and a continuous 24-hour shift in labour and delivery. The 24-hour samples were analysed using standard HRV measurements. HRV measurements obtained from each physician were then compared according to shift type, with each physician acting as his or her own comparator. There were no statistically significant differences in the most important measures of HRV between 24-hour periods which included either a 14-hour overnight shift or a continuous 24-hour shift on labour and delivery. We found no significant differences in key HRV measures in obstetricians working 14 hours versus 24 hours in labour and delivery. An anecdotal increase in physician awareness of his/her own health related to working conditions was noted during the study. Future studies should attempt to control for the hours prior to a night shift, assess associated endocrine variations, and focus upon HRV in the post-shift period. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

75 FR 285 - Hours of Service

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-05

... period long enough to provide restorative sleep regardless of the number of hours worked prior to the... No. FMCSA-2004-19608] RIN 2126-AB26 Hours of Service AGENCY: Federal Motor Carrier Safety... hold three public listening sessions to solicit comments and information on potential hours-of- service...

Duty Hour Reporting: Conflicting Values in Professionalism.

PubMed

Byrne, John M; Loo, Lawrence K; Giang, Dan W

2015-09-01

Duty hour limits challenge professional values, sometimes forcing residents to choose between patient care and regulatory compliance. This may affect truthfulness in duty hour reporting. We assessed residents' reasons for falsifying duty hour reports. We surveyed residents in 1 sponsoring institution to explore the reasons for noncompliance, frequency of violations, falsification of reports, and the residents' awareness of the option to extend hours to care for a single patient. The analysis used descriptive statistics. Linear regression was used to explore falsification of duty hour reports by year of training. The response rate was 88% (572 of 650). Primary reasons for duty hour violations were number of patients (19%) and individual patient acuity/complexity (19%). Junior residents were significantly more likely to falsify duty hours (R = -0.966). Of 124 residents who acknowledged falsification, 51 (41%) identified the primary reason as concern that the program will be in jeopardy of violating the Accreditation Council for Graduate Medical Education (ACGME) duty hour limits followed by fear of punishment (34, 27%). This accounted for more than two-thirds of the primary reasons for falsification. Residents' falsification of duty hour data appears to be motivated by concerns about adverse actions from the ACGME, and fear they might be punished. To foster professionalism, we recommend that sponsoring institutions educate residents about professionalism in duty hour reporting. The ACGME should also convey the message that duty hour limits be applied in a no-blame systems-based approach, and allow junior residents to extend duty hours for the care of individual patients.

Long hours in paid and domestic work and subsequent sickness absence: does control over daily working hours matter?

PubMed Central

Ala‐Mursula, L; Vahtera, J; Kouvonen, A; Väänänen, A; Linna, A; Pentti, J; Kivimäki, M

2006-01-01

Objectives To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours. Methods Prospective cohort study among 25 703 full‐time public sector employees in 10 towns in Finland. A survey of working hours and control over working hours was carried out in 2000–01. The survey responses were linked with register data on the number of self‐certified (⩽3 days) and medically certified (>3 days) sickness absences until the end of 2003. Poisson regression analyses with generalised estimating equations were used to take into account the fact that the employees were nested within work units. Adjustments were made for work and family characteristics and health behaviour. The mean follow‐up period was 28.1 (SD 8.1) months. Results Long domestic and total working hours were associated with higher rates of medically certified sickness absences among both genders. In contrast, long paid working hours were associated with lower rates of subsequent self‐certified sickness absences. Long commuting hours were related to increased rates of sickness absence of both types. Low control over daily working hours predicted medically certified sickness absences for both the women and men and self‐certified absences for the men. In combinations, high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences. Conclusions Employee control over daily working hours may protect health and help workers successfully combine a full‐time job with the demands of domestic work. PMID:16728502

Tracking and Explaining Credit-Hour Completion

ERIC Educational Resources Information Center

Kwenda, Maxwell Ndigume

2014-01-01

This study highlights factors associated with changes in earned hours for two cohorts of incoming freshmen during their first year. The objectives of this study are twofold: (a) to derive model(s) regressing the cumulative hours earned and differential hours earned on student demographic, socioeconomic, and academic characteristics; and (b) to…

AWBAT: early clinical experience.

PubMed

Vandenberg, Victoria B

2010-03-15

The purpose of this article is to describe the early clinical experience with AWBAT. Burn patients requiring (1) donor sites or (2) treatment of a superficial burn wound injury were treated. A total of 45 patients with 69 distinct wounds were included. AWBAT-D was evaluated in donor sites and AWBAT-S was evaluated in superficial partial-thickness burns. Days to healing, pain, hematoma/seroma formation, and infection were noted. Ease of application, adherence, transparency, and physical adaptability details were collected. Average period to healing of donor sites treated with AWBAT-D (n=22 patients with n=26 wounds) was 11.2 days, sigma =1.95, with a range of 8-15 days and a median of 11 days. Pain rating at 24 hours was 1.2, sigma =0.43 (n=18) and at 48 hours mean was 1.2, sigma =0.46 (n=15). Average period to healing of superficial burns treated with AWBAT-S (n=15 patients with n=18 wounds) was 8.1 days, sigma =2.48, with a range of 5-13 days and a median of 7 days. Pain rating at 24 hours was 1.5, sigma =0.85 (n=10) and at 48 hours mean was 1.75, sigma =0.89 (n=8). There was zero incidence of hematoma/seroma. No infections were seen. Results indicate that AWBAT was easily applied with good initial adherence. It was noted to be transparent, conformant, and pliable. Early experience demonstrates that AWBAT performs well on donor sites and superficial partial-thickness burns and delivers the desired attributes of a temporary skin substitute including good adherence, infection control, transparency, adapatability, and pain control.

Agreement between twenty-four hour salt ingestion and sodium excretion in a controlled environment

PubMed Central

Lerchl, Kathrin; Rakova, Natalia; Dahlmann, Anke; Rauh, Manfred; Goller, Ulrike; Basner, Mathias; Dinges, David F.; Beck, Luis; Agureev, Alexander; Larina, Irina; Baranov, Victor; Morukov, Boris; Eckardt, Kai-Uwe; Vassilieva, Galina; Wabel, Peter; Vienken, Jörg; Kirsch, Karl; Johannes, Bernd; Krannich, Alexander; Luft, Friedrich C.; Titze, Jens

2015-01-01

Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed two independent ultra-long-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 grams per day and collected all urine. The subjects’ daily menus consisted of 27,279 individual servings, out of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady state sodium balance in both studies. Even at fixed salt intake, 24-hour sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-gram difference in salt intake. Due to the biological variability in UNaV, only every-other daily urine sample correctly classified a 3-gram difference in salt intake (49%). By increasing the observations to three consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6–12 grams salt per day were not suitable to detect a 3-gram difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials. PMID:26259596

Infant botulism, type F, presenting at 54 hours of life.

PubMed

Keet, Corinne A; Fox, Christine K; Margeta, Marta; Marco, Elysa; Shane, Andi L; Dearmond, Stephen J; Strober, Jonathan B; Miller, Steven P

2005-03-01

We report a case of botulism in a 54-hour-old infant with rapidly progressive fulminant paralysis and rapid spontaneous recovery atypical for infant botulism. Clostridium baratii and type F botulinum neurotoxin were isolated from the patient's stool. This unique presentation with rapid recovery is consistent with pharmacokinetics of type F botulinum neurotoxin. Interestingly, a muscle biopsy also revealed pathologic changes early in the disease course. This article reports the youngest known case of infant botulism and only the third reported case of this disease caused by type F neurotoxin. Botulism should be considered in patients of any age with subacute or acute neuromuscular weakness.

10 CFR 26.205 - Work hours.

Code of Federal Regulations, 2013 CFR

2013-01-01

... REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Managing Fatigue § 26.205 Work hours. (a) Individuals subject to work hour controls. Any individual who performs duties identified in § 26.4(a)(1) through (a)(5... paragraphs (b)(1) through (b)(5) of this section, the calculated work hours must include all time performing...

10 CFR 26.205 - Work hours.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Managing Fatigue § 26.205 Work hours. (a) Individuals subject to work hour controls. Any individual who performs duties identified in § 26.4(a)(1) through (a)(5... paragraphs (b)(1) through (b)(5) of this section, the calculated work hours must include all time performing...

10 CFR 26.205 - Work hours.

Code of Federal Regulations, 2012 CFR

2012-01-01

... REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Managing Fatigue § 26.205 Work hours. (a) Individuals subject to work hour controls. Any individual who performs duties identified in § 26.4(a)(1) through (a)(5... paragraphs (b)(1) through (b)(5) of this section, the calculated work hours must include all time performing...

Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.

PubMed

Furlan, Julio C; Craven, B Catharine; Massicotte, Eric M; Fehlings, Michael G

2016-04-01

This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI). This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS. The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy. The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant. Copyright © 2016 Elsevier Inc. All rights reserved.

Organizations' Ways of Employing Early Retirees: The Role of Age-Based HR Policies.

PubMed

Oude Mulders, Jaap; Henkens, Kène; Schippers, Joop

2015-06-01

We examine whether from an organizational perspective it is possible to distinguish different ways of employing early retirees and explore how the employment of early retirees is related to the application of 4 age-based human resource (HR) policies, namely demotion, offering training opportunities to older workers, offering early retirement, and allowing flexible working hours. We perform a latent class analysis on a sample of 998 Dutch organizations in order to categorize them based on 3 dimensions of their employment of early retirees. We then run a multinomial logistic regression to relate the employment of early retirees to the 4 age-based HR policies. We distinguish 4 types of organizations based on their way of employing early retirees: nonusers (52.6%), users for mainly standard work (20.8%), users for mainly nonstandard work (9.8%), and users for standard and nonstandard work (16.7%). We find that organizations that apply demotion, offer early retirement, and allow flexible working hours are more likely to be users for mainly standard work. Also, organizations that do not offer early retirement are less likely to employ early retirees. Age-based HR policies, especially demotion, offering early retirement, and allowing flexible working hours, are conducive to the employment of early retirees for mainly standard work. Broader implementation of these policies may provide opportunities for older workers to make a more gradual transition from work to retirement. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Relationships between walking hours, sleeping hours, meaningfulness of life (ikigai) and mortality in the elderly: prospective cohort study].

PubMed

Seki, N

2001-07-01

The purpose of this study was to determine lifestyle factors in the elderly that affected longevity, using a population-based prospective study. The participants were 440 men and 625 women aged 60 to 74 living in a rural Japanese community. The baseline data such as age, sex, present illness, walking hours per day, sleeping hours per day, alcohol consumption, a history of smoking, and "ikigai" (meaningfulness of life) were collected in July 1990. During 90 months of follow-up from July 1990 to December 31 1997, there were 123 deaths. By Cox's multivariate hazard model adjusted age, sex, and medical histories, walking > or = 1 hour/day (HR = 0.63, 95% CI 0.44-0.91) and an "ikigai" (HR = 0.66, 95% CI 0.44-0.99) lowered the risk for all-cause mortality independently. In regard to hours of sleep, the cumulative survival curve showed that 7 hours/day was the border and sleeping > or = 7 hours/day lowered the risk (HR = 0.49 95% CI 0.33-0.74). Based on the findings in this study, walking > or = 1 hour/day, sleeping > or = 7 hours/day, and "ikigai" are important factors for longevity in the elderly.

Break-Even Income Analysis of Pharmacy Graduates Compared to High School and College Graduates

PubMed Central

Gatwood, Justin; Spivey, Christina A.; Dickey, Susan E.

2016-01-01

Objective. To project the net cumulative income break-even point between practicing pharmacists and those who enter the workforce directly after high school graduation or after obtaining a bachelor’s degree. Methods. Markov modeling and break-even analysis were conducted. Estimated costs of education were used in calculating net early career earnings of high school graduates, bachelor’s degree holders, pharmacists without residency training, and pharmacists with residency training. Results. Models indicate that over the first 10 years of a pharmacist’s career, they accumulate net earnings of $716 345 to $1 064 840, depending on cost of obtaining the PharmD degree and career path followed. In the break-even analysis, all pharmacy career tracks surpassed net cumulative earnings of high school graduates by age 33 and bachelor’s degree holders by age 34. Conclusion. Regardless of the chosen pharmacy career track and the typical cost of obtaining a PharmD degree, the model under study assumptions demonstrates that pharmacy education has a positive financial return on investment, with a projected break-even point of less than 10 years upon career entry. PMID:27170815

Duty Hour Reporting: Conflicting Values in Professionalism

PubMed Central

Byrne, John M.; Loo, Lawrence K.; Giang, Dan W.

2015-01-01

Background Duty hour limits challenge professional values, sometimes forcing residents to choose between patient care and regulatory compliance. This may affect truthfulness in duty hour reporting. Objective We assessed residents' reasons for falsifying duty hour reports. Methods We surveyed residents in 1 sponsoring institution to explore the reasons for noncompliance, frequency of violations, falsification of reports, and the residents' awareness of the option to extend hours to care for a single patient. The analysis used descriptive statistics. Linear regression was used to explore falsification of duty hour reports by year of training. Results The response rate was 88% (572 of 650). Primary reasons for duty hour violations were number of patients (19%) and individual patient acuity/complexity (19%). Junior residents were significantly more likely to falsify duty hours (R = −0.966). Of 124 residents who acknowledged falsification, 51 (41%) identified the primary reason as concern that the program will be in jeopardy of violating the Accreditation Council for Graduate Medical Education (ACGME) duty hour limits followed by fear of punishment (34, 27%). This accounted for more than two-thirds of the primary reasons for falsification. Conclusions Residents' falsification of duty hour data appears to be motivated by concerns about adverse actions from the ACGME, and fear they might be punished. To foster professionalism, we recommend that sponsoring institutions educate residents about professionalism in duty hour reporting. The ACGME should also convey the message that duty hour limits be applied in a no-blame systems-based approach, and allow junior residents to extend duty hours for the care of individual patients. PMID:26457145

10 CFR 26.205 - Work hours.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Work hours. 26.205 Section 26.205 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Managing Fatigue § 26.205 Work hours. (a) Individuals subject to work hour controls. Any individual who performs duties identified in § 26.4(a)(1) through (a)(5...

10 CFR 26.205 - Work hours.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Work hours. 26.205 Section 26.205 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Managing Fatigue § 26.205 Work hours. (a) Individuals subject to work hour controls. Any individual who performs duties identified in § 26.4(a)(1) through (a)(5...

Early esophagogastroduodenoscopy is associated with better Outcomes in upper gastrointestinal bleeding: a nationwide study

PubMed Central

Garg, Sushil K.; Anugwom, Chimaobi; Campbell, James; Wadhwa, Vaibhav; Gupta, Nancy; Lopez, Rocio; Shergill, Sukhman; Sanaka, Madhusudhan R.

2017-01-01

Background and study aims We analyzed NIS (National Inpatient Sample) database from 2007 – 2013 to determine if early esophagogastroduodenoscopy (EGD) (24 hours) for upper gastrointestinal bleeding improved the outcomes in terms of mortality, length of stay and costs. Patients and methods Patients were classified as having upper gastrointestinal hemorrhage by querying all diagnostic codes for the ICD-9-CM codes corresponding to upper gastrointestinal bleeding. For these patients, performance of EGD during admission was determined by querying all procedural codes for the ICD-9-CM codes corresponding to EGD; early EGD was defined as having EGD performed within 24 hours of admission and late EGD was defined as having EGD performed after 24 hours of admission. Results A total of 1,789,532 subjects with UGIH were identified. Subjects who had an early EGD were less likely to have hypovolemia, acute renal failure and acute respiratory failure. On multivariable analysis, we found that subjects without EGD were 3 times more likely to die during the admission than those with early EGD. In addition, those with late EGD had 50 % higher odds of dying than those with an early EGD. Also, after adjusting for all factors in the model, hospital stay was on average 3 and 3.7 days longer for subjects with no or late EGD, respectively, then for subjects with early EGD. Conclusion Early EGD (within 24 hours) is associated with lower in-hospital mortality, morbidity, shorter length of stay and lower total hospital costs. PMID:28512647

The new break-even analysis.

PubMed

Laskaris, James; Regan, Katie

2013-12-01

Changes in the economic and legislative environment have complicated the capital acquisition landscape. Hospitals and health systems should: Question the assumptions that underlie their break-even analysis. Revamp the break-even calculator. Engage in discussions about the clinical aspects of equipment and technology acquisition decisions.

48 CFR 16.602 - Labor-hour contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Labor-hour contracts. 16... METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Time-and-Materials, Labor-Hour, and Letter Contracts 16.602 Labor-hour contracts. Description. A labor-hour contract is a variation of the time-and-materials...

Extended working hours and health.

PubMed

Raediker, Britta; Janssen, Daniela; Schomann, Carsten; Nachreiner, Friedhelm

2006-01-01

Statistical analyses of the relation between the amount of working hours and impairments to health, based on data from a European survey on working conditions in 2000, clearly reveal that there is a substantial correlation between the number of working hours per week and the frequencies of health complaints. This applies to both musculo-skeletal disorders as well as to psycho-vegetative complaints. The relationship of the duration of the exposure to working conditions to health impairments is moderated by a great number of individual (e.g., age) and situational (e.g., shift-work) variables, showing additive or interactive effects for which selected examples have been presented. In general, however, there is a consistent functional relationship between the number or working hours and their effects on the workers that holds over a great variety of conditions. It is argued that requests for extending working hours should thus be handled with care.

Combined Effects of Working Hours, Income, and Leisure Time on Suicide in All 47 Prefectures of Japan

PubMed Central

TAKEUCHI, Akito; SAKANO, Noriko; MIYATAKE, Nobuyuki

2014-01-01

This study describes an ecological study that evaluated the combined effects of working hours, income, and leisure time on suicide in all 47 prefectures of Japan. In men, the age-adjusted rate of suicide (per 100,000 population) was significantly correlated with working hours (r=0.587, p<0.0001) as well as significantly and negatively correlated with income (r=−0.517, p=0.0002) and times for the leisure activities of self-education (r=−0.447, p=0.0016) and hobbies (r=−0.511, p=0.0002). In addition, a stepwise multiple regression analysis identified time for leisure social activities as a determining factor in suicide rate, even after adjusting for working hours and income. However, the impact of time for leisure social activities on suicide rate was smaller than that of working hours and income. In contrast, none of these factors affected suicide rate in women. These results suggest that increasing leisure time may be useful for preventing suicide among men in Japan. PMID:24464025

48 CFR 552.236-74 - Working Hours.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Working Hours. 552.236-74... Hours. As prescribed in 536.570-5, insert the following clause: Working Hours (APR 1984) (a) It is contemplated that all work will be performed during the customary working hours of the trades involved unless...

Comparison of Diurnal Characteristics of GPM-IMERG Precipitation Products with Hourly Rain Gauge Observations and TRMM-TMPA Products over Mainland China

NASA Astrophysics Data System (ADS)

Li, R.; Wang, K.; QI, D.

2017-12-01

The next generation global high resolutions precipitation products, the Integrated Multi-satellitE Retrievals for Global Precipitation Measurement (IMERG) provide new insights into the global hydrometeorology studies. Although there are some previous works to evaluate it on daily scale or above, its performance on sub-daily scale is still limited. This study evaluates the diurnal characteristics of the half-hourly IMERG product with the Tropical Rainfall Measuring Mission (TRMM) Multisatellite Precipitation Analysis (TMPA) data and the hourly rain gauge data from approximately 50000 automatic weather station (AWS) in China during 2014-2016. The results show that IMERG can roughly capture the diurnal cycle of precipitation amount with serial correlation for eight sub-regions ranging from 0.63 to 0.97, but less agreed in frequency (from 0.21 to 0.90) and intensity (from -0.22 to 0.83). IMERG can generally capture the nocturnal and early morning peak of amount, frequency and intensity, which it's a known issue unsolved by TMPA, partly due to the better detection of light rain in the morning. However as for the afternoon precipitation, overestimation of amount and frequency and underestimation of intensity still exist in IMERG product, which probably result from the overestimation of light and moderate rain. IMERG shows large bias in late morning (0900-1100 Beijing Time) and mid evening (2000-2200 Beijing Time). All these results highlight the cautions when using the IMERG sub-daily product and indicate the necessity of improved retrieval algorithm in the future.

Heat and risk of myocardial infarction: hourly level case-crossover analysis of MINAP database

PubMed Central

Armstrong, Ben; Hajat, Shakoor; Haines, Andy; Wilkinson, Paul; Smeeth, Liam

2012-01-01

Objective To quantify the association between exposure to higher temperatures and the risk of myocardial infarction at an hourly temporal resolution. Design Case-crossover study. Setting England and Wales Myocardial Ischaemia National Audit Project (MINAP) database. Participants 24 861 hospital admissions for myocardial infarction occurring in 11 conurbations during the warmest months (June to August) of the years 2003-09. Main outcome measure Odds ratio of myocardial infarction for a 1°C increase in temperature. Results Strong evidence was found for an effect of heat acting 1-6 hours after exposure to temperatures above an estimated threshold of 20°C (95% confidence interval 16°C to 25°C). For each 1°C increase in temperature above this threshold, the risk of myocardial infarction increased by 1.9% (0.5% to 3.3%, P=0.009). Later reductions in risk seemed to offset early increases in risk: the cumulative effect of a 1°C rise in temperature above the threshold was 0.2% (−2.1% to 2.5%) by the end of the third day after exposure. Conclusions Higher ambient temperatures above a threshold of 20°C seem to be associated with a transiently increased risk of myocardial infarction 1-6 hours after exposure. Reductions in risk at longer lags are consistent with heat triggering myocardial infarctions early in highly vulnerable people who would otherwise have had a myocardial infarction some time later (“short term displacement”). Policies aimed at reducing the health effects of hot weather should include consideration of effects operating at sub-daily timescales. PMID:23243290

On the role of extracellular polymeric substances during early stages of Xylella fastidiosa biofilm formation.

PubMed

Lorite, Gabriela S; de Souza, Alessandra A; Neubauer, Daniel; Mizaikoff, Boris; Kranz, Christine; Cotta, Mônica A

2013-02-01

The structural integrity and protection of bacterial biofilms are intrinsically associated with a matrix of extracellular polymeric substances (EPS) produced by the bacteria cells. However, the role of these substances during biofilm adhesion to a surface remains largely unclear. In this study, the influence of EPS on Xylella fastidiosa biofilm formation was investigated. This bacterium is associated with economically important plant diseases; it presents a slow growth rate and thus allows us to pinpoint more precisely the early stages of cell-surface adhesion. Scanning electron microscopy and atomic force microscopy show evidence of EPS production in such early stages and around individual bacteria cells attached to the substrate surface even a few hours after inoculation. In addition, EPS formation was investigated via attenuated total reflectance (ATR) Fourier transform infrared spectroscopy (FTIR). To this end, X. fastidiosa cells were inoculated within an ATR liquid cell assembly. IR-ATR spectra clearly reveal EPS formation already during the early stages of X. fastidiosa biofilm formation, thereby providing supporting evidence for the hypothesis of the relevance of the EPS contribution to the adhesion process. Copyright © 2012 Elsevier B.V. All rights reserved.

Extended working hours: Impacts on workers

Treesearch

D. Mitchell; T. Gallagher

2010-01-01

Some logging business owners are trying to manage their equipment assets by increasing the scheduled machine hours. The intent is to maximize the total tons produced by a set of equipment. This practice is referred to as multi-shifting, double-shifting, or extended working hours. One area often overlooked is the impact that working non-traditional hours can have on...

Immediate Tube Feeding after Percutaneous Endoscopic Gastrostomy: Early Return to Goal Tube Feeds without Added Complications.

PubMed

Lamb, Laura C; Jayaraman, Vijay; Montgomery, Stephanie C; Umer, Affan; Shapiro, David S; Feeney, James M

2017-02-01

Percutaneous endoscopic gastrostomy (PEG) is frequently performed for delivery of nonoral enteral nutrition (EN) in critically ill patients. Tube-based supplement initiation is often delayed for a variety of reasons despite evidence that EN interruption results in worse outcomes. To determine if early initiation of EN after PEG placement is safe and well-tolerated in critically ill patients and if early initiation of EN results in more goal-accomplished days of EN. A retrospective chart review of patients who underwent PEG and at least 24 hours of EN. Patients were stratified according to time to tube- feed initiation: immediate (< one hour), early (one to four hours), and late (four to 24 hours). 'Ihe three groups were similar with respect to demographics, comorbidities, and 30-day mortality. Sixty-one percent of patients in the immediate group were advanced to the previously-met goal EN rates compared to 24% and 18% in the early and delayed groups, respectively (P < .0001). Immediate reinitiation of nonoral EN after PEG procedure is safe and is associated with reaching goal nutrition faster.

Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England.

PubMed

Bobrovitz, Niklas; Lasserson, Daniel S; Briggs, Adam D M

2017-11-02

arrival to the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and management strategies from a senior practitioner.

Aerosolized Red Tide Toxins (Brevetoxins) and Asthma: Continued health effects after 1 hour beach exposure.

PubMed

Kirkpatrick, Barbara; Fleming, Lora E; Bean, Judy A; Nierenberg, Kate; Backer, Lorraine C; Cheng, Yung Sung; Pierce, Richard; Reich, Andrew; Naar, Jerome; Wanner, Adam; Abraham, William M; Zhou, Yue; Hollenbeck, Julie; Baden, Daniel G

2011-01-01

Blooms of the toxic dinoflagellate, Karenia brevis, produce potent neurotoxins in marine aerosols. Recent studies have demonstrated acute changes in both symptoms and pulmonary function in asthmatics after only 1 hour of beach exposure to these aerosols. This study investigated if there were latent and/or sustained effects in asthmatics in the days following the initial beach exposure during periods with and without an active Florida red tide.Symptom data and spirometry data were collected before and after 1 hour of beach exposure. Subjects kept daily symptom diaries and measured their peak flow each morning for 5 days following beach exposure. During non-exposure periods, there were no significant changes in symptoms or pulmonary function either acutely or over 5 days of follow-up. After the beach exposure during an active Florida red tide, subjects had elevated mean symptoms which did not return to the pre-exposure baseline for at least 4 days. The peak flow measurements decreased after the initial beach exposure, decreased further within 24 hours, and continued to be suppressed even after 5 days. Asthmatics may continue to have increased symptoms and delayed respiratory function suppression for several days after 1 hour of exposure to the Florida red tide toxin aerosols.

Aerosolized Red Tide Toxins (Brevetoxins) and Asthma: Continued health effects after 1 hour beach exposure

PubMed Central

Kirkpatrick, Barbara; Fleming, Lora E; Bean, Judy A; Nierenberg, Kate; Backer, Lorraine C; Cheng, Yung Sung; Pierce, Richard; Reich, Andrew; Naar, Jerome; Wanner, Adam; Abraham, William M; Zhou, Yue; Hollenbeck, Julie; Baden, Daniel G

2010-01-01

Blooms of the toxic dinoflagellate, Karenia brevis, produce potent neurotoxins in marine aerosols. Recent studies have demonstrated acute changes in both symptoms and pulmonary function in asthmatics after only 1 hour of beach exposure to these aerosols. This study investigated if there were latent and/or sustained effects in asthmatics in the days following the initial beach exposure during periods with and without an active Florida red tide. Symptom data and spirometry data were collected before and after 1 hour of beach exposure. Subjects kept daily symptom diaries and measured their peak flow each morning for 5 days following beach exposure. During non-exposure periods, there were no significant changes in symptoms or pulmonary function either acutely or over 5 days of follow-up. After the beach exposure during an active Florida red tide, subjects had elevated mean symptoms which did not return to the pre-exposure baseline for at least 4 days. The peak flow measurements decreased after the initial beach exposure, decreased further within 24 hours, and continued to be suppressed even after 5 days. Asthmatics may continue to have increased symptoms and delayed respiratory function suppression for several days after 1 hour of exposure to the Florida red tide toxin aerosols. PMID:21499552

Changing the formula of residents' work hours in internal medicine: moving from "years in training" to "hours in training".

PubMed

Mansi, Ishak A

2011-03-01

In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education. An innovative method of calculating credit hours for graduate medical education would shift the focus from "years of residency" to "hours of residency." For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of "multipliers" based on these parameters, and possibly others such as resident evaluation, is devised to calculate the "final adjusted accredited hours" that count toward graduation. Substituting "years of training" with "hours of training" may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education.

Long Hours and Premium Pay, May 1979.

ERIC Educational Resources Information Center

Stamas, George D.

1980-01-01

From 1978-79 incidence of long hours among full-time wage and salary workers dropped for the first time since the 1974-75 recession. Of those who worked long hours, about 43% received premium pay (time and one-half the regular wage for hours worked in excess of forty per week). Employers used overtime hours to cope with disequilibrium phenomena…

Hospitals by day, dispensaries by night: Hourly fluctuations of maternal mortality within Mexican health institutions, 2010-2014.

PubMed

Lamadrid-Figueroa, Hector; Montoya, Alejandra; Fritz, Jimena; Ortiz-Panozo, Eduardo; González-Hernández, Dolores; Suárez-López, Leticia; Lozano, Rafael

2018-01-01

Quality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths. To analyze the hourly variation of maternal mortality within Mexican health institutions. We performed a cross-sectional multivariate analysis of 3,908 maternal deaths and 10,589,444 births that occurred within health facilities in Mexico during the 2010-2014 period, using data from the Health Information Systems of the Mexican Ministry of Health. We fitted negative binomial regression models with covariate adjustment to all data, as well as similar models by basic cause of death and by weekdays/weekends. The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births. Hour of day was the main predictor; covariates were day of the week, c-section, marginalization, age, education, and number of pregnancies. Risk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2). This is almost twice the lowest risk, which occurred at noon (27.1 deaths per 100,000 live births [95% U.I.: 23.0, 32.0]). Risk shows peaks coinciding with shift changes, at 07:00, and 14:00 and was significantly higher on weekends and holidays. Evidence suggests strong hourly fluctuations in the risk of maternal death with during early morning hours and around the afternoon shift change. These results may reflect institutional management problems that cause an uneven quality of obstetric care.

The 24-hour normothermic machine perfusion of discarded human liver grafts.

PubMed

Vogel, Thomas; Brockmann, Jens G; Quaglia, Alberto; Morovat, Alireza; Jassem, Wayel; Heaton, Nigel D; Coussios, Constantin C; Friend, Peter J

2017-02-01

Donor organ shortage necessitates use of less than optimal donor allografts for transplantation. The current cold storage preservation technique fails to preserve marginal donor grafts sufficiently. Evidence from large animal experiments suggests superiority of normothermic machine preservation (NMP) of liver allografts. In this study, we analyze discarded human liver grafts that underwent NMP for the extended period of 24 hours. Thirteen human liver grafts which had been discarded for transplantation were entered into this study. Perfusion was performed with an automated device using an oxygenated, sanguineous perfusion solution at normothermia. Automated control was incorporated for temperature-, flow-, and pressure-regulation as well as oxygenation. All livers were perfused for 24 hours; parameters of biochemical and synthetic liver function as well as histological parameters of liver damage were analyzed. Livers were stratified for expected viability according to the donor's medical history, procurement data, and their macroscopic appearance. Normothermic perfusion preservation of human livers for 24 hours was shown to be technically feasible. Human liver grafts, all of which had been discarded for transplantation, showed levels suggesting organ viability with respect to metabolic and synthetic liver function (to varying degrees). There was positive correlation between instantly available perfusion parameters and generally accepted predictors of posttransplant graft survival. In conclusion, NMP is feasible reliably for periods of at least 24 hours, even in highly suboptimal donor organs. Potential benefits include not only viability testing (as suggested in recent clinical implementations), but also removal of the time constraints associated with the utilization of high-risk livers, and recovery of ischemic and other preretrieval injuries (possibly by enabling therapeutic strategies during NMP). Liver Transplantation 23 207-220 2017 AASLD. © 2016 by the

Flash-flood early warning using weather radar data: from nowcasting to forecasting

NASA Astrophysics Data System (ADS)

Liechti, Katharina; Panziera, Luca; Germann, Urs; Zappa, Massimiliano

2013-04-01

In our study we explore the limits of radar-based forecasting for hydrological runoff prediction. Two novel probabilistic radar-based forecasting chains for flash-flood early warning are investigated in three catchments in the Southern Swiss Alps and set in relation to deterministic discharge forecast for the same catchments. The first probabilistic radar-based forecasting chain is driven by NORA (Nowcasting of Orographic Rainfall by means of Analogues), an analogue-based heuristic nowcasting system to predict orographic rainfall for the following eight hours. The second probabilistic forecasting system evaluated is REAL-C2, where the numerical weather prediction COSMO-2 is initialized with 25 different initial conditions derived from a four-day nowcast with the radar ensemble REAL. Additionally, three deterministic forecasting chains were analysed. The performance of these five flash-flood forecasting systems was analysed for 1389 hours between June 2007 and December 2010 for which NORA forecasts were issued, due to the presence of orographic forcing. We found a clear preference for the probabilistic approach. Discharge forecasts perform better when forced by NORA rather than by a persistent radar QPE for lead times up to eight hours and for all discharge thresholds analysed. The best results were, however, obtained with the REAL-C2 forecasting chain, which was also remarkably skilful even with the highest thresholds. However, for regions where REAL cannot be produced, NORA might be an option for forecasting events triggered by orographic forcing.

Morning Versus Evening Bright Light Treatment at Home to Improve Function and Pain Sensitivity for Women with Fibromyalgia: A Pilot Study.

PubMed

Burgess, Helen J; Park, Margaret; Ong, Jason C; Shakoor, Najia; Williams, David A; Burns, John

2017-01-01

To test the feasibility, acceptability, and effects of a home-based morning versus evening bright light treatment on function and pain sensitivity in women with fibromyalgia. A single blind randomized study with two treatment arms: 6 days of a 1 hour morning light treatment or 6 days of a 1 hour evening light treatment. Function, pain sensitivity, and circadian timing were assessed before and after treatment. Participants slept at home, except for two nights in Sleep Center. Ten women meeting the American College of Rheumatology's diagnostic criteria for fibromyalgia, including normal blood test results. Self-reported function was assessed with the Fibromyalgia Impact Questionnaire (FIQ). Pain sensitivity was assessed using a heat stimulus that gave measures of threshold and tolerance. Circadian timing was assessed with the dim light melatonin onset. Both morning and evening light treatments led to improvements in function and pain sensitivity. However, only the morning light treatment led to a clinically meaningful improvement in function (>14% reduction from baseline FIQ) and morning light significantly increased pain threshold more than evening light ( P  < 0.05). Phase advances in circadian timing were associated with an increase in pain tolerance (r = 0.67, P  < 0.05). Bright light treatment appears to be a feasible and acceptable adjunctive treatment to women with fibromyalgia. Those who undergo morning light treatment may show improvements in function and pain sensitivity. Advances in circadian timing may be one mechanism by which morning light improves pain sensitivity. Findings can inform the design of a randomized controlled trial. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

AWBATTM: Early Clinical Experience

PubMed Central

Vandenberg, Victoria B.

2010-01-01

Objective: The purpose of this article is to describe the early clinical experience with AWBAT. Methods: Burn patients requiring (1) donor sites or (2) treatment of a superficial burn wound injury were treated. A total of 45 patients with 69 distinct wounds were included. AWBATTM-D was evaluated in donor sites and AWBATTM-S was evaluated in superficial partial-thickness burns. Days to healing, pain, hematoma/seroma formation, and infection were noted. Ease of application, adherence, transparency, and physical adaptability details were collected. Results: Average period to healing of donor sites treated with AWBAT-D (n=22 patients with n=26 wounds) was 11.2 days, σ =1.95, with a range of 8–15 days and a median of 11 days. Pain rating at 24 hours was 1.2, σ =0.43 (n=18) and at 48 hours mean was 1.2, σ =0.46 (n=15). Average period to healing of superficial burns treated with AWBAT-S (n=15 patients with n=18 wounds) was 8.1 days, σ =2.48, with a range of 5–13 days and a median of 7 days. Pain rating at 24 hours was 1.5, σ =0.85 (n=10) and at 48 hours mean was 1.75, σ =0.89 (n=8). There was zero incidence of hematoma/seroma. No infections were seen. Results indicate that AWBAT was easily applied with good initial adherence. It was noted to be transparent, conformant, and pliable. Discussion: Early experience demonstrates that AWBAT performs well on donor sites and superficial partial-thickness burns and delivers the desired attributes of a temporary skin substitute including good adherence, infection control, transparency, adapatability, and pain control. PMID:20361005

Early College High Schools

ERIC Educational Resources Information Center

Dessoff, Alan

2011-01-01

For at-risk students who stand little chance of going to college, or even finishing high school, a growing number of districts have found a solution: Give them an early start in college while they still are in high school. The early college high school (ECHS) movement that began with funding from the Bill and Melinda Gates Foundation 10 years ago…

16 CFR 0.3 - Hours.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Hours. 0.3 Section 0.3 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE ORGANIZATION § 0.3 Hours. Principal and field offices are open on each business day from 8:30 a.m. to 5 p.m. ...

48 CFR 1316.602 - Labor-hour contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Labor-hour contracts. 1316... AND CONTRACT TYPES TYPES OF CONTRACTS Time-and-Materials, Labor-Hour, and Letter Contracts 1316.602 Labor-hour contracts. ...

Early-stage aeolian protodune development and migration

NASA Astrophysics Data System (ADS)

Nield, J. M.; Baddock, M. C.; Wiggs, G.

2017-12-01

Early-stage bedforms, or protodunes, can be observed to form on sandy beaches, desert gravels or superimposed on the surfaces of larger dunes and can develop topography of 0.1 m or more over several hours. These protodunes are the precursors to embryo and eventually mature dunes, and so it is important to understand how feedbacks between flow, transport and form contribute to this development sequence. Whilst theory and conceptual models have offered some explanation for protodune existence and development, we know surprisingly little about how these bedforms initiate and migrate because it is difficult to measure small changes in form (millimetres; seconds) on highly active surfaces of limited topographic expression. Here, we employ terrestrial laser scanning (TLS) to measure morphological change at the high frequency and spatial resolution (sub-millimetre) required to gain new insights into protodune behaviour. Along with TLS derived saltation and surface moisture, additional sediment flux and windspeed measurements help to elucidate how the protodune topography interacts with airflow and sand transport. We focus on a number of coastal bedforms in various development stages including a 0.06 m high protodune which grew vertically by 0.005 m in two hours with the switch from erosion to deposition identified to occur at a point 0.07 m upwind of the crest. This growth was associated with a reduction in time-averaged sediment flux of 18% over the crestal region. We also observed a decline in lower stoss slope steepness (by 3°) and a steepening of the lee slope, indicating a reshaping of initial protodune form towards the morphology of a more mature dune. Our findings highlight the crucial role of form-flow feedbacks, even on very small bedforms, in driving early-stage bedform growth and development, and show how the use of high resolution TLS to measure both surface topography and grains moving above the surface, can offer new insights into a long standing deficiency

Hourly Updated GNSS Orbit and Clock

NASA Astrophysics Data System (ADS)

Song, S.; Xue, J.

2016-12-01

With the development of the performance of GNSS, the hourly updated orbit and clock of GNSS are paid much more attention and used by more and more users because of the timeliness and high accuracy. The hourly GNSS orbit and clock are produced routinely in Shanghai Analysis Center(AC) of the International GNSS Monitoring and Assessment Service (iGMAS).In this article, the accuracy of hourly and 6-hourly updated ultra-rapid GPS,GLONASS,GALILEO,BDS orbit and clock (SHU1 and SHU6) are analyzed relative to the final production in detail. The analysis show that, in calculation session, there's no much difference between the mean SHU1 and SHU6 RMS and STD for GNSS orbit and clock. However, for BDS clock in prediction session, the RMS and STD of BDS SHU1 are 2.6ns and 0.5ns respectively, the RMS of BDS SHU6 increase from 2.7ns to 4.5ns from the 1st to the 6th hour prediction session, but there's no much changes of STD. For GPS clock in prediction session, the RMS and STD of GPS SHU1 is quite stable with 0.5ns and 0.2ns.The RMS of GPS SHU6 clock increase from 0.6ns to 1.0ns from the 1st to the 6th hour, but STD is stable at about 0.2ns.For the orbit in calculate session, the RMS of BDS SHU1 is a little less than that of SHU6,the RMS of GPS SHU1 and SHU6 orbit are approximately at the same level. In prediction session, the RMS of IGSO/MEO for BDS SHU1 is relative stable, but the RMS of SHU6 1st-6th hour prediction session increase from about 26.5cm to 32.7cm. The RMS of GPS SHU1 orbit's prediction session is about 3.4cm,but which increase from 3.3cm to 4.3cm for GPS SHU6 1st-6th hour prediction session.The comparison of GLONASS and GALILEO orbit and clock also will be described.The results show that the hourly update is more important for BDS at this stage.Moreover,some problems appearing in satellites and stations can be found earlier by 1 hourly updated frequency.

Early versus delayed, provisional eptifibatide in acute coronary syndromes.

PubMed

Giugliano, Robert P; White, Jennifer A; Bode, Christoph; Armstrong, Paul W; Montalescot, Gilles; Lewis, Basil S; van 't Hof, Arnoud; Berdan, Lisa G; Lee, Kerry L; Strony, John T; Hildemann, Steven; Veltri, Enrico; Van de Werf, Frans; Braunwald, Eugene; Harrington, Robert A; Califf, Robert M; Newby, L Kristin

2009-05-21

Glycoprotein IIb/IIIa inhibitors are indicated in patients with acute coronary syndromes who are undergoing an invasive procedure. The optimal timing of the initiation of such therapy is unknown. We compared a strategy of early, routine administration of eptifibatide with delayed, provisional administration in 9492 patients who had acute coronary syndromes without ST-segment elevation and who were assigned to an invasive strategy. Patients were randomly assigned to receive either early eptifibatide (two boluses, each containing 180 microg per kilogram of body weight, administered 10 minutes apart, and a standard infusion > or = 12 hours before angiography) or a matching placebo infusion with provisional use of eptifibatide after angiography (delayed eptifibatide). The primary efficacy end point was a composite of death, myocardial infarction, recurrent ischemia requiring urgent revascularization, or the occurrence of a thrombotic complication during percutaneous coronary intervention that required bolus therapy opposite to the initial study-group assignment ("thrombotic bailout") at 96 hours. The key secondary end point was a composite of death or myocardial infarction within the first 30 days. Key safety end points were bleeding and the need for transfusion within the first 120 hours after randomization. The primary end point occurred in 9.3% of patients in the early-eptifibatide group and in 10.0% in the delayed-eptifibatide group (odds ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P=0.23). At 30 days, the rate of death or myocardial infarction was 11.2% in the early-eptifibatide group, as compared with 12.3% in the delayed-eptifibatide group (odds ratio, 0.89; 95% CI, 0.79 to 1.01; P=0.08). Patients in the early-eptifibatide group had significantly higher rates of bleeding and red-cell transfusion. There was no significant difference between the two groups in rates of severe bleeding or nonhemorrhagic serious adverse events. In patients who had acute

Outcome in patients admitted outside regular hospital working hours: does time until regular working hours matter?

PubMed

Nakajima, Makoto; Inatomi, Yuichiro; Yonehara, Toshiro; Watanabe, Masaki; Ando, Yukio

2015-01-01

The aim of this study was to investigate whether stratifying patients according to the time period from admission to the start of regular working hours would help detect a weekend effect in acute stroke patients. Ischemic stroke patients admitted between October 2002 and March 2012 were analyzed. Working hours were defined as 9:00-17:00 on weekdays. Patients were divided into those admitted during working hours (no-wait group) and three other groups according to the time from admission to working hours: ≤24 h (short-wait group), 24-48 h (medium-wait group), and >48 h (long-wait group). The modified Rankin Scale score and mortality at three-months were compared among the groups. Of 5625 patients, 3323 (59%) were admitted outside working hours. The proportion of patients with an mRS score 0-1 at three-months showed a decreasing trend with the time period before working hours: 47% (no-wait group), 42% (short-wait group), 42% (medium-wait group), and 38% (long-wait group), respectively (P < 0·001). When the no-wait group was used as a reference, the odds ratio for modified Rankin Scale score 0-1 was 0·88 (95% confidence interval, 0·75-1·04) in the short-wait group, 0·86 (0·69-1·07) in the medium-wait group, and 0·67 (0·53-0·85) in the long-wait group after adjusting for sex, age, premorbid mRS score, previous morbidity, stroke severity, and vascular risk factors. Mortality at three-months was not different between the no-wait group and the other groups. A weekend effect might be evident if patients were stratified according to the time period from admission until working hours. © 2014 World Stroke Organization.

Early Boost and Slow Consolidation in Motor Skill Learning

ERIC Educational Resources Information Center

Hotermans, Christophe; Peigneux, Philippe; de Noordhout, Alain Maertens; Moonen, Gustave; Maquet, Pierre

2006-01-01

Motor skill learning is a dynamic process that continues covertly after training has ended and eventually leads to delayed increments in performance. Current theories suggest that this off-line improvement takes time and appears only after several hours. Here we show an early transient and short-lived boost in performance, emerging as early as…

Breaking the Long Hours Culture.

ERIC Educational Resources Information Center

Kodz, J.; Kersley, B.; Strebler, M. T.; O'Regan, S.

Case studies of 12 leading British employers were driven by employers' interest in issues related to working long hours in light of introduction of the Working Time Directive, a European Community initiative enacted into British law that sets limits on working hours per week. Data showed over one-fourth of full-time employees worked over 48 hours…

Complete Metabolic Response of Advanced Melanoma to Vemurafenib Assessed with FDG-PET-CT at 85 Hours.

PubMed

Pascal, Pierre; Dercle, Laurent; Weyts, Kathleen; Meyer, Nicolas; Courbon, Fréderic

2018-05-01

Vemurafenib improves the management of advanced melanoma due to selective inhibition of the mutated BRAF V600E kinase. FDG-PET-CT is a tool for the evaluation of the biologic impact of inhibiting mutant BRAF. With vemurafenib at day 15, all the patients had at least partial metabolic response. Reductions in uptake correlate with longer progression free survival. In this case, incomplete information provided by the patient led to the performance of his third PET 85 hours after the introduction of vemurafenib. This early case of complete metabolic response suggests that FDG-PET-CT is a useful marker of early biologic response to vemurafenib.

Modeling temporal and spatial variability of traffic-related air pollution: Hourly land use regression models for black carbon

NASA Astrophysics Data System (ADS)

Dons, Evi; Van Poppel, Martine; Kochan, Bruno; Wets, Geert; Int Panis, Luc

2013-08-01

Land use regression (LUR) modeling is a statistical technique used to determine exposure to air pollutants in epidemiological studies. Time-activity diaries can be combined with LUR models, enabling detailed exposure estimation and limiting exposure misclassification, both in shorter and longer time lags. In this study, the traffic related air pollutant black carbon was measured with μ-aethalometers on a 5-min time base at 63 locations in Flanders, Belgium. The measurements show that hourly concentrations vary between different locations, but also over the day. Furthermore the diurnal pattern is different for street and background locations. This suggests that annual LUR models are not sufficient to capture all the variation. Hourly LUR models for black carbon are developed using different strategies: by means of dummy variables, with dynamic dependent variables and/or with dynamic and static independent variables. The LUR model with 48 dummies (weekday hours and weekend hours) performs not as good as the annual model (explained variance of 0.44 compared to 0.77 in the annual model). The dataset with hourly concentrations of black carbon can be used to recalibrate the annual model, resulting in many of the original explaining variables losing their statistical significance, and certain variables having the wrong direction of effect. Building new independent hourly models, with static or dynamic covariates, is proposed as the best solution to solve these issues. R2 values for hourly LUR models are mostly smaller than the R2 of the annual model, ranging from 0.07 to 0.8. Between 6 a.m. and 10 p.m. on weekdays the R2 approximates the annual model R2. Even though models of consecutive hours are developed independently, similar variables turn out to be significant. Using dynamic covariates instead of static covariates, i.e. hourly traffic intensities and hourly population densities, did not significantly improve the models' performance.

The Early Years: Animal Adventures

ERIC Educational Resources Information Center

Ashbrook, Peggy

2007-01-01

Children can have a new favorite animal every week or even every hour. The more familiar the children become with an animal, the more they will be able to understand how its body form and behavior allow it to survive. Learning about the characteristics of organisms and how organisms relate to their environment is part of the National Science…

Making residency work hour rules work.

PubMed

Cohen, I Glenn; Czeisler, Charles A; Landrigan, Christopher P

2013-01-01

In July 2011, the ACGME implemented new rules that limit interns to 16 hours of work in a row, but continue to allow 2nd-year and higher resident physicians to work for up to 28 consecutive hours. Whether the ACGME's 2011 work hour limits went too far or did not go far enough has been hotly debated. In this article, we do not seek to re-open the debate about whether these standards get matters exactly right. Instead, we wish to address the issue of effective enforcement. That is, now that new work hour limits have been established, and given that the ACGME has been unable to enforce work hour limits effectively on its own, what is the best way to make sure the new limits are followed in order to reduce harm to residents, patients, and others due to sleep-deprived residents? We focus on three possible national approaches to the problem, one rooted in funding, one rooted in disclosure, and one rooted in tort law. © 2013 American Society of Law, Medicine & Ethics, Inc.

24-hour urinary aldosterone excretion test

MedlinePlus

Aldosterone - urine; Addison disease - urine aldosterone; Cirrhosis - serum aldosterone ... A 24-hour urine sample is needed. You will need to collect your urine over 24 hours . Your health care provider will tell ...

Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy.

PubMed

Kaakaji, W; Barnett, G H; Bernhard, D; Warbel, A; Valaitis, K; Stamp, S

2001-06-01

The goal of this study was to determine the clinical and economic consequences of early discharge (< 8 hours) of patients following stereotactic brain biopsy (SBB). The records of all patients who underwent percutaneous SBB at The Cleveland Clinic Foundation, a tertiary care teaching hospital, during 1994 and 1995 (Group A) were retrospectively reviewed to collect data on the nature and timing of perioperative (< 48 hours) clinical and radiological complications. Biopsies were performed using image-guided stereotaxy either with or without a frame. Based on the results, guidelines for early discharge of patients following SBB were implemented. Information on the nature and timing of perioperative complications was also collected prospectively in all patients who underwent percutaneous SBB from January 1996 through July 1998 (Group B). Hospital financial records for patients who underwent SBB in 1997 and 1998 were also reviewed and assessed for net revenue stratified by discharge status: early discharge (< 8 hours), extended outpatient observation (> or = 8 and < 24 hours). and inpatient hospitalization (> or = 24 hours). In Group A, 130 biopsies were performed. There were five serious complications (3.8%), of which four were transient, and there was one death (0.8%). The death and any sustained deficit occurred in patients in whom a clot had been demonstrated on postoperative CT scans. All complications were detected within 6 hours after surgery. Intraoperative bleeding occurred in 12 patients (9.2%), but was associated with only 40% of cases in which hemorrhage appeared on postoperative CT scans. Guidelines for early discharge (< 8 hours) following SBB were developed and stipulated the absence of the following: 1) intraoperative hemorrhage; 2) new postoperative deficit; and 3) clot on a postoperative CT scan. In Group B, 139 biopsies were performed. There were three serious complications (2.2%), one of which was sustained due to a clot that had been demonstrated on

2,445 Hours of Code: What I Learned from Facilitating Hour of Code Events in High School Libraries

ERIC Educational Resources Information Center

Colby, Jennifer

2015-01-01

This article describes a school librarian's experience with initiating an Hour of Code event for her school's student body. Hadi Partovi of Code.org conceived the Hour of Code "to get ten million students to try one hour of computer science" (Partovi, 2013a), which is implemented during Computer Science Education Week with a goal of…

Evaluation of airfield pavement evenness

NASA Astrophysics Data System (ADS)

Pietruszewski, Paweł; Poświata, Adam; Wesołowski, Mariusz

2018-05-01

The evenness of airfield pavements is one of the basic operating parameters, which characterize them. The evenness determines not only comfort of traffic along an airfield pavement, but also influences the size of dynamic effect on the pavement, hence, the safety of air operations. In addition, the evenness condition changing as a result of dynamic loads, adverse weather conditions or inappropriate airfield pavement construction technology, lead to deviations from the desired condition in the form of longitudinal and transverse unevenness. As a result, systematic and correct performance of tests is a very significant and required factor impacting the improvement of traffic safety on airfield pavements. If the data obtained through the measurements are not sufficiently reliable, they may consequently lead to making incorrect decisions, which can ultimately impact the safety of air operations.

Is the Office Hour Obsolete?

ERIC Educational Resources Information Center

Behrens, Susan

2013-01-01

A colleague can't make a coffee date at a time the author proposes because it would conflict with his office hour. No student has actually made an appointment with him during the hour, but he is committed to being in his office as promised in case someone drops by. The author's reaction to her colleague's faithfulness to his posted office hour…

Postpartum Early and Extended Contact: Quality, Quantity or Both?

ERIC Educational Resources Information Center

Hopkins, John B.; Vietze, Peter M.

This study examined the effects of early vs. extended mother-infant contact on infant, maternal and interactional outcomes in the lying-in period for 104 lower class mother-infant dyads. The early contact treatment consisted of placing the mother and neonate together for 10 to 45 minutes within the first 3 postpartum hours. The extended contact…

Change from an 8-hour shift to a 12-hour shift, attitudes, sleep, sleepiness and performance.

PubMed

Lowden, A; Kecklund, G; Axelsson, J; Akerstedt, T

1998-01-01

The present study sought to evaluate the effect of a change from a rotating 3-shift (8-hour) to a 2-shift shift (12 hour) schedule on sleep, sleepiness, performance, perceived health, and well-being. Thirty-two shift workers at a chemical plant (control room operators) responded to a questionnaire a few months before a change was made in their shift schedule and 10 months after the change. Fourteen workers also filled out a diary, carried activity loggers, and carried out reaction-time tests (beginning and end of shift). Fourteen day workers served as a reference group for the questionnaires and 9 were intensively studied during a week with workdays and a free weekend. The questionnaire data showed that the shift change increased satisfaction with workhours, sleep, and time for social activities. Health, perceived accident risk, and reaction-time performance were not negatively affected. Alertness improved and subjective recovery time after night work decreased. The quick changes in the 8-hour schedule greatly increased sleep problems and fatigue. Sleepiness integrated across the entire shift cycle showed that the shift workers were less alert than the day workers, across workdays and days off (although alertness increased with the 12-hour shift). The change from 8-hour to 12-hour shifts was positive in most respects, possibly due to the shorter sequences of the workdays, the longer sequences of consecutive days off, the fewer types of shifts (easier planning), and the elimination of quick changes. The results may differ in groups with a higher work load.

48 CFR 536.570-5 - Working hours.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Working hours. 536.570-5... CATEGORIES OF CONTRACTING CONSTRUCTION AND ARCHITECT-ENGINEER CONTRACTS Contract Clauses 536.570-5 Working hours. Insert 552.236-74, Working Hours, in solicitations and contracts if construction, dismantling...

Evening Primrose Oil

MedlinePlus

... About NCCIH NCCIH At a Glance Mission and Vision Organizational Structure Director's Message Strategic Plans & Reports Budget & Legislation Advisory Council Job Opportunities All About NCCIH Health Topics A-Z # A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Evening Primrose Oil Share: On This Page ...

50 CFR 20.23 - Shooting hours.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PLANTS (CONTINUED) MIGRATORY BIRD HUNTING Taking § 20.23 Shooting hours. No person shall take migratory game birds except during the hours open to shooting as prescribed in subpart K of this part and subpart...

Early Enteral Nutrition in Burns: Compliance With Guidelines and Associated Outcomes in a Multicenter Study

PubMed Central

Mosier, Michael J.; Pham, Tam N.; Klein, Matthew B.; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Tompkins, Ronald G.; Herndon, David N.

2013-01-01

Early nutritional support is an essential component of burn care to prevent ileus, stress ulceration, and the effects of hypermetabolism. The American Burn Association practice guidelines state that enteral feedings should be initiated as soon as practical. The authors sought to evaluate compliance with early enteral nutrition (EN) guidelines, associated complications, and hospitalization outcomes in a prospective multicenter observational study. They conducted a retrospective review of mechanically ventilated burn patients enrolled in the prospective observational multicenter study “Inflammation and the Host Response to Injury.” Timing of initiation of tube feedings was recorded, with early EN defined as being started within 24 hours of admission. Univariate and multivariate analyses were performed to distinguish barriers to initiation of EN and the impact of early feeding on development of multiple organ dysfunction syndrome, infectious complications, days on mechanical ventilation, intensive care unit (ICU) length of stay, and survival. A total of 153 patients met study inclusion criteria. The cohort comprised 73% men, with a mean age of 41 ± 15 years and a mean %TBSA burn of 46 ± 18%. One hundred twenty-three patients (80%) began EN in the first 24 hours and 145 (95%) by 48 hours. Age, sex, inhalation injury, and full-thickness burn size were similar between those fed by 24 hours vs after 24 hours, except for higher mean Acute Physiology and Chronic Health Evaluation II scores (26 vs 23, P = .03) and smaller total burn size (44 vs 54% TBSA burn, P = .01) in those fed early. There was no significant difference in rates of hyperglycemia, abdominal compartment syndrome, or gastrointestinal bleeding between groups. Patients fed early had shorter ICU length of stay (adjusted hazard ratio 0.57, P = 0.03, 95% confidence interval 0.35–0.94) and reduced wound infection risk (adjusted odds ratio 0.28, P = 0.01, 95% confidence interval 0.10–0.76). The

Pregnancy outcomes using stallion epididymal sperm stored at 5 °C for 24 or 48 hours before harvest.

PubMed

Stawicki, R J; McDonnell, S M; Giguère, S; Turner, R M

2016-03-01

The cryopreservation of epididymal sperm can be useful in a variety of circumstances for ensuring genetic preservation of a valued stallion. Although early studies have reported pregnancy rates significantly lower than those achieved with cryopreserved ejaculated sperm, two recent studies report over 60% one-cycle pregnancy rates with epididymal sperm stored for 24 hours at 5 °C before harvest and cryopreservation. The aims of this study were to: (1) attempt to replicate the one-cycle pregnancy rate of over 60% using epididymal sperm cooled and stored within the epididymis for 24 hours before harvest and cryopreservation and (2) evaluate pregnancy outcome with sperm cooled and stored within the epididymis for 48 hours before sperm harvest and cryopreservation. Testicles were obtained from 13 stallions undergoing routine castration. The epididymides were stored at 5 °C for either 24 or 48 hours before sperm harvest and cryopreservation in an egg yolk and dimethylformamide-based freezing extender. Thirteen mares were bred on one cycle with cryopreserved epididymal sperm stored for 24 hours before harvest, and 10 of those 13 mares were also bred on a previous or subsequent cycle with samples from the same stallion that had been stored for 48 hours before harvest. Pregnancy occurred in 7 of the 13 inseminations of sperm stored for 24 hours before harvest, and in 4 of the 10 inseminations of sperm stored for 48 hours before harvest. The pregnancy rate using epididymal sperm stored for 24 hours before harvest is consistent with that of previous reports. In addition, these results provide evidence that pregnancies can be achieved when the epididymides are cooled and stored for 48 hours before sperm harvest and cryopreservation. Copyright © 2016 Elsevier Inc. All rights reserved.

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2010 CFR

2010-01-01

....184. This average is computed by dividing the total unscheduled duty hours for the annual period... workday means each day in the criminal investigator's basic workweek during which the investigator works at least 4 hours, excluding— (1) Overtime hours compensated under 5 U.S.C. 5542 and § 550.111; (2...

48 CFR 2816.602 - Labor-hour contracts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Labor-hour contracts. 2816... and Contract Types TYPES OF CONTRACTS Time-and-Materials, Labor-Hour, and Letter Contracts 2816.602 Labor-hour contracts. The limitations set forth in 2816.601 for time-and-material contracts also apply...

Scheduled evening sleep and enhanced lighting improve adaptation to night shift work in older adults.

PubMed

Chinoy, Evan D; Harris, Michael P; Kim, Min Ju; Wang, Wei; Duffy, Jeanne F

2016-12-01

We tested whether a sleep and circadian-based treatment shown to improve circadian adaptation to night shifts and attenuate negative effects on alertness, performance and sleep in young adults would also be effective in older adults. We assessed subjective alertness, sustained attention (psychomotor vigilance task, PVT), sleep duration (actigraphy) and circadian timing (salivary dim-light melatonin onset, DLMO) in 18 older adults (57.2±3.8 years; mean±SD) in a simulated shift work protocol. 4 day shifts were followed by 3 night shifts in the laboratory. Participants slept at home and were randomised to either the treatment group (scheduled evening sleep and enhanced lighting during the latter half of night shifts) or control group (ad-lib sleep and typical lighting during night shifts). Compared with day shifts, alertness and sustained attention declined on the first night shift in both groups, and was worse in the latter half of the night shifts. Alertness and attention improved on nights 2 and 3 for the treatment group but remained lower for the control group. Sleep duration in the treatment group remained similar to baseline (6-7 hours) following night shifts, but was shorter (3-5 hours) following night shifts in the control group. Treatment group circadian timing advanced by 169.3±16.1 min (mean±SEM) but did not shift (-9.7±9.9 min) in the control group. The combined treatment of scheduled evening sleep and enhanced lighting increased sleep duration and partially aligned circadian phase with sleep and work timing, resulting in improved night shift alertness and performance. 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/.

Objective working hour characteristics and work-life conflict among hospital employees in the Finnish public sector study.

PubMed

Karhula, Kati; Puttonen, Sampsa; Ropponen, Annina; Koskinen, Aki; Ojajärvi, Anneli; Kivimäki, Mika; Härmä, Mikko

2017-01-01

This epidemiological cohort study, based on Finnish public sector data, investigated the associations between objective working hour characteristics and work-life conflict in day and shift work. The comprehensive data of hospital workers (n = 8 931, 92% women, average age 45 years), consisted of survey responses from 2012, linked with the payroll data of working hour characteristics from 91 days preceding the survey. Logistic regression analysis was used to investigate the associations between working hour characteristics and experiencing work-life conflict often/very often. The analyses were adjusted for age (< 39, 40-49 and >50 years), sex, level of education, marital status, number of small (0-6 years) and school-aged (7-18 years) children, and the overall stressfulness of the life situation. We also conducted stratified analyses of age and sex on the basis of significant interactions. Difficulties in combining work and life were more often associated with shift work without night shifts and shift work with night shifts than with day work (41% and 34 versus 27%; OR for shift work with night shifts 1.78, 95% CI 1.59-2.00, OR for shift work without night shifts 1.42, 95% CI 1.26-1.60). A high proportion (> 25%) of long (> 40h, (OR 1.26, 95% 1.14-1.39) and very long (> 48h, OR 1.31, 95% CI 1.15-1.49) weekly working hours were associated with work-life conflict, and in the stratified analysis, the latter was also true among women (OR 1.54, 95% CI 1.25-1.89). Of the unsocial working hour characteristics, a relatively large amount (> 10% of all shifts) of evening (OR 1.56, 95% CI 1.41-1.72) and night shifts (OR 1.46, 95%CI 1.32-1.61), a high proportion (> 25% of all shifts) of quick returns (< 11h) (OR 1.46, 95% CI 1.31-1.63), and weekend work (OR 1.44, 95% CI 1.31-1.58) were associated with work-life conflict. A large amount of single days off (> 25% of all days off) was associated with work-life conflict among men (OR 1.90, 95% CI 1.11-3.25), but not in the whole

How extreme is extreme hourly precipitation?

NASA Astrophysics Data System (ADS)

Papalexiou, Simon Michael; Dialynas, Yannis G.; Pappas, Christoforos

2016-04-01

The importance of accurate representation of precipitation at fine time scales (e.g., hourly), directly associated with flash flood events, is crucial in hydrological design and prediction. The upper part of a probability distribution, known as the distribution tail, determines the behavior of extreme events. In general, and loosely speaking, tails can be categorized in two families: the subexponential and the hyperexponential family, with the first generating more intense and more frequent extremes compared to the latter. In past studies, the focus has been mainly on daily precipitation, with the Gamma distribution being the most popular model. Here, we investigate the behaviour of tails of hourly precipitation by comparing the upper part of empirical distributions of thousands of records with three general types of tails corresponding to the Pareto, Lognormal, and Weibull distributions. Specifically, we use thousands of hourly rainfall records from all over the USA. The analysis indicates that heavier-tailed distributions describe better the observed hourly rainfall extremes in comparison to lighter tails. Traditional representations of the marginal distribution of hourly rainfall may significantly deviate from observed behaviours of extremes, with direct implications on hydroclimatic variables modelling and engineering design.

5 CFR 551.421 - Regular working hours.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Regular working hours. 551.421 Section... Activities § 551.421 Regular working hours. (a) Under the Act there is no requirement that a Federal employee... distinction based on whether the activity is performed by an employee during regular working hours or outside...

The hour-to-hour influence of weather conditions on walking and cycling among Dutch older adults.

PubMed

Prins, Richard G; van Lenthe, F J

2015-09-01

physical activity (PA) is an important factor to promote healthy ageing. However, older adults are not physically active enough. Socio-ecological models suggest that weather conditions are determinants of PA and may bias relations between other environmental factors and PA. This may especially be the case for the most vulnerable and inactive older persons. Understanding the role of weather conditions is based on daily or seasonal variation in weather, but it can be improved by using hour-to-hour measured weather conditions. to study the hour-to-hour relationships between weather factors and objectively measured walking and cycling in a sample of Dutch older adults. baseline data (2013) of a sub-sample of older adults (3,248 observations clustered in 43 adults) participating in The Neighborhood Walking in Rotterdam Older ADultS (NEW.ROADS) trial were used. Participants wore a GPS logger for 7 consecutive days. Hour-to-hour weather data (temperature, wind speed, rain and sun time) for the city of Rotterdam were retrieved from the Royal Netherlands Meteorological Institute. Multilevel linear regression models were fitted with minutes walked and minutes cycled as dependent variables and the weather variables as independent variables. the time older adults walked increased with higher temperature, higher wind speed and the absence of rain. The time cycled increased with higher temperature. this study improves the evidence of weather factors as a determinant for walking and cycling in older adults. Studies on the relation between environmental factors and PA should consider adjustment for weather factors. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A high temporal-spatial vehicle emission inventory based on detailed hourly traffic data in a medium-sized city of China.

PubMed

Liu, Yong-Hong; Ma, Jin-Ling; Li, Li; Lin, Xiao-Fang; Xu, Wei-Jia; Ding, Hui

2018-05-01

To improve the accuracy and temporal-spatial resolution for a vehicle emission inventory in a medium-sized city with a strip road network, this study was conducted based on detailed hourly traffic-flow data for each day of 2014, and covered all road types and regions in the city of Foshan. Detailed hourly emission characteristics and sources in five regions were analysed. The results showed that the total vehicle emissions of CO, NO X , VOCs, and PM 2.5 were 13.10 × 10 4 , 0.23 × 10 4 , 4.46 × 10 4 , and 0.18 × 10 4 tons, respectively. Motorcycles (MCs) and light passenger cars (LPCs) were the dominant contributors of CO emissions, while buses and heavy passenger cars (HPCs) were the dominant contributors for NO X . As a whole, the daytime contributions to total emissions were close to 80%, and emissions during the peak periods accounted for almost 40%. Specifically, the hourly emissions of each pollutant on workdays were higher than on non-workdays (maximum up to 64.2%), and for some roads the early peak periods changed significantly from workdays to non-workdays. At expressways, artery roads, and local roads, the daily emission intensities of CO, NOx, and PM 2.5 in Foshan were close to or even higher than that of Beijing. On a regional scale, the temporal variation of vehicle emissions on workdays at artery roads of different regions were similar. In addition, the higher emission intensities of CO and VOCs were identified in DaLiang-RongGui (DLRG) and that of NO X and PM 2.5 were in Central Region (CR). These results are meaningful for decision-makers to help provide more detailed vehicle pollution control measures in Foshan with a strip road network and only one ring road. Copyright © 2018 Elsevier Ltd. All rights reserved.

The working hours of general practitioners 2000-2008.

PubMed

Aasland, Olaf G; Rosta, Judith

2011-06-03

There is little reliable information available on the working hours of general practitioners (GPs). The purpose of our study is to describe the development of weekly working hours of Norwegian general practitioners in the period from 2000 to 2008, as well as the length of their patient lists and their perceived workload. General practitioners in the reference panel of the Research Institute of the Norwegian Medical Association have reported their weekly working hours for 2000, 2002, 2004, 2006 and 2008, and the length of their patient lists for 2002 and 2008. We used non-overlapping 95 per cent confidence intervals for testing inter-group differences in interval variables and proportions. From 227 to 316 general practitioners responded to each survey round. Average weekly working hours constituted 45.1 hours (95 per cent CI: 43.6-46.5 hours) in 2000 and 46.4 hours (95 per cent CI: 45.2-47.6 hours) in 2008. The number of hours increased for women GPs, while the number of hours remained basically unchanged for men from 2000 to 2008. Average length of the patient lists in 2002 and 2008 constituted 1,325 and 1,278 for men, and 1,155 and 1,144 for women GPs respectively. The proportion of GPs who responded that they perceived their workload as unacceptable decreased significantly, from 38.1 per cent in 2000 to 25.5 per cent in 2008. Average weekly working hours for GPs increased by approximately one hour from 2000 to 2008, and this increase is found mainly among women GPs. We believe that the reduction in the proportion reporting to have an unacceptable workload can be explained by the introduction of the list-patient system, which has given the doctors better control of their own workload.

19 CFR 101.6 - Hours of business.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Hours of business. 101.6 Section 101.6 Customs... GENERAL PROVISIONS § 101.6 Hours of business. Except as specified in paragraphs (a) through (g) of this section, each CBP office shall be open for the transactions of general CBP business between the hours of 8...

19 CFR 101.6 - Hours of business.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Hours of business. 101.6 Section 101.6 Customs... GENERAL PROVISIONS § 101.6 Hours of business. Except as specified in paragraphs (a) through (g) of this section, each CBP office shall be open for the transactions of general CBP business between the hours of 8...

19 CFR 101.6 - Hours of business.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Hours of business. 101.6 Section 101.6 Customs... GENERAL PROVISIONS § 101.6 Hours of business. Except as specified in paragraphs (a) through (g) of this section, each CBP office shall be open for the transactions of general CBP business between the hours of 8...

29 CFR 778.101 - Maximum nonovertime hours.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Maximum nonovertime hours. 778.101 Section 778.101 Labor... Requirements Introductory § 778.101 Maximum nonovertime hours. As a general standard, section 7(a) of the Act provides 40 hours as the maximum number that an employee subject to its provisions may work for an employer...

The future of work hours--the European view.

PubMed

Akerstedt, Torbjörn; Kecklund, Göran

2005-01-01

In Europe the way work hours are handled varies between different countries. However, there are some issues that dominate the discussion in Europe and seem representative for what is happening. One such is the reduction of working hours--which was attempted in several countries but which now seems to be backfiring--probably related to the competition from countries outside Europe. Another area is compressed work hours--the drive towards maximizing the hours per work day in order to increase the number of days off. The health effects are debated--some find clear positive effects. A third area is company oriented flexible work hours, permitting the employer to make moderate changes in work hours when needed. The health impacts have not been evaluated but the loss of individual influence at work is obvious. In some parts of Europe self-determined work hours have been tried with very positive effects. The EU work hour directive is intended to provide uniformity but permits a counterproductive "opting out", creating problems of imbalance.

The effects of RN staffing hours on nursing home quality: a two-stage model.

PubMed

Lee, Hyang Yuol; Blegen, Mary A; Harrington, Charlene

2014-03-01

Based on structure-process-outcome approach, this study examined the association of registered nurse (RN) staffing hours and five quality indicators, including two process measures (catheter use and antipsychotic drug use) and three outcome measures (pressure ulcers, urinary tract infections, and weight loss). We used data on resident assessments, RN staffing, organizational characteristics, and market factors to examine the quality of 195 nursing homes operating in a rural state of United States - Colorado. Two-stage least squares regression models were performed to address the endogenous relationships between RN staffing and the outcome-related quality indicators, and ordinary least squares regression was used for the process-related ones. This analysis focused on the relationship of RN staffing to nursing home quality indicators, controlling for organizational characteristics, resources, resident casemix, and market factors with clustering to control for geographical differences. Higher RN hours were associated with fewer pressure ulcers, but RN hours were not related to the other quality indicators. The study finding shows the importance of understanding the role of 'nurse staffing' under nursing home care, as well as the significance of associated/contextual factors with nursing home quality even in a small rural state. Copyright © 2013 Elsevier Ltd. All rights reserved.

Index Blood Tests and National Early Warning Scores within 24 Hours of Emergency Admission Can Predict the Risk of In-Hospital Mortality: A Model Development and Validation Study

PubMed Central

Mohammed, Mohammed A.; Rudge, Gavin; Watson, Duncan; Wood, Gordon; Smith, Gary B.; Prytherch, David R.; Girling, Alan; Stevens, Andrew

2013-01-01

Background We explored the use of routine blood tests and national early warning scores (NEWS) reported within ±24 hours of admission to predict in-hospital mortality in emergency admissions, using empirical decision Tree models because they are intuitive and may ultimately be used to support clinical decision making. Methodology A retrospective analysis of adult emergency admissions to a large acute hospital during April 2009 to March 2010 in the West Midlands, England, with a full set of index blood tests results (albumin, creatinine, haemoglobin, potassium, sodium, urea, white cell count and an index NEWS undertaken within ±24 hours of admission). We developed a Tree model by randomly splitting the admissions into a training (50%) and validation dataset (50%) and assessed its accuracy using the concordance (c-) statistic. Emergency admissions (about 30%) did not have a full set of index blood tests and/or NEWS and so were not included in our analysis. Results There were 23248 emergency admissions with a full set of blood tests and NEWS with an in-hospital mortality of 5.69%. The Tree model identified age, NEWS, albumin, sodium, white cell count and urea as significant (p<0.001) predictors of death, which described 17 homogeneous subgroups of admissions with mortality ranging from 0.2% to 60%. The c-statistic for the training model was 0.864 (95%CI 0.852 to 0.87) and when applied to the testing data set this was 0.853 (95%CI 0.840 to 0.866). Conclusions An easy to interpret validated risk adjustment Tree model using blood test and NEWS taken within ±24 hours of admission provides good discrimination and offers a novel approach to risk adjustment which may potentially support clinical decision making. Given the nature of the clinical data, the results are likely to be generalisable but further research is required to investigate this promising approach. PMID:23734195

Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

PubMed

Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine

2017-04-18

Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage: Individual Patient Data Meta-Analysis.

PubMed

Dorhout Mees, Sanne M; Algra, Ale; Wong, George K C; Poon, Wai S; Bradford, Celia M; Saver, Jeffrey L; Starkman, Sidney; Rinkel, Gabriel J E; van den Bergh, Walter M; van Kooten, F; Dirven, C M; van Gijn, J; Vermeulen, M; Rinkel, G J E; Boet, R; Chan, M T V; Gin, T; Ng, S C P; Zee, B C Y; Al-Shahi Salman, R; Boiten, J; Kuijsten, H; Lavados, P M; van Oostenbrugge, R J; Vandertop, W P; Finfer, S; O'Connor, A; Yarad, E; Firth, R; McCallister, R; Harrington, T; Steinfort, B; Faulder, K; Assaad, N; Morgan, M; Starkman, S; Eckstein, M; Stratton, S J; Pratt, F D; Hamilton, S; Conwit, R; Liebeskind, D S; Sung, G; Kramer, I; Moreau, G; Goldweber, R; Sanossian, N

2015-11-01

Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH. Patients were divided into categories according to the delay between symptom onset and start of the study medication: <6, 6 to 12, 12 to 24, and >24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI. We included 5 trials totaling 1981 patients; 83 patients started treatment<6 hours. For poor outcome, the adjusted risk ratios of magnesium treatment for start <6 hours were 1.44 (95% confidence interval, 0.83-2.51); for 6 to 12 hours 1.03 (0.65-1.63), for 12 to 24 hours 0.84 (0.65-1.09), and for >24 hours 1.06 (0.87-1.31), and for DCI, <6 hours 1.76 (0.68-4.58), for 6 to 12 hours 2.09 (0.99-4.39), for 12 to 24 hours 0.80 (0.56-1.16), and for >24 hours 1.08 (0.88-1.32). This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH. © 2015 American Heart Association, Inc.

Effectiveness of the Twelve-Hour Shift.

ERIC Educational Resources Information Center

Brinton, Robert D.

1983-01-01

Although labor unions traditionally have fought for shorter working hours, there have been recent reversals in this trend. The Pulp and Paperboard Division of Temple-Eastex Incorporated converted to a 12-hour shift and found that safety improved, productivity increased, and overtime decreased. (JOW)

UncertiantyQuantificationinTsunamiEarlyWarningCalculations

NASA Astrophysics Data System (ADS)

Anunziato, Alessandro

2016-04-01

The objective of the Tsunami calculations is the estimation of the impact of waves caused by large seismic events on the coasts and the determination of potential inundation areas. In the case of Early Warning Systems, i.e. systems that should allow to anticipate the possible effects and give the possibility to react consequently (i.e. issue evacuation of areas at risk), this must be done in very short time (minutes) to be effective. In reality, the above estimation includes several uncertainty factors which make the prediction extremely difficult. The quality of the very first estimations of the seismic parameters is not very precise: the uncertainty in the determination of the seismic components (location, magnitude and depth) decreases with time because as time passes it is possible to use more and more seismic signals and the event characterization becomes more precise. On the other hand other parameters that are necessary to establish for the performance of a calculation (i.e. fault mechanism) are difficult to estimate accurately also after hours (and in some cases remain unknown) and therefore this uncertainty remains in the estimated impact evaluations; when a quick tsunami calculation is necessary (early warning systems) the possibility to include any possible future variation of the conditions to establish the "worst case scenario" is particularly important. The consequence is that the number of uncertain parameters is so large that it is not easy to assess the relative importance of each of them and their effect on the predicted results. In general the complexity of system computer codes is generated by the multitude of different models which are assembled into a single program to give the global response for a particular phenomenon. Each of these model has associated a determined uncertainty coming from the application of that model to single cases and/or separated effect test cases. The difficulty in the prediction of a Tsunami calculation response is

The Impact of Using Different Methods to Assess Completeness of 24-Hour Urine Collection on Estimating Dietary Sodium.

PubMed

Wielgosz, Andreas; Robinson, Christopher; Mao, Yang; Jiang, Ying; Campbell, Norm R C; Muthuri, Stella; Morrison, Howard

2016-06-01

The standard for population-based surveillance of dietary sodium intake is 24-hour urine testing; however, this may be affected by incomplete urine collection. The impact of different indirect methods of assessing completeness of collection on estimated sodium ingestion has not been established. The authors enlisted 507 participants from an existing community study in 2009 to collect 24-hour urine samples. Several methods of assessing completeness of urine collection were tested. Mean sodium intake varied between 3648 mg/24 h and 7210 mg/24 h depending on the method used. Excluding urine samples collected for longer or shorter than 24 hours increased the estimated urine sodium excretion, even when corrections for the variation in timed collections were applied. Until an accurate method of indirectly assessing completeness of urine collection is identified, the gold standard of administering para-aminobenzoic acid is recommended. Efforts to ensure participants collect complete urine samples are also warranted. ©2015 Wiley Periodicals, Inc.

The Student Credit Hour: Counting What Counts

ERIC Educational Resources Information Center

Wellman, Jane

2005-01-01

The article discusses the student credit hour (SCH). The author begins with a rethinking of the basic unit of measurement in American higher education--the SCH. The credit hour was developed at the turn of the 20th century as a measure of student time in the classroom: one hour per week in class for one semester equalled one SCH. The credit hour…

Extending the Precipitation Map Offshore Using Daily and 3-Hourly Combined Precipitation Estimates

NASA Technical Reports Server (NTRS)

Huffman, George J.; Adler, Robert F.; Bolvin, David T.; Curtis, Scott; Einaudi, Franco (Technical Monitor)

2001-01-01

One of the difficulties in studying landfalling extratropical cyclones along the Pacific Coast is the lack of antecedent data over the ocean, including precipitation. Recent research on combining various satellite-based precipitation estimates opens the possibility of realistic precipitation estimates on a global 1 deg. x 1 deg. latitude-longitude grid at the daily or even 3-hourly interval. The goal in this work is to provide quantitative precipitation estimates that correctly represent the precipitation- related variables in the hydrological cycle: surface accumulations (fresh-water flux into oceans), frequency and duration statistics, net latent heating, etc.

Association between sleeping hours, working hours and obesity in Hong Kong Chinese: the 'better health for better Hong Kong' health promotion campaign.

PubMed

Ko, G T C; Chan, J C N; Chan, A W Y; Wong, P T S; Hui, S S C; Tong, S D Y; Ng, S-M; Chow, F; Chan, C L W

2007-02-01

To study the inter-relationships between sleeping hours, working hours and obesity in subjects from a working population. A cross-sectional observation study under the 'Better Health for Better Hong Kong' Campaign, which is a territory-wide health awareness and promotion program. 4793 subjects (2353 (49.1%) men and 2440 (50.9%) women). Their mean age (+/-s.d.) was 42.4+/-8.9 years (range 17-83 years, median 43.0 years). Subjects were randomly selected using computer-generated codes in accordance to the distribution of occupational groups in Hong Kong. The mean daily sleeping time was 7.06+/-1.03 h (women vs men: 7.14+/-1.08 h vs 6.98+/-0.96 h, P<0.001). Increasing body mass index (BMI) was associated with reducing number of sleeping hours and increasing number of working hours reaching significance in the whole group as well as among male subjects. Those with short sleeping hour (6 h or less) and long working hours (>9 h) had the highest BMI and waist in both men and women. Based on multiple regression analysis with age, smoking, alcohol drinking, systolic and diastolic blood pressure, mean daily sleeping hours and working hours as independent variables, BMI was independently associated with age, systolic and diastolic blood pressure in women, whereas waist was associated with age, smoking and blood pressure. In men, blood pressure, sleeping hours and working hours were independently associated with BMI, whereas waist was independently associated with age, smoking, blood pressure, sleeping hours and working hours in men. Obesity is associated with reduced sleeping hours and long working hours in men among Hong Kong Chinese working population. Further studies are needed to investigate the underlying mechanisms of this relationship and its potential implication on prevention and management of obesity.

Use and Underlying Reasons for Duty Hour Flexibility in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.

PubMed

Bilimoria, Karl Y; Quinn, Christopher M; Dahlke, Allison R; Kelz, Rachel R; Shea, Judy A; Rajaram, Ravi; Love, Remi; Kreutzer, Lindsey; Biester, Thomas; Yang, Anthony D; Hoyt, David B; Lewis, Frank R

2017-02-01

The Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial randomly assigned surgical residency programs to either standard duty hour policies or flexible policies that eliminated caps on shift lengths and time off between shifts. Our objectives were to assess adherence to duty hour requirements in the Standard Policy arm and examine how often and why duty hour flexibility was used in the Flexible Policy arm. A total of 3,795 residents in the FIRST trial completed a survey in January 2016 (response rate >95%) that asked how often and why they exceeded current standard duty hour limits in both study arms. Flexible Policy interns worked more than 16 hours continuously at least once in a month more frequently than Standard Policy residents (86% vs 37.8%). Flexible Policy residents worked more than 28 hours once in a month more frequently than Standard Policy residents (PGY1: 64% vs 2.9%; PGY2 to 3: 62.4% vs 41.9%; PGY4 to 5: 52.2% vs 36.6%), but this occurred most frequently only 1 to 2 times per month. Although residents reported working more than 80 hours in a week 3 or more times in the most recent month more frequently under Flexible Policy vs Standard Policy (19.9% vs 16.2%), the difference was driven by interns (30.9% vs 19.6%), and there were no significant differences in exceeding 80 hours among PGY2 to 5 residents. The most common reasons reported for extending duty hours were facilitating care transitions (76.6%), stabilizing critically ill patients (70.7%), performing routine responsibilities (67.9%), and operating on patients known to the trainee (62.0%). There were differences in duty hours worked by residents in the Flexible vs Standard Policy arms of the FIRST trial, but it appeared that residents generally used the flexibility for patient care and educational opportunities selectively. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Delinking resident duty hours from patient safety

PubMed Central

2014-01-01

Patient safety is a powerful motivating force for change in modern medicine, and is often cited as a rationale for reducing resident duty hours. However, current data suggest that resident duty hours are not significantly linked to important patient outcomes. We performed a narrative review and identified four potential explanations for these findings. First, we question the relevance of resident fatigue in the creation of harmful errors. Second, we discuss factors, including workload, experience, and individual characteristics, that may be more important determinants of resident fatigue than are duty hours. Third, we describe potential adverse effects that may arise from – and, therefore, counterbalance any potential benefits of – duty hour reductions. Fourth, we explore factors that may mitigate any risks to patient safety associated with using the services of resident trainees. In summary, it may be inappropriate to justify a reduction in working hours on the grounds of a presumed linkage between patient safety and resident duty hours. Better understanding of resident-related factors associated with patient safety will be essential if improvements in important patient safety outcomes are to be realized through resident-focused strategies. PMID:25561349

The Credit Hour and Public Budgeting.

ERIC Educational Resources Information Center

Wellman, Jane V.

2003-01-01

Discusses the ways the credit hour has come to be used by public funding systems in higher education. The literature review shows that the credit hour has become a barrier to innovation and a way to create systemic inequities between institutions or sectors in resource allocation. (SLD)

14 CFR 65.47 - Maximum hours.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Maximum hours. 65.47 Section 65.47 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRMEN CERTIFICATION: AIRMEN OTHER THAN FLIGHT CREWMEMBERS Air Traffic Control Tower Operators § 65.47 Maximum hours...

Myths and realities of the 80-hour work week.

PubMed

Schenarts, Paul J; Anderson Schenarts, Kimberly D; Rotondo, Michael F

2006-01-01

Myths are so ingrained into cultural traditions that emotion frequently overshadows a rational evaluation of the facts. The reduction in resident work hours has resulted in the formation of several myths. The purpose of this review is to examine the published data on resident work hours to separate out myth from reality. An electronic database was searched for publications related to resident training, work-hours, continuity of care, sleep deprivation, quality of life, patient safety, clinical/operative experience, faculty work hours, and surgical education. Sleep deprivation has been shown to be harmful, and residents played a role in advocating for work-hour limits. Surgical residents have seen a less dramatic improvement in quality of life compared with other disciplines. Work-hour reductions have decreased participation in clinic but have not resulted in a significant decline in clinical or operative exposure. Limiting resident work hours will unlikely result in a decrease health-care cost. Reduction in resident work hours has not resulted in an improvement or deterioration in patient outcome. Reduction of work hours has not increased faculty work hours nor made surgery a more attractive career choice. Despite strongly held opinions, resident work-hour reduction has resulted in little significant change in lifestyle, clinical exposure, patient well-being, faculty work hours, or medical student recruitment.

5 CFR 610.408 - Use of credit hours.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Flexible and Compressed Work Schedules § 610.408 Use of credit hours. Members of the Senior Executive Service (SES) may not accumulate credit hours under an alternative work schedule. Any credit hours...

[Staff Satisfaction within Duty Hour Models: Longitudinal Survey on Suitability and Legal Conformity at a Surgical Maximum Care Department].

PubMed

Langelotz, C; Koplin, G; Pascher, A; Lohmann, R; Köhler, A; Pratschke, J; Haase, O

2017-12-01

criticised 24-hour duty model seems to be much better than its reputation, if augmented by additional staff members in the evening hours. Georg Thieme Verlag KG Stuttgart · New York.

[General practitioners' participation in out-of-hours work].

PubMed

Sandvik, Hogne; Zakariassen, Erik; Hunskår, Steinar

2007-10-04

Out-of-hours work is often perceived as burdensome and there is an inherent increased risk of making mistakes. The aim of the study was to examine Regular General Practitioners' (RGPs') experiences with and attitudes to out-of-hours work. A questionnaire was sent to all RGPs in Norway. Participation in out-of-hours work was analysed against characteristics of the physician, list, and municipality. 2,913 RGPs responded (78%). 50% participated fully, 15% partly, and 35% did not participate in out-of-hours work. 28% were formally exempted, and 13% had a regular locum. Women and elderly RGPs participated less, as did RGPs in large and central municipalities. Out-of-hours cooperatives covering several municipalities reduced the amount of work, but did not increase the RGPs' participation rate. List characteristics had little influence on the participation rate. 60% of the RGPs tried to give away most of their duties, 16% wanted more out-of-hours work than their regular duties and 16% of those below 55 years who were still doing out-of-hours work wanted to continue after 55 years. RGPs in small and remote municipalities considered out-of-hours work more challenging, but less remunerating, and more often wanted to move from the municipality. Many RGPs do not participate in out-of-hours work. As Norwegian RGPs constitute an aging cohort, this may become an increasing problem.

Working hours, occupational stress and depression among physicians.

PubMed

Tomioka, K; Morita, N; Saeki, K; Okamoto, N; Kurumatani, N

2011-05-01

Physicians report high prevalence of depression, work long hours and are exposed to many occupational stresses (OSs). To investigate the cross-sectional association between working hours, OS and depression among physicians. A self-administered questionnaire was mailed to 1902 alumni of a medical school. The questionnaire evaluated working hours in the previous week, OS assessed by the effort-reward imbalance model, social support and depression evaluated by the Center for Epidemiologic Studies Depression scale. The associations between these occupational factors and depression were analyzed using multiple logistic regression. The questionnaire was returned by 795 alumni (response rate, 42%), and 706 respondents (534 men and 172 women) were suitable for analysis. The odds ratio (OR) of depression in the long working hours group (>70 h/week) was 1.8 (95% CI: 1.1-2.8) compared with the short working hours group (<54 h/week), adjusted for basic attributes. The adjusted ORs of depression in the upper effort-reward ratio (ERR) tertile versus the lower ERR tertile were 0.6 (0.2-1.8) in the short working hours group, 8.5 (3.0-24.0) in the middle working hours group and 9.9 (3.8-25.7) in the long working hours group. The adjusted ORs of depression stratified according to working hours and ERR tended to be higher in the groups with a higher ERR, but no association between working hours and depression was found. This study indicates that the management of OS is needed as a countermeasure against depression among physicians.

The Development and Performance of After-Hours Primary Care in the Netherlands: A Narrative Review.

PubMed

Smits, Marleen; Rutten, Martijn; Keizer, Ellen; Wensing, Michel; Westert, Gert; Giesen, Paul

2017-05-16

In many Western countries, hospital emergency departments are overcrowded, leading to the desire to strengthen primary care, particularly after hours. To achieve this goal, an increasing number of Western nations are reorganizing their after-hours primary care systems into large-scale primary care physician (PCP) cooperatives. This article provides an overview of the organization, performance, and development of PCP cooperatives in the Netherlands. The Dutch after-hours primary care system might offer opportunities for other countries facing problems with after-hours care and inappropriate emergency department visits. During the past several years, the number of contacts with Dutch PCP cooperatives has increased to 245 contacts per 1000 citizens per year. Many contacts (45%) are nonurgent, and about half occur as part of a series of primary care contacts. Low accessibility and availability of daytime primary care are related to greater use of after-hours primary care. To prevent unnecessary attendance at the cooperatives, physicians advocate copayment, a stricter triage system, and a larger role for telephone doctors. More than half of the PCP cooperatives in the Netherlands have integrated with hospital emergency departments, forming "emergency care access points." This collaboration has decreased emergency department use by 13% to 22%, and treatment of self-referrals by PCP cooperatives in emergency care access points is safe and cost-effective. Direct access to diagnostic facilities may optimize efficiency even more. Other recent developments include access to electronic health records of daytime primary care practices, task substitution from physicians to nurses, and the launch of a 2-year training program for PCPs to become experts in emergency care.

17 CFR 201.104 - Business hours.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 17 Commodity and Securities Exchanges 3 2014-04-01 2014-04-01 false Business hours. 201.104 Section 201.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice General Rules § 201.104 Business hours. The Headquarters office of the Commission, at...

17 CFR 201.104 - Business hours.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Business hours. 201.104 Section 201.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice General Rules § 201.104 Business hours. The Headquarters office of the Commission, at...

17 CFR 201.104 - Business hours.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Business hours. 201.104 Section 201.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice General Rules § 201.104 Business hours. The Headquarters office of the Commission, at...

17 CFR 201.104 - Business hours.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Business hours. 201.104 Section 201.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice General Rules § 201.104 Business hours. The Headquarters office of the Commission, at...

17 CFR 201.104 - Business hours.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Business hours. 201.104 Section 201.104 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Rules of Practice General Rules § 201.104 Business hours. The Headquarters office of the Commission, at...

Experience With Flexible Hours of Work

ERIC Educational Resources Information Center

Hartley, Jo

1976-01-01

A summary of an 80-page booklet called Hours of Work When Workers Can Choose is presented. The booklet reports a survey and focuses on the benefits of flexible hours of work. It was published by the Business and Professional Women's Foundation and is available from that organization. (EC)

Role of Early Family Configuration and Hours Worked on Student Success in Two-Year Colleges

ERIC Educational Resources Information Center

Boswell, Robert A.; Passmore, David L.

2013-01-01

The purpose of this study was to examine factors that influence student success in two-year colleges, community colleges, or junior colleges. In determining the purpose of the study, a research framework is established to review the relationships between student success and biological children, marriage/co-habitation, early family configuration,…

The Evening/Morning Star.

ERIC Educational Resources Information Center

Riddle, Bob

1997-01-01

Explains how Venus changes visibility regularly from morning to evening because of its quick orbit time during part of the year. Includes a brief history of observations of this phenomenon and provides a detailed account from the Australian Aborigines. (DDR)

Meeting the 80-hour work week requirement: what did we cut?

PubMed

Chung, Raphael; Ahmed, Naveed; Chen, Peter

2004-01-01

To meet the new accreditation requirement, small programs with limited manpower must make hard decisions to safeguard quality. We devised a system to meet the requirement in our own environment, making the obligatory cuts in educational components as prioritized by the trainees. This study examined what aspect of training is impacted and the residents' perception of the resulting change. In a fully accredited program where the baseline work hours/week exceeded the new requirement by over 20% even with full deployment of physician's assistants, the strategies used included reducing external rotations, transitioning PGY-3 into senior responsibility, and integrating senior rotations to 2 hospitals into 1 (2 weeks/month), so that time in a lower volume hospital helped to bring the monthly average to target. Residents were surveyed at 6-month intervals for their perception of the change. Compared with baseline, the new system averaged 77 +/- 5 hours/week, significantly reduced from before (98 +/- 12, p < 0.01), but with greatly reduced continuity of care (28 +/- 10% vs. 88 +/- 8%, p < 0.001), reduced consultations seen (19 +/- 4 vs. 36 +/- 7 per week, p < 0.001), reduced conference attendance (5.7 vs. 3.5 per week, p < 0.001), and reduced operations (55 +/- 7 vs. 68 +/- 9 per week for the program). External rotations have been reduced by 3 months, and outpatient clinics merged from 5 to 2. Surveys showed improvement in fatigue-related issues for junior residents. Senior residents were dissatisfied with the reduced educational components. Reducing work hours cannot be accomplished without reducing educational components. Unlike junior residents, senior residents felt less fulfilled with the new system and do not benefit in physical fatigue.

Early effect of intra-arterial treatment in ischemic stroke on aphasia recovery in MR CLEAN.

PubMed

Crijnen, Yvette S; Nouwens, Femke; de Lau, Lonneke M L; Visch-Brink, Evy G; van de Sandt-Koenderman, Mieke W M E; Berkhemer, Olvert A; Fransen, Puck S S; Beumer, Debbie; van den Berg, Lucie A; Lingsma, Hester F; Roos, Yvo B W E M; van der Lugt, Aad; van Oostenbrugge, Robert J; van Zwam, Wim H; Majoie, Charles B L M; Dippel, Diederik W J

2016-05-31

To investigate the effect of intra-arterial treatment (IAT) on early recovery from aphasia in acute ischemic stroke. We hypothesized that the early effect of IAT on aphasia is smaller than the effect on motor deficits. We included patients with aphasia from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), in which 500 patients with a proximal anterior circulation stroke were randomized to usual care plus IAT (<6 hours after stroke, mainly stent retrievers) or usual care alone. We estimated the effect of IAT on the shift on the NIH Stroke Scale (NIHSS) item language and the NIHSS item motor arm at 24 hours and 1 week after stroke with multivariable ordinal logistic regression as a common odds ratio, adjusted for prognostic variables (acOR). Differences between the effect of IAT on aphasia and on motor deficits were tested in a multilevel model with a multiplicative interaction term. Of the 288 patients with aphasia, 126 were assigned to IAT and 162 to usual care alone. The acOR for improvement of language score at 24 hours was 1.65 (95% confidence interval [CI] 1.05-2.60), and at 1 week 1.86 (95% CI 1.18-2.94). The acOR for improvement of motor deficit at 24 hours was 2.44 (95% CI 1.54-3.88), and at 1 week 2.32 (95% CI 1.43-3.77). The effect of IAT on language deficits was significantly different from the effect on motor deficits at 24 hours and 1 week (p = 0.005 and p = 0.011). IAT results in better early recovery from aphasia than usual care alone. The early effect of IAT on aphasia is smaller than the effect on motor deficits. This study provides Class II evidence that for patients with acute ischemic stroke IAT increases early recovery from aphasia and that the early effect on aphasia, as measured by the NIHSS, is smaller than the effect on motor deficits. © 2016 American Academy of Neurology.

Administrative work consumes one-sixth of U.S. physicians' working hours and lowers their career satisfaction.

PubMed

Woolhandler, Steffie; Himmelstein, David U

2014-01-01

Doctors often complain about the burden of administrative work, but few studies have quantified how much time clinicians devote to administrative tasks. We quantified the time U.S. physicians spent on administrative tasks, and its relationship to their career satisfaction, based on a nationally representative survey of 4,720 U.S. physicians working 20 or more hours per week in direct patient care. The average doctor spent 8.7 hours per week (16.6% of working hours) on administration. Psychiatrists spent the highest proportion of their time on administration (20.3%), followed by internists (17.3%) and family/general practitioners (17.3%). Pediatricians spent the least amount of time, 6.7 hours per week or 14.1 percent of professional time. Doctors in large practices, those in practices owned by a hospital, and those with financial incentives to reduce services spent more time on administration. More extensive use of electronic medical records was associated with a greater administrative burden. Doctors spending more time on administration had lower career satisfaction, even after controlling for income and other factors. Current trends in U.S. health policy--a shift to employment in large practices, the implementation of electronic medical records, and the increasing prevalence of financial risk sharing--are likely to increase doctors' paperwork burdens and may decrease their career satisfaction.

34 CFR 668.9 - Relationship between clock hours and semester, trimester, or quarter hours in calculating Title...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Relationship between clock hours and semester, trimester, or quarter hours in calculating Title IV, HEA program assistance. 668.9 Section 668.9 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION...

Early boost and slow consolidation in motor skill learning.

PubMed

Hotermans, Christophe; Peigneux, Philippe; Maertens de Noordhout, Alain; Moonen, Gustave; Maquet, Pierre

2006-01-01

Motorskill learning is a dynamic process that continues covertly after training has ended and eventually leads to delayed increments in performance. Current theories suggest that this off-line improvement takes time and appears only after several hours. Here we show an early transient and short-lived boost in performance, emerging as early as 5-30 min after training but no longer observed 4 h later. This early boost is predictive of the performance achieved 48 h later, suggesting its functional relevance for memory processes.

The transition to parenthood and well-being: the impact of partner status and work hour transitions.

PubMed

Keizer, Renske; Dykstra, Pearl A; Poortman, Anne-Rigt

2010-08-01

Using data from the first two waves of the Netherlands Kinship Panel Study for 338 women and 262 men, we examine the consequences of making the transition to parenthood for life satisfaction, loneliness, positive affect, negative affect, and partnership satisfaction. We extend previous work by taking transitions in partner status and work hours into account. Results show a moderate impact of becoming a parent on well-being. In so far as effects of making the transition to parenthood emerge, they are attributable to changes in partner status and work hours. First, the decrease in negative affect upon making the transition to motherhood is attributable to the group of women who increase their working hours. Second, the detrimental impact of making the transition to motherhood on partnership satisfaction is attributable to the group of new mothers who quit their job. Third, the detrimental impact of making the transition to fatherhood on loneliness is attributable to the group of new fathers who become married. There is one exception to this pattern of partner status and work hours as mechanisms for changes in well-being. Men who become fathers remain less satisfied with their partnership, even when transitions in partner status and work hours have been taken into account. In the discussion-section, we consider the possible underestimation of negative effects because of the focus on the continuously partnered. We also reflect on our results in the light of the high incidence of part-time work in the Netherlands and Dutch policies aimed at supporting new parents.

Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study

PubMed Central

de Bont, Eefje G P M; Lepot, Julie M M; Hendrix, Dagmar A S; Loonen, Nicole; Guldemond-Hecker, Yvonne; Dinant, Geert-Jan; Cals, Jochen W L

2015-01-01

Objective Even though childhood fever is mostly self-limiting, children with fever constitute a considerable workload in primary care. Little is known about the number of contacts and management during general practitioners’ (GPs) out-of-hours care. We investigated all fever related telephone contacts, consultations, antibiotic prescriptions and paediatric referrals of children during GP out-of-hours care within 1 year. Design Observational cohort study. Setting and patients We performed an observational cohort study at a large Dutch GP out-of-hours service. Children (<12 years) whose parents contacted the GP out-of-hours service for a fever related illness in 2012 were included. Main outcome measures Number of contacts and consultations, antibiotic prescription rates and paediatric referral rates. Results We observed an average of 14.6 fever related contacts for children per day at GP out-of-hours services, with peaks during winter months. Of 17 170 contacts in 2012, 5343 (31.1%) were fever related and 70.0% resulted in a GP consultation. One in four consultations resulted in an antibiotic prescription. Prescriptions increased by age and referrals to secondary care decreased by age (p<0.001). The majority of parents (89.5%) contacted the out-of-hours service only once during a fever episode (89.5%) and 7.6% of children were referred to secondary care. Conclusions This study shows that childhood fever does account for a large workload at GP out-of-hours services. One in three contacts is fever related and 70% of those febrile children are called in to be assessed by a GP. One in four consultations for childhood fever results in antibiotic prescribing and most consultations are managed in primary care without referral. PMID:25991452

47 CFR 0.403 - Office hours.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Office hours. 0.403 Section 0.403 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMISSION ORGANIZATION General Information General § 0.403 Office hours. The main offices of the Commission are open from 8 a.m. to 5:30 p.m., Monday through...

"Hour of Code": A Case Study

ERIC Educational Resources Information Center

Du, Jie; Wimmer, Hayden; Rada, Roy

2018-01-01

This study investigates the delivery of the "Hour of Code" tutorials to college students. The college students who participated in this study were surveyed about their opinion of the Hour of Code. First, the students' comments were discussed. Next, a content analysis of the offered tutorials highlights their reliance on visual…

Changing the Formula of Residents' Work Hours in Internal Medicine: Moving From “Years in Training” to “Hours in Training”

PubMed Central

Mansi, Ishak A

2011-01-01

Background In a recent report, the Institute of Medicine recommended more restrictions on residents' working hours. Several problems exist with a system that places a weekly limit on resident duty hours: (1) it assumes the presence of a linear relationship between hours of work and patient safety; (2) it fails to consider differences in intensity among programs; and (3) it does not address increases in the scientific content of medicine, and it places the burden of enforcing the duty hour limits on the Accreditation Council for Graduate Medical Education. Proposal An innovative method of calculating credit hours for graduate medical education would shift the focus from “years of residency” to “hours of residency.” For example, internal medicine residents would be requested to spend 8640 hours of total training hours (assuming 60 hours per week for 48 weeks annually) instead of the traditional 3 years. This method of counting training hours is used by other professions, such as the Intern Development Program of the National Council of Architectural Registration Boards. The proposed approach would allow residents and program directors to pace training based on individual capabilities. Standards for resident education should include the average number of patients treated in each setting (inpatient or outpatient). A possible set of “multipliers” based on these parameters, and possibly others such as resident evaluation, is devised to calculate the “final adjusted accredited hours” that count toward graduation. Anticipated Benefits Substituting “years of training” with “hours of training” may resolve many of the concerns with the current residency education model, as well as adapt to the demands of residents' personal lives. It also may allow residents to pace their training according to their capabilities and learning styles, and contribute to reflective learning and better quality education. PMID:22379516

Balancing Authority Cooperation Concepts - Intra-Hour Scheduling

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

Hunsaker, Matthew; Samaan, Nader; Milligan, Michael

2013-03-29

The overall objective of this study was to understand, on an Interconnection-wide basis, the effects intra-hour scheduling compared to hourly scheduling. Moreover, the study sought to understand how the benefits of intra-hour scheduling would change by altering the input assumptions in different scenarios. This report describes results of three separate scenarios with differing key assumptions and comparing the production costs between hourly scheduling and 10-minute scheduling performance. The different scenarios were chosen to provide insight into how the estimated benefits might change by altering input assumptions. Several key assumptions were different in the three scenarios, however most assumptions were similarmore » and/or unchanged among the scenarios.« less

Spatial updating depends on gaze direction even after loss of vision.

PubMed

Reuschel, Johanna; Rösler, Frank; Henriques, Denise Y P; Fiehler, Katja

2012-02-15

Direction of gaze (eye angle + head angle) has been shown to be important for representing space for action, implying a crucial role of vision for spatial updating. However, blind people have no access to vision yet are able to perform goal-directed actions successfully. Here, we investigated the role of visual experience for localizing and updating targets as a function of intervening gaze shifts in humans. People who differed in visual experience (late blind, congenitally blind, or sighted) were briefly presented with a proprioceptive reach target while facing it. Before they reached to the target's remembered location, they turned their head toward an eccentric direction that also induced corresponding eye movements in sighted and late blind individuals. We found that reaching errors varied systematically as a function of shift in gaze direction only in participants with early visual experience (sighted and late blind). In the late blind, this effect was solely present in people with moveable eyes but not in people with at least one glass eye. Our results suggest that the effect of gaze shifts on spatial updating develops on the basis of visual experience early in life and remains even after loss of vision as long as feedback from the eyes and head is available.

High gain signal averaged electrocardiogram combined with 24 hour monitoring in patients early after myocardial infarction for bedside prediction of arrhythmic events.

PubMed Central

Cripps, T; Bennett, E D; Camm, A J; Ward, D E

1988-01-01

The value of the high gain, signal averaged electrocardiogram combined with 24 hour electrocardiographic monitoring in the prediction of arrhythmic events was assessed in 159 patients in the first week after myocardial infarction. Eleven patients (7%) suffered arrhythmic events during a mean (SD) of 12 (6) months of follow up (range 2-22, median 13 months). The combination of high gain, signal averaged electrocardiography and 24 hour electrocardiographic monitoring was more accurate than either technique alone or than clinical information collected during admission in predicting these events. The combination identified a high risk group of 13 (8%) patients, with an arrhythmic event rate of 62% and a low risk group with an event rate of 2%. The combination of high gain, signal averaged electrocardiography and 24 hour electrocardiographic monitoring in the first week after myocardial infarction provides a rapid, cheap, and non-invasive bedside method for the prediction of arrhythmias. PMID:3179133

20 CFR 801.304 - Business hours.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Business hours. 801.304 Section 801.304 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Action by the Board § 801.304 Business hours. The office of the Clerk of the Board at Washington, DC...

20 CFR 801.304 - Business hours.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Business hours. 801.304 Section 801.304 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Action by the Board § 801.304 Business hours. The office of the Clerk of the Board at Washington, DC...

20 CFR 801.304 - Business hours.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Business hours. 801.304 Section 801.304 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Action by the Board § 801.304 Business hours. The office of the Clerk of the Board at Washington, DC...

20 CFR 801.304 - Business hours.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Business hours. 801.304 Section 801.304 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Action by the Board § 801.304 Business hours. The office of the Clerk of the Board at Washington, DC...

20 CFR 801.304 - Business hours.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Business hours. 801.304 Section 801.304 Employees' Benefits BENEFITS REVIEW BOARD, DEPARTMENT OF LABOR ESTABLISHMENT AND OPERATION OF THE BOARD Action by the Board § 801.304 Business hours. The office of the Clerk of the Board at Washington, DC...

Training for the future NHS: training junior doctors in the United Kingdom within the 48-hour European working time directive.

PubMed

Datta, Shreelatta T; Davies, Sally J

2014-01-01

Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998. Since that time, widespread concern has been expressed about the impact of restricted duty hours on the quality of postgraduate medical training in the UK, particularly in the "craft" specialties--that is, those disciplines in which trainees develop practical skills that are best learned through direct experience with patients. At the same time, specialist training in the UK has experienced considerable change since 2007 with the introduction of competency-based specialty curricula, workplace-based assessment, and the annual review of competency progression. The challenges presented by the reduction of duty hours include increased pressure on doctors-in-training to provide service during evening and overnight hours, reduced interaction with supervisors, and reduced opportunities for learning. This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision.

Early and Late Onset Side Effects of Photodynamic Therapy

PubMed Central

Borgia, Francesco; Giuffrida, Roberta; Caradonna, Emanuela; Guarneri, Fabrizio; Cannavò, Serafinella P.

2018-01-01

Photodynamic Therapy (PDT) is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC) in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations. PMID:29382133

40 CFR 51.905 - How do areas transition from the 1-hour NAAQS to the 8-hour NAAQS and what are the anti...

Code of Federal Regulations, 2011 CFR

2011-07-01

... obligation exists. (2) 8-Hour NAAQS Nonattainment/1-Hour NAAQS Maintenance. An area designated nonattainment for the 8-hour NAAQS that is a maintenance area for the 1-hour NAAQS at the time of designation for... deferred for so long as the area continues to maintain the 8-hour NAAQS; and (2) No longer applies once the...

40 CFR 51.905 - How do areas transition from the 1-hour NAAQS to the 8-hour NAAQS and what are the anti...

Code of Federal Regulations, 2010 CFR

2010-07-01

... obligation exists. (2) 8-Hour NAAQS Nonattainment/1-Hour NAAQS Maintenance. An area designated nonattainment for the 8-hour NAAQS that is a maintenance area for the 1-hour NAAQS at the time of designation for... deferred for so long as the area continues to maintain the 8-hour NAAQS; and (2) No longer applies once the...

The work hours of GPs: survey of English GPs.

PubMed

Gravelle, Hugh; Hole, Arne Risa

2007-02-01

There is no current information about the hours worked by English GPs. To compare the reported hours worked by GPs with that of other professions and to explain the variation in GP hours worked and on call. National postal survey of 1871 GPs in February 2004. English general practice. Multiple regression analyses of part-time versus full-time status, hours worked, and hours on call. Full-time male GPs report more hours worked (49.6; 95% CI [confidence interval] = 48.9 to 50.2) than males in other professional occupations (47.9; 95% CI = 47.6 to 48.1) and male managers (49.1; 95% CI = 48.8 to 49.5). Full-time female GPs report fewer hours (43.2; 95% CI = 42.0 to 44.3) than females in other professional occupations (44.7; 95% CI = 44.4 to 45.0) and female managers (44.1; 95% CI = 43.7 to 44.5). The number of hours worked decreased with practice list size, and increased with the number of patients per GP. GPs work longer hours in practices with older patients and with a higher proportion of patients in nursing homes. Fewer hours are worked in practices with higher 'additional needs' payments. Having children under 18 years of age increased the probability that female GPs work part-time but has no effect on the probability of male GPs working part-time. Given full-time/part-time status, having children under 18 years of age reduces the hours of male and female GPs. Male English GPs report longer hours worked than other professional groups and managers. The sex differences between GPs in hours worked are mostly attributable to the differential impact of family circumstances, particularly the number of children they have. Perversely, 'additional needs' payments are higher in practices where GPs work fewer hours.

Orthopaedic resident and program director opinions of resident duty hours: a national survey.

PubMed

Mir, Hassan R; Cannada, Lisa K; Murray, Jayson N; Black, Kevin P; Wolf, Jennifer M

2011-12-07

that the suggested strategic five-hour evening rest period implemented in July 2011 for on-call residents was appropriate (p > 0.05), and both groups (84% of residents and 74% of program directors) also disagreed with the limitation of intern shifts to sixteen hours (p < 0.001). Seventy percent of residents and 79% of program directors thought that the new duty-hour regulations would result in an increased number of handoffs that would be detrimental to patient care (p < 0.001). The mean responses of junior residents and senior residents differed for eight of the fifteen survey items (p < 0.001), with the responses of senior residents more closely resembling those of program directors on six of these eight questions. The mean responses and percentiles for the survey items did not differ significantly between residency directors and fellowship directors (p > 0.05). This national survey indicated significant differences between the opinions of orthopaedic residents and program (residency and fellowship) directors regarding the 2003 ACGME resident duty-hour regulations and the effects of these regulations on resident education and patient care. However, both residents and program directors agreed that the further reductions in duty hours in the 2011 rules may be detrimental to resident education and patient care.

Daily temporal patterns of heroin and cocaine use and craving: relationship with business hours regardless of actual employment status.

PubMed

Phillips, Karran A; Epstein, David H; Preston, Kenzie L

2013-10-01

Real-time monitoring of behavior using Ecological Momentary Assessment (EMA) has provided detailed data about daily temporal patterns of craving and use in cigarette smokers. We have collected similar data from a sample of cocaine and heroin users. Here we analyzed it in the context of its relationship with a societal construct of daily temporal organization: 9-to-5 business hours. In a 28-week prospective study, 112 methadone-maintained polydrug-abusing individuals initiated an electronic-diary entry and provided data each time they used cocaine, heroin, or both during weeks 4 to 28. EMA data were collected for 10,781 person-days and included: 663 cocaine-craving events, 710 cocaine-use events, 288 heroin-craving events, 66 heroin-use events, 630 craving-both-drugs events, and 282 use-of-both-drugs events. At baseline, 34% of the participants reported full-time employment in the preceding 3-year period. Most participants' current employment status fluctuated throughout the study. In a generalized linear mixed model (SAS Proc Glimmix), cocaine use varied by time of day relative to business hours (p<0.0001) and there was a significant interaction between Day of the Week and Time Relative to Business Hours (p<0.002) regardless of current work status. Cocaine craving also varied by time of day relative to business hours (p<0.0001), however, there was no significant interaction between Day of the Week and Time Relative to Business Hours (p=.57). Heroin craving and use were mostly reported during business hours, but data were sparse. Cocaine craving is most frequent during business hours while cocaine use is more frequent after business hours. Cocaine use during business hours, but not craving, seems suppressed on most weekdays, but not weekends, suggesting that societal conventions reflected in business hours influence drug-use patterns even in individuals whose daily schedules are not necessarily dictated by employment during conventional business hours. Published by

Absence from work in relation to length and distribution of shift hours

PubMed Central

Walker, J.; Mare, Gwynneth de la

1971-01-01

Walker, J., and de la Mare, Gwynneth (1971). Brit. J. industr. Med., 28, 36-44. Absence from work in relation to length and distribution of shift hours. A long period on night shift or even permanent night work has sometimes been suggested for those on continuous shift work to allow circadian rhythms to adapt. As the weekly hours of work have been reduced there is some evidence that a permanent night shift is practical, and about 12% of all shift workers are on this type of work. However, the case for permanent night shift must be established on grounds of both effectiveness and acceptability. The present study compares the absence experience, including sickness absence, of permanent day workers and permanent night workers matched for age and job in three undertakings which contained a range of working conditions. The question of the relationship between absence from work and total hours worked including overtime has been reopened, and in comparing absence from work according to the type of shift the total hours worked must also be taken into account. The relationship between the average hours when a man was at work and the amount of absence was tested. The men in the three undertakings worked a wide range of voluntary overtime. The results showed that in two undertakings long-term absence, mainly sickness absence, was higher on the night shift than on the day shift; and, in the third, absence was about the same on the two shifts. As the work load was less in the two undertakings with a higher absence on the night shift it was suggested that selective factors were operating. These results may be contrasted to studies which have compared the absence of rotating shift workers and day workers. In all three undertakings there was a tendency for absence to be less among high overtime workers than among those who worked medium or small amounts of overtime, although the trends were not consistent. There was no evidence at all that high overtime and absence from work were

Anxiety associated with diagnostic uncertainty in early pregnancy.

PubMed

Richardson, A; Raine-Fenning, N; Deb, S; Campbell, B; Vedhara, K

2017-08-01

To determine anxiety levels of women presenting to an early pregnancy assessment unit (EPAU) with abdominal pain and/or vaginal bleeding and to assess how these levels change over time and according to ultrasonographic diagnosis. We undertook a prospective cohort study in an EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (< 12 weeks' gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardized short form of Spielberger's state-trait anxiety inventory (STAI) on three occasions (before, immediately after and 48-72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive, i.e. a viable intrauterine pregnancy (IUP), or negative, i.e. a non-viable IUP or ectopic pregnancy. Uncertain diagnoses included pregnancy of unknown location and pregnancy of uncertain viability. Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test. A total of 160 women were included in the study. Anxiety levels decreased over time for women with a certain diagnosis (n = 128), even when negative (n = 64), and increased over time for women with an uncertain diagnosis (n = 32). Before the ultrasound examination, anxiety levels were high (STAI value, 21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound examination, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than in any other group. The difference between the five groups was significant (P < 0.005). After 48-72 hours, women with a certain diagnosis had significantly lower anxiety levels than had those with an uncertain diagnosis (10.77 ± 4.30 vs 22.94 ± 1.65; P < 0.005). The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an

Effects on subjective and objective alertness and sleep in response to evening light exposure in older subjects

PubMed Central

Münch, M; Scheuermaier, KD; Zhang, R; Dunne, SP; Guzik, AM; Silva, EJ; Ronda, JM; Duffy, JF

2011-01-01

Evening bright light exposure is reported to ameliorate daytime sleepiness and age-related sleep complaints, and also delays the timing of circadian rhythms. We tested whether evening light exposure given to older adults with sleep-wake complaints would delay the timing of their circadian rhythms with respect to their sleep timing, thereby reducing evening sleepiness and improving subsequent sleep quality. We examined the impact of evening light exposure from two different light sources on subjective alertness, EEG activity during wakefulness, and sleep stages. Ten healthy older adults with sleep complaints (mean age=63.3 yrs; 6F) participated in a 13-day study. After three baseline days, circadian phase was assessed. On the evening of days 5–8 the subjects were exposed for 2 h to either polychromatic blue-enriched white light or standard white fluorescent light, and on the following day circadian phase was re-assessed. Subjects were allowed to leave the laboratory during all but the two days when the circadian phase assessment took place. Evening assessments of subjective alertness, and wake and sleep EEG data were analyzed. Subjective alertness and wake EEG activity in the alpha range (9.75–11.25 Hz) were significantly higher during light exposures when compared to the pre-light exposure evening (p<0.05). The light exposures produced circadian phase shifts and significantly prolonged latency to rapid eye-movement (REM) sleep for both light groups (p<0.05). The increase in wake EEG alpha activity during the light exposures was negatively correlated with REM sleep duration (p<0.05). Evening light exposure could benefit older adults with early evening sleepiness, without negatively impacting the subsequent sleep episode. PMID:21664380

Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey.

PubMed

Zhou, Yin; Abel, Gary; Warren, Fiona; Roland, Martin; Campbell, John; Lyratzopoulos, Georgios

2015-05-01

It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. We analysed data from 567,049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal. Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal. This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Analysis of 24-hour versus 48-hour traffic counts for HPMS sampling.

DOT National Transportation Integrated Search

2014-04-01

The Illinois Department of Transportation (IDOT) has requested a waiver from the Federal Highway Administration (FHWA) to : allow IDOT to implement a 24-hour traffic-count program on the non-state HPMS routes, as opposed to the current Highway : Perf...

A new approach for evaluating flexible working hours.

PubMed

Giebel, Ole; Janssen, Daniela; Schomann, Carsten; Nachreiner, Friedhelm

2004-01-01

Recent studies on flexible working hours show at least some of these working time arrangements seem to be associated with impairing effects of health and well-being. According to available evidence, variability of working hours seems to play an important role. The question, however, is how this variability can be assessed and used to explain or predict impairments. Based on earlier methods used to assess shift-work effects, a time series analysis approach was applied to the matter of flexible working hours. Data on the working hours of 4 week's length of 137 respondents derived from a survey on flexible work hours involving 15 companies of different production and service sectors in Germany were converted to time series and analyzed by spectral analysis. A cluster analysis of the resulting power spectra yielded 5 clusters of flexible work hours. Analyzing these clusters for differences in reported impairments showed that workers who showed suppression of circadian and weekly rhythms experienced severest impairments, especially in circadian controlled functions like sleep and digestion. The results thus indicate that analyzing the periodicity of flexible working hours seems to be a promising approach for predicting impairments which should be investigated further in the future.

Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep.

PubMed

Tremblay, Mark S; Chaput, Jean-Philippe; Adamo, Kristi B; Aubert, Salomé; Barnes, Joel D; Choquette, Louise; Duggan, Mary; Faulkner, Guy; Goldfield, Gary S; Gray, Casey E; Gruber, Reut; Janson, Katherine; Janssen, Ian; Janssen, Xanne; Jaramillo Garcia, Alejandra; Kuzik, Nicholas; LeBlanc, Claire; MacLean, Joanna; Okely, Anthony D; Poitras, Veronica J; Rayner, Mary-Ellen; Reilly, John J; Sampson, Margaret; Spence, John C; Timmons, Brian W; Carson, Valerie

2017-11-20

The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination. The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1-2 years) and preschoolers (3-4 years) should achieve for a healthy day (24�

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: a case for dedicated early pregnancy services.

PubMed

Iyoke, C A; Ugwu, O G; Ezugwu, F O; Onah, H E; Agbata, A T; Ajah, L C

2014-01-01

It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by Nigerian Gynecologists, and determine if dedicated early pregnancy services such as Early Pregnancy Assessment Units could be introduced to improve care. A cross-sectional survey of Nigerian Gynecologists attending the 46 th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria. This was a questionnaire-based study. Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA). A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 ± 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 ± 1.4 hours (range ½-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy. Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these shortcomings in the way women with such conditions are currently managed.

Interleukin-6 as an early marker for fat embolism

PubMed Central

Yoga, R; Theis, JC; Walton, M; Sutherland, W

2009-01-01

Background Fat Embolism is a complication of long bone fractures, intramedullary fixation and joint arthroplasty. It may progress to fat embolism syndrome, which is rare but involves significant morbidity and can occasionally be fatal. Fat Embolism can be detected at the time of embolization by transoesophageal echocardiography or atrial blood sampling. Later, a combination of clinical signs and symptoms will point towards fat embolism but there is no specific test to confirm the diagnosis. We investigated serum Interleukin-6 (IL-6) as a possible early marker for fat embolism. Methods An animal study was conducted to simulate a hip replacement in 31 adult male Sprague Dawley rats. The procedure was performed under general anesthesia and the animals divided into 3 groups: control, uncemented and cemented. Following surgery and recovery from anaesthesia, the rats allowed to freely mobilize in their cages. Blood was taken before surgery and at 6 hours, 12 hours and 24 hours to measure serum IL-6 levels. The rats were euthanized at 24 hours and lungs removed and stained for fat. The amount of fat seen was then correlated with serum IL-6 levels. Results No rats in the control group had fat emboli. Numerous fat emboli were seen in both the uncemented and cemented implant groups. The interleukin levels were raised in all groups reaching a peak at 12 hours after surgery reaching 100 pg/ml in the control group and around 250 pg/ml in the uncemented and cemented implant groups. The IL-6 levels in the control group were significantly lower than any of the implant groups at 12 and 24 hours. At these time points, the serum IL-6 correlated with the amount of fat seen on lung histology. Conclusion Serum IL-6 is a possible early marker of fat embolism. PMID:19523233

Health problems due to long working hours in Japan: working hours, workers' compensation (Karoshi), and preventive measures.

PubMed

Iwasaki, Kenji; Takahashi, Masaya; Nakata, Akinori

2006-10-01

Late in the 1970s, serious social concern over health problems due to long working hours has arisen in Japan. This report briefly summarizes the Japanese circumstances about long working hours and what the Government has achieved so far. The national statistics show that more than 6 million people worked for 60 h or more per week during years 2000 and 2004. Approximately three hundred cases of brain and heart diseases were recognized as labour accidents resulting from overwork (Karoshi) by the Ministry of Health, Labour and Welfare (MHLW) between 2002 and 2005. Consequently, the MHLW has been working to establish a more appropriate compensation system for Karoshi, as well as preventive measures for overwork related health problems. In 2001, the MHLW set the standards for clearly recognizing Karoshi in association with the amount of overtime working hours. These standards were based on the results of a literature review and medical examinations indicating a relationship between overwork and brain and heart diseases. In 2002, the MHLW launched the program for the prevention of health impairment due to overwork, and in 2005 the health guidance through an interview by a doctor for overworked workers has been enacted as law. Long working hours are controversial issues because of conflicts between health, safety, work-life balance, and productivity. It is obvious that we need to continue research regarding the impact on worker health and the management of long working hours.

Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients

PubMed Central

2013-01-01

Introduction Close monitoring and repeated risk assessment of sepsis patients in the intensive care unit (ICU) is important for decisions regarding care intensification or early discharge to the ward. We studied whether considering plasma kinetics of procalcitonin, a biomarker of systemic bacterial infection, over the first 72 critical care hours improved mortality prognostication of septic patients from two US settings. Methods This retrospective analysis included consecutively treated eligible adults with a diagnosis of sepsis from critical care units in two independent institutions in Clearwater, FL and Chicago, IL. Cohorts were used for derivation or validation to study the association between procalcitonin change over the first 72 critical care hours and mortality. Results ICU/in-hospital mortality rates were 29.2%/31.8% in the derivation cohort (n = 154) and 17.6%/29.4% in the validation cohort (n = 102). In logistic regression analysis of both cohorts, procalcitonin change was strongly associated with ICU and in-hospital mortality independent of clinical risk scores (Acute Physiology, Age and Chronic Health Evaluation IV or Simplified Acute Physiology Score II), with area under the curve (AUC) from 0.67 to 0.71. When procalcitonin decreased by at least 80%, the negative predictive value for ICU/in-hospital mortality was 90%/90% in the derivation cohort, and 91%/79% in the validation cohort. When procalcitonin showed no decrease or increased, the respective positive predictive values were 48%/48% and 36%/52%. Discussion In septic patients, procalcitonin kinetics over the first 72 critical care hours provide prognostic information beyond that available from clinical risk scores. If these observations are confirmed, procalcitonin monitoring may assist physician decision-making regarding care intensification or early transfer from the ICU to the floor. PMID:23787145

Flexible working hours, health, and well-being in Europe: some considerations from a SALTSA project.

PubMed

Costa, Giovanni; Akerstedt, Torbjorn; Nachreiner, Friedhelm; Baltieri, Federica; Carvalhais, José; Folkard, Simon; Dresen, Monique Frings; Gadbois, Charles; Gartner, Johannes; Sukalo, Hiltraud Grzech; Härmä, Mikko; Kandolin, Irja; Sartori, Samantha; Silvério, Jorge

2004-01-01

The project brought together researchers from 9 EU-Countries and resulted in a number of actions, in particular the following: (a) There is an urgent need of defining the concept of flexible working hours, since it has been used in many different and even counterintuitive ways; the most obvious distinction is where the influence over the working hours lies, that is between the "company-based flexibility" and the "individual-oriented flexibility"; (b) The review of the Legislation in force in the 15 European countries shows that the regulation of working times is quite extensive and covers (Council Directive 93/104/EC) almost all the various arrangements of working hours (i.e., part-time, overtime, shift, and night work), but fails to provide for flexibility; (c) According to the data of the Third EU Survey on Working Conditions, longer and "irregular" working hours are in general linked to lower levels of health and well-being; moreover, low (individual) flexibility and high variability of working hours (i.e., company-based flexibility) were consistently associated with poor health and well-being, while low variability combined with high autonomy showed positive effects; (d) Six substudies from different countries demonstrated that flexible working hours vary according to country, economic sector, social status, and gender; overtime is the most frequent form of company-based flexibility but has negative effects on stress, sleep, and social and mental health; individual flexibility alleviates the negative effects of the company-based flexibility on subjective health, safety, and social well-being; (e) The literature review was able to list more than 1,000 references, but it was striking that most of these documents were mainly argumentative with very little empirical data. Thus, one may conclude that there is a large-scale intervention ongoing in our society with almost completely unknown and uncontrolled effects. Consequently, there is a strong need for systematic

Report of 1,000 Hour Catalyst Longevity Evaluation

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

Daniel M. Ginosar

2009-06-01

This report presents the results of a 1,000 hour, high-pressure, catalyst longevity test for the decomposition of concentrated sulfuric acid. The reaction is used for both the sulfur-iodine (S-I) cycle and hybrid sulfur cycle. By the time of the delivery date of April 17, 2009, for project milestone no. 2NIN07TC050114, the 1% Pt/TiO2 catalyst had been in the reaction environment for 658 hours. During the first 480 hours of testing, the catalyst activity provided stable, near-equilibrium yields of 46.8% SO2 and 22.8% O2. However, product yields declined at sample exposure times >480 hours. At 658 hours of operation, catalyst activitymore » (based on oxygen yield) declined to 57% relative to the stable period of catalyst activity. Thus, as of April 17, this catalyst did not provide the desired stability level of <10% degradation per 1,000 hours. The experiment was terminated on April 27, after 792 hours, when a fitting failed and the catalyst was displaced from the reactor such that the sample could not be recovered. Oxygen conversion at the end of the experiment was 12.5% and declining, suggesting that at that point, catalyst activity had decreased to 54% of the initial level.« less

29 CFR 4.178 - Computation of hours worked.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Compliance with Compensation Standards § 4.178 Computation of hours worked. Since employees subject to the... such hours are adequately segregated, as indicated in § 4.179, compensation in accordance with the Act will be required for all hours of work in any workweek in which the employee performs any work in...

5 CFR 551.521 - Fractional hours of work.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Fractional hours of work. 551.521 Section... ADMINISTRATION UNDER THE FAIR LABOR STANDARDS ACT Overtime Pay Provisions Fractional Hours of Work § 551.521 Fractional hours of work. (a) An employee shall be compensated for every minute of regular overtime work. (b...

5 CFR 551.521 - Fractional hours of work.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Fractional hours of work. 551.521 Section... ADMINISTRATION UNDER THE FAIR LABOR STANDARDS ACT Overtime Pay Provisions Fractional Hours of Work § 551.521 Fractional hours of work. (a) An employee shall be compensated for every minute of regular overtime work. (b...

29 CFR 778.100 - The maximum-hours provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false The maximum-hours provisions. 778.100 Section 778.100 Labor... Requirements Introductory § 778.100 The maximum-hours provisions. Section 7(a) of the Act deals with maximum... specifically exempt from its overtime pay requirements. It prescribes the maximum weekly hours of work...

Early prevention of pressure ulcers among elderly patients admitted through emergency departments: a cost-effectiveness analysis.

PubMed

Pham, Ba'; Teague, Laura; Mahoney, James; Goodman, Laurie; Paulden, Mike; Poss, Jeff; Li, Jianli; Ieraci, Luciano; Carcone, Steven; Krahn, Murray

2011-11-01

Every year, approximately 6.2 million hospital admissions through emergency departments (ED) involve elderly patients who are at risk of developing pressure ulcers. We evaluated the cost-effectiveness of pressure-redistribution foam mattresses on ED stretchers and beds for early prevention of pressure ulcers in elderly admitted ED patients. Using a Markov model, we evaluated the incremental effectiveness (quality-adjusted life-days) and incremental cost (hospital and home care costs) between early prevention and current practice (with standard hospital mattresses) from a health care payer perspective during a 1-year time horizon. The projected incidence of ED-acquired pressure ulcers was 1.90% with current practice and 1.48% with early prevention, corresponding to a number needed to treat of 238 patients. The average upgrading cost from standard to pressure-redistribution mattresses was $0.30 per patient. Compared with current practice, early prevention was more effective, with 0.0015 quality-adjusted life-days gained, and less costly, with a mean cost saving of $32 per patient. If decisionmakers are willing to pay $50,000 per quality-adjusted life-year gained, early prevention was cost-effective even for short ED stay (ie, 1 hour), low hospital-acquired pressure ulcer risk (1% prevalence), and high unit price of pressure-redistribution mattresses ($3,775). Taking input uncertainty into account, early prevention was 81% likely to be cost-effective. Expected value-of-information estimates supported additional randomized controlled trials of pressure-redistribution mattresses to eliminate the remaining decision uncertainty. The economic evidence supports early prevention with pressure-redistribution foam mattresses in the ED. Early prevention is likely to improve health for elderly patients and save hospital costs. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Compliance with the Australian 24-hour movement guidelines for the early years: associations with weight status.

PubMed

Santos, Rute; Zhang, Zhiguang; Pereira, João R; Sousa-Sá, Eduarda; Cliff, Dylan P; Okely, Anthony D

2017-11-20

For effective public health and surveillance it is important to document the proportion of young children who meet the new Australian Integrated 24 h Movement Guidelines for the Early Years and how these associate with health outcomes. We aimed to (i) assess compliance with the new Integrated 24 h Movement Guidelines for the Early Years in a sample of Australian toddlers; and (ii) ascertain whether compliance with the guidelines associates with weight status. The sample comprised 202 toddlers (104 girls) aged 19.74 ± 4.07 months from the GET UP! Participants wore accelerometers (Actigraph GT3X+) for 24 h over 7 consecutive days to assess physical activity, sedentary time and sleep. Parents reported participants' screen time. Weight and height were measured and body mass index (BMI) z-scores by age and sex were calculated. Analysis of Covariance (ANCOVA) was performed to test differences in BMI z-scores between participants complying with (i) none or any individual guideline, (ii) any combination of meeting two guidelines, and (iii) those who met all three guidelines, adjusting for child age, gender and socioeconomic status. Only 8.9% of the sample met the overall 24 h movement guidelines. Most of the sample met the physical activity (96.5%) and sleep (79.7%) guidelines but only 11.4% met the sedentary behavior guideline. Average BMI Z-scores did not significantly differ between children who complied with none or any individual guideline, any combination of meeting two guidelines, and those who met all three guidelines (p > 0.05). Although the lack of significant differences, participants who accomplished any combination of two guidelines or all three guidelines appear to have had a lower BMI Z-score than those complying with one of the guidelines or none. Just under 9% of our sample met the overall Australian 24 h Movement Guidelines for the Early Years. BMI was not associated with the accomplishment of any of the 24-h Movement Guidelines. Strategies to

40 CFR 51.905 - How do areas transition from the 1-hour NAAQS to the 1997 8-hour NAAQS and what are the anti...

Code of Federal Regulations, 2014 CFR

2014-07-01

... obligation exists. (2) 8-Hour NAAQS Nonattainment/1-Hour NAAQS Maintenance. An area designated nonattainment for the 8-hour NAAQS that is a maintenance area for the 1-hour NAAQS at the time of designation for... deferred for so long as the area continues to maintain the 8-hour NAAQS; and (2) No longer applies once the...

40 CFR 51.905 - How do areas transition from the 1-hour NAAQS to the 1997 8-hour NAAQS and what are the anti...

Code of Federal Regulations, 2012 CFR

2012-07-01

... obligation exists. (2) 8-Hour NAAQS Nonattainment/1-Hour NAAQS Maintenance. An area designated nonattainment for the 8-hour NAAQS that is a maintenance area for the 1-hour NAAQS at the time of designation for... deferred for so long as the area continues to maintain the 8-hour NAAQS; and (2) No longer applies once the...

40 CFR 51.905 - How do areas transition from the 1-hour NAAQS to the 1997 8-hour NAAQS and what are the anti...

Code of Federal Regulations, 2013 CFR

2013-07-01

... obligation exists. (2) 8-Hour NAAQS Nonattainment/1-Hour NAAQS Maintenance. An area designated nonattainment for the 8-hour NAAQS that is a maintenance area for the 1-hour NAAQS at the time of designation for... deferred for so long as the area continues to maintain the 8-hour NAAQS; and (2) No longer applies once the...

Effect of a Protected Sleep Period on Hours Slept During Extended Overnight In-hospital Duty Hours Among Medical Interns

PubMed Central

Volpp, Kevin G.; Shea, Judy A.; Small, Dylan S.; Basner, Mathias; Zhu, Jingsan; Norton, Laurie; Ecker, Adrian; Novak, Cristina; Bellini, Lisa M.; Dine, C. Jessica; Mollicone, Daniel J.; Dinges, David F.

2013-01-01

Context A 2009 Institute of Medicine report recommended protected sleep periods for medicine trainees on extended overnight shifts, a position reinforced by new Accreditation Council for Graduate Medical Education requirements. Objective To evaluate the feasibility and consequences of protected sleep periods during extended duty. Design, Setting, and Participants Randomized controlled trial conducted at the Philadelphia VA Medical Center medical service and Oncology Unit of the Hospital of the University of Pennsylvania (2009–2010). Of the 106 interns and senior medical students who consented, 3 were not scheduled on any study rotations. Among the others, 44 worked at the VA center, 16 at the university hospital, and 43 at both. Intervention Twelve 4-week blocks were randomly assigned to either a standard intern schedule (extended duty overnight shifts of up to 30 hours; equivalent to 1200 overnight intern shifts at each site), or a protected sleep period (protected time from 12:30 AM to 5:30 AM with handover of work cell phone; equivalent to 1200 overnight intern shifts at each site). Participants were asked to wear wrist actigraphs and complete sleep diaries. Main Outcome Measures Primary outcome was hours slept during the protected period on extended duty overnight shifts. Secondary outcome measures included hours slept during a 24-hour period (noon to noon) by day of call cycle and Karolinska sleepiness scale. Results For 98.3% of on-call nights, cell phones were signed out as designed. At the VA center, participants with protected sleep had a mean 2.86 hours (95% CI, 2.57–3.10 hours) of sleep vs 1.98 hours (95% CI, 1.68–2.28 hours) among those who did not have protected hours of sleep (P < .001). At the university hospital, participants with protected sleep had a mean 3.04 hours (95% CI, 2.77–3.45 hours) of sleep vs 2.04 hours (95% CI, 1.79–2.24) among those who did not have protected sleep (P <.001). Participants with protected sleep were

Long working hours and physical activity.

PubMed

Angrave, David; Charlwood, Andy; Wooden, Mark

2015-08-01

It is widely believed that persons employed in jobs demanding long working hours are at greater risk of physical inactivity than other workers, primarily because they have less leisure time available to undertake physical activity. The aim of this study was to test this hypothesis using prospective data obtained from a nationally representative sample of employed persons. Longitudinal data from the Household, Income and Labour Dynamics in Australia Survey (93,367 observations from 17,893 individuals) were used to estimate conditional fixed effects logistic regression models of the likelihood of moderate or vigorous physical exercise for at least 30 min, at least four times a week. No significant associations between long working hours and the incidence of healthy levels of physical activity were uncovered once other exogenous influences on activity levels were controlled for. The odds of men or women who usually work 60 or more hours per week exercising at healthy levels were 6% and 11% less, respectively, than those of comparable persons working a more standard 35-40 h/week; however, neither estimate was significantly different from 0 at 95% CI. The findings suggest that there is no trade-off between long working hours and physical activity in Australia. It is argued that these findings are broadly consistent with previous research studies from Anglo-Saxon countries (where long working hours are pervasive) that employed large nationally representative samples. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

12 CFR 7.3000 - Bank hours and closings.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Bank hours and closings. 7.3000 Section 7.3000 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Bank Operations § 7.3000 Bank hours and closings. (a) Bank hours. A national bank's board of directors...

12 CFR 7.3000 - Bank hours and closings.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Bank hours and closings. 7.3000 Section 7.3000 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Bank Operations § 7.3000 Bank hours and closings. (a) Bank hours. A national bank's board of directors...

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety

ERIC Educational Resources Information Center

Ulmer, Cheryl, Ed.; Wolman, Dianne Miller, Ed.; Johns, Michael M. E., Ed.

2009-01-01

Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect…

Flexible working hours and well-being in Finland.

PubMed

Kandolin, I; Härmä, M; Toivanen, M

2001-12-01

Flexibility of working hours became more prevalent in the 1990s in Finland. According to a representative survey on Finnish wage and salary earners (n = 1790) at the beginning of 2000, a great majority of male (76%) and female (65%) employees regularly worked overtime and/or had irregular working hours every month. These employees were flexible in meeting the needs of their companies/employers. Individual flexibility of working hours was far less common, only one third of male and female employees were able to regulate their working hours. A better balance between company-controlled and individual flexibility would, however, improve the well-being of employees. Employees working overtime without being allowed to regulate their working hours felt more symptoms of distress and had more conflicts in combining workplace and family roles than those who could individually determine their working hours flexibly. An investment in individually determined flexibility, for example by means of participatory planning, would improve the well-being of employees, and thus also improve the productivity of the organization.

Making rice even healthier!

USDA-ARS?s Scientific Manuscript database

Rice is a naturally healthy food, but what if it could be made even healthier? Would Americans eat more rice if it could be advertised to be a 'New and Improved' source of calcium to promote bone growth, or iron to prevent anemia? Grocery stores are full of foods that are vitamin enhanced to attract...

29 CFR 2530.200b-2 - Hour of service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... regular work schedule of 40 hours per week. The employee's hourly rate of compensation is, therefore, $4... is scheduled to work 371/2 hours per week (although from time to time working overtime). B must... calculated on the basis of units of time (weeks). C has no regular work schedule but works at least 50 hours...

Regulating danger on the highways: hours of service regulations.

PubMed

Mansfield, Daniel; Kryger, Meir

2015-12-01

Current hours of service regulations governing commercial truck drivers in place in the United States, Canada, Australia, and the European Union are summarized and compared to facilitate the assessment of the effectiveness of such provisions in preventing fatigue and drowsiness among truck drivers. Current hours of service provisions governing commercial truck drivers were derived from governmental sources. The commercial truck driver hours of service provisions in the United States, Canada, and the European Union permit drivers to work 14 hours and those of Australia permit drivers to work 12 hours a day on a regular basis. The regulations do not state what a driver may do with time off. They are consistent with a driver being able to drive after 24 hours without sleep. They do not take into account circadian rhythm by linking driving or rest to time of day. Current hours of service regulations governing commercial truck drivers leave gaps--permitting drivers to work long hours on a regular basis, permitting driving after no sleep for 24 hours, and failing to take into account the importance of circadian rhythm, endangering the public safety and the truck drivers themselves. Copyright © 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Effects of the toxic benthic dinoflagellate Ostreopsis cf. ovata on fertilization and early development of the sea urchin Lytechinus variegatus.

PubMed

Neves, Raquel A F; Contins, Mariana; Nascimento, Silvia M

2018-04-01

Blooms of the benthic dinoflagellate Ostreopsis cf. ovata have been recorded with increasing frequency, intensity and geographic distribution. This dinoflagellate produces potent toxins that may cause mortality of marine invertebrates. Adults of sea urchins are commonly affected by O. cf. ovata exposure with evidence of spines loss and high mortality during periods of high dinoflagellate abundances. Here, we report on the effects of the toxic dinoflagellate O. cf. ovata on fertilization and early development of the sea urchin Lytechinus variegatus, a key ecological herbivore. Lytechinus variegatus eggs and sperm were experimentally exposed to different concentrations of Ostreopsis cf. ovata (4, 40, 400, and 4000 cells ml -1 ) to test the hypothesis that fertilization success, embryonic and larval development of the sea urchin are negatively affected by the toxic dinoflagellate even at low abundances. Reduced fertilization, developmental failures, embryo and larval mortality, and occurrence of abnormal offspring were evident after exposure to O. cf. ovata. Fertilization decreased when gametes were exposed to high O. cf. ovata abundances (400 and 4000 cells ml -1 ), but just the exposure to the highest abundance significantly reduced fertilization success. Sea urchin early development was affected by O. cf. ovata in a dose-dependent way, high dinoflagellate abundances fully inhibited the early development of L. variegatus. Ostreopsis cf. ovata significantly increased the mortality of sea urchin eggs and embryos in the first hours of exposure (∼1-3 h), regardless of dinoflagellate abundance. Abundances of 400 and 4000 O. cf. ovata cells ml -1 induced significantly higher mortality on sea urchin initial stages in the first hours, and no egg or embryo was found in these treatments after 18 h of incubation. The early echinopluteus larva was only reached in the control and in treatments with low Ostreopsis cf. ovata abundances (4 and 40 cells ml -1 ). The

Effect of the 80-hour workweek on resident burnout.

PubMed

Gelfand, Dmitri V; Podnos, Yale D; Carmichael, Joseph C; Saltzman, Darin J; Wilson, Samuel E; Williams, Russell A

2004-09-01

With the introduction of the newly mandated restrictions on resident work hours, we expected improvement in subjective feelings of personal accomplishment and lessened emotional exhaustion and depersonalization. Residents and faculty members completed an anonymous online Maslach Burnout Inventory Human Services Survey (3rd ed; Consulting Psychologist Press Inc, Palo Alto, Calif) and work-hour registry before and after implementation of new restrictions. Urban, university-based department of surgery. All house staff (n = 37) and faculty (n = 27). Introduction of new Institutional Standards for Resident Duty Hours 2003. Main Outcome Measure Resident work hours and levels of emotional exhaustion, perceived degree of depersonalization, and personal accomplishment. Resident work hours per week decreased from 100.7 to 82.6 (P < .05) with introduction of the new schedule. Home call and formal educational activity time within working hours (eg, clinical conferences) significantly (P < .05) decreased from 11.5 and 4.8 hours to 4.6 and 2.5 hours per week, respectively. Operating room hours, clinic time, and duration of rounds did not show a significant change. Changes in parameters of resident and faculty emotional exhaustion, depersonalization, and personal accomplishment did not show statistical significance (P > .05). Despite successful reductions in resident work hours, measures of burnout were not significantly affected. However, important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained. Formal in-hospital education time was reduced.

Migration plans and hours of work in Malaysia.

PubMed

Gillin, E D; Sumner, D A

1985-01-01

"This article describes characteristics of prospective migrants in the Malaysian Family Life Survey and investigates how planning to move affects hours of work. [The authors] use ideas about intertemporal substitution...to discuss the response to temporary and permanent wage expectations on the part of potential migrants. [An] econometric section presents reduced-form estimates for wage rates and planned migration equations and two-stage least squares estimates for hours of work. Men currently planning a move were found to work fewer hours. Those originally planning only a temporary stay at their current location work more hours." excerpt

The impact of early specialist management on outcomes of patients with in-hospital stroke.

PubMed

Manawadu, Dulka; Choyi, Jithesh; Kalra, Lalit

2014-01-01

Delays in treatment of in-hospital stroke (IHS) adversely affect patient outcomes. We hypothesised that early referral and specialist management of IHS patients will improve outcomes at 90 days. Baseline characteristics, assessment delays, thrombolysis eligibility, 90-day functional outcomes and all-cause mortality were compared between IHS patients referred for specialist stroke management within 3 hours of symptom onset (early referrals) and later referrals. Patients were identified from a prospective stroke registry between January 2009 and December 2010. Inclusion criteria were primary admission with a non-stroke diagnosis, onset of new neurological deficits after admission and early ischaemic changes on CT or MR imaging. Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 year; 51% male, median NIHSS score 10). There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 (76%) of the 37/78 (47%) potentially eligible patients; 7 patients were excluded because specialist referral was delayed beyond 4.5 hours despite symptom recognition within 3 hours of onset. Early referral improved functional outcomes (modified Rankin Scale 0-2 at 90 days 40% v 7%, p = 0.001) and was an independent predictor of mRS 0-2 at 90 days after adjusting for age, pre-morbid function, primary cause for hospital admission and stroke severity [OR 1.13 (95% C.I.  = 1.10-1.27), p = 0.002]. Early referral and specialist management of IHS patients that includes thrombolysis is associated with better functional outcomes at 90 days.

Even Superheroes Need Help

ERIC Educational Resources Information Center

Sussman, Mel

2018-01-01

It is not clear exactly when school leaders first started wearing an "S" on their chests and began defiantly uttering the phrase, "I can do it all myself!" But after days, weeks, months, or even years of racing wildly from task to task, many a superhero principal has come to the stark realization that nothing could be further…

Teaching Large Evening Classes

ERIC Educational Resources Information Center

Wambuguh, Oscar

2008-01-01

High enrollments, conflicting student work schedules, and the sheer convenience of once-a-week classes are pushing many colleges to schedule evening courses. Held from 6 to 9 pm or 7 to 10 pm, these classes are typically packed, sometimes with more than 150 students in a large lecture theater. How can faculty effectively teach, control, or even…

Reliable Analysis of Single-Unit Recordings from the Human Brain under Noisy Conditions: Tracking Neurons over Hours

PubMed Central

Boström, Jan; Elger, Christian E.; Mormann, Florian

2016-01-01

Recording extracellulary from neurons in the brains of animals in vivo is among the most established experimental techniques in neuroscience, and has recently become feasible in humans. Many interesting scientific questions can be addressed only when extracellular recordings last several hours, and when individual neurons are tracked throughout the entire recording. Such questions regard, for example, neuronal mechanisms of learning and memory consolidation, and the generation of epileptic seizures. Several difficulties have so far limited the use of extracellular multi-hour recordings in neuroscience: Datasets become huge, and data are necessarily noisy in clinical recording environments. No methods for spike sorting of such recordings have been available. Spike sorting refers to the process of identifying the contributions of several neurons to the signal recorded in one electrode. To overcome these difficulties, we developed Combinato: a complete data-analysis framework for spike sorting in noisy recordings lasting twelve hours or more. Our framework includes software for artifact rejection, automatic spike sorting, manual optimization, and efficient visualization of results. Our completely automatic framework excels at two tasks: It outperforms existing methods when tested on simulated and real data, and it enables researchers to analyze multi-hour recordings. We evaluated our methods on both short and multi-hour simulated datasets. To evaluate the performance of our methods in an actual neuroscientific experiment, we used data from from neurosurgical patients, recorded in order to identify visually responsive neurons in the medial temporal lobe. These neurons responded to the semantic content, rather than to visual features, of a given stimulus. To test our methods with multi-hour recordings, we made use of neurons in the human medial temporal lobe that respond selectively to the same stimulus in the evening and next morning. PMID:27930664

Early detection: the impact of genomics.

PubMed

van Lanschot, M C J; Bosch, L J W; de Wit, M; Carvalho, B; Meijer, G A

2017-08-01

The field of genomics has shifted our view on disease development by providing insights in the molecular and functional processes encoded in the genome. In the case of cancer, many alterations in the DNA accumulate that enable tumor growth or even metastatic dissemination. Identification of molecular signatures that define different stages of progression towards cancer can enable early tumor detection. In this review, the impact of genomics will be addressed using early detection of colorectal cancer (CRC) as an example. Increased understanding of the adenoma-to-carcinoma progression has led to the discovery of several diagnostic biomarkers. This combined with technical advancements, has facilitated the development of molecular tests for non-invasive early CRC detection in stool and blood samples. Even though several tests have already made it to clinical practice, sensitivity and specificity for the detection of precancerous lesions still need improvement. Besides the diagnostic qualities, also the accuracy of the intermediate endpoint is an important issue on how the effectiveness of a novel test is perceived. Here, progression biomarkers may provide a more precise measure than the currently used morphologically based features. Similar developments in biomarker use for early detection have taken place in other cancer types.

Validation of a Pediatric Early Warning Score in Hospitalized Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients.

PubMed

Agulnik, Asya; Forbes, Peter W; Stenquist, Nicole; Rodriguez-Galindo, Carlos; Kleinman, Monica

2016-04-01

To evaluate the correlation of a Pediatric Early Warning Score with unplanned transfer to the PICU in hospitalized oncology and hematopoietic stem cell transplant patients. We performed a retrospective matched case-control study, comparing the highest documented Pediatric Early Warning Score within 24 hours prior to unplanned PICU transfers in hospitalized pediatric oncology and hematopoietic stem cell transplant patients between September 2011 and December 2013. Controls were patients who remained on the inpatient unit and were matched 2:1 using age, condition (oncology vs hematopoietic stem cell transplant), and length of hospital stay. Pediatric Early Warning Scores were documented by nursing staff at least every 4 hours as part of routine care. Need for transfer was determined by a PICU physician called to evaluate the patient. A large tertiary/quaternary free-standing academic children's hospital. One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls. None. Using the highest score in the 24 hours prior to transfer for cases and a matched time period for controls, the Pediatric Early Warning Score was highly correlated with the need for PICU transfer overall (area under the receiver operating characteristic = 0.96), and in the oncology and hematopoietic stem cell transplant groups individually (area under the receiver operating characteristic = 0.95 and 0.96, respectively). The difference in Pediatric Early Warning Score results between the cases and controls was noted as early as 24 hours prior to PICU admission. Seventeen patients died (15.4%). Patients with higher Pediatric Early Warning Scores prior to transfer had increased PICU mortality (p = 0.028) and length of stay (p = 0.004). We demonstrate that our institution's Pediatric Early Warning Score is highly correlated with the need for unplanned PICU transfer in hospitalized oncology and

Evaluation of Hematopoietic Stem Cell Mobilization Rates with Early Plerixafor Administration for Adult Stem Cell Transplantation.

PubMed

Stover, Jessica T; Shaw, J Ryan; Kuchibhatla, Maragatha; Horwitz, Mitchell E; Engemann, Ashley M

2017-08-01

The addition of plerixafor to high-dose colony-stimulating growth factor has been shown to improve stem cell mobilization rates in autologous transplant patients with multiple myeloma and non-Hodgkin lymphoma. This study evaluates the change in administration time of plerixafor to determine if cell mobilization rates are similar between the US Food and Drug Administration-approved administration time of 11 hours before apheresis and an earlier administration time of 16 hours before apheresis. Medical records of patients age ≥ 18 years undergoing autologous stem cell transplantation requiring the use of plerixafor after at least 4 days of granulocyte colony-stimulating factor therapy to complete stem cell mobilization from January 1, 2010 through September 30, 2014 were retrospectively reviewed. The primary outcome was CD34 + cell mobilization success rates when plerixafor was administered 11 ± 2 hours (standard administration group) compared with 16 ± 2 hours before cell apheresis (early administration group), as defined as collection of  ≥2 × 10 6 CD34 + cells/kg. Secondary outcomes included the number of plerixafor therapy days required to collect a total of ≥2 × 10 6 CD34 + cells/kg, the number of apheresis cycles required to achieve ≥2 × 10 6 CD34 + cells/kg, the median CD34 + cells/kg collected in each apheresis session, and the rates of reported adverse events that occurred in the standard administration time group compared with the early administration time group. Of the 197 patients included, 114 patients received plerixafor 11 ± 2 hours before apheresis and 83 patients received plerixafor 16 hours ± 2 hours before apheresis. Ninety-four percent of patients in the early administration group achieved successful stem cell mobilization compared with 81.6% in the standard administration group (P = .0111). The median number of plerixafor days to reach the collection goal of  ≥2 × 10 6 CD34 + cells/kg was 1 day for

Are long physician working hours harmful to patient safety?

PubMed

Ehara, Akira

2008-04-01

Pediatricians of Japanese hospitals including not only residents but also attending physicians work long hours, and 8% work for >79 h per week. Most of them work consecutively for >or=32 h when they are on call. The aim of the present study was to evaluate the effect of long work hours on patient safety. The electronic databases MEDLINE and EMBASE to searched identify the English- and Japanese-language literature for studies on work hours, medical errors, patient safety, and malpractice for years 1966-2005. Studies that analyzed the relationship between physician work hours and outcomes directly related to patient safety were selected. Seven studies met the criteria. Four studies suggest that reduction of work hours has a favorable effect on patient safety indicators. In the other three studies no significant changes of the indicators were observed, but no report found that shorter work hours were harmful to patient safety. Decrease of physician work hours is not harmful but favorable to patient safety.

Work-hour restrictions as an ethical dilemma for residents.

PubMed

Carpenter, Robert O; Austin, Mary T; Tarpley, John L; Griffin, Marie R; Lomis, Kimberly D

2006-04-01

We propose that the standardized work-hour limitations have created an ethical dilemma for residents. A survey tool was designed to assess factors that influence the number of hours residents work and report. The program directors of pediatrics, internal medicine, and general surgery at our institution supported their residents' participation. A voluntary, anonymous survey of these residents was performed. One hundred seventy of 265 eligible residents were surveyed. Eighty-one percent of residents surveyed responded. Eighty percent of respondents reported exceeding work-hour restrictions at least once within the past 6 months. The factor of greatest influence measured was concern for patient care (80%). Forty-nine percent of respondents admitted underreporting their work hours. The Accreditation Council for Graduate Medical Education work-hour restrictions have created an ethical dilemma for residents. Our data show that a significant number of residents feel compelled to exceed work-hour regulations and report those hours falsely.

Can one hour per week of therapy lead to lasting changes in young children with autism?

PubMed

Vismara, Laurie A; Colombi, Costanza; Rogers, Sally J

2009-01-01

Deficits in attention, communication, imitation, and play skills reduce opportunities for children with autism to learn from natural interactive experiences that occur throughout the day. These developmental delays are already present by the time these children reach the toddler period. The current study provided a brief 12 week, 1 hour per week, individualized parent-child education program to eight toddlers newly diagnosed with autism. Parents learned to implement naturalistic therapeutic techniques from the Early Start Denver Model, which fuses developmental- and relationship-based approaches with Applied Behavior Analysis into their ongoing family routines and parent-child play activities. Results demonstrated that parents acquired the strategies by the fifth to sixth hour and children demonstrated sustained change and growth in social communication behaviors. Findings are discussed in relation to providing parents with the necessary tools to engage, communicate with, and teach their young children with autism beginning immediately after the diagnosis.

Training for the future NHS: training junior doctors in the United Kingdom within the 48-hour European working time directive

PubMed Central

2014-01-01

Since August 2009, the National Health Service of the United Kingdom has faced the challenge of delivering training for junior doctors within a 48-hour working week, as stipulated by the European Working Time Directive and legislated in the UK by the Working Time Regulations 1998. Since that time, widespread concern has been expressed about the impact of restricted duty hours on the quality of postgraduate medical training in the UK, particularly in the “craft” specialties – that is, those disciplines in which trainees develop practical skills that are best learned through direct experience with patients. At the same time, specialist training in the UK has experienced considerable change since 2007 with the introduction of competency-based specialty curricula, workplace-based assessment, and the annual review of competency progression. The challenges presented by the reduction of duty hours include increased pressure on doctors-in-training to provide service during evening and overnight hours, reduced interaction with supervisors, and reduced opportunities for learning. This paper explores these challenges and proposes potential responses with respect to the reorganization of training and service provision. PMID:25560369

21 CFR 1316.45 - Filings; address; hours.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Filings; address; hours. 1316.45 Section 1316.45 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES Administrative Hearings § 1316.45 Filings; address; hours. Documents required or...

Night Owl: Maryland's After-Hours Reference Service.

ERIC Educational Resources Information Center

Duke, Deborah C.

1994-01-01

Discusses "Night Owl," a Maryland public library's after hours telephone reference service. Issues include project start-up, user profiles, types of questions, volume, after hours reference accessibility, security, costs, service limits, publicity, staffing, and employee turnover. Similar services in other states are cited. (Contains six…

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

5 CFR 550.183 - Substantial hours requirement.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Substantial hours requirement. 550.183 Section 550.183 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay Law Enforcement Availability Pay § 550.183 Substantial hours requirement. (a...

Self-reporting of internal medicine house staff work hours.

PubMed

Saunders, David L; Kehoe, Kimberly C; Rinehart, Vivian H; Berg, Benjamin W

2005-01-01

The 80-hour workweek became a reality for residency programs nationwide on July 1, 2003. In this review of administrative data, we examine the self-reporting of work hours by a cohort of Internal Medicine residents. Data was collected from 27 residents in training at Tripler Army Medical Center over a 4 month period from September 1 to December 31 2002. House staff reported their hours on a daily basis by responding to an email message, as well as on a monthly basis utilizing the Army's UCAPERs (Uniform Chart of Account Personnel System) mandatory monthly workload tracking system. Data from the two separate reporting systems was compared for accuracy, completeness and internal consistency. Compliance with daily reporting was variable (67-97% with overall compliance rate of 86%) but lower when compared with the mandatory military monthly reporting system (95-100%). There were large differences in reporting of average weekly work hours among individual residents when monthly reporting was compared to daily reporting of data with higher averages with monthly data reporting. Weekly totals averaged nearly 12 hours higher when reported monthly compared to reporting on a daily basis (p < 0.0001). A total of 18 residents reported that they worked more than 80 hours per week during one month using monthly data, while only 7 reported that they averaged more than 80 hours with the daily reporting data. When average weekly hours reported on a daily basis were compared with the total number of inpatient days worked over the four month period using a simple regression model, there was a significant relationship with average hours increasing with increasing number of inpatient days worked (adjusted R square = 0. 19, p = 0.01). Little internal consistency was found in the comparison of daily versus monthly work hour reporting, indicating that self-reporting may not provide accurate data. Complying with the 80-hour workweek is crucial for residency programs to maintain

Changes in Doctors' Working Hours: A Longitudinal Analysis.

PubMed

Joyce, Catherine M; Wang, Wei C; Cheng, Terence C

2015-10-01

The study examined changes in doctors' working hours and satisfaction with working hours over five time points and explored the influence of personal characteristics on these outcomes. Latent growth curve modeling was applied to Medicine in Australia: Balancing Employment and Life data, collected from 2008 to 2012. Findings showed that working hours significantly declined over time, with a greater decrease among males, older doctors, and doctors with fewer children. Satisfaction increased faster over time among specialists, doctors with poorer health, those whose partners did not work full-time, and those with older children. The more hours the doctors worked initially, the lower satisfaction reported, and the greater the increase in satisfaction. Findings are consistent with a culture change in the medical profession, whereby long working hours are no longer seen as synonymous with professionalism. This is important to take into account in projecting future workforce supply. © The Author(s) 2015.

Duty hour reform in a shifting medical landscape.

PubMed

Jena, Anupam B; Prasad, Vinay

2013-09-01

The circumstances that led to the death of Libby Zion in 1984 prompted national discussions about the impact of resident fatigue on patient outcomes. Nearly 30 years later, national duty hour reforms largely motivated by patient safety concerns have demonstrated a negligible impact of duty hour reductions on patient mortality. We suggest that the lack of an impact of duty hour reforms on patient mortality is due to a different medical landscape today than existed in 1984. Improvements in quality of care made possible by computerized order entry, automated medication checks, inpatient pharmacists, and increased resident supervision have, among other systemic changes, diminished the adverse impact that resident fatigue is able to have on patient outcomes. Given this new medical landscape, advocacy towards current and future duty hour reforms may be best justified by evidence of the impact of duty hour reform on resident wellbeing, education, and burnout.

Work hours and absenteeism among police officers.

PubMed

Fekedulegn, Desta; Burchfiel, Cecil M; Hartley, Tara A; Baughman, Penelope; Charles, Luenda E; Andrew, Michael E; Violanti, John M

2013-01-01

In this study, the cross-sectional association of paid work hours with episodes of work absence was examined in a cohort of police officers. Study subjects were participants from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study examined between 2004 and 2009. Among 395 study participants with complete data, day-by-day work history records during the one-year period prior to date of examination were used to determine episodes of one-day and three day work absence. The Negative binomial regression analysis was used to examine rate ratios (RR) of work absence. Analyses were also stratified by gender. A one-hour increase in total work hours was associated with 5% reduction in rate of one-day work absence (RR = 0.95, 95% CI: 0.92 - 0.98) and with 8% reduction in rate of three-day work absence (RR = 0.92, 95% CI: 0.89 - 0.95). The association of total work hours with episodes of one-day work absence was significant only in men while the association with episodes of three-day work absence was evident in men and women. In conclusion, in this cohort of police officers, work hours were negatively associated with both durations of work absence (one-day, > or = 3 consecutive days).

Work Hours and Absenteeism Among Police Officers

PubMed Central

Fekedulegn, Desta; Burchfiel, Cecil M.; Hartley, Tara A.; Baughman, Penelope; Charles, Luenda E.; Andrew, Michael E.; Violanti, John M.

2015-01-01

In this study, the cross-sectional association of paid work hours with episodes of work absence was examined in a cohort of police officers. Study subjects were participants from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study examined between 2004 and 2009. Among 395 study participants with complete data, day-by-day work history records during the one-year period prior to date of examination were used to determine episodes of one-day and three day work absence. The Negative binomial regression analysis was used to examine rate ratios (RR) of work absence. Analyses were also by gender. A one-hour increase in total work hours was associated with 5% reduction in rate of stratified one-day work absence (RR = 0.95, 95% CI: 0.92 – 0.98) and with 8% reduction in rate of three-day work absence (RR = 0.92, 95% CI: 0.89 – 0.95). The association of total work hours with episodes of one-day work absence was significant only in men while the association with episodes of three-day work absence was evident in men and women. In conclusion, in this cohort of police officers, work hours were negatively associated with both durations of work absence (one-day, ≥ 3 consecutive days). PMID:24707589

mHealth to the Rescue: Growing use of wireless and mobile technologies improves community health, even in rural areas.

PubMed

Mertz, Leslie

2016-01-01

In rural areas, it is not unusual for patients to travel 50 miles or more to reach their doctors? offices or for doctors to refer patients to specialists whose offices are 80, 100, even 200-plus miles away. The sheer distance is a major obstacle for patients of all kinds: those who need urgent specialist care, those who have a chronic condition that requires regular visits, those who live in areas prone to poor weather-related driving conditions-really, anyone who has better things to do than spend hours traveling to and from a medical appointment.

29 CFR 778.406 - Nonovertime hours as well as overtime hours must be irregular if section 7(f) is to apply.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... Midland Finance Co. (N.D. Ga.), 16 WH Cases 141; Trager v. J. E. Plastics Mfg. Co. (S.D.N.Y.), 13 WH Cases... 29 Labor 3 2014-07-01 2014-07-01 false Nonovertime hours as well as overtime hours must be... must be irregular if section 7(f) is to apply. Any employment in which the employee's hours fluctuate...

29 CFR 778.406 - Nonovertime hours as well as overtime hours must be irregular if section 7(f) is to apply.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Midland Finance Co. (N.D. Ga.), 16 WH Cases 141; Trager v. J. E. Plastics Mfg. Co. (S.D.N.Y.), 13 WH Cases... 29 Labor 3 2010-07-01 2010-07-01 false Nonovertime hours as well as overtime hours must be... must be irregular if section 7(f) is to apply. Any employment in which the employee's hours fluctuate...

29 CFR 778.406 - Nonovertime hours as well as overtime hours must be irregular if section 7(f) is to apply.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... Midland Finance Co. (N.D. Ga.), 16 WH Cases 141; Trager v. J. E. Plastics Mfg. Co. (S.D.N.Y.), 13 WH Cases... 29 Labor 3 2011-07-01 2011-07-01 false Nonovertime hours as well as overtime hours must be... must be irregular if section 7(f) is to apply. Any employment in which the employee's hours fluctuate...

29 CFR 778.406 - Nonovertime hours as well as overtime hours must be irregular if section 7(f) is to apply.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... Midland Finance Co. (N.D. Ga.), 16 WH Cases 141; Trager v. J. E. Plastics Mfg. Co. (S.D.N.Y.), 13 WH Cases... 29 Labor 3 2012-07-01 2012-07-01 false Nonovertime hours as well as overtime hours must be... must be irregular if section 7(f) is to apply. Any employment in which the employee's hours fluctuate...

29 CFR 778.406 - Nonovertime hours as well as overtime hours must be irregular if section 7(f) is to apply.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... Midland Finance Co. (N.D. Ga.), 16 WH Cases 141; Trager v. J. E. Plastics Mfg. Co. (S.D.N.Y.), 13 WH Cases... 29 Labor 3 2013-07-01 2013-07-01 false Nonovertime hours as well as overtime hours must be... must be irregular if section 7(f) is to apply. Any employment in which the employee's hours fluctuate...

Flexibility of working hours in the 24-hour society.

PubMed

Costa, G

2006-01-01

The 24-hour Society undergoes an ineluctable process towards a social organisation where time constraints are no more restricting human life. The borders between working and social times are no more fixed and rigidly determined, and the value of working time changes according to the different economic and social effects you may consider. Shift and night work, irregular and flexible working hours, together with new technologies, are the milestone of this epochal passage. What are the advantages and disadvantages for the individual, the companies, and the society? What is the cost/benefit ratio in terms of health and social well-being? Coping properly with this process means avoiding a passive acceptance of it with consequent maladjustments at both individual and social level, but adopting effective preventive and compensative strategies aimed at building up a more sustainable society. Flexible working times now appear to be one of the best ways to cope with the demands of the modern life, but there are different points of view about labour and temporal 'flexibility" between employers and employees. For the former it means a prompt adaptation to market demands and technological innovations; for the latter it is a way to improve working and social life, by decreasing work constraints and increasing control and autonomy. Although it can be easily speculated that individual-based 'flexibility" should improve health and well-being, and especially satisfaction, whereas company-based flexibility" might interfere negatively, the effective consequences on health and well-being have still to be analysed properly.

Predicting the optical observables for nucleon scattering on even-even actinides

NASA Astrophysics Data System (ADS)

Martyanov, D. S.; Soukhovitskiĩ, E. Sh.; Capote, R.; Quesada, J. M.; Chiba, S.

2017-09-01

The previously derived Lane consistent dispersive coupled-channel optical model for nucleon scattering on 232Th and 238U nuclei is extended to describe scattering on even-even actinides with Z = 90-98. A soft-rotator-model (SRM) description of the low-lying nuclear structure is used, where the SRM Hamiltonian parameters are adjusted to the observed collective levels of the target nucleus. SRM nuclear wave functions (mixed in K quantum number) have been used to calculate the coupling matrix elements of the generalized optical model. The “effective” deformations that define inter-band couplings are derived from the SRM Hamiltonian parameters. Conservation of nuclear volume is enforced by introducing a dynamic monopolar term to the deformed potential, leading to additional couplings between rotational bands. The fitted static deformation parameters are in very good agreement with those derived by Wang and collaborators using the Weizsäcker-Skyrme global mass model (WS4), allowing use of the latter to predict cross sections for nuclei without experimental data. A good description of the scarce “optical” experimental database is achieved. SRM couplings and volume conservation allow a precise calculation of the compound-nucleus formation cross sections, which is significantly different from that calculated with rigid-rotor potentials coupling the ground-state rotational band. The derived parameters can be used to describe both neutron- and proton-induced reactions. Supported by International Atomic Energy Agency, through the IAEA Research Contract 19263, by the Spanish Ministry of Economy and Competitivity under Contracts FPA2014-53290-C2-2-P and FPA2016-77689-C2-1-R.

Thrombolysis in the age of Primary Percutaneous Coronary Intervention: Mini-Review and Meta-analysis of Early PCI.

PubMed

Al Shammeri, O; Garcia, LA

2013-01-01

Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Assess the safety and effectiveness of Early PCI. We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy. Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, p<0.001). There were no significant bleeding complications when doing early PCI 4 to 24 hours after successful thrombolysis. Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis.

19 CFR 360.107 - Hours of operation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 3 2010-04-01 2010-04-01 false Hours of operation. 360.107 Section 360.107 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE STEEL IMPORT MONITORING AND ANALYSIS SYSTEM § 360.107 Hours of operation. The automatic licensing system will generally be accessible...

19 CFR 360.107 - Hours of operation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 3 2014-04-01 2014-04-01 false Hours of operation. 360.107 Section 360.107 Customs Duties INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE STEEL IMPORT MONITORING AND ANALYSIS SYSTEM § 360.107 Hours of operation. The automatic licensing system will generally be accessible...

19 CFR 360.107 - Hours of operation.