Dredged Material Disposal Study, U.S. Navy Home Port, Everett, Washington. Technical Supplement.
1987-09-01
Group (CVBG) Home Port at Puget Sound in the east waterway of Everett Harbor, Washington (Fig- ure 1). Construction of the home port facility will...significant portion of the material remains in "clumps." This situation is especially true for the Puget Sound area, where much of the dredging is done...0; P’RFOPM %G ORCA % 2A-ON 60 0 CE SYMBOL 7a NAME OF %’OR .G ORGAN ZATON, ’, .. ’\\VES 1 (It applicable) Hv.drauli’s Laboratory WESHE 5c ADDRESS Ccty
Guidelines for port authorities and governments on the privatization of port facilities
DOT National Transportation Integrated Search
1998-09-23
Definitions of privatization as there are port practitioners and experts. In these circumstances, drafting "Guidelines for Port Authorities and Governments on the privatization of port facilities" is a challenge. The ten-step approach presented in th...
33 CFR 158.133 - Which ports and terminals must provide reception facilities?
Code of Federal Regulations, 2010 CFR
2010-07-01
... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Which ports and terminals must provide reception facilities? 158.133 Section 158.133 Navigation and Navigable Waters COAST GUARD..., AND GARBAGE General § 158.133 Which ports and terminals must provide reception facilities? (a) A port...
33 CFR 158.133 - Which ports and terminals must provide reception facilities?
Code of Federal Regulations, 2012 CFR
2012-07-01
... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Which ports and terminals must provide reception facilities? 158.133 Section 158.133 Navigation and Navigable Waters COAST GUARD..., AND GARBAGE General § 158.133 Which ports and terminals must provide reception facilities? (a) A port...
33 CFR 158.133 - Which ports and terminals must provide reception facilities?
Code of Federal Regulations, 2014 CFR
2014-07-01
... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Which ports and terminals must provide reception facilities? 158.133 Section 158.133 Navigation and Navigable Waters COAST GUARD..., AND GARBAGE General § 158.133 Which ports and terminals must provide reception facilities? (a) A port...
32 CFR 644.424 - Development of public port or industrial facilities.
Code of Federal Regulations, 2011 CFR
2011-07-01
... industrial facilities upon the available land shall file a written application with the District Engineer... development of public port or industrial facilities, the District Engineer shall give notice of such... 32 National Defense 4 2011-07-01 2011-07-01 false Development of public port or industrial...
32 CFR 644.424 - Development of public port or industrial facilities.
Code of Federal Regulations, 2010 CFR
2010-07-01
... industrial facilities upon the available land shall file a written application with the District Engineer... development of public port or industrial facilities, the District Engineer shall give notice of such... 32 National Defense 4 2010-07-01 2010-07-01 true Development of public port or industrial...
The use of the deposit-refund framework in port reception facilities charging systems.
Georgakellos, Dimitrios A
2007-05-01
The European Union set in place Directive 2000/59/EC with the aim of substantially reducing discharges of ship-generated waste into the sea by improving the availability and use of port reception facilities. According to the Directive, port administrations shall ensure that the cost recovery system must aim to discourage ships from discharging their waste into the sea, while simultaneously placing the burden of costs on ships, in line with the "polluter pays principle". The present paper examines the extent to which the deposit-refund framework could be used in charging systems of port reception facilities. This has been realized through a case study involving a Greek port. Specifically, the charging system proposed here seems to approach quite close to the primary target, i.e. to a charging system that motivates ships to act more environmentally responsible manner regarding their waste, without significantly affecting their total cost nor the competitiveness of the port.
Code of Federal Regulations, 2010 CFR
2010-07-01
..., and port and harbor areas, including vessels and harbor craft therein. 125.15 Section 125.15....15 Access to waterfront facilities, and port and harbor areas, including vessels and harbor craft....09 to those waterfront facilities, and port and harbor areas, including vessels and harbor craft...
A demonstration of a low cost approach to security at shipping facilities and ports
NASA Astrophysics Data System (ADS)
Huck, Robert C.; Al Akkoumi, Mouhammad K.; Herath, Ruchira W.; Sluss, James J., Jr.; Radhakrishnan, Sridhar; Landers, Thomas L.
2010-04-01
Government funding for the security at shipping facilities and ports is limited so there is a need for low cost scalable security systems. With over 20 million sea, truck, and rail containers entering the United States every year, these facilities pose a large risk to security. Securing these facilities and monitoring the variety of traffic that enter and leave is a major task. To accomplish this, the authors have developed and fielded a low cost fully distributed building block approach to port security at the inland Port of Catoosa in Oklahoma. Based on prior work accomplished in the design and fielding of an intelligent transportation system in the United States, functional building blocks, (e.g. Network, Camera, Sensor, Display, and Operator Console blocks) can be assembled, mixed and matched, and scaled to provide a comprehensive security system. The following functions are demonstrated and scaled through analysis and demonstration: Barge tracking, credential checking, container inventory, vehicle tracking, and situational awareness. The concept behind this research is "any operator on any console can control any device at any time."
NASA Astrophysics Data System (ADS)
Nordin, Nik Muhammad Faris Bin Nik; Hasbollah, Hasif Rafidee bin; Ibrahim, Mohd Asrul Hery Bin; Marican, Nor Dalila bin; Halim, Muhd Hafzal bin Abdul; Rashid, Ahmad Faezi Bin Ab.; Yasin, Nurul Hafizah Binti Mohd
2017-10-01
The numbers of elderly in Malaysia are increased every year. The request towards elderly care services necessitated by the Nursing Home are in demand. However, Nursing Home in Malaysia is lack of standard of facilities in order to cater the care services for the elderly. This paper intends review the minimum standard facilities for the Nursing Homes in globally. The paper also offered insights in developing standard Nursing Home facilities in Malaysia.
[Home anti-cancer therapy with a venous port].
Muto, A; Ashino, Y; Miyazawa, M; Sato, M; Kanno, A; Kawahara, Y; Fujita, Y; Matsushiro, T
2000-12-01
Home anti-cancer chemotherapy and palliation in the terminal stage were performed for patients with advanced cancer of the digestive system, using a venous port implanted beneath the skin via the subclavian vein. Patients under 75 years of age (5 with esophageal, 61 gastric, 59 colorectal, 5 cholangio, 5 pancreatic, 1 hepatic and 1 ileal cancer) were treated. With two portable balloon pumps, continuous intravenous infusion of 5-FU (300 or 400 mg/body/day) combined low-dose injection of cisplatin (5 mg/body/day) was continued for 10 days, and repeated 3 times for 6 weeks. The response rate was 17.9% in 78 patients according to valuation of the tumor mass. In 119 patients also undergoing a tumor marker evaluation, an effect was seen in 26.1%. No severe side effects such as renal dysfunction or bone marrow suppression were seen, and no special infusion was needed. Therefore, such treatment can be continued for a long time. Use of a venous port should make easy the switchover to HPN and the amelioration of the symptoms of the terminal stage, such as pain, and helps patients cope with the worry. Therefore, the present technique is useful in a series of cancer treatments including surgery, chemotherapy and the amelioration of symptoms.
Design of the Long-term Waste Management Facility for Historic LLRW Port Hope Project - 13322
DOE Office of Scientific and Technical Information (OSTI.GOV)
Campbell, Don; Barton, David; Case, Glenn
2013-07-01
The Municipality of Port Hope is located on the northern shores of Lake Ontario approximately 100 km east of Toronto, Ontario, Canada. Starting in the 1930's, radium and later uranium processing by Eldorado Gold Mines Limited (subsequently Eldorado Nuclear Limited) (Eldorado) at their refinery in Port Hope resulted in the generation of process residues and wastes that were disposed of indiscriminately throughout the Municipality until about the mid-1950's. These process residues contained radium (Ra- 226), uranium, arsenic and other contaminants. Between 1944 and 1988, Eldorado was a Federal Crown Corporation, and as such, the Canadian Federal Government has assumed responsibilitymore » for the clean-up and long-term management of the historic waste produced by Eldorado during this period. The Port Hope Project involves the construction and development of a new long-term waste management facility (LTWMF), and the remediation and transfer of the historic wastes located within the Municipality of Port Hope to the new LTWMF. The new LTWMF will consist of an engineered above-ground containment mound designed to contain and isolate the wastes from the surrounding environment for the next several hundred years. The design of the engineered containment mound consists of a primary and secondary composite base liner system and composite final cover system, made up of both natural materials (e.g., compacted clay, granular materials) and synthetic materials (e.g., geo-synthetic clay liner, geo-membrane, geo-textiles). The engineered containment mound will cover an area of approximately 13 hectares and will contain the estimated 1.2 million cubic metres of waste that will be generated from the remedial activities within Port Hope. The LTWMF will also include infrastructure and support facilities such as access roads, administrative offices, laboratory, equipment and personnel decontamination facilities, waste water treatment plant and other ancillary facilities. Preliminary
DOE Office of Scientific and Technical Information (OSTI.GOV)
Conroy, Kevin W.; Vandergaast, Gerald
2012-07-01
The Port Granby Project (the Project) is located near the north shore of Lake Ontario in the Municipality of Clarington, Ontario, Canada. The Project consists of relocating approximately 450,000 m{sup 3} of historic Low-Level Radioactive Waste (LLRW) and contaminated soil from the existing Port Granby Waste Management Facility (WMF) to a proposed Long-Term Waste Management Facility (LTWMF) located adjacent to the WMF. The LTWMF will include an engineered waste containment facility, a Wastewater Treatment Plant (WTP), and other ancillary facilities. A series of bench- and pilot-scale test programs have been conducted to identify preferred treatment processes to be incorporated intomore » the WTP to treat wastewater generated during the construction, closure and post-closure periods at the WMF/LTWMF. (authors)« less
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 42 Public Health 3 2011-10-01 2011-10-01 false Return to home skilled nursing facility. 422.133....133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing facility if the...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 3 2010-10-01 2010-10-01 false Return to home skilled nursing facility. 422.133....133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing facility if the...
Simulating storm surge inundation and damage potential within complex port facilities
NASA Astrophysics Data System (ADS)
Mawdsley, Robert; French, Jon; Fujiyama, Taku; Achutan, Kamalasudhan
2017-04-01
Storm surge inundation of port facilities can cause damage to critical elements of infrastructure, significantly disrupt port operations and cause downstream impacts on vital supply chains. A tidal surge in December 2013 in the North Sea partly flooded the Port of Immingham, which handles the largest volume of bulk cargo in the UK including major flows of coal and biomass for power generation. This flooding caused damage to port and rail transport infrastructure and disrupted operations for several weeks. This research aims to improve resilience to storm surges using hydrodynamic modelling coupled to an agent-based model of port operations. Using the December 2013 event to validate flood extent, depth and duration, we ran a high resolution hydrodynamic simulation using the open source Telemac 2D finite element code. The underlying Digital Elevation Model (DEM) was derived from Environment Agency LiDAR data, with ground truthing of the flood defences along the port frontage. Major infrastructure and buildings are explicitly resolved with varying degrees of permeability. Telemac2D simulations are run in parallel and take only minutes on a single 16 cpu compute node. Inundation characteristics predicted using Telemac 2D differ from a simple Geographical Information System 'bath-tub' analysis of the DEM based upon horizontal application of the maximum water level across the port topography. The hydrodynamic simulation predicts less extensive flooding and more closely matches observed flood extent. It also provides more precise depth and duration curves. Detailed spatial flood depth and duration maps were generated for a range of tide and surge scenarios coupled to mean sea-level rise projections. These inundation scenarios can then be integrated with critical asset databases and an agent-based model of port operation (MARS) that is capable of simulating storm surge disruption along wider supply chains. Port operators are able to act on information from a particular
Facility and market factors affecting transitions from nursing home to community.
Arling, Greg; Abrahamson, Kathleen A; Cooke, Valerie; Kane, Robert L; Lewis, Teresa
2011-09-01
Research into nursing home transitions has given limited attention to the facility or community contexts. To identify facility and market factors affecting transitions of nursing home residents back to the community. Multilevel models were used to estimate effects of facility and market factors on facility-level community discharge rates after controlling for resident demographic, health, and functional conditions. Facility discharge rates were adjusted using Empirical Bayes estimation. Annual cohort of first-time admissions (N=24,648) to 378 Minnesota nursing facilities in 75 nursing home markets from July 2005 to June 2006. Community discharge within 90 days of admission; facility occupancy, payer mix, ownership, case-mix acuity, size, admissions from hospitals, nurse staffing level, and proportion of admissions preferring or having support to return to the community; and nursing market population size, average occupancy, market concentration, and availability of home and community-based services. Rates of community discharge (Empirical Bayes residual) were highest in facilities with more residents preferring community discharge, more Medicare days, higher nurse staffing levels, and higher occupancy. In addition, facilities had higher community discharge rates if they were located in markets with a greater ratio of home and community-based services recipients to nursing home residents and with larger populations. State Medicaid programs should undertake system-level interventions that encourage nursing facilities to reduce unused bed capacity, balance the mix of payers, invest in nurse staffing, and take other steps to promote community discharges. In addition, states should increase home and community-based services, particularly in markets with low community discharge rates.
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 42 Public Health 3 2012-10-01 2012-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 3 2013-10-01 2013-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing...
42 CFR 422.133 - Return to home skilled nursing facility.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 3 2014-10-01 2014-10-01 false Return to home skilled nursing facility. 422.133... Protections § 422.133 Return to home skilled nursing facility. (a) General rule. MA plans must provide coverage of posthospital extended care services to Medicare enrollees through a home skilled nursing...
38 CFR 59.130 - General requirements for all State home facilities.
Code of Federal Regulations, 2013 CFR
2013-07-01
... all State home facilities. 59.130 Section 59.130 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.130 General requirements for all State home facilities. As a condition for receiving a grant and grant funds...
38 CFR 59.130 - General requirements for all State home facilities.
Code of Federal Regulations, 2012 CFR
2012-07-01
... all State home facilities. 59.130 Section 59.130 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.130 General requirements for all State home facilities. As a condition for receiving a grant and grant funds...
38 CFR 59.130 - General requirements for all State home facilities.
Code of Federal Regulations, 2014 CFR
2014-07-01
... all State home facilities. 59.130 Section 59.130 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.130 General requirements for all State home facilities. As a condition for receiving a grant and grant funds...
38 CFR 59.130 - General requirements for all State home facilities.
Code of Federal Regulations, 2011 CFR
2011-07-01
... all State home facilities. 59.130 Section 59.130 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.130 General requirements for all State home facilities. As a condition for receiving a grant and grant funds...
Facility-level outcome performance measures for nursing homes.
Porell, F; Caro, F G
1998-12-01
Risk-adjusted nursing home performance scores were developed for four health outcomes and five quality indicators from resident-level longitudinal case-mix reimbursement data for Medicaid residents of more than 500 nursing homes in Massachusetts. Facility performance was measured by comparing actual resident outcomes with expected outcomes derived from quarterly predictions of resident-level econometric models over a 3-year period (1991-1994). Performance measures were tightly distributed among facilities in the state. The intercorrelations among the nine outcome performance measures were relatively low and not uniformly positive. Performance measures were not highly associated with various structural facility attributes. For most outcomes, longitudinal analyses revealed only modest correlations between a facility's performance score from one time period to the next. Relatively few facilities exhibited consistent superior or inferior performance over time. The findings have implications toward the practical use of facility outcome performance measures for quality assurance and reimbursement purposes in the near future.
Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis
Walker, David R.; Inglese, Gary W.; Sloand, James A.
2010-01-01
Background and objectives: Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Design, setting, participants, & measurements: Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network’s annual reports. Facility characteristic data were collected from Medicare’s Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. Results: The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Conclusions: Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive. PMID:20634324
Dialysis facility and patient characteristics associated with utilization of home dialysis.
Walker, David R; Inglese, Gary W; Sloand, James A; Just, Paul M
2010-09-01
Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network's annual reports. Facility characteristic data were collected from Medicare's Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive.
ERIC Educational Resources Information Center
South Carolina State Dept. of Education, Columbia. Home Economics Education Section.
Suggestions and recommendations presented in this guide are intended to provide teachers, administrators, and architects who plan and equip home economics departments with the objectives and an overview of home economics education programs so that functional facilities will be designed. The first section, consumer and homemaking education, lists…
Freight movement, port facilities, and economic competitiveness.
DOT National Transportation Integrated Search
2014-07-01
This research report examines how the Panama Canal expansion will affect freight at three ports, truck movement : between the ports and inland economic hubs and the economic impacts accompanying the shift in cargo shipping : patterns. Economic impact...
Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.
Morita, Kojiro; Ono, Sachiko; Ishimaru, Miho; Matsui, Hiroki; Naruse, Takashi; Yasunaga, Hideo
2018-04-01
To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.
Lee, Joo Yong; Kang, Dong Hyuk; Lee, Seung Wook
2012-06-01
We report our initial experience with a laparoendoscopic single-site (LESS) repair of a bladder rupture using a home-made single-port device. A 37-year-old man presented to the emergency department with complaints of voiding difficulty and gross hematuria after blunt trauma. Cystography and computed tomography revealed an intraperitoneal bladder rupture. The patient underwent LESS repair of a bladder rupture using the Alexis wound retractor, which was inserted through the umbilical incision. A home-made single-port device was made by fixing 6½ surgical gloves to the outer rim of the retractor and securing the glove finger to the end of 3 trocars with a tie. Using the flexible laparoscopic instruments and rigid instruments, LESS surgery was performed using a procedure similar to conventional laparoscopic surgery. The patient did not have any voiding problem after removal of the urethral Foley catheter on the 10th postoperative day. To our knowledge, this is the first published report of LESS repair of a traumatic bladder rupture using a home-made single-port device in the literature.
Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003-2011.
Mezuk, Briana; Lohman, Matthew; Leslie, Marc; Powell, Virginia
2015-07-01
We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Data come from the Virginia Violent Death Reporting System (2003-2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. LTC may be an important point of engagement in suicide prevention.
Valdor, Paloma F; Gómez, Aina G; Puente, Araceli
2015-01-15
Diffuse pollution from oil spills is a widespread problem in port areas (as a result of fuel supply, navigation and loading/unloading activities). This article presents a method to assess the environmental risk of oil handling facilities in port areas. The method is based on (i) identification of environmental hazards, (ii) characterization of meteorological and oceanographic conditions, (iii) characterization of environmental risk scenarios, and (iv) assessment of environmental risk. The procedure has been tested by application to the Tarragona harbor. The results show that the method is capable of representing (i) specific local pollution cases (i.e., discriminating between products and quantities released by a discharge source), (ii) oceanographic and meteorological conditions (selecting a representative subset data), and (iii) potentially affected areas in probabilistic terms. Accordingly, it can inform the design of monitoring plans to study and control the environmental impact of these facilities, as well as the design of contingency plans. Copyright © 2014 Elsevier Ltd. All rights reserved.
Developing the port of Belawan as a modern and international port
NASA Astrophysics Data System (ADS)
Many, N.
2018-03-01
This study discusses the processes of government to pass the port development plan in Indonesia with the Port of Belawan and its port expansion as the study case. The study uses a descriptive approach by reviewing and analyzing some of relevant literature as the sources. It also reviews and examines the port development theoretical concepts and models giving attention to the international hub port models resulted from the previous studies. The international hub port aspects assessed to be further applied and compared to the actual situation of the Port of Belawan. This process draws the conclusion on which concept and model the port classified, followed by some recommendations concerning the necessary actions to be taken. The results show that: (1) The port planning regulated in port master plan is the guideline and foundation to implement the port development; (2) Spatial and zoning plan regulations are very important in the preparation, planning, and implementation of port development; (3) It has not provided the necessary facilities and criteria of the global hub port model has not been met completely. The port is strategic to be completely developed as the regional hub port to compete with the major ports of neighboring countries. Eventually, this study requires further analysis to examine the economic feasibility of the Port of Belawan in more comprehensive way functioning as an international hub port along with the ongoing development of Kuala Tanjung Port to achieve its ultimate objectives, among other things, the port effectiveness, efficiency, and competitiveness.
Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011
Lohman, Matthew; Leslie, Marc; Powell, Virginia
2015-01-01
Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions. LTC may be an important point of engagement in suicide prevention. PMID:25973805
Community Discharge of Nursing Home Residents: The Role of Facility Characteristics.
Holup, Amanda A; Gassoumis, Zachary D; Wilber, Kathleen H; Hyer, Kathryn
2016-04-01
Using a socio-ecological model, this study examines the influence of facility characteristics on the transition of nursing home residents to the community after a short stay (within 90 days of admission) or long stay (365 days of admission) across states with different long-term services and supports systems. Data were drawn from the Minimum Data Set, the federal Online Survey, Certification, and Reporting (OSCAR) database, the Area Health Resource File, and the LTCFocUs.org database for all free-standing, certified nursing homes in California (n = 1,127) and Florida (n = 657) from July 2007 to June 2008. Hierarchical generalized linear models were used to examine the impact of facility characteristics on the probability of transitioning to the community. Facility characteristics, including size, occupancy, ownership, average length of stay, proportion of Medicare and Medicaid residents, and the proportion of residents admitted from acute care facilities are associated with discharge but differed by state and whether the discharge occurred after a short or long stay. Short- and long-stay nursing home discharge to the community is affected by resident, facility, and sometimes market characteristics, with Medicaid consistently influencing discharge in both states. © Health Research and Educational Trust.
... venous catheter - home; Port - home; PICC line - home; Infusion therapy - home; Home health care - IV treatment ... is given quickly, all at once. A slow infusion, which means the medicine is given slowly over ...
Comparing the nutrition environment and practices of home- and centre-based child-care facilities.
Martyniuk, Olivia J M; Vanderloo, Leigh M; Irwin, Jennifer D; Burke, Shauna M; Tucker, Patricia
2016-03-01
To assess and compare the nutrition environment and practices (as they relate to pre-schoolers) of centre- and home-based child-care facilities. Using a cross-sectional study design, nineteen child-care facilities (ten centre-based, nine home-based) were assessed for one full day using the Environment and Policy Assessment and Observation (EPAO) tool (consisting of a day-long observation/review of the nutrition environment, practices and related documents). Specifically, eight nutrition-related subscales were considered. Child-care facilities in London, Ontario, Canada. Child-care facilities were recruited through directors at centre-based programmes and the providers of home-based programmes. The mean total nutrition environment EPAO scores for centre- and home-based facilities were 12·3 (sd 1·94) and 10·8 (sd 0·78) out of 20 (where a higher score indicates a more supportive environment with regard to nutrition), respectively. The difference between the total nutrition environment EPAO score for centre- and home-based facilities was approaching significance (P=0·055). For both types of facilities, the highest nutrition subscale score (out of 20) was achieved in the staff behaviours domain (centre mean=17·4; home mean=17·0) and the lowest was in the nutrition training and education domain (centre mean=3·6; home mean=2·0). Additional research is needed to confirm these findings. In order to better support child-care staff and enhance the overall nutrition environment in child care, modifications to food practices could be adopted. Specifically, the nutritional quality of foods/beverages provided to pre-schoolers could be improved, nutrition-related training for child-care staff could be provided, and a nutrition curriculum could be created to educate pre-schoolers about healthy food choices.
Region 2 Port-area Investigation of Emissions Reduction (R2PIER)
Background Region 2 is home to the Port of New York and New Jersey (Port), the largest marine port on the East Coast and third largest in the nation. The Port is a concentrated source of diesel pollution, as more than 3 million containers move each year on diesel-powered ships, ...
Principles of subcutaneous port placement.
Gonda, Shaun J; Li, Ruizong
2011-12-01
The introduction of totally implantable subcutaneous devices in the early 1980s provided patients with secure, reliable venous access and also gave them the ability to move more freely and have a more normal lifestyle with these devices in place. The most common totally implantable device used today is the subcutaneous port. These ports consist of an injection port connected to a catheter. Ports provide a number of advantages compared with other venous catheters; the most important is the reduced risk of infection. These devices have significantly lower rates of infection than nontunneled and tunneled catheters. Additional advantages include less frequent irrigation and minimal home care, and they are less prone to environmental or cutaneous contamination when not being accessed. This article will focus on the placement of these ports. Copyright © 2011 Elsevier Inc. All rights reserved.
Bowblis, John R; Meng, Hongdao; Hyer, Kathryn
2013-02-01
To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes. Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes. We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder-Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics. Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6-8 percent, and structure and operational characteristics account for 10-22 percent of the disparity. While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care. © Health Research and Educational Trust.
Bowblis, John R; Meng, Hongdao; Hyer, Kathryn
2013-01-01
Objective To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes. Data Sources Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes. Study Design We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder–Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics. Principal Findings Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6–8 percent, and structure and operational characteristics account for 10–22 percent of the disparity. Conclusion While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care. PMID:22670847
33 CFR 125.33 - Holders of Coast Guard Port Security Cards.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Holders of Coast Guard Port... Card are such as to warrant the belief that his presence on waterfront facilities and port and harbor... as to warrant the belief that his presence on waterfront facilities, and port and harbor areas...
33 CFR 125.33 - Holders of Coast Guard Port Security Cards.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Holders of Coast Guard Port... Card are such as to warrant the belief that his presence on waterfront facilities and port and harbor... as to warrant the belief that his presence on waterfront facilities, and port and harbor areas...
33 CFR 125.33 - Holders of Coast Guard Port Security Cards.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Holders of Coast Guard Port... Card are such as to warrant the belief that his presence on waterfront facilities and port and harbor... as to warrant the belief that his presence on waterfront facilities, and port and harbor areas...
33 CFR 125.33 - Holders of Coast Guard Port Security Cards.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Holders of Coast Guard Port... Card are such as to warrant the belief that his presence on waterfront facilities and port and harbor... as to warrant the belief that his presence on waterfront facilities, and port and harbor areas...
33 CFR 125.33 - Holders of Coast Guard Port Security Cards.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Holders of Coast Guard Port... Card are such as to warrant the belief that his presence on waterfront facilities and port and harbor... as to warrant the belief that his presence on waterfront facilities, and port and harbor areas...
U.S. Offshore Wind Port Readiness
DOE Office of Scientific and Technical Information (OSTI.GOV)
C. Elkinton, A. Blatiak, H. Ameen
2013-10-13
This study will aid decision-makers in making informed decisions regarding the choice of ports for specific offshore projects, and the types of investments that would be required to make individual port facilities suitable to serve offshore wind manufacturing, installation and/or operations.
Port Granby Project Overview - 13208
DOE Office of Scientific and Technical Information (OSTI.GOV)
Smith, David W.; Vandergaast, Gary; Sungaila, Mark
2013-07-01
The Port Granby Project is an integral part of the Port Hope Area Initiative (PHAI), and is located approximately 14 kilometres west of the Municipality of Port Hope in the adjacent Municipality of Clarington, Ontario. The principal objective of the project is the excavation and relocation of low-level radioactive waste (LLRW) and marginally contaminated soils, which were deposited at the Port Granby Waste Management Facility (PGWMF) by Eldorado Nuclear Limited during the period 1955 to 1988, to a new, highly engineered above-ground Long-term Waste Management Facility (LTWMF) to be constructed on a nearby site. The Environmental Assessment for the Projectmore » was approved in 2009 August and the required Waste Nuclear Substance License was received in 2011 November. Once the detailed engineering design was completed, in 2011 March, the Port Granby Project was divided into three major contracts for construction implementation purposes. The first of these contracts was completed in late 2012 and the second is planned to start in early 2013. The contracting process for the third major contract is also expected to be completed during 2013. This paper provides an overview of the Port Granby Project as well as discussion on the status of the Project, including the regulatory approvals process, the approach to contracting the construction works and an update of work recently completed and soon to get underway. (authors)« less
Kawagoe, Koh; Matsuura, Shinobu
2008-12-01
This is a case of a 50s male with cecal cancer suffering from severe pain caused by osteolytic metastasis to the lumbar vertebra, right iliac bone, and the head of the right femur. The pain was palliated by continuous infusion of morphine using a subarachnoid catheter that had access to the subcutaneous "Port". The maximum dose of morphine used a day was 384 mg, which corresponded to 57,600 mg/day of oral morphine. Sixty eight days after the start of home hospice care, the patient died at home because of diffuse peritonitis caused by intestinal rupture.
Sediment management alternatives for the Biloxi ports.
DOT National Transportation Integrated Search
2010-02-01
The objective of this project is to determine the source of sedimentation in the Ports of Biloxi and provide engineered solutions which will reduce : or eliminate the need for dredging within the ports. : The Commercial Docking Facility, Small Craft ...
Analysis of neutron propagation from the skyshine port of a fusion neutron source facility
NASA Astrophysics Data System (ADS)
Wakisaka, M.; Kaneko, J.; Fujita, F.; Ochiai, K.; Nishitani, T.; Yoshida, S.; Sawamura, T.
2005-12-01
The process of neutron leaking from a 14 MeV neutron source facility was analyzed by calculations and experiments. The experiments were performed at the Fusion Neutron Source (FNS) facility of the Japan Atomic Energy Institute, Tokai-mura, Japan, which has a port on the roof for skyshine experiments, and a 3He counter surrounded with a polyethylene moderator of different thicknesses was used to estimate the energy spectra and dose distributions. The 3He counter with a 3-cm-thick moderator was also used for dose measurements, and the doses evaluated by the counter counts and the calculated count-to-dose conversion factor agreed with the calculations to within ˜30%. The dose distribution was found to fit a simple analytical expression, D(r)=Q{exp(-r/λD)}/{r} and the parameters Q and λD are discussed.
Assessment of Ports for Offshore Wind Development in the United States
DOE Office of Scientific and Technical Information (OSTI.GOV)
Elkinton, Chris; Blatiak, Alicia; Ameen, Hafsa
As offshore wind energy develops in the United States, port facilities will become strategic hubs in the offshore wind farm supply chain because all plant and transport logistics must transit through these facilities. Therefore, these facilities must provide suitable infrastructure to meet the specific requirements of the offshore wind industry. As a result, it is crucial that federal and state policy-makers and port authorities take effective action to position ports in the offshore wind value chain to take best advantage of their economic potential. The U.S. Department of Energy tasked the independent consultancy GL Garrad Hassan (GL GH) with carryingmore » out a review of the current capability of U.S. ports to support offshore wind project development and an assessment of the challenges and opportunities related to upgrading this capability to support the growth of as many as 54 gigawatts of offshore wind installed in U.S. waters by 2030. The GL GH report and the open-access web-based Ports Assessment Tool resulting from this study will aid decision-makers in making informed decisions regarding the choice of ports for specific offshore projects, and the types of investments that would be required to make individual port facilities suitable to serve offshore wind manufacturing, installation and/or operations. The offshore wind industry in the United States is still in its infancy and this study finds that additional port facilities capable of supporting offshore wind projects are needed to meet the anticipated project build-out by 2030; however, no significant barriers exist to prevent the development of such facilities. Furthermore, significant port capabilities are in place today with purpose-build port infrastructure currently being built. While there are currently no offshore wind farms operating in the United States, much of the infrastructure critical to the success of such projects does exist, albeit in the service of other industries. This conclusion
The influence of facility and home pen design on the welfare of the laboratory-housed dog.
Scullion Hall, Laura E M; Robinson, Sally; Finch, John; Buchanan-Smith, Hannah M
We have an ethical and scientific obligation to Refine all aspects of the life of the laboratory-housed dog. Across industry there are many differences amongst facilities, home pen design and husbandry, as well as differences in features of the dogs such as strain, sex and scientific protocols. Understanding how these influence welfare, and hence scientific output is therefore critical. A significant proportion of dogs' lives are spent in the home pen and as such, the design can have a considerable impact on welfare. Although best practice guidelines exist, there is a paucity of empirical evidence to support the recommended Refinements and uptake varies across industry. In this study, we examine the effect of modern and traditional home pen design, overall facility design, husbandry, history of regulated procedures, strain and sex on welfare-indicating behaviours and mechanical pressure threshold. Six groups of dogs from two facilities (total n=46) were observed in the home pen and tested for mechanical pressure threshold. Dogs which were housed in a purpose-built modern facility or in a modern design home pen showed the fewest behavioural indicators of negative welfare (such as alert or pacing behaviours) and more indicators of positive welfare (such as resting) compared to those in a traditional home pen design or traditional facility. Welfare indicating behaviours did not vary consistently with strain, but male dogs showed more negative welfare indicating behaviours and had greater variation in these behaviours than females. Our findings showed more positive welfare indicating behaviours in dogs with higher mechanical pressure thresholds. We conclude that factors relating to the design of home pens and implementation of Refinements at the facility level have a significant positive impact on the welfare of laboratory-housed dogs, with a potential concomitant impact on scientific endpoints. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights
Lessons from Hurricane Sandy for port resilience.
DOT National Transportation Integrated Search
2013-12-01
New York Harbor was directly in the path of the most damaging part of Hurricane Sandy causing significant impact on many of the : facilities of the Port of New York and New Jersey. The U.S. Coast Guard closed the entire Port to all traffic before the...
FHWA operations support : port peak pricing program evaluation
DOT National Transportation Integrated Search
2009-01-01
This report evaluates the applicability, Federal policy implications, and possible public and private sector roles related to peak pricing strategies at ports and intermodal facilities in the U.S. A number of ports and intermodal terminals are consid...
Courtney, K L
2008-01-01
With large predicted increases of the older adult (65 years and older) population, researchers have been exploring the use of smart home information technologies (IT) in residential care (RC) facilities to enhance resident quality of life and safety. Older adults' perceptions of privacy can inhibit their acceptance and subsequent adoption of smart home IT. This qualitative study, guided by principles of grounded theory research, investigated the relationship between privacy, living environment and willingness of older adults living in residential care facilities to adopt smart home IT through focus groups and individual interviews. The findings from this study indicate that privacy can be a barrier for older adults' adoption of smart home IT; however their own perception of their need for the technology may override their privacy concerns. Privacy concerns, as a barrier to technology adoption, can be influenced by both individual-level and community-level factors. Further exploration of the factors influencing older adults' perceptions of smart home IT need is necessary.
An analysis of the development of port operation in Da Nang Port, Vietnam
NASA Astrophysics Data System (ADS)
Nguyen, T. D. H.; Cools, M.
2018-04-01
This paper presents the current operating status in Da Nang Port, Vietnam in the period 2012-2016. The port operation had positive changes that were reflected by a significant increase in total throughputs, especially containerized cargo volumes. Classical decomposition techniques are used to find trend-cycle and seasonal components of monthly throughput flows. Appropriate predictive models of different kinds of throughputs are proposed. Finally, a development strategy towards containerization and investment policies in facilities, equipment, and infrastructure are suggested based on the predictive results.
NPDES Permit for Woodcock Home Addition Wastewater Treatment Facility in Montana
Under NPDES permit MT-0030554, the Salish and Kootenai Housing Authority is authorized to discharge from its Woodcock Home Addition Wastewater Treatment Facility in Lake County, Montana, to a swale draining to Middle Crow Creek.
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 3 2013-10-01 2013-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services of...
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 42 Public Health 3 2012-10-01 2012-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services of...
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 3 2014-10-01 2014-10-01 false Services of residents in skilled nursing facilities... SETTINGS Services of Residents § 415.204 Services of residents in skilled nursing facilities and home... nursing facility. Payment to a participating skilled nursing facility may include the cost of services of...
Wang, Duojin; Wu, Jing; Lin, Qinglian
2018-05-01
The home-based rehabilitation of elderly patients improves their autonomy, independence and reintegration into society. Hence, a suitable environment plays an important role in rehabilitation, as do different assistance technologies. The majority of accidents at home involving elderly people occur in the bathroom. Therefore, the planning of the layout of facilities is important in this potentially dangerous area. This paper proposes an approach towards designing and optimizing the layout of facilities in the bathroom, based on logistical and nonlogistical relationships. A fuzzy-based analytical hierarchical process (fuzzy-AHP) is then proposed for a comprehensive evaluation of the alternatives for this layout plan. This approach was applied to the home of a 71 years old female patient, who was experiencing home-based rehabilitation. After the initial designing and optimizing of the layout of the facilities in her bathroom, a plan could then be created for her particular needs. The results of this research could then enable the home-based rehabilitation of elderly patients to be more effective. Value: This paper develops a new approach to design and optimize the layout of facilities in bathroom for the elderly. Implications for Rehabilitation Develop a new approach to design and optimize the layout of facilities in bathroom. Provide a mathematical and more scientific approach to home layout design for home-based rehabilitation. Provide new opportunities for research, for both the therapist and the patient to analyse the home facility layout.
Code of Federal Regulations, 2014 CFR
2014-10-01
... by the NSA. (b) No person shall use any port facility for any purpose or use other than that for... purpose or use has been approved by the NSA. (c) No person shall change or alter the terms or conditions... part, unless such change has been approved by the NSA: Provided, That this restriction shall not relate...
Code of Federal Regulations, 2012 CFR
2012-10-01
... by the NSA. (b) No person shall use any port facility for any purpose or use other than that for... purpose or use has been approved by the NSA. (c) No person shall change or alter the terms or conditions... part, unless such change has been approved by the NSA: Provided, That this restriction shall not relate...
Code of Federal Regulations, 2011 CFR
2011-10-01
... by the NSA. (b) No person shall use any port facility for any purpose or use other than that for... purpose or use has been approved by the NSA. (c) No person shall change or alter the terms or conditions... part, unless such change has been approved by the NSA: Provided, That this restriction shall not relate...
Code of Federal Regulations, 2010 CFR
2010-10-01
... by the NSA. (b) No person shall use any port facility for any purpose or use other than that for... purpose or use has been approved by the NSA. (c) No person shall change or alter the terms or conditions... part, unless such change has been approved by the NSA: Provided, That this restriction shall not relate...
Code of Federal Regulations, 2013 CFR
2013-10-01
... by the NSA. (b) No person shall use any port facility for any purpose or use other than that for... purpose or use has been approved by the NSA. (c) No person shall change or alter the terms or conditions... part, unless such change has been approved by the NSA: Provided, That this restriction shall not relate...
AP@home: a novel European approach to bring the artificial pancreas home.
Heinemann, Lutz; Benesch, Carsten; DeVries, J Hans
2011-11-01
The development of an artificial pancreas (AP) made huge strides from 2006 to 2008 and a large number of activities are going on in this area of research. Until now, most AP systems under development were tested only under highly controlled conditions. The aim of our project, funded by the European Union, is to develop an AP system to such a level that it can be studied under daily life conditions at the home of patients with diabetes (hence AP@home). Based on a subcutaneous-subcutaneous closed-loop strategy (i.e., glucose sensing and insulin infusion in the subcutaneous tissue), two different approaches will be taken to achieve this aim: a two-port AP system and a single-port AP system. The two-port AP system will use off-the-shelf-components for the glucose sensor and insulin pump in combination with closed-loop algorithms generated in Europe. As to the single-port AP system, two different innovative single-port systems will be developed; in this case, continuous glucose monitoring and insulin infusion will take place via a single catheter. The first clinical trials with the two-port AP system under controlled clinical conditions have started and good progress has been made in the development of the single-port AP systems. We believe that our consortium of 12 European partners, which builds on existing achievements and close cooperation between academic centers and industry, can contribute substantially to the development of an AP system that can be used by patients in daily life. © 2011 Diabetes Technology Society.
An Analysis of Unit Deployments Through US East Coast Ports
1992-06-01
comprehensive description of port facilities and an analysis of ship/berth capability. B. PURPOSE To evaluate US east coast commercial port facilities to...an internal highway bridge. This bridge crosses Colgate Creek. The site was formerly a containment area for disposal of excavated material from the...and Sea-Land can berth breakbulk vessels. However, loading at the Sea-Land berth will be time- consuming because of the configuration of the pier. II
Geothermal greenhouse-heating facilities for the Klamath County Nursing Home, Klamath Falls, Oregon
DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
The Klamath County Nursing Home, located in Klamath Falls, Oregon, was constructed in 1976. The building of 55,654 square feet currently houses care facilities for approximately 120 persons. During the initial planning for the Nursing Home, the present site was selected primarily on the basis of its geothermal resource. This resource (approx. 190/sup 0/F) currently provides space and domestic hot water heating for the Nursing Home, Merle West Medical Center and the Oregon Institute of Technology. The feasibility of installing a geothermal heating system in a planned greenhouse for the Nursing Home is explored. The greenhouse system would be tiedmore » directly to the existing hot water heating system for the Nursing Home.« less
Carter, Mary W; Porell, Frank W
2003-04-01
This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents. Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays. Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates. Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.
Smart Homes and Buildings Research at the Energy Systems Integration Facility
DOE Office of Scientific and Technical Information (OSTI.GOV)
Christensen, Dane; Sparn, Bethany; Hannegan, Bryan
Watch how NREL researchers are using the unique capabilities of the Energy Systems Integration Facility (ESIF) to develop technologies that will help the “smart” homes and buildings of the future perform efficiently and communicate effectively with the electricity grid while enhancing occupants' comfort and convenience.
Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M
2017-07-01
To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. Retrospective cohort study using hospice patient electronic medical record data. Large, national hospice provider. Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
Health Benefits and Risks of Pets in Nursing Homes: A Survey of Facilities in Ohio.
Stull, Jason W; Hoffman, Cydney C; Landers, Timothy
2018-05-01
Pets are encountered in nursing homes and although they provide health benefits to individuals, they are also a source of health risks. The current study aimed to determine the frequency and types of animals in nursing homes, perceived benefits, and content of policies addressing health risks. Ninety-five administrators from unique nursing homes in Ohio completed an online survey addressing perceived benefits and risks of animals and policies in place. Animals were permitted in 99% of nursing homes, with dogs (95%), cats (85%), birds (71%), fish (55%), and farm animals (40%) most frequently reported. Respondents perceived animal interactions resulted in high health benefits for residents. Most facilities (70/75; 93%) reported having an animal policy, yet important gaps were frequently identified in the content of policies. Most respondents (75%) did not report health and safety concerns with animals in facilities. Best practice guidelines and policies should be developed and implemented in nursing homes to address requirements for different animal ownership models, range of animal species, and staff knowledge. [Journal of Gerontological Nursing, 44(5), 39-45.]. Copyright 2018, SLACK Incorporated.
America's container ports : linking markets at home and abroad
DOT National Transportation Integrated Search
2011-01-01
This report provides an overview of the movement of maritime freight handled by the Nations container ports in 2009 through mid-2010, based on the most current available data through that time period. It summarizes trends in maritime freight movem...
Introduction to the Delaware River Port Authority's Smart Bridges initiative
NASA Astrophysics Data System (ADS)
Box, Robert A.; McCullough, Patrick J.; Bistline, Robert S.
2000-06-01
The Delaware River Port Authority, whose mission is to manage, plan and construct transportation facilities and provide transportation services to maximize the safe and efficient movement of people and freight within the Delaware River Valley, located in southwestern Pennsylvania and southern New Jersey, is a self-financing, bi-state Authority, formed by a compact between the Commonwealth of Pennsylvania and the State of New Jersey and approved by the Congress of the United States. The Delaware River Port Authority is firmly committed to the strategic and integrated use of advanced transportation technology to improve traffic flow, operational efficiency and safety on DRPA's four bridges. To this end, the Delaware River Port Authority has initiated a program, appropriately named 'Smart Bridges.' The Delaware River Port Authority has recognized that this type of program is essential to the advancement of the DRPA's mission as an efficient, customer- friendly transportation and regional development agency. Under the Smart Bridges program the Delaware River Port Authority is introducing new technology into its aging infrastructure and transportation systems to ensure that the facilities continue to serve the region into the 21st century and beyond. Initiatives introduced under this program include EZ Pass, video surveillance systems, computerized traffic control systems and partnering with local universities to investigate the application of various innovative technologies to assist in the maintenance of the bridge facilities.
Liu, Chang
2015-01-01
Objective To assess the association between ownership of Chinese elder care facilities and their performance quality; and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Design Cross-sectional study. Setting Census of elder care homes surveyed in Nanjing (in 2009) and Tianjin (in 2010). Population 140 (or 95% of all) elder care facilities located in urban Nanjing, and 157 (or 97% of all) facilities in urban Tianjin. Main study outcome measures We created a summary case-mix index based on activities of daily living (ADL) limitations and cognitive impairment to measure levels of care needs among residents in each facility. We selected structure, process, and outcome measures to assess facility-level quality of care. We also developed a structural quality measure, under-staffing relative to residents’ levels of care needs, which indicates potentially inadequate staffing given the residents’ case-mix. Results Government-owned homes have significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but they serve residents who, on average, have fewer ADL and cognitive functioning limitations than do private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages to either ownership type. However, when staffing to resident ratio is gauged relative to residents’ case-mix, private-sector facilities were more likely to be under-staffed than government-owned facilities. Conclusions In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer, on average, than those in government facilities. The case-mix differences are likely the result of selective admission policies that favor relatively healthier residents in government facilities than in private-sector homes. PMID:24433350
Smart Homes and Buildings Research at the Energy Systems Integration Facility
Christensen, Dane; Sparn, Bethany; Hannegan, Bryan
2018-01-16
Watch how NREL researchers are using the unique capabilities of the Energy Systems Integration Facility (ESIF) to develop technologies that will help the âsmartâ homes and buildings of the future perform efficiently and communicate effectively with the electricity grid while enhancing occupants' comfort and convenience.
Liu, Chang; Feng, Zhanlian; Mor, Vincent
2014-02-01
To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Okuno, Junko; Tomura, Shigeo; Yanagi, Hisako
2006-01-01
The number of users of long-term care insurance has been increasing rapidly since it started in 2000. The number of those who want to enter the long-term care insurance facilities has increased. Although the basic philosophy of long-term care insurance is independence support and self-decision, to enter a facility or home return from facilities is likely to be decided by family caregivers, not by the elderly themselves. Moreover, the number of elderly who return home from welfare facilities is decreasing. We investigated the intension of caregivers who are willing to accept the institutionalized elderly at home and analyzed the factors affecting the acceptance of caregivers. Subjects were elderly who were in long-term care insurance facility in June 2004, and their caregivers. The study was conducted between June 2004 and September 2004 in Ibaraki Prefecture in Japan. A face-to-face interview based on a questionnaire was conducted for the institutionalized elderly and by the mail for the caregivers. The caregivers of 34.6% of the elderly who hoped to return home intended to accept them home. There were differences between the plans of the elderly and caregivers. The risk factors (OR, 95% CI) to make the intention of the caregivers to accept the institutionalized elderly home difficult were level of cooperation with other family members to take care of elderly (OR 15.37, 2.05-115.24), dementia behavior disturbance category with more than one (OR 8.34, 1.02-68.05), time spending in bed of a day (OR 1.31, 1.01-1.71), few knowledge of long-term care insurance system of caregivers (OR 3.65,0.81-16.38). It has been suggested that more physical activities in the facility, establishment of a care-system for the demented elderly living in the community and an educational campaign by the long-term care insurance system are necessary to increase the willingness of caregivers to accept home return of institutionalized elderly.
Qatargas exporting LNG from Qatar`s new Ras Laffan Port
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
When the 135,000 cu m LNG carrier Al Zubarah departed Ras Laffan Port in December, Qatar entered a new era of commerce that will both boost the emirate`s economic development and influence energy trade around the world. The event capped more than a decade of planning, design, and construction of Ras Laffan Port--the world`s newest and largest LNG exporting facility. During the 1980s, the focus in Qatar was on exploration and development of North field, which holds the world`s largest reserves of nonassociated natural gas. In the 1990s, efforts concentrated on establishing a direct production and export link between Northmore » field, the new multi-billion-dollar Qatar Liquefied Gas Co. (Qatargas) gas liquefaction plant at Ras Laffan, and LNG export facilities at the 8.5 sq km Ras Laffan Port. Markets of the Far East will be first to be served by LNG from Ras Laffan Port. Two 25-year LNG supply contracts have been signed with buyers in Japan and South Korea, and negotiations are under way with potential customers from China, Taiwan, and Thailand. The paper describes the port, its operations, and export projects.« less
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 42 Public Health 3 2011-10-01 2011-10-01 false Services of residents in skilled nursing facilities... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health...' services furnished in the following settings that meet the specified requirements: (1) Skilled nursing...
42 CFR 415.204 - Services of residents in skilled nursing facilities and home health agencies.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 3 2010-10-01 2010-10-01 false Services of residents in skilled nursing facilities... Services of Residents § 415.204 Services of residents in skilled nursing facilities and home health...' services furnished in the following settings that meet the specified requirements: (1) Skilled nursing...
NASA Astrophysics Data System (ADS)
Smuda, William; Freiburger, Lonnie A.; Gerhart, Grant R.; Mallon, Lawrence
2004-09-01
The capacity through the use of robots with on board visual, NBC and HAZMAT sensors to rapidly and continuously screen convoys and staged exposed assets would be a force multiplier and measurably improve base and force protection at both inbound and outbound DOD and commercial facilities. This paper chronicles our experiment with the ODIS robot at the Ports of Los Angeles (POLA) and Long Beach (POLB) in July of 2003. POLA & POLB are responsible for moving over 30% of the United States trade goods. Queues of 54" container trucks routinely exceed 100 trucks, extending for over a mile from the port entrances. Spotted equipment and convoys at staging areas are a high visibility and value assets to a terrorist incident. The POLA/POLB scenario is also representative of TRANSCOM operations at the port of Basra during current operation in Iraq. The California Highway Patrol is responsible for physically inspecting these vehicles for roadworthiness and contraband, a dangerous and dirty job. We will also discuss the use of ODIS robots for this task.
Wong, Bonny Yee-Man; Cerin, Ester; Ho, Sai-Yin; Mak, Kwok-Kei; Lo, Wing-Sze; Lam, Tai-Hing
2010-04-01
To examine the independent, competing, and interactive effects of perceived availability of specific types of media in the home and neighborhood sport facilities on adolescents' leisure-time physical activity (PA). Survey data from 34 369 students in 42 Hong Kong secondary schools were collected (2006-07). Respondents reported moderate-to-vigorous leisure-time PA, presence of sport facilities in the neighborhood and of media equipment in the home. Being sufficiently physically active was defined as engaging in at least 30 minutes of non-school leisure-time PA on a daily basis. Logistic regression and post-estimation linear combinations of regression coefficients were used to examine the independent and competing effects of sport facilities and media equipment on leisure-time PA. Perceived availability of sport facilities was positively (OR(boys) = 1.17; OR(girls) = 1.26), and that of computer/Internet negatively (OR(boys) = 0.48; OR(girls) = 0.41), associated with being sufficiently active. A significant positive association between video game console and being sufficiently active was found in girls (OR(girls) = 1.19) but not in boys. Compared with adolescents without sport facilities and media equipment, those who reported sport facilities only were more likely to be physically active (OR(boys) = 1.26; OR(girls) = 1.34), while those who additionally reported computer/Internet were less likely to be physically active (OR(boys) = 0.60; OR(girls) = 0.54). Perceived availability of sport facilities in the neighborhood may positively impact on adolescents' level of physical activity. However, having computer/Internet may cancel out the effects of active opportunities in the neighborhood. This suggests that physical activity programs for adolescents need to consider limiting the access to computer-mediated communication as an important intervention component.
Are nursing home survey deficiencies higher in facilities with greater staff turnover.
Lerner, Nancy B; Johantgen, Meg; Trinkoff, Alison M; Storr, Carla L; Han, Kihye
2014-02-01
To examine CNA and licensed nurse (RN+LPN/LVN) turnover in relation to numbers of deficiencies in nursing homes. A secondary data analysis of information from the National Nursing Home Survey (NNHS) and contemporaneous data from the Online Survey, Certification and Reporting (OSCAR) database. Data were linked by facility as the unit of analysis to determine the relationship of CNA and licensed nurse turnover on nursing home deficiencies. The 2004 NNHS used a multistage sampling strategy to generate a final sample of 1174 nursing homes, which represent 16,100 NHs in the United States. This study focused on the 1151 NNHS facilities with complete deficiency data. Turnover was defined as the total CNAs/licensed nurse full-time equivalents (FTEs) who left during the preceding 3 months (full- and part-time) divided by the total FTE. NHs with high turnover were defined as those with rates above the 75th percentile (25.3% for CNA turnover and 17.9% for licensed nurse turnover) versus all other facilities. This study used selected OSCAR deficiencies from the Quality of Care, Quality of Life, and Resident Behavior categories, which are considered to be more closely related to nursing care. We defined NHs with high deficiencies as those with numbers of deficiencies above the 75th percentile versus all others. Using SUDAAN PROC RLOGIST, we included NNHS sampling design effects and examined associations of CNA/licensed nurse turnover with NH deficiencies, adjusting for staffing, skill mix, bed size, and ownership in binomial logistic regression models. High CNA turnover was associated with high numbers of Quality of Care (OR 1.53, 95% CI 1.10-2.13), Resident Behavior (OR 1.42, 95% CI 1.03-1.97) and total selected deficiencies (OR 1.54, 95% CI 1.12-2.12). Licensed nurse turnover was significantly related to Quality of Care deficiencies (OR 2.06, 95% CI 1.50-2.82) and total selected deficiencies (OR 1.71, 95% CI 1.25-2.33). When both CNA turnover and licensed nurse turnover were
2012-11-30
The recycling of lead has increased during the past 20 years, with more workers and their families potentially being exposed to lead from recycling facilities, including facilities that recycle lead-acid batteries. During November 2010-May 2011, four voluntary blood lead screening clinics for children of employees of a battery recycling facility in Puerto Rico were conducted. A total of 227 persons from 78 families had blood lead tests. Among 68 children aged <6 years, 11 (16%) had confirmed blood lead levels (BLLs) ≥10 µg/dL, the BLL at which CDC recommended individual intervention to reduce BLLs in 2010, and 39 (57%) children aged <6 years had venous or capillary BLLs ≥5 µg/dL, the reference value for elevated BLLs in children established by CDC in 2012. To determine whether take-home lead exposure contributed to the children's BLLs of ≥10 µg/dL, vehicle and household environmental samples were collected and analyzed. Eighty-five percent of vehicle dust samples and 49% of home dust samples exceeded the U.S. Environmental Protection Agency (EPA) level of concern of ≥40 µg/ft² (430.6 µg/m²) [corrected]. EPA began clean-up of employee homes and vehicles, focusing first on homes with children with BLLs ≥10 µg/dL. EPA also required that the company set up shower facilities, shoe washes, and clean changing areas at the battery recycling facility. Lastly, CDC assigned a case manager to provide education, environmental follow-up, and case management of all children with BLLs ≥5 µg/dL. On average, children's BLLs have decreased 9.9 µg/dL since being enrolled in case management.
Leedahl, Skye N; Chapin, Rosemary K; Little, Todd D
2015-01-01
Testing a model based on past research and theory, this study assessed relationships between facility characteristics (i.e., culture change efforts, social workers) and residents' social networks and social support across nursing homes; and examined relationships between multiple aspects of social integration (i.e., social networks, social capital, social engagement, social support) and mental and functional health for older adults in nursing homes. Data were collected at nursing homes using a planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with nursing home staff. The best fitting multilevel structural equation model indicated that the culture change subscale for relationships significantly predicted differences in residents' social networks. Additionally, social networks had a positive indirect relationship with mental and functional health among residents primarily via social engagement. Social capital had a positive direct relationship with both health outcomes. To predict better social integration and mental and functional health outcomes for nursing homes residents, study findings support prioritizing that close relationships exist among staff, residents, and the community as well as increased resident social engagement and social trust. © The Author 2014. 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.
AED use in businesses, public facilities and homes by minimally trained first responders.
Jorgenson, Dawn B; Skarr, Teresa; Russell, James K; Snyder, David E; Uhrbrock, Karen
2003-11-01
Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community to treat sudden cardiac arrest (SCA). We sought to study the use of AEDs in the home, businesses and other public settings by minimally trained first responders. The frequency of AED use, type of training offered to first responders, and outcomes of AED use were investigated. In addition, minimally trained responders were asked if they had encountered any safety problems associated with the AED. We conducted a telephone survey of businesses and public facilities (2683) and homes (145) owning at least one AED for at least 12 months. Use was defined as an AED taken to a medical emergency thought to be a SCA, regardless of whether the AED was applied to the patient or identified a shockable rhythm. Of owners that participated in the survey, 13% (209/1581) of businesses and 5% (4/73) of homes had responded with the AED to a suspected cardiac arrest. Ninety-five percent of the businesses/public facilities offered training that specifically covered AED use. The rate of use for the AEDs was highest in residential buildings, public places, malls and recreational facilities with an overall usage rate of 11.6% per year. In-depth interviews were conducted with lay responders who had used the AED in a suspected cardiac arrest. In the four cases where the AED was used solely by a lay responder, all four patients survived to hospital admission and two were known to be discharged from the hospital. There were no reports of injury or harm. This survey demonstrates that AEDs purchased by businesses and homes were frequently taken to suspected cardiac arrests. Lay responders were able to successfully use the AEDs in emergency situations. Further, there were no reports of harm or injury to the operators, bystanders or patients from lay responder use of the AEDs.
Why is continuum of care from home to health facilities essential to improve perinatal survival?
Bahl, Rajiv; Qazi, Shamim; Darmstadt, Gary L; Martines, Jose
2010-12-01
The period around the time of delivery is extremely hazardous for infants in developing countries. After the first week the risk drops sharply, and survival improves markedly. To reduce perinatal mortality, a continuum of care between the home and the various facilities is essential during pregnancy, childbirth and the newborn period. This paper reviews strategies to promote the establishment of this continuum: providing health care within or close to home by frontline workers and increasing the use of services in health facilities through community mobilization and financing strategies. As perinatal care and care for seriously sick children face common challenges and lessons could be learned from successful strategies for management of other illnesses, this paper also reviews intervention models involving community health workers (CHWs) to improve case management of sick children at the household and community levels. Available evidence suggests that the community strategy with the greatest impact on neonatal mortality is home visits by CHWs combined with community mobilization. The same strategy appears to be effective in increasing health facility utilization. An equally effective strategy for increasing health facility utilization seems to be financing health care to remove financial access barriers, particularly using conditional cash transfers or vouchers. Although the availability of information on the effect of community interventions to improve newborn health has increased in the recent past, significant gaps remain. Information on the effectiveness of strategies in different settings, particularly in sub-Saharan Africa, cost-effectiveness and sustainability are particularly needed and should be gathered in future studies. Copyright © 2010 Elsevier Inc. All rights reserved.
ERIC Educational Resources Information Center
Pillemer, Karl; Meador, Rhoda; Henderson, Charles, Jr.; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie
2008-01-01
Purpose: This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. Design and Methods: We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and…
Conflict resolution styles: a comparison of assisted living and nursing home facilities.
Small, Jeff A; Montoro-Rodriguez, Julian
2006-01-01
In this exploratory study, the authors investigated how interpersonal conflict is resolved in assisted living and nursing home facilities. In particular, the authors examined whether conflict resolution styles differed between type of facility and between residents and staff in each type of facility. Four focus groups were conducted--two with residents and two with staff from each type of facility. The focus groups centered on discussing the occurrence of conflict and how each participant handled it. Discourse analysis was employed to identify participants' use of three styles of conflict resolution: controlling, solution-oriented, and non-confrontational. The results indicate that staff in each care context showed a preference for the solution-oriented approach. Residents in each setting reported equal use of the non-confrontational and solution-oriented styles. The findings suggest that preferred conflict resolution styles may vary more as a function of the role of each communicator than the context of the care setting.
Be'eri, Eliezer; Owen, Simon; Beeri, Maurit; Millis, Scott R; Eisenkraft, Arik
2018-02-21
Chemical-biological-radio-nuclear (CBRN) gas masks are the standard means for protecting the general population from inhalation of toxic industrial compounds (TICs), for example after industrial accidents or terrorist attacks. However, such gas masks would not protect patients on home mechanical ventilation, as ventilator airflow would bypass the CBRN filter. We therefore evaluated in vivo the safety of adding a standard-issue CBRN filter to the air-outflow port of a home ventilator, as a method for providing TIC protection to such patients. Eight adult patients were included in the study. All had been on stable, chronic ventilation via a tracheostomy for at least 3 months before the study. Each patient was ventilated for a period of 1 hour with a standard-issue CBRN filter canister attached to the air-outflow port of their ventilator. Physiological and airflow measurements were made before, during, and after using the filter, and the patients reported their subjective sensation of ventilation continuously during the trial. For all patients, and throughout the entire study, no deterioration in any of the measured physiological parameters and no changes in measured airflow parameters were detected. All patients felt no subjective difference in the sensation of ventilation with the CBRN filter canister in situ, as compared with ventilation without it. This was true even for those patients who were breathing spontaneously and thus activating the ventilator's trigger/sensitivity function. No technical malfunctions of the ventilators occurred after addition of the CBRN filter canister to the air-outflow ports of the ventilators. A CBRN filter canister can be added to the air-outflow port of chronically ventilated patients, without causing an objective or subjective deterioration in the quality of the patients' mechanical ventilation. (Disaster Med Public Health Preparedness. 2018;page 1 of 5).
U.S. ports and the funding of intermodal facilities : an overview of key issues
DOT National Transportation Integrated Search
2000-03-28
The growing us eof containers to move freight has led carriers to use fewer but larger ports. In their efforts to attract and retain carriers, U.S. ports have made or are planning substantial investments in new berths, docks, and improved connections...
Ports Primer: 3.2 Port Governance
State and local governments are important players in port governance and in oversight of transportation projects that may affect ports. Private corporations may also play a role if they lease or own a terminal at a port.
Pillemer, Karl; Meador, Rhoda; Henderson, Charles; Robison, Julie; Hegeman, Carol; Graham, Edwin; Schultz, Leslie
2008-07-01
This article reports on a randomized, controlled intervention study designed to reduce employee turnover by creating a retention specialist position in nursing homes. We collected data three times over a 1-year period in 30 nursing homes, sampled in stratified random manner from facilities in New York State and Connecticut and randomly assigned to treatment and control conditions. Staff outcomes were measured through certified nursing assistant interviews, and turnover rates were measured over the course of the year. In the intervention condition, a staff member was selected to be the facility retention specialist, who would advocate for and implement programs to improve staff retention and commitment throughout the facility. Retention specialists received an intensive 3-day training in retention leadership and in a number of evidence-based retention programs. Ongoing support was provided throughout the project. Treatment facilities experienced significant declines in turnover rates compared to control facilities. As predicted, we found positive effects on certified nursing assistant assessments of the quality of retention efforts and of care provided in the facility; we did not find effects for job satisfaction or stress. The study provides evidence for the effectiveness of the retention specialist model. Findings from a detailed process evaluation suggest modifications of the program that may increase program effects.
Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities.
Hall, Rasheeda K; Toles, Mark; Massing, Mark; Jackson, Eric; Peacock-Hinton, Sharon; O'Hare, Ann M; Colón-Emeric, Cathleen
2015-03-06
Older adults with ESRD often receive care in skilled nursing facilities (SNFs) after an acute hospitalization; however, little is known about acute care use after SNF discharge to home. This study used Medicare claims for North and South Carolina to identify patients with ESRD who were discharged home from a SNF between January 1, 2010 and August 31, 2011. Nursing Home Compare data were used to ascertain SNF characteristics. The primary outcome was time from SNF discharge to first acute care use (hospitalization or emergency department visit) within 30 days. Cox proportional hazards models were used to identify patient and facility characteristics associated with the outcome. Among 1223 patients with ESRD discharged home from a SNF after an acute hospitalization, 531 (43%) had at least one rehospitalization or emergency department visit within 30 days. The median time to first acute care use was 37 days. Characteristics associated with a shorter time to acute care use were black race (hazard ratio [HR], 1.25; 95% confidence interval [95% CI], 1.04 to 1.51), dual Medicare-Medicaid coverage (HR, 1.24; 95% CI, 1.03 to 1.50), higher Charlson comorbidity score (HR, 1.07; 95% CI, 1.01 to 1.12), number of hospitalizations during the 90 days before SNF admission (HR, 1.12; 95% CI, 1.03 to 1.22), and index hospital discharge diagnoses of cellulitis, abscess, and/or skin ulcer (HR, 2.59; 95% CI, 1.36 to 4.45). Home health use after SNF discharge was associated with a lower rate of acute care use (HR, 0.72; 95% CI, 0.59 to 0.87). There were no statistically significant associations between SNF characteristics and time to first acute care use. Almost one in every two older adults with ESRD discharged home after a post-acute SNF stay used acute care services within 30 days of discharge. Strategies to reduce acute care utilization in these patients are needed. Copyright © 2015 by the American Society of Nephrology.
Ports Primer: 4.0 Port-Community Relations
Ports support and benefit local, regional and national economies through their role in creating jobs and transporting goods. The relationship between ports and near-port communities can be complex, as illustrated by case studies.
Randall, G. Kevin; Martin, Peter; MacDonald, Maurice; Margrett, Jennifer; Bishop, Alex J.; Poon, Leonard W.
2011-01-01
We investigated the influence of social relations on health outcomes in very late life by examining the support-efficacy convoy model among older adults who resided in three different residential environments (centenarians in private homes, n = 126; centenarians in assisted living facilities, n = 55; centenarians in nursing homes, n = 105). For each group, path analytic models were employed to test our hypotheses; analyses controlled for sex, mental status, education, perceived economic sufficiency, and activities of daily living. The hypothesized relationships among the models' variables were unique to each of the three groups; three different models fit the data depending upon residential environment. The direct and indirect effects of social relations assessments were positive for the mental and physical health of very old adults, suggesting that participants welcomed the support. However, residential status moderated the associations between the assessments of social relations, self-efficacy, and both outcomes, physical and mental health. PMID:21792391
76 FR 11339 - Update to NFPA 101, Life Safety Code, for State Home Facilities
Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-02
... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 51 RIN 2900-AN59 Update to NFPA 101, Life Safety Code..., Life Safety Code. The change is designed to assure that State Home facilities meet current industry- wide standards regarding life safety and fire safety. DATES: Effective Date: This final rule is...
Federal Register 2010, 2011, 2012, 2013, 2014
2013-06-24
... License Application: Liberty Natural Gas LLC, Port Ambrose Deepwater Port AGENCY: Maritime Administration... Deepwater Port License Application. The application describes an offshore natural gas deepwater port... assistance such as sign language interpretation or other reasonable accommodation, please notify the USCG...
Location of an intermediate hub for port activities
NASA Astrophysics Data System (ADS)
Burciu, Ş.; Ştefănică, C.; Roşca, E.; Dragu, V.; Ruscă, F.
2015-11-01
An intermediate hub might increase the accessibility level of ports but also hinterland and so it can be considered more than a facility with a transhipment role. These hubs might lead to the development of other transport services and enhance their role in gathering and covering economic centres within hinterlands and also getting the part of logistic facility for the ports, with effects on port utilization and its connectivity to global economy. A new location for a hub terminal leads to reduced transport distances within hinterland, with decreased transport costs and external effects, so with gains in people's life quality. Because the production and distribution systems are relatively fixed on short and medium term and the location decisions are strategic and on long term, the logistic chains activities location models have to consider the uncertainties regarding the possible future situations. In most models, production costs are considered equal, the location problem reducing itself to a problem that aims to minimize the total transport costs, meaning the transport problem. The main objective of the paper is to locate a hub terminal that links the producers of cereals that are going to be exported by naval transportation with the Romanian fluvial-maritime ports (Galaţi, Brăila). GIS environment can be used to integrate and analyse a great amount of data and has the ability of using functions as location - allocation models necessary both to private and public sector, being able to determine the optimal location for services like factories, warehouses, logistic platforms and other public services.
Federal Register 2010, 2011, 2012, 2013, 2014
2011-01-25
... DEPARTMENT OF TRANSPORTATION Maritime Administration [USCG-2010-0993] Liberty Natural Gas LLC, Liberty Liquefied Natural Gas (LNG) Deepwater Port License Application AGENCY: Maritime Administration... application describes an offshore natural gas deepwater port facility that would be located approximately 16.2...
ERIC Educational Resources Information Center
Imamoglu, Cagri; Imamoglu, E. Olcay
2006-01-01
In this paper, the authors aim to (a) explore attitudes toward and preferences for living in the newly emerging place type of assisted living facilities in comparison to nursing homes, and (b) assess the possible impact of familiarity on those attitudes and preferences. Ninety-eight respondents (with a mean age of 62) were surveyed. Respondents…
The Use of Hip Protectors in Long-Term Care Facilities: A Survey of Nursing Home Staff
Sawka, Anna M.; Nixon, Madeline; Giangregorio, Lora; Thabane, Lehana; Adachi, Jonathan D.; Gafni, Amiram; Goeree, Ron; Raina, Parminder; Ranford, Jennifer; Papaioannou, Alexandra
2016-01-01
Objectives To determine the level of exposure to hip protectors and barriers to their use in nursing homes. Design, Setting, and Participants We conducted a written survey of 160 staff (including administrators) in 5 nursing homes in the Hamilton-Wentworth region, Ontario, Canada. Measurements The results of primary analyses were expressed as percentage of respondents. Results Among respondents of respective institutions, the rate of prior exposure to hip protectors varied from 40.9% to 100.0% and the rate of prior experience applying these devices varied from 14.3% to 80.0%. The most frequently cited main barriers to the use of hip protectors in long-term care facilities included physicians not thinking to prescribe them, expense, lack of evidence of benefit in this population, wearer discomfort, and wearer removal. A lack of staff time to apply these devices was rarely cited. The majority of staff believed that nursing home residents with a prior history of fracture, those who fall frequently, or those who are unsteady on their feet should wear hip protectors. Conclusions The exposure of surveyed nursing home staff to hip protectors was variable but most agreed that residents who are at increased risk of hip fracture should wear them. Some identified barriers to the use of hip protectors in long-term care facilities were physicians not thinking to prescribe them, expense, lack of evidence of benefit in this population, wearer discomfort, and wearer removal. Such barriers need to be addressed for hip protector implementation strategies to be successful in nursing homes. PMID:17498606
Campbell, Lauren J; Li, Qinghua; Li, Yue
2014-10-01
Nursing home (NH) employee influenza vaccination is associated with reductions in morbidity and mortality among residents. Little is known regarding associations between NH characteristics and employee influenza vaccination rates (EVRs). This study identifies NH characteristics that may be associated with EVRs. Data on employee vaccination rates and programs were gathered from the Office for Oregon Health Policy and Research reports for 3 influenza seasons from 2009 to 2012 and merged with Online Survey, Certification, and Reporting files, from which facility characteristics were obtained. Market controls were obtained from the 2010 Area Health Resource File. Multivariate linear and logistic regression were used to model relationships between facility characteristics and EVR per facility per year, whether formal education for employees was conducted, and whether 2010, 2015, and 2020 Healthy People targets were met. Oregon nursing homes from 2009 to 2012. NHs reporting sufficient data to calculate an EVR were included. Based on information obtained from 2009-2010, 2010-2011, and 2011-2012 surveys, EVRs were calculated for 113/140, 129/141, and 137/140 (81%, 91%, and 98% of) NHs, respectively. Dependent variables were EVR per facility per year, whether formal education for employees was conducted, and whether 2010, 2015, and 2020 Healthy People targets were met. Independent variables included facility characteristics and market controls. On average, chain-affiliated NHs had 9% higher EVRs (P = .01) and 73% higher odds of achieving 60% EVR (2010 target, P = .05) than free-standing NHs. For-profit NHs had, on average, 8% lower EVRs (P = .04) than not-for-profit NHs. Surprisingly, a 10% increase in proportion of Medicaid residents was associated with a 2% increase in EVR (P = .01) and higher odds of achieving 60% (odds ratio = 1.20, P = .004) and 70% (2015 target, odds ratio = 1.14, P = .05) EVR. Given that NHs generally have low employee influenza vaccination
Ports Primer: 2.0 The Role of Ports
Our nation’s ports are an important part of our national economy and intermodal transportation system. The port industry faces many challenges, many of which can also involve and affect near-port communities.
Federal Register 2010, 2011, 2012, 2013, 2014
2010-08-20
... Coast Guard is establishing regulated navigation areas (RNAs) and safety and security zones around the recently constructed Neptune Deepwater Port Facility, and modifying RNA and safety zone regulations for the... and Northeast Gateway deepwater ports. The Neptune RNAs will prohibit vessels from anchoring or...
General view looking aft along the port side of the ...
General view looking aft along the port side of the Orbiter Discovery into its payload bay. Note the Remote Manipulator System, Canadarm, in the foreground mounted on the port side longeron. The Remote Sensor Arm is mounted on the opposite, starboard, longeron. Also note the airlock and the protective covering over the docking mechanism. This image was taken in the Orbiter Processing Facility at Kennedy Space Center. - Space Transportation System, Orbiter Discovery (OV-103), Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, Harris County, TX
Norton, Peter G; Murray, Michael; Doupe, Malcolm B; Cummings, Greta G; Poss, Jeff W; Squires, Janet E; Teare, Gary F; Estabrooks, Carole A
2014-01-01
Objectives To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility. Design Calculation of adjusted Resident Assessment Instrument – Minimum Data Set 2.0 (RAI–MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2–4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts). Setting A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces. Measurements Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared. Results In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions. Conclusions Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI–MDS 2.0 data, and quite probably from any RAI measures. PMID:24523428
Argonne National Laboratory Applied Battery Research for Transportation Program DOE Logo Home ; ABR > About ABR Projects News cell fabrication faciity posttest facility MERF Cell Fabrication Facility Post-Test Facility Materials Engineering Research Facility Battery News Recent Reports Funding
ERIC Educational Resources Information Center
Lowe, Timothy J.; Lucas, Judith A.; Castle, Nicholas G.; Robinson, Joanne P.; Crystal, Stephen
2003-01-01
Purpose: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. Design and Methods: Data on state initiatives and programs…
Temporary vs. Permanent Sub-slab Ports: A Comparative ...
Vapor intrusion (VI) is the migration of subsurface vapors, including radon and volatile organic compounds (VOCs), from the subsurface to indoor air. The VI exposure pathway extends from the contaminant source, which can be impacted soil, non-aqueous phase liquid, or contaminated groundwater, to indoor air-exposure points. Therefore, contaminated matrices may include groundwater, soil, soil gas, and indoor air. VOC contaminants of concern typically include halogenated solvents such as trichloroethene, tetrachloroethene, and chloroform, as well as petroleum hydrocarbons, such as the aromatic VOCs benzene, toluene, and xylenes. Radon is a colorless radioactive gas that is released by radioactive decay of radionuclides in rock and soil that migrate into homes through VI in a similar fashion to VOCs. This project focused on the performance of permanent versus temporary sub-slab sampling ports for the determination of VI of halogenated VOCs and radon into an unoccupied house. VOC and radon concentrations measured simultaneously in soil gas using collocated temporary and permanent ports appeared to be independent of the type of port. The variability between collocated temporary and permanent ports was much less than the spatial variability between different locations within a single residential duplex. The agreement of the majority of VOC and radon concentrations, 0–36% relative percent difference, and 2–19% relative standard deviation respectively, of each sub-sl
Green Port / Eco Port Project - Applications and Procedures in Turkey
NASA Astrophysics Data System (ADS)
Akgul, Burak
2017-12-01
As being the heartlands of international trade, sea ports are the junction points of land and sea routes. The growth of global trade has led to the development of number and capacity as well as the service quality of ports. The policies and procedures applied during construction, operation and development of ports under development with environmental considerations scope has evolved in accordance with the needs of global trends. Although maritime transportation provides the most ecofriendly transportation method, the reduction of potential environmental threats and continuous improvement of ports and their vicinity is paramount from environmental concerns with regards to the international environmental standards. In the context of the study, national and international legal regulations governing the control of the environmental impacts of the activity groups causing pollution in Turkey based sea ports were viewed. In addition, the models applied during the measurement and documentation of environmental impacts were investigated. The most important aspects in terms of the effectiveness of the environmental management models are legal regulations. However, the standards applied at the ports without any legal obligation, such as EcoPorts applications, ISO 14001 standard, and the EMAS (Eco-Management and Audit Scheme) were sought in the scope of the study. The boundaries of the study were determined as the EU based Environmental Management Systems and the Green Port/Eco Port Project which is being administered by the Turkish Ministry of Transport, Maritime and Communication. “Marport”, which is Turkey’s first certified Green Port / Eco Port is designated as the experimental study site. In addition, the provisions in the ports of ESPO member countries are approached in order to compare the effectiveness and applicability of Green Port / Eco Port Project.
Port Stakeholder Summit: Advancing More Sustainable Ports (April 2014)
EPA's National Port Stakeholders Summit, Advancing More Sustainable Ports, focused on actions to protect air quality while reducing climate risk and supporting economic growth, making ports more environmentally sustainable.
EPA's Ports Initiative works in collaboration with the port industry, communities, and government to improve environmental performance and increase economic prosperity. This effort helps people near ports breath cleaner air and live better lives.
Hazardous Waste Cleanup: Beazer Incorporated in Port Newark, New Jersey
The Beazer East, Inc. site consists of approximately eight acres, located on Maritime and Tyler Streets, between the Elizabeth and Port Newark shipping channels, in Essex County, New Jersey. Several wood-treating facilities were located at the site from
Design and evaluation of candidate pressure ports for the HYFLITE experiment
NASA Technical Reports Server (NTRS)
Teter, John E., Jr.; Cleckner, Craig S.; Vontheumer, Alfred E.
1994-01-01
A concept for placing a pressure transducer directly in a shuttle type tile was developed at Langley Research Center. A 5 inch long quartz with a .020 inch inner diameter provides the thermal isolation necessary to allow 2800 F surface pressure measurements to be taken by pressure transducer rated at 250 F. The assembly is potted in place with RTV 560 in a piece of FRCI-12 thermal protection system insulation tile. The integrity of the thermal protection system is maintained even with the intrusion of the pressure port assembly and the pressure port does not disrupt the air flow across the lifting body. Approximately 200 of these pressure ports are to be used in each of the Hypersonic Flight Experiment (HYFLITE) flight tests. Initial vibroacoustic and aerothermal testing of the pressure port designs have been completed at Langley Research vibration laboratory and the 20 MWatt 2 x 9 turbulent duct facility at Ames Research Center. The performance of the pressure ports were found to be well within the required design limits for all cases. In addition, a failure mode in which the entire pressure port assembly was removed proved to be a begin case.
NASA Technical Reports Server (NTRS)
Muniz, Beau
2009-01-01
One unique project that the Prototype lab worked on was PORT I (Post-landing Orion Recovery Test). PORT is designed to test and develop the system and components needed to recover the Orion capsule once it splashes down in the ocean. PORT II is designated as a follow up to PORT I that will utilize a mock up pressure vessel that is spatially compar able to the final Orion capsule.
Aerial surveillance vehicles augment security at shipping ports
NASA Astrophysics Data System (ADS)
Huck, Robert C.; Al Akkoumi, Muhammad K.; Cheng, Samuel; Sluss, James J., Jr.; Landers, Thomas L.
2008-10-01
With the ever present threat to commerce, both politically and economically, technological innovations provide a means to secure the transportation infrastructure that will allow efficient and uninterrupted freight-flow operations for trade. Currently, freight coming into United States ports is "spot checked" upon arrival and stored in a container yard while awaiting the next mode of transportation. For the most part, only fences and security patrols protect these container storage yards. To augment these measures, the authors propose the use of aerial surveillance vehicles equipped with video cameras and wireless video downlinks to provide a birds-eye view of port facilities to security control centers and security patrols on the ground. The initial investigation described in this paper demonstrates the use of unmanned aerial surveillance vehicles as a viable method for providing video surveillance of container storage yards. This research provides the foundation for a follow-on project to use autonomous aerial surveillance vehicles coordinated with autonomous ground surveillance vehicles for enhanced port security applications.
Ports Primer: 4.1 Port Impacts to Local Communities
State and local governments are important players in port governance and in oversight of transportation projects that may affect ports. Private corporations may also play a role if they lease or own a terminal at a port.
Code of Federal Regulations, 2011 CFR
2011-07-01
... of Tampa, Port of Saint Petersburg, Port Manatee, Rattlesnake, Old Port Tampa, Big Bend, Weedon..., Old Port Tampa, Big Bend, Weedon Island, and Crystal River, Florida. (a) Location. The following areas, denoted by coordinates fixed using the North American Datum of 1983 (World Geodetic System 1984), are...
Code of Federal Regulations, 2010 CFR
2010-07-01
... of Tampa, Port of Saint Petersburg, Port Manatee, Rattlesnake, Old Port Tampa, Big Bend, Weedon..., Old Port Tampa, Big Bend, Weedon Island, and Crystal River, Florida. (a) Location. The following areas, denoted by coordinates fixed using the North American Datum of 1983 (World Geodetic System 1984), are...
Code of Federal Regulations, 2013 CFR
2013-07-01
... of Tampa, Port of Saint Petersburg, Port Manatee, Rattlesnake, Old Port Tampa, Big Bend, Weedon..., Old Port Tampa, Big Bend, Weedon Island, and Crystal River, Florida. (a) Location. The following areas, denoted by coordinates fixed using the North American Datum of 1983 (World Geodetic System 1984), are...
Code of Federal Regulations, 2014 CFR
2014-07-01
... of Tampa, Port of Saint Petersburg, Port Manatee, Rattlesnake, Old Port Tampa, Big Bend, Weedon..., Old Port Tampa, Big Bend, Weedon Island, and Crystal River, Florida. (a) Location. The following areas, denoted by coordinates fixed using the North American Datum of 1983 (World Geodetic System 1984), are...
Code of Federal Regulations, 2012 CFR
2012-07-01
... of Tampa, Port of Saint Petersburg, Port Manatee, Rattlesnake, Old Port Tampa, Big Bend, Weedon..., Old Port Tampa, Big Bend, Weedon Island, and Crystal River, Florida. (a) Location. The following areas, denoted by coordinates fixed using the North American Datum of 1983 (World Geodetic System 1984), are...
Fewer-than-four ports versus four ports for laparoscopic cholecystectomy.
Gurusamy, Kurinchi Selvan; Vaughan, Jessica; Rossi, Michele; Davidson, Brian R
2014-02-20
Traditionally, laparoscopic cholecystectomy is performed using two 10-mm ports and two 5-mm ports. Recently, a reduction in the number of ports has been suggested as a modification of the standard technique with a view to decreasing pain and improving cosmesis. The safety and effectiveness of using fewer-than-four ports has not yet been established. To assess the benefits (such as improvement in cosmesis and earlier return to activity) and harms (such as increased complications) of using fewer-than-four ports (fewer-than-four-ports laparoscopic cholecystectomy) versus four ports in people undergoing laparoscopic cholecystectomy for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 8, 2013), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization International Clinical Trials Registry Platform portal to September 2013. We included all randomised clinical trials comparing fewer-than-four ports versus four ports, that is, with standard laparoscopic cholecystectomy that is performed with two ports of at least 10-mm incision and two ports of at least 5-mm incision. Two review authors independently identified the trials and extracted the data. We analysed the data using both the fixed-effect and the random-effects models. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis, whenever possible. We found nine trials with 855 participants that randomised participants to fewer-than-four-ports laparoscopic cholecystectomy (n = 427) versus four-port laparoscopic cholecystectomy (n = 428). Most trials included low anaesthetic risk participants undergoing elective laparoscopic cholecystectomy. Seven of the nine trials used a single port laparoscopic cholecystectomy and the remaining two trials used three-port laparoscopic
Tsunami Defense Efforts at Samcheok Port, Korea
NASA Astrophysics Data System (ADS)
Cho, Y. S.
2016-02-01
Tsunamis mainly triggered by impulsive undersea motions are long waves and can propagate a long distance. Thus, they can cause huge casualties not only neighboring countries but also distant countries. Recently, several devastating tsunamis have been occurred around the Pacific Ocean rim. Among them, the Great East Japan tsunami occurred on March 11, 2011 is probably recorded as one of the most destructive tsunamis during last several decades. The Tsunami killed more than 20,000 people (including missing people) and deprived of property damage of approximately 300 billion USD. The eastern coast of the Korean Peninsula has been attacked historically by unexpected tsunami events. These tsunamis were generated by undersea earthquakes occurred off the west coast of Japan. For example, the Central East Sea Tsunami occurred on May 26, 1983 killed 3 people and caused serious property damage at Samcheok Port located at the eastern coast of Korea. Thus, a defense plan against unexpected tsunami strikes is an essential task for the port authority to protect lives of human beings and port facilities. In this study, a master plan of tsunami defense is introduced at Samcheok Port. A tsunami hazard map is also made by employing both propagation and inundation models. Detailed defense efforts are described including the procedure of development of a tsunami hazard map. Keywords: tsunami, hazard map, run-up height, emergency action plan
Castle, Nicholas; Engberg, John B; Wagner, Laura M; Handler, Steven
2017-02-01
This research examined resident and facility-specific factors associated with a diagnosis of a urinary tract infection (UTI) in the nursing home setting. Minimum Data Set and Online Survey, Certification and Reporting system data were used to identify all nursing home residents in the United States on April 1, 2006, who did not have a UTI ( n = 1,138,418). Residents were followed until they contracted a UTI (9.5%), died (8.3%), left the nursing home (33.2%), or the year ended (49.0%). A Cox proportional hazards model was estimated, controlling for resident and facility characteristics and for the state of residence. The presence of an indwelling catheter was the primary predictor of whether a resident contracted a UTI (adjusted incidence ratio = 3.35, p < .001), but only 6.1% of the residents in the sample had such a catheter. Therefore, only one eighth of the UTIs were contracted by residents with a catheter. Thus, subsequent analysis examined the populations with and without catheters separately. Demographic characteristics (such as age) have a much greater association with incidence among residents without catheters. The association with facility factors such as percentage of Medicaid residents, for-profit, and chain status was less significant. Estimates regarding staffing levels indicate that increased contact hours with more highly educated nursing staff are associated with less catheter use. Several facility-specific risk factors are of significance. Of significance, UTIs may be reduced by modifying factors such as staffing levels.
Bazzano, Alessandra N.; Taub, Leah; Oberhelman, Richard A.; Var, Chivorn
2016-01-01
Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming. PMID:28009812
Shippee, Tetyana P.; Henning-Smith, Carrie; Gaugler, Joseph E.; Held, Robert; Kane, Robert L.
2018-01-01
This article explores the factor structure of a new family satisfaction with nursing home care instrument and determines the relationship of resident quality of life (QOL) and facility characteristics with family satisfaction. Data sources include (1) family satisfaction interviews (n = 16,790 family members), (2) multidimensional survey of resident QOL (n = 13,433 residents), and (3) facility characteristics (n = 376 facilities). We used factor analysis to identify domains of family satisfaction and multivariate analyses to identify the role of facility-level characteristics and resident QOL on facility-mean values of family satisfaction. Four distinct domains were identified for family satisfaction: “care,” “staff,” “environment,” and “food.” Chain affiliation, higher resident acuity, more deficiencies, and large size were all associated with less family satisfaction, and resident QOL was a significant (albeit weak) predictor of family satisfaction. Results suggest that family member satisfaction is distinct from resident QOL but is associated with resident QOL and facility characteristics. PMID:26534835
Public Participation Guide: Container Handling in the Port of Durban, South Africa
This case study describes the public participation process that was conducted in the context of an Integrated Environmental Management exercise related to the proposed expansion of container handling facilities at the Port of Durban, South Africa.
Hameed, Waqas; Ishaque, Muhammad; Gul, Xaher; Siddiqui, Junaid-Ur-Rehman; Hussain, Sharmeen; Hussain, Wajahat; Ahmed, Aftab; Balal, Asma
2017-01-01
Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality) and perception-based (satisfaction) questions in the context of SF centers, while at NGO clinics the interview location only affected clients' responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality). Our study indicates signs of courtesy bias and possibly the Hawthorne effect in exit interviews. Program implementers could opt for home-based interviews for women receiving services at NGO clinics or SF center, whereas exit interviews could be used in outreach settings.
Community Near-Port Modeling System (C-PORT): Briefing for ...
What C-PORT is: Screening level tool for assessing port activities and exploring the range of potential impacts that changes to port operations might have on local air quality; Analysis of decision alternatives through mapping of the likely pattern of potential pollutant dispersion and an estimated change in pollutant concentrations for user-designated scenarios; Designed primarily to evaluate the local air quality impacts of proposed port expansion or modernization, as well as to identify options for mitigating any impacts; Currently includes data from 21 US seaports and features a map-based interface similar to the widely used Google Earth; Still under development, C-PORT is designed as an easy-to-use computer modeling tool for users, such as state air quality managers and planners. This is part of our product outreach prior to model public release and to solicit for additional beta testers.
Ownership conversions and nursing home performance.
Grabowski, David C; Stevenson, David G
2008-08-01
To examine the effects of ownership conversions on nursing home performance. Online Survey, Certification, and Reporting system data from 1993 to 2004, and the Minimum Data Set (MDS) facility reports from 1998 to 2004. Regression specification incorporating facility fixed effects, with terms to identify trends in the pre- and postconversion periods. The annual rate of nursing home conversions almost tripled between 1994 and 2004. Our regression results indicate converting facilities are generally different throughout the pre/postconversion years, suggesting little causal effect of ownership conversions on nursing home performance. Before and after conversion, nursing homes converting from nonprofit to for-profit status generally exhibit deterioration in their performance, while nursing homes converting from for-profit to nonprofit status generally exhibit improvement. Policy makers have expressed concern regarding the implications of ownership conversions for nursing home performance. Our results imply that regulators and policy makers should not only monitor the outcomes of nursing home conversions, but also the targets of these conversions.
Subedi, Bikram; Sullivan, Kenneth D; Dhungana, Birendra
2017-11-01
The quality of indoor environment has received considerable attention owing to the declining outdoor human activities and the associated public health issues. The prolonged exposure of children in childcare facilities or the occupational exposure of adults to indoor environmental triggers can be a culprit of the pathophysiology of several commonly observed idiopathic syndromes. In this study, concentrations of potentially toxic plasticizers (phthalates as well as non-phthalates) were investigated in 28 dust samples collected from three different indoor environments across the USA. The mean concentrations of non-phthalate plasticizers [acetyl tri-n-butyl citrate (ATBC), di-(2-ethylhexyl) adipate (DEHA), and di-isobutyl adipate (DIBA)] were found at 0.51-880 μg/g for the first time in indoor dust samples from childcare facilities, homes, and salons across the USA. The observed concentrations of these replacement non-phthalate plasticizer were as high as di-(2-ethylhexyl) phthalate, the most frequently detected phthalate plasticizer at highest concentration worldwide, in most of indoor dust samples. The estimated daily intakes of total phthalates (n = 7) by children and toddlers through indoor dust in childcare facilities were 1.6 times higher than the non-phthalate plasticizers (n = 3), whereas estimated daily intake of total non-phthalates for all age groups at homes were 1.9 times higher than the phthalate plasticizers. This study reveals, for the first time, a more elevated (∼3 folds) occupational intake of phthalate and non-phthalate plasticizers through the indoor dust at salons (214 and 285 ng/kg-bw/day, respectively) than at homes in the USA. Copyright © 2017 Elsevier Ltd. All rights reserved.
Scoping studies of shielding to reduce the shutdown dose rates in the ITER ports
NASA Astrophysics Data System (ADS)
Juárez, R.; Guirao, J.; Pampin, R.; Loughlin, M.; Polunovskiy, E.; Le Tonqueze, Y.; Bertalot, L.; Kolsek, A.; Ogando, F.; Udintsev, V.; Walsh, M.
2018-07-01
The planned in situ maintenance tasks in the ITER port interspace are fundamental to ensure the operation of equipment to control, evaluate and optimize the plasma performance during the entire facility lifetime. They are subject to a limit of shutdown dose rates (SDDR) of 100 µSv h‑1 after 106 s of cooling time, which is nowadays a design driver for the port plugs as well as the application of ALARA. Three conceptual shielding proposals outside the ITER ports are studied in this work to support the achievement of this objective. Considered one by one, they offer reductions ranging from 25% to 50%, which are rather significant. This paper shows that, by combining these shields, the SDDR as low as 57Δ µSv h‑1 can be achieved with a local approach considering only radiation from one port (no cross-talk form neighboring ports). The locally evaluated SDDR are well below the limit which is an essential pre-requisite for achieving 100µSv h‑1 in a global analysis including all contributions. Further studies will have to deal with a realistic port plug design and the cross-talks from neighbour ports.
Candy, B; Holman, A; Leurent, B; Davis, S; Jones, L
2011-01-01
Hospice care supports patients and their families physically and emotionally through the dying phase. In many countries a substantial portion of specialised end-of-life care is provided through hospices. Such care has developed outside of general healthcare and is commonly provided in a patient's home or in dedicated facilities. Hospice provision may need to increase in the future due to an ageing population with a greater need for access to end-of-life care. In this systematic review we sought to identify the current evidence on (1) the effectiveness, including cost-effectiveness, of hospices, and hospice care in a patient's home and in nursing homes and (2) the experiences of those who use and of those who provide such services. We included quantitative and qualitative studies on hospice care that was provided in a patient's home, nursing home or hospice. We did not include studies on end-of-life care that was provided as part of general healthcare provision, such as by general practitioners in primary care, community nurses or within general hospitals. For quantitative evaluations we included only those that compared hospice care with usual generalist healthcare. The databases CINAHL, MEDLINE, EMBASE, and The Cochrane Library were searched from 2003 to 2009. Evidence was assessed for quality and data extractions double-checked. For quantitative studies we present the outcome data comparing hospice versus usual care. For qualitative evaluations we organise findings thematically. Eighteen comparative evaluations and four thematic papers were identified. Quantitative evidence, mostly of limited quality in design, showed that hospice care at home reduced general health care use and increased family and patient satisfaction with care. Main themes in the qualitative literature revealed that home hospice services support families to sustain patient care at home and hospice day care services generate for the patient a renewed sense of meaning and purpose. Although
Hosaka, Seiji; Ohdaira, Takeshi; Umemoto, Satoshi; Hashizume, Makoto; Kawamoto, Shunji
2013-12-01
Endoscopic surgery is currently a standard procedure in many countries. Furthermore, conventional four-port laparoscopic cholecystectomy is developing into a single-port procedure. However, in many developing countries, disposable medical products are expensive and adequate medical waste disposable facilities are absent. Advanced medical treatments such as laparoscopic or single-port surgeries are not readily available in many areas of developing countries, and there are often no other sterilization methods besides autoclaving. Moreover, existing reusable metallic ports are impractical and are thus not widely used. We developed a novel controllable, multidirectional single-port device that can be autoclaved, and with a wide working space, which was employed in five patients. In all patients, laparoscopic cholecystectomy was accomplished without complications. Our device facilitates single-port surgery in areas of the world with limited sterilization methods and offers a novel alternative to conventional tools for creating a smaller incision, decrease postoperative pain, and improve cosmesis. This novel device can also lower the cost of medical treatment and offers a promising tool for major surgeries requiring a wide working space.
Information to help near-port community leaders participate effectively in the decision-making process by increasing the understanding of the role of ports, how ports can impact local land use, economic trends, and environment.
Hameed, Waqas; Ishaque, Muhammad; Gul, Xaher; Siddiqui, Junaid-ur-Rehman; Hussain, Sharmeen; Hussain, Wajahat; Ahmed, Aftab; Balal, Asma
2017-01-01
Purpose Despite a general understanding that exit interviews being conducted at service providers’ facilities may influence clients’ responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients’ perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews. Methods A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels – nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January 2016 in 70 districts across all four provinces of Pakistan. A total of 2,807 clients were interviewed, of whom 1,404 clients were interviewed at health facilities after receiving services and 1,403 were interviewed at their homes within 3 days of method uptake. Results Overall, we found no significant differences between the characteristics of study participants interviewed at health facilities or at home. The findings suggested that experiences reported in exit surveys at facilities were strongly biased positively. This was true for both experiential (service quality) and perception-based (satisfaction) questions in the context of SF centers, while at NGO clinics the interview location only affected clients’ responses regarding service quality. However, in outreach settings, clients are more likely to share bad experiences in exit interviews than in home-based interviews on objectively asked questions (service quality). Conclusion Our study indicates signs of courtesy bias and possibly the Hawthorne effect in exit interviews. Program implementers could opt for home-based interviews for women receiving services at NGO clinics or SF center, whereas exit interviews could be used in outreach settings. PMID:29760573
33 CFR 158.210 - Ports and terminals loading crude oil.
Code of Federal Regulations, 2010 CFR
2010-07-01
...); (b) Bilge water containing oily mixtures in the amount of 10 metric tons (11 short tons) or 2 metric...) Ballast water containing oily mixtures in the amount of 30% of the deadweight tonnage of the largest of... Criteria for Reception Facilities: Oily Mixtures § 158.210 Ports and terminals loading crude oil. The...
33 CFR 158.210 - Ports and terminals loading crude oil.
Code of Federal Regulations, 2013 CFR
2013-07-01
...); (b) Bilge water containing oily mixtures in the amount of 10 metric tons (11 short tons) or 2 metric...) Ballast water containing oily mixtures in the amount of 30% of the deadweight tonnage of the largest of... Criteria for Reception Facilities: Oily Mixtures § 158.210 Ports and terminals loading crude oil. The...
33 CFR 158.210 - Ports and terminals loading crude oil.
Code of Federal Regulations, 2011 CFR
2011-07-01
...); (b) Bilge water containing oily mixtures in the amount of 10 metric tons (11 short tons) or 2 metric...) Ballast water containing oily mixtures in the amount of 30% of the deadweight tonnage of the largest of... Criteria for Reception Facilities: Oily Mixtures § 158.210 Ports and terminals loading crude oil. The...
33 CFR 158.210 - Ports and terminals loading crude oil.
Code of Federal Regulations, 2014 CFR
2014-07-01
...); (b) Bilge water containing oily mixtures in the amount of 10 metric tons (11 short tons) or 2 metric...) Ballast water containing oily mixtures in the amount of 30% of the deadweight tonnage of the largest of... Criteria for Reception Facilities: Oily Mixtures § 158.210 Ports and terminals loading crude oil. The...
33 CFR 158.210 - Ports and terminals loading crude oil.
Code of Federal Regulations, 2012 CFR
2012-07-01
...); (b) Bilge water containing oily mixtures in the amount of 10 metric tons (11 short tons) or 2 metric...) Ballast water containing oily mixtures in the amount of 30% of the deadweight tonnage of the largest of... Criteria for Reception Facilities: Oily Mixtures § 158.210 Ports and terminals loading crude oil. The...
Does investor ownership of nursing homes compromise the quality of care?
Harrington, C; Woolhandler, S; Mullan, J; Carrillo, H; Himmelstein, D U
2001-09-01
Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. We analyzed 1998 data from state inspections of 13,693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.
Does Investor Ownership of Nursing Homes Compromise the Quality of Care?
Harrington, Charlene; Woolhandler, Steffie; Mullan, Joseph; Carrillo, Helen; Himmelstein, David U.
2001-01-01
Objectives. Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. Methods. We analyzed 1998 data from state inspections of 13 693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. Results. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. Conclusions. Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes. PMID:11527781
Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.
Kang, Yu; Meng, Hongdao; Miller, Nancy A
2011-12-01
To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.
Sampling Challenges in Nursing Home Research
Tilden, Virginia P.; Thompson, Sarah A.; Gajewski, Byron J.; Buescher, Colleen M.; Bott, Marjorie J.
2012-01-01
Background Research on end-of-life care in nursing homes is hampered by challenges in retaining facilities in samples through study completion. Large-scale longitudinal studies in which data are collected on-site can be particularly challenging. Objectives To compare characteristics of nursing homes that dropped from study to those that completed the study. Methods 102 nursing homes in a large geographic 2-state area were enrolled in a prospective study of end-of-life care of residents who died in the facility. The focus of the study was the relationship of staff communication, teamwork, and palliative/end-of-life care practices to symptom distress and other care outcomes as perceived by family members. Data were collected from public data bases of nursing homes, clinical staff on site at each facility at two points in time, and from decedents’ family members in a telephone interview. Results 17 of the 102 nursing homes dropped from the study before completion. These non-completer facilities had significantly more deficiencies and a higher rate of turnover of key personnel compared to completer facilities. A few facilities with a profile typical of non-completers actually did complete the study after an extraordinary investment of retention effort by the research team. Discussion Nursing homes with a high rate of deficiencies and turnover have much to contribute to the goal of improving end-of-life care, and their loss to study is a significant sampling challenge. Investigators should be prepared to invest extra resources to maximize retention. PMID:23041332
The National Nursing Home Survey provides includes characteristics such as size of nursing home facilities, ownership, Medicare/Medicaid certification, occupancy rate, number of days of care provided, and expenses.
The port side view of the Orbiter Discovery while mounted ...
The port side view of the Orbiter Discovery while mounted atop the 76-wheeled orbiter transfer system as it is being rolled from the Orbiter Processing Facility to the Vehicle Assembly Building at Kennedy Space Center. - Space Transportation System, Orbiter Discovery (OV-103), Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, Harris County, TX
ERIC Educational Resources Information Center
Queensland Dept. of Education, Brisbane (Australia).
The first national study of facilities for isolated Australian children living away from home was undertaken by the Commonwealth Schools Commission in 1981 and released in 1983. This document contains the conclusions, findings, and recommendations of the Commonwealth Schools Commission Working Party report. The results prompted the Commission to…
Integrated circuit test-port architecture and method and apparatus of test-port generation
DOE Office of Scientific and Technical Information (OSTI.GOV)
Teifel, John
A method and apparatus are provided for generating RTL code for a test-port interface of an integrated circuit. In an embodiment, a test-port table is provided as input data. A computer automatically parses the test-port table into data structures and analyzes it to determine input, output, local, and output-enable port names. The computer generates address-detect and test-enable logic constructed from combinational functions. The computer generates one-hot multiplexer logic for at least some of the output ports. The one-hot multiplexer logic for each port is generated so as to enable the port to toggle between data signals and test signals. Themore » computer then completes the generation of the RTL code.« less
Pemberton, Bradley E [Aiken, SC; May, Christopher P [Columbia, MD; Rossabi, Joseph [Aiken, SC; Riha, Brian D [Augusta, GA; Nichols, Ralph L [North Augusta, SC
1998-07-07
A sampling port is provided which has threaded ends for incorporating the port into a length of subsurface pipe. The port defines an internal receptacle which is in communication with subsurface fluids through a series of fine filtering slits. The receptacle is in further communication through a bore with a fitting carrying a length of tubing there which samples are transported to the surface. Each port further defines an additional bore through which tubing, cables, or similar components of adjacent ports may pass.
Pemberton, Bradley E.; May, Christopher P.; Rossabi, Joseph; Riha, Brian D.; Nichols, Ralph L.
1999-01-01
A sampling port is provided which has threaded ends for incorporating the port into a length of subsurface pipe. The port defines an internal receptacle which is in communication with subsurface fluids through a series of fine filtering slits. The receptacle is in further communication through a bore with a fitting carrying a length of tubing there which samples are transported to the surface. Each port further defines an additional bore through which tubing, cables, or similar components of adjacent ports may pass.
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following...
38 CFR 17.57 - Use of community nursing homes.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Use of community nursing... MEDICAL Use of Community Nursing Home Care Facilities § 17.57 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following...
7 CFR 354.1 - Overtime work at border ports, sea ports, and airports.
Code of Federal Regulations, 2011 CFR
2011-01-01
... 7 Agriculture 5 2011-01-01 2011-01-01 false Overtime work at border ports, sea ports, and airports. 354.1 Section 354.1 Agriculture Regulations of the Department of Agriculture (Continued) ANIMAL AND... EXPORTS; AND USER FEES § 354.1 Overtime work at border ports, sea ports, and airports. (a)(1) Any person...
7 CFR 354.1 - Overtime work at border ports, sea ports, and airports.
Code of Federal Regulations, 2010 CFR
2010-01-01
... 7 Agriculture 5 2010-01-01 2010-01-01 false Overtime work at border ports, sea ports, and airports... EXPORTS; AND USER FEES § 354.1 Overtime work at border ports, sea ports, and airports. (a)(1) Any person... of aircraft at airports of entry or other places of inspection as a consequence of the operation of...
Community Near-Port Modeling System (C-PORT): Briefing for Environmental Defense Fund
What C-PORT is: Screening level tool for assessing port activities and exploring the range of potential impacts that changes to port operations might have on local air quality; Analysis of decision alternatives through mapping of the likely pattern of potential pollutant dispersi...
75 FR 47899 - Bayside Savings Bank, Port St. Joe, FL; Notice of Appointment of Receiver
Federal Register 2010, 2011, 2012, 2013, 2014
2010-08-09
... DEPARTMENT OF THE TREASURY Office of Thrift Supervision Bayside Savings Bank, Port St. Joe, FL... section 5(d)(2) of the Home Owners' Loan Act, the Office of Thrift Supervision has duly appointed the..., (OTS No. 17957) on July 30, 2010. Dated: August 2, 2010. By the Office of Thrift Supervision. Sandra E...
Mendler, Edward Charles
2005-02-01
The volumetric efficiency and power of internal combustion engines is improved with an intake port having an intake nozzle, a venturi, and a surge chamber. The venturi is located almost halfway upstream the intake port between the intake valves and the intake plenum enabling the venturi throat diameter to be exceptionally small for providing an exceptionally high ram velocity and an exceptionally long and in turn high efficiency diffuser flowing into the surge chamber. The intake port includes an exceptionally large surge chamber volume for blow down of the intake air into the working cylinder of the engine.
Code of Federal Regulations, 2010 CFR
2010-07-01
... (CONTINUED) PORTS AND WATERWAYS SAFETY REGULATED NAVIGATION AREAS AND LIMITED ACCESS AREAS Specific Regulated Navigation Areas and Limited Access Areas Eighth Coast Guard District § 165.809 Security Zones; Port of Port...) Location. The following area is designated as a security zone: all waters of the Corpus Christi Inner...
An oblique view of the forward fuselage and port side ...
An oblique view of the forward fuselage and port side of the Orbiter Discovery while mounted atop the 76-wheeled orbiter transfer system as it is being rolled from the Orbiter Processing Facility to the Vehicle Assembly Building at Kennedy Space Center. - Space Transportation System, Orbiter Discovery (OV-103), Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, Harris County, TX
Garland, F C; Garland, C F; Gorham, E D; Miller, M R; Cunnion, S O; Berg, S W; Balazs, L L
1993-12-13
The US Navy visits ports on all continents and many islands of the world, many of which are reported to have a high endemicity of human immunodeficiency virus (HIV) infection. The objective of this study was to determine whether visits to foreign ports by active-duty navy personnel were associated with increased risk of HIV infection. The Naval Health Research Center in San Diego, Calif, maintains records of all HIV enzyme-linked immunosorbent assay and Western blot tests given in the navy. This information, along with career histories and ship movement data, was used in a nested case-control design to examine the relationship between visits to the 100 foreign ports most frequently visited by the navy and risk of HIV seroconversion. All visits to a port and total time in each port during the study period were examined. A total of 813 seroconverters were matched to 6993 seronegative active-duty controls by age, race, sex, occupational group, home port, and year of test. Estimated relative risks of seroconversion associated with visits to foreign ports showed no statistically significant excess risk of HIV infection for navy personnel after visits to any foreign port. These results do not imply that an individual's risk of acquisition of HIV would be less in a foreign port if the individual engaged in high-risk activity there. Rather, they imply that despite the mobility of the US Navy and the large variation in HIV seroprevalence rates throughout the world, navy personnel generally do not appear to be acquiring HIV infections abroad.
9 CFR 97.1 - Overtime work at laboratories, border ports, ocean ports, and airports. 1
Code of Federal Regulations, 2011 CFR
2011-01-01
... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Overtime work at laboratories, border ports, ocean ports, and airports. 1 97.1 Section 97.1 Animals and Animal Products ANIMAL AND PLANT... laboratories, border ports, ocean ports, and airports. 1 1 For designated ports of entry for certain animals...
9 CFR 97.1 - Overtime work at laboratories, border ports, ocean ports, and airports. 1
Code of Federal Regulations, 2014 CFR
2014-01-01
... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Overtime work at laboratories, border ports, ocean ports, and airports. 1 97.1 Section 97.1 Animals and Animal Products ANIMAL AND PLANT... laboratories, border ports, ocean ports, and airports. 1 1 For designated ports of entry for certain animals...
9 CFR 97.1 - Overtime work at laboratories, border ports, ocean ports, and airports. 1
Code of Federal Regulations, 2013 CFR
2013-01-01
... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Overtime work at laboratories, border ports, ocean ports, and airports. 1 97.1 Section 97.1 Animals and Animal Products ANIMAL AND PLANT... laboratories, border ports, ocean ports, and airports. 1 1 For designated ports of entry for certain animals...
Creating peer groups for assessing and comparing nursing home performance.
Byrne, Margaret M; Daw, Christina; Pietz, Ken; Reis, Brian; Petersen, Laura A
2013-11-01
Publicly reported performance data for hospitals and nursing homes are becoming ubiquitous. For such comparisons to be fair, facilities must be compared with their peers. To adapt a previously published methodology for developing hospital peer groupings so that it is applicable to nursing homes and to explore the characteristics of "nearest-neighbor" peer groupings. Analysis of Department of Veterans Affairs administrative databases and nursing home facility characteristics. The nearest-neighbor methodology for developing peer groupings involves calculating the Euclidean distance between facilities based on facility characteristics. We describe our steps in selection of facility characteristics, describe the characteristics of nearest-neighbor peer groups, and compare them with peer groups derived through classical cluster analysis. The facility characteristics most pertinent to nursing home groupings were found to be different from those that were most relevant for hospitals. Unlike classical cluster groups, nearest neighbor groups are not mutually exclusive, and the nearest-neighbor methodology resulted in nursing home peer groupings that were substantially less diffuse than nursing home peer groups created using traditional cluster analysis. It is essential that healthcare policy makers and administrators have a means of fairly grouping facilities for the purposes of quality, cost, or efficiency comparisons. In this research, we show that a previously published methodology can be successfully applied to a nursing home setting. The same approach could be applied in other clinical settings such as primary care.
Removal of Historic Low-Level Radioactive Sediment from the Port Hope Harbour - 13314
DOE Office of Scientific and Technical Information (OSTI.GOV)
Kolberg, Mark; Case, Glenn; Ferguson Jones, Andrea
2013-07-01
At the Port Hope Harbour, located on the north shore of Lake Ontario, the presence of low-level radioactive sediment, resulting from a former radium and uranium refinery that operated alongside the Harbour, currently limits redevelopment and revitalization opportunities. These waste materials contain radium-226, uranium, arsenic and other contaminants. Several other on-land locations within the community of Port Hope are also affected by the low-level radioactive waste management practices of the past. The Port Hope Project is a community initiated undertaking that will result in the consolidation of an estimated 1.2 million cubic metres of the low-level radioactive waste from themore » various sites in Port Hope into a new engineered above ground long-term waste management facility. The remediation of the estimated 120,000 m{sup 3} of contaminated sediments from the Port Hope Harbour is one of the more challenging components of the Port Hope Project. Following a thorough review of various options, the proposed method of contaminated sediment removal is by dredging. The sediment from the dredge will then be pumped as a sediment-water slurry mixture into geo-synthetic containment tubes for dewatering. Due to the hard substrate below the contaminated sediment, the challenge has been to set performance standards in terms of low residual surface concentrations that are attainable in an operationally efficient manner. (authors)« less
Johnson, Rebecca A.; Bibbo, Jessica
2014-01-01
The transition from community dwelling to a nursing home is a common, though idiosyncratic, experience in the United States. This study employed an interpretive phenomenological approach to uncover how eight older adults in nursing homes in the Midwestern U.S. constructed the meaning of home shortly following the relocation and again approximately two months later. The degree to which the individual had been involved in the decision making process was also explored as it related to the meaning of home within the nursing home setting. The majority of individuals did not consider the facility to be “home,” but actively changed their attitudes toward the facility and themselves to better adjust to the setting. The findings demonstrate the importance of autonomy in older adults’ definitions of home. PMID:24984908
Federal Register 2010, 2011, 2012, 2013, 2014
2013-06-14
... (NEPA) of 1969 (42 U.S.C. 4321 et seq.). The U.S. Environmental Protection Agency (EPA) and the U.S... Coastal State'' any coastal state which (A) would be directly connected by pipeline to a deepwater port as... the Designation of Adjacent Coastal States for Deepwater Port License Applications in the Federal...
Milwaukee Arts Board Historic Preservation Commission History of Milwaukee's City Hall Business and Port of Milwaukee Purchasing Division Judicial and Oversight Ethics Board Fire and Police Commission ) Deferred Compensation Plan Port of Milwaukee About Us Board of Harbor Commissioners History Directions to
Ishizaki, T
1992-02-01
Geriatric intermediate care facilities (GICFs) were started with subsidies from the Ministry of Health and Welfare in 1987 to encourage return of the elderly from hospitals to their homes rather than other destinations such as nursing homes or hospitals. Contrary to the initial expectation, only half of users (the elderly) have returned home. In order to examine the factors influencing destination after discharge from GICFs, characteristics of the users of a GICF and their primary caregivers were analyzed in a rural community in Nagano. The users were grouped according to their discharge destinations (i.e. 1: home, 2: hospital, 3: nursing home and other GICFs) and compared with respect to the users' and caregivers' socio-demographic characteristics, the length of stay, the users' activities of daily living (ADL) and mental status, the type of place before admission and after discharge, and the caring capacity of the family (i.e. manpower, housing conditions, household economic level and social support). A multiple logistic regression analysis revealed that the following factors were correlated to their return home: good ADL, a short admission period, good level of health of caregivers, adequate space in the residence, negative perception of the caregivers regarding the costs of GICF, and economic level of the household. Evaluation of these factors at an early stage of admission to GICFs may enable prediction of whether or not a user can be successfully discharged to return home.
A quantitative risk analysis approach to port hydrocarbon logistics.
Ronza, A; Carol, S; Espejo, V; Vílchez, J A; Arnaldos, J
2006-01-16
A method is presented that allows quantitative risk analysis to be performed on marine hydrocarbon terminals sited in ports. A significant gap was identified in the technical literature on QRA for the handling of hazardous materials in harbours published prior to this work. The analysis is extended to tanker navigation through port waters and loading and unloading facilities. The steps of the method are discussed, beginning with data collecting. As to accident scenario identification, an approach is proposed that takes into account minor and massive spills due to loading arm failures and tank rupture. Frequency estimation is thoroughly reviewed and a shortcut approach is proposed for frequency calculation. This allows for the two-fold possibility of a tanker colliding/grounding at/near the berth or while navigating to/from the berth. A number of probability data defining the possibility of a cargo spill after an external impact on a tanker are discussed. As to consequence and vulnerability estimates, a scheme is proposed for the use of ratios between the numbers of fatal victims, injured and evacuated people. Finally, an example application is given, based on a pilot study conducted in the Port of Barcelona, where the method was tested.
40 CFR 1068.20 - May EPA enter my facilities for inspections?
Code of Federal Regulations, 2010 CFR
2010-07-01
..., manufacturing processes, storage facilities (including port facilities for imported engines and equipment or... inspect if we learn that local law prohibits it, but we may suspend your certificate if we are not allowed...
Rurality and Nursing Home Quality: Evidence from the 2004 National Nursing Home Survey
ERIC Educational Resources Information Center
Kang, Yu; Meng, Hongdao; Miller, Nancy A.
2011-01-01
Purpose of the Study: To evaluate the impact of rural geographic location on nursing home quality of care in the United States. Design and Methods: The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used…
23. CREW'S BERTHING, TOWARDS PORT, BUNKS ALONG PORT WALL, LOCKERS ...
23. CREW'S BERTHING, TOWARDS PORT, BUNKS ALONG PORT WALL, LOCKERS LINE CROSS CORRIDOR. - U.S. Coast Guard Cutter WHITE LUPINE, U.S. Coast Guard Station Rockland, east end of Tillson Avenue, Rockland, Knox County, ME
Does investor-ownership of nursing homes compromise the quality of care?
Harrington, Charlene; Woolhandler, Steffie; Mullan, Joseph; Carrillo, Helen; Himmelstein, David U
2002-01-01
Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.
Effect of prospective reimbursement on nursing home costs.
Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P
1993-04-01
This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems.
Ishizaki, T; Kai, I; Hisata, M; Kobayashi, Y; Wakatsuki, K; Ohi, G
1995-06-01
To determine the factors that influence users' destinations on discharge from Geriatric Intermediate Care Facilities (GICFs), which were established in Japan in 1987 to help hospitalized older people return home. Retrospective chart review. A 94-bed GICF attached to Saku Central Hospital in Japan. Charts of all users (N = 437) aged 65 years and older, discharged from the GICF between July 1987 and February 1991, were reviewed. The independent variables, obtained from users' admission records, were age, sex, place of residence before admission, length of stay, intellectual impairment (assessed by Karasawa's diagnostic criteria for senile dementia), ability to perform activities of daily living (ADLs), and living arrangement of users in the GICF. The dependent variable was destination after discharge from the GICF. Multiple logistic regression analyses revealed that, compared with users who were able to successfully return home, users with little ability to perform ADLs, male users, and those admitted from other institutions were more likely to be hospitalized. Such analyses also revealed that users who came from institutions, had low ability to perform ADLs, and lived alone were more likely to be institutionalized in nursing homes. Evaluating a user's physical, mental, and socioeconomic conditions at an early stage of admission to a GICF may allow us to predict whether the user can be successfully discharged to his or her home or will have to remain in the GICF for an extended period.
Nanaumi, Yoko; Matoba, Shunya; Onda, Mitsuko; Tanaka, Rie; Tsubota, Kenichi; Mukai, Yusuke; Sakurai, Hidehiko; Hayase, Yukitoshi; Arakawa, Yukio
2012-01-01
A survey was conducted among pharmacists providing "home-visit guidance on drug management" to patients taking medication for dementia. Factors related to medication adherence among patients and pharmacists' acquisition of patient information were then verified. The survey items were: (1) patient attributes (degree of care received, bed-ridden, family composition, and living environment); (2) the person controlling medications; (3) drug storage method and location; (4) dispensing method; (5) patient management of visiting nurses; (6) patient management of visiting physician; (7) details of pharmacist's home-visit guidance; (8) medication adherence; (9) five items related to cognitive function (short-term memory, autonomous judgment, fluctuations in level of consciousness, excitation and loss of orientation, understanding); and (10) ten items related of ADL (mobility in bed, transferring, mobility within the home or outdoors, dressing upper/lower body, eating, toilet use, individual hygiene, bathing). The t test was used to verify the number of items of patient information concerning cognitive function and physical function that pharmacists could acquire at a visit. It was suggested that pharmacists were able to acquire more patient information (①cognitive function and ②ADL) when they visited patients cared for at home, compared to facility residents (①p=0.008, ② p=0.006). Thus, it was suggested that there is a latent risk concerning the pharmacist's ability to discover problems with administration of medications among facility residents. These findings demonstrate that it is essential for pharmacists to be more proactive about providing home-visit guidance.
51. Port elevation, in port. Note reduced turtle deck due ...
51. Port elevation, in port. Note reduced turtle deck due to quarters expansion. - U.S. Coast Guard Cutter WHITE SUMAC, U.S. Coast Guard 8th District Base, 4640 Urquhart Street, New Orleans, Orleans Parish, LA
Pediatric Hospital Discharges to Home Health and Postacute Facility Care: A National Study.
Berry, Jay G; Hall, Matt; Dumas, Helene; Simpser, Edwin; Whitford, Kathleen; Wilson, Karen M; O'Neill, Margaret; Mittal, Vineeta; Agrawal, Rishi; Dribbon, Michael; Haines, Christopher J; Traul, Christine; Marks, Michelle; O'Brien, Jane
2016-04-01
Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. Retrospective analysis of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids' Inpatient Database. Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes. We compared children's characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6% were female. Of 2,423,031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122,673 discharges (5.1%) were to HHC and 26,282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54,589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11,275). When compared with PAC, more discharges to HHC had no chronic condition (34.4% vs 18.0%, P < .001) and fewer discharges to HHC had 4 or more chronic conditions (22.5% vs 37.7%, P < .001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8% vs 1.1%; odds ratio [OR], 0.9 [95% CI, 0.8-0.9]) or HHC (3.3% vs 5.5%; OR, 0.8 [95% CI, 0.7-0.8]) compared with other children. Children with 4 or
Polynuclear Aromatic Hydrocarbons in Port Valdez Shrimp and Sediment.
Carls, Mark G; Holland, Larry; Pihl, Erik; Zaleski, Marilyn A; Moran, John; Rice, Stanley D
2016-07-01
Polynuclear aromatic hydrocarbons (PAHs) from oil were present in some shrimp from Port Valdez, site of a ballast water treatment facility at the Alyeska Alaska Marine Terminal (AMT). Low-level petrogenic PAH concentrations were generally restricted to shrimp eggs in the vicinity of the AMT and extended along the southern shore of Port Valdez to Anderson Bay. Eggs had greater lipid content than other tissues and thus were the most vulnerable biological compartment to hydrocarbon accumulation. Petrogenic hydrocarbons were not observed in shrimp muscle and cephalothoraxes; thus, these tissues do not pose a human health risk. Risk for children older than age 2 years and adults consuming eggs also was low except for two unusual samples (of 32), collected about 17 km west of the treatment facility. In general, PAH loads were consistent with local time series data in other species. We infer that the accumulation mechanism was dissolved uptake from water, consistent with passive sampler observations completed more than a decade earlier. Hydrocarbon levels in the majority of samples were below toxic thresholds. Total PAH accumulation was substantially greater in some pink shrimp than in other species, thus differences in habitat utilization (muddy vs. rocky substrate) are potentially important.
W-band six-port network analyzer for two-port characterization of millimeter wave transistors
NASA Technical Reports Server (NTRS)
Moeller, Karl J.; Schaffner, James H.; Fetterman, Harold R.
1989-01-01
A W-band (75-100 GHz) six-port junction network analyzer was constructed from commercially available descrete waveguide components and was used for the direct two-port S-parameter measurement of active three-terminal devices. A comparison between the six-port and a down-converter-type frequency extender for a conventional network analyzer revealed the superior performance of the six-port. The application of the six-port to characterize a 0.1-micron gate-length HEMT at W-band is described, and representative results are presented.
Nakanishi, Miharu; Hattori, Keiko; Nakashima, Taeko; Sawamura, Kanae
2014-01-01
Japan has had high rates of transition to nursing homes from other long term care facilities. It has been hypothesized that care transitions occur because a resident's condition deteriorates. The aim of the present study was to compare the health care and personal care needs of residents in nursing homes, group homes, and congregate housing in Japan. The present study was conducted using a cross-sectional study design. The present study included 70,519 elderly individuals from 5 types of residential facilities: care medical facilities (heavy medical care; n = 17,358), geriatric intermediate care facilities (rehabilitation aimed toward a discharge to home; n = 26,136), special nursing homes (permanent residence; n = 20,564), group homes (group living, n = 1454), and fee-based homes for the elderly (congregate housing; n = 5007). The managing director at each facility provided information on the residents' health care and personal care needs, including activities of daily living (ADLs), level of required care, level of cognitive impairment, current disease treatment, and medical procedures. A multinomial logistic regression analysis demonstrated a significantly lower rate of medical procedures among the residents in special nursing homes compared with those in care medical facilities, geriatric intermediate care facilities, group homes, and fee-based homes for the elderly. The residents of special nursing homes also indicated a significantly lower level of required care than those in care medical facilities. The results of our study suggest that care transitions occur because of unavailable permanent residence option for people who suffer with medical deterioration. The national government should modify residential facilities by reorganizing several types of residential facilities into nursing homes that provide a place of permanent residence. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-31
... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality... State homes providing nursing home and adult day health services care to Veterans. VA requires...
Pippel, Kristina; Meinck, M; Lübke, N
2017-06-01
Mobile geriatric rehabilitation can be provided in the setting of nursing homes, short-term care (STC) facilities and exclusively in private homes. This study analyzed the common features and differences of mobile rehabilitation interventions in various settings. Stratified by setting 1,879 anonymized mobile geriatric rehabilitation treatments between 2011 and 2014 from 11 participating institutions were analyzed with respect to patient, process and outcome-related features. Significant differences between the settings nursing home (n = 514, 27 %), STC (n = 167, 9 %) and private homes (n = 1198, 64 %) were evident for mean age (83 years, 83 years and 80 years, respectively), percentage of women (72 %, 64 % and 55 %), degree of dependency on pre-existing care (92 %, 76 % and 64 %), total treatment sessions (TS, 38 TS, 42 TS and 41 TS), treatment duration (54 days, 61 days and 58 days) as well as the Barthel index at the start of rehabilitation (34 points, 39 points and 46 points) and the gain in the Barthel index (15 points, 21 points and 18 points), whereby the gain in the capacity for self-sufficiency was significant in all settings. The setting-specific evaluation of mobile geriatric rehabilitation showed differences for relevant patient, process and outcome-related features. Compared to inpatient rehabilitation mobile rehabilitation in all settings made an above average contribution to the rehabilitation of patients with pre-existing dependency on care. The gains in the capacity for self-sufficiency achieved in all settings support the efficacy of mobile geriatric rehabilitation under the current prerequisites for applicability.
Factors associated with increasing nursing home closures.
Castle, Nicholas G; Engberg, John; Lave, Judith; Fisher, Andrew
2009-06-01
We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.
Graham, Megan E; Fabricius, Andréa
2017-11-01
This study examined the benefits of expanding upon the "home-like" design by introducing an immersive creative space for residents, staff, and visitors to explore in a long-term care facility in Eastern Ontario, Canada. Data were collected through guestbook comments ( N = 93) and coded for themes according to guidelines for thematic analysis. Selected themes included visitors' enjoyment of the winter aesthetic, expressions of gratitude to the artists, time spent socializing with family and visitors in a creative milieu, and the experience of remembering in an evocative space. The results indicate that residents and visitors benefited from the experience of a creative space that was neither institutional, nor "home-like." Implications for future research are discussed.
NASA Technical Reports Server (NTRS)
Kalil, Ford
1990-01-01
NASA is considering the use of various airplanes for a Shuttle Laser Technology Experiment Facility (LTEF)-to-Airplane laser communications experiment. As supporting documentation, pertinent technical details are included about the potential use of airplanes located at Ames Research Center and Wallops Flight Facility. The effects and application of orbital mechanics considerations are also presented, including slant range, azimuth, elevation, and time. The pros and cons of an airplane equipped with a side port with a bubble window versus a top port with a dome are discussed.
Federal Register 2010, 2011, 2012, 2013, 2014
2012-08-01
... Diem for Nursing Home Care of Veterans in State Homes; Per Diem for Adult Day Care of Veterans in State... information needed to ensure that nursing home and adult day health care facilities are providing high quality... per diem to State homes providing nursing home and adult day health services care to Veterans. VA...
Wanchese Harbor--Community Development. Project CAPE Teaching Module SOC.
ERIC Educational Resources Information Center
Gray, R. Wayne; Martin, William T.
North Carolina and Dare County, with assistance from the federal government, are developing a seafood industrial park at Wanchese, a small residential community. The purposes of this park are to develop a major commercial seafood handling, processing, and distribution port in North Carolina; and to provide a home port with support facilities for a…
Smart Home Test Bed: Examining How Smart Homes Interact with the Power Grid
DOE Office of Scientific and Technical Information (OSTI.GOV)
This fact sheet highlights the Smart Home Test Bed capability at the Energy Systems Integration Facility. The National Renewable Energy Laboratory (NREL) is working on one of the new frontiers of smart home research: finding ways for smart home technologies and systems to enhance grid operations in the presence of distributed, clean energy technologies such as photovoltaics (PV). To help advance this research, NREL has developed a controllable, flexible, and fully integrated Smart Home Test Bed.
Rural-urban differences in end-of-life nursing home care: facility and environmental factors.
Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B
2012-06-01
This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used CY2005-2007 100% Minimum Data Set, Medicare beneficiary file, and inpatient and hospice claims. Logistic regression models were estimated to predict the probability of each outcome conditional on decedents' risk factors. For each facility, QMs were calculated as the difference between the actual and the expected risk-adjusted outcome rates. We fit multivariate linear regression models, with fixed state effects, for each QM to assess the association with urban-rural location. We found urban-rural differences for in-hospital death and hospice QMs, but not for pain. Compared with NHs located in urban areas, facilities in smaller towns and in isolated rural areas have significantly (p < .001) worse EOL quality for in-hospital death and hospice use. Whereas the differences in these QMs are statistically significant between facilities located in large versus small towns, they are not statistically significant between facilities located in small towns and isolated rural areas. This study provides empirical evidence for urban-rural differences in EOL quality of care using a national sample of NHs. Identifying differences is a necessary first step toward improving care for dying NH residents and for bridging the urban-rural gap.
Effect of prospective reimbursement on nursing home costs.
Coburn, A F; Fortinsky, R; McGuire, C; McDonald, T P
1993-01-01
OBJECTIVE. This study evaluates the effect of Maine's Medicaid nursing home prospective payment system on nursing home costs and access to care for public patients. DATA SOURCES/STUDY SETTING. The implementation of a facility-specific prospective payment system for nursing homes provided the opportunity for longitudinal study of the effect of that system. Data sources included audited Medicaid nursing home cost reports, quality-of-care data from state facility survey and licensure files, and facility case-mix information from random, stratified samples of homes and residents. Data were obtained for six years (1979-1985) covering the three-year period before and after implementation of the prospective payment system. STUDY DESIGN. This study used a pre-post, longitudinal analytical design in which interrupted, time-series regression models were estimated to test the effects of prospective payment and other factors, e.g., facility characteristics, nursing home market factors, facility case mix, and quality of care, on nursing home costs. PRINCIPAL FINDINGS. Prospective payment contributed to an estimated $3.03 decrease in total variable costs in the third year from what would have been expected under the previous retrospective cost-based payment system. Responsiveness to payment system efficiency incentives declined over the study period, however, indicating a growing problem in achieving further cost reductions. Some evidence suggested that cost reductions might have reduced access for public patients. CONCLUSIONS. Study findings are consistent with the results of other studies that have demonstrated the effectiveness of prospective payment systems in restraining nursing home costs. Potential policy trade-offs among cost containment, access, and quality assurance deserve further consideration, particularly by researchers and policymakers designing the new generation of case mix-based and other nursing home payment systems. PMID:8463109
Doody, Thomas J.
1978-08-22
A multiple-port valve assembly is designed to direct flow from a primary conduit into any one of a plurality of secondary conduits as well as to direct a reverse flow. The valve includes two mating hemispherical sockets that rotatably receive a spherical valve plug. The valve plug is attached to the primary conduit and includes diverging passageways from that conduit to a plurality of ports. Each of the ports is alignable wih one or more of a plurality of secondary conduits fitted into one of the hemispherical sockets. The other hemispherical socket includes a slot for the primary conduit such that the conduit's motion along that slot with rotation of the spherical plug about various axes will position the valve-plug ports in respect to the secondary conduits.
360 PORT MDA - A Strategy to Improve Port Security
2006-09-01
Participating Agencies (After: Executive Briefing..........................27 Table 6. Designated Joint Operations Center Participants (From: SAFE...Investigations CGIP Coast Guard Intelligence Program CHOC Charleston Harbor Operations Center CIO Command Intelligence Officer CMT Combating Maritime... EXECUTIVE SUMMARY Ports are critical to our economy and national security. Key hubs in the international trade network, U.S. ports accounted for more than
Li, Yue; Cai, Xueya; Ye, Zhiqiu; Glance, Laurent G.; Harrington, Charlene; Mukamel, Dana B.
2013-01-01
Since 2005 Massachusetts has publicly reported results from biennial surveys of satisfaction with nursing homes, completed by responsible parties for residents, to promote consumer-centered care. Our analysis of the results from 2005, 2007, and 2009 revealed generally high satisfaction with care, which remained stable over time. On a scale of 1 to 5 (from very dissatisfied to very satisfied), average satisfaction with overall care was 4.22–4.31 and satisfaction that overall residents’ needs were met was 4.09–4.16; 89.9–90.1 percent of respondents would recommend the facility. Satisfaction ratings varied considerably across facilities, with higher scores associated with higher nursing staffing levels, fewer deficiency citations, and nonprofit or government ownership. Scores for six domains of care were, in general, closely associated with satisfaction scores. However, family members seemed less satisfied with the physical and social activities available to residents and with the food and meals served than with such attributes as the physical environment. Our findings suggest that including the consumer's perspective would improve the Centers for Medicare and Medicaid Services’ current nursing home reporting efforts, but that refinements may be necessary to detect the impact of consumer reporting on the quality of patient-centered care. PMID:23918486
Li, Yue; Cai, Xueya; Ye, Zhiqiu; Glance, Laurent G; Harrington, Charlene; Mukamel, Dana B
2013-08-01
Since 2005 Massachusetts has publicly reported results from biennial surveys of satisfaction with nursing homes, completed by responsible parties for residents, to promote consumer-centered care. Our analysis of the results from 2005, 2007, and 2009 revealed generally high satisfaction with care, which remained stable over time. On a scale of 1 to 5 (from very dissatisfied to very satisfied), average satisfaction with overall care was 4.22-4.31, and satisfaction that overall residents' needs were met was 4.09-4.16. Around 90 percent of respondents would recommend the facility. Satisfaction ratings varied considerably across facilities, with higher scores associated with higher nursing staffing levels, fewer deficiency citations, and nonprofit or government ownership. Scores for six domains of care were, in general, closely associated with satisfaction scores. However, family members seemed less satisfied with the physical and social activities available to residents and with the food and meals served than with such attributes as the physical environment. Our findings suggest that including the consumer's perspective would improve the Centers for Medicare and Medicaid Services' current nursing home reporting efforts. However, refinements may be necessary to detect the impact of consumer reporting on the quality of patient-centered care.
Safety systems in gamma irradiation facilities.
Drndarevic, V
1997-08-01
A new electronic device has been developed to guard against individuals gaining entry through the product entry and exit ports into our irradiation facility for industrial sterilization. This device uses the output from electronic sensors and pressure mats to assure that only the transport cabins may pass through these ports. Any intention of personnel trespassing is detected, the process is stopped by the safety system, and the source is placed in safe position. Owing to a simple construction, the new device enables reliable operation, is inexpensive, easy to implement, and improves the existing safety systems.
Jansen, Marijke; Ettema, Dick; Pierik, Frank; Dijst, Martin
2016-03-04
Physical activity (PA) is influenced by the built environment. However, little is known about the types of built environment where adults spend their time, and at what levels of PA they engage in those environments. Understanding the effect of the built environment on PA requires insight into PA behavior at different types of locations (e.g., home, work, shopping centers, and sports facilities). Therefore, this study describes where adults aged 45-65 years were active with moderate-to-vigorous intensity (MVPA), and examines associations of socio-demographic factors and neighborhood with MVPA at these locations. Participants' (N = 308) PA was measured for seven days using accelerometers and GPS-devices. Adults spent most minutes of MVPA at home and work. Highest MVPA-ratios of total time spent at a location were achieved in sports facilities and during transport. Neighborhood characteristics and socio-demographic factors such as work status, health status and household structure, had significant effects on MVPA at various locations and on total MVPA. Understanding PA behavior at various locations may provide insights that allow professionals in different domains (e.g., health, landscaping, urban planning) to develop strategies to stimulate PA.
Jansen, Marijke; Ettema, Dick; Pierik, Frank; Dijst, Martin
2016-01-01
Physical activity (PA) is influenced by the built environment. However, little is known about the types of built environment where adults spend their time, and at what levels of PA they engage in those environments. Understanding the effect of the built environment on PA requires insight into PA behavior at different types of locations (e.g., home, work, shopping centers, and sports facilities). Therefore, this study describes where adults aged 45–65 years were active with moderate-to-vigorous intensity (MVPA), and examines associations of socio-demographic factors and neighborhood with MVPA at these locations. Participants’ (N = 308) PA was measured for seven days using accelerometers and GPS-devices. Adults spent most minutes of MVPA at home and work. Highest MVPA-ratios of total time spent at a location were achieved in sports facilities and during transport. Neighborhood characteristics and socio-demographic factors such as work status, health status and household structure, had significant effects on MVPA at various locations and on total MVPA. Understanding PA behavior at various locations may provide insights that allow professionals in different domains (e.g., health, landscaping, urban planning) to develop strategies to stimulate PA. PMID:26959041
ITER Port Interspace Pressure Calculations
DOE Office of Scientific and Technical Information (OSTI.GOV)
Carbajo, Juan J; Van Hove, Walter A
The ITER Vacuum Vessel (VV) is equipped with 54 access ports. Each of these ports has an opening in the bioshield that communicates with a dedicated port cell. During Tokamak operation, the bioshield opening must be closed with a concrete plug to shield the radiation coming from the plasma. This port plug separates the port cell into a Port Interspace (between VV closure lid and Port Plug) on the inner side and the Port Cell on the outer side. This paper presents calculations of pressures and temperatures in the ITER (Ref. 1) Port Interspace after a double-ended guillotine break (DEGB)more » of a pipe of the Tokamak Cooling Water System (TCWS) with high temperature water. It is assumed that this DEGB occurs during the worst possible conditions, which are during water baking operation, with water at a temperature of 523 K (250 C) and at a pressure of 4.4 MPa. These conditions are more severe than during normal Tokamak operation, with the water at 398 K (125 C) and 2 MPa. Two computer codes are employed in these calculations: RELAP5-3D Version 4.2.1 (Ref. 2) to calculate the blowdown releases from the pipe break, and MELCOR, Version 1.8.6 (Ref. 3) to calculate the pressures and temperatures in the Port Interspace. A sensitivity study has been performed to optimize some flow areas.« less
Port Stakeholder Summit - April 2014
EPA's National Port Stakeholders Summit, Advancing More Sustainable Ports, focused on actions to protect air quality while reducing climate risk and supporting economic growth, making ports more environmentally sustainable.
Nursing home prices and market structure: the effect of assisted living industry expansion.
Bowblis, John R
2014-01-01
Since the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes.
DOT National Transportation Integrated Search
2003-06-12
This website presents the press kit which accompanied the announcement by U.S. Secretary of Homeland Security Tom Ridge at Port Elizabeth, New Jersey on June 12, 2003 of new port security initiatives and investments to provide increased international...
The Challenges Of Investigating And Remediating Port Hope's Small-Scale Urban Properties - 13115
DOE Office of Scientific and Technical Information (OSTI.GOV)
Veen, Walter van; Case, Glenn; Benson, John
2013-07-01
An important component of the Port Hope Project, the larger of the two projects comprising the Port Hope Area Initiative (PHAI), is the investigation of all 4,800 properties in the Municipality of Port Hope for low level radioactive waste (LLRW) and the remediation of approximately 10% of these. Although the majority of the individual properties are not expected to involve technically sophisticated remediation programs, the large number of property owners and individually unique properties are expected to present significant logistic challenges that will require a high degree of planning, organization and communication. The protocol and lessons learned described will bemore » of interest to those considering similar programs. Information presented herein is part of a series of papers presented by the PHAI Management Office (PHAI MO) at WM Symposium '13 describing the history of the Port Hope Project and current project status. Other papers prepared for WM Symposium '13 address the large-scale site cleanup and the construction of the long-term waste management facility (LTWMF) where all of the LLRW will be consolidated and managed within an engineered, above-ground mound. (authors)« less
Ports Primer: 7.4 Agency Responsibilities
Near-port communities are often disproportionately impacted by air emissions due to port operations, goods movement operations and other industries that may be co-located with ports. Air emissions at ports also impact regional air quality.
Ports Primer: 7.2 Air Emissions
Near-port communities are often disproportionately impacted by air emissions due to port operations, goods movement operations and other industries that may be co-located with ports. Air emissions at ports also impact regional air quality.
Sociocultural determinants of home delivery in Ethiopia: a qualitative study.
Kaba, Mirgissa; Bulto, Tesfaye; Tafesse, Zergu; Lingerh, Wassie; Ali, Ismael
2016-01-01
Maternal health remains a major public health problem in Ethiopia. Despite the government's measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women. The study aims to identify determinants that sustain home delivery in Ethiopia. A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples' Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11. Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home. The government's endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of women deliver at home and this was found to be the
Case Study links for improving environmental performance and economic prosperity at ports and in near-port communities. Case studies on equipment upgrades, jobs and benefits, land use and transportation, port-community engagement, and citizen science.
The determinants of nursing home costs in Nebraska's proprietary nursing homes.
Palm, D W; Nelson, S
1984-01-01
In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost
Detail view of the port side of the payload bay ...
Detail view of the port side of the payload bay of the Orbiter Discovery. This view shows Remote Manipulator System, Canadarm, sensors in the center of the image and a close-up view of a small segment of the orbiter's radiator panel. This photograph was taken in the Orbiter Processing Facility at the Kennedy Space Center. - Space Transportation System, Orbiter Discovery (OV-103), Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, Harris County, TX
... Laser therapy is most successful in removing port-wine stains. It is the only method that can destroy the tiny blood vessels in the skin without causing much damage to the skin. The exact type ... on the person's age, skin type, and particular port-wine stain.
Private investment purchase and nursing home financial health.
Orfaly Cadigan, Rebecca; Stevenson, David G; Caudry, Daryl J; Grabowski, David C
2015-02-01
To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998-2010. Regression specification incorporating facility and time fixed effects. We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company's real estate holdings. Private investment acquired facilities are an important feature of today's nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. © Health Research and Educational Trust.
Predicting nursing home placement among home- and community-based services program participants.
Greiner, Melissa A; Qualls, Laura G; Iwata, Isao; White, Heidi K; Molony, Sheila L; Sullivan, M Terry; Burke, Bonnie; Schulman, Kevin A; Setoguchi, Soko
2014-12-01
Several states offer publicly funded-care management programs to prevent long-term care placement of high-risk Medicaid beneficiaries. Understanding participant risk factors and services that may prevent long-term care placement can facilitate efficient allocation of program resources. To develop a practical prediction model to identify participants in a home- and community-based services program who are at highest risk for long-term nursing home placement, and to examine participant-level and program-level predictors of nursing home placement. In a retrospective observational study, we used deidentified data for participants in the Connecticut Home Care Program for Elders who completed an annual assessment survey between 2005 and 2010. We analyzed data on patient characteristics, use of program services, and short-term facility admissions in the previous year. We used logistic regression models with random effects to predict nursing home placement. The main outcome measures were long-term nursing home placement within 180 days or 1 year of assessment. Among 10,975 study participants, 1249 (11.4%) had nursing home placement within 1 year of annual assessment. Risk factors included Alzheimer's disease (odds ratio [OR], 1.30; 95% CI, 1.18-1.43), money management dependency (OR, 1.33; 95% CI, 1.18-1.51), living alone (OR, 1.53; 95% CI, 1.31-1.80), and number of prior short-term skilled nursing facility stays (OR, 1.46; 95% CI, 1.31-1.62). Use of a personal care assistance service was associated with 46% lower odds of nursing home placement. The model C statistic was 0.76 in the validation cohort. A model using information from a home- and community-based service program had strong discrimination to predict risk of long-term nursing home placement and can be used to identify high-risk participants for targeted interventions.
Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto
2017-09-01
Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30-120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.
78 FR 73441 - Grants to States for Construction or Acquisition of State Homes
Federal Register 2010, 2011, 2012, 2013, 2014
2013-12-06
... of State home facilities that furnish domiciliary, nursing home, or adult day health care to veterans... States of State home facilities that furnish domiciliary, nursing home, or adult day health care to... Providers Grant and Per Diem Program; and 64.026, Veterans State Adult Day Health Care. Signing Authority...
Simulation of liquefaction-induced damage of the Port of Long Beach using the UBC3DPLM Model.
DOT National Transportation Integrated Search
2016-12-31
In the past decades, expansion projects of port facilities in California, USA, have been completed by placing hydraulic fills. These loose manmade : fills and even their subjacent natural estuarine and marine deposits, have shown to be susceptible to...
Catheter-Salvage in Home Infusion Patients with Central Line-Associated Bloodstream Infection
Caroff, Daniel A.; Norris, Anne H.; Keller, Sara; Vinnard, Christopher; Zeitler, Kristen E.; Lukaszewicz, Jennifer; Zborowski, Kristine A.; Linkin, Darren R.
2014-01-01
In a retrospective study of home infusion patients with central line-associated bloodstream infection, use of a central venous port, cancer diagnosis, and the absence of systemic inflammatory response syndrome were associated with use of catheter-salvage. Relapse of infection was uncommon. PMID:25465266
Mor, Vincent; Volandes, Angelo E; Gutman, Roee; Gatsonis, Constantine; Mitchell, Susan L
2017-04-01
Background/Aims Nursing homes are complex healthcare systems serving an increasingly sick population. Nursing homes must engage patients in advance care planning, but do so inconsistently. Video decision support tools improved advance care planning in small randomized controlled trials. Pragmatic trials are increasingly employed in health services research, although not commonly in the nursing home setting to which they are well-suited. This report presents the design and rationale for a pragmatic cluster randomized controlled trial that evaluated the "real world" application of an Advance Care Planning Video Program in two large US nursing home healthcare systems. Methods PRagmatic trial Of Video Education in Nursing homes was conducted in 360 nursing homes (N = 119 intervention/N = 241 control) owned by two healthcare systems. Over an 18-month implementation period, intervention facilities were instructed to offer the Advance Care Planning Video Program to all patients. Control facilities employed usual advance care planning practices. Patient characteristics and outcomes were ascertained from Medicare Claims, Minimum Data Set assessments, and facility electronic medical record data. Intervention adherence was measured using a Video Status Report embedded into electronic medical record systems. The primary outcome was the number of hospitalizations/person-day alive among long-stay patients with advanced dementia or cardiopulmonary disease. The rationale for the approaches to facility randomization and recruitment, intervention implementation, population selection, data acquisition, regulatory issues, and statistical analyses are discussed. Results The large number of well-characterized candidate facilities enabled several unique design features including stratification on historical hospitalization rates, randomization prior to recruitment, and 2:1 control to intervention facilities ratio. Strong endorsement from corporate leadership made randomization
Does Information Matter? Competition, Quality, and the Impact of Nursing Home Report Cards
Grabowski, David C; Town, Robert J
2011-01-01
Objective We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. Data Sources The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. Study Design We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. Results The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. Conclusions The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. PMID:21790590
Does information matter? Competition, quality, and the impact of nursing home report cards.
Grabowski, David C; Town, Robert J
2011-12-01
We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-16
... Neptune LNG LLC Deepwater Port License and Temporary Suspension of Operations at the Neptune LNG Deepwater... decision to approve the request of Neptune LNG LLC (Neptune) for a temporary five-year suspension of port operations at the Neptune Deepwater Port by amending the Neptune Deepwater Port License. ADDRESSES: The...
DOT National Transportation Integrated Search
2011-06-01
Seaports are a critical transportation component that supports the nations economy. Many U.S. : ports are now experiencing significant truck congestion at the gate, which decreases the productivity of : ports and truck fleets (e.g. truck wait time...
Private Investment Purchase and Nursing Home Financial Health
Cadigan, Rebecca Orfaly; Stevenson, David G; Caudry, Daryl J; Grabowski, David C
2015-01-01
Objective To explore the impact of nursing home acquisition by private investment firms on nursing home costs, revenue, and overall financial health. Data Sources Merged data from the Medicare Cost Reports and the Online Survey, Certification, and Reporting system for the period 1998–2010. Study Design Regression specification incorporating facility and time fixed effects. Principal Findings We found little impact on the financial health of nursing homes following purchase by private investment companies. However, our findings did suggest that private investment firms acquired nursing home chains in good financial health, possibly to derive profit from the company’s real estate holdings. Conclusions Private investment acquired facilities are an important feature of today’s nursing home sector. Although we did not observe a negative impact on the financial health of nursing homes, this development raises important issues about ownership oversight and transparency for the entire nursing home sector. PMID:25104476
Malpractice litigation and nursing home quality of care.
Konetzka, R Tamara; Park, Jeongyoung; Ellis, Robert; Abbo, Elmer
2013-12-01
To assess the potential deterrent effect of nursing home litigation threat on nursing home quality. We use a panel dataset of litigation claims and Nursing Home Online Survey Certification and Reporting (OSCAR) data from 1995 to 2005 in six states: Florida, Illinois, Wisconsin, New Jersey, Missouri, and Delaware, for a total of 2,245 facilities. Claims data are from Westlaw's Adverse Filings database, a proprietary legal database, on all malpractice, negligence, and personal injury/wrongful death claims filed against nursing facilities. A lagged 2-year moving average of the county-level number of malpractice claims is used to represent the threat of litigation. We use facility fixed-effects models to examine the relationship between the threat of litigation and nursing home quality. We find significant increases in registered nurse-to-total staffing ratios in response to rising malpractice threat, and a reduction in pressure sores among highly staffed facilities. However, the magnitude of the deterrence effect is small. Deterrence in response to the threat of malpractice litigation is unlikely to lead to widespread improvements in nursing home quality. This should be weighed against other benefits and costs of litigation to assess the net benefit of tort reform. © Health Research and Educational Trust.
Malpractice Litigation and Nursing Home Quality of Care
Konetzka, R Tamara; Park, Jeongyoung; Ellis, Robert; Abbo, Elmer
2013-01-01
Objective. To assess the potential deterrent effect of nursing home litigation threat on nursing home quality. Data Sources/Study Setting. We use a panel dataset of litigation claims and Nursing Home Online Survey Certification and Reporting (OSCAR) data from 1995 to 2005 in six states: Florida, Illinois, Wisconsin, New Jersey, Missouri, and Delaware, for a total of 2,245 facilities. Claims data are from Westlaw's Adverse Filings database, a proprietary legal database, on all malpractice, negligence, and personal injury/wrongful death claims filed against nursing facilities. Study Design. A lagged 2-year moving average of the county-level number of malpractice claims is used to represent the threat of litigation. We use facility fixed-effects models to examine the relationship between the threat of litigation and nursing home quality. Principal Findings. We find significant increases in registered nurse-to-total staffing ratios in response to rising malpractice threat, and a reduction in pressure sores among highly staffed facilities. However, the magnitude of the deterrence effect is small. Conclusions. Deterrence in response to the threat of malpractice litigation is unlikely to lead to widespread improvements in nursing home quality. This should be weighed against other benefits and costs of litigation to assess the net benefit of tort reform. PMID:23741985
An ecological study of cancer incidence in Port Hope, Ontario from 1992 to 2007.
Chen, Jing; Moir, Deborah; Lane, Rachel; Thompson, Patsy
2013-03-01
A plant processing radium and uranium ores has been operating in the town of Port Hope since 1932. Given the nuclear industry located in the community and ongoing public health concerns, cancer incidence rates in Port Hope were studied for a recent 16 year period (1992-2007) for continued periodic cancer incidence surveillance of the community. The cancer incidence in the local community for all cancers combined was similar to the Ontario population, health regions with similar socio-economic characteristics in Ontario and in Canada, and the Canadian population. No statistically significant differences in childhood cancer, leukaemia or other radiosensitive cancer incidence were observed, with the exception of statistically significant elevated lung cancer incidence among women. However, the statistical significance was reduced or disappeared when the comparison was made to populations with similar socio-economic characteristics. These findings are consistent with previous ecological, case-control and cohort studies conducted in Port Hope, environmental assessments, and epidemiological studies conducted elsewhere on populations living around similar facilities or exposed to similar environmental contaminants. Although the current study covered an extended period of time, the power to detect risk at the sub-regional level of analysis was limited since the Port Hope population is small (16,500). The study nevertheless indicated that large differences in cancer incidence are not occurring in Port Hope compared to other similar communities and the general population.
[Alcohol and drug misuse of the elderly in health care facilities].
Kuhn, S; Haasen, C
2012-05-01
A nationwide representative survey was conducted in residential care facilities and facilities offering care for the elderly in their homes (home care facilities) with the aim to estimate the rate of alcohol and drug misuse among this population and to evaluate the way in which nursing staff deal with the problem. A total of 5000 randomly selected facilities were contacted with a 2-page questionnaire. Reliable data were obtained from 550 residential care facilities and from 436 home care facilities. According to the investigated facilities, the mean rate of misuse among the elderly was 14%. Nearly all facilities acknowledge the necessity to react to these facts, but only a quarter of them considered their staff to be sufficiently trained. 38.4% of the residential care facilities and 26.9% of the home care facilities have a concept on how to react to misuse problems. Addiction services are rarely contacted. The prevalence of alcohol and drug misuse among the elderly in health care facilities is high compared to the same age cohort of the total population. The lack of networking between facilities for the elderly and addiction services is remarkable. © Georg Thieme Verlag KG Stuttgart · New York.
Sociocultural determinants of home delivery in Ethiopia: a qualitative study
Kaba, Mirgissa; Bulto, Tesfaye; Tafesse, Zergu; Lingerh, Wassie; Ali, Ismael
2016-01-01
Background Maternal health remains a major public health problem in Ethiopia. Despite the government’s measures to ensure institutional delivery assisted by skilled attendants, home delivery remains high, estimated at over 80% of all pregnant women. Objective The study aims to identify determinants that sustain home delivery in Ethiopia. Methods A total of 48 women who delivered their most recent child at home, 56 women who delivered their most recent child in a health facility, 55 husbands of women who delivered within 1 year preceding the study, and 23 opinion leaders in selected districts of Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ Region, and Tigray regions were involved in the study. Key informant interview, in-depth interviews, and focus group discussions were conducted to collect data using checklists developed for this purpose. Data reduction and analysis were facilitated by Maxqda qualitative data analysis software version 11. Results Findings show that pregnancy and delivery is a normal and natural life event. Research participants unanimously argue that such a life event should not be linked with health problems. Home is considered a natural space for delivery and most women aspire to deliver at home where rituals during labor and after delivery are considered enjoyable. Even those who delivered in health facilities appreciate events in connection to home delivery. Efforts are underway to create home-like environments in health facilities, but health facilities are not yet recognized as a natural place of delivery. The positive tendency to deliver at home is further facilitated by poor service delivery at the facility level. Perceived poor competence of providers and limited availability of supplies and equipment were found to maintain the preference to deliver at home. Conclusion The government’s endeavor to improve maternal health has generated positive results with more women now attending antenatal care. Yet over 80% of
Best practices for port authorities include near-port community collaboration, anti-idling policies, expanding off-peak hours, development of EMS, developing an emissions inventory, education, electric power and substituting trucking for rail or barge.
NASA Technical Reports Server (NTRS)
Kocher, Joshua E; Gilliam, David P.
2005-01-01
Secure computing is a necessity in the hostile environment that the internet has become. Protection from nefarious individuals and organizations requires a solution that is more a methodology than a one time fix. One aspect of this methodology is having the knowledge of which network ports a computer has open to the world, These network ports are essentially the doorways from the internet into the computer. An assessment method which uses the nmap software to scan ports has been developed to aid System Administrators (SAs) with analysis of open ports on their system(s). Additionally, baselines for several operating systems have been developed so that SAs can compare their open ports to a baseline for a given operating system. Further, the tool is deployed on a website where SAs and Users can request a port scan of their computer. The results are then emailed to the requestor. This tool aids Users, SAs, and security professionals by providing an overall picture of what services are running, what ports are open, potential trojan programs or backdoors, and what ports can be closed.
Examining Racial and Ethnic Differences in Nursing Home Quality.
Hefele, Jennifer Gaudet; Ritter, Grant A; Bishop, Christine E; Acevedo, Andrea; Ramos, Candi; Nsiah-Jefferson, Laurie A; Katz, Gabrielle
2017-11-01
Identifying racial/ethnic differences in quality is central to identifying, monitoring, and reducing disparities. Although disparities across all individual nursing home residents and disparities associated with between-nursing home differences have been established, little is known about the degree to which quality of care varies by race//ethnicity within nursing homes. A study was conducted to measure within-facility differences for a range of publicly reported nursing home quality measures. Resident assessment data on approximately 15,000 nursing homes and approximately 3 million residents (2009) were used to assess eight commonly used and publicly reported long-stay quality measures: the proportion of residents with weight loss, with high-risk and low-risk pressure ulcers, with incontinence, with depressive symptoms, in restraints daily, and who experienced a urinary tract infection or functional decline. Each measure was stratified by resident race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic), and within-facility differences were examined. Small but significant differences in care on average were found, often in an unexpected direction; in many cases, white residents were experiencing poorer outcomes than black and Hispanic residents in the same facility. However, a broad range of differences in care by race/ethnicity within nursing homes was also found. The results suggest that care is delivered equally across all racial/ethnic groups in the same nursing home, on average. The results support the call for publicly reporting stratified nursing home quality measures and suggest that nursing home providers should attempt to identify racial/ethnic within-facility differences in care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.
Future Development of Nursing Home Quality Indicators
ERIC Educational Resources Information Center
Arling, Greg; Kane, Robert L.; Lewis, Teresa; Mueller, Christine
2005-01-01
Nursing home quality indicators have been developed over the past 10 years to quantify nursing home quality and to draw systematic comparisons between facilities. Although these indicators have been applied widely for nursing home regulation, quality improvement, and public reporting, researchers and stakeholders have raised concerns about their…
Code of Federal Regulations, 2010 CFR
2010-10-01
... 46 Shipping 7 2010-10-01 2010-10-01 false Port lights. 171.116 Section 171.116 Shipping COAST... Port lights. (a) A vessel may have port lights below the bulkhead deck if— (1) It is greater than 150 gross tons; and (2) It is in ocean service. (b) All port lights in a space must be non-opening if the...
Code of Federal Regulations, 2012 CFR
2012-10-01
... 46 Shipping 7 2012-10-01 2012-10-01 false Port lights. 171.116 Section 171.116 Shipping COAST... Port lights. (a) A vessel may have port lights below the bulkhead deck if— (1) It is greater than 150 gross tons; and (2) It is in ocean service. (b) All port lights in a space must be non-opening if the...
Code of Federal Regulations, 2013 CFR
2013-10-01
... 46 Shipping 7 2013-10-01 2013-10-01 false Port lights. 171.116 Section 171.116 Shipping COAST... Port lights. (a) A vessel may have port lights below the bulkhead deck if— (1) It is greater than 150 gross tons; and (2) It is in ocean service. (b) All port lights in a space must be non-opening if the...
Code of Federal Regulations, 2011 CFR
2011-10-01
... 46 Shipping 7 2011-10-01 2011-10-01 false Port lights. 171.116 Section 171.116 Shipping COAST... Port lights. (a) A vessel may have port lights below the bulkhead deck if— (1) It is greater than 150 gross tons; and (2) It is in ocean service. (b) All port lights in a space must be non-opening if the...
Code of Federal Regulations, 2014 CFR
2014-10-01
... 46 Shipping 7 2014-10-01 2014-10-01 false Port lights. 171.116 Section 171.116 Shipping COAST... Port lights. (a) A vessel may have port lights below the bulkhead deck if— (1) It is greater than 150 gross tons; and (2) It is in ocean service. (b) All port lights in a space must be non-opening if the...
NASA Technical Reports Server (NTRS)
Mathis, K. (Principal Investigator); Cato, J. C.; Degner, P. D.; Landrum, P. D.; Prochaska, F. J.
1978-01-01
The author has identified the following significant results. Seven major counties were examined: Escambia, Bay, Gulf, Franklin, Wakulla, Nassau, and Duval. Population and economic activity were reviewed, along with commercial fishing and port facilities. Recommendations for five northwest Florida counties were based on interpretation of aerial photographs, satellite imagery, an aerial survey site visit, and published data. Major needs in Pensacola included docking, ice supply, and net and engine repair services. Costs for additional docks, an ice plant, and gear storage were estimated at $3,658,600. Port users in Panama City identified additional docking and gear storage as primary needs, along with gear repair and a marine railway. Estimated costs for dock and gear storage were $2,860,000. Added docking, gear storage, and ice supply, as well as gear electronics and diesel repair were needed in Port St. Joe. Costs were calculated at $1,231,500. Franklin County has three ports (Apalachicola - $1,107,000 for docks and gear storage, Eastpoint - $420,000 for additional docks, and Carrabella - $2,824,100 for docks, gear storage, and ice plant).
Effect of port-care frequency on venous port catheter-related complications in cancer patients.
Odabas, Hatice; Ozdemir, Nuriye Yıldırım; Ziraman, Ipek; Aksoy, Sercan; Abali, Huseyin; Oksuzoglu, Berna; Isik, Metin; Civelek, Burak; Dede, Dogan; Zengin, Nurullah
2014-08-01
Subcutaneous central venous port catheters (SCVPC) are of great importance in the treatment of patients with malignancies since they provide secure vascular access. Our aim was to assess the impact of long-term catheter care frequency on the frequency of port-related complications. Two hundred and seven patients who had not been on active chemotherapy through their SCVPC for at least 3 months were enrolled into the study. Those who received catheter care every 3 months or more frequently were assigned to the frequent care group, and the others to the infrequent care group. The patients were examined for port-related complications and thrombosis including port occlusion. Routinely in our clinic, catheter care was done by using 300 IU of heparin. According to the frequency of SCVPC care, 49 (23.7 %) patients were in the frequent care group and 158 (76.3 %) were in the infrequent care group. Median follow-up of all patients was 671 days (range 133-1712). Median frequency of port care in the frequent care group was 90 days (range 30-90), but 441.5 days in the infrequent care group (range 91-1630). None of the patients experienced port-related severe complications during the follow-up time. None of them presented with port occlusion. When the groups were analysed for thrombus (symptomatic and asymptomatic), there was no statistically significant difference (6.4 vs 13.8 %, p = 0.17). Those patients who had received more than first-line chemotherapy were found to have more thrombi than the patients who were treated with only one type of chemotherapy protocol (28.6 vs 10.2 %, p = 0.01), and the patients who had metastatic disease at the last control were found out to have thrombi more frequently than the non-metastatic patients (24.3 vs 9.3 %) (p = 0.01). In the present study, there was no difference in port-related severe complications between frequent and infrequent care groups during follow-up. However, the rate of thrombosis was slightly higher in the infrequent port
DOE Office of Scientific and Technical Information (OSTI.GOV)
none,
2015-09-01
Case study of two DOE 2015 Housing Innovation Award winning custom homes in the marine climate that got HERS 39 and 38 without PV or HERS 2-12 and -9 with PV, with 6.5” SIP walls and 10.25” SIP roof; 11.75 ICF around slab, R-20 rigid foam under slab; radiant floor heat and passive design; air-to-water heatpump, fresh air intake with fan, triple-pane windows, 100% LED.
47 CFR 52.35 - Porting Intervals.
Code of Federal Regulations, 2014 CFR
2014-10-01
... “telecommunications carrier” includes an interconnected Voice over Internet Protocol (VoIP) provider as that term in... ports” includes (i) Wireline-to-wireless ports; (ii) Wireless-to-wireline ports; and (iii) Ports...
The Identification and Classification of Inland Ports
DOT National Transportation Integrated Search
2001-08-01
This report presents a formal definition for inland ports and creates a classification methodology to promote familiarity with inland port operations and aid transportation planners interested in supporting inland port operations. Inland ports are si...
42 CFR 494.100 - Condition: Care at home.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at...
42 CFR 494.100 - Condition: Care at home.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at...
42 CFR 494.100 - Condition: Care at home.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at...
42 CFR 494.100 - Condition: Care at home.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at...
42 CFR 494.100 - Condition: Care at home.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...
38 CFR 59.140 - Nursing home care requirements.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this part...
77 FR 49351 - Safety Zone; Port Huron Float-Down, St. Clair River, Port Huron, MI
Federal Register 2010, 2011, 2012, 2013, 2014
2012-08-16
...-AA00 Safety Zone; Port Huron Float-Down, St. Clair River, Port Huron, MI AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: The Coast Guard is establishing a temporary safety zone on the St. Clair River, Port Huron, MI. This zone is intended to restrict vessels from a portion of the St. Clair...
32 CFR 728.76 - Naval Home residents.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 32 National Defense 5 2014-07-01 2014-07-01 false Naval Home residents. 728.76 Section 728.76... FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons § 728.76 Naval Home residents. Provide necessary medical and dental care, both inpatient and outpatient, to residents of the Naval Home...
Analysis of a Pediatric Home Mechanical Ventilator Population.
Amirnovin, Rambod; Aghamohammadi, Sara; Riley, Carley; Woo, Marlyn S; Del Castillo, Sylvia
2018-05-01
The population of children requiring home mechanical ventilation has evolved over the years and has grown to include a variety of diagnoses and needs that have led to changes in the care of this unique population. The purpose of this study was to provide a descriptive analysis of pediatric patients requiring home mechanical ventilation after hospitalization and how the evolution of this technology has impacted their care. A retrospective, observational, longitudinal analysis of 164 children enrolled in a university-affiliated home mechanical ventilation program over 26 years was performed. Data included each child's primary diagnosis, date of tracheostomy placement, duration of mechanical ventilation during hospitalization that consisted of home mechanical ventilator initiation, total length of pediatric ICU stay, ventilator settings at time of discharge from pediatric ICU, and disposition (home, facility, or died). Univariate, bivariate, and regression analysis was used as appropriate. The most common diagnosis requiring the use of home mechanical ventilation was neuromuscular disease (53%), followed by chronic pulmonary disease (29%). The median length of stay in the pediatric ICU decreased significantly after the implementation of a ventilator ward (70 d [30-142] vs 36 d [18-67], P = .02). The distribution of subjects upon discharge was home (71%), skilled nursing facility (24%), and died (4%), with an increase in the proportion of subjects discharged on PEEP and those going to nursing facilities over time ( P = 0.02). The evolution of home mechanical ventilation has allowed earlier transition out of the pediatric ICU and with increasing disposition to skilled nursing facilities over time. There has also been a change in ventilator management, including increased use of PEEP upon discharge, possibly driven by changes in ventilators and in-patient practice patterns. Copyright © 2018 by Daedalus Enterprises.
47 CFR 52.35 - Porting Intervals.
Code of Federal Regulations, 2010 CFR
2010-10-01
... work week of Monday through Friday represents mandatory business days and 8 a.m. to 5 p.m. represents... ports” includes (i) Wireline-to-wireless ports; (ii) Wireless-to-wireline ports; and (iii) Ports...
47 CFR 52.35 - Porting Intervals.
Code of Federal Regulations, 2011 CFR
2011-10-01
... work week of Monday through Friday represents mandatory business days and 8 a.m. to 5 p.m. represents... ports” includes (i) Wireline-to-wireless ports; (ii) Wireless-to-wireline ports; and (iii) Ports...
University of Maryland MRSEC - Facilities
MRSEC Templates Opportunities Search Home » Facilities Shared Experimental Facilities The University of . Permission to redistribute the contents without alteration is granted to educational institutions for non
Port of Davisville utilization study : phase II.
DOT National Transportation Integrated Search
2011-02-01
This project investigated the feasibility of expanding the Port of Davisville (Quonset Point, RI) to serve : as a port of entry and departure for international container shipments. As an international port of entry : (departure), the Port of Davisvil...
The effects of ownership and ownership change on nursing home industry costs.
Holmes, J S
1996-08-01
This study examines the effects of ownership type and ownership change on nursing home cost structures, differentiating patient care costs from plant costs. Administrative data from the Michigan Department of Social Services, Medical Services Administration (Medicaid), and the Michigan Department of Public Health are used. Cost data are based on audited cost reports for 393 nursing care facilities in Michigan in 1989. Other facility characteristics are based on data from the 1989 annual licensing and certification survey conducted by the Michigan Department of Public Health. A series of ordinary least squares regressions is estimated, in which the dependent variable is either per diem patient costs or per diem plant costs. Ownership types are defined as chain, proprietary non-chain, freestanding non-profit, government-owned, and hospital-based facilities. Pooled estimation techniques, as well as separate regressions by ownership type, are presented to test for interaction effects. Key variables include whether a facility changed ownership in the preceding five years and whether chain facilities are in-state- or out-of-state-owned, in addition to size, payer mix, and case mix. Behavioral differences among nursing home ownership types in respect to patient care costs tended to distinguish government-owned and hospital-based facilities from the freestanding homes rather than the usual distinction between for-profit and not-for-profit classes. Variables traditionally included in nursing home cost studies, such as size, occupancy, payer mix and case mix, were found to have similar effects on per diem patient care costs for freestanding non-profit homes as well as for chain proprietary facilities. With regard to the effects of ownership change on per diem plant and per diem patient costs, however, there are few differences among ownership types. Chain and non-chain for-profit facilities, non-profit homes, and hospital long-term care units that had changed ownership
Mattingly, J.T.
1963-02-12
This invention provides a simple pressure-actuated closure whereby windowless observation ports are opened to the atmosphere at preselected altitudes. The closure comprises a disk which seals a windowless observation port in rocket hull. An evacuated instrument compartment is affixed to the rocket hull adjacent the inner surface of the disk, while the outer disk surface is exposed to the atmosphere through which the rocket is traveling. The pressure differential between the evacuated instrument compartment and the relatively high pressure external atmosphere forces the disk against the edge of the observation port, thereby effecting a tight seai. The instrument compartment is evacuated to a pressure equal to the atmospheric pressure existing at the altitude at which it is desiretl that the closure should open. When the rocket reaches this preselected altitude, the inwardly directed atmospheric force on the disk is just equaled by the residual air pressure force within the instrument compartment. Consequently, the closure disk falls away and uncovers the open observation port. The separation of the disk from the rocket hull actuates a switch which energizes the mechanism of a detecting instrument disposed within the instrument compartment. (AE C)
Mississippi's industrial gulf ports
DOT National Transportation Integrated Search
2001-09-01
As a State, Mississippi ranked 20th in waterborne traffic in 1999, moving over 46 million short tons of commodities. Mississippi's port activities generate $38 million in state payroll taxes and $21 million in state sales taxes. Port and servicing in...
Bahrmann, A; Wörz, E; Specht-Leible, N; Oster, P; Bahrmann, P
2015-04-01
The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.
Nursing home cost and ownership type: evidence of interaction effects.
Arling, G; Nordquist, R H; Capitman, J A
1987-06-01
Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed.
Nursing home cost and ownership type: evidence of interaction effects.
Arling, G; Nordquist, R H; Capitman, J A
1987-01-01
Due to steadily increasing public expenditures for nursing home care, much research has focused on factors that influence nursing home costs, especially for Medicaid patients. Nursing home cost function studies have typically used a number of predictor variables in a multiple regression analysis to determine the effect of these variables on operating cost. Although several authors have suggested that nursing home ownership types have different goal orientations, not necessarily based on economic factors, little attention has been paid to this issue in empirical research. In this study, data from 150 Virginia nursing homes were used in multiple regression analysis to examine factors accounting for nursing home operating costs. The context of the study was the Virginia Medicaid reimbursement system, which has intermediate care and skilled nursing facility (ICF and SNF) facility-specific per diem rates, set according to facility cost histories. The analysis revealed interaction effects between ownership and other predictor variables (e.g., percentage Medicaid residents, case mix, and region), with predictor variables having different effects on cost depending on ownership type. Conclusions are drawn about the goal orientations and behavior of chain-operated, individual for-profit, and public and nonprofit facilities. The implications of these findings for long-term care reimbursement policies are discussed. PMID:3301746
Outcomes after endoscopic port surgery for spontaneous intracerebral hematomas.
Ochalski, Pawel; Chivukula, Srinivas; Shin, Samuel; Prevedello, Daniel; Engh, Johnathan
2014-05-01
Spontaneous intracerebral hemorrhages (ICHs) cause significant morbidity and mortality. Traditional open surgical management strategies offer limited benefit except for the most superficial hemorrhages in select patients. Recent reports suggest that endoscopic approaches may improve outcomes, particularly for deep subcortical hemorrhages. However, the management of these patients remains controversial. We reviewed our experience using endoscopic port surgery to identify characteristics that may predict acceptable outcomes. We completed a retrospective chart and imaging review of patients who underwent endoscopic port surgery for evacuation of spontaneous ICH at a single center. Data were gathered regarding patient demographics, hemorrhage locations, operative findings, and clinical outcomes. From 2007 to 2011, 18 patients underwent evacuation of spontaneous intracerebral hematomas using an endoscopic port. The mean age in years was 62 years (range, 43-84 years). Six of 18 patients (33%) died before discharge, and 2 others (11%) died after at least 1 month of survival. Of 12 initial survivors, all were discharged to a rehabilitation or nursing facility. Complete hematoma evacuation was achieved in 7 of 18 patients, with the remaining 11 having a partial evacuation. The patients who died (n = 6) before discharge were statistically more likely to have a left-sided hemorrhage, partial evacuation, or older age than the survivors; death at least 1 month after evacuation was additionally associated with greater preoperative hematoma volumes. Our series demonstrates that endoscopic port surgery for acute intracerebral hematoma evacuation has the ability to achieve significant decompression of large and deep-seated hematomas. Patient age, extent of evacuation, laterality, and preoperative hematoma volume appear to influence patient outcome. Most overall outcomes remain poor. Future studies are necessary to determine if surgical evacuation is in fact superior to best
Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model.
Poudel, Saseem; Kurashima, Yo; Shichinohe, Toshiaki; Kitashiro, Shuji; Kanehira, Eiji; Hirano, Satoshi
2016-01-01
The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures.
Evaluation of hands-on seminar for reduced port surgery using fresh porcine cadaver model
Poudel, Saseem; Kurashima, Yo; Shichinohe, Toshiaki; Kitashiro, Shuji; Kanehira, Eiji; Hirano, Satoshi
2016-01-01
BACKGROUND: The use of various biological and non-biological simulators is playing an important role in training modern surgeons with laparoscopic skills. However, there have been few reports of the use of a fresh porcine cadaver model for training in laparoscopic surgical skills. The purpose of this study was to report on a surgical training seminar on reduced port surgery using a fresh cadaver porcine model and to assess its feasibility and efficacy. MATERIALS AND METHODS: The hands-on seminar had 10 fresh porcine cadaver models and two dry boxes. Each table was provided with a unique access port and devices used in reduced port surgery. Each group of 2 surgeons spent 30 min at each station, performing different tasks assisted by the instructor. The questionnaire survey was done immediately after the seminar and 8 months after the seminar. RESULTS: All the tasks were completed as planned. Both instructors and participants were highly satisfied with the seminar. There was a concern about the time allocated for the seminar. In the post-seminar survey, the participants felt that the number of reduced port surgeries performed by them had increased. CONCLUSION: The fresh cadaver porcine model requires no special animal facility and can be used for training in laparoscopic procedures. PMID:27279391
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2013 CFR
2013-07-01
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2010 CFR
2010-07-01
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2014 CFR
2014-07-01
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2011 CFR
2011-07-01
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...
38 CFR 17.60 - Extensions of community nursing home care beyond six months.
Code of Federal Regulations, 2012 CFR
2012-07-01
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for any...
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Are women deciding against home births in low and middle income countries?
Amoako Johnson, Fiifi; Padmadas, Sabu S; Matthews, Zoë
2013-01-01
Although there is evidence to tracking progress towards facility births within the UN Millennium Development Goals framework, we do not know whether women are deciding against home birth over their reproductive lives. Using Demographic and Health Surveys (DHS) data from 44 countries, this study aims to investigate the patterns and shifts in childbirth locations and to determine whether these shifts are in favour of home or health settings. The analyses considered 108,777 women who had at least two births in the five years preceding the most recent DHS over the period 2000-2010. The vast majority of women opted for the same place of childbirth for their successive births. However, about 14% did switch their place and not all these decisions favoured health facility over home setting. In 24 of the 44 countries analysed, a higher proportion of women switched from a health facility to home. Multilevel regression analyses show significantly higher odds of switching from home to a facility for high parity women, those with frequent antenatal visits and more wealth. However, in countries with high infant mortality rates, low parity women had an increased probability of switching from home to a health facility. There is clear evidence that women do change their childbirth locations over successive births in low and middle income countries. After two decades of efforts to improve maternal health, it might be expected that a higher proportion of women will be deciding against home births in favour of facility births. The results from this analysis show that is not the case.
38 CFR 17.58 - Evacuation of community nursing homes.
Code of Federal Regulations, 2014 CFR
2014-07-01
... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes. When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated...
38 CFR 17.58 - Evacuation of community nursing homes.
Code of Federal Regulations, 2013 CFR
2013-07-01
... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes. When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated...
38 CFR 17.58 - Evacuation of community nursing homes.
Code of Federal Regulations, 2012 CFR
2012-07-01
... nursing homes. 17.58 Section 17.58 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.58 Evacuation of community nursing homes. When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated...
Zimmerman, Sheryl; Gruber-Baldini, Ann L; Hebel, J Richard; Sloane, Philip D; Magaziner, Jay
2002-12-01
Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection. Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up. A stratified random sample of 59 nursing homes across Maryland. Two thousand fifteen new admissions aged 65 and older. Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records). The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes. The association between RN
Private equity ownership and nursing home financial performance.
Pradhan, Rohit; Weech-Maldonado, Robert; Harman, Jeffrey S; Laberge, Alex; Hyer, Kathryn
2013-01-01
Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performance-for instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities.
Lutfiyya, May Nawal; Gessert, Charles E; Lipsky, Martin S
2013-08-01
Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site. Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating. Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986). Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for
22 CFR 120.24 - Port Directors.
Code of Federal Regulations, 2013 CFR
2013-04-01
... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Port Directors. 120.24 Section 120.24 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.24 Port Directors. Port Directors of U.S. Customs and Border Protection means the U.S. Customs and Border...
22 CFR 120.24 - Port Directors.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Port Directors. 120.24 Section 120.24 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.24 Port Directors. Port Directors of U.S. Customs and Border Protection means the U.S. Customs and Border...
22 CFR 120.24 - Port Directors.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Port Directors. 120.24 Section 120.24 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.24 Port Directors. Port Directors of U.S. Customs and Border Protection means the U.S. Customs and Border...
22 CFR 120.24 - Port Directors.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Port Directors. 120.24 Section 120.24 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.24 Port Directors. Port Directors of U.S. Customs and Border Protection means the U.S. Customs and Border...
22 CFR 120.24 - Port Directors.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Port Directors. 120.24 Section 120.24 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.24 Port Directors. Port Directors of U.S. Customs and Border Protection means the U.S. Customs and Border...
University of Maryland MRSEC - Facilities: Nanoelectronics
MRSEC Templates Opportunities Search Home » Facilities » Nanoelectronics Facility Shared Experimental . Permission to redistribute the contents without alteration is granted to educational institutions for non
Federal Register 2010, 2011, 2012, 2013, 2014
2013-02-01
... 1625-AA00 Safety Zone; Alaska Marine Highway System Port Valdez Ferry Terminal, Port Valdez; Valdez, AK... Alaska Marine Highway System (AMHS) Port Valdez Ferry Terminal. The purpose of the safety zone is to... Security Delegation No. 0170.1. A representative of the Alaska Marine Highway System requested that the...
Benchmark dynamics in the environmental performance of ports.
Puig, Martí; Michail, Antonis; Wooldridge, Chris; Darbra, Rosa Mari
2017-08-15
This paper analyses the 2016 environmental benchmark performance of the port sector, based on a wide representation of EcoPorts members. This is the fifth time that this study has been conducted as an initiative of the European Sea Ports Organisation (ESPO). The data and results are derived from the Self-Diagnosis Method (SDM), a concise checklist against which port managers can self-assess the environmental management of their port in relation to the performance of the EcoPorts membership. The SDM tool was developed in the framework of the ECOPORTS project (2002-2005) and it is managed by ESPO. A total number of 91 ports from 20 different European Maritime States contributed to this evaluation. The main results are that air quality remains as the top environmental priority of the respondent ports, followed by energy consumption and noise. In terms of environmental management, the study confirms that key components are commonly implemented in the majority of European ports. 94% of contributing ports have a designated environmental manager, 92% own an environmental policy and 82% implement an environmental monitoring program. Waste is identified as the most monitored issue in ports (80%), followed by energy consumption (73%) and water quality (70%). Copyright © 2017 Elsevier Ltd. All rights reserved.
Scavenging a Piston-ported Two-stroke Cylinder
NASA Technical Reports Server (NTRS)
Rogowski, A R; Bouchard, C L
1938-01-01
An investigation was made with a specially designed engine to determine the scavenging characteristics of a large number of inlet-port shapes and arrangements and the optimum port arrangement and timing for this particular type of engine. A special cylinder construction permitted wide variations in timing for this particular type of engine. A special cylinder construction permitted wide variations in timing as well as in shape and arrangement of both the inlet and exhaust ports. The study of the effect of port shape combinations and timings on engine performance was made using illuminating gas as a fuel. Through variations in inlet-port arrangement and port timings, the value of the scavenging efficiency was increased from an original 44 percent to approximately 67 percent with a corresponding increase in power. With the optimum port arrangement and timing determined, a large number of performance runs were made under both spark-ignition and compression-ignition operation.
[Single-port laparoscopic cholecystectomy: advantages and disadvantages].
Alekberzade, A V; Lipnitsky, E M; Krylov, N N; Sundukov, I V; Badalov, D A
2016-01-01
To analyze the outcomes of single-port laparoscopic cholecystectomy. Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.
University of Maryland MRSEC - Facilities: VTSTM
MRSEC Templates Opportunities Search Home » Facilities » UHV-VT-STM Shared Experimental Facilities redistribute the contents without alteration is granted to educational institutions for non-profit
Federal Register 2010, 2011, 2012, 2013, 2014
2012-08-09
...-AA08 Special Local Regulation; Port Huron Offshore Gran Prix, St. Clair River; Port Huron, MI AGENCY... regulation on the St. Clair River, Port Huron, Michigan. This action is necessary and intended to ensure... movement of, vessels in a portion of the St. Clair River. During the enforcement period, no person or...
The Practice of Guangzhou Port Planning Environmental Impact Assessment
NASA Astrophysics Data System (ADS)
Wang, Ning; Zhao, Junjie; Shou, Youping; Qiao, Jianzhe; Dong, Shipei; Zhang, Lu
2018-01-01
In this paper, the effects of the implementation of Guangzhou port plan were analyzed from hydrological condition, water environment and ecological environment. Regional water environmental carrying capacity was analyzed. Guangzhou port is a main port in the coast of China, it is an important port of foreign trade in south China, it is an important port for energy supplies and raw materials in Guangdong province [1]. With the shipping channel condition improvement and the construction of large specialized container port area, Guangzhou port will gradually become trunk line port of container transport in south China.
Mwangi, Tabitha W.; Ndirangu, Kennedy K.; Abdullahi, Osman A.; Munywoki, Patrick K.
2018-01-01
Background Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya. Methods A cross-sectional design using mixed methods was used. Quantitative data were collected using interviewer-administered questionnaires from HIV-infected women with a recent pregnancy (within 5 years, n = 425), whilst qualitative data were collected using focused group discussions (FGD, n = 5). Data were analysed using logistic regression and a thematic framework approach respectively. Results Overall, 108 (25.4%, [95% CI: 21.3–29.8]) participants delivered at home. Correlates of home delivery included lack of formal education (aOR 12.4 [95% CI: 3.4–46.0], p<0.001), history of a previous home delivery (2.7 [95% CI:1.2–6.0], p = 0.019) and being on highly active antiretroviral therapy (HAART, 0.4 [95% CI:0.2–0.8], p = 0.006).Despite a strong endorsement against home delivery, major thematic challenges included consumer-associated barriers, health care provider associated barriers and structural barriers. Conclusion A quarter of HIV-infected women delivered at home, which is comparable to estimates reported from the general population in this rural setting, and much lower than estimates from other sSA settings. A tailored package of care targeting women with no formal education and with a history of a previous home delivery, coupled with interventions towards scaling up HAART and improving the quality of maternal care in HIV-infected women may positively contribute to a decline in home delivery and subsequent maternal mortality in
Malpractice paid losses and financial performance of nursing homes.
Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J
2011-01-01
Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.
Testing and Analysis of Sensor Ports
NASA Technical Reports Server (NTRS)
Zhang, M.; Frendi, A.; Thompson, W.; Casiano, M. J.
2016-01-01
This Technical Publication summarizes the work focused on the testing and analysis of sensor ports. The tasks under this contract were divided into three areas: (1) Development of an Analytical Model, (2) Conducting a Set of Experiments, and (3) Obtaining Computational Solutions. Results from the experiment using both short and long sensor ports were obtained using harmonic, random, and frequency sweep plane acoustic waves. An amplification factor of the pressure signal between the port inlet and the back of the port is obtained and compared to models. Comparisons of model and experimental results showed very good agreement.
Neutron Scattering Home Page (Low-Graphics)
will be added. We encourage everyone interested in neutron scattering to take full advantage of this Home Page | Facilities | Reference | Software | Conferences | Announcements | Mailing Lists Neutron Scattering Banner Neutron Scattering Home Page A new portal for neutron scattering has just been established
[Utility of Smartphone in Home Care Medicine - First Trial].
Takeshige, Toshiyuki; Hirano, Chiho; Nakagawa, Midori; Yoshioka, Rentaro
2015-12-01
The use of video calls for home care can reduce anxiety and offer patients peace of mind. The most suitable terminals at facilities to support home care have been iPad Air and iPhone with FaceTime software. However, usage has been limited to specific terminals. In order to eliminate the need for special terminals and software, we have developed a program that has been customized to meet the needs of facilities using Web Real Time Communication(WebRTC)in cooperation with the University of Aizu. With this software, video calls can accommodate the large number of home care patients.
One, Two, or Three Ports in Laparoscopic Cholecystectomy?
Justo-Janeiro, Jaime Manuel; Vincent, Gustavo Theurel; Vázquez de Lara, Fernando; de la Rosa Paredes, René; Orozco, Eduardo Prado; Vázquez de Lara, Luis G.
2014-01-01
Single-port laparoscopic cholecystectomy (LC) has been compared with 3- or 4-port LC. To our knowledge, there are no studies comparing the 3-, 2-, and 1-port techniques. Patients were randomized into 3 groups: LC 1-port using SILS, LC 2-port using a laparoscope with a working channel, and LC 3-port using the standard ports. Pain was evaluated at recovery, 4 hours, 24 hours, day 5, and day 8, using an analog visual scale. Homogenous groups in their demographic characteristics; all confirmed gallbladder lithiasis. At recovery, there was less pain in group 1 (P = 0.002); at 4 hours pain was similar in all groups (P = 0.899); at 24 hours there was less pain in groups 2 and 3 (P = 0.031); and at days 5 and 8 there was marginal (P = 0.053) and significant (P = 0.003) relevance. In terms of pain perception, LC performed through 1 port does not offer advantages when compared with 2 or 3 ports. More clinical trials are needed to confirm these data. PMID:25437581
Do nursing home chain size and proprietary status affect experiences with care?
You, Kai; Li, Yue; Intrator, Orna; Stevenson, David; Hirth, Richard; Grabowski, David; Banaszak-Holl, Jane
2015-01-01
Background In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. Objectives To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. Data Sources and Study Design Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all non-governmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. Results Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. Conclusions Evidence suggests that Maryland nursing homes affiliated with large- and medium- for-profit chains had lower ratings of family reported experience with care. PMID:26765147
Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care?
You, Kai; Li, Yue; Intrator, Orna; Stevenson, David; Hirth, Richard; Grabowski, David; Banaszak-Holl, Jane
2016-03-01
In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.
Moore, Roland S; Ames, Genevieve M; Cunradi, Carol B
2007-01-01
Background Heavy alcohol consumption rates are higher in the young adult military enlisted population than among civilians of the same age. The literature on alcohol availability, both generally and specifically with respect to work-related drinking, establishes clear links between ease of access, alcohol consumption rates and alcohol-related problems. Methods In this paper, a qualitative analysis of 50 semi-structured interviews with U.S. Navy personnel was combined with quantitative findings from a mail survey of 713 young enlisted men and women in order to shed light on alcohol availability and its correlates in the home port environments of young adult enlisted personnel. The interviews were analyzed by two anthropologists seeking recurring themes or topics related to alcohol availability. These qualitative data were contextualized by descriptive statistics of the survey responses regarding ease of obtaining alcohol on and around naval bases, and from friends in and out of the Navy. Results Findings associated with social and physical availability of alcohol include low prices in Navy Exchange base stores, frequent barracks parties, drink promotions in bars surrounding bases, and multiple opportunities for underage drinking despite age limits on alcohol purchases and official efforts to deglamorize alcohol use in the Navy. Both qualitative and qualitative findings suggest that respondents found alcohol and opportunities to drink overwhelmingly available in both on-base and off-base settings, and from friends both in and out of the Navy. Conclusion There is qualitative and quantitative evidence for extensive physical and social availability of alcohol in and around bases for young adults in the military. Policy implications include raising the presently tax-free alcohol prices in base stores and enforcing existing policies regarding underage drinking, particularly the provision of alcohol by people of legal drinking age, and by bars in and around bases
Moore, Roland S; Ames, Genevieve M; Cunradi, Carol B
2007-06-30
Heavy alcohol consumption rates are higher in the young adult military enlisted population than among civilians of the same age. The literature on alcohol availability, both generally and specifically with respect to work-related drinking, establishes clear links between ease of access, alcohol consumption rates and alcohol-related problems. In this paper, a qualitative analysis of 50 semi-structured interviews with U.S. Navy personnel was combined with quantitative findings from a mail survey of 713 young enlisted men and women in order to shed light on alcohol availability and its correlates in the home port environments of young adult enlisted personnel. The interviews were analyzed by two anthropologists seeking recurring themes or topics related to alcohol availability. These qualitative data were contextualized by descriptive statistics of the survey responses regarding ease of obtaining alcohol on and around naval bases, and from friends in and out of the Navy. Findings associated with social and physical availability of alcohol include low prices in Navy Exchange base stores, frequent barracks parties, drink promotions in bars surrounding bases, and multiple opportunities for underage drinking despite age limits on alcohol purchases and official efforts to deglamorize alcohol use in the Navy. Both qualitative and qualitative findings suggest that respondents found alcohol and opportunities to drink overwhelmingly available in both on-base and off-base settings, and from friends both in and out of the Navy. There is qualitative and quantitative evidence for extensive physical and social availability of alcohol in and around bases for young adults in the military. Policy implications include raising the presently tax-free alcohol prices in base stores and enforcing existing policies regarding underage drinking, particularly the provision of alcohol by people of legal drinking age, and by bars in and around bases. Cooperative preventive efforts with
Teno, Joan M; Gozalo, Pedro; Mitchell, Susan L; Bynum, Julie P W; Dosa, David; Mor, Vincent
2011-06-01
Terminal hospitalizations are costly and often avoidable with appropriate advance care planning. This study examined the association between advance care planning, as measured by facility rate of do not resuscitate (DNR) orders in U.S. nursing homes (NHs) and changes in terminal hospitalization rates. Retrospective cohort study of the changing prevalence of DNR orders in U.S. NHs. Using a fixed effect multivariate model, we examined whether increasing facility rate of DNR orders correlates with reductions in terminal hospitalizations in the last week of life, controlling for changes in facility characteristics (staffing, use of NP/PA, case mix of nursing residents, admission volume, racial composition, payer mix). The average facility rate of terminal hospitalizations was 15.5%, fluctuating between 1999 (15.0%) and 2007 (14.8%). NHs starting with low rates of DNR orders that increased their rates had fewer terminal hospital admissions in 2007 (11.2%) than facilities with continuously low DNR usage. Even after applying a multivariate fixed effect model, the effect of changes in facility DNR order rate on terminal hospitalization was -0.056 (95% confidence interval: -0.061, -0.050), indicating that for every 10% increase in DNR orders there was 0.56% decrease in terminal hospitalizations. This rate can be compared with the increase of 0.70% in the terminal hospitalization rate when an NH became disproportionately dependent on Medicaid funding or the 0.40% decrease in terminal hospitalization rate associated with adding a nurse practitioner to the clinical staff complement. NHs that changed their culture of decision making by increasing their facility rate of DNR orders decreased their rate of terminal hospitalizations. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Pathology of deaths from carbon monoxide poisoning in Port Harcourt: an autopsy study of 75 cases.
Seleye-Fubara, D; Etebu, E N; Athanasius, B
2011-01-01
Carbon monoxide (CO) poisoning is a notable cause of death at homes and industries that is posing public health problem worldwide that requires an elaborate study. To study and characterize deaths resulting from the noxious gas (CO). A ten year (January 1st, 1995 December 31st 2004) autopsy study. Port Harcourt, Nigeria. Coroners and hospital autopsies performed by the authors at the University of Port Harcourt Teaching Hospital (UPTH), other hospitals and private mortuaries in Port Harcourt on deaths from carbon monoxide poisoning were studied over ten years. The circumstances of death reported by police were accidental, homicidal or suicidal; and other autopsy findings were used for the study. A total of seventy five autopsies were studied; out which 21 (28.0%) were females and 54 (72.0%) males giving a ratio 1:2.6 male dominance. The highest frequency of death 25 (33.3%) occurred in the age group 60 69 years; while the least 3 (4%) occurred in the age group 0 9 years. The youngest was an unborn 7 month old male fetus while the eldest was 85 years old female. The most common was accidental carbon monoxide poisoning which accounted for 48 (64%) cases. While Homicidal CO poisoning .was 24 (32%) and suicidal CO poisoning was 3 (4.0%). Body recovered from fumy electric generator rooms was 46 (61.3%) while least frequency was bodies recovered from naked flame 3 (4%). Carbon monoxide poisoning is posing a serious public health problem when ever it occurs. There is need for public enlightenment about this gas as it is related to fumes from generator, car exhausts, poorly ventilated rooms and enclosed chambers in order to reduce the carnage associated with it both at home and industries.
Evaluation of a polymer implanted port access device.
Brown, J M
1996-01-01
The implanted port vascular access system has provided many patients with safe and reliable vascular access. Its implanted design provides improved body image, reduced maintenance and a better quality of life. The Huber needle has been the standard means of accessing the implanted port system. Because of the problems associated with the Huber needle system, current standards recommend that the Huber needle be changed every 7 days. This evaluation examines the use of a polymer cannula to access the implanted port system. This polymer cannula eliminates many of the problems associated with the Huber needle and provides longer dwell times without increased complications. Seventy nine patients were accessed for a total of 1533 days with the mean dwell time being 19.4 days with no increase in complications associated with port access. To establish implanted port access times of greater than 7 days without increased complications. A multicenter voluntary enrollment evaluation of a medical device. Patients were offered the opportunity to participate in the evaluation if they had an implanted port and were going to be accessed for therapy for periods of 7 days or more. Patients were observed for adverse cutaneous reactions at the insertion site and any port access complications such as sepsis, leakage, changes in portal chamber integrity, and implant pocket integrity. From October 1994 through November 1995, 79 L-Cath for Ports (Luther Medical Products) polymer catheter port access devices (Illustration 1) were inserted in 54 patients. This polymer port access device was used instead of a rigid metal Huber needle for port access. The total number of access days was 1533 days with the mean duration of access being 19.4 days. Two patients experienced blood stream infections while they were accessed with the polymer port access device. These infections ensued with fever of unknown origin as the presenting symptom during neutropenic episodes after chemotherapy treatment. The
Code of Federal Regulations, 2013 CFR
2013-07-01
... Harbor, Portsmouth, New Hampshire. (a) Location. The following areas are safety and security zones: (1... receiving facility on the Piscataqua River, Newington, New Hampshire. (b) Definitions. For purposes of this... Vessel Transits in Portland, Maine, Captain of the Port Zone, Portsmouth Harbor, Portsmouth, New...
Code of Federal Regulations, 2014 CFR
2014-07-01
... Harbor, Portsmouth, New Hampshire. (a) Location. The following areas are safety and security zones: (1... receiving facility on the Piscataqua River, Newington, New Hampshire. (b) Definitions. For purposes of this... Vessel Transits in Portland, Maine, Captain of the Port Zone, Portsmouth Harbor, Portsmouth, New...
Code of Federal Regulations, 2012 CFR
2012-07-01
... Harbor, Portsmouth, New Hampshire. (a) Location. The following areas are safety and security zones: (1... receiving facility on the Piscataqua River, Newington, New Hampshire. (b) Definitions. For purposes of this... Vessel Transits in Portland, Maine, Captain of the Port Zone, Portsmouth Harbor, Portsmouth, New...
Code of Federal Regulations, 2010 CFR
2010-07-01
... Harbor, Portsmouth, New Hampshire. (a) Location. The following areas are safety and security zones: (1... receiving facility on the Piscataqua River, Newington, New Hampshire. (b) Definitions. For purposes of this... Vessel Transits in Portland, Maine, Captain of the Port Zone, Portsmouth Harbor, Portsmouth, New...
Code of Federal Regulations, 2011 CFR
2011-07-01
... Harbor, Portsmouth, New Hampshire. (a) Location. The following areas are safety and security zones: (1... receiving facility on the Piscataqua River, Newington, New Hampshire. (b) Definitions. For purposes of this... Vessel Transits in Portland, Maine, Captain of the Port Zone, Portsmouth Harbor, Portsmouth, New...
Medicare part D and the nursing home setting.
Stevenson, David G; Huskamp, Haiden A; Newhouse, Joseph P
2008-08-01
The purpose of this article is to explore how the introduction of Medicare Part D is changing the operations of long-term-care pharmacies (LTCPs) and nursing homes, as well as implications of those changes for nursing home residents. We reviewed existing sources of information and interviewed stakeholders across various perspectives. We conducted 31 semistructured telephone interviews with key stakeholders between November 2006 and January 2007. Part D represents a substantial departure from how prescription drugs were previously financed and administered in nursing homes, and nursing home providers and LTCPs have struggled in adapting to some of these changes. Part D increased the variation around formularies and drug management processes for residents at the facility level, creating additional burden on clinical and pharmacy staff and introducing a tension between facilities' need to dispense medications quickly and assuring of coverage for those drugs. Nursing home and LTCP stakeholders perceive wide variation across Part D plans in their ability to meet the needs of nursing home residents. Although LTCPs, nursing homes and their clinicians, and Part D plans will gain experience with the benefit in the nursing home setting over time, stakeholders we interviewed identified a range of longer term issues and questions that merit attention as the benefit proceeds.
Medicare Part D and the Nursing Home Setting
Stevenson, David G.; Huskamp, Haiden A.; Newhouse, Joseph P.
2008-01-01
Purpose To explore how Medicare Part D's introduction is changing the operations of long-term care pharmacies (LTCPs) and nursing homes, as well as implications of those changes for nursing home residents. Design and Methods We reviewed existing sources of information and interviewed stakeholders across various perspectives. Thirty-one semi-structured, telephone interviews were conducted with key stakeholders between November 2006 and January 2007. Results Part D represents a substantial departure from how prescription drugs were previously financed and administered in nursing homes, and nursing home providers and LTCPs have struggled in adapting to some of these changes. Part D increased the variation around formularies and drug management processes for residents at the facility level, creating additional burden on clinical and pharmacy staff and introducing a tension between facilities' need to dispense medications quickly and assuring coverage for those drugs. Nursing home and LTCP stakeholders perceive wide variation across Part D plans in their ability to meet the needs of nursing home residents. Implications Although LTCPs, nursing homes and their clinicians, and Part D plans will gain experience with the benefit in the nursing home setting over time, stakeholders we interviewed identified a range of longer-term issues and questions that merit attention as the benefit proceeds. PMID:18728293
Air Traffic Forecasting at the Port Authority of New York and New Jersey
NASA Technical Reports Server (NTRS)
Augustine, J. G.
1972-01-01
Procedures for conducting air traffic forecasts with specific application to the Port Authority of New York and New Jersey are discussed. The procedure relates air travel growth to detailed socio-economic and demographic characteristics of the U.S. population rather than to aggregate economic data such as Gross National Product, personal income, and industrial production. Charts are presented to show the relationship between various selected characteristics and the use of air transportation facilities.
Keohane, Laura; Mor, Vincent
2014-01-01
We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states’ efforts to expand HCBS for this population should continue. PMID:25211711
Thomas, Kali S; Keohane, Laura; Mor, Vincent
2014-11-01
We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.
Xu, Dongjuan; Kane, Robert L; Shippee, Tetyana; Lewis, Teresa M
2016-12-01
There is a general belief that the markers of nursing home quality do not aggregate easily. Identifying consistent and coherent dimensions of quality that usefully summarize the multiplicity of nursing home quality measures is an important goal. It would simplify interpretation and help consumers, their families and advocates to choose nursing facilities. This study uses quality indicators (QIs) from a state nursing home report card to explore the dimensionality of quality in nursing homes and to determine whether aggregation at the resident versus facility level yields the same underlying dimensions. Cross-sectional study. 382 Medicare- and/or Medicaid-certified nursing homes in Minnesota. Residents admitted to the nursing homes during 2011-2012. 16 QIs obtained from the Minimum Data Set 3.0 assessment instrument between 2011 and 2012 were used in the exploratory factor analysis. Factor analysis results suggest four main factors or dimensions to characterize facility performance: continence care (including 4 QIs), restraints and behavioral symptoms (including 3 QIs), care for specific conditions (including 6 QIs), and physical functioning (including 3 QIs). The resident-level and facility-level results generally agreed for 11 QIs. Nursing home quality of care can be captured in summary measures, which can be used by consumers, providers and researchers. Reporting at the resident or facility level will depend on the purpose. These summary measures can be used by policy-makers to identify and reward high-performing facilities and by families to choose nursing facilities for care. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Measuring Work Environment and Performance in Nursing Homes
Temkin-Greener, Helena; Zheng, Nan (Tracy); Katz, Paul; Zhao, Hongwei; Mukamel, Dana B.
2008-01-01
Background Qualitative studies of the nursing home work environment have long suggested that such attributes as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant. Objectives This study is designed to: develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance. Research Design and Methods The analysis was based on survey responses provided by managers (N=308) and direct care workers (N=7,418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Chronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness. Results The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness has been demonstrated. Several individual (e.g. occupation, race) and facility characteristics (e.g. management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified. Conclusions The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care. PMID:19330892
Grabowski, David C; Stevenson, David G; Caudry, Daryl J; O'Malley, A James; Green, Lisa H; Doherty, Julia A; Frank, Richard G
2017-08-01
To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration period. Nursing homes were randomized to the intervention in New York, while the comparison facilities were constructed via propensity score matching in Arizona and Wisconsin. We used a difference-in-difference analysis to compare outcomes across the base-year relative to outcomes in each of the three demonstration years. To provide context and assist with interpretation of results, we also interviewed staff members at participating facilities. Medicare savings were observed in Arizona in the first year only and Wisconsin for the first 2 years; no savings were observed in New York. The demonstration did not systematically impact any of the quality measures. Discussions with nursing home administrators suggested that facilities made few, if any, changes in response to the demonstration, leading us to conclude that the observed savings likely reflected regression to the mean rather than true savings. The Federal nursing home pay-for-performance demonstration had little impact on quality or Medicare spending. © Health Research and Educational Trust.
ERIC Educational Resources Information Center
de Guzman, Allan B.; Guevara, Katrina Illyana J.; Guiang, Frances Jane B.; Gutierez, Anton Lorenzo I.; Habaluyas, Alayne S.; Hizon, Marc Alison P.; Idanan, Shalaine G.
2012-01-01
This grounded study examined the process of acclimatization or the process of changing perspectives of a person so as to get used to or feel "at home" among a select group of Filipino elderly in a nursing care facility. As institutionalization of the elderly is not typical in the Philippine context, varied responses were analyzed to…
Two-port robotic hysterectomy: a novel approach.
Moawad, Gaby N; Tyan, Paul; Khalil, Elias D Abi
2018-03-24
The objective of the study was to demonstrate a novel technique for two-port robotic hysterectomy with a particular focus on the challenging portions of the procedure. The study is designed as a technical video, showing step-by-step a two-port robotic hysterectomy approach (Canadian Task Force classification level III). IRB approval was not required for this study. The benefits of minimally invasive surgery for gynecological pathology have been clearly documented in multiple studies. Patients had fewer medical and surgical complications postoperatively, better cosmesis and quality of life. Most gynecological surgeons require 3-5 ports for the standard gynecological procedure. Even though the minimally invasive multiport system provides an excellent safety profile, multiple incisions are associated with a greater risk for morbidity including infection, pain, and hernia. In the past decade, various new methods have emerged to minimize the number of ports used in gynecological surgery. The interventions employed were a two-port robotic hysterectomy, using a camera port plus one robotic arm, with a focus on salpingectomy and cuff closure. We describe a transvaginal and a transabdominal approach for salpingectomy and a novel method for cuff closure. The transvaginal and transabdominal techniques for salpingectomy for two-port robotic-assisted hysterectomy provide excellent tension and exposure for a safe procedure without the need for an extra port. We also describe a transvaginal technique to place the vaginal cuff on tension during closure. With the necessary set of skills on a carefully chosen patient, two-port robotic-assisted total laparoscopic hysterectomy is a feasible procedure.
Sato, Junya; Kumagai, Masumi; Kato, Kenichi; Akahane, Akio; Suzuki, Michiko; Kashiwaba, Masahiro; Sone, Miyuki; Kudo, Kenzo
2014-08-01
Subcutaneous implantation type central venous ports(CV ports)are used in chemotherapy. Here, we prospectively examined the frequency of CV port-related infections when the disinfectant was changed from 10% povidone iodine to 1% chlorhexidine ethanol or 70% ethanol. The subjects were patients with malignant tumors, who had newly been implanted with CV ports. We examined CV port-related infections at 1 week after CV port implantation and every 2 weeks thereafter, following sterilization upon insertion of a Huber needle to the CV port. CV port evulsion due to CV port-related infection was noted in 3 patients(4.8%)in whom 15%chlorhexidine ethanol was used(n=62)and in 2 patients(3.3%)in whom 70% ethanol was used(n=60). Infection rates per 1,000 days of CV port use were 1.48% and 1.01%, respectively. Thus, the outcomes of sterilization using 1% chlorhexidine ethanol and 70% ethanol did not differ significantly from those on using 10% povidone iodine for sterilization, based on preliminary results at our institution(3 of 59 patients[5.1%]had port evulsion due to CV port-related infection and the infection rate per 1,000 days of CV port use was 1.47%, Akahane et al, 2012). Chlorhexidine ethanol and ethanol are very convenient to use because they dry quickly and do not need discoloration. Accordingly, chlorhexidine ethanol and ethanol might be useful in CV port management.
Single port VATS: recent developments in Asia.
Yu, Peter S Y; Capili, Freddie; Ng, Calvin S H
2016-03-01
Single port video-assisted thoracic surgery (VATS) is the most recent evolution in minimally invasive thoracic surgery. With increasing global popularity, the single port VATS approach has been adopted by experienced thoracic surgeons in many Asian countries. From initial experience of single port VATS lobectomy to the more complex sleeve resection procedures now forming part of daily practice in some Asia institutes, the region has been the proving ground for single port VATS approaches' feasibility and safety. In addition, certain technical refinements in single port VATS lung resection and lymph node dissection have also sprung from Asia. Novel equipment designed to facilitate single port VATS allowing further reduce access trauma are being realized by the partnership between surgeons and the industries. Advanced thoracoscopes and staplers that are narrower and more maneuverable are particularly important in the smaller habitus of patients from Asia. These and similar new generation equipment are being applied to single port VATS in novel ways. As dedicated thoracic surgeons in the region continue to striving for excellence, innovative ideas in single incision access including subxiphoid and embryonic natural-orifice transluminal endoscopic surgery (e-NOTES) have been explored. Adjunct techniques and technology used in association with single port VATS such as non-intubated surgery, hybrid operating room image guidance and electromagnetic navigational bronchoscopy are all in rapid development in Asia.
Federal Register 2010, 2011, 2012, 2013, 2014
2010-07-20
... was also published in the Federal Register for the proposed IHA for Northeast Gateway's LNG Port... Gateway Energy Bridge\\TM\\ L.L.C. (Northeast Gateway or NEG) and its partner, Algonquin Gas Transmission... its proposal to issue an authorization to Northeast Gateway and Algonquin to incidentally take, by...
NASA Technical Reports Server (NTRS)
Waithe, Kenrick A.; Deere, Karen A.
2003-01-01
A computational and experimental study was conducted to investigate the effects of multiple injection ports in a two-dimensional, convergent-divergent nozzle, for fluidic thrust vectoring. The concept of multiple injection ports was conceived to enhance the thrust vectoring capability of a convergent-divergent nozzle over that of a single injection port without increasing the secondary mass flow rate requirements. The experimental study was conducted at static conditions in the Jet Exit Test Facility of the 16-Foot Transonic Tunnel Complex at NASA Langley Research Center. Internal nozzle performance was obtained at nozzle pressure ratios up to 10 with secondary nozzle pressure ratios up to 1 for five configurations. The computational study was conducted using the Reynolds Averaged Navier-Stokes computational fluid dynamics code PAB3D with two-equation turbulence closure and linear Reynolds stress modeling. Internal nozzle performance was predicted for nozzle pressure ratios up to 10 with a secondary nozzle pressure ratio of 0.7 for two configurations. Results from the experimental study indicate a benefit to multiple injection ports in a convergent-divergent nozzle. In general, increasing the number of injection ports from one to two increased the pitch thrust vectoring capability without any thrust performance penalties at nozzle pressure ratios less than 4 with high secondary pressure ratios. Results from the computational study are in excellent agreement with experimental results and validates PAB3D as a tool for predicting internal nozzle performance of a two dimensional, convergent-divergent nozzle with multiple injection ports.
Mauriello, Claudio; Chouillard, Elie; d'alessandro, Antonio; Marte, Gianpaolo; Papadimitriou, Argyri; Chahine, Elias; Kassir, Radwan
2018-04-16
Evaluate the efficacy of single-port sleeve gastrectomy (SPSG) and then compare it to a less-invasive sleeve approach (three-port) (3PSG) according to a propensity score (PS) matching analysis. We analyzed all patients who underwent SG through a three-port or a single-port laparoscopic approach. After 2 years, the follow-up was completed in 84% patients treated with 3PSG and 95% patients of the SPSG group. Excess weight loss (EWL) was comparable for the first year of follow-up within the two groups except for the controls at 3 months in which the SPSG group showed a higher EWL (p = 0.0243). We demonstrated the efficacy of SPSG in bariatric surgery even compared to another, less invasive, laparoscopic SG approach (three-port).
Maternity waiting homes in Ethiopia--three decades experience.
Gaym, Asheber; Pearson, Luwei; Soe, Khynn Win Win
2012-07-01
Access to comprehensive emergency obstetric care is limited in Ethiopia. Maternity waiting homes are part of the strategies utilized to improve access to hard to reach rural populations. Despite long years of existence of this service in Ethiopia, the practice has not been adequately assessed so far. Describe the current status of maternity waiting home services in Ethiopia All facilities in Ethiopia that have a maternity waiting home were identified from FMOH data as well as personal contacts with focal persons at Regional Health Bureaus in the nine regions and UNICEF regional offices. A standardized data collection tool for facility assessment was developed by the quality referral team, Health Section, UNICEF. Data collection included site visits and documentation of infrastructural related issues through a facility checklist. Service related issues were also collected from log books and other documents as well as through interview with relevant staff Focus group discussions were held with all MWHs attendants who were found admitted at the time of the review at Attat, Wolisso and Gidole hospital maternity waiting homes on major thematic areas identified by the review team regarding MWH care The practice of maternity waiting homes in Ethiopia spans more than three decades. Nine facilities located in five Regional States had maternity waiting home services. All except one were located in hospitals. Admission capacity ranged from 4 up to 44 mothers at a time. Seven of the maternity waiting homes required the clients to cater for their own food, firewood and clothing supply providing only kitchen space and few kitchen utensils. Clients came from as far as 400 kms away to obtain services. Medical care and documentation of services were not standardized Duration of stay varied from 3-90 days. Monthly admission rates varied from 0-84 mothers at different institutions. Major indications for admission were previous caesarean section 34%; previous fistula repair 12
Benizri, F; Balladur, E; Darse, J; Guérin, J; Boudy, V; Echard, M; Brodin, M; Hagenmüller, J B; Prognon, P; Bonan, B
2010-09-01
While home-based chemotherapy improves comfort and quality of life of patients, quality and safety conditions must be equivalent to hospital settings. In addition, organization is much more complex. At the hospital at home "Assistance publique-Hôpitaux de Paris", prescribers are potentially spread across 21 health facilities. The administration of chemotherapy is performed by about 300 nurses at the patient's home in Paris and its suburbs. Centralized preparations of chemotherapy began in September 2009 by the pharmacy department of Georges-Pompidou European hospital, with a progressive increase of the activity. This article describes the quality insurance system established with this new organization to meet the specific challenges of home therapy: choice of eligible anticancer drugs, computerized information systems and networking with other heath facilities, secure transport conditions, traceability from the prescription to the administration, security of administration. This experience can offer an important support for other centres in their approach of quality insurance for home chemotherapy.
5-fluorouracil extravasation following port failure.
Nesti, S P; Kovac, R
2000-01-01
A case is presented of cytotoxic extravasation as a result of an implantable venous port being perforated by a standard Huber needle. A patient receiving 5-fluorouracil via a dual reservoir port, implanted within the left chest wall, presented with hemoserous discharge from the right needle entry site. The left chest wall was warm to touch, erythematous, and swollen. Subcutaneous infiltration was suspected, and the infusion was ceased. A venogram was performed demonstrating significant extravasation around the left reservoir only. On port removal, inspection showed the Huber needle had penetrated the base plate on the left side. It is recommended that this complication be added as a possible sequelae of central venous port use.
Public Port Finance Survey for FY 1999
DOT National Transportation Integrated Search
2001-01-01
The Public Port Finance Survey has been compiled for over 20 years, first by the AAPA or a member port, now by the Maritime Administration (MARAD).It is the only report of its kind in the port industry covering U.S. (including U.S. territories) and C...
An Examination of Special Focus Facility Nursing Homes
ERIC Educational Resources Information Center
Castle, Nicholas G.; Engberg, John
2010-01-01
Purpose: Nursing facilities that are determined to have a greater number of quality problems, more serious problems than average, and a demonstrated pattern of quality problems are included in the Special Focus Facility (SFF) initiative. The purpose of this research was to provide descriptive information on these SFFs and to examine the quality…
Trinkoff, Alison M; Lerner, Nancy B; Storr, Carla L; Han, Kihye; Johantgen, Mary E; Gartrell, Kyungsook
2015-01-01
Leadership is a key consideration in improving nursing home care quality. Previous research found nursing homes with more credentialed leaders had lower rates of care deficiencies than nursing homes with less credentialed leaders. Evidence that nursing home administrator (NHA) and director of nursing (DON) education and certification is related to resident outcomes is limited. To examine associations of education and certification among NHAs and DONs with resident outcomes. Cross-sectional secondary data analysis. This study used National Nursing Home Survey data on leadership education and certification and Nursing Home Compare quality outcomes (e.g. pain, catheter use). 1142 nursing homes in the survey which represented 16628 nursing homes in the US. Leadership education and certification were assessed separately for NHAs and DONs. Nursing home resident outcomes were measured using facility-level nursing home quality indicator rates selected from the Minimum Data Set. Facility-level quality indicators were regressed onto leadership variables in models that also held constant facility size and ownership status. Nursing homes led by NHAs with both Master's degrees or higher and certification had significantly better outcomes for pain. Nursing homes led by DONs with Bachelor's degrees or higher plus certification also had significantly lower pain and catheter use. Whereas pressure ulcer rates were higher in facilities led by DONs with more education. Selected outcomes for nursing home residents might be improved by increasing the education and certification requirements for NHAs and DONs. Additional research is needed to clarify these relationships. Copyright © 2014 Elsevier Ltd. All rights reserved.
Home advantage in retractable-roof baseball stadia.
Romanowich, Paul
2012-10-01
This study examined whether the home advantage varies for open-air, domed, or retractable-roof baseball stadia, and whether having the roof open or closed affects the home advantage in retractable-roof baseball stadia. Data from Major League Baseball (MLB) games played between 2001 and 2009 were analyzed for whether or not the presence of a home-advantage was dependent on the type of home stadium used. Home advantage was robust for all three types of stadia. A significant effect of stadium type on home advantage was found, with a greater home advantage for teams playing home games in domed stadia relative to open-air stadia, replicating a previous study. There was a greater home advantage for teams playing home games in domed stadia relative to retractable-roof stadia. No other differences in the home advantage were found; results are discussed in terms of familiarity with the facility.
Prediction of Advisability of Returning Home Using the Home Care Score
Matsugi, Akiyoshi; Tani, Keisuke; Tamaru, Yoshiki; Yoshioka, Nami; Yamashita, Akira; Mori, Nobuhiko; Oku, Kosuke; Ikeda, Masashi; Nagano, Kiyoshi
2015-01-01
Purpose. The aim of this study was to assess whether the home care score (HCS), which was developed by the Ministry of Health and Welfare in Japan in 1992, is useful for the prediction of advisability of home care. Methods. Subjects living at home and in assisted-living facilities were analyzed. Binominal logistic regression analyses, using age, sex, the functional independence measure score, and the HCS, along with receiver operating characteristic curve analyses, were conducted. Findings/Conclusions. Only HCS was selected for the regression equation. Receiver operating characteristic curve analysis revealed that the area under the curve (0.9), sensitivity (0.82), specificity (0.83), and positive predictive value (0.84) for HCS were higher than those for the functional independence measure, indicating that the HCS is a powerful predictor for advisability of home care. Clinical Relevance. Comprehensive measurements of the condition of provided care and the activities of daily living of the subjects, which are included in the HCS, are required for the prediction of advisability of home care. PMID:26491568
Rorschach inkblot port-wine stain.
Coots, N V; Elston, D M
1997-01-01
We present an infant born with bilaterally symmetric, anterior and posterior port-wine stains. These lesions presented a striking resemblance to Rorschach inkblots, a phenomenon not previously reported. A discussion of the case as well as a discussion of syndromes associated with port-wine stains is provided.
Wounds caused by contact with muzzle-lift relief ports (Mag-Na-Port).
Rogers, D R; Shem, R J
1992-12-01
Fan-shaped stippled burns were produced on the skin when a revolver whose barrel had been modified by the Mag-Na-Port process was fired twice with the side of the muzzle in contact. A grazing wound was produced by one bullet, and an oblique entry was produced by the other. The characteristics of Mag-Na-Port wounds and test shots are described, and these are compared with test shots from two other higher power revolvers.
Detecting and Characterizing Semantic Inconsistencies in Ported Code
NASA Technical Reports Server (NTRS)
Ray, Baishakhi; Kim, Miryung; Person, Suzette J.; Rungta, Neha
2013-01-01
Adding similar features and bug fixes often requires porting program patches from reference implementations and adapting them to target implementations. Porting errors may result from faulty adaptations or inconsistent updates. This paper investigates (I) the types of porting errors found in practice, and (2) how to detect and characterize potential porting errors. Analyzing version histories, we define five categories of porting errors, including incorrect control- and data-flow, code redundancy, inconsistent identifier renamings, etc. Leveraging this categorization, we design a static control- and data-dependence analysis technique, SPA, to detect and characterize porting inconsistencies. Our evaluation on code from four open-source projects shows thai SPA can dell-oct porting inconsistencies with 65% to 73% precision and 90% recall, and identify inconsistency types with 58% to 63% precision and 92% to 100% recall. In a comparison with two existing error detection tools, SPA improves precision by 14 to 17 percentage points
Detecting and Characterizing Semantic Inconsistencies in Ported Code
NASA Technical Reports Server (NTRS)
Ray, Baishakhi; Kim, Miryung; Person,Suzette; Rungta, Neha
2013-01-01
Adding similar features and bug fixes often requires porting program patches from reference implementations and adapting them to target implementations. Porting errors may result from faulty adaptations or inconsistent updates. This paper investigates (1) the types of porting errors found in practice, and (2) how to detect and characterize potential porting errors. Analyzing version histories, we define five categories of porting errors, including incorrect control- and data-flow, code redundancy, inconsistent identifier renamings, etc. Leveraging this categorization, we design a static control- and data-dependence analysis technique, SPA, to detect and characterize porting inconsistencies. Our evaluation on code from four open-source projects shows that SPA can detect porting inconsistencies with 65% to 73% precision and 90% recall, and identify inconsistency types with 58% to 63% precision and 92% to 100% recall. In a comparison with two existing error detection tools, SPA improves precision by 14 to 17 percentage points.
Chain reaction: an exploratory study of nursing home bankruptcy in California.
Kitchener, Martin; O'neill, Ciaran; Harrington, Charlene
2005-01-01
This paper reports on an exploratory study of nursing home bankruptcy. From state and industry data regarding nearly 1,000 California facilities, it was possible to identify 155 homes in five chains (multi-facility organizations) that were operating in bankruptcy in 2000. When compared with facilities in non-bankrupt chains, while the bankrupt chain facilities had significantly worse financial liquidity, higher administrative costs, and higher payables to related parties, they also had more Medicare residents, fewer Medicaid residents, better solvency, and were located in less competitive county markets and in areas with higher Medicaid reimbursement rates. These findings indicate that, rather than facility characteristics and local market factors, strategic decisions taken at the corporate (chain) level are the major determinants of nursing facility bankruptcy status.
Northwest Ports Achievements in Reducing Emissions and Improving Performance
Case history on the status of the Northwest Ports Clean Air Strategy for the Port of Seattle, Port of Tacoma, and Port Metro Vancouver. Presents key objectives, emission and performance goals and outcomes.
Trocar Port Hernias After Bariatric Surgery.
Coblijn, Usha K; de Raaff, Christel A L; van Wagensveld, Bart A; van Tets, Willem F; de Castro, Steve M M
2016-03-01
Laparoscopic bariatric surgery is increasingly being performed worldwide. It is estimated that trocar port hernias occur more often in obese patients due to their obesity and because the ports are not closed routinely. The aim of the present study was to analyze the incidence, risk factors, and management of patients with trocar port hernias after laparoscopic bariatric surgery. All patients who were operated between 2006 and 2013 were included. During the study period, the trocar ports were not closed routinely. All patients who had any symptomatic abdominal wall hernia during follow-up were included. Overall, 1524 laparoscopic bariatric procedures were performed. There were 1249 female (82 %) and 275 male (18 %) patients. The mean age was 44 years, and median body mass index was 43 kg/m(2). Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 859), laparoscopic adjustable gastric banding (LAGB) (n = 364), laparoscopic sleeve gastrectomy (LSG) (n = 68), revisional surgery (n = 226), and other procedures (n = 7). Three hundred and one patients (20 %) had one or more postoperative complications and the overall mortality was 0.3 % (four patients). There were 14 patients (0.9 %) with an abdominal wall hernia, of which eight (0.5 %) had a trocar port hernia, three (0.2 %) an incisional hernia from other previous surgery, and three (0.2 %) an umbilical hernia. Gender, age, BMI, smoking, type II diabetes, procedure type, complications, and weight loss were not associated with the occurrence of abdominal wall hernias. Trocar port hernias after bariatric surgery occur seldom if the trocar port is not routinely closed.
Comparing Public Quality Ratings for Accredited and Nonaccredited Nursing Homes.
Williams, Scott C; Morton, David J; Braun, Barbara I; Longo, Beth Ann; Baker, David W
2017-01-01
Compare quality ratings of accredited and nonaccredited nursing homes using the publicly available Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare data set. This cross-sectional study compared the performance of 711 Joint Commission-accredited (TJC-accredited) nursing homes (81 of which also had Post-Acute Care Certification) to 14,926 non-Joint Commission-accredited (non-TJC-accredited) facilities using the Nursing Home Compare data set (as downloaded on April 2015). Measures included the overall Five-Star Quality Rating and its 4 components (health inspection, quality measures, staffing, and RN staffing), the 18 Nursing Home Compare quality measures (5 short-stay measures, 13 long-stay measures), as well as inspection deficiencies, fines, and payment denials. t tests were used to assess differences in rates for TJC-accredited nursing homes versus non-TJC-accredited nursing homes for quality measures, ratings, and fine amounts. Analysis of variance models were used to determine differences in rates using Joint Commission accreditation status, nursing home size based on number of beds, and ownership type. An additional model with an interaction term using Joint Commission accreditation status and Joint Commission Post-Acute Care Certification status was used to determine differences in rates for Post-Acute Care Certified nursing homes. Binary variables (eg, deficiency type, fines, and payment denials) were evaluated using a logistic regression model with the same covariates. After controlling for the influences of facility size and ownership type, TJC-accredited nursing homes had significantly higher star ratings than non-TJC-accredited nursing homes on each of the star rating component subscales (P < .05) (but not on the overall star rating), and TJC-accredited nursing homes with Post-Acute Care Certification performed statistically better on the overall star rating, as well as 3 of the 4 subscales (P < .05). TJC-accredited nursing homes
DOE Office of Scientific and Technical Information (OSTI.GOV)
Freihammer, Till; Chaput, Barb; Vandergaast, Gary
2013-07-01
The Port Granby Project is part of the larger Port Hope Area Initiative, a community-based program for the development and implementation of a safe, local, long-term management solution for historic low level radioactive waste (LLRW) and marginally contaminated soils (MCS). The Port Granby Project involves the relocation and remediation of up to 0.45 million cubic metres of such waste from the current Port Granby Waste Management Facility located in the Municipality of Clarington, Ontario, adjacent to the shoreline of Lake Ontario. The waste material will be transferred to a new suitably engineered Long-Term Waste Management Facility (LTWMF) to be locatedmore » inland approximately 700 m from the existing site. The development of the LTWMF will include construction and commissioning of a new Wastewater Treatment Plant (WWTP) designed to treat wastewater consisting of contaminated surface run off and leachate generated during the site remediation process at the Port Granby Waste Management Facility as well as long-term leachate generated at the new LTWMF. Numerous factors will influence the variable wastewater flow rates and influent loads to the new WWTP during remediation. The treatment processes will be comprised of equalization to minimize impacts from hydraulic peaks, fine screening, membrane bioreactor technology, and reverse osmosis. The residuals treatment will comprise of lime precipitation, thickening, dewatering, evaporation and drying. The distribution of the concentration of uranium and radium - 226 over the various process streams in the WWTP was estimated. This information was used to assess potential worker exposure to radioactivity in the various process areas. A mass balance approach was used to assess the distribution of uranium and radium - 226, by applying individual contaminant removal rates for each process element of the WTP, based on pilot scale results and experience-based assumptions. The mass balance calculations were repeated for
Analysis of laparoscopic port site complications: A descriptive study
Karthik, Somu; Augustine, Alfred Joseph; Shibumon, Mundunadackal Madhavan; Pai, Manohar Varadaraya
2013-01-01
CONTEXT: The rate of port site complications following conventional laparoscopic surgery is about 21 per 100,000 cases. It has shown a proportional rise with increase in the size of the port site incision and trocar. Although rare, complications that occur at the port site include infection, bleeding, and port site hernia. AIMS: To determine the morbidity associated with ports at the site of their insertion in laparoscopic surgery and to identify risk factors for complications. SETTINGS AND DESIGN: Prospective descriptive study. MATERIALS AND METHODS: In the present descriptive study, a total of 570 patients who underwent laparoscopic surgeries for various ailments between August 2009 and July 2011 at our institute were observed for port site complications prospectively and the complications were reviewed. STATISTICAL ANALYSIS USED: Descriptive statistical analysis was carried out in the present study. The statistical software, namely, SPSS 15.0 was used for the analysis of the data. RESULTS: Of the 570 patients undergoing laparoscopic surgery, 17 (3%) had developed complications specifically related to the port site during a minimum follow-up of three months; port site infection (PSI) was the most frequent (n = 10, 1.8%), followed by port site bleeding (n = 4, 0.7%), omentum-related complications (n = 2; 0.35%), and port site metastasis (n = 1, 0.175%). CONCLUSIONS: Laparoscopic surgeries are associated with minimal port site complications. Complications are related to the increased number of ports. Umbilical port involvement is the commonest. Most complications are manageable with minimal morbidity, and can be further minimized with meticulous surgical technique during entry and exit. PMID:23741110
Evaluation of nursing manpower allocation in a nursing home.
Chen, Chun-Hsi; Tsai, Wen-Chen; Chang, Wei-Chieh
2007-03-01
The subjects of this study encompassed the nursing staffs (nurses and nursing aids) and residents of a public hospital-based nursing home. By intensive sampling, this study explored the differences in actual times that nurses spent caring for residents. We assessed the functional status of nursing home residents of various illness severities as well as measured the actual nursing manpower needed to meet the residents' care needs using Typology of the Aged with Illustration (TAI). Results showed that current nursing manpower levels in nursing homes was adequate, although some units had excessive manpower allocation. As a result, this study suggests the establishment of a resident classification system for use in long-term care (LTC) facilities to assist with manpower allocation and reasonable utilization of resources within the facility. Adequate nurse staffing will enhance the quality and accessibility of care for the residents with severe illnesses in LTC facilities.
Predictors of nursing home residents' time to hospitalization.
O'Malley, A James; Caudry, Daryl J; Grabowski, David C
2011-02-01
To model the predictors of the time to first acute hospitalization for nursing home residents, and accounting for previous hospitalizations, model the predictors of time between subsequent hospitalizations. Merged file from New York State for the period 1998-2004 consisting of nursing home information from the minimum dataset and hospitalization information from the Statewide Planning and Research Cooperative System. Accelerated failure time models were used to estimate the model parameters and predict survival times. The models were fit to observations from 50 percent of the nursing homes and validated on the remaining observations. Pressure ulcers and facility-level deficiencies were associated with a decreased time to first hospitalization, while the presence of advance directives and facility staffing was associated with an increased time. These predictors of the time to first hospitalization model had effects of similar magnitude in predicting the time between subsequent hospitalizations. This study provides novel evidence suggesting modifiable patient and nursing home characteristics are associated with the time to first hospitalization and time to subsequent hospitalizations for nursing home residents. © Health Research and Educational Trust.
Nursing home consumer complaints and quality of care: a national view.
Stevenson, David G
2006-06-01
This study uses 5 years of national data on investigated nursing home complaints (1998-2002) to evaluate whether complaints might be used to assess nursing home quality of care. On-Line Survey Certification and Reporting (OSCAR) data are used to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. The analyses are undertaken in the context of considerable cross-state variation in nursing home complaint processes and rates. Complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were significantly positively associated with survey deficiencies and the presence of serious survey deficiencies, and significantly negatively associated with nurse and nurse aide staffing. Complaints performance was significantly predictive of survey deficiencies at subsequent inspections. This study presents the first national evidence for using consumer complaints to assess nursing home quality of care. Despite limitations, nursing home complaints appear to offer a real-time signal of quality concerns.
Bae, Sung Uk; Jeong, Woon Kyung
2016-01-01
The concept of complete mesocolic excision and central vascular ligation for colonic cancer has been recently introduced. The paper describes a technique of right-sided complete mesocolic excision and intracorporeal anastomosis by using a single-port robotic approach with an additional conventional robotic port. We performed a single-port plus an additional port robotic surgery using the Da Vinci Single-Site platform via the Pfannenstiel incision and the wristed robotic instruments via an additional robotic port in the left lower quadrant. The total operative and docking times were 280 and 25 minutes, respectively. The total number of lymph nodes harvested was 36 and the proximal and distal resection margins were 31 and 50 cm, respectively. Single-port plus an additional port robotic surgery for right-sided complete mesocolic excision and intracorporeal anastomosis appears to be feasible and safe. This system can overcome certain limitations of the previous robotic systems and conventional single-port laparoscopic surgery. PMID:27757400
Bae, Sung Uk; Jeong, Woon Kyung; Baek, Seong Kyu
2016-10-01
The concept of complete mesocolic excision and central vascular ligation for colonic cancer has been recently introduced. The paper describes a technique of right-sided complete mesocolic excision and intracorporeal anastomosis by using a single-port robotic approach with an additional conventional robotic port. We performed a single-port plus an additional port robotic surgery using the Da Vinci Single-Site platform via the Pfannenstiel incision and the wristed robotic instruments via an additional robotic port in the left lower quadrant. The total operative and docking times were 280 and 25 minutes, respectively. The total number of lymph nodes harvested was 36 and the proximal and distal resection margins were 31 and 50 cm, respectively. Single-port plus an additional port robotic surgery for right-sided complete mesocolic excision and intracorporeal anastomosis appears to be feasible and safe. This system can overcome certain limitations of the previous robotic systems and conventional single-port laparoscopic surgery.
Impact of medical director certification on nursing home quality of care.
Rowland, Frederick N; Cowles, Mick; Dickstein, Craig; Katz, Paul R
2009-07-01
This study tests the research hypothesis that certified medical directors are able to use their training, education, and knowledge to positively influence quality of care in US nursing homes. F-tag numbers were identified within the State Operations Manual that reflect dimensions of quality thought to be impacted by the medical director. A weighting system was developed based on the "scope and severity" level at which the nursing homes were cited for these specific tag numbers. Then homes led by certified medical directors were compared with homes led by medical directors not known to be certified. DATA/PARTICIPANTS: Data were obtained from the Centers for Medicare & Medicaid Services' Online Survey Certification and Reporting database for nursing homes. Homes with a certified medical director (547) were identified from the database of the American Medical Directors Association. The national survey database was used to compute a "standardized quality score" (zero representing best possible score and 1.0 representing average score) for each home, and the homes with certified medical directors compared with the other homes in the database. Regression analysis was then used to attempt to identify the most important contributors to measured quality score differences between the homes. The standardized quality score of facilities with certified medical directors (n=547) was 0.8958 versus 1.0037 for facilities without certified medical directors (n=15,230) (lower number represents higher quality). When nursing facility characteristics were added to the regression equation, the presence of a certified medical director accounted for up to 15% improvement in quality. The presence of certified medical directors is an independent predictor of quality in US nursing homes.
Development, validation and testing of a nursing home to emergency room transfer checklist.
Tsai, Hsiu-Hsin; Tsai, Yun-Fang
2018-01-01
To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults
Mody, Lona; Greene, M Todd; Saint, Sanjay; Meddings, Jennifer; Trautner, Barbara W; Wald, Heidi L; Crnich, Christopher; Banaszak-Holl, Jane; McNamara, Sara E; King, Beth J; Hogikyan, Robert; Edson, Barbara S; Krein, Sarah L
2017-03-01
OBJECTIVE The impact of healthcare system integration on infection prevention programs is unknown. Using catheter-associated urinary tract infection (CAUTI) prevention as an example, we hypothesize that US Department of Veterans Affairs (VA) nursing homes have a more robust infection prevention infrastructure due to integration and centralization compared with non-VA nursing homes. SETTING VA and non-VA nursing homes participating in the AHRQ Safety Program for Long-Term Care collaborative. METHODS Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to CAUTI prevention via a needs assessment questionnaire. RESULTS A total of 353 of 494 nursing homes from 41 states (71%; 47 VA and 306 non-VA facilities) responded. VA nursing homes reported more hours per week devoted to infection prevention-related activities (31 vs 12 hours; P<.001) and were more likely to have committees that reviewed healthcare-associated infections. Compared with non-VA facilities, a higher percentage of VA nursing homes reported tracking CAUTI rates (94% vs 66%; P<.001), sharing CAUTI data with leadership (94% vs 70%; P=.014) and with nursing personnel (85% vs 56%, P=.003). However, fewer VA nursing homes reported having policies for appropriate catheter use (64% vs 81%; P=.004) and catheter insertion (83% vs 94%; P=.004). CONCLUSIONS Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems. Infect Control Hosp Epidemiol 2017;38:287-293.
1. AERIAL VIEW, NAVAL INACTIVE SHIPS MAINTENANCE FACILITY, SINCLAIR ISLET, ...
1. AERIAL VIEW, NAVAL INACTIVE SHIPS MAINTENANCE FACILITY, SINCLAIR ISLET, BREMERTON, KITSAP COUNTY, WASHINGTON WITH EX-USS HORNET CVS-12, THREE MINECRAFT ALONGSIDE TO PORT. OTHER INACTIVE SHIPS IN BACKGROUND. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA
A longitudinal analysis of nursing home outcomes.
Porell, F; Caro, F G; Silva, A; Monane, M
1998-10-01
To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data. Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes. The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes. The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures.
Port-Orford-Cedar Root Disease
Lewis F. Roth; Robert D. Jr. Harvey; John T. Kliejunas
1987-01-01
The most serious disease of Port-Orford-cedar (Chamaecyparis lawsoniana (A. Murr.) Parl.) is a root disease caused by the fungus Phytophthora lateralis. Nursery stock, ornamentals, and timber trees are subject to attack. Other species of Chamaecyparis are less susceptible than Port-Orford-cedar, and trees of other genera are not affected.
Cost-effectiveness implications based on a comparison of nursing home and home health case mix.
Kramer, A M; Shaughnessy, P W; Pettigrew, M L
1985-01-01
Case-mix differences between 653 home health care patients and 650 nursing home patients, and between 455 Medicare home health patients and 447 Medicare nursing home patients were assessed using random samples selected from 20 home health agencies and 46 nursing homes in 12 states in 1982 and 1983. Home health patients were younger, had shorter lengths of stay, and were less functionally disabled than nursing home patients. Traditional long-term care problems requiring personal care were more common among nursing home patients, whereas problems requiring skilled nursing services were more prevalent among home health patients. Considering Medicare patients only, nursing home patients were much more likely to be dependent in activities of daily living (ADLs) than home health patients. Medicare nursing home and home health patients were relatively similar in terms of long-term care problems, and differences in medical problems were less pronounced than between all nursing home and all home health patients. From the standpoint of cost-effectiveness, it would appear that home health care might provide a substitute for acute care hospital use at the end of a hospital stay, and appears to be a more viable option in the care of patients who are not severely disabled and do not have profound functional problems. The Medicare skilled nursing facility, however, is likely to continue to have a crucial role in posthospital care as the treatment modality of choice for individuals who require both highly skilled care and functional assistance. PMID:3932258
Survival on Home Dialysis in New Zealand
Marshall, Mark R.; Walker, Rachael C.; Polkinghorne, Kevan R.; Lynn, Kelvin L.
2014-01-01
Background New Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities. Methods We analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression. Results We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (<3 years) that is offset by a 33% greater mortality risk in the late period (>3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era. Conclusion Our study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase. PMID:24806458
Nursing home report card and performance gap.
Kim, Ae-Sook
2016-01-01
With the aging of our society, concerns about the quality of nursing homes have been increasing. The Nursing Home Compare (NHC) report card is believed to reduce information asymmetry between the facility and potential residents and, consequently, improve nursing home quality. However, there is limited evidence about how nursing homes use this publicly disseminated performance information. The aim of this study was to analyze the performance gap between nursing home administrators' self-assessment and the NHC report card performance ratings and explore the factors contributing to the gap. All 515 Medicare- and Medicaid-certified nursing homes in Indiana were surveyed between August and December 2013. The response rate was approximately 45%. The survey data were compared with the NHC data to identify the gap. Ordered logistic regression analysis was conducted. Despite voluntary participation, a reasonably high response rate, and anonymity, this study found that 62% of respondents either under- or overrated their facilities' performance, with the majority overrating their performance. The following factors were associated with a smaller performance gap: nonprofit or government-owned status, higher staffing levels, a higher percentage of hours worked by registered nurses, and a higher market concentration. Longer work experience and greater county occupancy rates were associated with a larger performance gap. The significant gap implies that administrators either do not regularly review the NHC report card or do not concur with the NHC ratings. To reduce the gap and thereby improve performance, it is necessary to stabilize the administrators' position so that administrators know how they stand in the market and are consequently better equipped to successfully respond to the market. Facilities may also need to provide regular training on current technologies and facilitate use of the NHC report card, targeting administrators who are old and have many years of work
Ports Primer: 7.0 Environmental Impacts
Port operations can lead to environmental impacts on air, water and land. Many communities with environmental justice concerns also experience disparities in health outcomes that they attribute to exposure to emissions from port operations.
Ports Primer: 7.1 Environmental Impacts
Port operations can lead to environmental impacts on air, water and land. Many communities with environmental justice concerns also experience disparities in health outcomes that they attribute to exposure to emissions from port operations.
Nursing practice environment and registered nurses' job satisfaction in nursing homes.
Choi, JiSun; Flynn, Linda; Aiken, Linda H
2012-08-01
Recruiting and retaining registered nurses (RNs) in nursing homes is problematic, and little research is available to guide efforts to make nursing homes a more attractive practice environment for RNs. The purpose of this study was to examine relationships between aspects of the nursing practice environment and job satisfaction among RNs in nursing homes. The sample included 863 RNs working as staff RNs in 282 skilled nursing facilities in New Jersey. Two-level hierarchical linear modeling was used to account for the RNs nested by nursing homes. Controlling for individual and nursing home characteristics, staff RNs' participation in facility affairs, supportive manager, and resource adequacy were positively associated with RNs' job satisfaction. Ownership status was significantly related to job satisfaction; RNs working in for-profit nursing homes were less satisfied. A supportive practice environment is significantly associated with higher job satisfaction among RNs working in nursing homes. Unlike other nursing home characteristics, specific dimensions of the nursing practice environment can be modified through administrative actions to enhance RN job satisfaction.
Who are the innovators? Nursing homes implementing culture change.
Grabowski, David C; Elliot, Amy; Leitzell, Brigitt; Cohen, Lauren W; Zimmerman, Sheryl
2014-02-01
A key directive of the Affordable Care Act of 2010 is to transform both institutional and community-based long-term care into a more person-centered system. In the nursing home industry, the culture change movement is central to this shift in philosophy. If policymakers are to further encourage implementation of culture change, they need to better understand the factors associated with implementation. Using logistic regression (N = 16,835), we examined the extent to which resident, facility, and state characteristics relate to a nursing home being identified by experts as having implemented culture change over the period 2004 through 2011. At baseline, the 291 facilities that were later identified by experts to have implemented culture change were more often nonprofit-owned, larger in size, and had fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. States experienced greater culture change implementation when they paid a higher Medicaid per diem. To date, nursing home culture change has been implemented differentially by higher resource facilities, and nursing homes have been responsive to state policy factors when implementing culture change.
Draft Environmental Justice Primer for Ports
This document is intended to help port decision-makers better understand the needs of near-port communities and how they can help address these needs and build productive community relationships during planning activities and operations.
Ports Primer: 3.3 Federal and International Governance
State and local governments are important players in port governance and in oversight of transportation projects that may affect ports. Private corporations may also play a role if they lease or own a terminal at a port.
An integrated port camera and display system for laparoscopy.
Terry, Benjamin S; Ruppert, Austin D; Steinhaus, Kristen R; Schoen, Jonathan A; Rentschler, Mark E
2010-05-01
In this paper, we built and tested the port camera, a novel, inexpensive, portable, and battery-powered laparoscopic tool that integrates the components of a vision system with a cannula port. This new device 1) minimizes the invasiveness of laparoscopic surgery by combining a camera port and tool port; 2) reduces the cost of laparoscopic vision systems by integrating an inexpensive CMOS sensor and LED light source; and 3) enhances laparoscopic surgical procedures by mechanically coupling the camera, tool port, and liquid crystal display (LCD) screen to provide an on-patient visual display. The port camera video system was compared to two laparoscopic video systems: a standard resolution unit from Karl Storz (model 22220130) and a high definition unit from Stryker (model 1188HD). Brightness, contrast, hue, colorfulness, and sharpness were compared. The port camera video is superior to the Storz scope and approximately equivalent to the Stryker scope. An ex vivo study was conducted to measure the operative performance of the port camera. The results suggest that simulated tissue identification and biopsy acquisition with the port camera is as efficient as with a traditional laparoscopic system. The port camera was successfully used by a laparoscopic surgeon for exploratory surgery and liver biopsy during a porcine surgery, demonstrating initial surgical feasibility.
Rotary sequencing valve with flexible port plate
Wagner, Glenn Paul
2005-05-10
Rotary sequencing valve comprising a rotor having a rotor face rotatable about an axis perpendicular to the rotor face, wherein the rotor face has a plurality of openings, one or more of which are disposed at a selected radial distance from the axis, and wherein the rotor includes at least one passage connecting at least one pair of the plurality of openings. The valve includes a flexible port plate having a first side and a second side, wherein the first side faces the rotor and engages the rotor such that the flexible port plate can be rotated coaxially by the rotor and can move axially with respect to the rotor, wherein the flexible port plate has a plurality of ports between the first and second sides, which ports are aligned with the openings in the rotor face. The valve also includes a stator having a stator face disposed coaxially with the rotor and the flexible port plate, wherein the second side of the flexible port plate is in sealable, slidable rotary contact with the stator face, wherein the stator face has a plurality of openings, some of which are disposed at the selected radial distance from the axis, and wherein the plurality of openings extend as passages through the stator. The valve may be used in pressure or temperature swing adsorption systems.
Carpenter, Angela; Lozano, Rodrigo; Sammalisto, Kaisu; Astner, Linda
2018-03-01
Ports are an important player in the world, due to their role in global production and distributions systems. They are major intermodal transport hubs, linking the sea to the land. For all ports, a key requirement for commercial and economic viability is to retain ships using them and to remain accessible to those ships. Ports need to find approaches to help them remain open. They must ensure their continued economic viability. At the same time, they face increasing pressure to become more environmentally and socially conscious. This paper examines the approach taken by the Port of Gävle, Sweden, which used contaminated dredged materials to create new land using principles of Circular Economy. The paper demonstrates that using Circular Economy principles can be a viable way of securing a port's future and contributing to its sustainability, and that of the city/region where it operates. Copyright © 2018 Elsevier Ltd. All rights reserved.
Queuing theory models used for port equipment sizing
NASA Astrophysics Data System (ADS)
Dragu, V.; Dinu, O.; Ruscă, A.; Burciu, Ş.; Roman, E. A.
2017-08-01
The significant growth of volumes and distances on road transportation led to the necessity of finding solutions to increase water transportation market share together with the handling and transfer technologies within its terminals. It is widely known that the biggest times are consumed within the transport terminals (loading/unloading/transfer) and so the necessity of constantly developing handling techniques and technologies in concordance with the goods flows size so that the total waiting time of ships within ports is reduced. Port development should be achieved by harmonizing the contradictory interests of port administration and users. Port administrators aim profit increase opposite to users that want savings by increasing consumers’ surplus. The difficulty consists in the fact that the transport demand - supply equilibrium must be realised at costs and goods quantities transiting the port in order to satisfy the interests of both parties involved. This paper presents a port equipment sizing model by using queueing theory so that the sum of costs for ships waiting operations and equipment usage would be minimum. Ship operation within the port is assimilated to a mass service waiting system in which parameters are later used to determine the main costs for ships and port equipment.
Outsourcing veterans for long-term care: comparison of community and state veterans' nursing homes.
Laberge, Alexandre; Weech-Maldonado, Robert; Johnson, Christopher E; Jia, Huanguang; Dewald, Lloyd
2008-01-01
This study compares the characteristics of state veterans' nursing homes and community nursing homes with VA per-diem residentes between 1999 - 2002. A structure, process, and outcome model was used to examine whether there was any difference in the multi-dimensional quality measures among the three types of community nursing homes (for profit, not-for-profit, and government) and state veterans' nursing homes. For profit community nursing homes were less likely to achieve nurse staffing standards while government facilities were more likely to achieve CNA staffing standards when compared to the state veterans' homes. All community nursing homes had a lower prevelance of tube feeds and catheterization when compared to state veterans' nursing homes. Only government community nursing homes had significantly lower quality of life deficiencies and pressure sore prevelance when compared to state veterans' nursing homes. Vigilant monitoring of all long-term care facilities utilized by veterans is needed.
Snowdon, John
2010-11-01
Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended. This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008-2009 were collected from three Sydney nursing homes. CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged. Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.
PROTOTYPE EICHER FISH SCREEN AND EVALUATION FACILITY, INSTALLED IN 1990 ...
PROTOTYPE EICHER FISH SCREEN AND EVALUATION FACILITY, INSTALLED IN 1990 ON #1 PENSTOCK. PROJECT SPONSORED BY THE ELECTRICAL POWER RESEARCH INSTITUTE TO TRANSFER FISH DOWNSTREAM PAST THE TURBINES. PHOTO BY JET LOWE, HAER, 1995. - Elwha River Hydroelectric System, Elwha Hydroelectric Dam & Plant, Port Angeles, Clallam County, WA
Research Animal Holding Facility Prevents Space Lab Contamination
NASA Technical Reports Server (NTRS)
Savage, P. D., Jr.; Jahns, G. C.; Dalton, B. P.; Hogan, R. P.; Wray, A. E.
1991-01-01
Healthy environment for both rodents and human researchers maintained. Research animal holding facility (RAHF) and rodent cage prevent solid particles (feces, food bits, hair), micro-organisms, ammonia, and odors from escaping into outside environment during spaceflight. Rodent cage contains compartments for two animals. Provides each drinking-water dispenser, feeding alcove, and activity-monitoring port. Feeding and waste trays removable.
Lee, H.J.; Haeussler, P.J.; Kayen, R.E.; Hampton, M.A.; Locat, Jacques; Suleimani, E.; Alexander, C.R.
2007-01-01
The M9.2 Alaska earthquake of 1964 caused major damage to the port facilities and town of Valdez, most of it the result of submarine landslide and the consequent tsunamis. Recent bathymetric multibeam surveys, high-resolution subbottom profiles, and dated sediment cores in Port Valdez supply new information about the morphology and character of the landslide deposits. A comparison of pre- and post-earthquake bathymetry provides an estimate of the net volume of landslide debris deposited in the basin and the volume of sediment removed from the source region. Landslide features include (1) large blocks (up to 40-m high) near the location of the greatest tsunamiwave runup (~50 m), (2) two debris lobes associated with the blocks, (3) a series of gullies, channels and talus, near the fjord-head delta and badly damaged old town of Valdez, and (4) the front of a debris lobe that flowed half-way down the fjord from the east end.
Debra D. Warren
1989-01-01
Volumes and average values of log exports by port have been compiled by quarter for 1987. The tables show the four Northwest customs districts by ports, species, and destinations. These data were received from the U.S. Department of Commerce too late to be published in the 1987 quarterly reports, "Production, Prices, Employment, and Trade in Northwest Forest...
FRED: an innovative approach to nursing home level-of-care assignments.
Morris, J N; Sherwood, S; May, M I; Bernstein, E
1987-04-01
A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED.
FRED: an innovative approach to nursing home level-of-care assignments.
Morris, J N; Sherwood, S; May, M I; Bernstein, E
1987-01-01
A clear need currently exists to consider new approaches for classifying nursing home residents. The traditional intermediate care facility/skilled nursing facility (ICF/SNF) dichotomy cannot provide adequate information on the type of care required by any one individual, and it provides only the most limited information required to address the care and quality-of-life needs of the total patient population within a facility, as well as the level of reimbursement appropriate for their care. This article describes an alternative procedure for allocating nursing home residents according to a more comprehensive array of internally homogeneous categories. This system is based on an operational perspective focused on the total nursing and staffing requirements for types of nursing home residents. The tool is titled "Functionally Ranked Explanatory Designations," or FRED. PMID:3570811
Port Security: A National Planning Guide
DOT National Transportation Integrated Search
1997-01-01
Port Security: A National Planning Guide has been produced for the purpose of conveying the United States Department of Transportations policy perspective on port security to the maritime community. This guide provides an overview of the essential as...
Occupational hazards to health of port workers.
Wang, Yukun; Zhan, Shuifen; Liu, Yan; Li, Yan
2017-12-01
The aim of this article is to reduce the risk of occupational hazards and improve safety conditions by enhancing hazard knowledge and identification as well as improving safety behavior for freight port enterprises. In the article, occupational hazards to health and their prevention measures of freight port enterprises have been summarized through a lot of occupational health evaluation work, experience and understanding. Workers of freight port enterprises confront an equally wide variety of chemical, physical and psychological hazards in production technology, production environment and the course of labor. Such health hazards have been identified, the risks evaluated, the dangers to health notified and effective prevention measures which should be put in place to ensure the health of the port workers summarized. There is still a long way to go for the freight port enterprises to prevent and control the occupational hazards. Except for occupational hazards and their prevention measures, other factors that influence the health of port workers should also be paid attention to, such as age, work history, gender, contraindication and even the occurrence and development rules of occupational hazards in current production conditions.
Peripheral Venous Access Ports: Outcomes Analysis in 109 Patients
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bodner, Leonard J.; Nosher, John L.; Patel, Kaushik M.
Purpose: To perform a retrospective outcomes analysis of central venous catheters with peripheral venous access ports, with comparison to published data.Methods: One hundred and twelve central venous catheters with peripherally placed access ports were placed under sonographic guidance in 109 patients over a 4-year period. Ports were placed for the administration of chemotherapy, hyperalimentation, long-term antibiotic therapy, gamma-globulin therapy, and frequent blood sampling. A vein in the upper arm was accessed in each case and the catheter was passed to the superior vena cava or right atrium. Povidone iodine skin preparation was used in the first 65 port insertions. Amore » combination of Iodophor solution and povidone iodine solution was used in the last 47 port insertions. Forty patients received low-dose (1 mg) warfarin sodium beginning the day after port insertion. Three patients received higher doses of warfarin sodium for preexistent venous thrombosis. Catheter performance and complications were assessed and compared with published data.Results: Access into the basilic or brachial veins was obtained in all cases. Ports remained functional for a total of 28,936 patient days. The port functioned in 50% of patients until completion of therapy, or the patient's expiration. Ports were removed prior to completion of therapy in 18% of patients. Eleven patients (9.9% of ports placed) suffered an infectious complication (0.38 per thousand catheter-days)-in nine, at the port implantation site, in two along the catheter. In all 11 instances the port was removed. Port pocket infection in the early postoperative period occurred in three patients (4.7%) receiving a Betadine prep vs two patients (4.2%) receiving a standard O.R. prep. This difference was not statistically significant (p = 0.9). Venous thrombosis occurred in three patients (6.8%) receiving warfarin sodium and in two patients (3%) not receiving warfarin sodium. This difference was not statistically
Nursing home financial performance: the role of ownership and chain affiliation.
Weech-Maldonado, Robert; Laberge, Alex; Pradhan, Rohit; Johnson, Christopher E; Yang, Zhou; Hyer, Kathryn
2012-01-01
The nursing home industry serves one of the most vulnerable populations, and its financial sustainability is a matter of public concern. However, limited empirical evidence exists on the impact of ownership and chain affiliation on nursing home financial performance. The aim of this study was to examine the joint effects of ownership and chain affiliation on the financial performance of the nursing home industry for the study period 1999-2004 on a national sample of 11,236 nursing homes per year. Data included the Medicare Cost Reports; the Online Survey, Certification, and Reporting file; and the Area Resource File. Dependent variables included operating and total margins. Independent variables included four ownership/chain affiliation combinations: for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent. Random effects generalized least square regressions were performed. Results show that for-profit nursing homes delivered better financial performance than not-for-profit facilities did across both operating and total margins. However, the relationship between chain affiliation and financial performance was more nuanced. In the case of operating margin, chain-affiliated facilities delivered superior financial performance irrespective of ownership type; however, in the case of total margin, independents outperformed chain-affiliated facilities among for-profits. Our findings show an interactive effect of ownership and chain affiliation on nursing home financial performance, suggesting the pursuit of different organizational strategies by different ownership/chain affiliation subgroups (for-profit chain, for-profit independent, not-for-profit chain, and not-for-profit independent), with implications for financial performance. For-profit independent nursing homes managed to be the top performing group in terms of overall financial despite the operating financial advantage of for-profit chain-affiliated nursing homes. Similarly
DOT National Transportation Integrated Search
2008-02-01
Planners concerned with deep-water port operations are interested in strategies that improve : regional truck flows associated with the container trade while also mitigating related problems of : highway congestion and air pollution. An inland port o...
2003-07-18
KENNEDY SPACE CENTER, FLA. - STS-115 Mission Specialist Heidemarie Stefanyshyn-Piper talks to workers in the Space Station Processing Facility. She and other crew members are at KSC for hardware familiarization. The mission will deliver the second port truss segment, the P3/P4 Truss, to attach to the first port truss segment, the P1 Truss, as well as deploy solar array sets 2A and 4A.. The crew is scheduled to activate and check out the Solar Alpha Rotary Joint (SARJ) and deploy the P4 Truss radiator.
DOT National Transportation Integrated Search
1997-11-06
Gretna and Governor Nicholls Light facilities are two manned shore side : facilities mounted in critical areas on the banks of the Mississippi River in : the port of New Orleans, Louisiana. Coast Guard plans call for the lights to : be remotely contr...
Research for Foreign Advanced Ports for Protection and Development Experience
NASA Astrophysics Data System (ADS)
Zhang, Lu; Tian, Mingjing; Zhao, Junjie; Shou, Youping; Wang, Ning; Qiao, Jianzhe; Li, Guanglou
2018-04-01
Into the twenty-first century, the process globalization of economic and trade is getting faster and faster, As of 2014, China's annual port trading amount topped the world, But in the port of environmental protection sustainable development approach with foreign advanced port environmental management concept has a big gap. Combined with the present situation of modern ports in China. Drawing lessons from foreign advanced environmental protection idea of port, in order to promote the protection of port environment in our country. The experience of protection and development of foreign advanced port environment will be discussed and discussed.
United States Port Development Expenditure Report
DOT National Transportation Integrated Search
2001-12-01
This report is the eleventh in a series of reports that continues the capital expenditure survey first begun by the Port Authority of New York and New Jersey in 1956. Subsequent reports were published by the American Association of Port Authorities (...
Jiao, W; Zhao, Y; Xuan, Y; Wang, M
2015-02-01
For thoracoscopic upper lobectomies, most cutting endostaplers must be inserted through the camera port when using a two-port approach. Access to the hilar vasculature through only the utility port remains a challenge. In this study, we describe a procedure to access the hilar vasculature without transferring the endostapler site during a thoracoscopic right upper lobectomy. A 2.5-cm utility anterior incision was made in the fourth intercostal space. The posterior mediastinal visceral pleura were dissected to expose the posterior portion of the right upper bronchus and the anterior trunk of the right pulmonary artery. The pleura over the right hilar vasculature were then peeled with an electrocoagulation hook. The anterior trunk of the right pulmonary artery was then transected with a cutting endostapler through the utility port firstly. This crucial maneuver allowed the endostapler access to the right upper lobe pulmonary vein. The hilar structures were then easily handled in turn. This novel technique was performed successfully in 32 patients, with no perioperative deaths. The average operation time was 120.6 min (range 75-180 min). This novel technique permits effective control of the hilar vessels through the utility port, enabling simple, safe, quick and effective resection.
United States Port Development Expenditure Report
DOT National Transportation Integrated Search
1997-10-01
This report is the seventh edition in a series of reports that continues the capital expenditure survey first begun by the Port Authority of New York and New Jersey in 1956. Subsequent reports were published by the American Association of Port Author...
United States Port Development Expenditure Report
DOT National Transportation Integrated Search
2000-12-01
This report is the tenth in a series of reports that continues the capital expenditure survey first begun by the Port Authority of New York and New Jersey in 1956. Subsequent reports were published by the American Association of Port Authorities (AAP...
Nursing home resident smoking policies.
Stefanacci, Richard G; Lester, Paula E; Kohen, Izchak
2008-01-01
To identify nursing home standards related to resident smoking through a nation wide survey of directors of nursing. A national survey was distributed online and was completed by 248 directors of nursing. The directors of nurses answered questions concerning resident smoking including the criteria utilized to determine an unsafe resident smoker. For those residents identified as unsafe, the questions asked were specifically related to monitoring, staff involvement, safety precautions and policy. The results of the survey demonstrated a consistent policy practiced among facilities across the United States. The monitoring of nursing home residents is based on a resident's mental acuity, physical restrictions and equipment requirements. Once a resident was identified as a smoker at risk of harm to self or others, staff involvement ranged from distributing cigarettes to direct supervision. In addition, the majority of facilities required residents to wear fire resistant aprons and provided a fire extinguisher in smoking areas. Monitoring policies of nursing home residents who smoke starts with identifying those residents at risk based on an assessment of mental acuity, physical restrictions and equipment requirements. Those that are identified as being at risk smokers have their cigarettes controlled and distributed by nursing staff and are supervised by facility staff when smoking. This policy is implemented through written policy as well as staff education. Despite some discrepancies in the actual implementation of policies to supervise residents who smoke, the policies for assessment for at-risk smokers requiring monitoring is consistent on a national basis.
Transanal endoscopic surgery using a single access port: a practical tool in the surgeon's toybox.
Gorgun, I E; Gorgun, I Emre; Aytac, Erman; Costedio, Meagan M; Erem, Hasan H; Valente, Michael A; Stocchi, Luca
2014-03-01
Large polyps and early carcinomas of the rectum may be excised with transanal endoscopic surgery (TES). Single-port techniques are emerging in the field of colorectal surgery and have been adapted to many colorectal procedures so far. In this article, we aimed to present our initial experience with TES using a single access port with its technical details. Patients undergoing TES using a single access port between July 2010 and January 2013 were included in the study. Patient demographics, operative technique, and both operative and postoperative outcomes were evaluated and presented. A total of 12 patients (ten males) were included in our study. The median age was 63.5 years (50-84), median American Society of Anesthesiologists (ASA) score was 3 (2-4), and median body mass index was 28.8 kg/m(2) (17.4-55.6). Median operating time was 79 min (43-261). Histopathological diagnoses were as follows: tubulovillous adenoma (n = 6), tubular adenoma (n = 4), adenocarcinoma (n = 1), and neuroendocrine tumor (n = 1). Five patients were sent home on the day of surgery and the median postoperative hospital stay was 1 day (0-38). Median estimated blood loss was 22.5 ml (5-150). A transient urinary retention was developed in one patient postoperatively, and two patients had postoperative bleeding. The first of these patients with a long history of anticoagulant usage had rectal bleeding 13 days after surgery, which was successfully managed with medical treatment. The second patient was morbidly obese, had multiple comorbidities, and had rectal bleeding on postoperative day 7 which was managed with local epinephrine injection. He suffered unrelated cardiac death on postoperative day 38. TES is safe and feasible when using a single port and in the standard laparoscopic setting. The single-port technique may play a major role in the widespread utilization of TES as a treatment for large adenomas and early rectal cancers.
Determinants of the use of specialist mental health services by nursing home residents.
Shea, D G; Streit, A; Smyer, M A
1994-01-01
OBJECTIVE. This study examines the effects of resident and facility characteristics on the probability of nursing home residents receiving treatment by mental health professionals. DATA SOURCES/STUDY SETTING. The study uses data from the Institutional Population Component of the 1987 National Medical Expenditure Survey, a secondary data source containing data on 3,350 nursing home residents living in 810 nursing homes as of January 1, 1987. STUDY DESIGN. Andersen's health services use model (1968) is used to estimate a multivariate logistic equation for the effects of independent variables on the probability that a resident has received services from mental health professionals. Important variables include resident race, sex, and age; presence of several behaviors and reported mental illnesses; and facility ownership, facility size, and facility certification. DATA COLLECTION/EXTRACTION METHODS. Data on 188 residents were excluded from the sample because information was missing on several important variables. For some additional variables residents who had missing information were coded as negative responses. This left 3,162 observations for analysis in the logistic regressions. PRINCIPAL FINDINGS. Older residents and residents with more ADL limitations are much less likely than other residents to have received treatment from a mental health professional. Residents with reported depression, schizophrenia, or psychoses, and residents who are agitated or hallucinating are more likely to have received treatment. Residents in government nursing homes, homes run by chains, and homes with low levels of certification are less likely to have received treatment. CONCLUSIONS. Few residents receive treatment from mental health professionals despite need. Older, physically disabled residents need special attention. Care in certain types of facilities requires further study. New regulations mandating treatment for mentally ill residents will demand increased attention from
Campbell, Marnie L; Hewitt, Chad L
2011-07-01
Biofouling of vessels is implicated as a high risk transfer mechanism of non-indigenous marine species (NIMS). Biofouling on international vessels is managed through stringent border control policies, however, domestic biofouling transfers are managed under different policies and legislative arrangements as they cross internal borders. As comprehensive guidelines are developed and increased compliance of international vessels with 'clean hull' expectations increase, vessel movements from port to port will become the focus of biosecurity management. A semi-quantitative port to port biofouling risk assessment is presented that evaluates the presence of known NIMS in the source port and determines the likelihood of transfer based on the NIMS association with biofouling and environmental match between source and receiving ports. This risk assessment method was used to assess the risk profile of a single dredge vessel during three anticipated voyages within Australia, resulting in negligible to low risk outcomes. This finding is contrasted with expectations in the literature, specifically those that suggest slow moving vessels pose a high to extreme risk of transferring NIMS species.
Wind Energy Facilities and Residential Properties: The Effect of Proximity and View on Sales Prices
DOE Office of Scientific and Technical Information (OSTI.GOV)
Hoen, Ben; Wiser, Ryan; Cappers, Peter
2010-04-01
With an increasing number of communities considering nearby wind power developments, there is a need to empirically investigate community concerns about wind project development. One such concern is that property values may be adversely affected by wind energy facilities, and relatively little research exists on the subject. The present research investigates roughly 7,500 sales of single-family homes surrounding 24 existing U.S. wind facilities. Across four different hedonic models the results are consistent: neither the view of the wind facilities nor the distance of the home to those facilities is found to have a statistically significant effect on home sales prices.
A longitudinal analysis of nursing home outcomes.
Porell, F; Caro, F G; Silva, A; Monane, M
1998-01-01
OBJECTIVE: To investigate resident and facility attributes associated with long-term care health outcomes in nursing homes. DATA SOURCES: Quarterly Management Minutes Questionnaire (MMQ) survey data for Medicaid case-mix reimbursement of nursing homes in Massachusetts from 1991 to 1994, for specification of outcomes and resident attributes. Facility attributes are specified from cost report data. STUDY DESIGN: Multivariate logistic and "state-dependence" regression models are estimated for survival, ADL functional status, incontinence status, and mental status outcomes from longitudinal residence histories of Medicaid residents spanning 3 to 36 months in length. Outcomes are specified to be a function of resident demographic and diagnostic attributes and facility-level operating and nurse staffing attributes. PRINCIPAL FINDINGS: The estimated parameters for resident demographic and diagnostic attributes showed a great deal of construct validity with respect to clinical expectations regarding risk factors for adverse outcomes. Few facility attributes were associated with outcomes generally, and none was significantly associated with all four outcomes. CONCLUSIONS: The absence of uniform associations between facility attributes and the various long-term care health outcomes studied suggests that strong facility performance on one health outcome may coexist with much weaker performance on other outcomes. This has implications for the aggregation of individual facility performance measures on multiple outcomes and the development of overall outcome performance measures. PMID:9776939
NASA Astrophysics Data System (ADS)
de Beer, F. C.; Radebe, M. J.; Schillinger, B.; Nshimirimana, R.; Ramushu, M. A.; Modise, T.
A common denominator of all neutron radiography (NRAD) facilities worldwide is that the perimeter of the experimental chamber of the facility is a radiation shielding structure which,in some cases, also includes flight tube and filter chamber structures. These chambers are normally both located on the beam port floor outside the biological shielding of the neutron source. The main function of the NRAD-shielding structure isto maintain a radiological safe working environment in the entire beam hall according to standards set by individual national radiological safety regulations. In addition, the shielding's integrity and capability should not allow, during NRAD operations, an increase in radiation levels in the beam port hall and thus negatively affectadjacent scientific facilities (e.g. neutron diffraction facilities).As a bonus, the shielding for the NRAD facility should also prevent radiation scattering towards the detector plane and doing so, thus increase thecapability of obtaining better quantitative results. This paper addresses Monte Carlo neutron-particletransport simulations to theoretically optimize the shielding capabilities of the biological barrierfor the SANRAD facility at the SAFARI-1 nuclear research reactor in South Africa. The experimental process to develop the shielding, based on the principles of the ANTARES facility, is described. After casting, the homogeneity distribution of these concrete mix materials is found to be near perfect and first order experimental radiation shielding characteristicsthrough film badge (TLD) exposure show acceptable values and trends in neutron- and gamma-ray attenuation.
Robotic right middle lobectomy with a subxiphoid utility port.
Jayakumar, Shruti; Nardini, Marco; Papoulidis, Pavlos; Dunning, Joel
2018-06-01
We present the case of a 74-year-old man with Stage IIa pulmonary adenocarcinoma, for which he underwent a robotic right middle lobectomy. A 4-armed, 5-port approach was used. Four intercostal ports were created above the ninth rib using the Cerfolio's technique. The subxiphoid port was created in the midline, 5 cm down from the xiphisternum. The robot offers higher image quality, depth perception and improved articulation of the instruments, allowing for more accurate dissection and stitching. The usage of a subxiphoid utility port reduces the clashing between instruments, offers a good angle for stapling and provides a direct view of the instruments entering into the chest. Specimen removal through the subxiphoid port may reduce postoperative pain and enhance patient recovery. The use of the subxiphoid approach as a utility port for robotic surgery is promising and may be a suitable replacement for the traditional utility port.
9 CFR 93.102 - Ports designated for the importation of birds.
Code of Federal Regulations, 2013 CFR
2013-01-01
... the importation of birds. (a) Special ports for pet birds. The following ports are designated as ports of entry for pet birds imported under the provisions of § 93.101(c) and performing or theatrical... § 93.105. (d) Limited ports. The following ports are designated as ports of entry for pet birds...
9 CFR 93.102 - Ports designated for the importation of birds.
Code of Federal Regulations, 2014 CFR
2014-01-01
... the importation of birds. (a) Special ports for pet birds. The following ports are designated as ports of entry for pet birds imported under the provisions of § 93.101(c) and performing or theatrical... § 93.105. (d) Limited ports. The following ports are designated as ports of entry for pet birds...
9 CFR 93.102 - Ports designated for the importation of birds.
Code of Federal Regulations, 2012 CFR
2012-01-01
... the importation of birds. (a) Special ports for pet birds. The following ports are designated as ports of entry for pet birds imported under the provisions of § 93.101(c) and performing or theatrical... § 93.105. (d) Limited ports. The following ports are designated as ports of entry for pet birds...
Ports Primer: 7.3 Federal Environmental Regulations, Initiatives and Standards
Near-port communities are often disproportionately impacted by air emissions due to port operations, goods movement operations and other industries that may be co-located with ports. Air emissions at ports also impact regional air quality.
Hazard report. Infants may fall through insecure ports on incubators.
2010-01-01
If the iris ports or access ports on infant incubators are not sufficiently secure, infants may work their way through the ports and fall. To reduce this risk, users should make sure that the ports are closed securely following each use. When possible, users should pass tubing through the incubator hood's grommets instead of through the larger and potentially less secure iris ports.
Regulation and Mindful Resident Care in Nursing Homes
Colón-Emeric, Cathleen S.; Plowman, Donde; Bailey, Donald; Corazzini, Kirsten; Utley-Smith, Queen; Ammarell, Natalie; Toles, Mark; Anderson, Ruth
2009-01-01
Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple case study including field notes, interviews, and documents collected in 8 nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities. PMID:20479137
Design of the smart home system based on the optimal routing algorithm and ZigBee network.
Jiang, Dengying; Yu, Ling; Wang, Fei; Xie, Xiaoxia; Yu, Yongsheng
2017-01-01
To improve the traditional smart home system, its electric wiring, networking technology, information transmission and facility control are studied. In this paper, we study the electric wiring, networking technology, information transmission and facility control to improve the traditional smart home system. First, ZigBee is used to replace the traditional electric wiring. Second, a network is built to connect lots of wireless sensors and facilities, thanks to the capability of ZigBee self-organized network and Genetic Algorithm-Particle Swarm Optimization Algorithm (GA-PSOA) to search for the optimal route. Finally, when the smart home system is connected to the internet based on the remote server technology, home environment and facilities could be remote real-time controlled. The experiments show that the GA-PSOA reduce the system delay and decrease the energy consumption of the wireless system.
Design of the smart home system based on the optimal routing algorithm and ZigBee network
Xie, Xiaoxia
2017-01-01
To improve the traditional smart home system, its electric wiring, networking technology, information transmission and facility control are studied. In this paper, we study the electric wiring, networking technology, information transmission and facility control to improve the traditional smart home system. First, ZigBee is used to replace the traditional electric wiring. Second, a network is built to connect lots of wireless sensors and facilities, thanks to the capability of ZigBee self-organized network and Genetic Algorithm-Particle Swarm Optimization Algorithm (GA-PSOA) to search for the optimal route. Finally, when the smart home system is connected to the internet based on the remote server technology, home environment and facilities could be remote real-time controlled. The experiments show that the GA-PSOA reduce the system delay and decrease the energy consumption of the wireless system. PMID:29131868
Code JEF Facilities Engineering Home Page for the Internet
NASA Technical Reports Server (NTRS)
Mahaffey, Valerie A.; Harrison, Marla J. (Technical Monitor)
1995-01-01
There are always many activities going on in JEF. We work on and manage the Construction of Facilities (C of F) projects at NASA-Ames. We are constantly designing or analyzing a new facility or project, or a modification to an existing facility. Every day we answer numerous questions about engineering policy, codes and standards, we attend design reviews, we count dollars and we make sure that everything at the Center is designed and built according to good engineering judgment. In addition, we study literature and attend conferences to make sure that we keep current on new legislation and standards.
The VisPort Project: Visualization of Port Logistics
ERIC Educational Resources Information Center
Katsioloudis, Petros J.; Watson, Ginger
2011-01-01
There is concern about the diminishing availability of skilled personnel that can operate in the wide variety of disciplines associated with port operations. Increasing cargo volume, combined with a shrinking workforce, could potentially create alarming situations in the future, hence the motivation to publicize to current students the breadth and…
[Periinterventional prophylactic antibiotics in radiological port catheter implantation].
Gebauer, B; Teichgräber, U; Werk, M; Wagner, H-J
2007-08-01
To evaluate whether catheter-related infections after radiologically placed port catheters can be reduced by single-shot periinterventional antibiosis. Between January and September 2002, 164 consecutive patients with indication for central venous port catheter implantation were included in the present study. During implantation the interventional radiologist was responsible for deciding whether to administer a prophylactic single-shot antibiosis. The prophylactic antibiosis entailed intravenous administration of ampicillin and sulbactam (3 g Unacid, Pfizer) or 100 mg ciprofloxacine (Ciprobay, Bayer) in the case of an allergy history to penicillins. Catheter-related infection was defined as a local or systemic infection necessitating port catheter extraction. Indication for port catheter implantation was a malignant disease requiring chemotherapy in 158 cases. The port catheter (Chemosite [Tyco Healthcare] [n = 123], low-profile [Arrow International] [n = 35], other port system [n = 6]) was implanted via sonographically guided puncture of the right jugular vein in 139 patients, via the left jugular vein in 24 cases and via the right subclavian vein in one patient. 75 patients received periinterventional prophylactic antibiosis (Unacid [n = 63] Ciprobay [n = 12]) and 89 patients did not receive antibiosis. The prophylactic antibiosis caused a minor allergic reaction in one patient that improved with antihistamic and corticoid medication. A total of 7 ports, 6 without prophylactic antibiosis versus one with periinterventional prophylaxis, were extracted due to infectious complications. Single-shot periinterventional prophylactic antibiosis can reduce early and late infectious complications after radiological-interventional placement of central venous port catheters.
The home hemodialysis hub: physical infrastructure and integrated governance structure.
Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M
2015-04-01
An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis.
Nursing home consumer complaints and their potential role in assessing quality of care.
Stevenson, David G
2005-02-01
State survey agencies collect and investigate consumer complaints for care in nursing homes and other health care settings. Complaint investigations play a key role in quality assurance, because they can respond to concerns of consumers and families. This study uses 5 years of nursing home complaints data from Massachusetts (1998-2002) to investigate whether complaints might be used to assess nursing home quality of care. The investigator matches facility-level complaints data with On-Line Survey Certification and Reporting (OSCAR) data and Minimum Data Set Quality Indicator (MDS QI) data to evaluate the association between consumer complaints, facility and resident characteristics, and other nursing home quality measures. Consumer complaints varied across facility characteristics in ways consistent with the nursing home quality literature. Complaints were consistently and significantly associated with survey deficiencies, the presence of a serious survey deficiency, and nurse aide staffing. Complaints were not significantly associated with nurse staffing, and associations with 6 MDS QIs were mixed. The number of complaints was significantly predictive of survey deficiencies identified at the subsequent inspection. Nursing home consumer complaints provide a supplemental tool with which to differentiate nursing homes on quality. Despite limitations, complaints data have potential strengths when used in combination with other quality measures. The potential of using consumer complaints to assess nursing home quality of care should be evaluated in states beyond Massachusetts. Evaluating consumer complaints also might be a productive area of inquiry for other health care settings such as hospitals and home health agencies.
Conceptualization and design of a variable-gravity research facility
NASA Technical Reports Server (NTRS)
1987-01-01
The goal is to provide facilities for the study of the effects of variable-gravity levels in reducing the physiological stresses upon the humans of long-term stay time in zero-g. The designs studied include: twin-tethered two module system with a central despun module with docking port and winch gear; and rigid arm tube facility using shuttle external tanks. Topics examined included: despun central capsule configuration, docking clearances, EVA requirements, crew selection, crew scheduling, food supply and preparation, waste handling, leisure use, biomedical issues, and psycho-social issues.
Sharma, Dinesh C
2006-04-01
In many parts of the world, shipping-related emissions have already exceeded or are expected to soon exceed those from land-based sources. Shipping emissions can be reduced substantially by using some of the same technologies being applied to land-based sources, including cleaner engines and fuels, exhaust control methods, and operational modifications. Various ports are testing the feasibility of these mechanisms with varying degrees of success. What is perhaps most greatly needed is expedited creation of better regulations at all levels, from the International Maritime Organization to port city authorities.
4. View of houses from Port Ludlow, houses no. 69 ...
4. View of houses from Port Ludlow, houses no. 69 and 70, facing southwest. House no. 69 in foreground, house no. 70 in background. - Houses Moved from Port Ludlow, Various Addresses (moved from Port Ludlow, WA), Port Gamble, Kitsap County, WA
Xu, Wu; Wang, Yang; Song, Jianping; Mo, Lanying; Jiang, Tao
2017-01-01
To further understand the effects of video-assisted thoracic surgery (VATS) with one-port versus three-port VATS for primary spontaneous pneumothorax (PSP). In this study, we searched information from the PubMed, Cochrane Library, Embase, ScienceDirect, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Data databases from inception to September 2015 to collect data of randomized controlled trials (RCTs) and cohort studies about one-port VATS versus three-port VATS for PSP. Two independent authors were committed to screen literature, extract data, and assess the risk of bias of related studies. Then, we used the RevMan 5.20 software for a meta-analysis of one-port VATS versus three-port VATS for PSP. Six cohort studies involving 310 patients were finally selected in this meta-analysis. The results of our study indicate that one-port VATS had a shorter hospital stay (SMD = -0.39, 95 % CI -0.69 to 0.09, P = 0.01), lower VAS score of 24-h post-operative pain (SMD = -0.78, 95 % CI -1.40 to -0.52, P < 0.00001), shorter chest drainage time (SMD = -0.68, 95 % CI -1.15 to -0.22, P = 0.004), and lower incidence of post-operative paraesthesia (OR = 0.13, 95 % CI 0.06 to 0.29, P < 0.00001) compared with three-port VATS. However, one-port VATS had a lower patient satisfaction score at 24 h (SMD = -0.65, 95 % CI -0.95 to -0.35, P < 0.0001) and 48 h (SMD = -0.46, 95 % CI -0.71 to -0.21, P = 0.0002). No differences in the recurrence of pneumothorax (OR = 0.58, 95 % CI 0.20 to 1.67, P = 0.32), the operation time (SMD = 1.01, 95 % CI -4.63 to 2.60, P = 0.58), and the satisfaction score at 72 h (SMD = -0.11, 95 % CI -0.44 to 0.22, P < 0.00001) were noted between the groups. Current evidence suggests that one-port VATS may have certain advantages over three-port VATS for PSP. More large-scale and high-quality studies are needed for authentication.
Code of Federal Regulations, 2011 CFR
2011-07-01
..., Morgan City-Port Allen Route from Mile Marker 0 to Port Allen Lock. 165.T08-0432 Section 165.T08-0432... Limited Access Areas Eighth Coast Guard District § 165.T08-0432 Safety Zone; Waterway Closure, Morgan City... Water Way on the Morgan City—Port Allen route from MM 0 to the Port Allen lock. (b) Effective date. This...
Person-environment interactions contributing to nursing home resident falls.
Hill, Elizabeth E; Nguyen, Tam H; Shaha, Maya; Wenzel, Jennifer A; DeForge, Bruce R; Spellbring, Ann Marie
2009-10-01
Although approximately 50% of nursing home residents fall annually, the surrounding circumstances remain inadequately understood. This study explored nursing staff perspectives of person, environment, and interactive circumstances surrounding nursing home falls. Focus groups were conducted at two nursing homes in the mid-Atlantic region with the highest and lowest fall rates among corporate facilities. Two focus groups were conducted per facility: one with licensed nurses and one with geriatric nursing assistants. Thematic and content analysis revealed three themes and 11 categories. Three categories under the Person theme were Change in Residents' Health Status, Decline in Residents' Abilities, and Residents' Behaviors and Personality Characteristics. There were five Nursing Home Environment categories: Design Safety, Limited Space, Obstacles, Equipment Misuse and Malfunction, and Staff and Organization of Care. Three Interactions Leading to Falls categories were identified: Reasons for Falls, Time of Falls, and High-Risk Activities. Findings highlight interactions between person and environment factors as significant contributors to resident falls. Copyright 2009, SLACK Incorporated.
Hoss, Daniel R; Bedros, Antranik A; Mesipam, Avinash; Criddle, Jared; Smith, Jason C
2017-03-01
To determine if severe neutropenia at the time of chest port insertion is a risk factor for port removal and central catheter-associated bloodstream infection (CCABSI) in pediatric patients. From May 2007 to June 2015, 183 consecutive patients (mean age, 9.9 y; range, 0.75-21 y) had a port inserted at a single tertiary pediatric center. Seventy-two had severe neutropenia at the time of port insertion (absolute neutrophil count [ANC] range, 0-500/mm 3 ; mean, 185/mm 3 ). Follow-up until port removal or death and CCABSI events were recorded. Within the first 30 days, similar incidences of CCABSI (12.5% of patients with severe neutropenia [n = 9] vs 4.5% of patients without [n = 5]), port removal for infection (2.8% [n = 2] vs 2.7% [n = 3]), and local port infection (2.8% [n = 2] vs 0.9% [n = 1]) were observed in both groups (P > .05), but the rate of CCABSI per 1,000 catheter-days was higher for patients with severe neutropenia (P = .045). Overall, similar incidences of CCABSI (18.1% [n = 13] vs 16.2% [n = 18]), port removal for infection (2.8% [n = 2] vs 7.2% [n = 8]), local port infection (2.8% [n = 2] vs 2.7% [n = 3]), and CCABSIs per 1,000 catheter-days (0.332 vs 0.400) were observed in both groups (P > .05). Port placement in patients with severe neutropenia can be performed without an increased incidence of port removal for infection. The majority of CCABSIs were successfully treated without port removal. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.
Research-based resources on PhysPort
NASA Astrophysics Data System (ADS)
Sayre, Eleanor
2017-01-01
PhysPort (http://physport.org) is a website that supports physics faculty in implementing research-based teaching practices in their classrooms. We provide expert recommendations and practical information about teaching methods and assessment. The PhysPort Data Explorer is an intuitive online tool for physics faculty to analyze their assessment data. Faculty upload their students' responses using our secure interface. The Data Explorer matches their pre/post data, scores it, compares it to national data, and graphs it in an interactive and intuitive manner. The Periscope collection on Physport brings together classroom video of students working groups with professional development materials for faculty, pre-service teachers, and learning assistants. To support PhysPort's development efforts, we conduct research on faculty needs around teaching and assessment, secondary analysis of published PER studies, and primary analysis of assessment data. In this talk, I'll introduce some of PhysPort's research-based resources and the research results which support them.
Avery, Chris; Humphrey, Charles; Balany, Jo Anne
2014-11-01
Health inspections are performed at nursing homes to identify and reduce risk and to help maintain a safe environment for nursing home residents. The study described in this article aimed to identify the most frequent violations, types of violations (hygiene or structural), and repeat violations in nursing home facilities during health inspections; and to determine if the age of the facility influenced inspection scores. Nursing home health inspection forms (N = 131) completed between 2005 and 2011 in Pitt County, North Carolina, were analyzed. Results indicated that 60% of all violations were hygiene-related and could possibly be corrected without significant financial investments by management. Significant correlations occurred between the total number of violations and the facility age (p = .003) and between the number of repeat violations and total violations (p < .001). The average inspection score for nursing homes could be increased by more than three points if sanitation practices were improved.
Is single port enough in minimally surgery for pneumothorax?
Ocakcioglu, Ilhan; Alpay, Levent; Demir, Mine; Kiral, Hakan; Akyil, Mustafa; Dogruyol, Talha; Tezel, Cagatay; Baysungur, Volkan; Yalcinkaya, Irfan
2016-01-01
Video-assisted thoracoscopic surgery is a widespread used procedure for treatment of primary spontaneous pneumothorax patients. In this study, the adaptation of single-port video-assisted thoracoscopic surgery approach to primary spontaneous pneumothorax patients necessitating surgical treatment, with its pros and cons over the traditional two- or three-port approaches are examined. Between January 2011 and August 2013, 146 primary spontaneous pneumothorax patients suitable for surgical treatment are evaluated prospectively. Indications for surgery included prolonged air leak, recurrent pneumothorax, or abnormal findings on radiological examinations. Visual analog scale and patient satisfaction scale score were utilized. Forty triple-port, 69 double-port, and 37 single-port operations were performed. Mean age of 146 (126 male, 20 female) patients was 27.1 ± 16.4 (range 15-42). Mean operation duration was 63.59 ± 26 min; 61.7 for single, 64.2 for double, and 63.8 min for triple-port approaches. Total drainage was lower in the single-port group than the multi-port groups (P = 0.001). No conversion to open thoracotomy or 30-day hospital mortality was seen in our group. No recurrence was seen in single-port group on follow-up period. Visual analog scale scores on postoperative 24th, 48th, and 72nd hours were 3.42 ± 0.94, 2.46 ± 0.81, 1.96 ± 0.59 in the single-port group; significantly lower than the other groups (P = 0.011, P = 0.014, and P = 0.042, respectively). Patient satisfaction scale scores of patients in the single-port group on 24th and 48th hours were 1.90 ± 0.71 and 2.36 ± 0.62, respectively, indicating a significantly better score than the other two groups (P = 0.038 and P = 0.046). This study confirms the competency of single-port procedure in first-line surgical treatment of primary spontaneous pneumothorax.
Physical Oceanographic Real-Time System (PORTS) (Invited)
NASA Astrophysics Data System (ADS)
Wright, D.
2013-12-01
The 1999 Assessment of U.S. Marine Transportation System report to Congress noted that the greatest safety concern voiced by the maritime community was the availability of timely, accurate, and reliable navigation information, including real time environment data. Real time oceanographic and meteorological data, along with other navigation tools, gives the mariner a good situational understanding of their often challenging operational environment, to make the best safety of life and property decisions. The National Oceanic and Atmospheric Administration's (NOAA) Physical Oceanographic Real Time System (PORTS) was developed in response to accidents like the Sunshine Skyway Bridge collision in Tampa, FL in 1980, where the lack of accurate, reliable and timely environmental conditions directly contributed to an accident that resulted in a high loss of life and property. Since that time, PORTS has expanded to over 20 locations around the country, and its capabilities have been continually expanded and improved as well. PORTS primary mission is to prevent maritime accidents. Preventing an accident from occurring is the most cost effective approach and the best way to avoid damage to the environment. When accidents do occur, PORTS data is used to improve the effectiveness of response efforts by providing input for trajectory models and real time conditions for response efforts. However, benefits derived from PORTS go well beyond navigation safety. Another large benefit to the local maritime community is potential efficiencies in optimizing use of the existing water column. PORTS provides information that can be used to make economic decisions to add or offload cargo to a vessel and/or to maintain or adjust transit schedules based upon availability of water depth, strength/timing of tidal currents, and other conditions. PORTS data also helps improve and validate local National Weather Service marine weather forecasts. There are many benefits beyond the local maritime
Kim, Yong-Wook; Park, Byung-Joon; Ro, Duck-Yeong; Kim, Tae-Eung
2010-01-01
To evaluate the feasibility of single-port laparoscopic myomectomy with transumbilical morcellation and suturing. Continuing prospective study (Canadian Task Force classification II-3). University hospital. Fifteen patients who underwent single-port laparoscopic myomectomy between September 2008 and October 2009 to remove single or multiple uterine myomas, at least 1 in each patient measuring greater than 4 cm in diameter. All single-port laparoscopic myomectomy procedures were performed by a single surgeon (Dr. Y.W. Kim). Myomas were extracted transumbilically by cutting the myomas into smaller pieces with a knife or a conventional electromechanical morcellator. After making a single 1.5- to 2.0-cm umbilical incision, the single-port system, created with a wound retractor and a surgical glove, was inserted. All operations were performed using conventional rigid straight laparoscopic instruments. Laparoscopic suturing was performed in intramural myomas and some subserosal myomas. Patient mean (SD; range) age was 38.3 (5.6; 29-49) years. The number of myomas per patient was 1.6 (1.4; 1-6). The diameter of the largest myomas was 6.1 (1.5; 4.2-9.6) cm. In 4 patients, only a knife was required for transumbilical extraction of myomas, and in 11 patients, transumbilical morcellation with an electromechanical morcellator with or without a knife was used. Transumbilical drainage tubes were inserted into the pelvic cavity in 11 of 15 patients. Operative time was 96.7 (33.8; 35-150) minutes. The decrease in postoperative hemoglobin concentration was 1.8 (1.2; 0.4-3.6) g/dL. During the operations, no patients required blood transfusion. No patients developed postoperative fever. Neither bowel injury nor urinary tract injury occurred in any patient. The postoperative hospital stay was 3.1 (0.8; 2-4) days. Single-port transumbilical morcellation using a conventional electromechanical morcellator with or without a knife is feasible. Single-port laparoscopic myomectomy is an
Constraining Medicare Home Health Reimbursement: What Are the Outcomes?
McCall, Nelda; Korb, Jodi; Petersons, Andrew; Moore, Stanley
2002-01-01
The implementation of the Balanced Budget Act (BBA) of 1997 resulted in substantial decreases in the amount of Medicare home health use. Use among home health users decreased by two-fifths from fiscal year (FY) 1997, just before the passage of the BBA to FY 1999, the first full year after the implementation of the home health interim payment system. This article examines whether these dramatic reductions in use resulted in increased incidence of potential adverse outcomes, i.e., increases in hospitalizations, skilled nursing home facility admissions, emergency room (ER) use, or death among home health users. PMID:12690695
Intracorporeal hybrid single port vs conventional laparoscopic appendectomy in children.
Karam, Paul Anthony; Hiuser, Amy; Magnuson, David; Seifarth, Federico Gian Filippo
2016-12-20
Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK® hem-o-lock® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes) but did not differ significantly (P=0.19). This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.
Labhardt, Niklaus D; Ringera, Isaac; Lejone, Thabo I; Klimkait, Thomas; Muhairwe, Josephine; Amstutz, Alain; Glass, Tracy R
2018-03-20
Home-based HIV testing is a frequently used strategy to increase awareness of HIV status in sub-Saharan Africa. However, with referral to health facilities, less than half of those who test HIV positive link to care and initiate antiretroviral therapy (ART). To determine whether offering same-day home-based ART to patients with HIV improves linkage to care and viral suppression in a rural, high-prevalence setting in sub-Saharan Africa. Open-label, 2-group, randomized clinical trial (February 22, 2016-September 17, 2017), involving 6 health care facilities in northern Lesotho. During home-based HIV testing in 6655 households from 60 rural villages and 17 urban areas, 278 individuals aged 18 years or older who tested HIV positive and were ART naive from 268 households consented and enrolled. Individuals from the same household were randomized into the same group. Participants were randomly assigned to be offered same-day home-based ART initiation (n = 138) and subsequent follow-up intervals of 1.5, 3, 6, 9, and 12 months after treatment initiation at the health facility or to receive usual care (n = 140) with referral to the nearest health facility for preparatory counseling followed by ART initiation and monthly follow-up visits thereafter. Primary end points were rates of linkage to care within 3 months (presenting at the health facility within 90 days after the home visit) and viral suppression at 12 months, defined as a viral load of less than 100 copies/mL from 11 through 14 months after enrollment. Among 278 randomized individuals (median age, 39 years [interquartile range, 28.0-52.0]; 180 women [65.7%]), 274 (98.6%) were included in the analysis (137 in the same-day group and 137 in the usual care group). In the same-day group, 134 (97.8%) indicated readiness to start ART that day and 2 (1.5%) within the next few days and were given a 1-month supply of ART. At 3 months, 68.6% (94) in same-day group vs 43.1% (59) in usual care group had linked to care
Nurses take center stage in private duty home care.
Brackett, Nicole
2013-06-01
The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care.
Porting of EPICS to Real Time UNIX, and Usage Ported EPICS for FEL Automation
NASA Astrophysics Data System (ADS)
Salikova, Tatiana
This article describes concepts and mechanisms used in porting of EPICS (Experimental Physical and Industrial Control System) codes to platform of operating system UNIX. Without destruction of EPICS architecture, new features of EPICS provides the support for real time operating system LynxOS/x86 and equipment produced by INP (Budker Institute of Nuclear Physics). Application of ported EPICS reduces the cost of software and hardware is used for automation of FEL (Free Electron Laser) complex.
4. View of Port Gamble residential district, facing northwest across ...
4. View of Port Gamble residential district, facing northwest across Rainier Avenue. Thompson House in foreground, house no. 17A in right background. - Port Gamble National Historic Landmark, Bounded by Hood Canal, Port Gamble Bay, State Road 104, & Town Limits, Port Gamble, Kitsap County, WA
Central Vein Dilatation Prior to Concomitant Port Implantation
DOE Office of Scientific and Technical Information (OSTI.GOV)
Krombach, Gabriele A., E-mail: krombach@rad.rwth-aachen.de; Plumhans, Cedric; Goerg, Fabian
2010-04-15
Implantation of subcutaneous port systems is routinely performed in patients requiring repeated long-term infusion therapy. Ultrasound- and fluoroscopy-guided implantation under local anesthesia is broadly established in interventional radiology and has decreased the rate of complications compared to the surgical approach. In addition, interventional radiology offers the unique possibility of simultaneous management of venous occlusion. We present a technique for recanalization of central venous occlusion and angioplasty combined with port placement in a single intervention which we performed in two patients. Surgical port placement was impossible owing to occlusion of the superior vena cava following placement of a cardiac pacemaker andmore » occlusion of multiple central veins due to paraneoplastic coagulopathy, respectively. In both cases the affected vessel segments were dilated with balloon catheters and the port systems were placed thereafter. After successful dilatation, the venous access was secured with a 25-cm-long, 8-Fr introducer sheath, a subcutaneous pocket prepared, and the port catheter tunneled to the venipuncture site. The port catheter was introduced through the sheath with the proximal end connected to a 5-Fr catheter. This catheter was pulled through the tunnel in order to preserve the tunnel and, at the same time, allow safe removal of the long sheath over the wire. The port system functioned well in both cases. The combination of recanalization and port placement in a single intervention is a straightforward alternative for patients with central venous occlusion that can only be offered by interventional radiology.« less
Architectural style and green spaces predict older adults' evaluations of residential facilities.
Cerina, Veronica; Fornara, Ferdinando; Manca, Sara
2017-09-01
The purpose of this study was to analyse the effects of residential facilities' design features on older adults' psychosocial responses. Participants ( N = 192) were over 65-year-old residents who were randomly exposed to different experimental scenarios concerning a hypothetical residential facility for older adults, using a 3 × 2 between-subjects design (i.e. home-like vs. hotel-like vs. usual-standard architectural style; presence vs. absence of green spaces). After the experimental session, participants were asked to fill in a questionnaire that measured their attitudes towards short- and long-term relocation, anticipated residential satisfaction with the facility, and feelings of broken home attachment. The results showed (1) more positive responses to "home-like" and "hotel-like" architectural styles than the usual-standard type and (2) the positive impact of green spaces on the assessment of the facilities. These design features should thus play a role in both reducing the stressful impact of leaving home and promoting beneficial patterns, hence fostering "successful ageing".
42 CFR 431.105 - Consultation to medical facilities.
Code of Federal Regulations, 2010 CFR
2010-10-01
... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... 42 Public Health 4 2010-10-01 2010-10-01 false Consultation to medical facilities. 431.105 Section 431.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...
The Impact of Special Focus Facility Nursing Homes on Market Quality
ERIC Educational Resources Information Center
Castle, Nicholas G.; Sonon, Kristen; Antonova, Jenya
2010-01-01
Purpose: Special Focus Facilities (SFFs) are nursing facilities designated by the Centers for Medicare & Medicaid Services to be of chronic poor quality. Relatively few nursing facilities are included in this initiative. The purpose of this research was to examine whether nursing facilities included in the 2007 SFF initiative subsequently…
50 CFR 300.188 - Ports of entry.
Code of Federal Regulations, 2010 CFR
2010-10-01
... International Trade Documentation and Tracking Programs for Highly Migratory Species § 300.188 Ports of entry... United States. If NMFS determines that the diversity of handling practices at certain ports at which fish...
50 CFR 300.188 - Ports of entry.
Code of Federal Regulations, 2011 CFR
2011-10-01
... International Trade Documentation and Tracking Programs for Highly Migratory Species § 300.188 Ports of entry... United States. If NMFS determines that the diversity of handling practices at certain ports at which fish...
Evaluation of correlations between underlying disease and port complications.
Teichgräber, U; Nagel, S N; Kausche, S
2014-05-01
Evaluation of correlations between underlying disease and port complications. Retrospective analysis of a data set of 3160 port systems, which had been interventionally implanted over a period of 10 years. Of these, 1393 were included in the final evaluation. The 7 most common underlying diseases and port-induced complications were considered. Port-related thrombotic events, port pocket infections as well as the port-induced sepsis were evaluated and classified as either early or late complications. In 1393 ports, 131 experienced complications. Of these, 22.1 % (n = 29) were early and 79.6 % (n = 102) late complications. The overall incidence rate of late complications was 0.253/1000 observed days. It differed significantly between the underlying diseases (p < 0.001) and was significantly lower in colon carcinoma when compared with pancreatic (p = 0.049), gastric (p = 0.012) and bronchial carcinoma (p = 0.042). The incidence rate of the port sepsis between the underlying diseases also differed significantly (p = 0.006) and had the highest rate in gastric and bronchial carcinoma. The occurrence of a thrombotic event also showed a significant difference in the incidence rates between the underlying diseases (p = 0.045) and was highest in pancreatic and gastric carcinoma. There are significant differences in the incidences of complications between the underlying diseases. Knowledge about this can help to improve the port-care and to take specific preventive measures. © Georg Thieme Verlag KG Stuttgart · New York.
Simulation model for port shunting yards
NASA Astrophysics Data System (ADS)
Rusca, A.; Popa, M.; Rosca, E.; Rosca, M.; Dragu, V.; Rusca, F.
2016-08-01
Sea ports are important nodes in the supply chain, joining two high capacity transport modes: rail and maritime transport. The huge cargo flows transiting port requires high capacity construction and installation such as berths, large capacity cranes, respectively shunting yards. However, the port shunting yards specificity raises several problems such as: limited access since these are terminus stations for rail network, the in-output of large transit flows of cargo relatively to the scarcity of the departure/arrival of a ship, as well as limited land availability for implementing solutions to serve these flows. It is necessary to identify technological solutions that lead to an answer to these problems. The paper proposed a simulation model developed with ARENA computer simulation software suitable for shunting yards which serve sea ports with access to the rail network. Are investigates the principal aspects of shunting yards and adequate measures to increase their transit capacity. The operation capacity for shunting yards sub-system is assessed taking in consideration the required operating standards and the measure of performance (e.g. waiting time for freight wagons, number of railway line in station, storage area, etc.) of the railway station are computed. The conclusion and results, drawn from simulation, help transports and logistics specialists to test the proposals for improving the port management.
ERIC Educational Resources Information Center
Hill, Bradley K.; And Others
The study surveyed 181 specialized foster care homes or small (with 6 or fewer residents) group homes providing residential care for persons (N=336) with mental retardation and related developmental disabilities. The study found that the community residential facility sample was generally much less well integrated into the life of the community…
Water quality assessment of Australian ports using water quality evaluation indices
Jahan, Sayka
2017-01-01
Australian ports serve diverse and extensive activities, such as shipping, tourism and fisheries, which may all impact the quality of port water. In this work water quality monitoring at different ports using a range of water quality evaluation indices was applied to assess the port water quality. Seawater samples at 30 stations in the year 2016–2017 from six ports in NSW, Australia, namely Port Jackson, Botany, Kembla, Newcastle, Yamba and Eden, were investigated to determine the physicochemical and biological variables that affect the port water quality. The large datasets obtained were designed to determine the Water Quality Index, Heavy metal Evaluation Index, Contamination Index and newly developed Environmental Water Quality Index. The study revealed medium water quality index and high and medium heavy metal evaluation index at three of the study ports and high contamination index in almost all study ports. Low level dissolved oxygen and higher level of total dissolved solids, turbidity, fecal coliforms, copper, iron, lead, zinc, manganese, cadmium and cobalt are mainly responsible for the poor water qualities of the port areas. Good water quality at the background samples indicated that various port activities are the likely cause for poor water quality inside the port area. PMID:29244876
33 CFR 150.940 - Safety zones for specific deepwater ports.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Safety zones for specific... SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Safety Zones, No Anchoring Areas, and Areas To Be Avoided § 150.940 Safety zones for specific deepwater ports. (a) Louisiana Offshore Oil Port...
33 CFR 150.940 - Safety zones for specific deepwater ports.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Safety zones for specific... SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Safety Zones, No Anchoring Areas, and Areas To Be Avoided § 150.940 Safety zones for specific deepwater ports. (a) Louisiana Offshore Oil Port...
33 CFR 150.940 - Safety zones for specific deepwater ports.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Safety zones for specific... SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Safety Zones, No Anchoring Areas, and Areas To Be Avoided § 150.940 Safety zones for specific deepwater ports. (a) Louisiana Offshore Oil Port...
33 CFR 150.940 - Safety zones for specific deepwater ports.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Safety zones for specific... SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Safety Zones, No Anchoring Areas, and Areas To Be Avoided § 150.940 Safety zones for specific deepwater ports. (a) Louisiana Offshore Oil Port...
33 CFR 150.940 - Safety zones for specific deepwater ports.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Safety zones for specific... SECURITY (CONTINUED) DEEPWATER PORTS DEEPWATER PORTS: OPERATIONS Safety Zones, No Anchoring Areas, and Areas To Be Avoided § 150.940 Safety zones for specific deepwater ports. (a) Louisiana Offshore Oil Port...
Use of mental health services by nursing home residents after hurricanes.
Brown, Lisa M; Hyer, Kathryn; Schinka, John A; Mando, Ahed; Frazier, Darvis; Polivka-West, Lumarie
2010-01-01
A growing body of research supports the value of mental health intervention to treat people affected by disasters. This study used a mixed-methods approach to evaluate pre- and posthurricane mental health service use in Florida nursing homes. A questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes, representing two-thirds of Florida's counties, to identify residents' mental health needs and service use. In four subsequent focus group meetings with 22 nursing home administrators, underlying factors influencing residents' use of services were evaluated. Although most nursing homes provided some type of mental health care during normal operations, disaster-related mental health services were not routinely provided to residents. Receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents. Nursing home staff should be trained to deliver disaster-related mental health intervention and in procedures for making referrals for follow-up evaluation and formal intervention.
Troyer, Jennifer L; Sause, Wendy
2013-01-01
Objective To test for an association between traditional nursing home quality measures and two sources of resident- and caregiver-derived nursing home complaints. Data Sources Nursing home complaints to the North Carolina Long-Term Care Ombudsman Program and state certification agency from October 2002 through September 2006 were matched with Online Survey Certification and Reporting data and Minimum Data Set Quality Indicators (MDS-QIs). Study Design We examine the association between the number of complaints filed against a facility and measures of inspection violations, staffing levels, and MDS-QIs. Data Extraction One observation per facility per quarter is constructed by matching quarterly data on complaints to OSCAR data from the same or most recent prior quarter and to MDS-QIs from the same quarter. One observation per inspection is obtained by matching OSCAR data to complaint totals from both the same and the immediate prior quarter. Principal Findings There is little relationship between MDS-QIs and complaints. Ombudsman complaints and inspection violations are generally unrelated, but there is a positive relationship between state certification agency complaints and inspection violations. Conclusions Ombudsman and state certification agency complaint data are resident- and caregiver-derived quality measures that are distinctive from and complement traditional quality measures. PMID:23216541
Midterm outcomes of single port thoracoscopic surgery for major pulmonary resection
2017-01-01
Introduction Single-port thoracoscopic surgery has widened the current minimally invasive surgical techniques toward more less invasive procedures in terms of reducing the number of incisions. However, the current status of oncologic outcome with this technique is not well known for lung cancer surgery. The purpose of this study is to evaluate the oncologic outcomes in early stage lung cancer for impact of the survival outcomes with our experience of conversion to a single-port approach from the conventional three-port approach. Materials and methods Retrospective data of patients who underwent thoracoscopic major lung resection for non-small cell lung cancer between January 2006 and June 2015 were analyzed. Patients’ characteristics, perioperative outcomes, pathologic result, and postoperative follow-up data of thoracoscopic surgery were reviewed and surgical outcomes were compared between conventional three-port (n = 168), two-port (n = 68), and single-port thoracoscopic surgery (n = 203). Results Of the 203 single-port thoracoscopic surgeries, we performed 167 single-port thoracoscopic lobectomy and mediastinal lymph node dissections. During the learning period of each thoracoscopic approach, the mean operation time for single-port thoracoscopic surgery (189±62 min) was not significantly different from those of two-port (175±46 min) and three-port (195±75 min) thoracoscopic lobectomy (p = 0.165). Perioperative outcomes including drain indwelling time (p <0.001), complication (p = 0.185) and conversion event (p = 0.911) were not worsened during learning period with two-port. Midterm survival (p = 0.753) and recurrence free survival (p = 0.656) of single port thoracoscopic lobectomy showed acceptable results compared with two- and three-port approach. Conclusions Single-port thoracoscopic surgery is safe and a feasible option for major lung resection in lung malignancy and this approach following experiences of two-port approach may yield similar oncologic
Closeup view from the starboard side looking towards the port ...
Close-up view from the starboard side looking towards the port side of the Orbiter Discovery looking at the airlock and payload bay. The docking ring has been removed from the airlock prior to this photo being taken. Note that the Orbiter Boom Sensor System is still attached while the Remote Manipulator System has been removed. Also note the suspended protective panels and walkways in place to protect the interior surfaces of the payload bay doors while in their open position. This view was taken from a service platform in the Orbiter Processing Facility at Kennedy Space Center. - Space Transportation System, Orbiter Discovery (OV-103), Lyndon B. Johnson Space Center, 2101 NASA Parkway, Houston, Harris County, TX
From Pushing Paper to Pushing Dirt - Canada's Largest LLRW Cleanup Gets Underway - 13111
DOE Office of Scientific and Technical Information (OSTI.GOV)
Veen, Walter van; Lawrence, Dave
2013-07-01
The Port Hope Project is the larger of the two projects in the Port Hope Area Initiative (PHAI), Canada's largest low level radioactive waste (LLRW) cleanup. With a budget of approximately $1 billion, the Port Hope Project includes a broad and complex range of remedial elements from a state of the art water treatment plant, an engineered waste management facility, municipal solid waste removal, remediation of 18 major sites within the Municipality of Port Hope (MPH), sediment dredging and dewatering, an investigation of 4,800 properties (many of these homes) to identify LLRW and remediation of approximately 450 of these properties.more » This paper discusses the status of the Port Hope Project in terms of designs completed and regulatory approvals received, and sets out the scope and schedule for the remaining studies, engineering designs and remediation contracts. (authors)« less
Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care
ERIC Educational Resources Information Center
Davitt, Joan K.
2014-01-01
Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…
Optimal port-based teleportation
NASA Astrophysics Data System (ADS)
Mozrzymas, Marek; Studziński, Michał; Strelchuk, Sergii; Horodecki, Michał
2018-05-01
Deterministic port-based teleportation (dPBT) protocol is a scheme where a quantum state is guaranteed to be transferred to another system without unitary correction. We characterise the best achievable performance of the dPBT when both the resource state and the measurement is optimised. Surprisingly, the best possible fidelity for an arbitrary number of ports and dimension of the teleported state is given by the largest eigenvalue of a particular matrix—Teleportation Matrix. It encodes the relationship between a certain set of Young diagrams and emerges as the optimal solution to the relevant semidefinite programme.
Quality rating and private-prices: Evidence from the nursing home industry.
Huang, Sean Shenghsiu; Hirth, Richard A
2016-12-01
We use the rollout of the five-star rating of nursing homes to study how private-pay prices respond to quality rating. We find that star rating increases the price differential between top- and bottom-ranked facilities. On average, prices of top-ranked facilities increased by 4.8 to 6.0 percent more than the prices of bottom-ranked facilities. We find stronger price effects in markets that are less concentrated where consumers may have more choices of alternative nursing homes. Our results suggest that with simplified design and when markets are less concentrated, consumers are more responsive to quality reporting. Copyright © 2016 Elsevier B.V. All rights reserved.
Targeting nursing homes under the Quality Improvement Organization program's 9th statement of work.
Stevenson, David G; Mor, Vincent
2009-09-01
In the Quality Improvement Organization (QIO) program's latest Statement of Work, the Centers for Medicare and Medicaid Services (CMS) is targeting its nursing home activities toward facilities that perform poorly on two quality measures-pressure ulcers and restraint use. The designation of target facilities is a shift in strategy for CMS and a direct response to criticism that QIO program resources were not being targeted effectively to facilities or clinical areas that most needed improvement. Using administrative data, this article analyzes implications of using narrowly defined criteria to identify facilities that need improvement, particularly in light of considerable evidence showing that nursing home quality is multidimensional and may change over time. The analyses show that one in four facilities is targeted for improvement nationally but that approximately half of some states' facilities are targeted while other states have almost none targeted. The analyses also convey deeper limitations to using threshold values on individual measures to identify poorly performing homes. Target facilities can be among the top performers on a range of other quality measures, and their performance on targeted measures themselves may change over time. The implication of these features is that a very different group of facilities would have been chosen had the QIO program targeted other measures or examined performance at a different point in time. Ultimately, CMS has chosen a blunt instrument to identify poorly performing nursing homes, and supplemental strategies-such as soliciting input from state survey agencies and more closely aligning quality improvement and quality assurance efforts-should be considered to address potential limitations.
A Comparison of Single-, Two- and Three-Port Laparoscopic Myomectomy
Kim, Su Mi; Baek, Jong Min; Park, Eun Kyung; Jeung, In Cheul; Choi, Ji Hyang; Kim, Chan Joo
2015-01-01
Background and Objective: A recent FDA safety communication has discouraged the use of a power morcellator for myoma extraction and has called for a change in surgical techniques for myomectomy. The objective of this study was to compare surgical outcomes of laparoscopic single-, two-, and conventional three-port myomectomy and to evaluate the feasibility of contained manual morcellation for uterine myoma. Methods: This retrospective study was a review and analysis of data from 191 consecutive women who underwent single-, two-, or three-port myomectomy for the management of uterine myoma from January 1, 2009, through December 31, 2014. Results: The 3 study groups did not differ demographically. Apart from operative time, the single- and two-port groups showed operative outcomes comparable to those of the multiport group. The single-port group had significantly longer operative times (P = .0053) than the two- and three-port groups. However, in the latter half of the single-port cases, the operative time was similar to those in the three-port group. The two-port surgery group showed a consistent operative time without a learning period. Conclusion: Single- or two-port myomectomy with transumbilical myoma morcellation is feasible and safe, with outcomes comparable to those of three-port myomectomy. These results suggest the potential for minimally invasive management of symptomatic uterine myoma, without the use of a power morcellator. PMID:26648680
Staffing and Worker Injury in Nursing Homes
Trinkoff, Alison M.; Johantgen, Meg; Muntaner, Carles; Le, Rong
2005-01-01
Objectives. We examined the relationship between nursing home staffing levels and worker injury rates in 445 nursing homes in 3 states. Methods. We obtained First Reports of Injury and workers’ compensation data from 3 states (Ohio, West Virginia, and Maryland) for the year 2000. We then linked these data to Medicare’s Online Survey, Certification and Reporting system to obtain nursing home staffing details and organizational descriptors. We used ordinary least squares and log-transformed regression models to examine the association between worker injury rate and nursing home staffing and organizational characteristics. Results. Total nursing hours per resident day were significantly associated with worker injury rates in nursing homes after we adjusted for organizational characteristics and state dummy variables (P=.0004). Conclusions. Our findings suggest that nursing home staffing levels have an important impact on worker health. These findings were supported for multiple facilities across different states; therefore, policies and resources that increase staffing levels in nursing homes are warranted. PMID:15983274
Patient-specific port placement for laparoscopic surgery using atlas-based registration
NASA Astrophysics Data System (ADS)
Enquobahrie, Andinet; Shivaprabhu, Vikas; Aylward, Stephen; Finet, Julien; Cleary, Kevin; Alterovitz, Ron
2013-03-01
Laparoscopic surgery is a minimally invasive surgical approach, in which abdominal surgical procedures are performed through trocars via small incisions. Patients benefit by reduced postoperative pain, shortened hospital stays, improved cosmetic results, and faster recovery times. Optimal port placement can improve surgeon dexterity and avoid the need to move the trocars, which would cause unnecessary trauma to the patient. We are building an intuitive open source visualization system to help surgeons identify ports. Our methodology is based on an intuitive port placement visualization module and atlas-based registration algorithm to transfer port locations to individual patients. The methodology follows three steps:1) Use a port placement visualization module to manually place ports in an abdominal organ atlas. This step generates port-augmented abdominal atlas. This is done only once for a given patient population. 2) Register the atlas data with the patient CT data, to transfer the prescribed ports to the individual patient 3) Review and adjust the transferred port locations using the port placement visualization module. Tool maneuverability and target reachability can be tested using the visualization system. Our methodology would decrease the amount of physician input necessary to optimize port placement for each patient case. In a follow up work, we plan to use the transferred ports as starting point for further optimization of the port locations by formulating a cost function that will take into account factors such as tool dexterity and likelihood of collision between instruments.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ferguson Jones, Andrea; Lee, Angela; Palmeter, Tim
2013-07-01
The Port Hope Project is part of the larger CAN$1.28 billion Port Hope Area Initiative (PHAI), a community-based program for the development and implementation of a safe, local, long-term management solution for historic Low-Level Radioactive Waste (LLRW) in the Municipalities of Port Hope and Clarington, Ontario, Canada. Atomic Energy of Canada (AECL) is the Project Proponent, Public Works and Government Services (PWGSC) is managing the procurement of services and the MMM Group Limited - Conestoga Rovers and Associates Joint Venture (MMM-CRA Joint Venture) is providing detailed design and construction oversight and administration services for the Project. The Port Hope Projectmore » includes the construction of a long-term waste management facility (LTWMF) in the Municipality of Port Hope and the remediation of 18 (eighteen) large-scale LLRW, numerous small-scale sites still being identified and industrial sites within the Municipality. The total volume to be remediated is over one million cubic metres and will come from sites that include temporary storage sites, ravines, beaches, parks, private commercial and residential properties and vacant industrial sites all within the urban area of Port Hope. Challenges that will need to be overcome during this 10 year project include: - Requirements stipulated by the Environmental Assessment (EA) that affect Project logistics and schedule. - Coordination of site remediation with the construction schedule at the LTWMF. - Physical constraints on transport routes and at sites affecting production rates. - Despite being an urban undertaking, seasonal constrains for birds and fish (i.e., nesting and spawning seasons). - Municipal considerations. - Site-specific constraints. - Site interdependencies exist requiring consideration in the schedule. Several sites require the use of an adjacent site for staging. (authors)« less
Racial and ethnic disparities in social engagement among US nursing home residents.
Li, Yue; Cai, Xueya
2014-04-01
The numbers and proportions of racial and ethnic minorities have increased dramatically in US nursing homes in recent years. Concerns exist about whether nursing homes can serve appropriately the clinical and psychosocial needs of patients with increasingly diverse ethnic and cultural backgrounds. This study determined racial and ethnic disparities in social engagement among nursing home long-term residents. We analyzed the 2008 national Minimum Data Set supplemented with the Online Survey, Certification, and Reporting File and the Area Resource File. We estimated multivariable logistic regressions to determine disparities and how disparities were explained by individual, facility, and geographic factors. Stratified analyses further determined persistent disparities within patient and facility subgroups. Compared with white residents (n = 690,228), black (n = 123,116), Hispanic (n = 37,099), and other (n = 17,568) residents showed lower social engagement, with overall scores (mean ± SD) being 2.5 ± 1.7, 2.2 ± 1.6, 2.0 ± 1.6, and 2.1 ± 1.6, respectively. Disparities were partially explained by variations in individual, facility, and geographic covariates, but persisted after multivariable adjustments. Stratified analyses confirmed that disparities were similar in magnitude across patient and facility subgroups. Although nursing home residents showed overall low social engagement levels, racial/ethnic minority residents were even less socially engaged than white residents. Efforts to address disparities in psychosocial well-being and quality of life of nursing home residents are warranted.
Mozetič, Patricija; Cangini, Monica; Francé, Janja; Bastianini, Mauro; Bernardi Aubry, Fabrizio; Bužančić, Mia; Cabrini, Marina; Cerino, Federica; Čalić, Marijeta; D'Adamo, Raffaele; Drakulović, Dragana; Finotto, Stefania; Fornasaro, Daniela; Grilli, Federica; Kraus, Romina; Kužat, Nataša; Marić Pfannkuchen, Daniela; Ninčević Gladan, Živana; Pompei, Marinella; Rotter, Ana; Servadei, Irene; Skejić, Sanda
2017-12-30
An inventory of phytoplankton diversity in 12 Adriatic ports was performed with the port baseline survey. Particular emphasis was put on the detection of harmful aquatic organisms and pathogens (HAOP) because of their negative impact on ecosystem, human health, and the economy. Phytoplanktonic HAOP are identified as species, either native or non-indigenous (NIS), which can trigger harmful algal blooms (HAB). A list of 691 taxa was prepared, and among them 52 were classified as HAB and five as NIS. Records of toxigenic NIS (Pseudo-nitzschia multistriata, Ostreopsis species including O. cf. ovata) indicate that the intrusion of non-native invasive phytoplankton species has already occurred in some Adriatic ports. The seasonal occurrence and abundance of HAOP offers a solid baseline for a monitoring design in ports in order to prevent ballast water uptake and possible expansion of HAOP outside their native region. Copyright © 2017 Elsevier Ltd. All rights reserved.
Code of Federal Regulations, 2010 CFR
2010-07-01
... all waters between Watson Park and Star Island on the MacArthur Causeway south to the Port of Miami...′ N, 080°10.92′ W to 25°46.88′ N, 080°10.84′ W, and ending on Watson Park at 25°47.00′ N, 080°10.67′ W...
Code of Federal Regulations, 2011 CFR
2011-07-01
... all waters between Watson Park and Star Island on the MacArthur Causeway south to the Port of Miami...′ N, 080°10.92′ W to 25°46.88′ N, 080°10.84′ W, and ending on Watson Park at 25°47.00′ N, 080°10.67′ W...
Code of Federal Regulations, 2014 CFR
2014-07-01
... all waters between Watson Park and Star Island on the MacArthur Causeway south to the Port of Miami...′ N, 080°10.92′ W to 25°46.88′ N, 080°10.84′ W, and ending on Watson Park at 25°47.00′ N, 080°10.67′ W...
Code of Federal Regulations, 2012 CFR
2012-07-01
... all waters between Watson Park and Star Island on the MacArthur Causeway south to the Port of Miami...′ N, 080°10.92′ W to 25°46.88′ N, 080°10.84′ W, and ending on Watson Park at 25°47.00′ N, 080°10.67′ W...
Code of Federal Regulations, 2013 CFR
2013-07-01
... all waters between Watson Park and Star Island on the MacArthur Causeway south to the Port of Miami...′ N, 080°10.92′ W to 25°46.88′ N, 080°10.84′ W, and ending on Watson Park at 25°47.00′ N, 080°10.67′ W...
7. View of Port Gamble residential district, facing northwest across ...
7. View of Port Gamble residential district, facing northwest across intersection of Rainier Avenue with Pope Street. House no. 11 in left foreground, Jackson House, house no. 10 in center foreground. - Port Gamble National Historic Landmark, Bounded by Hood Canal, Port Gamble Bay, State Road 104, & Town Limits, Port Gamble, Kitsap County, WA
5. View of Port Gamble residential district, facing northwest across ...
5. View of Port Gamble residential district, facing northwest across Rainier Avenue, house no. 16A in left foreground, house no. 16 in center, house no. 15 in right background. - Port Gamble National Historic Landmark, Bounded by Hood Canal, Port Gamble Bay, State Road 104, & Town Limits, Port Gamble, Kitsap County, WA
Strategic groups, performance, and strategic response in the nursing home industry.
Zinn, J S; Aaronson, W E; Rosko, M D
1994-06-01
This study examines the effect of strategic group membership on nursing home performance and strategic behavior. Data from the 1987 Medicare and Medicaid Automated Certification Survey were combined with data from the 1987 and 1989 Pennsylvania Long Term Care Facility Questionnaire. The sample consisted of 383 Pennsylvania nursing homes. Cluster analysis was used to place the 383 nursing homes into strategic groups on the basis of variables measuring scope and resource deployment. Performance was measured by indicators of the quality of nursing home care (rates of pressure ulcers, catheterization, and restraint usage) and efficiency in services provision. Changes in Medicare participation after passage of the 1988 Medicare Catastrophic Coverage Act (MCCA) measured strategic behavior. MANOVA and Turkey HSD post hoc means tests determined if significant differences were associated with strategic group membership. Cluster analysis produced an optimal seven-group solution. Differences in group means were significant for the clustering, performance, and conduct variables (p < .0001). Strategic groups characterized by facilities providing a continuum of care services had the best patient care outcomes. The most efficient groups were characterized by facilities with high Medicare census. While all strategic groups increased Medicare census following passage of the MCCA, those dominated by for-profits had the greatest increases. Our analysis demonstrates that strategic orientation influences nursing home response to regulatory initiatives, a factor that should be recognized in policy formation directed at nursing home reform.
Strategic groups, performance, and strategic response in the nursing home industry.
Zinn, J S; Aaronson, W E; Rosko, M D
1994-01-01
OBJECTIVE. This study examines the effect of strategic group membership on nursing home performance and strategic behavior. DATA SOURCES AND STUDY SETTING. Data from the 1987 Medicare and Medicaid Automated Certification Survey were combined with data from the 1987 and 1989 Pennsylvania Long Term Care Facility Questionnaire. The sample consisted of 383 Pennsylvania nursing homes. STUDY DESIGN. Cluster analysis was used to place the 383 nursing homes into strategic groups on the basis of variables measuring scope and resource deployment. Performance was measured by indicators of the quality of nursing home care (rates of pressure ulcers, catheterization, and restraint usage) and efficiency in services provision. Changes in Medicare participation after passage of the 1988 Medicare Catastrophic Coverage Act (MCCA) measured strategic behavior. MANOVA and Turkey HSD post hoc means tests determined if significant differences were associated with strategic group membership. FINDINGS. Cluster analysis produced an optimal seven-group solution. Differences in group means were significant for the clustering, performance, and conduct variables (p < .0001). Strategic groups characterized by facilities providing a continuum of care services had the best patient care outcomes. The most efficient groups were characterized by facilities with high Medicare census. While all strategic groups increased Medicare census following passage of the MCCA, those dominated by for-profits had the greatest increases. CONCLUSIONS. Our analysis demonstrates that strategic orientation influences nursing home response to regulatory initiatives, a factor that should be recognized in policy formation directed at nursing home reform. PMID:8005789
Phytophthora lateralis on Port-Orford-cedar.
John Hunt
1959-01-01
Results from annual surveys of the destructive Phytophthora root disease of Port-Orford-cedar (Chamaecyparis lawsoniana (A. Murr.) Parl.) show that the disease is gradually spreading and intensifying within the natural range of Port-Orford-cedar. The disease became established on native trees in the early 1950's in the vicinity of Coos Bay,...
New NREL Research Facility Slashes Energy Use by 66 Percent
Thermal Test Facility, which serves as a showcase of energy-saving features and the home of NREL's cutting technologies now being developed at the Thermal Test Facility will help us reach this goal." The facility energy-efficient building design, NREL's Thermal Test Facility houses sophisticated equipment for
Single-port laparoscopic and robotic partial nephrectomy.
Kaouk, Jihad H; Goel, Raj K
2009-05-01
Partial nephrectomy (PN) for small renal masses provides effective oncologic outcomes. Single-port laparoscopic (SPL) and robotic surgeries are evolving approaches to advance minimally invasive surgery. To determine the feasibility of laparoscopic and robotic single-port PN. Since 2007, evaluation of patients undergoing SPL and single-port robotic (SPR) PN at a primary referral center was performed. Patients with small, solitary, exophytic-enhancing renal masses were selected. Patients with a solitary kidney, endophytic or hilar tumors, and previous abdominal and/or kidney surgery were excluded. Perioperative and pathologic data were entered prospectively into an institutional review board (IRB)-approved database. Tumor location determined either an open Hasson transperitoneal or retroperitoneal approach. A single multichannel port or Triport provided intra-abdominal access. The Harmonic Scalpel was used for tumor excision under normal renal perfusion. The da Vinci surgical robot was used for SPR cases. Patient demographics, perioperative, hematologic, and pathologic data as well as pain assessment using the Visual Analog Pain Scale (VAPS) were assessed. A total of seven patients underwent single-port PN (SPL=5, SPR=2). One patient with a right anterior upper-pole mass required conversion from SPL to standard laparoscopy following tumor excision because of intraoperative bleeding. Pathology revealed six lesions compatible with renal cell carcinoma (RCC) and one benign cyst. One negative frozen section came back focally positive on final histopathology. All other surgical margins were negative. A mean difference of 3.0+/-2.0 g/dl in hemoglobin was noted in all patients. Minimal pain was noted at discharge following both laparoscopic and robotic single-port surgery (VAPS=1.7+/-1.2 vs 1+/-0.5/10). SPL and SPR PN is feasible for select exophytic tumors. Robotics may improve surgical capabilities during single-port surgery.
Lapane, Kate L; Hughes, Carmel M
2004-10-01
There is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes. This study evaluated the relation between organizational characteristics and management of depression using antidepressants. This was a cross-sectional study of Medicare/Medicaid certified nursing homes in 6 states in 2000. We studied 87,907 residents with depression in 2,128 facilities. Minimum Data Set (MDS) provided information regarding use of antidepressants and resident factors. On-line Survey and Certification of Automated Records (OSCAR) provided facility characteristics information including structural, resource, and staffing levels. Adjusted estimates of organizational effects on antidepressant drug use were derived from generalized estimating equations. Increased treatment of depression with antidepressants was associated with facilities with a higher percentage of residents from payer sources other than Medicare/Medicaid (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06) and more professional nursing staff (OR, 1.15; 95% CI, 1.05-1.26). Decreased treatment tended to be related to larger homes (OR, 0.76; 95% CI, 0.68-0.84) or if the home employed full-time physicians (OR, 0.87; 95% CI, 0.78-0.96). Once the decision to treat was made, treatment with tricyclics tended to be inversely related to larger homes, for-profit facilities, and homes with more Medicare residents. Facilities that are required to be more fiscally conservative, be it larger facilities with fewer private pay patients or for profit facilities, have lower rates of pharmacologic treatment. Resource and structural characteristics influence the type of antidepressant being prescribed; resident characteristics may not be the over-riding factor in prescribing.
An analytical and experimental study of injection-locked two-port oscillators
NASA Technical Reports Server (NTRS)
Freeman, Jon C.; Downey, Alan N.
1987-01-01
A Ku-band IMPATT oscillator with two distinct output power ports was injection-locked alternately at both ports. The transmission locking bandwidth was nearly the same for either port. The lower free running power port had a reflection locking bandwidth that was narrower than its transmission locking one. Just the opposite was found at the other port. A detailed analytical model for two-port injection-locked oscillators is presented, and its results agree quite well with the experiments. A critique of the literature on this topic is included to clear up misconceptions and errors. It is concluded that two-port injection-locked oscillators may prove useful in certain communication systems.
Scientific Design of the New Neutron Radiography Facility (SANRAD) at SAFARI-1 for South Africa
NASA Astrophysics Data System (ADS)
de Beer, F. C.; Gruenauer, F.; Radebe, J. M.; Modise, T.; Schillinger, B.
The final scientific design for an upgraded neutron radiography/tomography facility at beam port no.2 of the SAFARI-1 nuclear research reactor has been performed through expert advice from Physics Consulting, FRMII in Germany and IPEN, Brazil. A need to upgrade the facility became apparent due to the identification of various deficiencies of the current SANRAD facility during an IAEA-sponsored expert mission of international scientists to Necsa, South Africa. A lack of adequate shielding that results in high neutron background on the beam port floor, a mismatch in the collimator aperture to the core that results in a high gradient in neutron flux on the imaging plane and due to a relative low L/D the quality of the radiographs are poor, are a number of deficiencies to name a few.The new design, based on results of Monte Carlo (MCNP-X) simulations of neutron- and gamma transport from the reactor core and through the new facility, is being outlined. The scientific design philosophy, neutron optics and imaging capabilities that include the utilization of fission neutrons, thermal neutrons, and gamma-rays emerging from the core of SAFARI-1 are discussed.
Salazar, Gloria; Yeddula, Kalpana; Wicky, Stephan; Oklu, Ramhi; Ganguli, Suvranu; Waltman, Arthur C; Walker, Thomas G; Kalva, Sanjeeva P
2013-01-01
To compare complication rates in patients who have port-a-catheters inserted and left accessed for immediate use and those who have ports inserted but not accessed. In this retrospective, IRB-approved study, medical records of patients who received a port catheter between 9/2009 and 2/2010 were reviewed. The data collected included patient demographics, diagnosis, procedure and complications. The patients were categorized into two groups: accessed (patients in whom the port was accessed with a Huber needle for immediate intravenous use and the patient left the procedure area with needle indwelling) and control (patients in whom the ports were not accessed). Complications were classified according to Society of Interventional Radiology guidelines. Results are given as mean ±SD. Statistical analysis was performed with student t test and statistical significance was considered at P<.05. A total of 467 ports were placed in 465 patients (Men: 206); 10.7% in the accessed group (n=50, age: 60±13.9) and 89.3% in the control group (n=417, age: 59±13.5). There were no statistically significant differences in patient demographics between the groups. The overall complication rate was 0.6% (n=3). Two complications (hematoma causing skin necrosis and thrombosis of the port) occurred in the control group and one (infection) in the accessed group. Infection rates after procedures were 2% (1/50) in the accessed group and 0% (0/417) in the control group. There was no statistically significant difference in overall complication (P=.1) and infection (P=.1) rates among the groups. Leaving the port accessed immediately after placement does not increase the risk of infection or other complications.
19 CFR 4.86 - Intercoastal residue-cargo procedure; optional ports.
Code of Federal Regulations, 2010 CFR
2010-04-01
... agent is unable at that time to designate the specific port or ports of discharge of that residue cargo... ports, Great Lakes coast,” as the case may be. The traveling manifest shall be similarly noted. Upon arrival of the vessel at the first port on the next coast, the master, owner, or agent must designate the...
44 CFR 402.4 - Calls at restricted ports en route to an unrestricted port with restricted cargo.
Code of Federal Regulations, 2012 CFR
2012-10-01
... port or other place in Communist China.) For example, an American flag ship may call at one of the restricted ports (except one in Communist China), even though it has on board the following classes of... for Communist China (the transportation and discharge of which is covered by Order T-2). None of these...
44 CFR 402.4 - Calls at restricted ports en route to an unrestricted port with restricted cargo.
Code of Federal Regulations, 2013 CFR
2013-10-01
... port or other place in Communist China.) For example, an American flag ship may call at one of the restricted ports (except one in Communist China), even though it has on board the following classes of... for Communist China (the transportation and discharge of which is covered by Order T-2). None of these...
44 CFR 402.4 - Calls at restricted ports en route to an unrestricted port with restricted cargo.
Code of Federal Regulations, 2014 CFR
2014-10-01
... port or other place in Communist China.) For example, an American flag ship may call at one of the restricted ports (except one in Communist China), even though it has on board the following classes of... for Communist China (the transportation and discharge of which is covered by Order T-2). None of these...
44 CFR 402.4 - Calls at restricted ports en route to an unrestricted port with restricted cargo.
Code of Federal Regulations, 2010 CFR
2010-10-01
... port or other place in Communist China.) For example, an American flag ship may call at one of the restricted ports (except one in Communist China), even though it has on board the following classes of... for Communist China (the transportation and discharge of which is covered by Order T-2). None of these...
44 CFR 402.4 - Calls at restricted ports en route to an unrestricted port with restricted cargo.
Code of Federal Regulations, 2011 CFR
2011-10-01
... port or other place in Communist China.) For example, an American flag ship may call at one of the restricted ports (except one in Communist China), even though it has on board the following classes of... for Communist China (the transportation and discharge of which is covered by Order T-2). None of these...
... or surgery. Port-wine stains can also develop grape-like growths of small blood vessels called vascular ... another part of themselves — like their height or eye color. It's also important, emotionally, for kids to ...
33 CFR 401.65 - Communication-ports, docks and anchorages.
Code of Federal Regulations, 2010 CFR
2010-07-01
... anchorages. 401.65 Section 401.65 Navigation and Navigable Waters SAINT LAWRENCE SEAWAY DEVELOPMENT....65 Communication—ports, docks and anchorages. (a) Every vessel entering or leaving a lake port shall... the harbor entrance. (b) Every vessel arriving at a port, dock or anchorage shall report to the...
33 CFR 401.65 - Communication-ports, docks and anchorages.
Code of Federal Regulations, 2014 CFR
2014-07-01
... anchorages. 401.65 Section 401.65 Navigation and Navigable Waters SAINT LAWRENCE SEAWAY DEVELOPMENT....65 Communication—ports, docks and anchorages. (a) Every vessel entering or leaving a lake port shall... the harbor entrance. (b) Every vessel arriving at a port, dock or anchorage shall report to the...
33 CFR 401.65 - Communication-ports, docks and anchorages.
Code of Federal Regulations, 2011 CFR
2011-07-01
... anchorages. 401.65 Section 401.65 Navigation and Navigable Waters SAINT LAWRENCE SEAWAY DEVELOPMENT....65 Communication—ports, docks and anchorages. (a) Every vessel entering or leaving a lake port shall... the harbor entrance. (b) Every vessel arriving at a port, dock or anchorage shall report to the...
33 CFR 401.65 - Communication-ports, docks and anchorages.
Code of Federal Regulations, 2013 CFR
2013-07-01
... anchorages. 401.65 Section 401.65 Navigation and Navigable Waters SAINT LAWRENCE SEAWAY DEVELOPMENT....65 Communication—ports, docks and anchorages. (a) Every vessel entering or leaving a lake port shall... the harbor entrance. (b) Every vessel arriving at a port, dock or anchorage shall report to the...
33 CFR 401.65 - Communication-ports, docks and anchorages.
Code of Federal Regulations, 2012 CFR
2012-07-01
... anchorages. 401.65 Section 401.65 Navigation and Navigable Waters SAINT LAWRENCE SEAWAY DEVELOPMENT....65 Communication—ports, docks and anchorages. (a) Every vessel entering or leaving a lake port shall... the harbor entrance. (b) Every vessel arriving at a port, dock or anchorage shall report to the...
The construction strategy and measures for ecological analysis of China's ports
NASA Astrophysics Data System (ADS)
Zhang, Lu; Zhao, Junjie; Shou, Youping; Wang, Ning; Qiao, Jianzhe; Tian, Mingjing
2018-04-01
The Port is an important transport hub, one of the important infrastructure of the national economy, the corresponding regional development has a great role in promoting.The construction of the port has been developed rapidly, but it has also brought about more serious environmental problems. Therefore, this paper discusses the nature of ecological ports, summarized the experience of ecological protection measures on the international advanced ports and port construction ecology. The central idea is to explore the construction of ecological port ideas and development countermeasures.
Medicaid nursing home pay for performance: where do we stand?
Arling, Greg; Job, Carol; Cooke, Valerie
2009-10-01
Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make recommendations for further development of nursing home P4P. We surveyed the six states with operational P4P systems in 2007. The range of performance measures employed by the states is quite broad: staffing level and satisfaction, findings from the regulatory system, clinical quality indicators, resident quality of life or satisfaction with care, family satisfaction, access to care for special populations, and efficiency. The main data sources for the measures are the Minimum Data Set (MDS), nursing home inspections, special surveys of nursing home residents, consumers or employees, and facility cost reports or other administrative systems. The most common financial incentive for better performance is a percentage bonus or an add-on to a facility's per diem rate. The bonus is generally proportional to a facility performance score, which consists of simple or weighted sums of scores on individual measures. States undertaking nursing home P4P programs should involve key stakeholders at all stages of P4P system design and implementation. Performance measures should be comprehensive, valid and reliable, risk adjusted where appropriate, and communicated clearly to providers and consumers. The P4P system should encourage provider investment in better care yet recognize state fiscal restraints. Consumer report cards, quality improvement initiatives, and the regulatory process should complement and reinforce P4P. Finally, the P4P system should be transparent and continuously evaluated.
Schlaich, Clara; Riemer, Tobias; Lamshöft, Maike; Hagelstein, Jan-Gerd; Oldenburg, Marcus
2010-01-01
Despite international notification requirements, the magnitude of disease transmission on board ships remains undetermined. This case series aims to exemplify that varicella aboard ships is a topic of interest for maritime medicine and of public health significance. Systematic presentation of cases of chickenpox reported to the Hamburg Port Health Authority between November 2007 and April 2008. A systematic literature search on 'ships and chickenpox' was performed. Five crew cases of chickenpox were reported from two passenger ships and two cargo ships. The cases originated from Indonesia (2), the Philippines (1), and Sri Lanka (2). Three cases were notified by the shipmaster, one by a general practitioner, and one by the immigration service. Sources of infection were other crewmembers, passengers, and persons in the home countries. This description of five varicella cases aboard ships points to the significance of the disease among seafarers. Many seafarers originate from tropical countries where seroconversion to varicella zoster virus generally occurs in late adolescents and adults. Thus, a substantial portion of the crew may be non-immune and have the potential to introduce the disease from their home country to the ship, or are at risk for infection on the ship. Port health authorities, shipmasters, and doctors need to be well informed about the relevance of chickenpox on ships and the recommended control measures. Travellers should be advised to report to the ship doctor with any signs of infectious disease.