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  1. Hospitalization Costs for Patients Undergoing Orthopedic Surgery Treated With Intravenous Acetaminophen (IV-APAP) Plus Other IV Analgesics or IV Opioid Monotherapy for Postoperative Pain.

    PubMed

    Maiese, Brett A; Pham, An T; Shah, Manasee V; Eaddy, Michael T; Lunacsek, Orsolya E; Wan, George J

    2017-02-01

    To assess the impact on hospitalization costs of multimodal analgesia (MMA), including intravenous acetaminophen (IV-APAP), versus IV opioid monotherapy for postoperative pain management in patients undergoing orthopedic surgery. Utilizing the Truven Health MarketScan(®) Hospital Drug Database (HDD), patients undergoing total knee arthroplasty (TKA), total hip arthroplasty (THA), or surgical repair of hip fracture between 1/1/2011 and 8/31/2014 were separated into postoperative pain management groups: MMA with IV-APAP plus other IV analgesics (IV-APAP group) or an IV opioid monotherapy group. All patients could have received oral analgesics. Baseline characteristics and total hospitalization costs were compared. Additionally, an inverse probability treatment weighting [IPTW] with propensity scores analysis further assessed hospitalization cost differences. The IV-APAP group (n = 33,954) and IV opioid monotherapy group (n = 110,300) differed significantly (P < 0.0001) across baseline characteristics, though the differences may not have been clinically meaningful. Total hospitalization costs (mean ± standard deviation) were significantly lower for the IV-APAP group than the IV opioid monotherapy group (US$12,540 ± $9564 vs. $13,242 ± $35,825; P < 0.0001). Medical costs accounted for $701 of the $702 between-group difference. Pharmacy costs were similar between groups. Results of the IPTW-adjusted analysis further supported the statistically significant cost difference. Patients undergoing orthopedic surgery who received MMA for postoperative pain management, including IV-APAP, had significantly lower total costs than patients who received IV opioid monotherapy. This difference was driven by medical costs; importantly, there was no difference in pharmacy costs. Generalizability of the results may be limited to patients admitted to hospitals similar to those included in HDD. Dosing could not be determined, so it was not possible to quantify

  2. Confirmatory Factor Analysis of the WISC-IV in a Hospital Referral Sample

    ERIC Educational Resources Information Center

    Devena, Sarah E.; Gay, Catherine E.; Watkins, Marley W.

    2013-01-01

    Confirmatory factor analysis was used to determine the factor structure of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) scores of 297 children referred to a children's hospital in the Southwestern United States. Results support previous findings that indicate the WISC-IV is best represented by a direct hierarchical…

  3. Confirmatory Factor Analysis of the WISC-IV in a Hospital Referral Sample

    ERIC Educational Resources Information Center

    Devena, Sarah E.; Gay, Catherine E.; Watkins, Marley W.

    2013-01-01

    Confirmatory factor analysis was used to determine the factor structure of the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) scores of 297 children referred to a children's hospital in the Southwestern United States. Results support previous findings that indicate the WISC-IV is best represented by a direct hierarchical…

  4. Who needs an IV? Retrospective service analysis in a tertiary pediatric hospital.

    PubMed

    Wilson, Graham; Engelhardt, Thomas

    2012-05-01

    The question if it is possible and safe to anesthetize children for short procedures without intravenous (IV) access provokes strong opinions among pediatric anesthetists. However, only limited data are available to support either side of the arguments. This pediatric university hospital provides anesthesia to a community dental service, led by staff anesthesiologists. A rapid turnover system based on inhalational induction and maintenance of anesthesia without mandatory IV access has been employed since 2005. A retrospective service analysis was performed to identify the incidence of adverse anesthesia events. A total of 6440 children with an average (± SD) age of 8.1 (± 4.1) years and weight of 29.6 (± 13.5) kg were cared for over the 5-year period. The total number of children refusing to undergo inhalational induction was 81 (1.26%) and 19 (0.3%) elected for an IV induction. One-third received cannulation for delivery of IV analgesia. There were no adverse anesthesia events requiring emergency cannulation and/or intubation over the 5-year period. This service review indicates that general anesthesia for outpatient dental anesthesia may be safely performed without mandatory IV access. The technique employed in this center emphasizes the need for the clinician to primarily concentrate on pediatric airway management in a safe environment with experienced assistance. It supports the hypothesis that instrumentation of the airway (insertion of laryngeal mask airway) can be satisfactorily achieved without prior IV access. © 2010 Blackwell Publishing Ltd.

  5. A Population-Based Survival Assessment of Categorizing Level III and IV Rural Hospitals as Trauma Centers

    ERIC Educational Resources Information Center

    Arthur, Melanie; Newgard, Craig D.; Mullins, Richard J.; Diggs, Brian S.; Stone, Judith V.; Adams, Annette L.; Hedges, Jerris R.

    2009-01-01

    Context: Patients injured in rural areas are hypothesized to have improved outcomes if statewide trauma systems categorize rural hospitals as Level III and IV trauma centers, though evidence to support this belief is sparse. Purpose: To determine if there is improved survival among injured patients hospitalized in states that categorize rural…

  6. A Population-Based Survival Assessment of Categorizing Level III and IV Rural Hospitals as Trauma Centers

    ERIC Educational Resources Information Center

    Arthur, Melanie; Newgard, Craig D.; Mullins, Richard J.; Diggs, Brian S.; Stone, Judith V.; Adams, Annette L.; Hedges, Jerris R.

    2009-01-01

    Context: Patients injured in rural areas are hypothesized to have improved outcomes if statewide trauma systems categorize rural hospitals as Level III and IV trauma centers, though evidence to support this belief is sparse. Purpose: To determine if there is improved survival among injured patients hospitalized in states that categorize rural…

  7. Sterile product compounding using an i.v. compounding workflow management system at a pediatric hospital.

    PubMed

    Moniz, Thomas T; Chu, Stephen; Tom, Crystal; Lutz, Peter; Arnold, Alana; Gura, Kathleen M; Patterson, Al

    2014-08-01

    Patient safety enhancements achieved through the use of an automated i.v. compounding workflow management system are reported. Automated systems integrating barcode verification of ingredients and the capture of serial images of all steps of the admixture process have the potential to improve the accuracy of parenteral i.v. medication dose preparation. About 18 months after the implementation of such a system at a large pediatric hospital, a retrospective analysis of dose preparation outcomes was conducted to evaluate the effectiveness of the i.v. workflow manager in detecting compounding errors and to categorize detected errors. In verifying the accuracy of 425,683 medication doses prepared during the approximately 13-month evaluation period, dispensing pharmacists detected preparation or documentation errors affecting 2,900 doses (0.68%); 1,223 of those doses (0.29%) required reworking, and 1,677 (0.4%) were rejected and destroyed. Roughly 23% of the detected errors were classified as undetectable via the pharmacy's previous verification practices, with 167 errors judged to pose the potential for adverse drug events resulting in moderate (n=146) or severe (n=21) harm. Among the reworked and rejected doses, 43.8% and 31.3%, respectively, were due to newly emergent problems not seen with traditional paper-based verification systems; however, most of these errors involved blurry or missing images and were not judged to be clinically significant. Implementation of an i.v. workflow management system that integrates barcode verification, automated calculations, and image-capture capabilities led to increased detection of errors in the sterile product compounding process. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Direct variable cost of the topical treatment of stages III and IV pressure injuries incurred in a public university hospital.

    PubMed

    Chacon, Julieta M F; Blanes, Leila; Borba, Luis G; Rocha, Luis R M; Ferreira, Lydia M

    2017-05-01

    to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time. Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses. The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834). The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37. Copyright © 2016. Published by Elsevier Ltd.

  9. The use of ultrasound for peripheral IV placement by vascular access team nurses at a tertiary children's hospital.

    PubMed

    Elkhunovich, Marsha; Barreras, Joanna; Bock Pinero, Valerie; Ziv, Nurit; Vaiyani, Aisha; Mailhot, Thomas

    2017-01-18

    Children receiving treatment in the hospital frequently require intravenous (IV) access. Placement of short peripheral catheters can be painful and challenging especially in those children who have difficult access. Many children's hospitals have teams of specialized vascular access nurses experienced in peripheral catheter insertion, and at times use vein visualization devices, including ultrasound (US), to assist in peripheral IV placement. Our objectives were to describe the prevalence and success rate of US-guided peripheral IV placement by vascular access team nurses at a single tertiary children's hospital. We retrospectively reviewed quality assurance data kept by our institution's vascular access team between February, 2014 and March, 2014. Data extracted included: age, gender, number of attempts, if difficult, if ultimately successful and modality used to aid IV placement. Descriptive statistics and chi-square tests were used to analyze and report data. There were 1111 patient-nurse encounters reported for peripheral IV placement over a six-week period, and a total of 1579 attempts. Ultimately 84% of the patients had successful IV placement. Overall, visualization and palpation was the most frequently used technique (50.1%), followed by near-infrared light (40.6%), US (8.0%), and transillumination (1.3%). The success rate of US (60% overall and 59.2% difficult) was not significantly different from other advanced visualization techniques. Vascular access team nurses use US infrequently for peripheral IV placement, including in children with difficult access. Methods to increase its skillful use in difficult access patients and improve successful IV placements should be explored.

  10. A Minimally Invasive Cox-Maze IV is as Effective as Sternotomy While Decreasing Major Morbidity and Hospital Stay

    PubMed Central

    Lawrance, Christopher P.; Henn, Matthew C.; Miller, Jacob; Sinn, Laurie A.; Schuessler, Richard B.; Maniar, Hersh S.; Damiano, Ralph J.

    2015-01-01

    Objectives The Cox-Maze IV has the best results for the surgical treatment of atrial fibrillation. It has been traditionally performed through sternotomy with excellent outcomes, but this has been felt to be too invasive. An alternative approach is to perform a less invasive right anterolateral minithoracotomy. This series compared these approaches at a single center in consecutive patients. Methods Patients receiving Cox-Maze IV (n=356) were retrospectively reviewed from January 2002 to February 2014. Patients were stratified into two groups: right mini-thoracotomy (RMT: n=104) and sternotomy (ST: n=252). Preoperative and perioperative variables were compared as well as long term outcomes. Patients were followed for up two years and rhythm was confirmed with electrocardiogram or prolonged monitoring. Results Freedom from atrial tachyarrhythmias off antiarrhythmic drugs was 81% and 74% at 1 and 2 year respectively using a RMT approach and was not significantly different from the ST group at these same time points. Overall complication rate was lower in the RMT group (6% vs. 13%, p=0.044) as was 30 day morality (0% vs. 4%, p=0.039). Median ICU length of stay was lower in the RMT group (2 days [range 0-21] vs. 3 days [range 1-61], p=0.004) as was median hospital length of stay (7 days [range 4-35] vs. 9 days [range 1-111], p<0.001). Conclusions The Cox-Maze IV performed through a right mini-thoracotomy is as effective as sternotomy in the treatment of atrial fibrillation. This approach was associated with fewer complications and decreased mortality and decreased ICU and hospital length of stays. PMID:25048635

  11. Pharmacodynamic evaluation of i.v. antimicrobials against Pseudomonas aeruginosa samples collected from U.S. hospitals.

    PubMed

    Keel, Rebecca A; Kuti, Joseph L; Sahm, Daniel F; Nicolau, David P

    2011-09-01

    Selected i.v. antimicrobials were evaluated against Pseudomonas aeruginosa isolates collected from U.S. hospitals to predict the likelihood of achieving maximal bactericidal activity. The pharmacodynamic profiles of ceftazidime, doripenem, imipenem-cilastatin, levofloxacin, meropenem, and piperacillin-tazobactam were simulated for 5000 adult patients using pharmacokinetic data from infected patients with the minimum inhibitory concentrations of 6142 P. aeruginosa isolates in U.S. hospitals collected during 2009. The probability of achieving bactericidal activity in this population, referred to as the cumulative fraction of response (CFR), was calculated for each antimicrobial. An optimal regimen was defined as achieving a CFR of ≥90%. The majority of isolates were collected from male inpatients who were not in an intensive care unit (ICU) and were over age 65 years. Standard dosing for all antimicrobials failed to achieve optimal CFRs, regardless of hospital location. While high-dose prolonged infusions improved the CFRs for the β-lactams, optimal exposures were only attained by doripenem (2 g every 8 hours infused over 1 hour; 0.5-2 g every 8 hours infused over 4 hours) and meropenem (2 g every 8 hours infused over 0.5 and 3 hours) for all isolates. Non-ICU isolates had approximately 5-10% higher CFRs compared with those collected in the ICU. Lower-respiratory-tract isolates had a lower predicted CFR than did isolates from the blood and skin or wounds. Simulated pharmacodynamic profiles of i.v. antimicrobials commonly used to treat P. aeruginosa indicated that higher dosages and prolonged infusion times are needed to achieve optimal exposure for bactericidal activity.

  12. IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in a Single Accredited Bariatric Center.

    PubMed

    El Chaar, Maher; Stoltzfus, Jill; Claros, Leonardo; Wasylik, Tara

    2016-04-01

    Postoperative pain control in bariatric surgery is challenging, despite use of intravenous (IV) narcotics. IV acetaminophen is one pain control alternative. The aim of this study was to investigate the economic impact of IV acetaminophen in bariatric surgery and its effect on patients' pain, satisfaction, and hospital length of stay. In a randomized controlled trial, Group 1 (treatment) received IV acetaminophen plus IV narcotics 30 min before surgery, then medication plus IV narcotics/PO narcotics for the remaining 18 h. Group 2 (control) received IV normal saline plus IV/PO narcotics. Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (SG). Primary outcomes included direct hospital costs, length of stay, postoperative pain, and patient satisfaction. Secondary outcomes included indirect costs, rescue narcotics dosage, and 30-day outcomes. Mean direct hospital cost in the treatment group (n = 50) was $3089.18 versus $2991.62 for the control group (n = 50) (p > 0.05). Pain scores did not differ significantly (p = 0.61). After adjusting for surgery type, there was no significant difference in length of stay (p = 0.95). Significantly more control group patients incurred surgery-related indirect costs (10 versus 2%, p < 0.05), with greater presentation to the emergency department (ED) for abdominal pain (5/50 versus 1/50), yielding higher total indirect costs ($39,293 versus $13,185). Using IV acetaminophen for postoperative pain management produced notable indirect cost savings and reduced ED visits in the first 30 days postoperatively, with good safety and tolerance. Decreased statistical power may have accounted for certain non-significant findings.

  13. [Demand for neuropediatric services at a general referral hospital. IV. Psychomotor development and physical examination].

    PubMed

    López-Pisón, J; Baldellou, A; Rebage, V; Arana, T; Lobera, M P; Peña-Segura, J L

    1997-12-01

    Diagnosis in neuropediatrics requires a detailed personal and family history and thorough physical examination. In this paper we study the psychomotor development and physical examination of children evaluated during a 5 year period, from May 1990 to May 1995 by a neuropediatrician newly appointed to the Hospital Miguel Servet in Zaragoza, which previously did not have such a specialist. Psychomotor retardation was seen in 19% of the children. In 50% of the children evaluated, significant data was obtained from the physical examination. The commonest finding, observed in 14% of the children, was of anomalous behaviour or an impression of mental deficiency. In decreasing order of frequency other data were: Diffuse pyramidal involvement, cranial nerve involvement, anomalous phenotype, microcephaly, microsomy, signs of neuromuscular involvement, hemiparesia, macrocephaly, skin markings, scoliosis, signs of extrapyramidal involvement, signs of cerebellar involvement, macrosomy and sensory disorders. Diagnosis in neuropediatrics is directed or established, sometimes exclusively, by an extensive personal and family history and adequate interpretation of this, which in the end depends on the skill of the clinician.

  14. Crash characteristics and injury patterns among commercial motorcycle users attending Kitale level IV district hospital, Kenya.

    PubMed

    Sisimwo, Peter Kiteywo; Mwaniki, Peter Kabanya; Bii, Christine

    2014-01-01

    Motorcycle users involved in crashes are likely to die or be severely injured due to high frequency of head, chest and leg injuries. We carried out a descriptive cross sectional study to determine crash characteristics and injury patterns among motorcycle users attending Kitale district hospital, Kenya. Motorcycle trauma patients were recruited between 1(st) August 2013 and 31(st) October 2013. Data collection was done using a pre-tested, coded questionnaire. Frequencies mean (SD) and chi-square was employed in the analysis. Analysis was done using SPSS V.20. Results were considered significant at α = 0.05. Motorcycle trauma patients formed 39.4% of all road traffic injuries. Males constituted 69.8%, females 30.2% and mean age was 30(±13) years. Riders accounted for majority of injury patients (45%), passengers (38.8%) and pedestrians (15.9%). Mechanism of motorcycle crash was involving motorcycle versus vehicle (45.6%). Riders suffered severe injuries compared to passengers (χ(2)=129.936, p < 0.001). Head injury patients were assessed as having Glasgow coma scale (GCS) of 70% 9-12, 26% GCS of 13-15 and 7% GCS of 3-8. Injuries sustained by victims included head and neck injury 40%, lower extremity injury 39.9% and chest injury 8.2%. Riders without helmets during the crash sustained head injuries (χ(2)=111.352, p < 0.001). Head injuries and lower extremity injuries accounted for the major proportion of injuries sustained by motorcycle users. Non helmet use was associated with increased risk of head injuries. Morbidity can be mitigated by encouraging use of protective gear like helmets.

  15. Crash characteristics and injury patterns among commercial motorcycle users attending Kitale level IV district hospital, Kenya

    PubMed Central

    Sisimwo, Peter Kiteywo; Mwaniki, Peter Kabanya; Bii, Christine

    2014-01-01

    Introduction Motorcycle users involved in crashes are likely to die or be severely injured due to high frequency of head, chest and leg injuries. We carried out a descriptive cross sectional study to determine crash characteristics and injury patterns among motorcycle users attending Kitale district hospital, Kenya. Methods Motorcycle trauma patients were recruited between 1st August 2013 and 31stOctober 2013. Data collection was done using a pre-tested, coded questionnaire. Frequencies mean (SD) and chi-square was employed in the analysis. Analysis was done using SPSS V.20. Results were considered significant at α = 0.05. Results Motorcycle trauma patients formed 39.4% of all road traffic injuries. Males constituted 69.8%, females 30.2% and mean age was 30(±13) years. Riders accounted for majority of injury patients (45%), passengers (38.8%) and pedestrians (15.9%). Mechanism of motorcycle crash was involving motorcycle versus vehicle (45.6%). Riders suffered severe injuries compared to passengers (χ2=129.936, p < 0.001). Head injury patients were assessed as having Glasgow coma scale (GCS) of 70% 9-12, 26% GCS of 13-15 and 7% GCS of 3-8. Injuries sustained by victims included head and neck injury 40%, lower extremity injury 39.9% and chest injury 8.2%. Riders without helmets during the crash sustained head injuries (χ2=111.352, p < 0.001). Conclusion Head injuries and lower extremity injuries accounted for the major proportion of injuries sustained by motorcycle users. Non helmet use was associated with increased risk of head injuries. Morbidity can be mitigated by encouraging use of protective gear like helmets. PMID:25883724

  16. Selection of first-line i.v. antibiotics for acute pyelonephritis in patients requiring emergency hospital admission.

    PubMed

    Yasufuku, Tomihiko; Shigemura, Katsumi; Yamashita, Masuo; Arakawa, Soichi; Fujisawa, Masato

    2011-04-01

    Febrile urinary tract infections (UTIs) often require the intravenous infusion of antibiotics and/or hospitalization. Acute pyelonephritis (AP) is one of the most severe forms of UTI, and the antibiotics we should use as the first line and the risk factors for treatment failure remain controversial. The objective of this study was to investigate the efficacy of i.v. antibiotics selected for the treatment of febrile AP and to examine the risk factors for antibiotic resistance. We set risk factors for antibiotic treatment failure such as age, sex, and the presence of underlying urinary tract disease. We classified all cases into 49 cases of complicated AP and 24 cases of uncomplicated AP according to the presence of underlying urinary tract diseases, and examined the characteristics of the patients and the efficacy of the antibiotics used in this study. We investigated risk factors which relate to initial treatment failure and the duration of antibiotic treatment. Initial antibiotic treatment failure was significantly correlated to C-reactive protein in complicated AP and to positive blood culture in uncomplicated AP. We revealed a significant correlation between the duration of the given antibiotics and diabetes mellitus or positive blood culture in uncomplicated AP, and tazobactam/piperacillin was significantly related to prolongation of antibiotic treatment in complicated AP. In conclusion, in this study, a positive blood culture was the representative risk factor that related to both initial treatment failure and longer duration of the given antibiotics in uncomplicated AP.

  17. Evaluation of the impact of non-inpatient i.v. antibiotic treatment for acute infections on the hospital, primary care services and the patient.

    PubMed

    Parker, S E; Nathwani, D; O'Reilly, D; Parkinson, S; Davey, P G

    1998-09-01

    The aim of this study was to assess the feasibility of providing i.v. antibiotic therapy outside hospital. The main outcome measures were the direct costs of providing i.v. antibiotic therapy in the community compared with standard hospital treatment and the perceptions of patients and General Practitioners (GPs). A total of 29 patients entered the study, of whom 15 received teicoplanin and 14 ceftriaxone. The costs of drugs exceeded the cost of the estimated alternative treatments (median Pound Sterling 208 and Pound Sterling 126 respectively) and this was only partially compensated for by a small reduction in costs of consumables. The staff time required to train patients was compensated for by savings in drug preparation and administration. Sensitivity analysis showed that these conclusions were sensitive to drug and patient selection, and that treatment of skin and soft tissue infections outside hospital with ceftriaxone was likely to have similar variable costs to treatment in hospital with drugs such as flucloxacillin. Non-inpatient i.v. (NIPIV) therapy was estimated to save a total of 532 bed days in the year of the study. Patients strongly preferred non-inpatient treatment to hospital treatment. GPs identified a number of potential disadvantages, mainly concerning safety and lack of support for patients at home. Following the study a strategy for development of NIPIV services in Tayside has been developed with local GPs and a plan has been agreed for funding a community liaison nurse based on the impact of NIPIV therapy on future bed requirements in Dundee Teaching Hospitals Trust.

  18. Comforting strategies and perceived barriers to pediatric pain management during IV line insertion procedure in Uganda's national referral hospital: A descriptive study.

    PubMed

    Katende, Godfrey; Mugabi, Benedicto

    2015-09-16

    Venipuncture and intravenous (IV) cannula insertions are the two common sources of pain in hospitalized children and health care today. The WHO asserts that, pain relief is a basic fundamental right and requires a multidisciplinary approach. Nonpharmacological comforting strategies when implemented are important to relive pain related distress in children during peripheral IV line insertion. However, evidence to date that suggests implementation of such strategies and their barriers in Uganda remains very limited. This study aimed at establishing the current practices in regard to the use of comforting strategies and the perceived barriers faced by health care providers to implement pediatric pain management during IV line insertion procedure in Uganda's national referral hospital, Mulago. A cross sectional and descriptive study was conducted between December 1, 2012 and February 28, 2013 involving doctors, nurses and interns in six pediatric wards of Mulago Hospital in Uganda. A pre-tested self- administered and semi- structured questionnaire was used to collect the data. Data was entered into SPSS and descriptive statistics run on all the variables. Of the 120 questionnaires distributed, 105 (RR = 87.5%) were returned and completed. The evidence based comforting strategies used for pain management during IV line insertion by the majority of health care professionals were; skin to skin (51%) and appropriate upright positioning of the child on mother's lap (69%). The least used comforting strategies were; allowing the child to suck his thumb or hand (70%), use of distraction (69%) and directing the child to suck one of his fingers into his mouth (90%). The identified barriers to implementing comforting strategies were; lack of time (42%), having emergency situations (18%), and not knowing the right method to use (11%). Of 105, 100 (95%) reported that there is need for continuous professional development on comforting strategies. Findings demonstrated that fewer

  19. The use of an IV to PO clinical intervention form to improve antibiotic administration in a community based hospital.

    PubMed

    Thompson, Cameron; Zahradnik, Michelle; Brown, Allison; Gina Fleming, Dimitra; Law, Madelyn

    2015-01-01

    Antimicrobials are among the most commonly prescribed medications in acute care settings, with 50% of antimicrobial use deemed inappropriate. Antimicrobial stewardship programs (ASP) aim to optimize antibiotic use in order to improve patient clinical outcomes while minimizing unwanted effects of therapy including Clostridium difficile infection (CDI) and the emergence of resistant organisms. Antimicrobial Stewardship involves a coordinated set of interventions that ensure patients who require antimicrobial therapy receive the most appropriate agent at the correct dose, by the correct route for the correct duration. This project focused on the appropriate conversion from intravenous (IV) to oral (PO) antibiotics. The purpose of the project was to determine whether antibiotic prescribing patterns improved following the implementation of an IV to PO conversion clinical intervention form. A collaborative approach was used by an interprofessional team to review medical records and design a clinical intervention form that adheres to evidence-based guidelines to promote appropriate conversion for patients on intravenous antibiotics. Education efforts were made to inform health system staff about the goal of the intervention and to gather feedback for the improvement of the clinical intervention form. A five-week pilot intervention period trial was carried out with a specific focus on the fluoroquinolone class of antibiotics, specifically ciprofloxacin, moxifloxacin, and levofloxacin. Data from the intervention phase, including overall antibiotic use, ratio of intravenous:oral antibiotic time and compliance with the clinical intervention form were assessed. The ratio of intravenous to oral fluoroquinolone use changed from 39.4% IV: 60.6% PO before the intervention, to 34.7% IV: 65.3% PO during the intervention, indicating an overall increase in the usage of oral fluoroquinolones during the intervention phase. In patients eligible to receive the clinical intervention form

  20. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis*.

    PubMed

    Raghunathan, Karthik; Shaw, Andrew; Nathanson, Brian; Stürmer, Til; Brookhart, Alan; Stefan, Mihaela S; Setoguchi, Soko; Beadles, Chris; Lindenauer, Peter K

    2014-07-01

    Isotonic saline is the most commonly used crystalloid in the ICU, but recent evidence suggests that balanced fluids like Lactated Ringer's solution may be preferable. We examined the association between choice of crystalloids and in-hospital mortality during the resuscitation of critically ill adults with sepsis. A retrospective cohort study of patients admitted with sepsis, not undergoing any surgical procedures, and treated in an ICU by hospital day 2. We used propensity score matching to control for confounding and compared the following outcomes after resuscitation with balanced versus with no-balanced fluids: in-hospital mortality, acute renal failure with and without dialysis, and hospital and ICU lengths of stay. We also estimated the dose-response relationship between receipt of increasing proportions of balanced fluids and in-hospital mortality. Three hundred sixty U.S. hospitals that were members of the Premier Healthcare alliance between November 2005 and December 2010. A total of 53,448 patients with sepsis, treated with vasopressors and crystalloids in an ICU by hospital day 2 including 3,396 (6.4%) that received balanced fluids. None. Patients treated with balanced fluids were younger and less likely to have heart or chronic renal failure, but they were more likely to receive mechanical ventilation, invasive monitoring, colloids, steroids, and larger crystalloid volumes (median 7 vs 5 L). Among 6,730 patients in a propensity-matched cohort, receipt of balanced fluids was associated with lower in-hospital mortality (19.6% vs 22.8%; relative risk, 0.86; 95% CI, 0.78, 0.94). Mortality was progressively lower among patients receiving larger proportions of balanced fluids. There were no significant differences in the prevalence of acute renal failure (with and without dialysis) or in-hospital and ICU lengths of stay. Among critically ill adults with sepsis, resuscitation with balanced fluids was associated with a lower risk of in-hospital mortality. If

  1. Guidelines for clinical engineering programs--Part III: the risk of electrical shock in hospitals; Part IV: isolated power in anesthetizing locations? History of an appeal.

    PubMed

    Ridgway, M

    1981-01-01

    This four-part series presents guidelines for: electrically isolated inputs and outputs; measuring the performance of hospital biomedical engineering programs; evaluation the risk of electric shock in hospitals; and for isolated power in anesthetizing locations. Parts I and II, covering the first two topics above, were published in the Oct.-Dec. 1980 issue of this Journal. Part III constitutes an attempt to place the risk of electric shock in hospitals in a quantitative perspective. Arguments are presented that indicate that electrical safety precautions usually take up a larger share of the hospital's biomedical equipment safety budget than is justified by the actual hazard levels. Part IV reviews the need for isolated power in anesthetizing locations. Three independently proposed revisions to the 1973 edition of NFPA Standard 56A would have significantly simplified the safety requirements for hospital anesthetizing locations (a) by reducing the area in flammable locations classified as hazardous to the internationally accepted "zone of risk," and (b) by permitting the use of conventional electrical power rather than isolated power in locations where the risk of electrical accidents can be shown to be no greater than it is in other areas of the hospital. Despite extensive technical testimony supported with substantial supporting documentation, the revisions were vetoed by the Technical Committee after they were voted into the document by a floor vote of the general membership attending the NFPA Annual Meeting in Anaheim in 1978. The chronology of the major events surrounding the subsequent appeal of this veto is traced back to 1974, and an analysis is presented of what are considered to be shortcomings in the NFPA appeals process revealed by this particular case history.

  2. Short versus long hospitalization: a propspective controlled study. IV. One-year follow-up results for schizophrenie patients.

    PubMed

    Glick, I D; Hargreaves, W A; Drues, J; Showstack, J A

    1976-05-01

    The authors compared treatment results for 141 schizophrenic patients randomly assigned to short-term or long-term hospitalization. Test results indicated that the long-term group was functioning significantly better one year after admission according to global measures only. The authors caution that the differences between the two groups, although statistically reliable, were modest and may have been confounded by the amount of psychotherapy the patients received after hospitalization. Although there appears to be a general advantage to the long-term approach, further work will be needed to identify patient subgroups for whom this more expensive treatment is cost effective.

  3. Predominance of SCCmec types IV and V among biofilm producing device-associated Staphylococcus aureus strains isolated from tertiary care hospitals in Mysuru, India.

    PubMed

    Halebeedu Prakash, Pradeep; Rajan, Vineeth; Gopal, Shubha

    2017-04-01

    Device associated infections caused by Staphylococcus aureus in hospitalised patients is a serious healthcare problem. The present study was designed to determine the prevalence of biofilm-producing MRSA in device-associated infections. Device-associated S. aureus strains (n=200) obtained from two tertiary care hospitals in Mysuru city, India were screened for biofilm production, antibiotic resistance, Panton-Valentine Leucocidin genes, SCCmec-types, spa-types, and intercellular adhesion (icaAD) dependent and independent genes. The efficacy of antibiotics (linezolid, vancomycin and rifampicin) on biofilms was studied using MTT assay, and the results were correlated with the occurrence of ica-dependent and independent factors. Multidrug resistance was observed in 155 strains (77.5%), and 124 strains (62%) were identified as biofilm producers. Methicillin resistance was identified in 145 strains (72.5%), and SCCmec typing of these isolates revealed high prevalence of type IV and type V. They also showed increased prevalence of pvl gene. icaAD was identified in 65 isolates, with 37 isolates showing both icaAD and ica-independent genes. spa types t852 and t657 were predominantly observed in MRSA isolates. Those isolates that had both ica-dependent and ica-independent genes showed more resistance to the screened antibiotics than the ica-dependent alone. This study reports a high prevalence of SCCmec type IV and V in biofilm producing S. aureus strains isolated from device-associated infections. Increased prevalence of pvl in SCCmec types IV and V strains suggests the role of community associated S. aureus in device-associated infections. The simultaneous presence of ica-dependent and independent genes increased the antibiotic resistance in established biofilms. Thus, S. aureus on medical devices is a potential risk for patients. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  4. Welding IV.

    ERIC Educational Resources Information Center

    Allegheny County Community Coll., Pittsburgh, PA.

    Instructional objectives and performance requirements are outlined in this course guide for Welding IV, a competency-based course in advanced arc welding offered at the Community College of Allegheny County to provide students with proficiency in: (1) single vee groove welding using code specifications established by the American Welding Society…

  5. Welding IV.

    ERIC Educational Resources Information Center

    Allegheny County Community Coll., Pittsburgh, PA.

    Instructional objectives and performance requirements are outlined in this course guide for Welding IV, a competency-based course in advanced arc welding offered at the Community College of Allegheny County to provide students with proficiency in: (1) single vee groove welding using code specifications established by the American Welding Society…

  6. IVS Organization

    NASA Technical Reports Server (NTRS)

    2004-01-01

    International VLBI Service (IVS) is an international collaboration of organizations which operate or support Very Long Baseline Interferometry (VLBI) components. The goals are: To provide a service to support geodetic, geophysical and astrometric research and operational activities. To promote research and development activities in all aspects of the geodetic and astrometric VLBI technique. To interact with the community of users of VLBI products and to integrate VLBI into a global Earth observing system.

  7. Oral gemifloxacin once daily for 5 days compared with sequential therapy with i.v. ceftriaxone/oral cefuroxime (maximum of 10 days) in the treatment of hospitalized patients with acute exacerbations of chronic bronchitis.

    PubMed

    Wilson, R; Langan, C; Ball, P; Bateman, K; Pypstra, R

    2003-03-01

    In a randomized, open-label, controlled, multicentre study, the clinical and bacteriological efficacy, safety and tolerability of oral gemifloxacin (320 mg once daily, 5 days) was compared with sequential intravenous (i.v.) ceftriaxone (1 g once daily, maximum 3 days) followed by oral cefuroxime axetil (500 mg twice daily, maximum 7 days) in adult hospitalized patients with acute exacerbations of chronic bronchitis (AECB) (n = 274). The clinical success rates at follow-up (21-28 days post-therapy) in the clinical per-protocol population (the primary endpoint) were 86.8% (105/121) for gemifloxacin vs. 81.3% (91/112) for ceftriaxone/cefuroxime (treatment difference = 5.5,95% CI -3.9,14.9). The corresponding clinical results in the clinical intention-to-treat (ITT) population were 82.6% (114/138) vs. 72.1% (98/136), respectively (treatment difference = 10.5,95% CI 0.7, 20.4).Thus, gemifloxacin had significantly higher clinical success rates than ceftriaxone/cefuroxime. The median time to discharge was 9 days in the gemifloxacin group vs. 11 days in the ceftriaxone/cefuroxime group (P = 0.04, Wilcoxon test). At follow-up, 120/138 (87.0%) gemifloxacin-treated patients had been discharged from hospital, compared with 111/136 (81.6%) ceftriaxone/cefuroxime-treated patients in the clinical ITT population. Both treatments were generally well tolerated and there was no significant difference between the treatment groups in the incidence or type of adverse events reported. A 5-day course of oral gemifloxacin was shown by this study to be at least equivalent to sequential i.v. ceftriaxone/cefuroxime axetil (for up to 10 days) in patients with AECB who require hospital treatment.

  8. Hospitalizations for Accidents and Induries in the U.S. Navy. IV. A Comparison of Nuclear and Conventionally Powered Surface Ships.

    DTIC Science & Technology

    1986-04-01

    particular hazards associated with each occupation and work environment , and...accidental injury-related hospitalizations as a function of the work environment , determining if duty aboard nuclear powered ships was more or less hazardous than duty aboard conventionally powered ships of the same type.

  9. Airborne infection in a fully air-conditioned hospital. IV. Airborne dispersal of Staphylococcus aureus and its nasal acquisition by patients.

    PubMed Central

    Lidwell, O. M.; Brock, B.; Shooter, R. A.; Cooke, E. M.; Thomas, G. E.

    1975-01-01

    Studies in a newly built hospital furnished with complete air conditioning where most of the patients are nursed in 6-bed rooms showed that the transfer of air from one patient room to another was very small, especially when there was substantial flow of air in a consistent direction between the patient rooms and the corridor, and that the direct transfer of airborne particles was even less. There was, however, no evidence of any reduction in the rates of nasal acquisition of Staphylococcus aureus compared with those to be found in naturally ventilated hospitals. The numbers of Staph. aureus found in the air of a given room that appeared to have originated from patient carriers in other rooms were many times greater than could be accounted for by direct airborne transfer. Although there was evidence that many carriers were not detected, detailed study showed that this excess transfer to the air of other rooms was genuine. It seems probable on the basis of investigations in this hospital and elsewhere that this excess transfer occurs indirectly, through dispersal from the clothing of the nursing and medical staff into the air of another room of strains with which their outer clothes have become contaminated while dealing with patients. Reduction in direct airborne transfer of micro-organisms from one room to another, whether by ventilation or other means, can only be of clinical advantage if transfer by other routes is, or can be made, less than that by the direct airborne route. PMID:1059710

  10. Characterization of PVL/ACME-positive methicillin-resistant Staphylococcus aureus (genotypes ST8-MRSA-IV and ST5-MRSA-II) isolated from a university hospital in Japan.

    PubMed

    Kawaguchiya, Mitsuyo; Urushibara, Noriko; Yamamoto, Dai; Yamashita, Toshiharu; Shinagawa, Masaaki; Watanabe, Naoki; Kobayashi, Nobumichi

    2013-02-01

    The ST8 methicillin-resistant Staphylococcus aureus (MRSA) with Staphylococcal cassette chromosome mec (SCCmec) type IVa, known as USA300, is a prevalent community-acquired MRSA (CA-MRSA) clone in the United States and has been spreading worldwide. The USA300 characteristically harbors Panton-Valentine Leukocidin (PVL) genes and the arginine catabolic mobile element (ACME, type I). Prevalence and molecular characteristics of PVL(+) and/or ACME(+) S. aureus were investigated in a university hospital located in northern Japan, for 1,366 S. aureus isolates, including 601 MRSA strains derived from clinical specimens collected from 2008 to 2010. The PVL gene was identified in three MRSA strains with SCCmec IV, which belonged to ST8, spa type t008, coagulase type III, and agr type I. Two PVL-positive MRSA strains had also type I ACME, and were isolated from skin abscess of outpatients who have not travelled abroad recently. One of these PVL(+)/ACME(+) strains carried tet(K), msrA, and aph(3')-IIIa, showing resistance to kanamycin, tetracycline, erythromycin, and ciprofloxacin, suggesting acquisition of more resistance than ST8 CA-MRSA reported in Japan previously. In contrast, another PVL(+)/ACME(+) strain and a PVL(+)/ACME(-) strain were susceptible to more antimicrobials and had less virulence factors than PVL(-)/ACME(+) MRSA strains. Besides the two PVL(+) MRSA strains, ACME (type-ΔII) was identified into seven MRSA strains with SCCmec II belonging to ST5, one of the three spa types (t002, t067, and t071), coagulase type II, and agr type II. These PVL(-)/ACME(+) MRSA strains showed multiple drug resistance and harbored various toxin genes as observed for ST5 PVL(-)/ACME(-) MRSA-II. The present study suggested the spread of ST8-MRSA-IV in northern Japan, and a potential significance of ACME-positive ST5-MRSA-II as an emerging MRSA clone in a hospital.

  11. Comparison of the Mortality Probability Admission Model III, National Quality Forum, and Acute Physiology and Chronic Health Evaluation IV hospital mortality models: implications for national benchmarking*.

    PubMed

    Kramer, Andrew A; Higgins, Thomas L; Zimmerman, Jack E

    2014-03-01

    To examine the accuracy of the original Mortality Probability Admission Model III, ICU Outcomes Model/National Quality Forum modification of Mortality Probability Admission Model III, and Acute Physiology and Chronic Health Evaluation IVa models for comparing observed and risk-adjusted hospital mortality predictions. Retrospective paired analyses of day 1 hospital mortality predictions using three prognostic models. Fifty-five ICUs at 38 U.S. hospitals from January 2008 to December 2012. Among 174,001 intensive care admissions, 109,926 met model inclusion criteria and 55,304 had data for mortality prediction using all three models. None. We compared patient exclusions and the discrimination, calibration, and accuracy for each model. Acute Physiology and Chronic Health Evaluation IVa excluded 10.7% of all patients, ICU Outcomes Model/National Quality Forum 20.1%, and Mortality Probability Admission Model III 24.1%. Discrimination of Acute Physiology and Chronic Health Evaluation IVa was superior with area under receiver operating curve (0.88) compared with Mortality Probability Admission Model III (0.81) and ICU Outcomes Model/National Quality Forum (0.80). Acute Physiology and Chronic Health Evaluation IVa was better calibrated (lowest Hosmer-Lemeshow statistic). The accuracy of Acute Physiology and Chronic Health Evaluation IVa was superior (adjusted Brier score = 31.0%) to that for Mortality Probability Admission Model III (16.1%) and ICU Outcomes Model/National Quality Forum (17.8%). Compared with observed mortality, Acute Physiology and Chronic Health Evaluation IVa overpredicted mortality by 1.5% and Mortality Probability Admission Model III by 3.1%; ICU Outcomes Model/National Quality Forum underpredicted mortality by 1.2%. Calibration curves showed that Acute Physiology and Chronic Health Evaluation performed well over the entire risk range, unlike the Mortality Probability Admission Model and ICU Outcomes Model/National Quality Forum models. Acute

  12. Asteroids IV

    NASA Astrophysics Data System (ADS)

    Michel, Patrick; DeMeo, Francesca E.; Bottke, William F.

    . Asteroids, like planets, are driven by a great variety of both dynamical and physical mechanisms. In fact, images sent back by space missions show a collection of small worlds whose characteristics seem designed to overthrow our preconceived notions. Given their wide range of sizes and surface compositions, it is clear that many formed in very different places and at different times within the solar nebula. These characteristics make them an exciting challenge for researchers who crave complex problems. The return of samples from these bodies may ultimately be needed to provide us with solutions. In the book Asteroids IV, the editors and authors have taken major strides in the long journey toward a much deeper understanding of our fascinating planetary ancestors. This book reviews major advances in 43 chapters that have been written and reviewed by a team of more than 200 international authorities in asteroids. It is aimed to be as comprehensive as possible while also remaining accessible to students and researchers who are interested in learning about these small but nonetheless important worlds. We hope this volume will serve as a leading reference on the topic of asteroids for the decade to come. We are deeply indebted to the many authors and referees for their tremendous efforts in helping us create Asteroids IV. We also thank the members of the Asteroids IV scientific organizing committee for helping us shape the structure and content of the book. The conference associated with the book, "Asteroids Comets Meteors 2014" held June 30-July 4, 2014, in Helsinki, Finland, did an outstanding job of demonstrating how much progress we have made in the field over the last decade. We are extremely grateful to our host Karri Muinonnen and his team. The editors are also grateful to the Asteroids IV production staff, namely Renée Dotson and her colleagues at the Lunar and Planetary Institute, for their efforts, their invaluable assistance, and their enthusiasm; they made life as

  13. Evaluation of the Coulter S-Plus IV three-part differential as a screening tool in a tertiary care hospital.

    PubMed

    Miers, M K; Fogo, A B; Federspiel, C F; McAllister, N W; Phillips, P A; Cousar, J B

    1987-06-01

    The Coulter S-Plus IV separates leukocytes in peripheral blood by volume analysis into granulocytes, lymphocytes, and mononuclear cell fractions, the so-called three-part differential (3PD). White blood cell (WBC) counts, hemoglobin concentrations, platelet counts, 3PDs, and histograms were compared with smear differentials on 3,861 samples, including samples from oncology patients, to determine the predictive value of the Coulter parameters in detecting smear abnormalities. Results showed good correlation between the 3PD and smear differential for granulocytes and lymphocytes (correlation coefficients were 0.883 and 0.868, respectively) and poor correlation for mononuclear cells (0.492). No histogram region flag indicators were observed in the following samples: 15 of 40 samples with greater than or 1% blasts; 105 of 183 with greater than or 1 nucleated red blood cell (NRBC) per 100 WBCs; 65 of 113 with monocytosis greater than 1,600/microL (1.6 X 10(9)/L); 425 of 548 with greater than 2,000 bands/microL (2.0 X 10(9)/L); 84 of 112 with eosinophilia greater than 600/microL (0.6 X 10(9)L); and 88 of 149 with greater than 2% immature granulocytes. All samples with greater than 5% blasts were indicated by region flags and abnormal histograms. Oncology patient data were analyzed, yielding similar results. The authors established guidelines for using the Coulter 3PD data in their tertiary care laboratory to select samples that require smear evaluation.

  14. Prevalence of plasmid-mediated quinolone resistance and mutations in the gyrase and topoisomerase IV genes in Salmonella isolated from 12 tertiary-care hospitals in Korea.

    PubMed

    Jeong, Haeng Soon; Kim, Jeong A; Shin, Jeong Hwan; Chang, Chulhun L; Jeong, Joseph; Cho, Ji-Hyun; Kim, Mi-Na; Kim, Sunjoo; Kim, Young Ree; Lee, Chae Hoon; Lee, Kyungwon; Lee, Mi Ae; Lee, Wee Gyo; Shin, Jong Hee; Lee, Jeong Nyeo

    2011-12-01

    The aim of this study was to investigate the prevalence of plasmid-mediated quinolone resistance (PMQR) and mutations in quinolone resistance-determining regions (QRDRs) of Salmonella and their association with fluoroquinolone susceptibility in Korea. A total of 284 nonduplicated clinical isolates of Salmonella were collected from various clinical specimens at 12 tertiary-care hospitals in Korea. The qnrA, qnrB, and qnrS genes were detected by multiplex polymerase chain reaction (PCR). The qepA and aac(6')-Ib-cr genes were amplified by PCR. The QRDRs of gyrA, gyrB, parC, and parE were amplified by PCR from the DNA of selected nalidixic acid-resistant and qnr-positive isolates. We detected six qnr-positive Salmonella (four qnrS1 and two qnrB19) and one aac(6')-Ib-cr-positive strain. A mutation in the QRDR of gyrA only (N=46) was the most common, followed by gyrA+parC (N=9), parC (N=7), gyrA+parE (N=3), parC+parE (N=3), gyrA+gyrB (N=2), and parE (N=1). There were seven novel mutations in the QRDR regions of gyrB, parC, and parE. Six of seven PMQR-positive isolates had high-level resistance to nalidixic acid, and all six strains had reduced susceptibility to ciprofloxacin. One qnrS1-positive isolate was resistant to ciprofloxacin, norfloxacin, and nalidixic acid. The resistant rates to nalidixic acid, ciprofloxacin, norfloxacin, and levofloxacin were 49.3%, 1.1%, 0.7%, and 0.4%, respectively. We report the first detection of PMQR in Salmonella isolates from Korea. It is essential to continue surveillance and to watch for the spread of PMQR in Salmonella for public health control.

  15. Investigation of mutation distribution in DNA gyrase and topoisomerase IV genes in ciprofloxacin-non-susceptible Enterobacteriaceae isolated from blood cultures in a tertiary care university hospital in South Korea, 2005-2010.

    PubMed

    Nam, You Sun; Cho, Sun Young; Yang, Hee Young; Park, Kyung Sun; Jang, Ji-Hyun; Kim, Yun-Tae; Jeong, Joo-Won; Suh, Jin-Tae; Lee, Hee Joo

    2013-02-01

    This study investigated the distribution of mutations in DNA gyrase (gyrA and gyrB) and topoisomerase IV (parC and parE) genes and compared the distribution of these mutations with the distribution of plasmid-mediated quinolone resistance (PMQR) genes and extended-spectrum β-lactamase (ESBL) production in 101 ciprofloxacin-non-susceptible Enterobacteriaceae from blood culture isolates (80 Escherichia coli and 21 Klebsiella pneumoniae) isolated in Kyung Hee University Hospital, a tertiary care university hospital in Seoul, South Korea. Among the 101 isolates, 80 (79.2%) contained PMQR genes and 28 (27.7%) produced ESBL. Mutations in the gyrA and parC genes were observed more frequently than in the gyrB and parE genes as well as more frequently in E. coli than in K. pneumoniae isolates, even in the same ciprofloxacin minimum inhibitory concentration (MIC) range of the two species. In E. coli isolates, the distribution of the codon 529 mutation (Ile→Leu) in parE was increased with an increase in the ciprofloxacin MIC. An increase in high-level resistance to quinolones may occur with double mutations compared with a single mutation in gyrA as well as with additional mutations in parC. However, this finding could not be applied to ciprofloxacin-resistant K. pneumoniae. A higher level of quinolone resistance may be correlated with an additional mutation in parE, especially Ile529→Leu. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  16. Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain.

    PubMed

    Hansen, Ryan N; Pham, An T; Lovelace, Belinda; Balaban, Stela; Wan, George J

    2017-10-01

    Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07). Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

  17. Predicting mortality rates: Comparison of an administrative predictive model (hospital standardized mortality ratio) with a physiological predictive model (Acute Physiology and Chronic Health Evaluation IV)--A cross-sectional study.

    PubMed

    Toua, Rene Elaine; de Kock, Jacques Erasmus; Welzel, Tyson

    2016-02-01

    Direct comparison of mortality rates has limited value because most deaths are due to the disease process. Predicting the risk of death accurately remains a challenge. A cross-sectional study compared the expected mortality rate as calculated with an administrative model to a physiological model, Acute Physiology and Chronic Health Evaluation IV. The combined cohort and stratified samples (<0.1, 0.1-0.5, or >0.5 predicted mortality) were considered. A total of 47,982 patients were scored from 1 July 2013 to 30 June 2014, and 46,061 records were included in the analysis. A moderate correlation was shown for the combined cohort (Pearson correlation index, 0.618; 95% confidence interval [CI], 0.380-0.779; R(2) = 0.38). A very good correlation for the less than 10% stratum (Pearson correlation index, 0.884; R(2) = 0.78; 95% CI, 0.79-0.937) and a moderate correlation for 0.1 to 0.5 predicted mortality rates (Pearson correlation index, 0.782; R(2) = 0.61; 95% CI, 0.623-0.879). There was no significant positive correlation for the greater than 50% predicted mortality stratum (Pearson correlation index, 0.087; R(2) = 0.007; 95% CI, -0.23 to 0.387). At less than 0.1, the models are interchangeable, but in spite of a moderate correlation, greater than 0.1 hospital standardized mortality ratio cannot be used to predict mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Intelligent Virtual Station (IVS)

    NASA Technical Reports Server (NTRS)

    2002-01-01

    The Intelligent Virtual Station (IVS) is enabling the integration of design, training, and operations capabilities into an intelligent virtual station for the International Space Station (ISS). A viewgraph of the IVS Remote Server is presented.

  19. Intelligent Virtual Station (IVS)

    NASA Technical Reports Server (NTRS)

    2002-01-01

    The Intelligent Virtual Station (IVS) is enabling the integration of design, training, and operations capabilities into an intelligent virtual station for the International Space Station (ISS). A viewgraph of the IVS Remote Server is presented.

  20. Ovarian Cancer Stage IV

    MedlinePlus

    ... hyphen, e.g. -historical Searches are case-insensitive Ovarian Cancer Stage IV Add to My Pictures View /Download : ... 1200x1335 View Download Large: 2400x2670 View Download Title: Ovarian Cancer Stage IV Description: Drawing of stage IV shows ...

  1. Improving Detection of IV Infiltrates in Neonates

    PubMed Central

    Driscoll, MD, Colleen; Langer, Melissa; Burke, Susan; El Metwally, MD, Dina

    2015-01-01

    Neonates and infants in the neonatal intensive care unit suffer significant morbidity when intravenous (IV) catheters infiltrate. The underreporting of adverse events through hospital voluntary reporting systems, such as ours, can complicate the monitoring of low incidence events, like IV infiltrates. Based on severe cases of IV infiltrates observed in our neonatal intensive care unit, we attempted to improve the detection of all infiltrates and reduce the incidence of Stage 4 infiltrates. We developed, and initiated the use of, an evidence-based guideline for the improved surveillance, prevention, and management of IV infiltrates, with corresponding educational interventions for faculty and staff. We instituted the use of a checklist for compliance with guidelines, and as a mechanism of surveillance. The baseline incidence rate of IV infiltrates, determined by the voluntary reporting system, was 5 per 1000 line days. Following initiation of the guidelines and checklist, the IV infiltrate rate increased to 9 per 1000 line days. In most months, the detection of IV infiltrates was improved by use of the checklist. During the post-intervention period the rate of Stage 4 infiltrates, as measured by usage of nitroglycerin ointment, was significantly reduced. In conclusion, the detection of IV infiltrates was improved following our quality improvement interventions. Further, use of an evidence-based guideline for managing infiltrates may reduce the most severe infiltrate injuries. PMID:26734388

  2. Energy levels and lifetimes of Nd IV, Pm IV, Sm IV, and Eu IV

    SciTech Connect

    Dzuba, V. A.; Safronova, U. I.; Johnson, W. R.

    2003-09-01

    To address the shortage of experimental data for electron spectra of triply ionized rare-earth elements we have calculated energy levels and lifetimes of 4f{sup n+1} and 4f{sup n}5d configurations of Nd IV (n=2), Pm IV (n=3), Sm IV (n=4), and Eu IV (n=5) using Hartree-Fock and configuration-interaction methods. To control the accuracy of our calculations we also performed similar calculations for Pr III, Nd III, and Sm III, for which experimental data are available. The results are important, in particular, for physics of magnetic garnets.

  3. Using PLATO IV.

    ERIC Educational Resources Information Center

    Meller, David V.

    This beginning reference manual describes PLATO IV hardware for prospective users and provides an introduction to PLATO for new authors. The PLATO terminal is described in detail in Chapter 1. Chapter 2 provides a block diagram of the PLATO IV system. Procedures for getting on line are described in Chapter 3, and Chapter 4 provides references to…

  4. IV treatment at home

    MedlinePlus

    ... 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 ...

  5. GCF Mark IV development

    NASA Technical Reports Server (NTRS)

    Mortensen, L. O.

    1982-01-01

    The Mark IV ground communication facility (GCF) as it is implemented to support the network consolidation program is reviewed. Changes in the GCF are made in the area of increased capacity. Common carrier circuits are the medium for data transfer. The message multiplexing in the Mark IV era differs from the Mark III era, in that all multiplexing is done in a GCF computer under GCF software control, which is similar to the multiplexing currently done in the high speed data subsystem.

  6. [Secondary Alveolar Bone Grafting in Orofacial Cleft: A Survey of a Portuguese Tertiary Hospital].

    PubMed

    Costa, Ana Isabel; Morgado, Hélder; Mariz, Carlos; Estevão-Costa, José Manuel

    2016-03-01

    Introdução: A fenda lábio-palatina é a malformação congénita craniofacial mais frequente. Na presença de defeito ósseo, a técnica de enxerto ósseo alveolar secundário é o método de correção mais consensual entre os autores. Neste estudo avalia-se o resultado da aplicação desta técnica num hospital terciário. Material e Métodos: Análise dos enxertos ósseos alveolares secundários realizados entre 2007 e 2014, sendo incluídos os casos em que a crista ilíaca foi a região dadora e em que a informação clínica e imagiológica estava completa. A eficácia da intervenção foi avaliada radiologicamente com recurso à escala de Bergland (tipo I-IV), e correlacionada com variáveis associadas à patologia e/ou correção cirúrgica. Resultados: Dos 32 enxertos ósseos alveolares secundários realizados, 29 cumpriam os critérios de inclusão: 13 casos (44,8%) correspondiam a fendas pré-forâmen unilaterais completas; quatro (13,8%) a fendas pré-forâmen bilaterais completas; oito (27,6%) a fendas transforâmen unilaterais e quatro (13,8%) a fendas transforâmen bilaterais. Pela escala de Bergland (aplicada com um seguimento médio de 8 ± 5 meses), seis eram do tipo I, 15 do tipo II, cinco de tipo III e três do tipo IV. Não foi encontrada associação entre a eficácia da intervenção cirúrgica e o tipo de fenda lábio-palatina, presença do incisivo e fase de erupção do canino. Cinco doentes foram submetidos a novo enxerto ósseo alveolar (três tipo II e dois tipo III na avaliação inicial). Discussão: Na presente série, o enxerto ósseo alveolar foi eficaz na maioria dos doentes (72%, tipo I e II), independentemente do tipo de fenda lábio-palatina. A proporção de falências (10,3%) e a necessidade ulterior de reintervenção (17%) foram relativamente altas justificando o seguimento a longo-prazo e a continuação deste estudo. Conclusão: Importa realçar o envolvimento multidisciplinar para identificação atempada do momento

  7. Interplanetary Type IV Bursts

    NASA Astrophysics Data System (ADS)

    Hillaris, A.; Bouratzis, C.; Nindos, A.

    2016-08-01

    We study the characteristics of moving type IV radio bursts that extend to hectometric wavelengths (interplanetary type IV or type {IV}_{{IP}} bursts) and their relationship with energetic phenomena on the Sun. Our dataset comprises 48 interplanetary type IV bursts observed with the Radio and Plasma Wave Investigation (WAVES) instrument onboard Wind in the 13.825 MHz - 20 kHz frequency range. The dynamic spectra of the Radio Solar Telescope Network (RSTN), the Nançay Decametric Array (DAM), the Appareil de Routine pour le Traitement et l' Enregistrement Magnetique de l' Information Spectral (ARTEMIS-IV), the Culgoora, Hiraso, and the Institute of Terrestrial Magnetism, Ionosphere and Radio Wave Propagation (IZMIRAN) Radio Spectrographs were used to track the evolution of the events in the low corona. These were supplemented with soft X-ray (SXR) flux-measurements from the Geostationary Operational Environmental Satellite (GOES) and coronal mass ejections (CME) data from the Large Angle and Spectroscopic Coronagraph (LASCO) onboard the Solar and Heliospheric Observatory (SOHO). Positional information of the coronal bursts was obtained by the Nançay Radioheliograph (NRH). We examined the relationship of the type IV events with coronal radio bursts, CMEs, and SXR flares. The majority of the events (45) were characterized as compact, their duration was on average 106 minutes. This type of events was, mostly, associated with M- and X-class flares (40 out of 45) and fast CMEs, 32 of these events had CMEs faster than 1000 km s^{-1}. Furthermore, in 43 compact events the CME was possibly subjected to reduced aerodynamic drag as it was propagating in the wake of a previous CME. A minority (three) of long-lived type {IV}_{{IP}} bursts was detected, with durations from 960 minutes to 115 hours. These events are referred to as extended or long duration and appear to replenish their energetic electron content, possibly from electrons escaping from the corresponding coronal

  8. Comparative Analysis of Length of Stay and Inpatient Costs for Orthopedic Surgery Patients Treated with IV Acetaminophen and IV Opioids vs. IV Opioids Alone for Post-Operative Pain.

    PubMed

    Hansen, Ryan N; Pham, An; Strassels, Scott A; Balaban, Stela; Wan, George J

    2016-09-01

    Recovery from orthopedic surgery is oriented towards restoring functional health outcomes while reducing hospital length of stay (LOS) and medical expenditures. Optimal pain management is a key to reaching these objectives. We sought to compare orthopedic surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia to those who received IV opioids alone and compared the two groups on LOS and hospitalization costs. We performed a retrospective analysis of the Premier Database (Premier, Inc.; between January 2009 and June 2015) comparing orthopedic surgery patients who received post-operative pain management with combination IV acetaminophen and IV opioids to those who received only IV opioids starting on the day of surgery and continuing up to the second post-operative day. The quarterly rate of IV acetaminophen use for all hospitalizations by hospital served as the instrumental variable in two-stage least squares regressions controlling for patient and hospital covariates to compare the LOS and hospitalization costs of IV acetaminophen recipients to opioid monotherapy patients. We identified 4,85,895 orthopedic surgery patients with 1,74,805 (36%) who had received IV acetaminophen. Study subjects averaged 64 years of age and were predominantly non-Hispanic Caucasians (78%) and female (58%). The mean unadjusted LOS for IV acetaminophen patients was 3.2 days [standard deviation (SD) 2.6] compared to 3.9 days (SD 3.9) with only IV opioids (P < 0.0001). Average unadjusted hospitalization costs were $19,024.9 (SD $13,113.7) for IV acetaminophen patients and $19,927.6 (SD $19,578.8) for IV opioid patients (P < 0.0001). These differences remained statistically significant in our instrumental variable models, with IV acetaminophen associated with 0.51 days shorter hospitalization [95% confidence interval (CI) -0.58 to -0.44, P < 0.0001] and $634.8 lower hospitalization costs (95% CI -$1032.5 to -$237.1, P = 0.0018). Compared

  9. Nurses' acceptance of Smart IV pump technology.

    PubMed

    Carayon, Pascale; Hundt, Ann Schoofs; Wetterneck, Tosha B

    2010-06-01

    "Smart" intravenous infusion pumps (Smart IV pumps) are increasingly being implemented in hospitals to reduce medication administration errors. This study examines nurses' experience with the implementation and use of a Smart IV pump in an academic hospital. Data were collected in three longitudinal surveys: (a) a pre-implementation survey, (b) a 6-week-post-implementation survey, and (c) a 1-year-post-implementation survey. We examined: (a) the technology implementation process, (b) technical performance of the pump, (c) usability of the pump, and (d) user acceptance of the pump. Initially, nurses had a somewhat positive acceptance of the Smart IV pump technology that significantly increased one year after implementation. User experiences associated with the pump in general improved over time, especially perceptions of pump efficiency. However, user experience with the pump implementation process and pump technical performance did not consistently improve from the pre-implementation survey to the post-implementation survey. Several characteristics of pump technical performance and usability influenced user acceptance at the one-year post-implementation survey. These data may be useful for other institutions to guide implementation and post-implementation follow-up of IV pump use; other institutions could use the survey instrument from this study to evaluate nurses' perceptions of the technology. Our study identified several characteristics of the implementation process that other institutions may need to pay attention to (e.g., sharing information about the implementation process with nurses). Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  10. Nurses’ Acceptance of Smart IV Pump Technology

    PubMed Central

    Carayon, Pascale; Hundt, Ann Schoofs; Wetterneck, Tosha B.

    2010-01-01

    Background “Smart” intravenous infusion pumps (Smart IV pumps) are increasingly being implemented in hospitals to reduce medication administration errors. Objectives This study examines nurses’ experience with the implementation and use of a Smart IV pump in an academic hospital. Method Data were collected in three longitudinal surveys: (a) a pre-implementation survey, (b) a 6-week-post-implementation survey, and (c) a 1-year-post-implementation survey. We examined: (a) the technology implementation process, (b) technical performance of the pump, (c) usability of the pump, and (d) user acceptance of the pump. Results Initially, nurses had a somewhat positive acceptance of the Smart IV pump technology that significantly increased one year after implementation. User experiences associated with the pump in general improved over time, especially perceptions of pump efficiency. However, user experience with the pump implementation process and pump technical performance did not consistently improve from the pre-implementation survey to the post-implementation survey. Several characteristics of pump technical performance and usability influenced user acceptance at the one-year post-implementation survey. Discussion These data may be useful for other institutions to guide implementation and post-implementation follow-up of IV pump use; other institutions could use the survey instrument from this study to evaluate nurses’ perceptions of the technology. Our study identified several characteristics of the implementation process that other institutions may need to pay attention to (e.g., sharing information about the implementation process with nurses). PMID:20219423

  11. The PLATO IV Architecture.

    ERIC Educational Resources Information Center

    Stifle, Jack

    The PLATO IV computer-based instructional system consists of a large scale centrally located CDC 6400 computer and a large number of remote student terminals. This is a brief and general description of the proposed input/output hardware necessary to interface the student terminals with the computer's central processing unit (CPU) using available…

  12. PLATO IV Accountancy Index.

    ERIC Educational Resources Information Center

    Pondy, Dorothy, Comp.

    The catalog was compiled to assist instructors in planning community college and university curricula using the 48 computer-assisted accountancy lessons available on PLATO IV (Programmed Logic for Automatic Teaching Operation) for first semester accounting courses. It contains information on lesson access, lists of acceptable abbreviations for…

  13. Little Jiffy, Mark IV

    ERIC Educational Resources Information Center

    Kaiser, Henry F.; Rice, John

    1974-01-01

    In this paper three changes and one new development for the method of exploratory factor analysis (a second generation Little Jiffy) developed by Kaiser are described. Following this short description a step-by-step computer algorithm of the revised method, dubbed Little Jiffy, Mark IV is presented. (MP)

  14. IVS Technology Coordinator Report

    NASA Technical Reports Server (NTRS)

    Whitney, Alan

    2013-01-01

    This report of the Technology Coordinator includes the following: 1) continued work to implement the new VLBI2010 system, 2) the 1st International VLBI Technology Workshop, 3) a VLBI Digital- Backend Intercomparison Workshop, 4) DiFX software correlator development for geodetic VLBI, 5) a review of progress towards global VLBI standards, and 6) a welcome to new IVS Technology Coordinator Bill Petrachenko.

  15. Enhanced Design Alternative IV

    SciTech Connect

    N. E. Kramer

    1999-05-18

    This report evaluates Enhanced Design Alternative (EDA) IV as part of the second phase of the License Application Design Selection (LADS) effort. The EDA IV concept was compared to the VA reference design using criteria from the ''Design Input Request for LADS Phase II EDA Evaluations'' (CRWMS M&O 1999b) and (CRWMS M&O 1999f). Briefly, the EDA IV concept arranges the waste packages close together in an emplacement configuration known as ''line load''. Continuous pre-closure ventilation keeps the waste packages from exceeding the 350 C cladding and 200 C (4.3.13) drift wall temperature limits. This EDA concept keeps relatively high, uniform emplacement drift temperatures (post-closure) to drive water away from the repository and thus dry out the pillars between emplacement drifts. The waste package is shielded to permit human access to emplacement drifts and includes an integral filler inside the package to reduce the amount of water that can contact the waste form. Closure of the repository is desired 50 years after first waste is emplaced. Both backfill and a drip shields will be emplaced at closure to improve post-closure performance.

  16. A sputnik IV saga

    NASA Astrophysics Data System (ADS)

    Lundquist, Charles A.

    2009-12-01

    The Sputnik IV launch occurred on May 15, 1960. On May 19, an attempt to deorbit a 'space cabin' failed and the cabin went into a higher orbit. The orbit of the cabin was monitored and Moonwatch volunteer satellite tracking teams were alerted to watch for the vehicle demise. On September 5, 1962, several team members from Milwaukee, Wisconsin made observations starting at 4:49 a.m. of a fireball following the predicted orbit of Sputnik IV. Requests went out to report any objects found under the fireball path. An early morning police patrol in Manitowoc had noticed a metal object on a street and had moved it to the curb. Later the officers recovered the object and had it dropped off at the Milwaukee Journal. The Moonwarch team got the object and reported the situation to Moonwatch Headquarters at the Smithsonian Astrophysical Observatory. A team member flew to Cambridge with the object. It was a solid, 9.49 kg piece of steel with a slag-like layer attached to it. Subsequent analyses showed that it contained radioactive nuclei produced by cosmic ray exposure in space. The scientists at the Observatory quickly recognized that measurements of its induced radioactivity could serve as a calibration for similar measurements of recently fallen nickel-iron meteorites. Concurrently, the Observatory directorate informed government agencies that a fragment from Sputnik IV had been recovered. Coincidently, a debate in the UN Committee on Peaceful Uses of Outer Space involved the issue of liability for damage caused by falling satellite fragments. On September 12, the Observatory delivered the bulk of the fragment to the US Delegation to the UN. Two days later, the fragment was used by US Ambassador Francis Plimpton as an exhibit that the time had come to agree on liability for damage from satellite debris. He offered the Sputnik IV fragment to USSR Ambassador P.D. Morozov, who refused the offer. On October 23, Drs. Alla Massevitch and E.K. Federov of the USSR visited the

  17. PMD IVS Analysis Center

    NASA Technical Reports Server (NTRS)

    Tornatore, Vincenza

    2013-01-01

    The main activities carried out at the PMD (Politecnico di Milano DIIAR) IVS Analysis Center during 2012 are briefly higlighted, and future plans for 2013 are sketched out. We principally continued to process European VLBI sessions using different approaches to evaluate possible differences due to various processing choices. Then VLBI solutions were also compared to the GPS ones as well as the ones calculated at co-located sites. Concerning the observational aspect, several tests were performed to identify the most suitable method to achieve the highest possible accuracy in the determination of GNSS (GLOBAL NAVIGATION SATELLITE SYSTEM) satellite positions using the VLBI technique.

  18. Division Iv: Stars

    NASA Astrophysics Data System (ADS)

    Corbally, Christopher; D'Antona, Francesca; Spite, Monique; Asplund, Martin; Charbonnel, Corinne; Docobo, Jose Angel; Gray, Richard O.; Piskunov, Nikolai E.

    2012-04-01

    This Division IV was started on a trial basis at the General Assembly in The Hague 1994 and was formally accepted at the Kyoto General Assembly in 1997. Its broad coverage of ``Stars'' is reflected in its relatively large number of Commissions and so of members (1266 in late 2011). Its kindred Division V, ``Variable Stars'', has the same history of its beginning. The thinking at the time was to achieve some kind of balance between the number of members in each of the 12 Divisions. Amid the current discussion of reorganizing the number of Divisions into a more compact form it seems advisable to make this numerical balance less of an issue than the rationalization of the scientific coverage of each Division, so providing more effective interaction within a particular field of astronomy. After all, every star is variable to a certain degree and such variability is becoming an ever more powerful tool to understand the characteristics of every kind of normal and peculiar star. So we may expect, after hearing the reactions of members, that in the restructuring a single Division will result from the current Divisions IV and V.

  19. 78 FR 2390 - CSOLAR IV South, LLC, Wistaria Ranch Solar, LLC, CSOLAR IV West, LLC, CSOLAR IV North, LLC v...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-11

    ... Energy Regulatory Commission CSOLAR IV South, LLC, Wistaria Ranch Solar, LLC, CSOLAR IV West, LLC, CSOLAR IV North, LLC v. California Independent System Operator Corporation; Notice of Complaint Take notice... IV South, LLC, Wistaria Ranch Solar, LLC, CSOLAR IV West, LLC and CSOLAR IV North, LLC (collectively...

  20. dBASE IV basics

    SciTech Connect

    O`Connor, P.

    1994-09-01

    This is a user`s manual for dBASE IV. dBASE IV is a popular software application that can be used on your personal computer to help organize and maintain your database files. It is actually a set of tools with which you can create, organize, select and manipulate data in a simple yet effective manner. dBASE IV offers three methods of working with the product: (1) control center: (2) command line; and (3) programming.

  1. 77 FR 2500 - Medicaid Program; Disproportionate Share Hospital Payments-Uninsured Definition

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-18

    ... calculating hospital- specific DSH limits. IV. Collection of Information Requirements This document does not...; Disproportionate Share Hospital Payments-- Uninsured Definition AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule addresses the hospital-specific...

  2. Improving IV-A/IV-D Interface. Handbook.

    ERIC Educational Resources Information Center

    National Inst. for Child Support Enforcement, Chevy Chase, MD.

    Effective interface between the Aid to Families with Dependent Children (IV-A) and the Child Support Enforcement (IV-D) programs is a key factor in assisting families in becoming self-sufficient, reducing welfare expenditures, and enforcing parental responsibility to support their children. Consequently, overcoming the procedural, technological,…

  3. Improving IV-A/IV-D Interface. Trainer Guide.

    ERIC Educational Resources Information Center

    National Inst. for Child Support Enforcement, Chevy Chase, MD.

    Effective interface between the Aid to Families with Dependent Children (IV-A) and the Child Support Enforcement (IV-D) programs is a key factor in assisting families in becoming self-sufficient, reducing welfare expenditures, and enforcing parental responsibility to support their children. Consequently, overcoming the procedural, technological,…

  4. Confirmatory Factor Analysis of the WAIS-IV/WMS-IV

    ERIC Educational Resources Information Center

    Holdnack, James A.; Zhou, Xiaobin; Larrabee, Glenn J.; Millis, Scott R.; Salthouse, Timothy A.

    2011-01-01

    The Wechsler Adult Intelligence Scale-fourth edition (WAIS-IV) and the Wechsler Memory Scale-fourth edition (WMS-IV) were co-developed to be used individually or as a combined battery of tests. The independent factor structure of each of the tests has been identified; however, the combined factor structure has yet to be determined. Confirmatory…

  5. Confirmatory Factor Analysis of the WAIS-IV/WMS-IV

    ERIC Educational Resources Information Center

    Holdnack, James A.; Zhou, Xiaobin; Larrabee, Glenn J.; Millis, Scott R.; Salthouse, Timothy A.

    2011-01-01

    The Wechsler Adult Intelligence Scale-fourth edition (WAIS-IV) and the Wechsler Memory Scale-fourth edition (WMS-IV) were co-developed to be used individually or as a combined battery of tests. The independent factor structure of each of the tests has been identified; however, the combined factor structure has yet to be determined. Confirmatory…

  6. [Decrease in hospitalizations due to polyvalent medical day hospital].

    PubMed

    Escobar, M A; García-Egido, A A; Carmona, R; Lucas, A; Márquez, C; Gómez, F

    2012-02-01

    The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. NATIONAL COASTAL CONDITION REPORT IV

    EPA Science Inventory

    The National Coastal Condition Report IV (NCCR IV) is the fourth in a series of environmental assessments of U.S. coastal waters and the Great Lakes. The report includes assessments of all the nation’s estuaries in the contiguous 48 states and Puerto Rico, south-eastern Alaska, ...

  8. NATIONAL COASTAL CONDITION REPORT IV

    EPA Science Inventory

    The National Coastal Condition Report IV (NCCR IV) is the fourth in a series of environmental assessments of U.S. coastal waters and the Great Lakes. The report includes assessments of all the nation’s estuaries in the contiguous 48 states and Puerto Rico, south-eastern Alaska, ...

  9. Aqueous complexation of thorium(IV), uranium(IV), neptunium(IV), plutonium(III/IV), and cerium(III/IV) with DTPA.

    PubMed

    Brown, M Alex; Paulenova, Alena; Gelis, Artem V

    2012-07-16

    Aqueous complexation of Th(IV), U(IV), Np(IV), Pu(III/IV), and Ce(III/IV) with DTPA was studied by potentiometry, absorption spectrophotometry, and cyclic voltammetry at 1 M ionic strength and 25 °C. The stability constants for the 1:1 complex of each trivalent and tetravalent metal were calculated. From the potentiometric data, we report stability constant values for Ce(III)DTPA, Ce(III)HDTPA, and Th(IV)DTPA of log β(101) = 20.01 ± 0.02, log β(111) = 22.0 ± 0.2, and log β(101) = 29.6 ± 1, respectively. From the absorption spectrophotometry data, we report stability constant values for U(IV)DTPA, Np(IV)DTPA, and Pu(IV)DTPA of log β(101) = 31.8 ± 0.1, 32.3 ± 0.1, and 33.67 ± 0.02, respectively. From the cyclic voltammetry data, we report stability constant values for Ce(IV) and Pu(III) of log β(101) = 34.04 ± 0.04 and 20.58 ± 0.04, respectively. The values obtained in this work are compared and discussed with respect to the ionic radius of each cationic metal.

  10. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  11. 21 CFR 880.5420 - Pressure infusor for an I.V. bag.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pressure infusor for an I.V. bag. 880.5420 Section 880.5420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  12. 21 CFR 880.5420 - Pressure infusor for an I.V. bag.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pressure infusor for an I.V. bag. 880.5420 Section 880.5420 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal...

  13. Characterization of Caramel Colour IV.

    PubMed

    Licht, B H; Shaw, K; Smith, C; Mendoza, M; Orr, J; Myers, D V

    1992-05-01

    A large number of commercial Caramel Colour IV samples were characterized in order to assess the uniformity of the class and to provide data to be used in specifications development. Owing to the chemical and physical complexity of caramel colour it was not feasible to perform detailed analysis of all constituents for assessment of uniformity. Instead, selected parameters were evaluated and judgements were made with respect to compositional uniformity based on the similarities of these parameters among the various samples. As Caramel Colour IV is required by the food industry in a range of colour intensities, there must be a range of properties that differ from sample to sample, but that are sufficiently similar for the material to still be considered as part of the Caramel Colour IV class. Fractions as well as whole caramel were analysed using selected spectrophotometric, chromatographic and chemical techniques. Samples were fractionated based on molecular weight and polarity. The data presented here provide evidence for the uniformity in composition of Caramel Colour IV with respect to molecular weight distribution, to nitrogen and sulphur content and their distribution throughout the fractions, to absorbance properties and to specific low molecular weight compounds. Thus, it can be concluded that Caramel Colour IV exhibits compositional uniformity within the range of colour intensity required by the food industry worldwide.

  14. Confirmatory Factor Analysis of the WAIS-IV/WMS-IV

    PubMed Central

    Holdnack, James A.; Zhou, Xiaobin; Larrabee, Glenn J.; Millis, Scott R.; Salthouse, Timothy A.

    2013-01-01

    The Wechsler Adult Intelligence Scale–fourth edition (WAIS-IV) and the Wechsler Memory Scale–fourth edition (WMS-IV) were co-developed to be used individually or as a combined battery of tests. The independent factor structure of each of the tests has been identified; however, the combined factor structure has yet to be determined. Confirmatory factor analysis was applied to the WAIS-IV/WMS-IV Adult battery (i.e., age 16-69 years) co-norming sample (n = 900) to test 13 measurement models. The results indicated that two models fit the data equally well. One model is a seven-factor solution without a hierarchical general ability factor: Verbal Comprehension, Perceptual Reasoning, Processing Speed, Auditory Working Memory, Visual Working Memory, Auditory Memory, and Visual Memory. The second model is a five-factor model composed of Verbal Comprehension, Perceptual Reasoning, Processing Speed, Working Memory, and Memory with a hierarchical general ability factor. Interpretative implications for each model are discussed. PMID:21208975

  15. Confirmatory factor analysis of the WAIS-IV/WMS-IV.

    PubMed

    Holdnack, James A; Xiaobin Zhou; Larrabee, Glenn J; Millis, Scott R; Salthouse, Timothy A

    2011-06-01

    The Wechsler Adult Intelligence Scale-fourth edition (WAIS-IV) and the Wechsler Memory Scale-fourth edition (WMS-IV) were co-developed to be used individually or as a combined battery of tests. The independent factor structure of each of the tests has been identified; however, the combined factor structure has yet to be determined. Confirmatory factor analysis was applied to the WAIS-IV/WMS-IV Adult battery (i.e., age 16-69 years) co-norming sample (n = 900) to test 13 measurement models. The results indicated that two models fit the data equally well. One model is a seven-factor solution without a hierarchical general ability factor: Verbal Comprehension, Perceptual Reasoning, Processing Speed, Auditory Working Memory, Visual Working Memory, Auditory Memory, and Visual Memory. The second model is a five-factor model composed of Verbal Comprehension, Perceptual Reasoning, Processing Speed, Working Memory, and Memory with a hierarchical general ability factor. Interpretative implications for each model are discussed.

  16. The MAX IV imaging concept.

    PubMed

    Matěj, Zdeněk; Mokso, Rajmund; Larsson, Krister; Hardion, Vincent; Spruce, Darren

    2017-01-01

    The MAX IV Laboratory is currently the synchrotron X-ray source with the beam of highest brilliance. Four imaging beamlines are in construction or in the project phase. Their common characteristic will be the high acquisition rates of phase-enhanced images. This high data flow will be managed at the local computing cluster jointly with the Swedish National Computing Infrastructure. A common image reconstruction and analysis platform is being designed to offer reliable quantification of the multidimensional images acquired at all the imaging beamlines at MAX IV.

  17. Contribution of alpha3(IV)alpha4(IV)alpha5(IV) Collagen IV to the Mechanical Properties of the Glomerular Basement Membrane

    NASA Astrophysics Data System (ADS)

    Gyoneva, Lazarina

    The glomerular basement membrane (GBM) is a vital part of the blood-urine filtration barrier in the kidneys. In healthy GBMs, the main tension-resisting component is alpha3(IV)alpha4(IV)alpha5(IV) type IV collagen, but in some diseases it is replaced by other collagen IV isoforms. As a result, the GBM becomes leaky and disorganized, ultimately resulting in kidney failure. Our goal is to understanding the biomechanical aspects of the alpha3(IV)alpha4(IV)alpha5(IV) chains and how their absence could be responsible for (1) the initial injury to the GBM and (2) progression to kidney failure. A combination of experiments and computational models were designed for that purpose. A model basement membrane was used to compare experimentally the distensibility of tissues with the alpha3(IV)alpha4(IV)alpha5(IV) chains present and missing. The experiments showed basement membranes containing alpha3(IV)alpha4(IV)alpha5(IV) chains were less distensible. It has been postulated that the higher level of lateral cross-linking (supercoiling) in the alpha3(IV)alpha4(IV)alpha5(IV) networks contributes additional strength/stability to basement membranes. In a computational model of supercoiled networks, we found that supercoiling greatly increased the stiffness of collagen IV networks but only minimally decreased the permeability, which is well suited for the needs of the GBM. It is also known that the alpha3(IV)alpha4(IV)alpha5(IV) networks are more protected from enzymatic degradation, and we explored their significance in GBM remodeling. Our simulations showed that the more protected network was needed to prevent the system from entering a dangerous feedback cycle due to autoregulation mechanisms in the kidneys. Overall, the work adds to the evidence of biomechanical differences between the alpha3(IV)alpha4(IV)alpha5(IV) networks and other collagen IV networks, points to supercoiling as the main source of biomechanical differences, discusses the suitability of alpha3(IV)alpha4(IV

  18. Characteristics of SCCmec IV and V Methicillin-Resistant Staphylococcus aureus (MRSA) in Israel.

    PubMed

    Shitrit, Pnina; Openhaim, Michal; Reisfeld, Sharon; Paitan, Yossi; Regev-Yochay, Gili; Carmeli, Yehuda; Chowers, Michal

    2015-08-01

    Isolation of methicillin-resistant Staphylococcus aureus (MRSA) in healthy individuals is not common in Israel. In our hospital, about 30% of MRSA isolates were SCCmec types IV and V. To identify the demographic and clinical characteristics of patients carrying MRSA SCCmec type IV or V, and to compare them with each other and with those of patients with SCCmec types I-III. We conducted a case-control study that included 501 patients from whom MRSA was isolated: 254 with SCCmec type I, II, or III, and 243 isolates from SCCmec types IV or V. MRSA was isolated from surveillance cultures in 75% of patients and from a clinical site in 25%. The majority of our study population was elderly, from nursing homes, and with extensive exposure to health care. First, we compared characteristics of patients identified through screening. Statistically significant predictors of SCCmec V vs. IV were Arab ethnicity (OR 7.44, 95% CI 1.5-37.9) and hospitalization in the year prior to study inclusion (OR 5.7, 95% CI 1.9-16.9). No differences were found between patients with SCCmec types I-III and patients with SCCmec type IV or V. Analysis of the subset of patients who had clinical cultures yielded similar results. SCCmec types IV and V were common in the hospital setting although rare in the community. It seems that in Israel, SCCmec IV and V are predominantly health care-associated MRSA.

  19. Understanding hospitality.

    PubMed

    Patten, C S

    1994-03-01

    Bridging patient/"customer" issues and business aspects can be aided through developing a specific nursing basis for hospitality. The ancient practice of hospitality has evolved into three distinct levels: public, personal and therapeutic. Understanding these levels is helpful in integrating various dimensions of guest relations programs in hospitals into a more comprehensive vision. Hospitality issues must become a greater part of today's nursing management.

  20. Title IV: Improving Indian Education.

    ERIC Educational Resources Information Center

    Barker, Kipp A.

    The Indian Education Act of 1972, Title IV, has improved Native American education by emphasizing Native American control; it comes after 400 years of Euro-American involvement in Indian education during which assimilation was the primary goal. In 1568 Jesuit priests began "civilizing" and Christianizing the "savage" Indians;…

  1. The PLATO IV Communications System.

    ERIC Educational Resources Information Center

    Sherwood, Bruce Arne; Stifle, Jack

    The PLATO IV computer-based educational system contains its own communications hardware and software for operating plasma-panel graphics terminals. Key echoing is performed by the central processing unit: every key pressed at a terminal passes through the entire system before anything appears on the terminal's screen. Each terminal is guaranteed…

  2. Radiation Monitor,IV-TEPC

    NASA Image and Video Library

    2012-12-30

    View of radiation monitor,Intra-Vehicular Tissue Equivalent Proportional Counter (IV-TEPC),relocated to NOD2 P3,Part Number (P/N): SEG33120960-301,Serial Number (S/N): 1002,in the Node 2. Photo was taken during Expedition 34.

  3. Facile Routes to Th(IV), U(IV), and Np(IV) Phosphites and Phosphates

    SciTech Connect

    Villa, Eric M.; Wang, Shuao; Alekseev, Evgeny V.; Depmeier, Wulf; Albrecht-Schmitt, Thomas E.

    2011-08-05

    Three actinide(IV) phosphites and a NpIV phosphate, AnIV(HPO₃)₂(H₂O)₂ (An = Th, U, Np) and Cs[Np(H1.5PO₄)(PO₄)]₂, respectively, were synthesized using mild hydrothermal conditions. The first three phases are isotypic and were obtained using similar reaction conditions. Cs[Np(H1.5PO₄)(PO₄)]₂ was synthesized using an analogous method to that of Np(HPO₃)₂(H₂O)₂. However, this fourth phase is quite different in comparison to the other phases in both composition and structure. The structure of Cs[Np(H1.5PO₄)(PO₄)]₂ is constructed from double layers of neptunium(IV) phosphate with caesium cations in the interlayer region. In contrast, An(HPO₃)₂(H₂O)₂ (An = Th, U, Np) form dense 3D networks. The actinide contraction is detected in variety of metrics obtained from single-crystal X-ray diffraction data. Changes in the oxidation state of the neptunium starting materials yield different products.

  4. Distraction Using the BUZZY for Children During an IV Insertion.

    PubMed

    Moadad, Nemat; Kozman, Katia; Shahine, Randa; Ohanian, Shake; Badr, Lina Kurdahi

    2016-01-01

    Needle pricks are rated by children as their most feared medical event resulting in acute pain, anxiety and distress, which negatively affects both the child and his/her parents. To investigate the effects of external cold and vibration via the "BUZZY" on pain ratings of children, their parents and nurses during peripheral IV insertion, to measure the time to a successful IV insertion and to assess the factors that are associated with pain perception of children. In this randomized control trial (RCT), children between the ages of 4 to 12years were assigned to either an intervention or a control group. The intervention group (n=25) had the "BUZZY" applied during IV insertion while the control group (n=23) did not have the "BUZZY". Children were asked to rate their pain along with their parents and nurses on the Wong-Baker FACES Pain Rating Scale. Time to successful IV insertion and background characteristic of children were assessed and compared. Pain scores were significantly lower in the "BUZZY" group for children and the nurses. Time to a successful IV insertion did not differ between groups. Gender, age, previous hospitalization, diagnoses and analgesics were all factors associated with the children's pain scores. However, a multiple regression analysis found that only the "BUZZY" remained a significant predictor of pain scores in children. The "BUZZY" may be an easily accessed, inexpensive ($39.95 each at $0.09 per 3 minute stick), and effective technique to control or reduce pain in young children undergoing IV insertion. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Hospital diversification.

    PubMed

    Eastaugh, Steven R

    2005-01-01

    Hospital diversification and its impact on the operating ratio are studied for 168 hospitals during the period from 1999 to 2004. Diversification and the operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield a better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution lifecycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. Management's attitude concerning risk and reward is considered.

  6. Genetics Home Reference: mucopolysaccharidosis type IV

    MedlinePlus

    ... types of mucopolysaccharidosis, MPS IV does not affect intelligence. The life expectancy of individuals with MPS IV ... qualified healthcare professional . About Selection Criteria for Links Data Files & API Site Map Customer Support USA.gov ...

  7. 75 FR 80762 - Medicare Program; Emergency Medical Treatment and Labor Act: Applicability to Hospital and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-23

    ... hospital inpatients in the May 9, 2002 Hospital Inpatient Prospective Payment System (IPPS) proposed rule... proposed rule could further burden the emergency system and could force hospitals providing emergency care... policy does not obligate hospitals with specialized capabilities to do so. IV. Collection of Information...

  8. Stage IV-S neuroblastoma. Results with definitive therapy

    SciTech Connect

    Stokes, S.H.; Thomas, P.R.; Perez, C.A.; Vietti, T.J.

    1984-05-15

    The results of management of 14 patients with Stage IV-S neuroblastoma are reported. The treatment policy, although not consistent over this time span, in general used a combination of radiotherapy and chemotherapy or infrequently one modality alone. Twelve of 14 (86%) survived more than 6 years. One patient, with a solitary mediastinal primary tumor, died of rapidly progressive disease at three months. The other death occurred in a 4.5-year-old presenting with hepatomegaly at diagnosis followed by skeletal dissemination 2.5 years later. Thirteen of the patients were younger than 1 year of age. Of the 11 patients that received radiotherapy, 4 experienced mild asymptomatic scoliosis or kyphoscoliosis at 3 to 12 years after initial therapy. A review of the literature indicates that spontaneous regression in this tumor is very frequent; therefore, it is recommended that for the common presentation of massive hepatomegaly in an infant, close observation is warranted, unless life threatening complications occur. However, initial therapeutic intervention may be indicated in those patients with life threatening presentations. This data did not substantiate the necessity for complete surgical excision of the primary tumor, as has been suggested by others.

  9. Mirizzi syndrome grades III and IV: surgical treatment.

    PubMed

    Reverdito, Ronald; Moricz, André DE; Campos, Tércio DE; Pacheco, Adhemar Monteiro; Silva, Rodrigo Altenfelder

    2016-01-01

    : to evaluate the epidemiology and outcomes of surgical treatment of patients with Mirizzi Syndrome (MS) grades III and IV, the most advanced according to Csendes classification. : we conducted a retrospective, cross-sectional study by reviewing records of thirteen patients with grades III and IV MS operated from December 2001 to September 2013, among the 3,691 cholecystectomies performed in the period. : the incidence of MS was 0.6% (23 cases) and grades III and IV amounted to 0.35% of this number. There was a predominance of type IV (12 cases). The preoperative diagnosis was possible in 53.8% of cases. The preferred approach was biliary-digestive derivation (10 cases), and "T" tube drainage with suture of the bile duct was the choice in three special occasions. Three patients had biliary fistula resolved with clinical management, and one coliperitoneum case required reoperation. In the outpatient follow-up of patients who underwent biliodigestive anastomosis (eight), 50% are asymptomatic, 25% had anastomotic stricture and 25% lost follow-up. The mean follow-up was 41.8 months. : MS in advanced degrees has low incidence, preoperative diagnosis in only half of cases, and has the biliodigestive anastomosis as the best conduct, but not without morbidity. avaliar a epidemiologia e os resultados do tratamento cirúrgico de doentes portadores de graus III e IV, mais avançados, da Síndrome de Mirizzi (SM) de acordo com a classificação de Csendes. estudo retrospectivo, de corte transversal através da revisão de prontuários de 13 pacientes portadores de graus III e IV da SM operados de dezembro de 2001 a setembro de 2013, entre 3691 colecistectomias realizadas neste período. a incidência da SM foi 0,6% (23 casos) e os graus III e IV perfizeram 0,35% deste número. Houve um predomínio de tipo IV (12 casos). O diagnóstico pré-operatório foi possível em 53,8% dos casos. A conduta preferencial foi derivação biliodigestiva (10 casos) e foi optado por drenagem

  10. Oxovanadium(IV) silsesquioxane complexes.

    PubMed

    Ohde, Christian; Limberg, Christian; Stösser, Reinhard; Demeshko, Serhiy

    2010-03-01

    In the context of a potential modeling of reduced oxovanadium species occurring on the surfaces of silica-supported vanadia catalysts in the course of its turnover, the incompletely condensed silsesquioxane H(3)(c-pentyl)T(7) was reacted with Cl(4)V(THF)(2) (where THF = tetrahydrofuran) in the presence of triethylamine. Precipitation of 3 equiv of HNEt(3)Cl seemed to point to the clean formation of [((c-pentyl)T(7))(V(IV)Cl)] (1), which was supported by electron paramagnetic resonance studies performed for the resulting solutions, but further analytical and spectroscopic investigations showed that the processes occurring at that stage are more complex than that and even include the formation of [((c-pentyl)T(7))(V(V)O)](2) as a side product. Storage of a red-brown hexane solution of this product mixture reproducibly led to the precipitation of blue crystals belonging to the chloride-free compound [((c-pentyl)T(7))(2)(V(IV)=O)(3)(THF)(2)] (2), as revealed by single-crystal X-ray diffraction. Performing the same reaction in the presence of 2 equiv of pyridine leads to an analogous product, where the THF ligands are replaced by pyridine. Subsequent investigations showed that the terminal oxo ligands at the vanadium centers are, on the one hand, due to the presence of adventitious water; on the other hand, the [(c-pentyl)T(7)](3-) ligand also acted as a source of O(2-). The results of SQUID measurements performed for 2 can be interpreted in terms of a ferromagnetic coupling between the vanadyl units. Exposing 2 to a dioxygen atmosphere resulted in its immediate oxidation to yield the V(V) complex [((c-pentyl)T(7))(V(V)O)](2), which may model a fast reoxidation reaction of oxovanadium(IV) trimers on silica surfaces.

  11. PREPARATION OF OXOPORPHINATOMANGANESE (IV) COMPLEX

    SciTech Connect

    Willner, I.; Otvos, J.; Calvin, M.

    1980-07-01

    Oxo-manganese-tetraphenylporphyrin (O=Mn{sup IV}-TPP) has been prepared by an oxygen-transfer reaction from iodosylbenzene to MnIITPP and characterized by its i.r. and field desorption mass spectra, which are identical to those of the product obtained by direct oxidation of Mn{sup III}(TPP) in an aqueous medium; it transfers oxygen to triphenylphosphine to produce triphenylphosphine oxide, and it is suggested that similar intermediates are important in oxygen activation by cytochrome P-450 as well as in the photosynthetic evolution of oxygen.

  12. Test Review: Advanced Clinical Solutions for WAIS-IV and WMS-IV

    ERIC Educational Resources Information Center

    Chu, Yiting; Lai, Mark H. C.; Xu, Yining; Zhou, Yuanyuan

    2012-01-01

    The authors review the "Advanced Clinical Solutions for WAIS-IV and WMS-IV". The "Advanced Clinical Solutions (ACS) for the Wechsler Adult Intelligence Scale-Fourth Edition" (WAIS-IV; Wechsler, 2008) and the "Wechsler Memory Scale-Fourth Edition" (WMS-IV; Wechsler, 2009) was published by Pearson in 2009. It is a…

  13. Test Review: Advanced Clinical Solutions for WAIS-IV and WMS-IV

    ERIC Educational Resources Information Center

    Chu, Yiting; Lai, Mark H. C.; Xu, Yining; Zhou, Yuanyuan

    2012-01-01

    The authors review the "Advanced Clinical Solutions for WAIS-IV and WMS-IV". The "Advanced Clinical Solutions (ACS) for the Wechsler Adult Intelligence Scale-Fourth Edition" (WAIS-IV; Wechsler, 2008) and the "Wechsler Memory Scale-Fourth Edition" (WMS-IV; Wechsler, 2009) was published by Pearson in 2009. It is a…

  14. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols.

  15. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise.

  16. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  17. A Community Hospital's Evaluation of Alarm Management Safety Factors.

    PubMed

    Kurnat-Thoma, Emma; Shah, Kayuri

    2016-12-01

    The Joint Commission's 2014 National Patient Safety Goals required hospitals to evaluate alarm safety in 2014-2015 and implement alarm safety policies. The aim of this study was to assess common alarm management safety factors in our 187-bed community hospital. Two weeks' worth of IV pump report data was evaluated to characterize 33 IV pump alarm types. Hospital and IV pump noise was measured, and an alarm management nurse survey was conducted. There were 8731 total IV pump alarms/alerts (24-hour mean, 623.6) across 6 units. The 2-minute idle alarm accounted for 32.4% of all total IV alarms/alerts, suggestive of high levels of nurse multitasking and nurse work interruptions. IV pump volumes contributed to overall hospital noise. Survey data identified patient units and alarm safety practices needing additional support. Characterization of IV pump alarms/alerts is an emerging area of scientific inquiry. Findings indicate the need for organizations to evaluate alarm burden and alarm management safety practices to reduce alarm fatigue risks.

  18. IVS contribution to ITRF2014

    NASA Astrophysics Data System (ADS)

    Bachmann, Sabine; Thaller, Daniela; Roggenbuck, Ole; Lösler, Michael; Messerschmitt, Linda

    2016-07-01

    Every few years the International Terrestrial Reference System (ITRS) Center of the International Earth Rotation and Reference Systems Service (IERS) decides to generate a new version of the International Terrestrial Reference Frame (ITRF). For the upcoming ITRF2014 the official contribution of the International VLBI Service for Geodesy and Astrometry (IVS) comprises 5796 combined sessions in SINEX file format from 1979.6 to 2015.0 containing 158 stations, overall. Nine AC contributions were included in the combination process, using five different software packages. Station coordinate time series of the combined solution show an overall repeatability of 3.3 mm for the north, 4.3 mm for the east and 7.5 mm for the height component over all stations. The minimum repeatabilities are 1.5 mm for north, 2.1 mm for east and 2.9 mm for height. One of the important differences between the IVS contribution to the ITRF2014 and the routine IVS combination is the omission of the correction for non-tidal atmospheric pressure loading (NTAL). Comparisons between the amplitudes of the annual signals derived by the VLBI observations and the annual signals from an NTAL model show that for some stations, NTAL has a high impact on station height variation. For other stations, the effect of NTAL is low. Occasionally other loading effects have a higher influence (e.g. continental water storage loading). External comparisons of the scale parameter between the VTRF2014 (a TRF based on combined VLBI solutions), DTRF2008 (DGFI-TUM realization of ITRS) and ITRF2008 revealed a significant difference in the scale. A scale difference of 0.11 ppb (i.e. 0.7 mm on the Earth's surface) has been detected between the VTRF2014 and the DTRF2008, and a scale difference of 0.44 ppb (i.e. 2.8 mm on the Earth's surface) between the VTRF2014 and ITRF2008. Internal comparisons between the EOP of the combined solution and the individual solutions from the AC contributions show a WRMS in X- and Y-Pole between

  19. Optical and Infrared Interferometry IV

    NASA Astrophysics Data System (ADS)

    Rajagopal, Jayadev K.; Creech-Eakman, Michelle J.; Malbet, Fabien

    2014-08-01

    Optical and IR Interferometry IV at the SPIE 2014 symposium in Montreal had a strong and vibrant program. After initial fears about budget cuts and travel-funding constraints, the Program Committee had to work hard to accommodate as many quality submissions as possible. Innovative, creative and visionary work ensured that the field has progressed well, despite the bleak funding climate felt in the US, Europe and elsewhere. Montreal proved an excellent venue for this, the largest of Interferometry conferences and the only one that brings together practitioners from the world over. Let us summarize a few highlights to convey a glimpse of the excitement that is detailed in the rest of these Proceedings.

  20. Rhenium(IV) sulfide nanotubes.

    PubMed

    Brorson, Michael; Hansen, Thomas W; Jacobsen, Claus J H

    2002-10-02

    Rhenium(IV) sulfide, ReS(2), has been prepared with nanotubular morphology by carbon nanotube templating. A multiwall carbon nanotube material was impregnated with solutions of NH(4)ReO(4) or ReCl(5), followed by drying and sulfidation with H(2)S at 1000 degrees C. The composite material synthesized was characterized by high-resolution transmission electron microscopy and X-ray powder diffraction. Like previously described MS(2) nanotube compounds, ReS(2) has a layered structure consisting of S-M-S layers. Re atoms in ordinary ReS(2) are octahedrally coordinated with S, and tetranuclear metal clusters are present as a consequence of metal-metal bonds.

  1. Underutilization of IV nitrates in the treatment of acute heart failure.

    PubMed

    Mohan, Mohapradeep; Hawkey, Sean; Baig, Fatima; Choy, Anna Maria; Lang, Chim C

    2015-08-01

    Acute heart failure (AHF) is a growing public health concern with high inhospital mortality and costs. Clinical practice guidelines, underpinned by positive randomized controlled trials, recommend the early use of intravenous (IV) nitrates in the treatment of AHF. However, the "real-world" usage of IV nitrates has not been clearly defined. The objective of this study was to examine the use of IV nitrates in the treatment of AHF as recommended by clinical practice guidelines. A case-record analysis was conducted of all admissions with AHF at a large teaching hospital. Of the 81 AHF patients (mean age 77 ± 11, mean SBP 130 ± 27 mmHg) enrolled for this analysis, only 5 (6%) received IV nitrates at the time of AHF admission. Forty (49%, mean age 77 ± 11, mean SBP 131 ± 27 mmHg) of these 81 patients met the guideline criteria for suitability for IV nitrates and only 5 (12%) of these received them during this admission. Patients who received IV nitrates were more likely to have higher blood pressure and all had myocardial ischemia as a precipitant. Seventy-five (93%) of the total population received loop diuretics on admission. Overall, this study shows that loop diuretics remain the first-line therapy in AHF with little use of IV nitrates, despite recommendations from clinical practice guidelines.

  2. Aprepitant for the management of nausea with inpatient IV dihydroergotamine

    PubMed Central

    Chou, Denise E.; Tso, Amy R.

    2016-01-01

    Objective: To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with a history of uncontrolled nausea with DHE. Methods: This was a retrospective chart review of prospectively collected hourly diary data and clinical notes of patients hospitalized between 2011 and 2015 for inpatient treatment with DHE. Patients were classified using the International Classification of Headache Disorders, 3rd edition (beta version). Peak and average daily nausea scores from hourly diaries, or daily entries of notes, and concurrent antiemetic use were collected and tabulated. Results: Seventy-four patients, of whom 24 had daily diaries, with chronic migraine with or without aura, with or without medication overuse, or new daily persistent headache of a migrainous type, were identified. In 36 of 57 cases in which aprepitant was administered during hospitalization, there was a 50% reduction in the average daily number of as-needed antinausea medications. Of 57 patients, 52 reported that the addition of aprepitant improved nausea. Among 21 of 24 patients with hourly diary data, nausea scores were reduced and in all 12 with vomiting there was cessation of emesis after aprepitant was added. Aprepitant was well tolerated with no treatment emergent adverse events. Conclusions: Aprepitant can be effective in the treatment of refractory DHE-induced nausea and emesis. Given the broader issue of troublesome nausea and vomiting in acute presentations of migraine, general neurologists may consider what place aprepitant has in the management of such patients. Classification of evidence: This study provides Class IV evidence that for patients with medically refractory migraine receiving IV DHE, oral aprepitant reduces nausea. PMID:27629088

  3. Intravenous Smart Pump Drug Library Compliance: A Descriptive Study of 44 Hospitals.

    PubMed

    Giuliano, Karen K; Su, Wan-Ting; Degnan, Daniel D; Fitzgerald, Kristy; Zink, Richard J; DeLaurentis, Poching

    2017-06-01

    Although intravenous (IV) smart pumps with built-in dose-error reduction systems (DERS) can reduce IV medication administration error, most serious adverse events still occur during IV medication administration. Sources of error include overriding DERS and manually bypassing drug libraries and the DERS. Our purpose was to use the Regenstrief National Center for Medical Device Informatics data set to better understand IV smart pump drug library and DERS compliance. Our sample consisted of 12 months of data from 7 hospital systems, 44 individual hospitals, and descriptive data from the American Hospital Directory (AHD) for 2015. The aims of the study were (1) to determine whether there are differences in IV smart pump drug library compliance between hospital systems and (2) to provide a broad descriptive overview of relevant trends related to IV smart pump compliance. For aim 1, we found 3 significant relationships among the 7 hospital systems: systems 3 (P < 0.001), 6 (P = 0.003), and 7 (P = 0.002) had significantly higher IV smart compliance as compared with system 4. For aim 2, the number of drug library profiles was positively correlated (P = 0.029) with IV smart pump compliance and the IV smart pump type used was significantly correlated (P = 0.013) with IV smart pump compliance. Our findings support that there are differences in IV smart pump compliance both within and between hospital systems and that IV smart pump type and the number of drug library profiles may be influencing factors. Further research is required to more accurately identify the impact of these factors in this very important area of patient safety.

  4. Level IV Ecoregions of Nevada

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  5. Level IV Ecoregions of Wyoming

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  6. Level IV Ecoregions of California

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  7. Level IV Ecoregions of Georgia

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  8. Level IV Ecoregions of Louisiana

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  9. Level IV Ecoregions of Oklahoma

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  10. Level IV Ecoregions of Wisconsin

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  11. Level IV Ecoregions of Nebraska

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  12. Level IV Ecoregions of Idaho

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  13. Level IV Ecoregions of Utah

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  14. Level IV Ecoregions of Kansas

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  15. Level IV Ecoregions of Colorado

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  16. Level IV Ecoregions of Oregon

    EPA Pesticide Factsheets

    Ecoregions by state were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 50 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 105 regions whereas the conterminous United States has 85 (U.S. Environmental Protection Agency, 2011). Level IV ecoregions are further subdivisions of Level III eco

  17. Hospital finance.

    PubMed

    Herman, M J

    1998-01-01

    This article summarizes key areas of focus for the analysis of risk in the hospital segment of the health care industry. The article is written from a commercial bank lending perspective. Both for-profit (C-corporations) and 501 (c)(3) not-for-profit segments are addressed.

  18. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  19. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  20. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  1. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  2. Metsahovi Radio Observatory - IVS Network Station

    NASA Technical Reports Server (NTRS)

    Uunila, Minttu; Zubko, Nataliya; Poutanen, Markku; Kallunki, Juha; Kallio, Ulla

    2013-01-01

    In 2012, Metsahovi Radio Observatory together with Finnish Geodetic Institute officially became an IVS Network Station. Eight IVS sessions were observed during the year. Two spacecraft tracking and one EVN X-band experiment were also performed. In 2012, the Metsahovi VLBI equipment was upgraded with a Digital Base Band Converter, a Mark 5B+, a FILA10G, and a FlexBuff.

  3. IVS Working Group 4: VLBI Data Structures

    NASA Technical Reports Server (NTRS)

    Gipson, John

    2010-01-01

    In 2007 the IVS Directing Board established IVS Working Group 4 on VLBI Data Structures. This note discusses the current VLBI data format, goals for a new format, the history and formation of the Working Group, and a timeline for the development of a new VLBI data format.

  4. CHLORINE ABSORPTION IN S(IV) SOLUTIONS

    EPA Science Inventory

    The report gives results of measurements of the rate of Chlorine (Cl2) absorption into aqueous sulfite/bisulfite -- S(IV) -- solutions at ambient temperature using a highly characterized stirred-cell reactor. The reactor media were 0 to 10 mM S(IV) with pHs of 3.5-8.5. Experiment...

  5. CHLORINE ABSORPTION IN S(IV) SOLUTIONS

    EPA Science Inventory

    The report gives results of measurements of the rate of Chlorine (Cl2) absorption into aqueous sulfite/bisulfite -- S(IV) -- solutions at ambient temperature using a highly characterized stirred-cell reactor. The reactor media were 0 to 10 mM S(IV) with pHs of 3.5-8.5. Experiment...

  6. 24 CFR Appendixes I-Iv to Subpart B - Appendixes I-IV to Subpart B

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Appendixes I-IV to Subpart B I Appendixes I-IV to Subpart B Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Appendixes I-IV to Subpart B Appendix I—Annual Contributions Contract “Special Provisions for Turnkey...

  7. 24 CFR Appendixes I-Iv to Subpart B - Appendixes I-IV to Subpart B

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Appendixes I-IV to Subpart B I Appendixes I-IV to Subpart B Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN... Appendixes I-IV to Subpart B Appendix I—Annual Contributions Contract “Special Provisions for Turnkey...

  8. NATIONAL COASTAL CONDITION REPORT IV | Science ...

    EPA Pesticide Factsheets

    The National Coastal Condition Report IV (NCCR IV) is the fourth in a series of environmental assessments of U.S. coastal waters and the Great Lakes. The report includes assessments of all the nation’s estuaries in the contiguous 48 states and Puerto Rico, south-eastern Alaska, Hawaii, the U.S. Virgin Islands, Guam, and American Samoa. The NCCR IV presents four main types of data: (1) coastal monitoring data, (2) coastal ocean/ offshore monitoring data, (3) offshore fisheries data, and (4) assessment and advisory data (new to NCCR IV). The NCCR IV relies heavily on coastal monitoring data from EPA’s National Coastal Assessment (NCA) to assess coastal condition by evaluating five indicators of condition—water quality, sediment quality, benthic community condition, coastal habitat loss, and fish tissue contaminants. To assess and report on the condition of the nation's coastal resources

  9. STUDIES IN METABOLIC SPECTRA IV.

    PubMed Central

    Cheng, Lorraine; Snell, J. F.

    1962-01-01

    Cheng, Lorraine (Radiobiochemistry Department, Chas. Pfizer & Co., Inc., Maywood, N. J.) and J. F. Snell. Studies in metabolic spectra. IV. Effects of tetracyclines, some of their derivatives, and chloramphenicol on accumulation of glutamic acid in Escherichia coli. J. Bacteriol. 83:711–719. 1962.—Escherichia coli strain 21 was incubated in the Warburg apparatus at 37 C with sodium acetate-2-C14 and 0.1 μmole/ml of various test compounds. Up to 1 hr, de novo C14-glutamic acid (synthesized from the C14-acetate precursor) accumulation in the fermentation broth was found to be a common phenomenon for the control cells and cells treated with oxytetracycline, chlortetracycline, tetracycline, and chloramphenicol. Subsequently, C14-glutamic acid continued to accumulate in the broth of the inhibited cells, but began to disappear from the broth of the control cells. During the first half hour, the rate of accumulation was most rapid in the presence of oxytetracycline. At 3 hr the total de nova C14-glutamic acid was found to be the same whether cells were treated with oxytetracycline or not. However, the distribution of this glutamic acid was different. In the oxytetracycline-treated cells, more than 87% of the total de nova C14-glutamic acid was in the broth, and only 13% was incorporated into the cell residue. In the control cells, no C14-glutamic acid was found in the broth, although 67% was in the cell residue. The possibility that the tetracyclines and chloramphenicol have different modes of action, and that oxytetracycline inhibits the incorporation of d-glutamic acid into the cell wall and membrane material in E. coli 21, was discussed. PMID:13878663

  10. Candiduria in hospitalized patients in teaching hospitals of Ahvaz.

    PubMed

    Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B

    2012-12-01

    Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.

  11. Surprising Coordination Geometry Differences in Ce(IV)- and Pu(IV)-Maltol Complexes

    SciTech Connect

    Lawrence Berkeley National Laboratory; Raymond, Kenneth; Szigethy, Geza; Xu, Jide; Gorden, Anne E.V.; Teat, Simon J.; Shuh, David K.; Raymond, Kenneth N.

    2008-02-12

    As part of a study to characterize the detailed coordination behavior of Pu(IV), single crystal X-ray diffraction structures have been determined for Pu(IV) and Ce(IV) complexes with the naturally-occurring ligand maltol (3-hydroxy-2-methyl-pyran-4-one) and its derivative bromomaltol (5-bromo-3-hydroxy-2-methyl-pyran-4-one). Although Ce(IV) is generally accepted as a structural analog for Pu(IV), and the maltol complexes of these two metals are isostructural, the corresponding bromomaltol complexes are strikingly different with respect to ligand orientation about the metal ion: All complexes exhibit trigonal dodecahedral coordination geometry but the Ce(IV)-bromomaltol complex displays an uncommon ligand arrangement not mirrored in the Pu(IV) complex, although the two metal species are generally accepted to be structural analogs.

  12. Stage IV work hardening in cubic metals

    SciTech Connect

    Rollett, A.D.; Kocks, U.F.; Doherty, R.D.

    1986-01-01

    The work hardening of fcc metals at large strains is discussed with reference to the linear stress-strain behavior often observed at large strains and known as Stage IV. The experimental evidence shows that Stage IV is a work hardening phenomenon that is found quite generally, even in pure fcc metals subjected to homogeneous deformation. A simple model for Stage IV in pure metals is presented, based on the accumulation of dislocation debris. Experiments are described for large strain torsion tests on four aluminum alloys. The level and extent of Stage IV scaled with the saturation stress that would represent the end of Stage III in the absence of a Stage IV. Reversing the torsion after large prestrains produced transient reductions in the work hardening. The strain rate sensitivity was also measured before and during the transient and found not to vary significantly. The microstructure observed at large strains in an Mg alloy suggest that Stage IV can occur in the absence of microband formation. Previous proposals for the cause of Stage IV are reviewed and found to be not supported by recent experimental data.

  13. Coordination of tetravalent actinides (An = Th(IV), U(IV), Np(IV), Pu(IV)) with DOTA - from dimers to hexamers.

    PubMed

    Tamain, Christelle; Dumas, Thomas; Hennig, Christoph; Guilbaud, Philippe

    2017-03-10

    Three tetravalent actinide (An(IV)) hexanuclear clusters with the octahedral core [An6(OH)4O4]12+ (An(IV) = U(IV), Np(IV), Pu(IV)) were structurally characterized in solid state and in aqueous solution using single crystal X-ray diffraction, X-ray absorption, IR, Raman and UV-Visible spectroscopy. The observed structure, [An6(OH)4O4(H2O)8(HDOTA)4].HCl/HNO3.nH2O (An = U (I), Np (II), Pu (III)), consists of a An(IV) hexanuclear pseudo-octahedral cluster stabilized by DOTA (1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid) ligands. The six actinide atoms are connected through alternative µ3-O2- and µ3-OH- groups. EXAFS investigations combined with UV-vis spectroscopy evidence the same local structure in moderate acidic and neutral aqueous solutions. The synthesis mechanism was partially elucidated and the main physicochemical properties (pH range stability, solubility and protonation constant) of the cluster were determined. The results underline the importance (i) to consider such polynuclear species in thermodynamic models and (ii) of competing reactions between hydrolysis and complexation. It is interesting to note that the same synthesis route with thorium(IV) leads to the formation of a dimer, Th2(H2O)10(H2DOTA)2.4NO3.xH2O (IV), which contrasts to the structure of the other An(IV) hexamers.

  14. Higher order factor structure of the WISC-IV in a clinical neuropsychological sample.

    PubMed

    Bodin, Doug; Pardini, Dustin A; Burns, Thomas G; Stevens, Abigail B

    2009-09-01

    A confirmatory factor analysis was conducted examining the higher order factor structure of the WISC-IV scores for 344 children who participated in neuropsychological evaluations at a large children's hospital. The WISC-IV factor structure mirrored that of the standardization sample. The second order general intelligence factor (g) accounted for the largest proportion of variance in the first-order latent factors and in the individual subtests, especially for the working memory index. The first-order processing speed factor exhibited the most unique variance beyond the influence of g. The results suggest that clinicians should not ignore the contribution of g when interpreting the first-order factors.

  15. Home intravenous antimicrobial therapy provided by a community hospital and a university hospital.

    PubMed

    Smego, R A; Gainer, R B

    1985-10-01

    A home intravenous antimicrobial program that was implemented at both a private community hospital and a university hospital with a wide rural referral base is described. Over an 18-month period, 63 patients were screened and selected for home i.v. antimicrobial management according to stringent criteria. The hospital pharmacies and two home health-care companies were used as the central points for coordinating the preparation and distribution of drug products and providing specialty nursing services. Predischarge inhospital education for each patient was conducted by a pharmacist and a nurse. On-call pharmacists and nurses were available to monitor and assist the patients, and the patients were seen regularly by physicians during the period of home therapy. The 63 patients received a total of 1108 days of home i.v. antimicrobial therapy; the mean duration of therapy was 17.6 days. Heparin-lock peripheral cannulae were used for 51 patients, while 12 patients received their treatment through central-subclavian or Hickman catheters. Home i.v. antimicrobial treatment seemed to be as effective as comparable inpatient management for each type of infection. Drug- and i.v. catheter-related adverse effects were uncommon and seemed similar in type and frequency to those of hospitalized patients. The estimated cost savings per treatment course was $3,514 for a total net savings of $221,406 over the 18-month study period. Home i.v. antimicrobial treatment programs can be successfully implemented in both community-based and tertiary-care settings. Home therapy is a safe, efficacious, and cost-effective alternative to prolonged hospitalization for a variety of infectious diseases.

  16. Integrating DSM-IV factors to predict violence in high-risk psychiatric patients.

    PubMed

    Lynch, Donna M; Noel, Helen C

    2010-01-01

    This study incorporated Axis-II and Axis-IV factors in DSM-IV to test the relationship between predicted risk for violence assessed in the psychiatric emergency room and actual violence during hospitalization. Psychiatric nurses lack an objective instrument to use during the acute psychiatric assessment. The retrospective study comprised consecutive psychiatric admissions (n = 161) in one tertiary veterans' hospital. Statistical testing for the predictive power of risk factors, relationships between variables, and violent events included nonparametric tests, factor analysis, and logistic regression. Of the 32 patients who committed violence during hospitalization, 12 had committed violence in the psychiatric emergency room. Statistical significance was shown for violent incidents and dementia, court-ordered admission, mood disorder, and for three or more risk factors. The 13-item Risk of Violence Assessment (ROVA) scale suggests validity and sensitivity for rating DSM-IV factors and psychosocial stressors to predict risk for violence during hospitalization. Replication studies are recommended to strengthen validity of the ROVA scale.

  17. The determination of uranium (IV) in apatite

    USGS Publications Warehouse

    Clarke, Roy S.; Altschuler, Zalman S.

    1956-01-01

    Geologic and mineralogic evidence indicate that the uranium present in apatite may proxy for calcium in the mineral structure as U(IV). An experimental investigation was conducted and chemical evidence was obtained that establishes the presence of U(IV) in apatite. The following analytical procedure was developed for the determination of U(IV). Carbonate-fluorapatite is dissolved in cold 1.5M orthophosphoric acid and fluorapatite is dissolved in cold 1.2M hydrochloric acid containing 1.5 g of hydroxylamine hydrochloride per 100 ml. Uranium (IV) is precipitated by cupferron using titanium as a carrier. The uranium in the precipitate is separated by use of the ethyl acetate extraction procedure and determined fluorimetrically. The validity and the limitations of the method have been established by spike experiments.

  18. Level III and IV Ecoregions by State

    EPA Pesticide Factsheets

    Information and links to downloadable maps and datasets for Level III and IV ecoregions, listed by state. Ecoregions are areas of general similarity in the type, quality, and quantity of environmental resources.

  19. Optimizing IV and V for Mature Organizations

    NASA Technical Reports Server (NTRS)

    Fuhman, Christopher

    2003-01-01

    NASA is intending for its future software development agencies to have at least a Level 3 rating in the Carnegie Mellon University Capability Maturity Model (CMM). The CMM has built-in Verification and Validation (V&V) processes that support higher software quality. Independent Verification and Validation (IV&V) of software developed by mature agencies can be therefore more effective than for software developed by less mature organizations. How is Independent V&V different with respect to the maturity of an organization? Knowing a priori the maturity of an organization's processes, how can IV&V planners better identify areas of need choose IV&V activities, etc? The objective of this research is to provide a complementary set of guidelines and criteria to assist the planning of IV&V activities on a project using a priori knowledge of the measurable levels of maturity of the organization developing the software.

  20. Optimizing IV and V for Mature Organizations

    NASA Technical Reports Server (NTRS)

    Fuhman, Christopher

    2003-01-01

    NASA is intending for its future software development agencies to have at least a Level 3 rating in the Carnegie Mellon University Capability Maturity Model (CMM). The CMM has built-in Verification and Validation (V&V) processes that support higher software quality. Independent Verification and Validation (IV&V) of software developed by mature agencies can be therefore more effective than for software developed by less mature organizations. How is Independent V&V different with respect to the maturity of an organization? Knowing a priori the maturity of an organization's processes, how can IV&V planners better identify areas of need choose IV&V activities, etc? The objective of this research is to provide a complementary set of guidelines and criteria to assist the planning of IV&V activities on a project using a priori knowledge of the measurable levels of maturity of the organization developing the software.

  1. IV&V Project Assessment Process Validation

    NASA Technical Reports Server (NTRS)

    Driskell, Stephen

    2012-01-01

    The Space Launch System (SLS) will launch NASA's Multi-Purpose Crew Vehicle (MPCV). This launch vehicle will provide American launch capability for human exploration and travelling beyond Earth orbit. SLS is designed to be flexible for crew or cargo missions. The first test flight is scheduled for December 2017. The SLS SRR/SDR provided insight into the project development life cycle. NASA IV&V ran the standard Risk Based Assessment and Portfolio Based Risk Assessment to identify analysis tasking for the SLS program. This presentation examines the SLS System Requirements Review/System Definition Review (SRR/SDR), IV&V findings for IV&V process validation correlation to/from the selected IV&V tasking and capabilities. It also provides a reusable IEEE 1012 scorecard for programmatic completeness across the software development life cycle.

  2. Observational properties of decameter type IV bursts

    NASA Astrophysics Data System (ADS)

    Melnik, Valentin; Brazhenko, Anatoly; Rucker, Helmut; Konovalenko, Alexander; Briand, Carine; Dorovskyy, Vladimir; Zarka, Philippe; Frantzusenko, Anatoly; Panchenko, Michael; Poedts, Stefan; Zaqarashvili, Teimuraz; Shergelashvili, Bidzina

    2013-04-01

    Oscillations of decameter type IV bursts were registered during observations of solar radio emission by UTR-2, URAN-2 and NDA in 2011-2012. Large majority of these bursts were accompanied by coronal mass ejections (CMEs), which were observed by SOHO and STEREO in the visible light. Only in some cases decameter type IV bursts were not associated with CMEs. The largest periods of oscillations P were some tens of minutes. There were some modes of long periods of oscillations simultaneously. Periods of oscillations in flux and in polarization profiles were close. Detailed properties of oscillations at different frequencies were analyzed on the example of two type IV bursts. One of them was observed on April 7, 2011 when a CME happened. Another one (August 1, 2011) was registered without any CME. The 7 April type IV burst had two periods in the frames 75-85 and 35-85 minutes. Interesting feature of these oscillations is decreasing periods with time. The observed decreasing rates dP/dt equaled 0.03-0.07. Concerning type IV burst observed on August 1, 2011 the period of its oscillations increases from 17 min. at 30 MHz to 44 min. at 10 MHz. Connection of type IV burst oscillations with oscillations of magnetic arches and CMEs at corresponding altitudes are discussed. The work is fulfilled in the frame of FP7 project "SOLSPANET".

  3. Preliminary results of thoracoscopic Belsey Mark IV antireflux procedure.

    PubMed

    Nguyen, N T; Schauer, P R; Hutson, W; Landreneau, R; Weigel, T; Ferson, P F; Keenan, R J; Luketich, J D

    1998-06-01

    Laparoscopic Nissen fundoplication has replaced open approaches for refractory gastroesophageal reflux disease (GERD) in many major medical centers. Here we report our preliminary results of the Belsey Mark IV antireflux procedure performed by video-assisted thoracoscopy (VATS-Belsey). Fifteen patients underwent VATS-Belsey. The indications for surgery included GERD refractory to medical therapy (n=10), achalasia (n=2), diffuse esophageal spasms (n=1), epiphrenic esophageal diverticulum (n=1), and paraesophageal hernia (n=1). The median operative time was 235 min. There were three conversions to open minithoracotomy (8-10 cm) necessitated by severe adhesions (n=2) and repair of a gastric perforation (n=1). The median hospital stay was 4 days. Postoperative complications included persistent air leaks, requiring discharge with a Heimlich valve in one patient. There were no perioperative deaths. At a median follow-up of 19 months, ten patients (66%) were asymptomatic and were not taking any antacids. One patient who had taken proton pump inhibitors preoperatively required postoperative H2 blockers for mild heartburn. In three patients, recurrent GERD symptoms (mean follow-up 6 months) led to laparoscopic takedown of the Belsey and Nissen fundoplication. One patient with achalasia, who had recurrent dysphagia after 1 year of relief following VATS myotomy and Belsey, underwent esophagectomy. The Belsey Mark IV antireflux procedure is technically feasible by VATS with minimal morbidity. However, our preliminary results suggest that open thoracotomy for Belsey Mark IV should remain the standard operation for GERD with poor esophageal motility when a thoracic approach is desired. We have modified our approach to laparoscopic partial fundoplications (Toupet or Dor) for severe GERD and poor esophageal motility when an abdominal approach is possible.

  4. Antipsychotic prescription amongst hospitalized patients with dementia.

    PubMed

    Gallagher, P; Curtin, D; de Siún, A; O'Shea, E; Kennelly, S; O'Neill, D; Timmons, S

    2016-09-01

    Antipsychotic drugs are used to treat behavioural and psychological symptoms of dementia, despite significant safety concerns regarding increased risk of stroke and mortality. The numbers of patients with dementia and related behavioural symptoms being treated in acute hospitals is increasing. (i) to determine pre-admission and in-hospital prevalence of antipsychotic use in a national sample of patients with dementia and acute illness; (ii) identify reasons for antipsychotic use; (iii) assess features of the ward environment which impact on patients with dementia; (iv) determine availability of dementia-specific policies, training, appraisal and mentorship programs which influence service delivery. Four-part standardized audit in 35 public acute hospitals comprising (i) retrospective healthcare record review (n = 660); (ii) prospective assessment of ward environment (n = 77); (iii) ward organization interview with clinical managers (n = 77); (iv) hospital organisation interview with senior managers (n = 35). Antipsychotic drugs were prescribed to 29% of patients with dementia before hospitalization and to 41% during hospitalization; one quarter received new or additional prescriptions. Assessments for delirium (45%), dementia symptoms (39%), mood (26%), mental state (64%) and distress-provoking factors (3%) were suboptimal. Drug indications were documented in 78%. Non-pharmacological interventions were not documented. Most wards lacked environmental cues to promote orientation. Dementia-specific care pathways existed in 2 of 35 hospitals. Staff support and training programmes were suboptimal. 12% of patients were discharged with new antipsychotic prescriptions. Antipsychotic medications are commonly prescribed for hospitalized patients with dementia in Ireland. Ward environments and dementia-related governance structures are suboptimal. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights

  5. Hypokalaemia: Addressing human factors and improving education around prescription and administration of Intravenous(IV) Potassium infusion in Trauma and Orthopaedics.

    PubMed

    Thirumal, Vanushia; Love, Gavin

    2017-01-01

    A high incidence of hypokalaemia was noted in Trauma and Orthopaedics of Ninewells Hospital. We sought to establish the reason behind this and implemented three PDSA cycles via questionnaires to 30 ward staff, both doctors and nurses over a 1 week period in December, February and July 2016. Key baseline measures include availability of IV fluids with 40mmol potassium on the wards, confidence prescribing or administering IV fluids with 40mmol potassium, necessity for cardiac monitoring during slow IV potassium replacement and recognition of confusion and learning need in this area. Interventions made include awareness and education session, departmental guideline, improving stock of IV fluids and hypokalaemia management pathway for mild, moderate and severe hypokalaemia. Post-intervention results showed 70% from 33% who said 40mmol IV potassium was available, 87% from 67% were confident prescribing or administering IV potassium and 70% from 27% were aware that cardiac monitoring was not necessary.

  6. Hypokalaemia: Addressing human factors and improving education around prescription and administration of Intravenous(IV) Potassium infusion in Trauma and Orthopaedics

    PubMed Central

    Thirumal, Vanushia; Love, Gavin

    2017-01-01

    A high incidence of hypokalaemia was noted in Trauma and Orthopaedics of Ninewells Hospital. We sought to establish the reason behind this and implemented three PDSA cycles via questionnaires to 30 ward staff, both doctors and nurses over a 1 week period in December, February and July 2016. Key baseline measures include availability of IV fluids with 40mmol potassium on the wards, confidence prescribing or administering IV fluids with 40mmol potassium, necessity for cardiac monitoring during slow IV potassium replacement and recognition of confusion and learning need in this area. Interventions made include awareness and education session, departmental guideline, improving stock of IV fluids and hypokalaemia management pathway for mild, moderate and severe hypokalaemia. Post-intervention results showed 70% from 33% who said 40mmol IV potassium was available, 87% from 67% were confident prescribing or administering IV potassium and 70% from 27% were aware that cardiac monitoring was not necessary. PMID:28469890

  7. Formation of recombinant triple-helical [alpha 1(IV)]2 alpha 2(IV) collagen molecules in CHO cells.

    PubMed

    Fukuda, K; Hori, H; Utani, A; Burbelo, P D; Yamada, Y

    1997-02-03

    Collagen IV molecules represent a major structural component of basement membranes providing a network of support for the supramolecular structure. Like other collagens, collagen IV forms a triple-helical molecule composed of three alpha chains. Six different alpha chains exist for collagen IV, although the most common isoform consists of two alpha 1(IV) and one alpha 2(IV) chain. To understand the molecular mechanism of triple-helical formation of collagen IV, we expressed recombinant alpha 1(IV) and alpha 2(IV) mouse collagen chains in Chinese hamster ovary (CHO) cells. An expression vector containing the full length cDNA for the mouse alpha 1(IV) chain was stably transfected into CHO cells and a cell line, A222, which expressed recombinant alpha 1(IV) chains was selected. These A222 cells were then infected with a retroviral expression vector containing the mouse alpha 2(IV) chain and a cell line, A222-A2, stably expressing both recombinant alpha 1(IV) and alpha 2(IV) chains was obtained. Immunoprecipitation of A222 cell lysates revealed a high level of alpha 1(IV) chain monomer, which was unable to form a homotrimer. Analysis of A222-A2 cell lysates revealed the presence of both monomeric alpha 2(IV) and alpha 1(IV) chains as well as a higher molecular weight collagen IV species. Second dimensional SDS-PAGE analysis demonstrated that the high molecular weight species was a heterotrimer consisting of two alpha 1(IV) and one alpha 2(IV) chain. This heterotrimer collagen IV species was pepsin-resistant indicating the formation of a stable triple-helical structure. Pulse-chase experiments showed that the monomer alpha 1(IV) chain was secreted, but at a much slower rate than the heterotrimer. Together these results demonstrate that the alpha 1(IV) chain is not capable of forming homotrimers and suggest that the coexpression with the alpha 2(IV) chain is necessary to form a triple-helical structure.

  8. IV Magnesium Sulfate for Bronchiolitis: A Randomized Trial.

    PubMed

    Alansari, Khalid; Sayyed, Rafah; Davidson, Bruce L; Al Jawala, Shahaza; Ghadier, Mohamed

    2017-07-01

    The goal of this study was to determine if IV magnesium, useful for severe pediatric asthma, reduces time to medical readiness for discharge in patients with bronchiolitis when added to supportive care. We compared a single dose of 100 mg/kg of IV magnesium sulfate vs placebo for acute bronchiolitis. Patients received bronchodilator therapy, nebulized hypertonic saline, and 5 days of dexamethasone if there was eczema and/or a family history of asthma. Time to medical readiness for discharge was the primary efficacy outcome. Bronchiolitis severity scores and need for infirmary or hospital admission and for clinic revisits within 2 weeks were secondary outcomes. Cardiorespiratory instability onset was the safety outcome. A total of 162 previously healthy infants diagnosed with bronchiolitis aged 22 days to 17.6 months (median, 3.7 months) were enrolled. Approximately one-half of patients had eczema and/or a family history of asthma; 86.4% had positive findings on nasopharyngeal virus swabs. Geometric mean time until medical readiness for discharge was 24.1 h (95% CI, 20.0-29.1) for the 78 magnesium-treated patients and 25.3 h (95% CI, 20.3-31.5) for the 82 patients receiving placebo (ratio, 0.95 [95% CI, 0.52-1.80]; P = .91). Mean bronchiolitis severity scores over time were similar for the two groups. The frequency of clinic visits in the subsequent 2 weeks (33.8% and 27.2%, respectively) was also similar. Fifteen magnesium recipients (19.5%) vs five placebo recipients (6.2%) were readmitted to the infirmary or hospital within 2 weeks (P = .016). No acute cardiorespiratory side effects were reported. IV magnesium did not provide benefit for patients with acute bronchiolitis and may be harmful. ClinicalTrials.gov; No.: NCT02145520; URL: www.clinicaltrials.gov. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  9. Confirmatory Factor Analysis of the WAIS-IV and WMS-IV in Older Adults

    ERIC Educational Resources Information Center

    Miller, Delyana I.; Davidson, Patrick S. R.; Schindler, Dwayne; Messier, Claude

    2013-01-01

    New editions of the Wechsler Adult Intelligence and Memory scales are now available. Yet, given the significant changes in these new releases and the skepticism that has met them, independent evidence on their psychometric properties is much needed but currently lacking. We administered the WAIS-IV and the Older Adult version of the WMS-IV to 145…

  10. Confirmatory Factor Analysis of the WAIS-IV and WMS-IV in Older Adults

    ERIC Educational Resources Information Center

    Miller, Delyana I.; Davidson, Patrick S. R.; Schindler, Dwayne; Messier, Claude

    2013-01-01

    New editions of the Wechsler Adult Intelligence and Memory scales are now available. Yet, given the significant changes in these new releases and the skepticism that has met them, independent evidence on their psychometric properties is much needed but currently lacking. We administered the WAIS-IV and the Older Adult version of the WMS-IV to 145…

  11. The Berkeley SETI program - SERENDIP IV instrumentation

    NASA Astrophysics Data System (ADS)

    Werthimer, Dan; Bowyer, Stuart; Ng, David; Donnelly, Charles; Cobb, Jeff; Lampton, Michael; Airieau, Sabine

    1997-01-01

    We discuss the hardware design of SERENDIP IV, which will be deployed in early 1997 for a 21-cm sky survey at the National Astronomy and Ionospheric Center's 305-m radio telescope in Arecibo, Puerto Rico. SERENDIP IV is a 167 million channel spectrum analyzer, covering a 100-Mhz bandwidth, with 0.6-Hz resolution and a 1.7-s integration time. SERENDIP IV's modular design incorporates a bank of digital mixers and filters to separate the 100 MHz band into 40 2.5 MHz subbands. Each 2.5 MHz subband is further broken down into 0.6 Hz bins by means of a four million point fast Fourier transform. The resulting power spectra are analyzed by 40 high-speed processors. Narrowband signals having power significantly above background noise levels are recorded along with telescope coordinates, time, and frequency. The data are sent in real time to Berkeley for analysis.

  12. Seafloor earthquake measurement system, SEMS IV

    SciTech Connect

    Platzbecker, M.R.; Ehasz, J.P.; Franco, R.J.

    1997-07-01

    Staff of the Telemetry Technology Development Department (2664) have, in support of the U.S. Interior Department Mineral Management Services (MMS), developed and deployed the Seafloor Earthquake Measurement System IV (SEMS IV). The result of this development project is a series of three fully operational seafloor seismic monitor systems located at offshore platforms: Eureka, Grace, and Irene. The instrument probes are embedded from three to seven feet into the seafloor and hardwired to seismic data recorders installed top side at the offshore platforms. The probes and underwater cables were designed to survive the seafloor environment with an operation life of five years. The units have been operational for two years and have produced recordings of several minor earthquakes in that time. Sandia Labs will transfer operation of SEMS IV to MMS contractors in the coming months. 29 figs., 25 tabs.

  13. Dipeptidyl peptidase IV inhibitors and diabetes therapy.

    PubMed

    McIntosh, Christopher H S

    2008-01-01

    Current type 2 diabetes therapies are mainly targeted at stimulating pancreatic beta-cell secretion and reducing insulin resistance. A number of alternative therapies are currently being developed to take advantage of the actions of the incretin hormones Glucagon-Like Peptide-1 (GLP-1) and Glucose-dependent Insulinotropic Polypeptide (GIP). These hormones are released from the small intestine in response to nutrient ingestion and stimulate insulin secretion in a glucose-dependent manner. One approach to potentiating their actions is based on inhibiting dipeptidyl peptidase IV (DPP IV), the major enzyme responsible for degrading the incretins in vivo. DPP IV exhibits characteristics that have allowed the development of specific orally administered inhibitors with proven efficacy in improving glucose tolerance in animal models of diabetes. A number of clinical trials have demonstrated that DPP IV inhibitors are effective in improving glucose disposal and reducing hemoglobin A1c levels in type 2 diabetic patients and one inhibitor, sitagliptin, is now in therapeutic use, with others likely to receive FDA approval in the near future. Studies aimed at elucidating the mode of action of the inhibitors are still ongoing. Both enhancement of insulin secretion and reduction in glucagon secretion, resulting from the blockade of incretin degradation, are believed to play important roles in DPP IV inhibitor action. Preclinical studies indicate that increased levels of incretins improve beta-cell secretory function and exert effects on beta-cell mitogenesis and survival that can preserve beta-cell mass. Roles for other hormones, neuropeptides and cytokines in DPP IV inhibitor-medicated responses are also possible.

  14. Stapled haemorrhoidectomy in the operative treatment of grade III and IV haemorrhoids.

    PubMed

    Shrestha, S; Pradhan, G B N; Shrestha, R; Poudel, P; Bhattachan, C L

    2014-09-01

    Stapled haemorrhoidectomy (SH) is a minimally invasive intervention that uses a stapling device which avoids the need for wounds in the sensitive anal area and reduces the pain after surgery. This study was undertaken in Nepal Medical College Teaching Hospital from January 2010 to December 2012 to evaluate the efficacy of this modality of treatment among patients (32) who presented in the Surgery OPD with grade III and grade IV haemorrhoids. The results of SH were evaluated by the relief of symptoms, severity of post operative pain, and complications of SH. Twenty five (78.1%) patients had grade III and 7 (21.9%) presented with grade IV hemorrhoids. The most frequent presentation reported in our study was bleeding per rectum with perianal prolapse. Mean operating time was 40-60 minutes whereas mean hospital stay was 1.9 days. Urinary retention was the most common complication found in 12 (37.5%) patients in the immediate post operative period. SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoperative pain, and shorter hospital stay.

  15. A novel technique for the treatment of stages III to IV hemorrhoids

    PubMed Central

    Lin, Guoqiang; Ge, Qiongxiang; He, Xiaokang; Qi, Haixin; Xu, Li

    2017-01-01

    Abstract To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan–Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P < .05). Compared with MMH group, ACS group had a lower postoperative static pain score from days 1 to 14 (P < .01). The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05). The incidence of postoperative anal edema and delayed wound healing in ACS group was lower than that in MMH group (P < .05). Compared with MMH, our novel technique ACS was more effective and had fewer postoperative complications in the treatment of stages III to IV hemorrhoids. PMID:28658138

  16. Consistency of IVS nutation time series

    NASA Astrophysics Data System (ADS)

    Gattano, César; Lambert, Sébastien; Bizouard, Christian

    2016-04-01

    We give a review of the various VLBI-derived nutation time series provided by the different operational analysis centers of the IVS and three combination centers (IVS, IERS EOP Center, and Rapid Service/Prediction Center). We focus on the stability of small nutation amplitudes, including the free core nutation and other atmospherically-driven nutations, that are of interest for improving Earth models. We discuss the possible origins of the differences (software packaged, inversion methods, analysis configuration including a priori and estimation strategy) and the consequences for scientific exploitation of the data, especially in terms of nutation modeling and inference of the Earth's internal structure.

  17. A Miniaturized Class IV Flextensional Ultrasonic Transducer

    NASA Astrophysics Data System (ADS)

    Feeney, Andrew; Tweedie, Andrew; Mathieson, Andrew; Lucas, Margaret

    The class V transducer has found popularity in a diverse range of applications such as surgical and underwater projection systems, where high vibration amplitude for relatively low piezoceramic volume is generated. The class IV transducer offers the potential to attain even higher performance per volume than the class V. In this research, a miniaturized class IV power ultrasonic flextensional transducer is proposed. Simulations were performed using PZFlex finite element analysis, and electrical impedance analysis and experimental modal analysis were conducted for validation, where a high correlation between simulation and experiment has been demonstrated.

  18. CAPE-2 Cubesat - ELaNa IV

    NASA Image and Video Library

    2016-07-25

    CAPE-2: Cajun Advanced Picosatellite Experiment – ELaNa IV CAPE-2 was developed by students from the University of Louisiana Lafayette to engage, inspire and educate K-12 students to encourage them to pursue STEM careers. The secondary focus is the technology demonstration of deployed solar panels to support the following payloads: text to speech, voice repeater, tweeting, email, file transfer and data collection from buoys. Launched by NASA’s CubeSat Launch Initiative on the ELaNa IV mission as an auxiliary payload aboard the U.S. Air Force-led Operationally Responsive Space (ORS-3) Mission on November 19, 2013.

  19. 45 CFR 1355.21 - E and IV-B.

    Code of Federal Regulations, 2010 CFR

    1996-10-01

    ... compliance with the Department's regulations listed in 45 CFR 1355.30. (c) The State plans and plan... requirements for titles IV PUBLIC WELFARE Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN.... 1355.21 State plan requirements for titles IV-E and IV-B. (a) The State plans for titles IV-E and...

  20. 46 CFR Appendix IV to Part 150 - Data Sheet

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 5 2013-10-01 2013-10-01 false Data Sheet IV Appendix IV to Part 150 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES COMPATIBILITY OF CARGOES Pt. 150, App. IV Appendix IV to Part 150—Data Sheet EC02FE91.080 EC02FE91.081 ...

  1. 46 CFR Appendix IV to Part 150 - Data Sheet

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 5 2012-10-01 2012-10-01 false Data Sheet IV Appendix IV to Part 150 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES COMPATIBILITY OF CARGOES Pt. 150, App. IV Appendix IV to Part 150—Data Sheet EC02FE91.080 EC02FE91.081 ...

  2. 46 CFR Appendix IV to Part 150 - Data Sheet

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 5 2014-10-01 2014-10-01 false Data Sheet IV Appendix IV to Part 150 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES COMPATIBILITY OF CARGOES Pt. 150, App. IV Appendix IV to Part 150—Data Sheet EC02FE91.080 EC02FE91.081 ...

  3. 46 CFR Appendix IV to Part 150 - Data Sheet

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Data Sheet IV Appendix IV to Part 150 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES COMPATIBILITY OF CARGOES Pt. 150, App. IV Appendix IV to Part 150—Data Sheet EC02FE91.080 EC02FE91.081 ...

  4. 46 CFR Appendix IV to Part 150 - Data Sheet

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false Data Sheet IV Appendix IV to Part 150 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES COMPATIBILITY OF CARGOES Pt. 150, App. IV Appendix IV to Part 150—Data Sheet EC02FE91.080 EC02FE91.081 ...

  5. 40 CFR 144.13 - Prohibition of Class IV wells.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Prohibition of Class IV wells. 144.13... IV wells. (a) The following are prohibited, except as provided in paragraph (c) of this section: (1) The construction of any Class IV well. (2) The operation or maintenance of any Class IV well not in...

  6. 40 CFR 144.13 - Prohibition of Class IV wells.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Prohibition of Class IV wells. 144.13... IV wells. (a) The following are prohibited, except as provided in paragraph (c) of this section: (1) The construction of any Class IV well. (2) The operation or maintenance of any Class IV well not in...

  7. 40 CFR Appendix IV to Part 266 - Reference Air Concentrations*

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Reference Air Concentrations* IV Appendix IV to Part 266 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... MANAGEMENT FACILITIES Pt. 266, App. IV Appendix IV to Part 266—Reference Air Concentrations* Constituent CAS...

  8. 40 CFR Appendix IV to Part 266 - Reference Air Concentrations*

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 27 2014-07-01 2014-07-01 false Reference Air Concentrations* IV Appendix IV to Part 266 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... MANAGEMENT FACILITIES Pt. 266, App. IV Appendix IV to Part 266—Reference Air Concentrations* Constituent...

  9. 78 FR 18325 - Defense Transportation Regulation, Part IV

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... of the Secretary Defense Transportation Regulation, Part IV AGENCY: United States Transportation... Department of Defense published a notice titled Defense Transportation Regulation, Part IV. DoD has completed... Transportation Regulation, Part IV Web site at http://www.transcom.mil/dtr/part-iv/phaseiii.cfm (DPM SECTION...

  10. Management and Outcomes of Bowel Obstruction in Patients with Stage IV Colon Cancer: A Population-Based Cohort Study

    PubMed Central

    Winner, Megan; Mooney, Stephen J.; Hershman, Dawn L.; Feingold, Daniel L.; Allendorf, John D.; Wright, Jason D.; Neugut, Alfred I.

    2015-01-01

    BACKGROUND Bowel obstruction is a common complication of late-stage abdominal cancer, especially colon cancer, which has been investigated predominantly in small, single-institution studies. OBJECTIVE We used a large, population-based data set to explore the surgical treatment of bowel obstruction and its outcomes after hospitalization for obstruction among patients with stage IV colon cancer. DESIGN This was a retrospective cohort study. SETTING AND PATIENTS We identified 1004 patients aged 65 years or older in the Surveillance, Epidemiology and End Results-Medicare database diagnosed with stage IV colon cancer January 1, 1991 to December 31, 2005, who were later hospitalized for bowel obstruction. MAIN OUTCOME MEASURES We describe outcomes after hospitalization and analyzed the associations between surgical treatment of obstruction and outcomes. RESULTS Hospitalization for bowel obstruction occurred a median of 7.4 months after colon cancer diagnosis, and median survival after obstruction was approximately 2.5 months. Median hospitalization for obstruction was about 1 week and in-hospital mortality was 12.7%. Between discharge and death, 25% of patients were readmitted to the hospital at least once for obstruction, and, on average, patients lived 5 days out of the hospital for every day in the hospital between obstruction diagnosis and death. Survival was 3 times longer in those whose obstruction claims suggested an adhesive obstruction origin. In multivariable models, surgical compared with nonsurgical management was not associated with prolonged survival (p = 0.134). LIMITATIONS Use of an administrative database did not allow determination of quality of life or relief of obstruction as an outcome, nor could nonsurgical interventions, eg, endoscopic stenting or octreotide, be assessed. CONCLUSIONS In this population-based study of patients with stage IV colon cancer who had bowel obstruction, overall survival following obstruction was poor irrespective of

  11. Can hospitals compete on quality? Hospital competition.

    PubMed

    Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

    2015-09-01

    In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

  12. Painlevé IV coherent states

    SciTech Connect

    Bermudez, David; Contreras-Astorga, Alonso; Fernández C, David J.

    2014-11-15

    A simple way to find solutions of the Painlevé IV equation is by identifying Hamiltonian systems with third-order differential ladder operators. Some of these systems can be obtained by applying supersymmetric quantum mechanics (SUSY QM) to the harmonic oscillator. In this work, we will construct families of coherent states for such subset of SUSY partner Hamiltonians which are connected with the Painlevé IV equation. First, these coherent states are built up as eigenstates of the annihilation operator, then as displaced versions of the extremal states, both involving the related third-order ladder operators, and finally as extremal states which are also displaced but now using the so called linearized ladder operators. To each SUSY partner Hamiltonian corresponds two families of coherent states: one inside the infinite subspace associated with the isospectral part of the spectrum and another one in the finite subspace generated by the states created through the SUSY technique. - Highlights: • We use SUSY QM to obtain Hamiltonians with third-order differential ladder operators. • We show that these systems are related with the Painlevé IV equation. • We apply different definitions of coherent states to these Hamiltonians using the third-order ladder operators and some linearized ones. • We construct families of coherent states for such systems, which we called Painlevé IV coherent states.

  13. DSM IV, Culture and Child Psychiatry

    PubMed Central

    Rousseau, Cécile; Measham, Toby; Bathiche-Suidan, Marie

    2008-01-01

    Objective The expanding cultural diversity of children and families with mental health needs raises questions about the cultural appropriateness of diagnostic classifications like the DSM IV. This paper briefly surveys the literature on culture and DSM-IV in child psychiatry, presenting ADHD as an example of the relationship between diagnostic categories and cultural issues, and illustrating some of the clinical dilemmas of differential diagnosis in a migration context. Method a literature review was performed and analysed, and a case vignette was constructed to illustrate key points. Results The literature does not provide a definite answer about the DSM IV cultural validity in child psychiatry. On the one hand it suggests that all diagnostic categories may be found universally. On the other, variations in prevalence rates support the hypothesis of a role for social and cultural factors in the diagnostic process. The clinical formulation may be a useful tool to address the validity issue by modulating the process of diagnosis with a cultural understanding of the symptoms, the patient-therapist alliance and the appropriateness of treatment recommendations. Conclusion Although the DSM IV diagnostic categories may be found cross culturally, clinicians need to be aware of how culture may influence the diagnostic process in child psychiatry. PMID:18516309

  14. The carbonate complexation of plutonium(IV)

    SciTech Connect

    Hobart, D E; Palmer, P D; Newton, T W

    1985-01-01

    Plutonium(IV) carbonate complexes are expected to be of particular importance in typical groundwaters at the Yucca Mountain site of the candidate nuclear waste repository being studied by the Nevada Nuclear Waste Storage Investigations Project. The chemistry of these complexes is also important in the areas of nuclear fuel reprocessing and purification, actinide separations, and environmental studies. This report describes initial experiments performed to determine the identity and equilibrium quotients of plutonium(IV) carbonate complexes. These experiments were performed at pH values between 7.2 and 9.6 using a spectrophotometric method. In addition, a brief review of the published literature on Pu(IV) carbonate complexes is presented. Since Pu(IV) exhibits low solubility in the near-neutral pH range, a complex-competition reaction where citrate ligands compete with carbonate ions for the plutonium will be employed. This will permit us to study the pure carbonate system; study the mixed carbonate/citrate system, and confirm and extend the literature work on the pure citrate system. The current experiments have demonstrated the existence of at least three distinct species in the pH region studied. This work will continue in the extended study of the pure citrate system, followed by the investigation of the citrate/carbonate complex/competition reaction. 9 refs., 4 figs., 2 tabs.

  15. National Coastal Condition Report IV (2012)

    EPA Pesticide Factsheets

    The NCCR IV data shows an overall condition score of 3.0 for the nation’s coastal waters; although this score has improved substantially since 1990, the overall condition of the nation’s coastal resources continues to be rated fair.

  16. Industrial Waste Landfill IV upgrade package

    SciTech Connect

    Not Available

    1994-03-29

    The Y-12 Plant, K-25 Site, and ORNL are managed by DOE`s Operating Contractor (OC), Martin Marietta Energy Systems, Inc. (Energy Systems) for DOE. Operation associated with the facilities by the Operating Contractor and subcontractors, DOE contractors and the DOE Federal Building result in the generation of industrial solid wastes as well as construction/demolition wastes. Due to the waste streams mentioned, the Y-12 Industrial Waste Landfill IV (IWLF-IV) was developed for the disposal of solid industrial waste in accordance to Rule 1200-1-7, Regulations Governing Solid Waste Processing and Disposal in Tennessee. This revised operating document is a part of a request for modification to the existing Y-12 IWLF-IV to comply with revised regulation (Rule Chapters 1200-1-7-.01 through 1200-1-7-.08) in order to provide future disposal space for the ORR, Subcontractors, and the DOE Federal Building. This revised operating manual also reflects approved modifications that have been made over the years since the original landfill permit approval. The drawings referred to in this manual are included in Drawings section of the package. IWLF-IV is a Tennessee Department of Environmental and Conservation/Division of Solid Waste Management (TDEC/DSWM) Class 11 disposal unit.

  17. Day Camp Manual: Program. Book IV.

    ERIC Educational Resources Information Center

    Babcock, William

    Book IV in a 5-book day camp manual discusses the camp program. Section I describes the organization, definition, and elements essential to successful day camp programs. Section II, which addresses the benefits and special considerations of mass programs, includes rainy day contingencies, materials to have on hand, and activity suggestions.…

  18. DSN command system Mark IV-85

    NASA Technical Reports Server (NTRS)

    Thorman, H. C.

    1986-01-01

    A functional description of the Deep Space Network Command System and its subsystem is presented. The DSP command system was implemented in 1986. Store and forward command functions are reviewed. Throughput command functions for Earth orbiter missions and subsystems configurations for Mark IV-85 system are summarized.

  19. Day Camp Manual: Program. Book IV.

    ERIC Educational Resources Information Center

    Babcock, William

    Book IV in a 5-book day camp manual discusses the camp program. Section I describes the organization, definition, and elements essential to successful day camp programs. Section II, which addresses the benefits and special considerations of mass programs, includes rainy day contingencies, materials to have on hand, and activity suggestions.…

  20. Intelsat IV-F5 Launch

    NASA Technical Reports Server (NTRS)

    1972-01-01

    An Atlas-Centaur space vehicle lifted off at 5:53 p.m. EDT, June 13, 1972, from Complex 36B carrying an Intelsat Communications Satellite, (Intelsat IV-F5) into Earth orbit. Visible in the foreground is the lighthouse located at Cape Canaveral Air Force Station.

  1. Leveraging Information Technology. Track IV: Support Services.

    ERIC Educational Resources Information Center

    CAUSE, Boulder, CO.

    Seven papers from the 1987 CAUSE conference's Track IV, Support Services, are presented. They include: "Application Development Center" (John F. Leydon); "College Information Management System: The Design and Implementation of a Completely Integrated Office Automation and Student Information System" (Karen L. Miselis);…

  2. Periodontal Disease Part IV: Periodontal Infections

    PubMed Central

    Turnbull, Robert S.

    1988-01-01

    In Part IV of this article, the author describes two periodontal infections, acute necrotizing ulcerative gingivitis (trench mouth) and periodontal abscess, both acute painful conditions for which patients may seek advice from their family physician rather than their dentist. PMID:21253201

  3. Assessing the Impact of Drug Use on Hospital Costs

    PubMed Central

    Stuart, Bruce C; Doshi, Jalpa A; Terza, Joseph V

    2009-01-01

    Objective To assess whether outpatient prescription drug utilization produces offsets in the cost of hospitalization for Medicare beneficiaries. Data Sources/Study Setting The study analyzed a sample (N=3,101) of community-dwelling fee-for-service U.S. Medicare beneficiaries drawn from the 1999 and 2000 Medicare Current Beneficiary Surveys. Study Design Using a two-part model specification, we regressed any hospital admission (part 1: probit) and hospital spending by those with one or more admissions (part 2: nonlinear least squares regression) on drug use in a standard model with strong covariate controls and a residual inclusion instrumental variable (IV) model using an exogenous measure of drug coverage as the instrument. Principal Findings The covariate control model predicted that each additional prescription drug used (mean=30) raised hospital spending by $16 (p<.001). The residual inclusion IV model prediction was that each additional prescription fill reduced hospital spending by $104 (p<.001). Conclusions The findings indicate that drug use is associated with cost offsets in hospitalization among Medicare beneficiaries, once omitted variable bias is corrected using an IV technique appropriate for nonlinear applications. PMID:18783453

  4. Gen IV Materials Handbook Implementation Plan

    SciTech Connect

    Rittenhouse, P.; Ren, W.

    2005-03-29

    A Gen IV Materials Handbook is being developed to provide an authoritative single source of highly qualified structural materials information and materials properties data for use in design and analyses of all Generation IV Reactor Systems. The Handbook will be responsive to the needs expressed by all of the principal government, national laboratory, and private company stakeholders of Gen IV Reactor Systems. The Gen IV Materials Handbook Implementation Plan provided here addresses the purpose, rationale, attributes, and benefits of the Handbook and will detail its content, format, quality assurance, applicability, and access. Structural materials, both metallic and ceramic, for all Gen IV reactor types currently supported by the Department of Energy (DOE) will be included in the Gen IV Materials Handbook. However, initial emphasis will be on materials for the Very High Temperature Reactor (VHTR). Descriptive information (e.g., chemical composition and applicable technical specifications and codes) will be provided for each material along with an extensive presentation of mechanical and physical property data including consideration of temperature, irradiation, environment, etc. effects on properties. Access to the Gen IV Materials Handbook will be internet-based with appropriate levels of control. Information and data in the Handbook will be configured to allow search by material classes, specific materials, specific information or property class, specific property, data parameters, and individual data points identified with materials parameters, test conditions, and data source. Details on all of these as well as proposed applicability and consideration of data quality classes are provided in the Implementation Plan. Website development for the Handbook is divided into six phases including (1) detailed product analysis and specification, (2) simulation and design, (3) implementation and testing, (4) product release, (5) project/product evaluation, and (6) product

  5. Changing hospital payments: implications for teaching hospitals.

    PubMed

    Bentley, J D

    1983-09-01

    Hospitals cannot continue to view themselves only as social institutions whose performance will be assessed on the good they do. Teaching hospitals, in particular, cannot view themselves simply as distinctive combinations of social and educational institutions. Under Medicare's prospective pricing system, the hospital's role as production system is enhanced, and all hospitals must learn to balance the new economic realities as they work with their medical staff to adapt to a changed future.

  6. The O IV and S IV intercombination lines in solar and stellar ultraviolet spectra

    NASA Technical Reports Server (NTRS)

    Cook, J. W.; Keenan, F. P.; Dufton, P. L.; Kingston, A. E.; Pradhan, A. K.; Zhang, H. L.; Doyle, J. G.; Hayes, M. A.

    1995-01-01

    New calculations of O IV electron density diagnostic emission-line ratios involving the 1399.8, 1401.2, 1404.8, and 14076.4 A transitions are presented. A comparison of these calculations with observational data from a quiet solar region, a sunspot, and an active region obtained with the High Resolution Telescope and Spectrograph (HRTS), two flares observed with the SO82B spectrograph on board Skylab, and Hubble Space Telescope (HST) observations by the Goddard High Resolution Spectrograph (GHRS) of Capella, gives good results using the ratio R(sub 1) = I(1407.4 A)/I(1401.2 A). However, the electron density obtained using the ratio R(sub 2) = I(1407.4 A)/I(1404.8 A) is often an order of magnitude smaller. The O IV 1404.8 A line is blended with the S IV 1404.8 A line, and we investigate whether this ratio may still be used as a density diagnostic if the S IV 1406.1 A line intensity is used to correct for the presence of S IV 1404.8 A, using previous S IV calculations by Dufton et al. We still find systematic differences compared to density determinations from line ratios that do not involve the O IV 1404.8 A line, which we suggest are due to errors in earlier theoretical calculations of the S IV atomic data, and also possibly to previously unconsidered fluorescent pumping of the upper level of the S IV 1404.8 A transition.

  7. Intravenous fluid therapy: a randomized controlled trial to investigate the effectiveness of the IV(2) flow medical device.

    PubMed

    Fraser, Nesta; Snyman, Jacques R; Wessels, Francois; Nel, George

    2007-09-01

    To investigate the hypothetical benefits of the IV(2) flow medical device. Intravenous fluid administration is a standard hospital procedure with assumed inadequacies. The IV-Event Study [Fraser N, Nel G, Snyman J & Wessels F (2004) IV-EVENT Study: Intravenous Infusion Therapy--Management and Adverse Events. Data on File: Varori International (Pty) Ltd., Centurion, South Africa] quantified these inadequacies; The 'Stargait' intervention trial investigated the effectiveness and possible cost-benefit of the IV(2) flow. The IV(2) flow is intended for routine use with gravitational intravenous infusion sets. The IV(2) flow should reduce the incidence rate of adverse events and maintain a set flow rate. Nursing staff assisted by study assessors captured relevant data. Consented patients were enrolled for the period of their prescribed infusions. Intervention. The Stargait Trial compared the treatment group (standard gravitational sets with the IV(2) flow) with the control group (standard gravitational infusion sets without IV(2) flow). The difference in observed events and the cost benefit derived from this were measured. A total of 2387 drip hours were observed in 52 patients. The adverse event rates were: Control group (without IV(2) flow) 33.8%. The treatment group (IV(2) flow) 15.4%. This 55% reduction is statistically significant (p = 0.0069). Adverse event related monetary wastage (labour and consumables) is reduced by 76% for infusion bags in the intervention group (with IV(2) flow). There was a significant difference between the treatment group and control group as far as deviation in flow rate was concerned (p = 0.00818). The mean deviation of the IV(2) flow group was just more than 5 ml per hour. The standard line group had a mean deviation of more than 30 ml per hour. Gravitational intravenous therapy compromises quality of patient care. The Stargait Trial has proven the care-effectiveness and cost-effectiveness of the IV(2) flow. The IV(2) flow improves

  8. Adding source positions to the IVS Combination

    NASA Astrophysics Data System (ADS)

    Bachmann, S.; Thaller, D.

    2016-12-01

    Simultaneous estimation of source positions, Earth orientation parameters (EOPs) and station positions in one common adjustment is crucial for a consistent generation of celestial and terrestrial reference frame (CRF and TRF, respectively). VLBI is the only technique to guarantee this consistency. Previous publications showed that the VLBI intra-technique combination could improve the quality of the EOPs and station coordinates compared to the individual contributions. By now, the combination of EOP and station coordinates is well established within the IVS and in combination with other space geodetic techniques (e.g. inter-technique combined TRF like the ITRF). Most of the contributing IVS Analysis Centers (AC) now provide source positions as a third parameter type (besides EOP and station coordinates), which have not been used for an operational combined solution yet. A strategy for the combination of source positions has been developed and integrated into the routine IVS combination. Investigations are carried out to compare the source positions derived from different IVS ACs with the combined estimates to verify whether the source positions are improved by the combination, as it has been proven for EOP and station coordinates. Furthermore, global solutions of source positions, i.e., so-called catalogues describing a CRF, are generated consistently with the TRF similar to the IVS operational combined quarterly solution. The combined solutions of the source positions time series and the consistently generated TRF and CRF are compared internally to the individual solutions of the ACs as well as to external CRF catalogues and TRFs. Additionally, comparisons of EOPs based on different CRF solutions are presented as an outlook for consistent EOP, CRF and TRF realizations.

  9. Multiple Hospital Systems and the Teaching Hospital.

    ERIC Educational Resources Information Center

    Levitan, Mark S.

    1979-01-01

    Although a substantial portion of hospital beds are in institutions that are in multiple hospital systems, the possible benefits to be gained through participation in such systems do not appear to be of sufficient magnitude to either core teaching hospitals or their parent universities to persuade them to join or form a multiple system.…

  10. Critical Access Hospitals (CAH)

    MedlinePlus

    ... Access Hospital from CMS and Critical Access Hospital Finance 101 Manual from TASC. Furthermore, the Joint Commission ... Hospital Mortgage Insurance Program – helps rural healthcare facilities finance new construction, refinance debt, or purchase new equipment ...

  11. Understanding your hospital bill

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000881.htm Understanding your hospital bill To use the sharing features on this ... help you save money. Charges Listed on Your Hospital Bill A hospital bill will list the major ...

  12. Going to the Hospital

    MedlinePlus

    ... Happens in the Operating Room? Going to the Hospital KidsHealth > For Kids > Going to the Hospital Print ... you flowers, balloons, or other treats! previous continue Hospital People You'll meet lots of people in ...

  13. [Visa at a tertiary hospital].

    PubMed

    Martínez-Jiménez, S; Lluch-Colomer, A; Desongles-Corrales, T; Bernal-González, D; Santos-Rubio, M D; Alfaro-Lara, E R; Galván-Banqueri, M

    2013-01-01

    Objetivo: Analizar el procedimiento de visado y su actividad en un hospital de tercer nivel. Material y métodos: Estudio descriptivo del procedimiento de visado durante el período abril 2011-abril 2012. Se diseñó una base de datos y se definieron categorías relativas a las variables de estudio: pacientes y recetas. Para los pacientes atendidos en la Unidad de Visado se registraron las incidencias detectadas en base a una clasificación previamente establecida. Resultados: Se incluyeron 6.738 pacientes (8.465 recetas visadas). Se visaron 170 medicamentos y productos de nutrición diferentes, siendo el mayoritario Tacrolimus. Se detectaron un total de 420 incidencias, siendo las más frecuentes la «Ausencia de documento clínico» (46,67 %) y los «Errores formales de cumplimentación» (28,57%). Conclusiones: El presente trabajo ha permitido un conocimiento más pormenorizado de la actividad, los tipos de incidencias y la identificación de áreas de mejora.

  14. Origin and course of the coronary arteries in normal mice and in iv/iv mice

    PubMed Central

    ICARDO, JOSÉ M.; COLVEE, ELVIRA

    2001-01-01

    This paper reports on the origin and distribution of the coronary arteries in normal mice and in mice of the iv/iv strain, which show situs inversus and heterotaxia. The coronary arteries were studied by direct observation of the aortic sinuses with the scanning electron microscope, and by examination of vascular corrosion casts. In the normal mouse, the left and right coronaries (LC, RC) arise from the respective Valsalva sinus and course along the ventricular borders to reach the heart apex. Along this course the coronary arteries give off small branches at perpendicular or acute angles to supply the ventricles. The ventricular septum is supplied by the septal artery, which arises as a main branch from the right coronary. Conus arteries arise from the main coronary trunks, from the septal artery and/or directly from the Valsalva sinus. The vascular casts demonstrate the presence of intercoronary anastomoses. The origin of the coronary arteries was found to be abnormal in 84% of the iv/iv mice. These anomalies included double origin, high take-off, slit-like openings and the presence of a single coronary orifice. These anomalies occurred singly or in any combination, and were independent of heart situs. The septal artery originated from RC in most cases of situs solitus but originated predominantly from LC in situs inversus hearts. Except for this anomalous origin no statistical correlation was found between the coronary anomalies and heart situs or a particular mode of heterotaxia. The coronary anomalies observed in the iv/iv mice are similar to those found in human hearts. Most coronary anomalies appear to be due to defective connections between the aortic root and the developing coronaries. iv/iv mice may therefore constitute a good model to study the development of similar anomalies in the human heart. PMID:11693308

  15. Annotations on Mexico's WISC-IV: a validity study.

    PubMed

    Fina, Anthony D; Sánchez-Escobedo, Pedro; Hollingworth, Liz

    2012-01-01

    This project seeks to provide evidence on the internal structure of the Escala Wechsler de Inteligencia para Niños-IV (EWIN-IV; Wechsler, 2007a ) through a confirmatory factor analysis and intercorrelational study. Also provided is information on the adaptation process and other sources of validity evidence in support of the EWIN-IV norms. The standardization data for the EWIN-IV were used for all analyses. The factor loadings and correlational patterns found on the EWIN-IV are comparable to those seen in the American versions of the test. The proposed factor and scoring structure of the EWIN-IV was supported.

  16. IV thrombolysis in very severe and severe ischemic stroke

    PubMed Central

    Lees, Kennedy R.; Collas, David; Rand, Viiu-Marika; Mikulik, Robert; Toni, Danilo; Wahlgren, Nils; Ahmed, Niaz

    2015-01-01

    Objective: To study the safety of off-label IV thrombolysis in patients with very severe stroke (NIH Stroke Scale [NIHSS] scores >25) compared with severe stroke (NIHSS scores 15–25), where treatment is within European regulations. Methods: Data were analyzed from 57,247 patients with acute ischemic stroke receiving IV tissue plasminogen activator in 793 hospitals participating in the Safe Implementation of Thrombolysis in Stroke (SITS) International Stroke Thrombolysis Registry (2002–2013). Eight hundred sixty-eight patients (1.5%) had NIHSS scores >25 and 19,995 (34.9%) had NIHSS scores 15–25. Outcome measures were parenchymal hemorrhage, symptomatic intracerebral hemorrhage, mortality, and functional outcome. Results: Parenchymal hemorrhage occurred in 10.7% vs 11.0% (p = 0.79), symptomatic intracerebral hemorrhage per SITS-MOST (SITS–Monitoring Study) in 1.4% vs 2.5% (p = 0.052), death at 3 months in 50.4% vs 26.9% (p < 0.001), and functional independence at 3 months in 14.0% vs 29.0% (p < 0.001) of patients with NIHSS scores >25 and NIHSS scores 15–25, respectively. Multivariate adjustment did not change findings from univariate comparisons. Posterior circulation stroke was more common in patients with NIHSS scores >25 (36.2% vs 7.4%, p < 0.001), who were also more often obtunded or comatose on presentation (58.4% vs 7.1%, p < 0.001). Of patients with NIHSS scores >25, 26.2% were treated >3 hours from symptom onset vs 14.5% with NIHSS scores of 15–25. Conclusions: Our data show no excess risk of cerebral hemorrhage in patients with NIHSS score >25 compared to score 15–25, suggesting that the European contraindication to IV tissue plasminogen activator treatment at NIHSS levels >25 may be unwarranted. Increased mortality and lower rates of functional independence in patients with NIHSS score >25 are explained by higher stroke severity, impaired consciousness on presentation due to posterior circulation ischemia, and longer treatment delays. PMID

  17. DNA clone of human type IV collagenase

    SciTech Connect

    Goldberg, G.I.; Eisen, A.Z.

    1990-05-08

    This patent relates to type IV collagenase, herein after also referred to as gelatinase. More particularly, the patent relates to the cDNA clone representing the full size human type IV collagenase (gelatinase). Collagens constitute the most abundant proteins of the extracellular matrix (ECM) in mammalian organisms. Collagen and other macromolecules of the ECM are deposited by resident cells and organized into a three-dimensional meshwork. This ECM environment plays an essential role in guiding cell migration, and in cell-to-cell communication during morphogenetic processes. The restructuring of the ECM during remodeling occurs as a cooperative multistep process involving a localized degradation of existing macromolecules, rearrangement of the cytoskeleton, cell translocation, and deposition of new ECM components.

  18. Mariner IV Mission to Mars. Part I

    NASA Technical Reports Server (NTRS)

    James, Jack N.

    1965-01-01

    This technical report is a series of individual papers documenting the Mariner-Mars project from its beginning in 1962 following the successful Mariner-Venus mission. Part I is pre-encounter data. It includes papers on the design, development, and testing of Mariner IV, as well as papers detailing methods of maintaining communication with and obtaining data from the spacecraft during flight, and expected results during encounter with Mars. Part 11, post-encounter data, to be published later, will consist of documentation of the events taking place during Mariner IV's encounter with Mars and thereafter. The Mariner-Mars mission, the culmination of an era of spacecraft development, has contributed much new technology to be used in future projects.

  19. Giant piezoelectricity of monolayer group IV monochalcogenides

    NASA Astrophysics Data System (ADS)

    Fei, Ruixiang; Li, Wenbin; Li, Ju; Yang, Li

    We predict enormous, anisotropic piezoelectric effects in intrinsic monolayer group IV monochalcogenides (MX, M =Sn or Ge, X =Se or S), including SnSe, SnS, GeSe, and GeS. Using first-principle simulations based on the modern theory of polarization, we find that their piezoelectric coefficients are about one to two orders of magnitude larger than those of other 2D materials, such as MoS2 and GaSe, and bulk quartz and AlN which are widely used in industry. This enhancement is a result of the unique ``puckered'' C2v symmetry and electronic structure of monolayer group IV monochalcogenides. Given the achieved experimental advances in the fabrication of monolayers, their flexible character, and ability to withstand enormous strain, these 2D structures with giant piezoelectric effects may be promising for a broad range of applications such as nano-sized sensors, piezotronics, and energy harvesting in portable electronic devices.

  20. Treatment burden in patients with at least one class IV or V CFTR mutation.

    PubMed

    Dewulf, Jonas; Vermeulen, François; Wanyama, Simeon; Thomas, Muriel; Proesmans, Marijke; Dupont, Lieven; De Boeck, Kris

    2015-12-01

    CFTR mutations are grouped according to disease-causing mechanism. Several studies demonstrated that patients having at least one mutation of class IV/V, present with a milder phenotype, but little is known about their relative treatment burden. We compared treatment burden between patients with two class I, II, or III mutations and patients with at least one mutation of class IV/V in the 2010 database of the Belgian CF Registry. We calculated a "Treatment Burden Index" (TBI) by assigning long term therapies to categories low, medium and high intensity, for differential weighing in the total score. There were 779 patients with two known class I/II/III mutations and 94 patients with at least one class IV/V mutation. Compared to class I/II/III, class IV/V patients had a lower median number of clinic visits (4 vs. 5; P < 0.001), a lower risk of hospitalization (24.7% vs. 50.8%; P < 0.001) and intravenous antibiotic treatment (23.5% vs. 46.0%; P < 0.001) and a lower median TBI (6 vs. 9; P < 0.001). These differences remained significant when only class IV/V patients with pancreatic insufficiency (n = 31) were considered. This study clearly demonstrates the significantly lower treatment burden in patients with CF and at least one class IV/V mutation compared to patients with two class I/II/III mutations and contributes to providing better individual counseling at time of diagnosis.

  1. Using failure mode and effects analysis to plan implementation of smart i.v. pump technology.

    PubMed

    Wetterneck, Tosha B; Skibinski, Kathleen A; Roberts, Tanita L; Kleppin, Susan M; Schroeder, Mark E; Enloe, Myra; Rough, Steven S; Hundt, Ann Schoofs; Carayon, Pascale

    2006-08-15

    Failure mode and effects analysis (FMEA) was used to evaluate a smart i.v. pump as it was implemented into a redesigned medication-use process. A multidisciplinary team conducted a FMEA to guide the implementation of a smart i.v. pump that was designed to prevent pump programming errors. The smart i.v. pump was equipped with a dose-error reduction system that included a pre-defined drug library in which dosage limits were set for each medication. Monitoring for potential failures and errors occurred for three months postimplementation of FMEA. Specific measures were used to determine the success of the actions that were implemented as a result of the FMEA. The FMEA process at the hospital identified key failure modes in the medication process with the use of the old and new pumps, and actions were taken to avoid errors and adverse events. I.V. pump software and hardware design changes were also recommended. Thirteen of the 18 failure modes reported in practice after pump implementation had been identified by the team. A beneficial outcome of FMEA was the development of a multidisciplinary team that provided the infrastructure for safe technology implementation and effective event investigation after implementation. With the continual updating of i.v. pump software and hardware after implementation, FMEA can be an important starting place for safe technology choice and implementation and can produce site experts to follow technology and process changes over time. FMEA was useful in identifying potential problems in the medication-use process with the implementation of new smart i.v. pumps. Monitoring for system failures and errors after implementation remains necessary.

  2. In vitro removal of actinide (IV) ions

    DOEpatents

    Weitl, Frederick L.; Raymond, Kenneth N.

    1982-01-01

    A compound of the formula: ##STR1## wherein X is hydrogen or a conventional electron-withdrawing group, particularly --SO.sub.3 H or a salt thereof; n is 2, 3, or 4; m is 2, 3, or 4; and p is 2 or 3. The present compounds are useful as specific sequestering agents for actinide (IV) ions. Also described is a method for the 2,3-dihydroxybenzamidation of azaalkanes.

  3. What Is New in Rome IV

    PubMed Central

    Schmulson, Max J; Drossman, Douglas A

    2017-01-01

    Functional gastrointestinal disorders (FGIDs) are diagnosed and classified using the Rome criteria; the criteria may change over time as new scientific data emerge. The Rome IV was released in May 2016. The aim is to review the main changes in Rome IV. FGIDs are now called disorders of gut-brain interaction (DGBI). Rome IV has a multicultural rather than a Western-culture focus. There are new chapters including multicultural, age-gender-women’s health, intestinal microenvironment, biopsychosocial, and centrally mediated disorders. New disorders have been included although not truly FGIDs, but fit the new definition of DGBI including opioid-induced gastrointestinal hyperalgesia, opioid-induced constipation, and cannabinoid hyperemesis. Also, new FGIDs based on available evidence including reflux hypersensitivity and centrally mediated abdominal pain syndrome. Using a normative survey to determine the frequency of normal bowel symptoms in the general population changes in the time frame for diagnosis were introduced. For irritable bowel syndrome (IBS) only pain is required and discomfort was eliminated because it is non-specific, having different meanings in different languages. Pain is now related to bowel movements rather than just improving with bowel movements (ie, can get worse with bowel movement). Functional bowel disorders (functional diarrhea, functional constipation, IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-C], and IBS with mixed bowel habits) are considered to be on a continuum rather than as independent entities. Clinical applications such as diagnostic algorithms and the Multidimensional Clinical Profile have been updated. The new Rome IV iteration is evidence-based, multicultural oriented and with clinical applications. As new evidence become available, future updates are expected. PMID:28274109

  4. What is new in Rome IV.

    PubMed

    Schmulson, Max J; Drossman, Douglas Arnold

    2017-03-09

    Functional gastrointestinal disorders (FGIDs) are diagnosed and classified using the Rome criteria; the criteria may change over time as new scientific data emerge. The Rome IV was released in May 2016. The aim is to review the main changes in Rome IV. FGIDs are now called disorders of gut-brain interaction (DGBI). Rome IV has a multicultural rather than a Western-culture focus. There are new chapters including multicultural, age-gender-women's health, intestinal microenvironment, biopsychosocial, and centrally mediated disorders. New disorders have been included although not truly FGIDs, but fit the new definition of DGBI including opioid-induced gastrointestinal hyperalgesia, opioid-induced constipation, and cannabinoid hyperemesis. Also, new FGIDs based on available evidence including reflux hypersensitivity and centrally mediatedabdominal pain syndrome. Using a normative survey to determine the frequency of normal bowel symptoms in the general population changes in the time frame for diagnosis were introduced. For irritable bowel syndrome (IBS) only pain is required and discomfort was eliminated because it is non-specific, having different meanings in different languages. Pain is now related to bowel movements rather than just improving with bowel movements (ie, can get worse with bowel movement). Functional bowel disorders (functional diarrhea, functional constipation, IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-D], and mixed IBS) are considered to be on a continuum rather than as independent entities. Clinical applications such as diagnostic algorithms and the Multidimensional Clinical Profile have been updated. The new Rome IV iteration is evidence-based, multicultural oriented and with clinical applications. As new evidence become available, future updates are expected.

  5. Flexible Manufacturing System Handbook. Volume IV. Appendices

    DTIC Science & Technology

    1983-02-01

    controls. (9) Sets of batteries (one set per vehicle per shift). (3) Battery chargers . (1) Frequency generator. Necessary area controllers. Necessary battery ...When Date Entered)__________________ REPOT DC -U171,NTATON AGEREAD INSTRUCTIONSREPOT DOIJIENTAION AGEBEFORE COMPLETING FORM I. REPORT NUb’EER 2.GOVT...Inc. Cambridge, Massachusetts 02139 ii FMS Handbook, Volume IV PREFACE This is the fourth volume in a five-volume series designed to answer the

  6. Quicksilver IV: The Real Operation Fortitude

    DTIC Science & Technology

    2010-06-01

    original research, primarily in the British National Archives at Kew Gardens . Chapter 1 provides a brief overview of the Allied deception campaign...Taxable and Glimmer Source: The National Archives, Kew In conjunction with the sea diversionary plans, the Allies also executed four airborne...operations (see figure 3). 18 Figure 3. The Airborne Diversions – Operations Titanic I-IV Source: The National Archives, Kew Titanic I worked

  7. APCS TYPE IV CAMERA POD TEST.

    DTIC Science & Technology

    The Type IV camera pod was evaluated for adaptation to the A-1E aircraft. Flight tests to evaluate camera pod steadiness were flown with the pod ...mounted on the No. 3 outboard station, the left inboard station, and the centerline station. After confirmation of minimal pod and camera vibration on...camera pod test aircraft. The camera pod photographic coverage of ordnance delivery was accomplished with forward and aft facing, 16mm, Milliken DB-5

  8. Examining Computational Assumptions For Godiva IV

    SciTech Connect

    Kirkland, Alexander Matthew; Jaegers, Peter James

    2016-08-11

    Over the course of summer 2016, the effects of several computational modeling assumptions with respect to the Godiva IV reactor were examined. The majority of these assumptions pertained to modeling errors existing in the control rods and burst rod. The Monte Carlo neutron transport code, MCNP, was used to investigate these modeling changes, primarily by comparing them to that of the original input deck specifications.

  9. Genome Sequencing and Analysis Conference IV

    SciTech Connect

    Not Available

    1993-12-31

    J. Craig Venter and C. Thomas Caskey co-chaired Genome Sequencing and Analysis Conference IV held at Hilton Head, South Carolina from September 26--30, 1992. Venter opened the conference by noting that approximately 400 researchers from 16 nations were present four times as many participants as at Genome Sequencing Conference I in 1989. Venter also introduced the Data Fair, a new component of the conference allowing exchange and on-site computer analysis of unpublished sequence data.

  10. The IVS data input to ITRF2014

    NASA Astrophysics Data System (ADS)

    Nothnagel, Axel; Alef, Walter; Amagai, Jun; Andersen, Per Helge; Andreeva, Tatiana; Artz, Thomas; Bachmann, Sabine; Barache, Christophe; Baudry, Alain; Bauernfeind, Erhard; Baver, Karen; Beaudoin, Christopher; Behrend, Dirk; Bellanger, Antoine; Berdnikov, Anton; Bergman, Per; Bernhart, Simone; Bertarini, Alessandra; Bianco, Giuseppe; Bielmaier, Ewald; Boboltz, David; Böhm, Johannes; Böhm, Sigrid; Boer, Armin; Bolotin, Sergei; Bougeard, Mireille; Bourda, Geraldine; Buttaccio, Salvo; Cannizzaro, Letizia; Cappallo, Roger; Carlson, Brent; Carter, Merri Sue; Charlot, Patrick; Chen, Chenyu; Chen, Maozheng; Cho, Jungho; Clark, Thomas; Collioud, Arnaud; Colomer, Francisco; Colucci, Giuseppe; Combrinck, Ludwig; Conway, John; Corey, Brian; Curtis, Ronald; Dassing, Reiner; Davis, Maria; de-Vicente, Pablo; De Witt, Aletha; Diakov, Alexey; Dickey, John; Diegel, Irv; Doi, Koichiro; Drewes, Hermann; Dube, Maurice; Elgered, Gunnar; Engelhardt, Gerald; Evangelista, Mark; Fan, Qingyuan; Fedotov, Leonid; Fey, Alan; Figueroa, Ricardo; Fukuzaki, Yoshihiro; Gambis, Daniel; Garcia-Espada, Susana; Gaume, Ralph; Gaylard, Michael; Geiger, Nicole; Gipson, John; Gomez, Frank; Gomez-Gonzalez, Jesus; Gordon, David; Govind, Ramesh; Gubanov, Vadim; Gulyaev, Sergei; Haas, Ruediger; Hall, David; Halsig, Sebastian; Hammargren, Roger; Hase, Hayo; Heinkelmann, Robert; Helldner, Leif; Herrera, Cristian; Himwich, Ed; Hobiger, Thomas; Holst, Christoph; Hong, Xiaoyu; Honma, Mareki; Huang, Xinyong; Hugentobler, Urs; Ichikawa, Ryuichi; Iddink, Andreas; Ihde, Johannes; Ilijin, Gennadiy; Ipatov, Alexander; Ipatova, Irina; Ishihara, Misao; Ivanov, D. V.; Jacobs, Chris; Jike, Takaaki; Johansson, Karl-Ake; Johnson, Heidi; Johnston, Kenneth; Ju, Hyunhee; Karasawa, Masao; Kaufmann, Pierre; Kawabata, Ryoji; Kawaguchi, Noriyuki; Kawai, Eiji; Kaydanovsky, Michael; Kharinov, Mikhail; Kobayashi, Hideyuki; Kokado, Kensuke; Kondo, Tetsuro; Korkin, Edward; Koyama, Yasuhiro; Krasna, Hana; Kronschnabl, Gerhard; Kurdubov, Sergey; Kurihara, Shinobu; Kuroda, Jiro; Kwak, Younghee; La Porta, Laura; Labelle, Ruth; Lamb, Doug; Lambert, Sébastien; Langkaas, Line; Lanotte, Roberto; Lavrov, Alexey; Le Bail, Karine; Leek, Judith; Li, Bing; Li, Huihua; Li, Jinling; Liang, Shiguang; Lindqvist, Michael; Liu, Xiang; Loesler, Michael; Long, Jim; Lonsdale, Colin; Lovell, Jim; Lowe, Stephen; Lucena, Antonio; Luzum, Brian; Ma, Chopo; Ma, Jun; Maccaferri, Giuseppe; Machida, Morito; MacMillan, Dan; Madzak, Matthias; Malkin, Zinovy; Manabe, Seiji; Mantovani, Franco; Mardyshkin, Vyacheslav; Marshalov, Dmitry; Mathiassen, Geir; Matsuzaka, Shigeru; McCarthy, Dennis; Melnikov, Alexey; Michailov, Andrey; Miller, Natalia; Mitchell, Donald; Mora-Diaz, Julian Andres; Mueskens, Arno; Mukai, Yasuko; Nanni, Mauro; Natusch, Tim; Negusini, Monia; Neidhardt, Alexander; Nickola, Marisa; Nicolson, George; Niell, Arthur; Nikitin, Pavel; Nilsson, Tobias; Ning, Tong; Nishikawa, Takashi; Noll, Carey; Nozawa, Kentarou; Ogaja, Clement; Oh, Hongjong; Olofsson, Hans; Opseth, Per Erik; Orfei, Sandro; Pacione, Rosa; Pazamickas, Katherine; Petrachenko, William; Pettersson, Lars; Pino, Pedro; Plank, Lucia; Ploetz, Christian; Poirier, Michael; Poutanen, Markku; Qian, Zhihan; Quick, Jonathan; Rahimov, Ismail; Redmond, Jay; Reid, Brett; Reynolds, John; Richter, Bernd; Rioja, Maria; Romero-Wolf, Andres; Ruszczyk, Chester; Salnikov, Alexander; Sarti, Pierguido; Schatz, Raimund; Scherneck, Hans-Georg; Schiavone, Francesco; Schreiber, Ulrich; Schuh, Harald; Schwarz, Walter; Sciarretta, Cecilia; Searle, Anthony; Sekido, Mamoru; Seitz, Manuela; Shao, Minghui; Shibuya, Kazuo; Shu, Fengchun; Sieber, Moritz; Skjaeveland, Asmund; Skurikhina, Elena; Smolentsev, Sergey; Smythe, Dan; Sousa, Don; Sovers, Ojars; Stanford, Laura; Stanghellini, Carlo; Steppe, Alan; Strand, Rich; Sun, Jing; Surkis, Igor; Takashima, Kazuhiro; Takefuji, Kazuhiro; Takiguchi, Hiroshi; Tamura, Yoshiaki; Tanabe, Tadashi; Tanir, Emine; Tao, An; Tateyama, Claudio; Teke, Kamil; Thomas, Cynthia; Thorandt, Volkmar; Thornton, Bruce; Tierno Ros, Claudia; Titov, Oleg; Titus, Mike; Tomasi, Paolo; Tornatore, Vincenza; Trigilio, Corrado; Trofimov, Dmitriy; Tsutsumi, Masanori; Tuccari, Gino; Tzioumis, Tasso; Ujihara, Hideki; Ullrich, Dieter; Uunila, Minttu; Venturi, Tiziana; Vespe, Francesco; Vityazev, Veniamin; Volvach, Alexandr; Vytnov, Alexander; Wang, Guangli; Wang, Jinqing; Wang, Lingling; Wang, Na; Wang, Shiqiang; Wei, Wenren; Weston, Stuart; Whitney, Alan; Wojdziak, Reiner; Yatskiv, Yaroslav; Yang, Wenjun; Ye, Shuhua; Yi, Sangoh; Yusup, Aili; Zapata, Octavio; Zeitlhoefler, Reinhard; Zhang, Hua; Zhang, Ming; Zhang, Xiuzhong; Zhao, Rongbing; Zheng, Weimin; Zhou, Ruixian; Zubko, Nataliya

    2015-01-01

    Very Long Baseline Interferometry (VLBI) is a primary space-geodetic technique for determining precise coordinates on the Earth, for monitoring the variable Earth rotation and orientation with highest precision, and for deriving many other parameters of the Earth system. The International VLBI Service for Geodesy and Astrometry (IVS, http://ivscc.gsfc.nasa.gov/) is a service of the International Association of Geodesy (IAG) and the International Astronomical Union (IAU). The datasets published here are the results of individual Very Long Baseline Interferometry (VLBI) sessions in the form of normal equations in SINEX 2.0 format (http://www.iers.org/IERS/EN/Organization/AnalysisCoordinator/SinexFormat/sinex.html, the SINEX 2.0 description is attached as pdf) provided by IVS as the input for the next release of the International Terrestrial Reference System (ITRF): ITRF2014. This is a new version of the ITRF2008 release (Bockmann et al., 2009). For each session/ file, the normal equation systems contain elements for the coordinate components of all stations having participated in the respective session as well as for the Earth orientation parameters (x-pole, y-pole, UT1 and its time derivatives plus offset to the IAU2006 precession-nutation components dX, dY (https://www.iau.org/static/resolutions/IAU2006_Resol1.pdf). The terrestrial part is free of datum. The data sets are the result of a weighted combination of the input of several IVS Analysis Centers. The IVS contribution for ITRF2014 is described in Bachmann et al (2015), Schuh and Behrend (2012) provide a general overview on the VLBI method, details on the internal data handling can be found at Behrend (2013).

  11. I-V characterization of solar cells

    NASA Astrophysics Data System (ADS)

    Veissid, N.; Ranvaud, R.; Fonseca, F. J.

    1981-06-01

    Equivalent circuits were analysed and then I-V characteristics obtained from different solar cells were compared with those from the circuits. The measures were obtained under natural conditions and under artificial conditions (solar simulator made of easily obtained light sources and several filters). The identification of components in the equivalent circuit, together with the theory of photovoltaic conversion, is very important in the optimization of the cell design. A numeric method for determination of the series resistance is proposed.

  12. Specialty hospitals: can general hospitals compete?

    PubMed

    Dummit, Laura A

    2005-07-13

    The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of "fair" competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals provided information to help assess their potential effect on health care delivery. This issue brief discusses the research on specialty hospitals, including their payments under Medicare's hospital inpatient payment system, the quality and cost of care they deliver, their effect on general hospitals and on overall health care delivery, and the regulatory and legal environment in which they have proliferated. It concludes with open issues concerning physician self-referral and the role of general hospitals in providing a range of health care services.

  13. Endonuclease IV (nfo) mutant of Escherichia coli.

    PubMed Central

    Cunningham, R P; Saporito, S M; Spitzer, S G; Weiss, B

    1986-01-01

    A cloned gene, designated nfo, caused overproduction of an EDTA-resistant endonuclease specific for apurinic-apyrimidinic sites in DNA. The sedimentation coefficient of the enzyme was similar to that of endonuclease IV. An insertion mutation was constructed in vitro and transferred from a plasmid to the Escherichia coli chromosome. nfo mutants had an increased sensitivity to the alkylating agents methyl methanesulfonate and mitomycin C and to the oxidants tert-butyl hydroperoxide and bleomycin. The nfo mutation enhanced the killing of xth (exonuclease III) mutants by methyl methanesulfonate, H2O2, tert-butyl hydroperoxide, and gamma rays, and it enhanced their mutability by methyl methanesulfonate. It also increased the temperature sensitivity of an xth dut (dUTPase) mutant that is defective in the repair of uracil-containing DNA. These results are consistent with earlier findings that endonuclease IV and exonuclease III both cleave DNA 5' to an apurinic-apyrimidinic site and that exonuclease III is more active. However, nfo mutants were more sensitive to tert-butyl hydroperoxide and to bleomycin than were xth mutants, suggesting that endonuclease IV might recognize some lesions that exonuclease III does not. The mutants displayed no marked increase in sensitivity to 254-nm UV radiation, and the addition of an nth (endonuclease III) mutation to nfo or nfo xth mutants did not significantly increase their sensitivity to any of the agents tested. Images PMID:2430946

  14. DNA ligase IV syndrome; a review.

    PubMed

    Altmann, Thomas; Gennery, Andrew R

    2016-10-07

    DNA ligase IV deficiency is a rare primary immunodeficiency, LIG4 syndrome, often associated with other systemic features. DNA ligase IV is part of the non-homologous end joining mechanism, required to repair DNA double stranded breaks. Ubiquitously expressed, it is required to prevent mutagenesis and apoptosis, which can result from DNA double strand breakage caused by intracellular events such as DNA replication and meiosis or extracellular events including damage by reactive oxygen species and ionising radiation.Within developing lymphocytes, DNA ligase IV is required to repair programmed DNA double stranded breaks induced during lymphocyte receptor development.Patients with hypomorphic mutations in LIG4 present with a range of phenotypes, from normal to severe combined immunodeficiency. All, however, manifest sensitivity to ionising radiation. Commonly associated features include primordial growth failure with severe microcephaly and a spectrum of learning difficulties, marrow hypoplasia and a predisposition to lymphoid malignancy. Diagnostic investigations include immunophenotyping, and testing for radiosensitivity. Some patients present with microcephaly as a predominant feature, but seemingly normal immunity. Treatment is mainly supportive, although haematopoietic stem cell transplantation has been used in a few cases.

  15. Type IV Pilin Proteins: Versatile Molecular Modules

    PubMed Central

    Giltner, Carmen L.; Nguyen, Ylan

    2012-01-01

    Summary: Type IV pili (T4P) are multifunctional protein fibers produced on the surfaces of a wide variety of bacteria and archaea. The major subunit of T4P is the type IV pilin, and structurally related proteins are found as components of the type II secretion (T2S) system, where they are called pseudopilins; of DNA uptake/competence systems in both Gram-negative and Gram-positive species; and of flagella, pili, and sugar-binding systems in the archaea. This broad distribution of a single protein family implies both a common evolutionary origin and a highly adaptable functional plan. The type IV pilin is a remarkably versatile architectural module that has been adopted widely for a variety of functions, including motility, attachment to chemically diverse surfaces, electrical conductance, acquisition of DNA, and secretion of a broad range of structurally distinct protein substrates. In this review, we consider recent advances in this research area, from structural revelations to insights into diversity, posttranslational modifications, regulation, and function. PMID:23204365

  16. Hospital marketing revisited.

    PubMed

    Costello, M M

    1987-05-01

    With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature.

  17. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  18. Measuring Rural Hospital Quality

    ERIC Educational Resources Information Center

    Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

    2004-01-01

    Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

  19. Decreasing IV Infiltrates in the Pediatric Patient--System-Based Improvement Project.

    PubMed

    Major, Tracie Wilt; Huey, Tricia K

    2016-01-01

    Intravenous infiltrates pose tremendous risk for the hospitalized pediatric patient. Infiltrate events increase hospital-acquired harm, the number of painful procedures, use of supplies, length of stay, and nursing time; it threatens relationships essential in patient- and family-centered care. The goal of this quality improvement project was to achieve a 10% decrease in the baseline infiltrate rate on two inpatient units and in the overall infiltrate rate across all of the pediatric units. A Lean Six Sigma methodology was used to guide project activities. Improvement strategies focused on evidence-based education, intravenous (IV) catheter securement, and family engagement. A comparative purposive sample was used to evaluate the pre- and post-implementation period to determine if desired project success measures were achieved. Data analysis revealed positive results across all units, with the number of events (n = 51 pre; n = 19 post) and the infiltration rates (13.5 pre; 7.1 post) decreasing over a three-month period. A decrease was also noted in the overall percent of IVs that infiltrated in the first 24 hours (45% pre; 42% post). A statistically significant increase (t = 15.16; p < 0.001) was noted in nurses' education pre- and post-assessment survey scores. The family engagement strategy revealed overall parental responses to be 88% positive. By decreasing infiltrates, quality of care improved, resulting in the delivery of safe, effective, and patient-centered IV therapy.

  20. Hospital libraries in perspective.

    PubMed Central

    Holst, R

    1991-01-01

    The proliferation of hospital libraries since World War II has created a generation of librarians who take for granted the existence of libraries in hospitals. A literature review for the first half of the twentieth century presents a picture of uncertainty and struggle for identity for the hospital library. Then as now, hospital libraries reflect the institutions within which they operate. A brief history of the development of the American hospital provides a context for describing the various roles that the hospital library has played within its parent institution during the twentieth century. Some personal reflections on working in a hospital library are also presented. PMID:1998812

  1. Competition among hospitals.

    PubMed

    Noether, M

    1988-09-01

    The traditional view of hospital competition has posited that hospitals compete primarily along 'quality' dimensions, in the form of fancy equipment to attract admitting physicians and pleasant surroundings to entice patients. Price competition among hospitals is thought to be non-existent. This paper estimates the effects of various hospital market characteristics on hospital prices and expenses in an attempt to determine the form of hospital competition. The results suggest that both price and quality competition are greater in markets that are less concentrated, although the net effect of the two on prices is insignificant. It appears, therefore, that, despite important distortions, hospital markets are not immune to standard competitive forces.

  2. Density diagnostics derived from the O iv and S iv intercombination lines observed by IRIS

    NASA Astrophysics Data System (ADS)

    Polito, V.; Del Zanna, G.; Dudík, J.; Mason, H. E.; Giunta, A.; Reeves, K. K.

    2016-10-01

    The intensity of the O iv 2s2 2p 2P-2s2p24P and S iv 3 s2 3p 2P-3s 3p24 P intercombination lines around 1400 Å observed with the Interface Region Imaging Spectrograph (IRIS) provide a useful tool to diagnose the electron number density (Ne) in the solar transition region plasma. We measure the electron number density in a variety of solar features observed by IRIS, including an active region (AR) loop, plage and brightening, and the ribbon of the 22-June-2015 M 6.5 class flare. By using the emissivity ratios of O iv and S iv lines, we find that our observations are consistent with the emitting plasma being near isothermal (logT[K] ≈ 5) and iso-density (Ne ≈ 1010.6 cm-3) in the AR loop. Moreover, high electron number densities (Ne ≈ 1013 cm-3) are obtained during the impulsive phase of the flare by using the S iv line ratio. We note that the S iv lines provide a higher range of density sensitivity than the O iv lines. Finally, we investigate the effects of high densities (Ne ≳ 1011 cm-3) on the ionization balance. In particular, the fractional ion abundances are found to be shifted towards lower temperatures for high densities compared to the low density case. We also explored the effects of a non-Maxwellian electron distribution on our diagnostic method. The movie associated to Fig. 3 is available at http://www.aanda.org

  3. Planning a Kinetic and Mechanistic Study with Cerium (IV)

    ERIC Educational Resources Information Center

    Hanna, Samir B.; And Others

    1976-01-01

    Presents a kinetic study that utilizes a method for varying the concentrations of the possible Ce(IV) species and computing the concentration distribution of the sulfato and hydroxo species of Ce(IV). (MLH)

  4. Expanding the Ecological Validity of WAIS-IV and WMS-IV With the Texas Functional Living Scale

    PubMed Central

    Drozdick, Lisa Whipple; Cullum, C. Munro

    2015-01-01

    Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV) and Wechsler Memory Scale–Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV. PMID:20921288

  5. Expanding the ecological validity of WAIS-IV and WMS-IV with the Texas functional living scale.

    PubMed

    Whipple Drozdick, Lisa; Munro Cullum, C

    2011-06-01

    Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV.

  6. [Collagen type IV: major component of basement membranes. Current knowledge].

    PubMed

    Mercier, P; Ekindjian, O G

    1990-01-01

    The collagen family represents the most abundant protein in animals. Type IV collagen ([alpha 1 (IV)]2 alpha 2 (IV)) differs from the other types in several respects and particularly in its distribution, being strictly limited to the basement membranes. Alterations in the structure and functions of basement membranes are observed in a number of diseases, such as tumoral angiogenesis and diabetic nephropathy. This article reviews current structural and pathophysiological knowledge concerning type IV collagen.

  7. [Evaluation of the efficiency and quality of hospitals publicly owned with private management and hospitals of the public sector].

    PubMed

    Giraldes, Maria Do Rosário

    2007-01-01

    The main aim of this article is to evaluate the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system using process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc), and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the case-mix index, in 2004, and have been weighted according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered: process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of caesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care The composite indicator of efficiency, weighted by the inverse of the case-mix index presents the lower values in Tondela, Seia, and Fafe, while the Hospital of the Litoral Alentejano is, in this group, the most inefficient. The Agueda Hospital presents the better Composite Efficiency Indicator, in Group II, followed by the Barcelos and S. João da Madeira Hospitals, while the Figueira da Foz Hospital presents the worst situation. In hospitals from Group III the Hospitals of Vale de Sousa, EPE, and the Vila Franca de Xira Hospital present the better Composite Efficiency Indicator followed by the Barreiro Hospital, EPE. In Group IV it is the Hospital of S. Sebastião, EPE, that presents the lowest Composite Efficiency Indicator, followed by the Cascais Hospital, SPA

  8. [Hospitals in Europe and Yugoslavia through the centuries].

    PubMed

    Topalović, R

    1998-01-01

    The primary object of this paper is to give a retrospective of hospital development in Europe and Yugoslavia for the past twenty-five centuries. The earliest records of hospitals called the "iatreia" date back to the V century B.C., ancient Greece. The sick in those hospitals were treated with drugs as well operated on. The Romans, during the reign of the emperor Augustus, built valetudinaries within military camps. The name "hospital" was introduced in the IV century A.D. and has been used ever since. The first hospital was founded in Cesarea, i.e. in the East Roman Empire in Asia Minor. The chronology of the hospital development in the Middle Ages is given in table 1--"Chronology of Hospital Development in the Middle Ages." St. Sava (Nemanjić) founded the first Serbian hospital in the Monastery of Hilandar about 1199 and in 1208/1209 a hospital in the Monastery of Studenica. In the hospital of the Monastery of St. Arhangel in Prizren, according to the regulations prescribed by tzar Dusan, only curable patients were to be treated. The first hospital in Vojvodina in Bac near Novi Sad dates back to 1234. More data about hospitals in former Yugoslavia are given in table 2--"The Oldest Hospitals in former Yugoslavia" and about the Frontier Hospitals in Vojvodina in table 3--"Frontier Hospitals for the Wounded and Sick in Vojvodina". The first medical high school was established in Salerno in the IX century and the first European University in Bologna in 1088, where the School of Medicine was founded in 1156. The University in Paris was founded in 1107 and in Oxford in 1145.

  9. 40 CFR 144.23 - Class IV wells.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Class IV wells. 144.23 Section 144.23... INJECTION CONTROL PROGRAM Authorization of Underground Injection by Rule § 144.23 Class IV wells. (a) Injection into existing Class IV wells is authorized for up to six months after approval or promulgation of...

  10. 34 CFR 85.1018 - Title IV, HEA transaction.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... responsibility for a grant, loan, or work study assistance under a title IV, HEA program. Authority: E.O. 12549... disbursement or delivery of funds provided under a title IV, HEA program to a student or borrower; (b) A certification by an educational institution of eligibility for a loan under a title IV, HEA program;...

  11. 34 CFR 85.1018 - Title IV, HEA transaction.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... responsibility for a grant, loan, or work study assistance under a title IV, HEA program. (Authority: E.O. 12549... disbursement or delivery of funds provided under a title IV, HEA program to a student or borrower; (b) A certification by an educational institution of eligibility for a loan under a title IV, HEA program;...

  12. Topoisomerase IV is a target of quinolones in Escherichia coli.

    PubMed Central

    Khodursky, A B; Zechiedrich, E L; Cozzarelli, N R

    1995-01-01

    We have demonstrated that, in Escherichia coli, quinolone antimicrobial agents target topoisomerase IV (topo IV). The inhibition of topo IV becomes apparent only when gyrase is mutated to quinolone resistance. In such mutants, these antibiotics caused accumulation of replication catenanes, which is diagnostic of a loss of topo IV activity. Mutant forms of topo IV provided an additional 10-fold resistance to quinolones and prevented drug-induced catenane accumulation. Drug inhibition of topo IV differs from that of gyrase. (i) Wild-type topo IV is not dominant over the resistant allele. (ii) Inhibition of topo IV leads to only a slow stop in replication. (iii) Inhibition of topo IV is primarily bacteriostatic. These differences may result from topo IV acting behind the replication fork, allowing for repair of drug-induced lesions. We suggest that this and a slightly higher intrinsic resistance of topo IV make it secondary to gyrase as a quinolone target. Our results imply that the quinolone binding pockets of gyrase and topo IV are similar and that substantial levels of drug resistance require mutations in both enzymes. Images Fig. 1 Fig. 2 Fig. 3 PMID:8524852

  13. 40 CFR Appendix IV to Part 600 - Reserved

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 30 2014-07-01 2014-07-01 false Reserved IV Appendix IV to Part 600 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND GREENHOUSE GAS EXHAUST EMISSIONS OF MOTOR VEHICLES Appendix IV to Part 600...

  14. Premixed intravenous admixtures: a positive development for hospital pharmacy.

    PubMed

    Lee, H E

    1983-06-01

    The development of premixed intravenous admixtures is reviewed in a historical context, and its effects on hospital pharmacy practice are discussed. As pharmaceutical manufacturers introduce more i.v. medications in ready-to-use containers, the same complaints that were voiced by pharmacists about unit dose packaging and ready-to-dispense tablets and capsules are being aired. But premixed i.v. admixtures are a logical extension of the basic unit dose principle of providing a readily identifiable and ready-to-administer dose. The time and cost savings these products offer are needed in hospital pharmacies. Some of the disadvantages of these products--including storage and freezer space and multiplicity of administration systems--are overcome by proper planning and education of personnel. If fewer personnel are now needed to prepare i.v. admixtures, then those personnel should be used to improve patient care in other ways. The use of premixed i.v. admixtures is a positive technological advance in drug packaging. Its advantages outweight its disadvantages, and it will soon be become the universally accepted form of i.v. drug packaging.

  15. Sysmex XT-2000iV scattergram analysis in a cat with basophilia.

    PubMed

    Stranieri, Angelica; Ferrari, Roberta; Zanzani, Sergio; Rossi, Gabriele

    2016-06-01

    A 13-year-old female Domestic Shorthair cat was presented to the Veterinary Teaching Hospital of the University of Milan for an interscapular mass suspected to be a mesenchymal malignant tumor. A preoperative CBC performed with Sysmex XT-2000iV showed leukocytosis with neutrophilia and eosinophilia. The Sysmex WBC/DIFF scattergram showed an additional, well-separated cluster of events between the neutrophil, eosinophil, and lymphocyte clusters. Blood smear evaluation revealed the presence of a significant number of basophils; thus, it was hypothesized that the additional cluster could represent the basophilic population. A second CBC, 24 days later, showed the same pattern on the WBC/DIFF scattergram in the absence of leukocytosis and neutrophilia. After surgical excision of the mass, a definitive diagnosis of feline injection site sarcoma was made. To the author's knowledge, there are no previous reports about the identification of feline basophils in the WBC/DIFF scattergram of Sysmex XT-2000iV.

  16. Resistance to apramycin in two enterobacterial clinical isolates: detection of a 3-N-acetyltransferase IV.

    PubMed

    Gómez-Lus, R; Rivera, M J; Gómez-Lus, M L; Gil, J; Gómez-Lus, S; Castillo, J; Goñi, P; Madero, P; Rubio, M C

    1990-08-01

    Considering the possible role of farm animals in the contamination of human consumers by plasmid-mediated apramycin-resistant enterobacteria strains, this type of resistance should be tested more systematically in human isolates. Very recently we isolated in Zaragoza one apramycin-resistant Escheria coli strain obtained from the blood of a hospitalized patient; this clinical isolate produced a plasmid-mediated 3-N-aminoglycoside acetyltransferase IV. We describe also the isolation in Madrid of one multiresistant Klebsiella pneumoniae clinical strain. This isolate harbored a single plasmid and carried determinants for apramycin, gentamicin, tobramycin, hygromycin B, streptomycin, and ampicillin, which could be transferred en bloc to E. coli K-12 J62. Extracts from donor and transconjugant strains carrying pUZ6776 plasmid produce acetyltransferase activity AAC(3)-IV and double phosphotransferase activity (HPH and APH(3'')).

  17. HIGHER ORDER FACTOR STRUCTURE OF THE WISC-IV IN A CLINICAL NEUROPSYCHOLOGICAL SAMPLE

    PubMed Central

    Bodin, Doug; Pardini, Dustin A.; Burns, Thomas G.; Stevens, Abigail B.

    2010-01-01

    A confirmatory factor analysis was conducted examining the higher order factor structure of the WISC-IV scores for 344 children who participated in neuropsychological evaluations at a large children’s hospital. The WISC-IV factor structure mirrored that of the standardization sample. The second order general intelligence factor (g) accounted for the largest proportion of variance in the first-order latent factors and in the individual subtests, especially for the working memory index. The first-order processing speed factor exhibited the most unique variance beyond the influence of g. The results suggest that clinicians should not ignore the contribution of g when interpreting the first-order factors. PMID:19132580

  18. Impacts of Title IV in Maryland

    SciTech Connect

    Sherwell, J.; Ellis, H.; Corio, L.; Seinfelt, J.

    1995-12-31

    The Maryland Department of Natural Resources` Power Plant Research Program has evaluated the environmental effects of acid deposition on Maryland`s air, land, water (especially the Chesapeake Bay), and human resources since the mid-1980`s. Title IV of the Clean Air Act Amendments of 1990 (CAAA90) has focused much attention on the mandated reductions of nitrogen oxides (NO{sub x}) and sulfur dioxide (SO{sub 2}) to control acid deposition. Baseline data on acidic deposition and air emissions/pollution control for NO{sub x} and SO{sub 2} acquired through PPRP studies have proved useful in evaluating the impacts of Title IV on Maryland power plants and resources. Three example programs are discussed: The first is an evaluation of SO{sub 2} emissions on ecosystems through the use of critical loads--the amount of acid rain that an ecosystem can tolerate without continuing to acidify. Results support the use of broadly based emissions trading scenarios: The second study is an evaluation of the potential for reducing nitrate loading in the Chesapeake Bay by reducing NO{sub x} emissions. Results indicate substantial NO{sub x} emission reductions could offer significant reductions in nitrate deposition to the Bay: The final study is a review of the impacts of Title IV on the Maryland coal industry and the prospects for coal cleaning and advanced combustion technologies. Current results indicate that Maryland coal will meet Phase 2 SO{sub 2} emission standards using advanced combustion techniques, such as fluidized bed technologies, but that additional emissions controls, such as a scrubber would be required in a conventional boiler.

  19. Does health plan generosity enhance hospital market power?

    PubMed

    Baker, Laurence C; Bundorf, M Kate; Kessler, Daniel P

    2015-12-01

    We test whether the generosity of employer-sponsored health insurance facilitates the exercise of market power by hospitals. We construct indices of health plan generosity and the price and volume of hospital services using data from Truven MarketScan for 601 counties from 2001 to 2007. We use variation in the industry and union status of covered workers within a county over time to identify the causal effects of generosity. Although OLS estimates fail to reject the hypothesis that generosity facilitates the exercise of hospital market power, IV estimates show a statistically significant and economically important positive effect of plan generosity on hospital prices in uncompetitive markets, but not in competitive markets. Our results suggest that most of the aggregate effect of hospital market structure on prices found in previous work may be coming from areas with generous plans.

  20. Hospitable Classrooms: Biblical Hospitality and Inclusive Education

    ERIC Educational Resources Information Center

    Anderson, David W.

    2011-01-01

    This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

  1. Gen IV Materials Handbook Functionalities and Operation

    SciTech Connect

    Ren, Weiju

    2009-12-01

    This document is prepared for navigation and operation of the Gen IV Materials Handbook, with architecture description and new user access initiation instructions. Development rationale and history of the Handbook is summarized. The major development aspects, architecture, and design principles of the Handbook are briefly introduced to provide an overview of its past evolution and future prospects. Detailed instructions are given with examples for navigating the constructed Handbook components and using the main functionalities. Procedures are provided in a step-by-step fashion for Data Upload Managers to upload reports and data files, as well as for new users to initiate Handbook access.

  2. COPPER Students - ELaNa IV

    NASA Image and Video Library

    2013-07-11

    The Close Orbiting Propellant Plume Elemental Recognition (COPPER) was developed by students from St. Louis University as a technology demonstration mission whose objective is to test the suitability of a commercially-available compact uncooled microbolometer (tiny infrared camera) array for scientific imagery of Earth in the long-wave infrared range (LWIR, 7-13 microns). Launched by NASA’s CubeSat Launch Initiative on the ELaNa IV mission as an auxiliary payload aboard the U.S. Air Force-led Operationally Responsive Space (ORS-3) Mission on November 19, 2013.

  3. New Materials for NGNP/Gen IV

    SciTech Connect

    Robert W. Swindeman; Douglas L. Marriott

    2009-12-18

    The bounding conditions were briefly summarized for the Next Generation Nuclear Plant (NGNP) that is the leading candidate in the Department of Energy Generation IV reactor program. Metallic materials essential to the successful development and proof of concept for the NGNP were identified. The literature bearing on the materials technology for high-temperature gas-cooled reactors was reviewed with emphasis on the needs identified for the NGNP. Several materials were identified for a more thorough study of their databases and behavioral features relative to the requirements ASME Boiler and Pressure Vessel Code, Section III, Division 1, Subsection NH.

  4. Onsala Space Observatory: IVS Network Station

    NASA Technical Reports Server (NTRS)

    Haas, Ruediger; Elgered, Gunnar; Loefgren, Johan; Ning, Tong; Scherneck, Hans-Georg

    2013-01-01

    During 2012 we participated in 40 IVS sessions. As in the previous four years, we used the majority of the sessions that involved both Onsala and Tsukuba to do ultra-rapid dUT1 observations together with our colleagues in Tsukuba. We observed one four-station ultra-rapid EOP session together with Tsukuba, Hobart, and HartRAO. We also observed the RadioAstron satellite and several GLONASS satellites using the Onsala 25-m telescope. The highlight in 2012 was that our proposal to the Knut and Alice Wallenberg Foundation to establish a twin-telescope system at Onsala in accordance with the VLBI2010 recommendations was accepted.

  5. Simulation - McCandless, Bruce (Syncom IV)

    NASA Image and Video Library

    1985-04-15

    S85-30800 (14 April 1985) --- Astronaut Bruce McCandless II tests one of the possible methods of attempting to activate a switch on the Syncom-IV (LEASAT) satellite released April 13 into space from the Space Shuttle Discovery. The communications spacecraft failed to behave properly upon release and NASA officials and satellite experts are considering possible means of repair. McCandless was using a full scale mockup of the satellite in the Johnson Space Center's (JSC) mockup and integration laboratory.

  6. Reconstruction for Type IV Radial Polydactyly.

    PubMed

    Wall, Lindley B; Goldfarb, Charles A

    2015-09-01

    Type IV radial polydactyly represents a thumb with an extra proximal and distal phalanx. Assessment of the thumb for surgical reconstruction includes observing thumb function, evaluating thumb size and stability, and assessing the first web space. Reconstruction includes excision of the smaller thumb, typically the radial thumb, and re-creating thumb stability and alignment by addressing tendon insertion and joint orientation. Although surgical results are satisfying and complications are uncommon, additional surgical intervention may be required over time owing to thumb malalignment or instability.

  7. Ternary Porphyrinato Hf(IV) and Zr(IV) - Polyoxometalate Complexes

    PubMed Central

    Falber, Alexander; Burton-Pye, Benjamin P.; Radivojevic, Ivana; Todaro, Louis; Saleh, Raihan; Francesconi, Lynn; Drain, Charles Michael

    2010-01-01

    We report a facile, high yield synthesis and characterization of discrete, ternary porphyrin-metal-polyoxometalate (Por-M-POM) complexes where a group (IV) transition metal ion is bound both to the porphyrin core and to the lacunary site of a Keggin POM, PW11O39−7. The remarkably robust complexes exploit the fact that Hf(IV) and Zr(IV) are 7–8 coordinate and reside outside the plane of the porphyrin macrocycle, thus enabling the simultaneous coordination to meso-tetraphenylporphyrin (TPP) or meso-tetra(4-pyridyl)porphyrin (TPyP) and to the defect site in the Keggin framework. The physical properties of the (TPP)Hf(PW11O39)[TBA]5, (TPyP)Hf(PW11O39)[TBA]5, and (TPP)Zr(PW11O39)[TBA]5 complexes are similar because the metal ions have similar oxidation states, and coordination chemistry. This architecture couples the photonic properties of the porphyrin to the POM because the metal ion is incorporated into both frameworks. Thus the ternary complexes can serve as a basis for the characterization of Hf(IV) and Zr(IV) porphyrins bound to oxide surfaces via the group (IV) metal ions. The Hf(Por) and Zr(Por) bind strongly to TiO2 nanoparticles and indium tin oxide (ITO) surfaces, but significantly less binds to crystalline SiO2 or TiO2 surfaces. Together, the strong binding of the metalloporphyrins to the POM, nanoparticles, and the ITO surfaces, and paucity of binding to crystalline surfaces, suggests that the 3–4 open coordination sites on the Hf(Por) and Zr(Por) are predominantly bound at surface defect sites. PMID:20543903

  8. Topological characterisation and identification of critical domains within glucosyltransferase IV (GtrIV) of Shigella flexneri

    PubMed Central

    2011-01-01

    Background The three bacteriophage genes gtrA, gtrB and gtr(type) are responsible for O-antigen glucosylation in Shigella flexneri. Both gtrA and gtrB have been demonstrated to be highly conserved and interchangeable among serotypes while gtr(type) was found to be specific to each serotype, leading to the hypothesis that the Gtr(type) proteins are responsible for attaching glucosyl groups to the O-antigen in a site- and serotype- specific manner. Based on the confirmed topologies of GtrI, GtrII and GtrV, such interaction and attachment of the glucosyl groups to the O-antigen has been postulated to occur in the periplasm. Results In this study, the topology of GtrIV was experimentally determined by creating different fusions between GtrIV and a dual-reporter protein, PhoA/LacZ. This study shows that GtrIV consists of 8 transmembrane helices, 2 large periplasmic loops, 2 small cytoplasmic N- and C- terminal ends and a re-entrant loop that occurs between transmembrane helices III and IV. Though this topology differs from that of GtrI, GtrII, GtrV and GtrX, it is very similar to that of GtrIc. Furthermore, both the N-terminal periplasmic and the C-terminal periplasmic loops are important for GtrIV function as shown via a series of loop deletion experiments and the creation of chimeric proteins between GtrIV and its closest structural homologue, GtrIc. Conclusion The current study provides the basis for elucidating the structure and mechanism of action of this important O-antigen modifying glucosyltransferase. PMID:22188643

  9. The Interview for the Diagnosis of Eating Disorders--IV: Application to DSM-IV Diagnostic Criteria.

    ERIC Educational Resources Information Center

    Kutlesic, Vesna; Williamson, Donald A.; Gleaves, David H.; Barbin, Jane M.; Murphy-Eberenz, Kathleen P.

    1998-01-01

    Describes psychometric development of the fourth revision of the Interview for Diagnosis of Eating Disorders (IDED-IV). IDED-IV internal consistency and item-total correlations were assessed. IDED-IV yields sufficiently reliable and valid data for determining diagnoses in research studies and clinics specializing in the treatment of eating…

  10. Titrimetric determination of vanadium(IV) with cerium (IV)sulphate at room temperature using ferroin as indicator.

    PubMed

    Sriramam, K; Rao, G G

    1966-10-01

    A procedure has been developed for the visual titrimetric determination of vanadium(IV) with cerium(IV) sulphate, using ferroin is redox indicator. The method has been extended to the determination of iron(II) and vanadium(IV) in mixtures.

  11. Grade III or Grade IV Hypertensive Retinopathy with Severely Elevated Blood Pressure

    PubMed Central

    Henderson, Amanda D.; Biousse, Valérie; Newman, Nancy J.; Lamirel, Cédric; Wright, David W.; Bruce, Beau B.

    2012-01-01

    Introduction: Hypertensive retinopathy describes a spectrum of retinal changes in patients with elevated blood pressure (BP). It is unknown why some patients are more likely to develop acute ocular end-organ damage than others with similar BP. We examined risk factors for grade III/IV hypertensive retinopathy among patients with hypertensive urgency in the emergency department (ED) and compared healthcare utilization and mortality between patients with and without grade III/IV hypertensive retinopathy. Methods: A preplanned subanalysis of patients who presented to a university hospital ED with diastolic BP ≥ 120 mmHg and who enrolled in the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the ED study was performed. Bilateral nonmydriatic ocular fundus photographs, vital signs, and demographics were obtained at presentation. Past medical history, laboratory values, healthcare utilization, and mortality were ascertained from medical record review at least 8 months after initial ED visit. Results: Twenty-one patients with diastolic BP ≥ 120 mmHg, 7 of whom (33%) had grade III/IV hypertensive retinopathy, were included. Patients with retinopathy were significantly younger than those without (median 33 vs 50 years, P= 0.02). Mean arterial pressure (165 vs 163 mmHg) was essentially equal in the 2 groups. Patients with retinopathy had substantially increased but nonsignificant rates of ED revisit (57% vs 29%, P = 0.35) and hospital admission after ED discharge (43% vs 14%, P = 0.28). One of the patients with retinopathy died, but none without. Conclusion: Younger patients may be at higher risk for grade III/IV hypertensive retinopathy among patients with hypertensive urgency. Chronic compensatory mechanisms may have not yet developed in these younger patients. Alternatively, older patients with retinopathy may be underrepresented secondary to increased mortality among these patients at a younger age (survivorship bias). Further research is needed to

  12. Zirconium(IV)- and hafnium(IV)-catalyzed highly enantioselective epoxidation of homoallylic and bishomoallylic alcohols.

    PubMed

    Li, Zhi; Yamamoto, Hisashi

    2010-06-16

    In this report, zirconium(IV)- and hafnium(IV)-bishydroxamic acid complexes were utilized in the highly enantioselective epoxidation of homoallylic alcohols and bishomoallylic alcohols, which used to be quite difficult substrates for other types of asymmetric epoxidation reactions. The performance of the catalyst was improved by adding polar additive and molecular sieves. For homoallylic alcohols, the reaction could provide epoxy alcohols in up to 83% yield and up to 98% ee, while, for bishomoallylic alcohols, up to 79% yield and 99% ee of epoxy alcohols rather than cyclized tetrahydrofuran compounds could be obtained in most cases.

  13. Zirconium(IV) and Hafnium(IV)-Catalyzed Highly Enantioselective Epoxidation of Homoallylic and Bishomoallylic Alcohols

    PubMed Central

    Li, Zhi; Yamamoto, Hisashi

    2010-01-01

    In this report, zirconium(IV) and hafnium(IV)-bishydroxamic acid complexes were utilized in the highly enantioselective epoxidation of homoallylic alcohols and bishomoallylic alcohols, which used to be quite difficult substrates for other types of asymmetric epoxidation reactions. The performance of the catalyst was improved by adding polar additive and molecular sieves. For homoallylic alcohols, the reaction could provide epoxy alcohols in up to 81% yield and up to 98% ee, while for bishomoallylic alcohols, up to 75% yield and 99% ee of epoxy alcohols rather than cyclize compounds could be obtained in most cases. PMID:20481541

  14. The application of hospitality elements in hospitals.

    PubMed

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

    In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

  15. Assessment of new drugs in a tertiary hospital using a standardized tool.

    PubMed

    González-Bueno, J; Chamorro-de-Vega, E; Alfaro-Lara, E R; Galván-Banqueri, M; Santos-Ramos, B

    2013-01-01

    Objetivo: Describir las características de los nuevos fármacos evaluados por la Comisión de Farmacia y Terapéutica (CFyT) en un hospital terciario mediante el empleo de una herramienta normalizada, la Guía para la valoración de Inclusión de Nuevos Fármacos, como objetivo principal. Material y métodos: Estudio observacional retrospectivo de aquellos fármacos evaluados en el periodo 2008-11. Fueron recogidas variables relativas al fármaco, a la solicitud y al resultado final de la evaluación mediante la información contenida en las guías GINF y en los informes finales de evaluación. Resultados: De los 75 medicamentos evaluados, 63 (84%) fueron incluidos en la Guía Farmacoterapéutica del Hospital. Únicamente 1 (1,3%) lo fue sin ningún tipo de restricción. El resto fueron incluidos como equivalentes terapéuticos (21,3%) o bajo recomendaciones específicas (61,3%). La mitad de los fármacos no incluidos (6) presentaban insuficiente evidencia respecto a su eficacia frente a los tratamientos habituales. Hematología y Oncología Médica se encontraron entre los servicios médicos más activos en la solicitud. Se observó un alto porcentaje de fármacos que disponían de más de un ensayo clínico en fase avanzada (III y/o IV). Por otra parte, el 28% de los fármacos evaluados se relacionaron con un impacto financiero superior 10.000 ??anuales. Las guías GINF proporcionadas por los solicitantes a la CFyT se caracterizaron por la alta calidad de la información contenida en ellas. Sin embargo, la relación entre la información proporcionada a la CFyT y la decisión final de la misma no fue estadísticamente significativa. Conclusiones: Las solicitudes recibidas pertenecieron principalmente a fármacos de administración parenteral, siendo la mayor parte de ellos antineoplásicos. Los servicios médicos más intensamente representados fueron Hematología y Oncología.

  16. Predicting DPP-IV inhibitors with machine learning approaches

    NASA Astrophysics Data System (ADS)

    Cai, Jie; Li, Chanjuan; Liu, Zhihong; Du, Jiewen; Ye, Jiming; Gu, Qiong; Xu, Jun

    2017-02-01

    Dipeptidyl peptidase IV (DPP-IV) is a promising Type 2 diabetes mellitus (T2DM) drug target. DPP-IV inhibitors prolong the action of glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP), improve glucose homeostasis without weight gain, edema, and hypoglycemia. However, the marketed DPP-IV inhibitors have adverse effects such as nasopharyngitis, headache, nausea, hypersensitivity, skin reactions and pancreatitis. Therefore, it is still expected for novel DPP-IV inhibitors with minimal adverse effects. The scaffolds of existing DPP-IV inhibitors are structurally diversified. This makes it difficult to build virtual screening models based upon the known DPP-IV inhibitor libraries using conventional QSAR approaches. In this paper, we report a new strategy to predict DPP-IV inhibitors with machine learning approaches involving naïve Bayesian (NB) and recursive partitioning (RP) methods. We built 247 machine learning models based on 1307 known DPP-IV inhibitors with optimized molecular properties and topological fingerprints as descriptors. The overall predictive accuracies of the optimized models were greater than 80%. An external test set, composed of 65 recently reported compounds, was employed to validate the optimized models. The results demonstrated that both NB and RP models have a good predictive ability based on different combinations of descriptors. Twenty "good" and twenty "bad" structural fragments for DPP-IV inhibitors can also be derived from these models for inspiring the new DPP-IV inhibitor scaffold design.

  17. Predicting DPP-IV inhibitors with machine learning approaches

    NASA Astrophysics Data System (ADS)

    Cai, Jie; Li, Chanjuan; Liu, Zhihong; Du, Jiewen; Ye, Jiming; Gu, Qiong; Xu, Jun

    2017-04-01

    Dipeptidyl peptidase IV (DPP-IV) is a promising Type 2 diabetes mellitus (T2DM) drug target. DPP-IV inhibitors prolong the action of glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP), improve glucose homeostasis without weight gain, edema, and hypoglycemia. However, the marketed DPP-IV inhibitors have adverse effects such as nasopharyngitis, headache, nausea, hypersensitivity, skin reactions and pancreatitis. Therefore, it is still expected for novel DPP-IV inhibitors with minimal adverse effects. The scaffolds of existing DPP-IV inhibitors are structurally diversified. This makes it difficult to build virtual screening models based upon the known DPP-IV inhibitor libraries using conventional QSAR approaches. In this paper, we report a new strategy to predict DPP-IV inhibitors with machine learning approaches involving naïve Bayesian (NB) and recursive partitioning (RP) methods. We built 247 machine learning models based on 1307 known DPP-IV inhibitors with optimized molecular properties and topological fingerprints as descriptors. The overall predictive accuracies of the optimized models were greater than 80%. An external test set, composed of 65 recently reported compounds, was employed to validate the optimized models. The results demonstrated that both NB and RP models have a good predictive ability based on different combinations of descriptors. Twenty "good" and twenty "bad" structural fragments for DPP-IV inhibitors can also be derived from these models for inspiring the new DPP-IV inhibitor scaffold design.

  18. Predicting DPP-IV inhibitors with machine learning approaches.

    PubMed

    Cai, Jie; Li, Chanjuan; Liu, Zhihong; Du, Jiewen; Ye, Jiming; Gu, Qiong; Xu, Jun

    2017-02-02

    Dipeptidyl peptidase IV (DPP-IV) is a promising Type 2 diabetes mellitus (T2DM) drug target. DPP-IV inhibitors prolong the action of glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP), improve glucose homeostasis without weight gain, edema, and hypoglycemia. However, the marketed DPP-IV inhibitors have adverse effects such as nasopharyngitis, headache, nausea, hypersensitivity, skin reactions and pancreatitis. Therefore, it is still expected for novel DPP-IV inhibitors with minimal adverse effects. The scaffolds of existing DPP-IV inhibitors are structurally diversified. This makes it difficult to build virtual screening models based upon the known DPP-IV inhibitor libraries using conventional QSAR approaches. In this paper, we report a new strategy to predict DPP-IV inhibitors with machine learning approaches involving naïve Bayesian (NB) and recursive partitioning (RP) methods. We built 247 machine learning models based on 1307 known DPP-IV inhibitors with optimized molecular properties and topological fingerprints as descriptors. The overall predictive accuracies of the optimized models were greater than 80%. An external test set, composed of 65 recently reported compounds, was employed to validate the optimized models. The results demonstrated that both NB and RP models have a good predictive ability based on different combinations of descriptors. Twenty "good" and twenty "bad" structural fragments for DPP-IV inhibitors can also be derived from these models for inspiring the new DPP-IV inhibitor scaffold design.

  19. Experimental Treatment for Burn Victims in Field Hospitals.

    DTIC Science & Technology

    1985-08-01

    useful as reported in the literature for the in vitro study of human skin graft rejection 1191 adaptation of the published assay to guinea pig cells can...FIELD HOSPITALS In Annual/Final Report Iv I.V. Yannas and E.M. Skrabut " D T r August 1985 ELECTE JAN 0 WE Supported by D U.S. ARMY MEDICAL RESEARCH AND...for public release; distributi(n unlimited LD wA-J LThe findings in this report are not to be construed as an official Department of the Army position

  20. Report for 2011 from the Bordeaux IVS Analysis Center

    NASA Technical Reports Server (NTRS)

    Charlot, Patrick; Bellanger, Antoine; Bourda, Geraldine; Collioud, Arnaud; Baudry, Alain

    2012-01-01

    This report summarizes the activities of the Bordeaux IVS Analysis Center during the year 2011. The work focused on (i) regular analysis of the IVS-R1 and IVS-R4 sessions with the GINS software package; (ii) systematic VLBI imaging of the RDV sessions and calculation of the corresponding source structure index and compactness values; (iii) imaging of the sources observed during the 2009 International Year of Astronomy IVS observing session; and (iv) continuation of our VLBI observational program to identify optically-bright radio sources suitable for the link with the future Gaia frame. Also of importance is the enhancement of the IVS LiveWeb site which now comprises all IVS sessions back to 2003, allowing one to search past observations for session-specific information (e.g. sources or stations).

  1. Atmosphere of Mars: Mariner IV Models Compared.

    PubMed

    Fjeldbo, G; Fjeldbo, W C; Eshleman, V R

    1966-09-23

    Three classes of models for the atmosphere of Mars differ in identifying the main ionospheric layer measured by Mariner IV as being analogous to a terrestrial F(2), F(1), or E layer. At an altitude of several hundred kilometers, the relative atmospheric mass densities for these models (in the order named) are approximately 1, 10(2), and 10(4), and the temperatures are roughly 100 degrees , 200 degrees , and 400 degrees K. Theory and observation are in best agreement for an F, s model, for which photodissociation of CO(2), and diffusive separation result in an atomic-oxygen upper atmosphere, with O(+) being the principal ion in the isothermal topside of the ionosphere. The mesopause temperature minimum would be at or below the freezing point of CO(2), and dry ice particles would be expected to form. However, an F(1) model, with molecular ions in a mixed and warmer upper atmosphere, might result if photodissociation and diffusive separation are markedly less than would be expected from analogy with Earth's upper atmosphere. The E model proposed by Chamberlain and McElroy appears very unlikely; it is not compatible with the measured ionization profile unless rather unlikely assumptions are made about the values, and changes with height, of the effective recombination coefficient and the average ion mass. Moreover our theoretical heat-budget computations for the atmospheric region probed by Mariner IV indicate markedly lower temperatures and temperature gradients than were obtained for the E model.

  2. Surgical treatment of type IV choledochal cysts.

    PubMed

    Kawarada, Yoshifumi; Das, Bidhan C; Tabata, Masami; Isaji, Shuji

    2009-01-01

    The benefit of total resection of the dilated bile duct has remained unclear. We describe here our surgical management of 13 patients with type IV choledochal cysts. All six younger patients (25-35 years old) underwent resection of the extrahepatic bile duct (EHBD) and hepaticojejunostomy (HJ), whereas three of the seven older patients (50-68 years old) underwent resection of the EHBD resection and HJ, with the remaining four older patients undergoing total resection of the dilated bile duct and removal of a pancreatobiliary maljunction (PBMJ) in the form of a S4a+S5 hepatectomy (so-called Taj Mahal) and/or pancreas head resection with second portion pancreaticoduodenectomy. No malignancies were detected in the dilated bile duct after resection in the younger patients, but cancer of the gallbladder and/or the dilated bile duct was found in two (27.5%) of the older patients. No cancers were detected during the long-term follow up (1974-2008) in those patients who underwent EHBD resection plus partial hepatectomy, but cancer developed in the remnant duct in one of the older patients who underwent EHBD resection alone. Based on our findings, we recommend that type IV choledochal cysts should be treated by total excision of the dilated bile duct, including the PBMJ, due to its frequent association with malignancy, and to prevent the development of cancer in the remnant duct and improve the long-term survival rate.

  3. Distribution of Dipeptidyl Peptidase IV in Patients with Chronic Tonsillitis▿

    PubMed Central

    Stankovic, Milan; Vlahovic, Predrag; Avramovic, Verica; Todorovic, Miroljub

    2008-01-01

    In the pathogeneses of recurrent tonsillitis (RT) and tonsillar hypertrophy (TH), different immunological mechanisms are involved. Dipeptidyl peptidase IV (DPP IV) and aminopeptidase N (APN) participate in the regulation of the immune response during inflammation. In this study, the localization of DPP IV and the enzymatic activities of DPP IV and APN in 32 patients, 13 with RT and 19 with TH, who underwent tonsillectomy were investigated. The localization of DPP IV in tonsils was studied using histochemical and immunohistochemical methods. The enzymatic activities of DPP IV and APN in tonsillar lymphocytes and the patients' sera were determined kinetically at 37°C using Gly-Pro-p-nitroanilide (for DPP IV) and Ala-p-nitroanilide (for APN) as chromogenic substrates. In samples from both RT and TH patients, DPP IV was found to localize mainly in extrafollicular areas of tonsillar tissue in a pattern corresponding to the T-cell distribution. Significantly higher (P < 0.001) levels of DPP IV and APN activities in sera from patients with TH than in sera from patients with RT were found. A correlation of DPP IV activities in sera and tonsillar lymphocytes from patients with TH was also found (r = 0.518; P < 0.05). Moreover, the results show that DPP IV and APN activities in sera decreased significantly with age. Tonsillar lymphocytes demonstrated a wide range of DPP IV and APN activities, without significant differences between the investigated groups. The results of this study show that the localization of DPP IV does not depend on the type of tonsillitis, whereas the variety in levels of DPP IV and APN activities in sera of patients with TH and RT suggests different patterns of participation of antigen-stimulated tonsils in the immune system. PMID:18385458

  4. Distribution of dipeptidyl peptidase IV in patients with chronic tonsillitis.

    PubMed

    Stankovic, Milan; Vlahovic, Predrag; Avramovic, Verica; Todorovic, Miroljub

    2008-05-01

    In the pathogeneses of recurrent tonsillitis (RT) and tonsillar hypertrophy (TH), different immunological mechanisms are involved. Dipeptidyl peptidase IV (DPP IV) and aminopeptidase N (APN) participate in the regulation of the immune response during inflammation. In this study, the localization of DPP IV and the enzymatic activities of DPP IV and APN in 32 patients, 13 with RT and 19 with TH, who underwent tonsillectomy were investigated. The localization of DPP IV in tonsils was studied using histochemical and immunohistochemical methods. The enzymatic activities of DPP IV and APN in tonsillar lymphocytes and the patients' sera were determined kinetically at 37 degrees C using Gly-Pro-p-nitroanilide (for DPP IV) and Ala-p-nitroanilide (for APN) as chromogenic substrates. In samples from both RT and TH patients, DPP IV was found to localize mainly in extrafollicular areas of tonsillar tissue in a pattern corresponding to the T-cell distribution. Significantly higher (P < 0.001) levels of DPP IV and APN activities in sera from patients with TH than in sera from patients with RT were found. A correlation of DPP IV activities in sera and tonsillar lymphocytes from patients with TH was also found (r = 0.518; P < 0.05). Moreover, the results show that DPP IV and APN activities in sera decreased significantly with age. Tonsillar lymphocytes demonstrated a wide range of DPP IV and APN activities, without significant differences between the investigated groups. The results of this study show that the localization of DPP IV does not depend on the type of tonsillitis, whereas the variety in levels of DPP IV and APN activities in sera of patients with TH and RT suggests different patterns of participation of antigen-stimulated tonsils in the immune system.

  5. Aqueous chemistry of Ce(iv): estimations using actinide analogues.

    PubMed

    Marsac, Rémi; Réal, Florent; Banik, Nidhu Lal; Pédrot, Mathieu; Pourret, Olivier; Vallet, Valérie

    2017-10-10

    The prediction of cerium (Ce) aqueous speciation is relevant in many research fields. Indeed, Ce compounds are used for many industrial applications, which may require the control of Ce aqueous chemistry for their synthesis. The aquatic geochemistry of Ce is also of interest. Due to its growing industrial use and its release into the environment, Ce is now considered as an emerging contaminant. Cerium is also used as a proxy of (paleo)redox conditions due to the Ce(iv)/Ce(iii) redox transition. Finally, Ce(iv) is often presented as a relevant analogue of tetravalent actinides (An(iv)). In the present study, quantum chemical calculations were conducted to highlight the similarities between the structures of Ce(iv) and tetravalent actinide (An(iv); An = Th, Pa, U, Np, Pu) aqua-ions, especially Pu(iv). The current knowledge of An(iv) hydrolysis, solubility and colloid formation in water was briefly reviewed but important discrepancies were observed in the available data for Ce(iv). Therefore, new estimations of the hydrolysis constants of Ce(iv) and the solubility of Ce(iv)-(hydr)oxides are proposed, by analogy with Pu(iv). By plotting pH-Eh (Pourbaix) diagrams, we showed that the pH values corresponding to the onset of Ce(iv) species formation (i.e. Ce(iv)-(hydr)oxide or dissolved Ce(iv)) agreed with various experimental results. Although further experimental studies are required to obtain a more accurate thermodynamic database, the present work might yet help to predict more accurately the Ce chemical behavior in aqueous solution.

  6. Correcting C IV-based virial black hole masses

    NASA Astrophysics Data System (ADS)

    Coatman, Liam; Hewett, Paul C.; Banerji, Manda; Richards, Gordon T.; Hennawi, Joseph F.; Prochaska, J. Xavier

    2017-02-01

    The C IVλλ1498,1501 broad emission line is visible in optical spectra to redshifts exceeding z ∼ 5. C IV has long been known to exhibit significant displacements to the blue and these 'blueshifts' almost certainly signal the presence of strong outflows. As a consequence, single-epoch virial black hole (BH) mass estimates derived from C IV velocity widths are known to be systematically biased compared to masses from the hydrogen Balmer lines. Using a large sample of 230 high-luminosity (LBol = 1045.5-1048 erg s-1), redshift 1.5 < z < 4.0 quasars with both C IV and Balmer line spectra, we have quantified the bias in C IV BH masses as a function of the C IV blueshift. C IV BH masses are shown to be a factor of 5 larger than the corresponding Balmer-line masses at C IV blueshifts of 3000 km s-1and are overestimated by almost an order of magnitude at the most extreme blueshifts, ≳5000 km s-1. Using the monotonically increasing relationship between the C IV blueshift and the mass ratio BH(C IV)/BH(Hα), we derive an empirical correction to all C IV BH masses. The scatter between the corrected C IV masses and the Balmer masses is 0.24 dex at low C IV blueshifts (∼0 km s-1) and just 0.10 dex at high blueshifts (∼3000 km s-1), compared to 0.40 dex before the correction. The correction depends only on the C IV line properties - i.e. full width at half-maximum and blueshift - and can therefore be applied to all quasars where C IV emission line properties have been measured, enabling the derivation of unbiased virial BH-mass estimates for the majority of high-luminosity, high-redshift, spectroscopically confirmed quasars in the literature.

  7. Comparison of the Safety and Pharmacokinetics of ST-246® after IV Infusion or Oral Administration in Mice, Rabbits and Monkeys

    PubMed Central

    Chen, Yali; Amantana, Adams; Tyavanagimatt, Shanthakumar R.; Zima, Daniela; Yan, X. Steven; Kasi, Gopi; Weeks, Morgan; Stone, Melialani A.; Weimers, William C.; Samuel, Peter; Tan, Ying; Jones, Kevin F.; Lee, Daniel R.; Kickner, Shirley S.; Saville, Bradley M.; Lauzon, Martin; McIntyre, Alan; Honeychurch, Kady M.; Jordan, Robert; Hruby, Dennis E.; Leeds, Janet M.

    2011-01-01

    Background ST-246® is an antiviral, orally bioavailable small molecule in clinical development for treatment of orthopoxvirus infections. An intravenous (IV) formulation may be required for some hospitalized patients who are unable to take oral medication. An IV formulation has been evaluated in three species previously used in evaluation of both efficacy and toxicology of the oral formulation. Methodology/Principal Findings The pharmacokinetics of ST-246 after IV infusions in mice, rabbits and nonhuman primates (NHP) were compared to those obtained after oral administration. Ten minute IV infusions of ST-246 at doses of 3, 10, 30, and 75 mg/kg in mice produced peak plasma concentrations ranging from 16.9 to 238 µg/mL. Elimination appeared predominately first-order and exposure dose-proportional up to 30 mg/kg. Short IV infusions (5 to 15 minutes) in rabbits resulted in rapid distribution followed by slower elimination. Intravenous infusions in NHP were conducted at doses of 1 to 30 mg/kg. The length of single infusions in NHP ranged from 4 to 6 hours. The pharmacokinetics and tolerability for the two highest doses were evaluated when administered as two equivalent 4 hour infusions initiated 12 hours apart. Terminal elimination half-lives in all species for oral and IV infusions were similar. Dose-limiting central nervous system effects were identified in all three species and appeared related to high Cmax plasma concentrations. These effects were eliminated using slower IV infusions. Conclusions/Significance Pharmacokinetic profiles after IV infusion compared to those observed after oral administration demonstrated the necessity of longer IV infusions to (1) mimic the plasma exposure observed after oral administration and (2) avoid Cmax associated toxicity. Shorter infusions at higher doses in NHP resulted in decreased clearance, suggesting saturated distribution or elimination. Elimination half-lives in all species were similar between oral and IV

  8. Hospitals as health educators

    MedlinePlus

    ... than your local hospital. From health videos to yoga classes, many hospitals offer information families need to ... care and breastfeeding Parenting Baby sign language Baby yoga or massage Babysitting courses for teens Exercise classes ...

  9. Help prevent hospital errors

    MedlinePlus

    ... www.ncbi.nlm.nih.gov/pubmed/23330698 . The Joint Commission. Hospital: 2014 National Patient Safety Goals. www.jointcommission. ... October 24, 2014. Accessed October 27, 2016. The Joint Commission. Hospital: 2016 National Patient Safety Goals. Updated January ...

  10. An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit.

    PubMed

    Wong, Rowena S Y; Ismail, Noor Azina; Tan, Cheng Cheng

    2015-04-01

    Intensive care unit (ICU) prognostic models are predominantly used in more developed nations such as the United States, Europe and Australia. These are not that popular in Southeast Asian countries due to costs and technology considerations. The purpose of this study is to evaluate the suitability of the acute physiology and chronic health evaluation (APACHE) IV model in a single centre Malaysian ICU. A prospective study was conducted at the single centre ICU in Hospital Sultanah Aminah (HSA) Malaysia. External validation of APACHE IV involved a cohort of 916 patients who were admitted in 2009. Model performance was assessed through its calibration and discrimination abilities. A first-level customisation using logistic regression approach was also applied to improve model calibration. APACHE IV exhibited good discrimination, with an area under receiver operating characteristic (ROC) curve of 0.78. However, the model's overall fit was observed to be poor, as indicated by the Hosmer-Lemeshow goodness-of-fit test (Ĉ = 113, P <0.001). Predicted in-ICU mortality rate (28.1%) was significantly higher than the actual in-ICU mortality rate (18.8%). Model calibration was improved after applying first-level customisation (Ĉ = 6.39, P = 0.78) although discrimination was not affected. APACHE IV is not suitable for application in HSA ICU, without further customisation. The model's lack of fit in the Malaysian study is attributed to differences in the baseline characteristics between HSA ICU and APACHE IV datasets. Other possible factors could be due to differences in clinical practice, quality and services of health care systems between Malaysia and the United States.

  11. 75 FR 2787 - Airworthiness Directives; Turbomeca Turmo IV A and IV C Turboshaft Engines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-19

    ... A and IV C Turboshaft Engines AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Final rule... oil leak was found on an engine deck. A circumferential crack on the intermediate bearing return... oil pipe union crack was then reported at the same location on another engine, on the same pipe part...

  12. The smart IV stand design through human tracking mobile robot system by CDS cell

    NASA Astrophysics Data System (ADS)

    Jo, Seong-Hyeon; Choe, Jong-Hun; Seo, Suk-Hyun; Kim, Won-Hoe; Lee, Hong-Kyu; Park, Se-Ho

    2015-03-01

    Vision-based recognition of the object as a general interface gives us high cost and complicated problem. This research suggests human tracking system by Arduino, and Laser-CdS cell system track wire that pass laser line. In this paper, we review existing literature on application systems of recognition which involves many interdisciplinary studies. We conclude that our method can only reduce cost, but is easy way to trace people's location with the use of wire. Furthermore, we apply several recognition systems including CdS-based mobile robot that is applied IV stand used at the hospital effectively.

  13. [Hospital care of snakebites in Africa].

    PubMed

    Bellefleur, J P; Le Dantec, P

    2005-11-01

    Snakebites constitute a public health problem in Africa, with some 600,000 envenomations and 20,000 estimated deaths per year. Hospital care of cases guided by written protocols which take into account the epidemiological and physiopathological data, as well as the hospital situation, starts in the emergency room and is based on the diagnosis of envenomation, either by vipers or elapids. If this diagnosis is confirmed, intensive treatment must ensue. It includes a non-specific component, particularly the treatment of hypovolemia, consumptive coagulopathy tissue necrosis and respiratory failure and a specific component, immunotherapy the only ethiological treatment. The latter consists in giving an iv injection of polyvalent purified immunoglobulin fragments against the venom. This attention is included in a general public health policy which takes into account the organization and financing of the treatment.

  14. Hospital Dermatology, Introduction.

    PubMed

    Fox, Lindy P

    2017-03-01

    Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.

  15. [The relationships of intelligence and memory assessed using the WAIS-IV and the WMS-IV].

    PubMed

    Lepach, A C; Daseking, M; Petermann, F; Waldmann, H C

    2013-11-01

    This study examines the relationships of intelligence and memory scores derived from WAIS-IV and WMS-IV. We were especially interested in the reciprocal predictive values of the test scales. A sample of 137 healthy adults with an age range between 16 and 69 years was assessed with the WAIS-IV and the WMS-IV. The test order was balanced. Pearson correlations were conducted on the subtest and scale level. A series of 14 linear regression models was tested with memory performance as predictor for intelligence and vice versa. A model including the 3 main memory scales of the WMS-IV was able to predict the global IQ best. It nevertheless explained only 46% of the variance. The memory and intelligence measures show significant relationships, but also represent distinct functions. WAIS-IV and WMS-IV complement one another. © Georg Thieme Verlag KG Stuttgart · New York.

  16. Differences in Process Management and In-Hospital Delays in Treatment with iv Thrombolysis

    PubMed Central

    Ferrari, Julia; Knoflach, Michael; Seyfang, Leonhard; Lang, Wilfried

    2013-01-01

    Objectives Rapid initiation of intravenous thrombolysis improves patient’s outcome in acute stroke. We analyzed inter-center variability and factors that influence the door-to-needle time with a special focus on process measurements in all Austrian stroke units. Methods Case level data of patients receiving intravenous thrombolysis in the Austrian Stroke Unit Registry were enriched with information of a structured questionnaire on center specific process measures of all Austrian stroke units. Influence of case and center specific variables was determined by LASSO procedure. Results Center specific median door-to-needle time ranged between 30 and 78 minutes. Between April 2004 and November 2012, 6246 of 57991 patients treated in Austrian stroke units with acute ischemic stroke received intravenous thrombolysis. An onset-to-door time >120 minutes, patients with total anterior circulation stroke, recent year of admission, patient transportation with ambulance crew and emergency physician, the use of point of care tests reduced the door-to-needle time, whereas onset-to-door ≤60 minutes, unknown onset-to-door, patients with an NIHSS ≤4 or posterior circulation stroke, initial admission to a general emergency department, a distant radiology department, primary imaging modality other than plain CT and waiting for the lab results were associated with an increase in door-to-needle time. Case level and center specific factors could explain the inter center variability of door-to-needle times in 31 of 34 stroke units in Austria. Conclusions In light of our results it seems crucial that every single stroke center documents and critically reviews possibilities of optimizing practice strategies in acute stroke care. PMID:24069406

  17. Differences in process management and in-hospital delays in treatment with iv thrombolysis.

    PubMed

    Ferrari, Julia; Knoflach, Michael; Seyfang, Leonhard; Lang, Wilfried

    2013-01-01

    Rapid initiation of intravenous thrombolysis improves patient's outcome in acute stroke. We analyzed inter-center variability and factors that influence the door-to-needle time with a special focus on process measurements in all Austrian stroke units. Case level data of patients receiving intravenous thrombolysis in the Austrian Stroke Unit Registry were enriched with information of a structured questionnaire on center specific process measures of all Austrian stroke units. Influence of case and center specific variables was determined by LASSO procedure. Center specific median door-to-needle time ranged between 30 and 78 minutes. Between April 2004 and November 2012, 6246 of 57991 patients treated in Austrian stroke units with acute ischemic stroke received intravenous thrombolysis. An onset-to-door time >120 minutes, patients with total anterior circulation stroke, recent year of admission, patient transportation with ambulance crew and emergency physician, the use of point of care tests reduced the door-to-needle time, whereas onset-to-door ≤ 60 minutes, unknown onset-to-door, patients with an NIHSS ≤ 4 or posterior circulation stroke, initial admission to a general emergency department, a distant radiology department, primary imaging modality other than plain CT and waiting for the lab results were associated with an increase in door-to-needle time. Case level and center specific factors could explain the inter center variability of door-to-needle times in 31 of 34 stroke units in Austria. In light of our results it seems crucial that every single stroke center documents and critically reviews possibilities of optimizing practice strategies in acute stroke care.

  18. A Mn(IV)/Fe(IV) Intermediate in Assembly of the Mn(IV)/Fe(III) Cofactor of Chlamydia trachomatis Ribonucleotide Reductase†

    PubMed Central

    Jiang, Wei; Hoffart, Lee M.; Krebs, Carsten; Bollinger, J. Martin

    2008-01-01

    We recently showed that the class Ic ribonucleotide reductase from the human pathogen, Chlamydia trachomatis, uses a MnIV/FeIII cofactor to generate protein and substrate radicals in its catalytic mechanism [Jiang, W., Yun, D., Saleh, L., Barr, E. W., Xing, G., Hoffart, L. M., Maslak, M.-A., Krebs, C., and Bollinger, J. M., Jr. (2007) Science 316, 1188-1191]. Here, we have dissected the mechanism of formation of this novel heterobinuclear redox cofactor from the MnII/FeII cluster and O2. An intermediate with a g = 2 EPR signal that shows hyperfine coupling to both 55Mn and 57Fe accumulates almost quantitatively in a second order reaction between O2 and the reduced R2 complex. The otherwise slow decay of the intermediate to the active MnIV/FeIII-R2 complex is accelerated by the presence of the one-electron reductant, ascorbate, implying that the intermediate is more oxidized than MnIV/FeIII. Mössbauer spectra show that the intermediate contains a high-spin FeIV center. Its chemical and spectroscopic properties establish that the intermediate is a MnIV/FeIV-R2 complex with an S = 1/2 electronic ground state arising from antiferromagnetic coupling between the MnIV (SMn = 3/2) and high-spin FeIV (SFe = 2) sites. PMID:17616152

  19. The Design of the IGE Evaluation Project Phase IV Comparative Studies. Comparative Study of Phase IV IGE Evaluation Project. Phase IV, Project Paper 80-2.

    ERIC Educational Resources Information Center

    Romberg, Thomas A.; And Others

    This paper outlines the design of two Comparative Studies of Phase IV of the Individually Guided Education (IGE) Evaluation Project. More than 2,000 elementary schools in 25 states use the IGE system. The Evaluation Project was designed to gain a comprehensive view of the system's operation and effectiveness. Phase IV investigated pupil outcomes,…

  20. Stabilization of polynuclear plutonium(IV) species by humic acid

    NASA Astrophysics Data System (ADS)

    Marsac, Rémi; Banik, Nidhu Lal; Marquardt, Christian Michael; Kratz, Jens Volker

    2014-04-01

    Although the formation of tetravalent plutonium (Pu(IV)) polymers with natural organic matter was previously observed by spectroscopy, there is no quantitative evidence of such reaction in batch experiments. In the present study, Pu(IV) interaction with humic acid (HA) was investigated at pH 1.8, 2.5 and 3, as a function of HA concentration and for Pu total concentration equal to 6 × 10-8 M. The finally measured Pu(IV) concentrations ([Pu(IV)]eq) are below Pu(IV) solubility limit. Pu(IV)-HA interaction can be explained by the complexation of Pu(IV) monomers by HA up to [Pu(IV)]eq ∼ 10-8 M. However, the slope of the log-log Pu(IV)-HA binding isotherm changes from ∼0.7 to ∼3.5 for higher [Pu(IV)]eq than ∼10-8 M and at any pH. This result suggests the stabilization of hydrolyzed polymeric Pu(IV) species by HA, with a 4:1 Pu:HA stoichiometry. This confirms, for the first time, previous observations made by spectroscopy in concentrated systems. The humic-ion binding model, Model VII, was introduced into the geochemical speciation program PHREEQC and was used to simulate Pu(IV) monomers binding to HA. The simulations are consistent with other tetravalent actinides-HA binding data from literature. The stabilization of a Pu tetramer (Pu4(OH)88+) by HA was proposed to illustrate the present experimental results for [Pu(IV)]eq > 10-8 M. Predictive simulations of Pu(IV) apparent solubility due to HA show that the chosen Pu(IV)-polymer has no impact for pH > 4. However, the comparison between these predictions and recent spectroscopic results suggest that more hydrolyzed polymeric Pu(IV) species can be stabilized by HA at pH > 4. Polymeric Pu(IV)-HA species might significantly enhance Pu(IV) apparent solubility due to humics, which support a colloid-facilitated transport of this low solubility element.

  1. The MAX IV storage ring project

    PubMed Central

    Tavares, Pedro F.; Leemann, Simon C.; Sjöström, Magnus; Andersson, Åke

    2014-01-01

    The MAX IV facility, currently under construction in Lund, Sweden, features two electron storage rings operated at 3 GeV and 1.5 GeV and optimized for the hard X-ray and soft X-ray/VUV spectral ranges, respectively. A 3 GeV linear accelerator serves as a full-energy injector into both rings as well as a driver for a short-pulse facility, in which undulators produce X-ray pulses as short as 100 fs. The 3 GeV ring employs a multibend achromat (MBA) lattice to achieve, in a relatively short circumference of 528 m, a bare lattice emittance of 0.33 nm rad, which reduces to 0.2 nm rad as insertion devices are added. The engineering implementation of the MBA lattice raises several technological problems. The large number of strong magnets per achromat calls for a compact design featuring small-gap combined-function magnets grouped into cells and sharing a common iron yoke. The small apertures lead to a low-conductance vacuum chamber design that relies on the chamber itself as a distributed copper absorber for the heat deposited by synchrotron radiation, while non-evaporable getter (NEG) coating provides for reduced photodesorption yields and distributed pumping. Finally, a low main frequency (100 MHz) is chosen for the RF system yielding long bunches, which are further elongated by passively operated third-harmonic Landau cavities, thus alleviating collective effects, both coherent (e.g. resistive wall instabilities) and incoherent (intrabeam scattering). In this paper, we focus on the MAX IV 3 GeV ring and present the lattice design as well as the engineering solutions to the challenges inherent to such a design. As the first realisation of a light source based on the MBA concept, the MAX IV 3 GeV ring offers an opportunity for validation of concepts that are likely to be essential ingredients of future diffraction-limited light sources. PMID:25177978

  2. Atlantic Flyway review: Region IV - Fall 2003

    USGS Publications Warehouse

    Robbins, Chandler S.

    2004-01-01

    We welcome the Eden Mill station in northeastern Maryland to Region IV this year. With three stations reporting their worst year ever, we really need to be refreshed. After a cool and wet July, August was hot and wet in the east. Temperatures in September remained close to normal, but thanks to tropical storms Henri (6-8 Sep) and Isabel (18 Sep), rainfall was excessive in the Chesapeake Bay states. The entire Northeast had cool weather in October, starting with an early freeze on 3 Oct that triggered some good banding days in our region. Precipitation was unusually spotty in October, but plentiful at most of the Region IV stations. November temperatures were consistently well above the norm, starting with a record-breaking 81 ø in Baltimore on the 1st.Four of the five Maryland stations had their best day on 19 or 20 Oct. One might expect some of the Virginia coastal stations, Chincoteague, Kiptopeke, and Back Bay, to share the same best day, but they did not. Three stations reported an increase in birds per net hour this year, while seven had a decline. Summarizing the changes in rank in Table 2, Gray Catbird was the species with the most (5) increases in rank (in excess of decreases), followed by junco (4) and Myrtle Warbler and Swamp Sparrow (3 each). Yellowthroat had the most decreases (5), followed by redstart (3).Myrtle Warbler (4572) was once again the most commonly banded species in Region IV, followed by White-throated Sparrow (1723), Gray Catbird (1349), and Western Palm Warbler (1090). Michelle Davis' station on Key Biscayne is the envy of the rest of us. Her top eight species were all warblers and there was not a Myrtle among them. Imagine having Parula, Prairie, and Worm-eating warblers fighting for sixth place!Not showing among the top ten, however, are other surprises. Several banders commented on Sawwhet Owls and Bicknell's Thrushes. Deanna Dawson banded a Cerulean Warbler at Patuxent. Danny Bystrak caught 138 Swamp Sparrows at Jug Bay. In addition

  3. The MAX IV storage ring project.

    PubMed

    Tavares, Pedro F; Leemann, Simon C; Sjöström, Magnus; Andersson, Ake

    2014-09-01

    The MAX IV facility, currently under construction in Lund, Sweden, features two electron storage rings operated at 3 GeV and 1.5 GeV and optimized for the hard X-ray and soft X-ray/VUV spectral ranges, respectively. A 3 GeV linear accelerator serves as a full-energy injector into both rings as well as a driver for a short-pulse facility, in which undulators produce X-ray pulses as short as 100 fs. The 3 GeV ring employs a multibend achromat (MBA) lattice to achieve, in a relatively short circumference of 528 m, a bare lattice emittance of 0.33 nm rad, which reduces to 0.2 nm rad as insertion devices are added. The engineering implementation of the MBA lattice raises several technological problems. The large number of strong magnets per achromat calls for a compact design featuring small-gap combined-function magnets grouped into cells and sharing a common iron yoke. The small apertures lead to a low-conductance vacuum chamber design that relies on the chamber itself as a distributed copper absorber for the heat deposited by synchrotron radiation, while non-evaporable getter (NEG) coating provides for reduced photodesorption yields and distributed pumping. Finally, a low main frequency (100 MHz) is chosen for the RF system yielding long bunches, which are further elongated by passively operated third-harmonic Landau cavities, thus alleviating collective effects, both coherent (e.g. resistive wall instabilities) and incoherent (intrabeam scattering). In this paper, we focus on the MAX IV 3 GeV ring and present the lattice design as well as the engineering solutions to the challenges inherent to such a design. As the first realisation of a light source based on the MBA concept, the MAX IV 3 GeV ring offers an opportunity for validation of concepts that are likely to be essential ingredients of future diffraction-limited light sources.

  4. Natural organic matter influences the dissolution and stability of reduced technetium(IV) and uranium(IV)

    NASA Astrophysics Data System (ADS)

    Gu, B.; Dong, W.; Liang, L.; Wall, N.

    2010-12-01

    Reductive precipitation and immobilization of soluble technetium (as pertechnetate, Tc(VII)O4-) and uranium (as uranyl, U(VI)O22+) to sparingly soluble Tc(IV) and U(IV) species have been proposed as one of the promising remediation technologies to immobilize uranium and technetium in situ in the subsurface. However, the dissolution and long-term stability of reduced Tc(IV) and U(IV) species are poorly understood, particularly in the presence of natural and synthetic organic ligands, which are known to form complexes with these metals or radionuclides and thus cause their mobilization. In this study, the kinetics of both ligand-promoted and oxidative dissolution of Tc(IV) and U(IV) solids are determined, and their mobility is evaluated in the presence of natural organic matter (e.g.,humic acid and fulvic acid) and synthetic ethylenediaminetetraacetate (EDTA). We found that EDTA and the humic acid are among the most effective in promoting the ligand-induced dissolution of Tc(IV) and U(IV) by complexation. However, EDTA is found to suppress the oxidative dissoltuion of Tc(IV) and U(IV), whereas the humic acid enhances the oxidative dissolution due to its redox reactive functional properties. Furthermore, the oxidative dissolution is found to be much quicker than the ligand-promoted dissolution by humic substances. Studies of the dissolution and stability of reduced U(IV) in a contaminated sediment column confirms that both the synthetic and natural organic ligands can cause the mobilization of U(IV) although the dissolution rate is relatively slow. Because these organic ligands commonly co-exit at comtaminated sites, our results suggest that their presence can potentially impact the long-term stability and mobility of reduced Tc(IV) or U(IV) and should be considered in designing remediation strategies using the reductive precipitation approach.

  5. Protótipo do primeiro interferômetro brasileiro - BDA

    NASA Astrophysics Data System (ADS)

    Cecatto, J. R.; Fernandes, F. C. R.; Neri, J. A. C. F.; Bethi, N.; Felipini, N. S.; Madsen, F. R. H.; Andrade, M. C.; Soares, A. C.; Alonso, E. M. B., Sawant, H. S.

    2004-04-01

    A interferometria é uma poderosa ferramenta usada para investigar estruturas espaciais de fontes astrofísicas fornecendo uma riqueza de detalhes inatingível pelas técnicas convencionais de imageamento. Em particular, a interferometria com ondas de rádio abre o horizonte de conhecimento do Universo nesta ampla banda do espectro eletromagnético, que vai de cerca de 20 kHz até centenas de GHz já próximo ao infravermelho, e que está acessível a partir de instrumentos instalados em solo. Neste trabalho, apresentamos o interferômetro designado por Arranjo Decimétrico Brasileiro (BDA). Trata-se do primeiro interferômetro a ser desenvolvido no Brasil e América Latina que já está em operação na fase de protótipo. Apresentamos o desenvolvimento realizado até o momento, o sítio de instalação do instrumento, o protótipo e os principais resultados dos testes de sua operação, as perspectivas futuras e a ciência a ser desenvolvida com o instrumento nas fases II e III. Neste trabalho é dada ênfase ao desenvolvimento, testes de operação e principais resultados do protótipo. É discutida brevemente a ciência que pode ser feita com o instrumento. Tanto os detalhes técnicos quanto os principais parâmetros estimados para o instrumento nas próximas fases de desenvolvimento e o desempenho do protótipo serão publicados em breve.

  6. Enhancing patient safety with intelligent intravenous infusion devices: experience in a specialty cardiac hospital.

    PubMed

    Wood, Jacqueline L; Burnette, Jeremy S

    2012-01-01

    The study objective was to evaluate patient safety, increase nursing satisfaction, and affect economic factors through implementation of intelligent intravenous (IV) infusion devices in a specialty cardiac hospital. Intelligent IV infusion devices have been shown to decrease medication errors associated with inpatient infusions. Intelligent IV infusion device evaluation and drug library creation were conducted by a multidisciplinary team within the hospital. Devices were then implemented into patient care, and the impact was analyzed over a 9-month period. Post-implementation data showed that compliance was approximately 100%. A total of 494 critical catches occurred over the study period, resulting in an estimated annual savings of $7,513,333. End-users became familiar with the new technology and recognized the increase in safety measures and time spent with patients. This evaluation suggests that intelligent IV infusion devices resulted in decreased costs and a safer environment for patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Subclassification of stage IV gastric cancer (IVa, IVb, and IVc) and prognostic significance of substages.

    PubMed

    Ma, Yan; Xue, Yingwei; Li, Yanfeng; Lan, Xiuwen; Zhang, Yongle; Zhang, Ming

    2010-03-01

    Although the prognosis of stage IV gastric cancer is poor, some patients with stage IV gastric cancer had a long-term survival after gastrectomy. The objective of this study was to subclassify stage IV gastric cancer according to survival differences, evaluate the prognosis by substage, and identify the factors associated with patient survival in each substage. The data from 1,176 patients who underwent gastric resection for stage IV gastric cancer between 1988 and 2007 at Tumor Hospital of Harbin Medical University were reviewed retrospectively. The patients were divided into three substages according to the survival differences: stage IVa (T1-2N3M0), stage IVb (T3N3M0 and T4N1-2M0), and stage IVc (T4N3M0 and TanyNanyM1). The clinicopathological characteristics as well as survival of the patients were evaluated retrospectively by substage. There were no significant differences in survival among T3N3M0, T4N1M0, and T4N2M0 groups (p = 0.884) and between T4N3M0 and TanyNanyM1 groups (p = 0.192). The 5-year survival rates in stage IVa (T1-2N3M0), stage IVb (T3N3M0 and T4N1-2M0), and stage IVc (T4N3M0 and TanyNanyM1) were 22.7%, 9.9%, and 2.2%, respectively (p < 0.001). Multivariate analysis showed the following independent prognostic factors for survival: subclassification, operation type, number of retrieved lymph nodes, curability, and chemotherapy for stage IV gastric cancer; curability, chemotherapy, and number of retrieved lymph nodes for stage IVa and IVb; chemotherapy and operation type for stage IVc. For 406 patients with curative resection in stage IVa and IVb, hematogenous recurrence (35.9%) was the dominant recurrence pattern in stage IVa, whereas the most common patterns of recurrence were peritoneal (40.8%) and locoregional recurrence (31.8%) in stage IVb. Subclassification of stage IV gastric cancer into IVa (T1-2N3M0), IVb (T3N3M0 and T4N1-2M0), and IVc (T4N3M0, TanyNanyM1) may be helpful to predict the outcome and determine the therapeutic strategies

  8. Positioning hospitals: a model for regional hospitals.

    PubMed

    Reddy, A C; Campbell, D P

    1993-01-01

    In an age of marketing warfare in the health care industry, hospitals need creative strategies to compete successfully. Lately, positioning concepts have been added to the health care marketer's arsenal of strategies. To blend theory with practice, the authors review basic positioning theory and present a framework for developing positioning strategies. They also evaluate the marketing strategies of a regional hospital to provide a case example.

  9. Gemini Program Mission Report: Gemini IV

    NASA Technical Reports Server (NTRS)

    1965-01-01

    The second manned mission of the Gemini Program, Gemini IV, was launched from Complex 19 at Cape Kennedy, Florida, at 10:16 a.m. e.s.t. on June 3, 1965. The mission was successfully concluded on June 7, 1965, with the recovery of the spacecraft by the prime recovery ship, the aircraft carrier U.S.S. Wasp, at 27 deg 44' N. latitude, 74 deg 11' W. longitude at 2:28 p.m. e.s.t. This manned long-duration flight was accomplished 10 weeks after the three-orbit manned flight which qualified the Gemini spacecraft and systems for orbital flight. The spacecraft was manned by Astronaut James A. McDivitt, command pilot, and Astronaut Edward H. White II, pilot. The flight crew completed the 4-day mission in excellent physical condition, and demonstrated full control of the spacecraft and competent management of all aspects of the mission.

  10. Characterization of a Grape Class IV Chitinase

    PubMed Central

    2015-01-01

    A chitinase was purified from Vitis vinifera Manzoni Bianco grape juice and characterized. On the basis of proteomic analysis of tryptic peptides, a significant match identified the enzyme as a type IV grape chitinase previously found in juices of other V. vinifera varieties. The optimal pH and temperature for activity toward colloidal chitin were found to be 6 and 30 °C, respectively. The enzyme was found to hydrolyze chitin and oligomers of N-acetylglucosamine, generating N,N′-diacetylchitobiose and N-acetylglucosamine as products, but was inactive toward N,N′-diacetylchitobiose. The enzyme exhibited both endo- and exochitinase activities. Because yeast contains a small amount of chitin in the cell wall, the possibility of growth inhibition was tested. At a concentration and pH expected in ripe grapes, no inhibition of wine yeast growth by the chitinase was observed. PMID:24845689

  11. Ratchet model for type IV pilus retraction

    NASA Astrophysics Data System (ADS)

    Lindén, Martin; Tuohimaa, Tomi; Jonsson, Ann-Beth; Wallin, Mats

    2004-03-01

    Type IV pilus rectraction is required for twitching motility in a wide range of bacteriae, including Neisseria gonorrhoeae, Myxococcus xanthus and Pseudomonas aeruginosa. The mechanism of retraction is believed to be filament disassembly mediated by PilT, a member of the AAA family of motor proteins. Recent laser tweezer measurements of the force-velocity relation of PilT in N. gonorrhoeae, reveal that single PilT complexes generate forces of over 100 pN. We assume that PilT forms a cyclic ATPase surrounding the base of the pilus and formulate a model of retraction in terms of coupled flashing ratchets. We obtain a force-velocity relation by numerical simulation of the model which is in qualitative agreement with the experimental results.

  12. Review of the BCI Competition IV

    PubMed Central

    Tangermann, Michael; Müller, Klaus-Robert; Aertsen, Ad; Birbaumer, Niels; Braun, Christoph; Brunner, Clemens; Leeb, Robert; Mehring, Carsten; Miller, Kai J.; Müller-Putz, Gernot R.; Nolte, Guido; Pfurtscheller, Gert; Preissl, Hubert; Schalk, Gerwin; Schlögl, Alois; Vidaurre, Carmen; Waldert, Stephan; Blankertz, Benjamin

    2012-01-01

    The BCI competition IV stands in the tradition of prior BCI competitions that aim to provide high quality neuroscientific data for open access to the scientific community. As experienced already in prior competitions not only scientists from the narrow field of BCI compete, but scholars with a broad variety of backgrounds and nationalities. They include high specialists as well as students. The goals of all BCI competitions have always been to challenge with respect to novel paradigms and complex data. We report on the following challenges: (1) asynchronous data, (2) synthetic, (3) multi-class continuous data, (4) session-to-session transfer, (5) directionally modulated MEG, (6) finger movements recorded by ECoG. As after past competitions, our hope is that winning entries may enhance the analysis methods of future BCIs. PMID:22811657

  13. Modcomp MAX IV System Processors reference guide

    SciTech Connect

    Cummings, J.

    1990-10-01

    A user almost always faces a big problem when having to learn to use a new computer system. The information necessary to use the system is often scattered throughout many different manuals. The user also faces the problem of extracting the information really needed from each manual. Very few computer vendors supply a single Users Guide or even a manual to help the new user locate the necessary manuals. Modcomp is no exception to this, Modcomp MAX IV requires that the user be familiar with the system file usage which adds to the problem. At General Atomics there is an ever increasing need for new users to learn how to use the Modcomp computers. This paper was written to provide a condensed Users Reference Guide'' for Modcomp computer users. This manual should be of value not only to new users but any users that are not Modcomp computer systems experts. This Users Reference Guide'' is intended to provided the basic information for the use of the various Modcomp System Processors necessary to, create, compile, link-edit, and catalog a program. Only the information necessary to provide the user with a basic understanding of the Systems Processors is included. This document provides enough information for the majority of programmers to use the Modcomp computers without having to refer to any other manuals. A lot of emphasis has been placed on the file description and usage for each of the System Processors. This allows the user to understand how Modcomp MAX IV does things rather than just learning the system commands.

  14. 2. View northwest of main hospital building complex, hospital building ...

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

    2. View northwest of main hospital building complex, hospital building (Building 90), administration and clinical hospital building (Building 88), and hospital building (Building 91) - National Home for Disabled Volunteer Soldiers Western Branch, 4101 South Fourth Street, Leavenworth, Leavenworth County, KS

  15. A comparison between IV paracetamol and IV metamizol for postoperative analgesia after retinal surgery.

    PubMed

    Landwehr, Susanne; Kiencke, Peter; Giesecke, Thorsten; Eggert, Dirk; Thumann, Gabriele; Kampe, Sandra

    2005-10-01

    To assess clinical efficacy of IV paracetamol 1 g and IV metamizol 1 IV metamizol 1 g on a 24-h dosing schedule in this randomized, double-blinded, placebo-controlled study of 38 ASA physical status I-III patients undergoing retinal surgery. General anaesthesia using remifentanil, propofol, and desflurane was performed for surgery. The patients were randomly allocated to three groups, receiving infusions of paracetamol 1 g/100 mL (Para Group), of metamizol 1 g/100 mL (Meta Group), or of 100 mL of saline solution as placebo control (Plac Group) 30 min before arrival in the recovery area and every 6 h up to 24 h postoperatively. All patients had unrestricted access to intravenous opioid rescue medication. The primary efficacy variables were pain scores at rest over 30 h postoperatively analysed by using repeated ANOVA measurement. Secondary efficacy variables were pain scores on coughing, also analysed by repeated ANOVA measurement. Five patients in the Plac Group and one patient in the Meta Group interrupted the study protocol. Regarding pain scores at rest, Mauchly-test of sphericity was significant (p = 0.03). For the p time effects a significant result was detected (p < 0.001). The main effect between the three treatment groups was significantly different (p = 0.01). The Bonferroni adjusted pair wise comparisons between p the Plac Group and the Para Group showed a significant difference in favour of IV paracetamol (p = 0.024; mean difference 14.8; p 95% CI 1.6-28.0), between the Plac Group and the Meta Group in favour of IV metamizol (p = 0.025; mean difference 14.4; 95% CI p 1.5-27.4), and no significant difference between the Para Group and the Meta Group (p = 1.0; mean difference 0.4; 95% CI-12.8 to 13.6). Pain scores on coughing showed a significant different main effect between the three treatment groups (p = 0.022). The Bonferroni adjusted pair wise comparisons between the Plac Group and the Para Group showed a significant difference in favour of IV

  16. Risk factors for peripheral intravenous catheter infection in hospitalized patients: a prospective study of 3165 patients.

    PubMed

    Lee, Wei-Ling; Chen, Hsiao-Lien; Tsai, Tzung-Yi; Lai, I-Chen; Chang, Wen-Ching; Huang, Cheng-Hua; Fang, Chi-Tai

    2009-10-01

    We conducted a prospective study of 6538 polyurethane peripheral intravenous (IV) catheters in 3165 hospitalized adult patients using semiquantitative culture techniques. We found that extending the scheduled catheter replacement interval from 48 to 72 hours to 72 to 96 hours was not a risk factor for local catheter infection, but that catheter insertion by personnel other than IV therapists and the use of continuous infusion to maintain catheter patency were 2 independent risk factors for infection.

  17. Ambienti Circumstellari ed Interstellari di Supernovae di vario Tipo ed Applicazioni Astrofisiche

    NASA Astrophysics Data System (ADS)

    Boffi, Francesca R.

    Nella presente tesi vengono studiati gli ambienti circumstellari ed interstellari di supernovae (anche SNe; singolare SN) di vario tipo. In particolare si descrivono alcune applicazioni astrofisiche, relative a questi ambienti, che permettono di desumere informazioni sui sistemi stellari progenitori delle supernovae o di determinare le distanze a tali oggetti. L' emissione radio da supernovae, prodotta nell' ambiente circumstellare ad opera dell'interazione idrodinamica del gas di SN con l' ambiente circostante, puo' essere impiegata come mezzo di indagine del sistema di pre-supernova. In particolare si e' introdotta l'idea che tale emissione possa essere impiegata nel caso delle SNe di tipo Ia come test dei sistemi progenitori di tipo simbiotico. Il test e' stato effettuato sulla SN 1986G, per la quale avevamo ottenuto limiti superiori a lunghezze d'onda radio. Nel caso che un sistema simbiotico sia responsabile di una SN Ia, l'interazione tra l' ejecta e una shell circumstellare origina, in un'epoca molto prossima al massimo di luce, un'emissione radio rivelabile con strumenti tipo Very Large Array. Inoltre l'emissione radio fornisce informazioni circa gli stadi di pre-supernova nel caso di altri tipi di supernova. In questo lavoro di tesi vengono presentati i risultati ottenuti nel caso delle SNe di tipo II 1984E e 1986E. Queste due SNe non mostrano emissione radio: la prima, in prossimita del massimo ottico, stava interagendo con una shell circumstellare prodotta da un episodio di perdita di massa di breve durata in fase di pre-supernova; la seconda, invece e' la prima SN ``vecchia'' ad essere rivelata nell' ottico ma non nel radio (l' oggetto non ha ancora iniziato la fase di supernova remnant ed emette radiazione ottica prodotta ancora per interazione circumstellare). In ambiente circum-interstellare, gli echi di luce, prodotti dallo scattering della luce della supernova ad opera della polvere presente, possono essere utilizzati per determinare le distanze

  18. SOLAR TRANSITION REGION LINES OBSERVED BY THE INTERFACE REGION IMAGING SPECTROGRAPH: DIAGNOSTICS FOR THE O IV AND Si IV LINES

    SciTech Connect

    Dudík, J.; Del Zanna, G.; Mason, H. E.; Dzifčáková, E.; Golub, L.

    2014-01-01

    The formation of the transition region O IV and Si IV lines observable by the Interface Region Imaging Spectrograph (IRIS) is investigated for both Maxwellian and non-Maxwellian conditions characterized by a κ-distribution exhibiting a high-energy tail. The Si IV lines are formed at lower temperatures than the O IV lines for all κ. In non-Maxwellian situations with lower κ, the contribution functions are shifted to lower temperatures. Combined with the slope of the differential emission measure, it is possible for the Si IV lines to be formed at very different regions of the solar transition region than the O IV lines; possibly close to the solar chromosphere. Such situations might be discernible by IRIS. It is found that photoexcitation can be important for the Si IV lines, but is negligible for the O IV lines. The usefulness of the O IV ratios for density diagnostics independently of κ is investigated and it is found that the O IV 1404.78 Å/1399.77 Å ratio provides a good density diagnostics except for very low T combined with extreme non-Maxwellian situations.

  19. Analgesia after Epidural Dexamethasone is Further Enhanced by IV Dipyrone, but Not IV Parecoxibe Following Minor Orthopedic Surgery

    PubMed Central

    Righeti, Claudia CF; Kitayama, Antonio T

    2014-01-01

    Background Epidural administration of dexamethasone has been suggested for pain control after minor orthopedic surgery. This study was conducted to assess its efficacy after such surgery, combined or not to IV dipyrone, IV parecoxibe or their combination. Methods 91 patients were randomly assigned to seven groups. Patients were submitted to spinal bupivacaine anesthesia combined to epidural administration of either 10 ml saline or 10 mg dexamethasone diluted to 10-ml volume. Patients also received 10 ml IV saline or 1 gr dipyrone and/or 40 mg parecoxibe diluted to 10 ml with saline. Control group (CG) received epidural and IV saline. Dexamethasone group (DexG) received epidural dexamethasone and IV saline. Dipyrone group (DipG) received epidural saline and IV dipyrone. Dex-Dip G received epidural dexamethasone and IV dipyrone. Parecoxibe group (ParG) received epidural saline and IV parecoxibe. Dex-ParG received epidural dexamethasone and IV parecoxibe. Finally, Dex-Dip-ParG received epidural dexamethasone and IV dipyrone plus IV parecoxibe. Results The CG expressed 4h of analgesia and sooner requested pain killer. DexG was similar to DipG or ParG or Dex-ParG (7-hours), and they requested less ketoprofen compared to the CG (P < 0.05). However, the Dex-DipG and the Dex-Dip-ParG resulted in longer time to demand pain killer (17-hours) and less ketoprofen consumption in 24-hours (P < 0.002). Adverse effects were similar among groups. Conclusions The analgesia secondary to epidural dexamethasone was enhanced by IV dipyrone, while no effects were observed by the addition of IV parecoxibe. PMID:25317284

  20. Intravenous Ibuprofen (IV-ibuprofen) Controls Fever Effectively in Adults with Acute Uncomplicated Plasmodium falciparum Malaria but Prolongs Parasitemia

    PubMed Central

    Krudsood, Srivicha; Tangpukdee, Noppadon; Wilairatana, Polrat; Pothipak, Nantaporn; Duangdee, Chatnapa; Warrell, David A.; Looareesuwan, Sornchai

    2010-01-01

    Because some febrile patients are unable to swallow or retain oral antipyretic drugs, we carried out a double-blind, placebo-controlled trial in which intravenous ibuprofen (IV-ibuprofen) was given to adults hospitalized with fever associated with acute uncomplicated falciparum malaria treated with oral artesunate plus mefloquine. Thirty patients received IV-ibuprofen 400 mg and 30 received placebo every 6 hours for 72 hours. Reduction in the area above 37.0°C versus time curve was significantly greater for IV-ibuprofen than for placebo during the first 72 hours after first administration. No patients developed severe malaria; parasite clearance was delayed in the patients whose fevers were controlled by IV-ibuprofen (median 37.3 hours versus 23.7 hours in the placebo group [P = 0.0024]). This difference did not appear to be clinically important Adverse events, none considered severe, occurred equally in both groups. IV-ibuprofen was effective and well tolerated in reducing fever in febrile inpatients with malaria. PMID:20595477

  1. Major Oncologic Surgery at a Community Hospital

    PubMed Central

    Loui, Hollyann; Benyamini, Pouya

    2017-01-01

    There is a national trend to refer patients requiring complex oncologic surgery to tertiary high-volume cancer centers. However, this presents major access challenges to Hawai‘i patients seeking care. The purpose of this study is to demonstrate that complex oncologic surgery can be safely performed at community hospitals like those in Hawai‘i. From July 2007 to December 2014, 136 patients underwent complex oncologic procedures at a community hospital in Hawai'i by a single general surgeon. Cases included esophagogastric, hepatobiliary, pancreatic, rectal, and retroperitoneal resections. A database of patients was created from information extracted from the EPIC database. Complications were evaluated using the Clavien-Dindo grading system. There was 0.7% mortality rate (grade V complication). The major morbidity rate was 12.5%, including 10.3% grade III complications and 2.2% grade IV complications. The median length of stay for all operations was 8 days. The mean estimated blood loss for all operations was 708 cc. There was a 2.9% hospital readmission rate within 30 days of initial discharge, and a 5.1% reoperation rate. Complex oncologic procedures can be safely performed at a low-volume community hospital, with outcomes similar to those from high-volume cancer centers. PMID:28210527

  2. Collagen type IV at the fetal-maternal interface.

    PubMed

    Oefner, C M; Sharkey, A; Gardner, L; Critchley, H; Oyen, M; Moffett, A

    2015-01-01

    Extracellular matrix proteins play a crucial role in influencing the invasion of trophoblast cells. However the role of collagens and collagen type IV (col-IV) in particular at the implantation site is not clear. Immunohistochemistry was used to determine the distribution of collagen types I, III, IV and VI in endometrium and decidua during the menstrual cycle and the first trimester of pregnancy. Expression of col-IV alpha chains during the reproductive cycle was determined by qPCR and protein localisation by immunohistochemistry. The structure of col-IV in placenta was examined using transmission electron microscopy. Finally, the expression of col-IV alpha chain NC1 domains and collagen receptors was localised by immunohistochemistry. Col-IV alpha chains were selectively up-regulated during the menstrual cycle and decidualisation. Primary extravillous trophoblast cells express collagen receptors and secrete col-IV in vitro and in vivo, resulting in the increased levels found in decidua basalis compared to decidua parietalis. A novel expression pattern of col-IV in the mesenchyme of placental villi, as a three-dimensional network, was found. NC1 domains of col-IV alpha chains are known to regulate tumour cell migration and the selective expression of these domains in decidua basalis compared to decidua parietalis was determined. Col-IV is expressed as novel forms in the placenta. These findings suggest that col-IV not only represents a structural protein providing tissue integrity but also influences the invasive behaviour of trophoblast cells at the implantation site. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Hospital diversification strategy.

    PubMed

    Eastaugh, Steven R

    2014-01-01

    To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

  4. The case for diffuse, collisionally ionized interstellar C IV and SI IV below Z = 1 KPC

    NASA Astrophysics Data System (ADS)

    Harris, Alan W.; Bromage, Gordon E.

    1986-09-01

    The results of a study of highly ionized gas in the galactic disc and disc/halo interface region are presented, based on IUE observations of C IV and Si IV absorption in a specially selected set of 19 co-directional sight-lines to early-type stars. Evidence is presented for a generally distributed, collisionally ionized phase of this gas having a density in the plane of ≡3×10-9cm-3 and a scale height in the range of 1 - 3 kpc. It is shown that the use in a restricted range of sight-line directions in studies such as this may reduce confusion resulting from inhomogeneities in the distribution of the highly ionized medium.

  5. Structural dynamic testing of the Engineering Test Satellite-IV

    NASA Astrophysics Data System (ADS)

    Shiraki, K.; Mitsuma, H.; Matsushita, T.; Izumi, H.

    The Engineering Test Satellite-IV (ETS-IV) was the first large scale spacecraft developed and launched successfully in Japan on a new N-II launch vehicle. This paper presents an approach taken for the structural development of the ETS-IV. Extensive structural tests were performed to demonstrate that the ETS-IV spacecraft meets all design requirements and will survive all critical environments. Details of the static load test, vibration tests, acoustic test, and pyrotechnic shock test were described. The test results were compared with analyses and measured flight data.

  6. DNA Ligase IV regulates XRCC4 nuclear localization.

    PubMed

    Francis, Dailia B; Kozlov, Mikhail; Chavez, Jose; Chu, Jennifer; Malu, Shruti; Hanna, Mary; Cortes, Patricia

    2014-09-01

    DNA Ligase IV, along with its interacting partner XRCC4, are essential for repairing DNA double strand breaks by non-homologous end joining (NHEJ). Together, they complete the final ligation step resolving the DNA break. Ligase IV is regulated by XRCC4 and XLF. However, the mechanism(s) by which Ligase IV control the NHEJ reaction and other NHEJ factor(s) remains poorly characterized. Here, we show that a C-terminal region of Ligase IV (aa 620-800), which encompasses a NLS, the BRCT I, and the XRCC4 interacting region (XIR), is essential for nuclear localization of its co-factor XRCC4. In Ligase IV deficient cells, XRCC4 showed deregulated localization remaining in the cytosol even after induction of DNA double strand breaks. DNA Ligase IV was also required for efficient localization of XLF into the nucleus. Additionally, human fibroblasts that harbor hypomorphic mutations within the Ligase IV gene displayed decreased levels of XRCC4 protein, implicating that DNA Ligase IV is also regulating XRCC4 stability. Our results provide evidence for a role of DNA Ligase IV in controlling the cellular localization and protein levels of XRCC4. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Development of Silicon-Based Group IV Lasers

    DTIC Science & Technology

    2014-05-01

    Final 3. DATES COVERED (From - To) 22 Aug 2011 – 21 Aug 2013 4. TITLE AND SUBTITLE Development of Silicon-Based Group IV Lasers 5a...project is to develop silicon-based group IV heterostructure lasers by the incorporation of anoth er group IV element of Sn. We have made significant...distribution is unlimited Final Report for AOARD Grant FA2386-11-1-4113 “Development of Silicon-Based Group IV Lasers ” 1/5/2014 Name of Principal

  8. DNA Ligase IV regulates XRCC4 nuclear localization

    PubMed Central

    Francis, Dailia B.; Kozlov, Mikhail; Chavez, Jose; Chu, Jennifer; Malu, Shruti; Hanna, Mary; Cortes, Patricia

    2014-01-01

    DNA Ligase IV, along with its interacting partner XRCC4, are essential for repairing DNA double strand breaks by non-homologous end joining (NHEJ). Together, they complete the final ligation step resolving the DNA break. Ligase IV is regulated by XRCC4 and XLF. However, the mechanism(s) by which Ligase IV control the NHEJ reaction and other NHEJ factor(s) remains poorly characterized. Here, we show that a C-terminal region of Ligase IV (aa 620 to 800), which encompasses a NLS, the BRCT I, and the XRCC4 interacting region (XIR), is essential for nuclear localization of its co-factor XRCC4. In Ligase IV deficient cells, XRCC4 showed deregulated localization remaining in the cytosol even after induction of DNA double strand breaks. DNA Ligase IV was also required for efficient localization of XLF into the nucleus. Additionally, human fibroblasts that harbor hypomorphic mutations within the Ligase IV gene displayed decreased levels of XRCC4 protein, implicating that DNA Ligase IV is also regulating XRCC4 stability. Our results provide evidence for a role of DNA Ligase IV in controlling the cellular localization and protein levels of XRCC4. PMID:24984242

  9. [Jejunostomy catheter feeding during postoperative chemotherapy for Stage IV gastric cancer].

    PubMed

    Matsuyama, Jin; Fukushima, Yukio; Toshiyama, Reishi; Takeda, Mitsunobu; Tokuoka, Masayoshi; Ide, Yoshihito; Hashimoto, Kazuhiko; Yokoyama, Shigekazu; Morimoto, Takashi; Nomura, Takashi; Kodama, Ken; Sasaki, Yo

    2013-11-01

    Chemotherapy followed by surgery for Stage IV gastric cancer with passage obstruction poses a problem in terms of poor postoperative nutritional status. By maintaining an adequate postoperative nutrition status with jejunostomy catheter feeding, chemotherapy may possibly be continued. We treated 40 cases of Stage IV gastric cancer with passage obstruction from January 2008 to December 2011. In every case, jejunostomy catheter feeding tubes were placed during gastric cancer surgery. We performed 13 total gastrectomies, 20 distal gastrectomies, and 7 gastrojejunal bypass surgeries. Tube obstruction in 4 cases( 10%) and tube deviation in 1 case( 2.5%) occurred during the tube feeding period. Chemotherapy could be resumed in 37 cases( 92.5%), and the duration of chemotherapy was 330 days( range, 41-721). In cases of Stage IV gastric cancer, patients are obliged to start postoperative chemotherapy at an unstable period. By starting jejunal catheter feeding at an early stage after surgery, improved results could be expected in terms of shortening of the hospital stay or continuation of chemotherapy.

  10. [EUROASPIRE-IV: European Society of Cardiology study of lifestyle, risk factors, and treatment approaches in patients with coronary artery disease: Data from Turkey].

    PubMed

    Tokgözoğlu, Lale; Kayıkçıoğlu, Meral; Altay, Servet; Aydoğdu, Sinan; Barçın, Cem; Bostan, Cem; Çakmak, Hüseyin Altuğ; Çatakoğlu, Alp Burak; Emet, Samim; Ergene, Oktay; Kalkan, Ali Kemal; Kaya, Barış; Tulunay Kaya, Cansın; Kaymaz, Cihangir; Koylan, Nevrez; Kültürsay, Hakan; Oğuz, Aytekin; Özpelit, Ebru; Ünlü, Serkan

    2017-03-01

    Data from EUROASPIRE-IV Turkey report investigating risk factors and adherence to guidelines in patients hospitalized for coronary artery disease are presented and results are compared with those of EUROASPIRE-III Turkey and EUROASPIRE-IV Europe. Study was performed in 24 European countries, including Turkey (17 centers). Patients (18-80 years old) hospitalized for coronary (index) event during preceding 3 years were identified from hospital records and interviewed ≥6 months later. Patient information regarding index event was acquired from hospital records. Anamnesis was obtained during the interview, and physical examination and laboratory analyses were performed. Median age at the index coronary event was 58.8 years, and it was significantly decreased compared with last EUROASPIRE-III study (60.5 years), which was conducted at the same centers 6 years earlier (p=0.017). Of all patients, 19.3% were under 50 years of age and mean age was lower than that of EUROASPIRE-IV Europe (62.5 years). Comparing EUROASPIRE-IV Turkey with EUROASPIRE-III Turkey, rate of smokers increased to 25.5% from 23.1% (p=0.499), obesity increased to 40.7% from 35.5% (p=0.211), total cholesterol level increased to 49.6% from 48.3% (p=0.767), and diabetes rate increased to 39.7% from 33.6% (p=0.139), however none of the differences reached a level of statistical significance. Only 11.7% of the smokers quit after coronary event. Rates for these factors were lower in EUROASPIRE-IV Europe (16% for smoking, 37.6% for obesity, and 26.8% for diabetes). EUROASPIRE-IV Turkey data revealed that secondary prevention was unsatisfactory and had progressed unfavorably compared with last EUROASPIRE study, some risk factors were more uncontrolled than overall European average, and coronary artery events at young age remain an important problem.

  11. Comparing IV With Structural Models: What Simple IV Can and Cannot Identify

    PubMed Central

    Heckman, James J.; Urzúa, Sergio

    2009-01-01

    This paper compares the economic questions addressed by instrumental variables estimators with those addressed by structural approaches. We discuss Marschak’s Maxim: estimators should be selected on the basis of their ability to answer well-posed economic problems with minimal assumptions. A key identifying assumption that allows structural methods to be more informative than IV can be tested with data and does not have to be imposed. PMID:20440375

  12. CMS’ Hospital-Acquired Conditions for the Neurohospitalist

    PubMed Central

    Sand, Heather; Owen, Mary; Amin, Alpesh

    2012-01-01

    In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a provision that denies Medicare payment for hospital-acquired conditions (HACs). This provision brings attention to the quality of patient care and the financial impact associated with “never-events” occurring during a patient’s hospitalization. Our review of HACs focuses on the 5 which are most pertinent to the neurohospitalist: stages III and IV pressure ulcers, catheter-associated urinary tract infection, vascular catheter-associated infection, manifestations of poor glycemic control, and falls resulting in fractures, dislocations, and/or intracranial injuries. We address why CMS came up with them, their impact on quality patient care and hospital finances, and how the neurohospitalist can continue to participate in the future of HAC prevention and management as they relate to one’s patients, hospital, and community. PMID:23983859

  13. Incidence and Predictors of Bowel Obstruction in Elderly Patients With Stage IV Colon Cancer

    PubMed Central

    Winner, Megan; Mooney, Stephen J.; Hershman, Dawn L.; Feingold, Daniel L.; Allendorf, John D.; Wright, Jason D.; Neugut, Alfred I.

    2015-01-01

    IMPORTANCE Research has been limited on the incidence, mechanisms, etiology, and treatment of symptoms that require palliation in patients with terminal cancer. Bowel obstruction (BO) is a common complication of advanced abdominal cancer, including colon cancer, for which small, single-institution studies have suggested an incidence rate of 15% to 29%. Large population-based studies examining the incidence or risk factors associated with BO in cancer are lacking. OBJECTIVE To investigate the incidence and risk factors associated with BO in patients with stage IV colon cancer. DESIGN AND SETTING Retrospective cohort, population-based study of patients in the Surveillance, Epidemiology, and End Results and Medicare claims linked databases who were diagnosed as having stage IV colon cancer from January 1, 1991, through December 31, 2005. PATIENTS Patients 65 years or older with stage IV colon cancer (n = 12 553). MAIN OUTCOMES AND MEASURES Time to BO, defined by inpatient hospitalization for BO. We used Cox proportional hazards regression models to determine associations between BO and patient, prior treatment, and tumor features. RESULTS We identified 1004 patients with stage IV colon cancer subsequently hospitalized with BO (8.0%). In multivariable analysis, proximal tumor site (hazard ratio, 1.22 [95% CI, 1.07–1.40]), high tumor grade (1.34 [1.16–1.55]), mucinous histological type (1.27 [1.08–1.50]), and nodal stage N2 (1.52 [1.26–1.84]) were associated with increased risk of BO, as was the presence of obstruction at cancer diagnosis (1.75 [1.47–2.04]). A more recent diagnosis was associated with decreased risk of subsequent obstruction (hazard ratio, 0.84 [95% CI, 0.72–0.98]). CONCLUSIONS AND RELEVANCE In this large population of patients with stage IV colon cancer, BO after diagnosis was less common (8.0%) than previously reported. Risk was associated with site and histological type of the primary tumor. Future studies will explore management and

  14. Hospital costs by cost center of inpatient hospitalization for medicare patients undergoing major abdominal surgery.

    PubMed

    Stey, Anne M; Brook, Robert H; Needleman, Jack; Hall, Bruce L; Zingmond, David S; Lawson, Elise H; Ko, Clifford Y

    2015-02-01

    This study aims to describe the magnitude of hospital costs among patients undergoing elective colectomy, cholecystectomy, and pancreatectomy, determine whether these costs relate as expected to duration of care, patient case-mix severity and comorbidities, and whether risk-adjusted costs vary significantly by hospital. Correctly estimating the cost of production of surgical care may help decision makers design mechanisms to improve the efficiency of surgical care. Patient data from 202 hospitals in the ACS-NSQIP were linked to Medicare inpatient claims. Patient charges were mapped to cost center cost-to-charge ratios in the Medicare cost reports to estimate costs. The association of patient case-mix severity and comorbidities with cost was analyzed using mixed effects multivariate regression. Cost variation among hospitals was quantified by estimating risk-adjusted hospital cost ratios and 95% confidence intervals from the mixed effects multivariate regression. There were 21,923 patients from 202 hospitals who underwent an elective colectomy (n = 13,945), cholecystectomy (n = 5,569), or pancreatectomy (n = 2,409). Median cost was lowest for cholecystectomy ($15,651) and highest for pancreatectomy ($37,745). Room and board costs accounted for the largest proportion (49%) of costs and were correlated with length of stay, R = 0.89, p < 0.001. The patient case-mix severity and comorbidity variables most associated with cost were American Society of Anesthesiologists (ASA) class IV (estimate 1.72, 95% CI 1.57 to 1.87) and fully dependent functional status (estimate 1.63, 95% CI 1.53 to 1.74). After risk-adjustment, 66 hospitals had significantly lower costs than the average hospital and 57 hospitals had significantly higher costs. The hospital costs estimates appear to be consistent with clinical expectations of hospital resource use and differ significantly among 202 hospitals after risk-adjustment for preoperative patient characteristics and procedure type

  15. Implementing WHO hospital guidelines improves quality of paediatric care in central hospitals in Lao PDR.

    PubMed

    Gray, Amy Zigrida; Soukaloun, Douangdao; Soumphonphakdy, Bandith; Duke, Trevor

    2015-04-01

    To evaluate the impact of implementing a multifaceted intervention based on the WHO Pocketbook of Hospital Care for Children on the quality of case management of common childhood illnesses in hospitals in Lao PDR. The quality of case management of four sentinel conditions was assessed in three central hospitals before and after the implementation of the WHO Pocketbook as part of a broader mixed-methods study. Data on performance of key steps in case management in more than 600 admissions were collected by medical record abstraction pre- and post-intervention, and change was measured according to the proportion of cases which key steps were performed as well as an overall score of case management for each condition. Improvements in mean case management scores were observed post-intervention for three of the four conditions, with the greatest change in pneumonia (53-91%), followed by diarrhoea and low birthweight. Rational drug prescribing, appropriate use of IV fluids and appropriate monitoring all occurred more frequently post-intervention. Non-recommended practices such as prescription of antitussives became less frequent. A multifaceted intervention based on the WHO Pocketbook of Hospital Care for children led to better paediatric care in central Lao hospitals. The degree of improvement was dependent on the condition assessed. © 2014 John Wiley & Sons Ltd.

  16. New mono-organotin (IV) dithiocarbamate complexes

    NASA Astrophysics Data System (ADS)

    Muthalib, Amirah Faizah Abdul; Baba, Ibrahim

    2014-09-01

    Eighteen new mono-organotin dithiocarbamate compounds derived each nine from methyltin(IV) and phenyltin(IV) reacted using in-situ method with various type of N-dialkylamine together with carbon disulphide with the ratio of 1:3:3. Elemental and gravimetric analysis showed that the general formula of these compounds were RSnCl[S2CNR'R″]2 (R= Ph, CH3, R' = CH3, C2H5, C7H7 and R″ = C2H5, C6H11, iC3H7, C7H7). These compounds had been characterized by infrared spectroscopy, ultraviolet spectroscopy, 1H, 13C NMR spectroscopy and single crystal X-ray crystallography. The infrared spectra of these compounds showed three important peaks indicating the formation of dithiocarbamate compounds, ν(CN), ν(CS) and ν(Sn-S) band which present in the region of 1444-1519, 954-1098 and 318-349 cm-1 respectively. The ultraviolet-visible spectra showed an absorption band for the π - π* transition of NCS group in the range of 253 - 259 nm due to the intramolecular charge transfer of the ligand. The 13C NMR spectra showed an important shift for δ(N13CS2) in the range of 196.8 - 201.9 ppm.. Single crystal X-ray diffraction studies showed three new structures with the general formula of PhSnCl[S2CN(Et)(i-Pr)]2, MeSnCl[S2CN(Me)(Cy)]2 and MeSnCl[S2CN(i-Pr)(CH2Ph)]2. All structures having a distorted octahedral geometry set by CClS4 donor atom from the two chelating dithiocarbamate ligands.

  17. New mono-organotin (IV) dithiocarbamate complexes

    SciTech Connect

    Muthalib, Amirah Faizah Abdul; Baba, Ibrahim

    2014-09-03

    Eighteen new mono-organotin dithiocarbamate compounds derived each nine from methyltin(IV) and phenyltin(IV) reacted using in-situ method with various type of N-dialkylamine together with carbon disulphide with the ratio of 1:3:3. Elemental and gravimetric analysis showed that the general formula of these compounds were RSnCl[S{sub 2}CNR′R″]{sub 2} (R= Ph, CH{sub 3}, R′ = CH{sub 3}, C{sub 2}H{sub 5}, C{sub 7}H{sub 7} and R″ = C{sub 2}H{sub 5}, C{sub 6}H{sub 11}, iC{sub 3}H{sub 7}, C{sub 7}H{sub 7}). These compounds had been characterized by infrared spectroscopy, ultraviolet spectroscopy, {sup 1}H, {sup 13}C NMR spectroscopy and single crystal X-ray crystallography. The infrared spectra of these compounds showed three important peaks indicating the formation of dithiocarbamate compounds, ν(CN), ν(CS) and ν(Sn-S) band which present in the region of 1444–1519, 954–1098 and 318–349 cm{sup −1} respectively. The ultraviolet-visible spectra showed an absorption band for the π - π* transition of NCS group in the range of 253 – 259 nm due to the intramolecular charge transfer of the ligand. The {sup 13}C NMR spectra showed an important shift for δ(N{sup 13}CS{sub 2}) in the range of 196.8 – 201.9 ppm.. Single crystal X-ray diffraction studies showed three new structures with the general formula of PhSnCl[S{sub 2}CN(Et)(i−Pr)]{sub 2}, MeSnCl[S{sub 2}CN(Me)(Cy)]{sub 2} and MeSnCl[S{sub 2}CN(i−Pr)(CH{sub 2}Ph)]{sub 2}. All structures having a distorted octahedral geometry set by CClS{sub 4} donor atom from the two chelating dithiocarbamate ligands.

  18. Toward Phase IV, Populating the WOVOdat Database

    NASA Astrophysics Data System (ADS)

    Ratdomopurbo, A.; Newhall, C. G.; Schwandner, F. M.; Selva, J.; Ueda, H.

    2009-12-01

    One of challenges for volcanologists is the fact that more and more people are likely to live on volcanic slopes. Information about volcanic activity during unrest should be accurate and rapidly distributed. As unrest may lead to eruption, evacuation may be necessary to minimize damage and casualties. The decision to evacuate people is usually based on the interpretation of monitoring data. Over the past several decades, monitoring volcanoes has used more and more sophisticated instruments. A huge volume of data is collected in order to understand the state of activity and behaviour of a volcano. WOVOdat, The World Organization of Volcano Observatories (WOVO) Database of Volcanic Unrest, will provide context within which scientists can interpret the state of their own volcano, during and between crises. After a decision during the 2000 IAVCEI General Assembly to create WOVOdat, development has passed through several phases, from Concept Development (Phase-I in 2000-2002), Database Design (Phase-II, 2003-2006) and Pilot Testing (Phase-III in 2007-2008). For WOVOdat to be operational, there are still two (2) steps to complete, which are: Database Population (Phase-IV) and Enhancement and Maintenance (Phase-V). Since January 2009, the WOVOdat project is hosted by Earth Observatory of Singapore for at least a 5-year period. According to the original planning in 2002, this 5-year period will be used for completing the Phase-IV. As the WOVOdat design is not yet tested for all types of data, 2009 is still reserved for building the back-end relational database management system (RDBMS) of WOVOdat and testing it with more complex data. Fine-tuning of the WOVOdat’s RDBMS design is being done with each new upload of observatory data. The next and main phase of WOVOdat development will be data population, managing data transfer from multiple observatory formats to WOVOdat format. Data population will depend on two important things, the availability of SQL database in volcano

  19. [Case of lupus vasculopathy associated with lupus nephritis class IV-G (A)].

    PubMed

    Eguchi, Eriko; Shimazu, Keiji; Takaori, Kouji; Nishiguchi, Kensuke; Mori, Keita; Yorifuji, Soushi; Murakami, Toru; Koshikawa, Masao; Tanaka, Atsuo; Kuwahara, Takashi

    2010-01-01

    Various renal vascular lesions are complicated with systemic lupus erythematosus (SLE), and are often overlooked in the actual renal biopsy specimen. We report a case of biopsy-proven lupus vasculopathy, with lupus nephritis class IV-G (A). She developed SLE at 15 years of age, and was treated with prednisolone(PSL) and cyclophosphamide (CTX). Sometimes she experienced a flare-up clinically or serologically, requiring a dose increase of oral PSL. At 40 years of age, she visited our hospital after discontinuation of hospital visits for about 4 months. Oral PSL at 30 mg per day was not effective for urinary abnormalities, increase of anti double-stranded DNA (ds-DNA) antibody titer and decrease in complement components. On admission she had hypertension (180/92 mmHg) and signs of microangiopathic hemolytic anemia. Renal biopsy findings showed the glomerular changes of lupus nephritis, WHO class IV-G (A), and lupus vasculopathy, which is marked luminal narrowing or total occlusion by abundant subendothelial accumulation of immunoglobulins and complement components. In addition to PSL, intravenous pulse CTX promptly achieved clinical remission. When lupus vasculopathy is complicated, CTX may be useful.

  20. Structural and biological characterization of two crotamine isoforms IV-2 and IV-3 isolated from the Crotalus durissus cumanensis venom.

    PubMed

    Ponce-Soto, Luis Alberto; Martins-de-Souza, Daniel; Martins, Daniel; Novello, José Camillo; Marangoni, Sergio

    2007-12-01

    In this work, we isolated the two new crotamine isoforms from the Crotalus durissus cumanensis rattlesnake venom and its "in vitro" neurotoxic, myotoxic and lethality (DL(50)) intracerebroventricular (i.c.v.) effects were characterized. These proteins were named IV-2 and IV-3 and were purified by combination of two chromatographic steps on molecular exclusion chromatography on Superdex 75 and reverse phase HPLC (mu-Bondapack C18). The molecular mass of the crotamine isoforms was 4905.96 Da for isoform IV-2 and 4956.97 Da for IV-3 and, as determined by mass spectrometry, and both contained six Cys residues. Enzymatic hydrolysis followed by de novo sequencing by tandem mass spectrometry was used to determine the primary structure of both isoforms. The positions of five sequenced tryptic peptides, including the N-terminal of the isoform IV-2 and four from isoform IV-3 were deduced by comparison with a homologous protein from the crotamine family. The isoforms IV-2 and IV-3 had a sequence of amino acids of 42 amino acid residues IV-2: YKRCHIKGGH CFPKEKLICI PPSSDIGKMD CPWKRKCCKK RS and pI value 9.54 and IV-3: YKQCHKKGGH CFPKEVLICI PPSSDFGKMD CRWKRKCCKK RS with a pI value of 9.54. This protein showed high molecular amino acid sequence identity with other crotamine-like proteins from Crotalus durissus terrificus. These new crotamine isoforms induced potent blockade of neuromuscular transmission in young chicken biventer cervicis preparation and potent myotoxic effect. In mice, both isoforms induced myonecrosis, upon intramuscular or subcutaneous injections. These activities were modulated by the presence of positively charged amino acid residues. The LD(50) of isoform IV-2 was 0.07 mg/kg and isoform IV-3 was 0.06 mg/kg the animal weight, by i.c.v. route.

  1. The Acute Physiology and Chronic Health Evaluation IV, a New Scoring System for Predicting Mortality and Complications of Severe Acute Pancreatitis.

    PubMed

    Mok, Shaffer R S; Mohan, Sachin; Elfant, Adam B; Judge, Thomas A

    2015-11-01

    Severe acute pancreatitis is associated with significant morbidity/mortality; thus, the ability to predict hospital course is imperative. An updated version of the Acute Physiology and Chronic Health Evaluation II (APACHE), APACHE IV, has recently been validated. Unlike other versions, APACHE IV uses hepatobiliary parameters and accounts for multiple comorbid conditions and sedation. The intention of this study was to examine APACHE IV for predicting mortality and secondary outcomes for pancreatitis in a prospective cohort. In addition, we compared APACHE IV to APACHE II, Bedside Index for Severity in Acute Pancreatitis, and Ranson criterion. We prospectively collected physiologic parameters for each scoring system in 266 patients with severe acute pancreatitis from August 2011 to April 2014. Prognostic value of each score was determined using the area under the receiver operating characteristic curve. Among 266 patients, 59% were men, 52% were white, and 36.5% had alcohol-induced pancreatitis. Mortality occurred in 15 (5.6%), and an APACHE IV of 44 or greater predicted mortality in 100% of cases. The receiver operating characteristic curve for APACHE IV was 0.93 (confidence interval [CI], 0.88-0.97); APACHE II, 0.87 (CI, 0.80-0.94); Bedside Index for Severity in Acute Pancreatitis, 0.86 (CI, 0.78-0.94); and Ranson criterion, 0.90 (CI, 0.94-0.96). The APACHE IV is a valid means for predicting mortality and disease-related complications in acute pancreatitis.

  2. A classification system for O-B2 stars based on the Si IV and C IV resonance lines

    NASA Technical Reports Server (NTRS)

    Henize, K. G.; Wray, J. D.; Parsons, S. B.

    1981-01-01

    Low-dispersion ultraviolet spectra from Skylab Experiment S-019 are used to explore the variations of Si IV and C IV line strengths with temperature and luminosity. These considerations lead to a classification system in which the Si/C ratio is used to discriminate luminosity among the O stars and temperature among the O9-B2 stars of lower luminosity. Stars falling in these two regimes may be distinguished either by the presence of C IV emission or on the basis of C IV absorption strength. The log(Si IV/C IV) vs C IV diagram is proposed as a primary tool in such a classification system. The rapid variation in the Si IV/C IV ratio from less than 1/10 at O9 to greater than 10 at B1.5 for luminosity class III-V stars appears to be an especially useful criterion for the temperature classification of stars in this spectral range.

  3. Distinct expression patterns of alpha1 (IV) and alpha5 (IV) collagen chains in cylindroma and malignant cylindroma.

    PubMed

    Quatresooz, Pascale; Piérard, Gérald E

    2005-01-01

    Cutaneous cylindromas are considered to derive from cells of the sweat gland apparatus. The composition of the thick hyaline eosinophilic basement membrane (BM)-like zone surrounding epithelial aggregates in cylindromas is similar to that of the dermo-epidermal junction. The presence of type IV collagen has been documented, but the distribution of the different constitutive a chains of collagen IV has not been studied so far. Alterations in the expression of these alpha chains have been described in some other conditions including basal cell carcinomas, testes with spermatogenic dysfunction and colorectal carcinomas. The aim was to study the distribution of the alpha1 (IV) and alpha5 (IV) collagen chains in cylindromas and malignant cylindroma, and to compare it with the BM of sweat glands. Seven cylindromas and one malignant cylindroma were studied. They were formalin-fixed and paraffin-embedded before processing for immunohistochemistry. Immunostaining was assessed using the avidin-biotin-peroxidase technique with antibodies directed to the alpha1 (IV) and alpha5 (IV) collagen chains. In all cylindromas, a thin continuous and sharply limited immunolabelling for the alpha1 (IV) collagen chain was abutted to the tumoral cell aggregates. A speckled immunoreactivity was found in the rest of the hyaline sheath. Globular structures encased in the cell aggregates also exhibited a thin peripheral rim positive for the alpha1 (IV) collagen chain. The immunoreactivity was faint and granular in the center of the globules. With the antibody directed against the alpha5 (IV) collagen chain, 3 cylindromas did not show any staining, 2 cases presented discrete focal positivity in the mid-part of the BM-like zone, and 2 cases exhibited a positive staining pattern similar to that observed for the alpha1 (IV) collagen chain, but with a focal and more discrete intensity. The malignant cylindroma showed a linear immunoreactivity for the alpha1 (IV) collagen chain undistinguishable from

  4. Measuring hospital competition.

    PubMed

    White, S L; Chirikos, T N

    1988-03-01

    This paper appraises the use of the Herfindahl market share index as an exogenous competition variable in empirical studies of the hospital sector. An analysis of cross-sectional Florida data shows that this index itself is significantly influenced by the demand and supply factors commonly included in econometric models of hospital performance. The analysis then illustrates that biased inferences about the effects of market competition on the costs of hospital care may result unless the values of the Herfindahl Index are treated endogenously in hospital cost models.

  5. Central line infections - hospitals

    MedlinePlus

    ... infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired infection - central line infection; Patient safety - central ...

  6. LSPRAY-IV: A Lagrangian Spray Module

    NASA Technical Reports Server (NTRS)

    Raju, M. S.

    2012-01-01

    LSPRAY-IV is a Lagrangian spray solver developed for application with parallel computing and unstructured grids. It is designed to be massively parallel and could easily be coupled with any existing gas-phase flow and/or Monte Carlo Probability Density Function (PDF) solvers. The solver accommodates the use of an unstructured mesh with mixed elements of either triangular, quadrilateral, and/or tetrahedral type for the gas flow grid representation. It is mainly designed to predict the flow, thermal and transport properties of a rapidly vaporizing spray. Some important research areas covered as a part of the code development are: (1) the extension of combined CFD/scalar-Monte- Carlo-PDF method to spray modeling, (2) the multi-component liquid spray modeling, and (3) the assessment of various atomization models used in spray calculations. The current version contains the extension to the modeling of superheated sprays. The manual provides the user with an understanding of various models involved in the spray formulation, its code structure and solution algorithm, and various other issues related to parallelization and its coupling with other solvers.

  7. The Mosaic Type IV Secretion Systems

    PubMed Central

    Christie, Peter J.

    2016-01-01

    Escherichia coli and other Gram-negative and -positive bacteria employ type IV secretion systems (T4SSs) to translocate DNA and protein substrates, generally by contact-dependent mechanisms, to other cells. The T4SSs functionally encompass two major subfamilies, the conjugation systems and the effector translocators. The conjugation systems are responsible for interbacterial transfer of antibiotic resistance genes, virulence determinants, and genes encoding other traits of potential benefit to the bacterial host. The effector translocators are used by many Gram-negative pathogens for delivery of potentially hundreds of virulence proteins termed effectors to eukaryotic cells during infection. In E. coli and other species of Enterobacteriaceae, T4SSs identified to date function exclusively in conjugative DNA transfer. In these species, the plasmid-encoded systems can be classified as the P, F, and I types. The P-type systems are the simplest in terms of subunit composition and architecture, and members of this subfamily share features in common with the paradigmatic Agrobacterium tumefaciens VirB/VirD4 T4SS. This review will summarize our current knowledge of the E. coli systems and the A. tumefaciens P-type system, with emphasis on the structural diversity of the T4SSs. Ancestral P-, F-, and I-type systems were adapted throughout evolution to yield the extant effector translocators, and information about well-characterized effector translocators also is included to further illustrate the adaptive and mosaic nature of these highly versatile machines. PMID:27735785

  8. Level IV Ecoregions of EPA Region 6

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  9. Level IV Ecoregions of EPA Region 7

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  10. Level IV Ecoregions of EPA Region 2

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  11. Level IV Ecoregions of EPA Region 5

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  12. Level IV Ecoregions of EPA Region 10

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  13. Milliken Clean Coal IV Demonstration Project update

    SciTech Connect

    Janik, G.S.; Chang, S.C.; Szalach, P.A.

    1995-12-31

    The Milliken Clean Coal IV Demonstration Project is being conducted at New York State Electric & Gas Corporation (NYSEG) Milliken station located in Lansing, New York. The Milliken station has two 150-MWe Combustion Engineering pulverized coal-fired units built in the 1950s. The S-H-U flue gas desulfurization process and the ABB/CE Low-NO{sub x} Concentric Firing System Level III (LNCFS-III) were retrofitted on both units. The Unit 2 scrubber started up in January 1995 and the Unit 1 scrubber started up in June 1995. The S-H-U scrubber consistently achieves 93-98% SO{sub 2} removal. The LNCFS-III burner system achieves less than 0.45 pounds NO{sub x} per million Btu. This paper will describe the FGD performance achieved to date and the S-H-U test program. The impact of burner operating parameters on NO{sub x} emissions, loss-on-ignition, and long-term NO{sub x} emission reduction also will be discussed.

  14. Level IV Ecoregions of EPA Region 3

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  15. Level IV Ecoregions of EPA Region 4

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  16. Level IV Ecoregions of EPA Region 1

    EPA Pesticide Factsheets

    Ecoregions by EPA region were extracted from the seamless national shapefile. Ecoregions denote areas of general similarity in ecosystems and in the type, quality, and quantity of environmental resources. They are designed to serve as a spatial framework for the research, assessment, management, and monitoring of ecosystems and ecosystem components. These general purpose regions are critical for structuring and implementing ecosystem management strategies across federal agencies, state agencies, and nongovernment organizations that are responsible for different types of resources within the same geographical areas. The approach used to compile this map is based on the premise that ecological regions can be identified through the analysis of patterns of biotic and abiotic phenomena, including geology, physiography, vegetation, climate, soils, land use, wildlife, and hydrology. The relative importance of each characteristic varies from one ecological region to another. A Roman numeral hierarchical scheme has been adopted for different levels for ecological regions. Level I is the coarsest level, dividing North America into 15 ecological regions. Level II divides the continent into 52 regions (Commission for Environmental Cooperation Working Group, 1997). At Level III, the continental United States contains 104 regions whereas the conterminous United States has 84 (U.S. Environmental Protection Agency, 2005). Level IV ecoregions are further subdivisions of Level I

  17. Conference Report: Masters Forum IV, February 2002

    NASA Technical Reports Server (NTRS)

    Post, Todd

    2002-01-01

    The purpose of the APPL Masters Forum is to bring together some of the best project managers at NASA, as well as those in industry and other government agencies, for 2 1/2 days of knowledge sharing. The project managers come eager to reflect on their project experiences, to learn new things from one another--and to unlearn a few things, too. This was the fourth Masters Forum, and the first one held outside Washington, DC. Fifty participants from across the country came to Dallas at the American Airlines Conference Center, a wonderful facility that was conveniently located by the airport and yet still seemed isolated from the rest of the world. Masters Forum IV was also the first one held during the winter. Previous Masters Forums have been during the summer. Hot, sticky Washington, D.C. in the summer may sound unpleasant, but frankly the popularity of earlier Forums is what led to this annual event becoming a semiannual one.

  18. ADHD Rating Scale-IV: Checklists, Norms, and Clinical Interpretation

    ERIC Educational Resources Information Center

    Pappas, Danielle

    2006-01-01

    This article reviews the "ADHD Rating Scale-IV: Checklist, norms, and clinical interpretation," is a norm-referenced checklist that measures the symptoms of attention deficit/hyperactivity disorder (ADHD) according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric…

  19. The PCP SYS IV Management System: Technical Overview.

    ERIC Educational Resources Information Center

    Bryan, John T.; Felty, J. Michael

    This paper is the second in a three-part series on SYS IV, an instructional management system developed by the PLATO Curriculum Project (PCP) that incorporates some of the features of the previous SYS systems. Focus is primarily on the new features that make the system unique. Following a brief background section explaining the purpose of SYS IV,…

  20. The PCP SYS IV Management System: Educational Overview.

    ERIC Educational Resources Information Center

    Siegel, Martin A.; Davis, Dennis M.

    This paper describes the structure and function of the SYS IV PLATO Curriculum Project's (PCP) computer-based management system and justifies the system design. A consideration of features most critical in the design of management systems provides the context for a discussion of specific SYS IV features, which include its ability to deliver any…

  1. CALIBRATING C-IV-BASED BLACK HOLE MASS ESTIMATORS

    SciTech Connect

    Park, Daeseong; Woo, Jong-Hak; Shin, Jaejin; Denney, Kelly D. E-mail: woo@astro.snu.ac.kr E-mail: kelly@dark-cosmology.dk

    2013-06-20

    We present the single-epoch black hole mass estimators based on the C IV {lambda}1549 broad emission line, using the updated sample of the reverberation-mapped active galactic nuclei and high-quality UV spectra. By performing multi-component spectral fitting analysis, we measure the C IV line widths (FWHM{sub C{sub IV}} and line dispersion, {sigma}{sub C{sub IV}}) and the continuum luminosity at 1350 A (L{sub 1350}) to calibrate the C-IV-based mass estimators. By comparing with the H{beta} reverberation-based masses, we provide new mass estimators with the best-fit relationships, i.e., M{sub BH}{proportional_to}L{sub 1350}{sup 0.50{+-}0.07}{sigma}{sub C{sub IV}{sup 2}} and M{sub BH}{proportional_to}L{sub 1350}{sup 0.52{+-}0.09} FWHM{sub C{sub IV}{sup 0.56{+-}0.48}}. The new C-IV-based mass estimators show significant mass-dependent systematic difference compared to the estimators commonly used in the literature. Using the published Sloan Digital Sky Survey QSO catalog, we show that the black hole mass of high-redshift QSOs decreases on average by {approx}0.25 dex if our recipe is adopted.

  2. Reducing Nitrogen Oxide Emissions: 1996 Compliance with Title IV Limits

    EIA Publications

    1998-01-01

    The purpose of this article is to summarize the existing federal nitrogen oxide (Nox) regulations and the 1996 performance of the 239 Title IV generating units. It also reviews the basics of low-Nox burner technology and presents cost and performance data for retrofits at Title IV units.

  3. 32 CFR 2003.4 - Membership (Article IV).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 6 2014-07-01 2014-07-01 false Membership (Article IV). 2003.4 Section 2003.4 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE...) BYLAWS, RULES, AND APPEAL PROCEDURES Bylaws § 2003.4 Membership (Article IV). (a) Member...

  4. Synthesis and Characterization of Cerium(IV) Metallocenes

    DOE PAGES

    Sutton, Andrew; Clark, David Lewis; Scott, Brian Lindley; ...

    2015-12-11

    In this study, by applying a salt metathesis approach between Ce(OtBu3)2(NO3)2(THF)2 and the potassium salts of mono- and ditrimethylsilyl substituted cyclopentadienes, we were able to isolate two new Ce(IV) metallocenes, including to the best of our knowledge, the first structurally characterized bis-cyclopentadiene Ce(IV) compound.

  5. 30 CFR 57.22226 - Testing for methane (IV mines).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Testing for methane (IV mines). 57.22226... Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22226 Testing for methane (IV mines). Tests for methane shall be conducted in the mine atmosphere by a competent person— (a) At least...

  6. On the ion chromatographic determination of S(IV)

    NASA Astrophysics Data System (ADS)

    Dasgupta, Purnendu K.

    Ion Chromatographie determination of S(IV) is described with special reference to the determination of SO 2(g) and/or aerosol S(IV) along with chloride, nitrate and sulfate in particulate matter. A method is presented for the baseline separation of the above species. The Chromatographic behavior of hydroxymethanesulfonate under various eluent conditions is discussed.

  7. Area 4 has layer IV in adult primates

    PubMed Central

    García-Cabezas, Miguel Ángel; Barbas, Helen

    2014-01-01

    There are opposing views about the status of layer IV in primary motor cortex (area 4). Cajal described a layer IV in area 4 of adult humans. In contrast, Brodmann found layer IV in development but not in adult primates and called area 4 ‘agranular’. We addressed this issue in rhesus monkeys using the neural marker SMI-32, which labels neurons in lower layer III and upper V, but not in layer IV. SMI-32 delineated a central unlabeled cortical stripe in area 4 that corresponds to layer IV, which was populated with small interneurons also found in layer IV in ‘granular’ areas (such as area 46). We distinguished layer IV interneurons from projection neurons in the layers above and below using cellular criteria. The commonly used term ‘agranular’ for area 4 is also used for the phylogenetically ancient limbic cortices, confusing areas that differ markedly in laminar structure. This issue pertains to the systematic variation in the architecture across cortices, traced from limbic cortices through areas with increasingly more elaborate laminar structure. The principle of systematic variation can be used to predict laminar patterns of connections across cortical systems. This principle places area 4 and agranular anterior cingulate cortices at opposite poles of the graded laminar differentiation of motor cortices. The status of layer IV in area 4 thus pertains to core organizational features of the cortex, its connections and evolution. PMID:24735460

  8. CDDIS Data Center Summary for the 2004 IVS Annual Report

    NASA Technical Reports Server (NTRS)

    Noll, Carey

    2005-01-01

    This report summarizes activities during the year 2004 and future plans of the Crustal Dynamics Data Information System (CDDIS) with respect to the International VLBI service for Geodesy and Astrometry (IVS). Included in this report are background information about the CDDIS, the computer architecture, staffing the support system, archive contents, and future plans for the CDDIS within the IVS.

  9. 30 CFR 57.22226 - Testing for methane (IV mines).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Testing for methane (IV mines). 57.22226... Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22226 Testing for methane (IV mines). Tests for methane shall be conducted in the mine atmosphere by a competent person— (a) At least...

  10. 2 CFR 3485.1018 - Title IV, HEA transaction.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... program to a student or borrower; (b) A certification by an educational institution of eligibility for a loan under a title IV, HEA program; (c) Guaranteeing a loan made under a title IV, HEA program; and (d) The acquisition or exercise of any servicing responsibility for a grant, loan, or work...

  11. 2 CFR 3485.1018 - Title IV, HEA transaction.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... program to a student or borrower; (b) A certification by an educational institution of eligibility for a loan under a title IV, HEA program; (c) Guaranteeing a loan made under a title IV, HEA program; and (d) The acquisition or exercise of any servicing responsibility for a grant, loan, or work...

  12. CDDIS Data Center Summary for the IVS 2012 Annual Report

    NASA Technical Reports Server (NTRS)

    Noll, Carey

    2013-01-01

    This report summarizes activities during 2012 and future plans of the Crustal Dynamics Data Information System (CDDIS) with respect to the International VLBI Service for Geodesy and Astrometry (IVS). Included in this report are background information about the CDDIS, the computer architecture, staff supporting the system, archive contents, and future plans for the CDDIS within the IVS.

  13. CDDIS Data Center Summary for the 2003 IVS Annual Report

    NASA Technical Reports Server (NTRS)

    Noll, Carey

    2004-01-01

    This report summarizes activities during the year 2003 and future plans of the Crustal Dynamics Data Information System (CDDIS) with respect to the International VLBI Service for Geodesy and Astrometry (IVS). Included in this report are background information about the CDDIS, the computer architecture, staffing supporting the system, archive contents, and future plans for the CDDIS within the IVS.

  14. 30 CFR 57.22226 - Testing for methane (IV mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Testing for methane (IV mines). 57.22226... Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22226 Testing for methane (IV mines). Tests for methane shall be conducted in the mine atmosphere by a competent person— (a) At least once...

  15. 30 CFR 57.22226 - Testing for methane (IV mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Testing for methane (IV mines). 57.22226... Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22226 Testing for methane (IV mines). Tests for methane shall be conducted in the mine atmosphere by a competent person— (a) At least once...

  16. 30 CFR 57.22226 - Testing for methane (IV mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Testing for methane (IV mines). 57.22226... Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22226 Testing for methane (IV mines). Tests for methane shall be conducted in the mine atmosphere by a competent person— (a) At least once...

  17. 32 CFR 2003.4 - Membership (Article IV).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 6 2013-07-01 2013-07-01 false Membership (Article IV). 2003.4 Section 2003.4 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY OVERSIGHT OFFICE...) BYLAWS, RULES, AND APPEAL PROCEDURES Bylaws § 2003.4 Membership (Article IV). (a) Member...

  18. 75 FR 16445 - Defense Transportation Regulation, Part IV

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF DEFENSE Office of the Secretary Defense Transportation Regulation, Part IV AGENCY: United States Transportation... for the Defense Personal Property Program (DP3) in the Defense Transportation Regulation (DTR) Part IV...

  19. 29 CFR 4022.63 - Estimated title IV benefit.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 9 2012-07-01 2012-07-01 false Estimated title IV benefit. 4022.63 Section 4022.63 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION COVERAGE AND BENEFITS BENEFITS PAYABLE IN TERMINATED SINGLE-EMPLOYER PLANS Benefit Reductions in Terminating Plans § 4022.63 Estimated title IV benefit. (a) General. If...

  20. 29 CFR 4022.63 - Estimated title IV benefit.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Estimated title IV benefit. 4022.63 Section 4022.63 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION COVERAGE AND BENEFITS BENEFITS PAYABLE IN TERMINATED SINGLE-EMPLOYER PLANS Benefit Reductions in Terminating Plans § 4022.63 Estimated title IV benefit. (a) General. If...

  1. 29 CFR 4022.63 - Estimated title IV benefit.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 9 2014-07-01 2014-07-01 false Estimated title IV benefit. 4022.63 Section 4022.63 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION COVERAGE AND BENEFITS BENEFITS PAYABLE IN TERMINATED SINGLE-EMPLOYER PLANS Benefit Reductions in Terminating Plans § 4022.63 Estimated title IV benefit. (a) General. If...

  2. 29 CFR 4022.63 - Estimated title IV benefit.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Estimated title IV benefit. 4022.63 Section 4022.63 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION COVERAGE AND BENEFITS BENEFITS PAYABLE IN TERMINATED SINGLE-EMPLOYER PLANS Benefit Reductions in Terminating Plans § 4022.63 Estimated title IV benefit. (a) General. If...

  3. 29 CFR 4022.63 - Estimated title IV benefit.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Estimated title IV benefit. 4022.63 Section 4022.63 Labor Regulations Relating to Labor (Continued) PENSION BENEFIT GUARANTY CORPORATION COVERAGE AND BENEFITS BENEFITS PAYABLE IN TERMINATED SINGLE-EMPLOYER PLANS Benefit Reductions in Terminating Plans § 4022.63 Estimated title IV benefit. (a) General. If...

  4. The PCP SYS IV Management System: Technical Overview.

    ERIC Educational Resources Information Center

    Bryan, John T.; Felty, J. Michael

    This paper is the second in a three-part series on SYS IV, an instructional management system developed by the PLATO Curriculum Project (PCP) that incorporates some of the features of the previous SYS systems. Focus is primarily on the new features that make the system unique. Following a brief background section explaining the purpose of SYS IV,…

  5. Beyond the DSM-IV: Assumptions, Alternatives, and Alterations

    ERIC Educational Resources Information Center

    Lopez, Shane J.; Edwards, Lisa M.; Pedrotti, Jennifer Teramoto; Prosser, Ellie C.; LaRue, Stephanie; Spalitto, Susan Vehige; Ulven, Jon C.

    2006-01-01

    Current diagnostic processes reflect the limitations and utility of the framework of the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; DSM-IV; American Psychiatric Association, 1994). Clinical information in the DSM-IV's 5-axis system almost exclusively focuses on weaknesses and pathology and is summarized in a flawed…

  6. Apolipoprotein A-IV: a protein intimately involved in metabolism

    PubMed Central

    Wang, Fei; Kohan, Alison B.; Lo, Chun-Min; Liu, Min; Howles, Philip; Tso, Patrick

    2015-01-01

    The purpose of this review is to summarize our current understanding of the physiological roles of apoA-IV in metabolism, and to underscore the potential for apoA-IV to be a focus for new therapies aimed at the treatment of diabetes and obesity-related disorders. ApoA-IV is primarily synthesized by the small intestine, attached to chylomicrons by enterocytes, and secreted into intestinal lymph during fat absorption. In circulation, apoA-IV is associated with HDL and chylomicron remnants, but a large portion is lipoprotein free. Due to its anti-oxidative and anti-inflammatory properties, and because it can mediate reverse-cholesterol transport, proposed functions of circulating apoA-IV have been related to protection from cardiovascular disease. This review, however, focuses primarily on several properties of apoA-IV that impact other metabolic functions related to food intake, obesity, and diabetes. In addition to participating in triglyceride absorption, apoA-IV can act as an acute satiation factor through both peripheral and central routes of action. It also modulates glucose homeostasis through incretin-like effects on insulin secretion, and by moderating hepatic glucose production. While apoA-IV receptors remain to be conclusively identified, the latter modes of action suggest that this protein holds therapeutic promise for treating metabolic disease. PMID:25640749

  7. Equilibrium between Different Coordination Geometries in Oxidovanadium(IV) Complexes

    ERIC Educational Resources Information Center

    Ugone, Valeria; Garribba, Eugenio; Micera, Giovanni; Sanna, Daniele

    2015-01-01

    In this laboratory activity, the equilibrium between square pyramidal and octahedral V(IV)O[superscript 2+] complexes is described. We propose a set of experiments to synthesize and characterize two types of V(IV)O[superscript 2+] complexes. The experiment allows great flexibility and may be effectively used at a variety of levels and the activity…

  8. Equilibrium between Different Coordination Geometries in Oxidovanadium(IV) Complexes

    ERIC Educational Resources Information Center

    Ugone, Valeria; Garribba, Eugenio; Micera, Giovanni; Sanna, Daniele

    2015-01-01

    In this laboratory activity, the equilibrium between square pyramidal and octahedral V(IV)O[superscript 2+] complexes is described. We propose a set of experiments to synthesize and characterize two types of V(IV)O[superscript 2+] complexes. The experiment allows great flexibility and may be effectively used at a variety of levels and the activity…

  9. FORTRAN IV Digital Filter Design Programs. Digital Systems Education Project.

    ERIC Educational Resources Information Center

    Reuss, E.; And Others

    The goals of the Digital Systems Education Project (DISE) include the development and distribution of educational/instructional materials in the digital systems area. Toward that end, this document contains three reports: (1) A FORTRAN IV Design Program for Low-Pass Butterworth and Chebychev Digital Filters; (2) A FORTRAN IV Design Program for…

  10. 40 CFR 144.23 - Class IV wells.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Class IV wells. 144.23 Section 144.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) UNDERGROUND INJECTION CONTROL PROGRAM Authorization of Underground Injection by Rule § 144.23 Class IV wells....

  11. Independent Verification and Validation (IV and V) Criteria

    NASA Technical Reports Server (NTRS)

    McGill, Kenneth

    2000-01-01

    The purpose of this appendix is to establish quantifiable criteria for determining whether IV&V should be applied to a given software development. Since IV&V should begin in the Formulation Subprocess of a project, the process here described is based on metrics which are available before project approval.

  12. Common molecular determinants of tarantula huwentoxin-IV inhibition of Na+ channel voltage sensors in domains II and IV.

    PubMed

    Xiao, Yucheng; Jackson, James O; Liang, Songping; Cummins, Theodore R

    2011-08-05

    The voltage sensors of domains II and IV of sodium channels are important determinants of activation and inactivation, respectively. Animal toxins that alter electrophysiological excitability of muscles and neurons often modify sodium channel activation by selectively interacting with domain II and inactivation by selectively interacting with domain IV. This suggests that there may be substantial differences between the toxin-binding sites in these two important domains. Here we explore the ability of the tarantula huwentoxin-IV (HWTX-IV) to inhibit the activity of the domain II and IV voltage sensors. HWTX-IV is specific for domain II, and we identify five residues in the S1-S2 (Glu-753) and S3-S4 (Glu-811, Leu-814, Asp-816, and Glu-818) regions of domain II that are crucial for inhibition of activation by HWTX-IV. These data indicate that a single residue in the S3-S4 linker (Glu-818 in hNav1.7) is crucial for allowing HWTX-IV to interact with the other key residues and trap the voltage sensor in the closed configuration. Mutagenesis analysis indicates that the five corresponding residues in domain IV are all critical for endowing HWTX-IV with the ability to inhibit fast inactivation. Our data suggest that the toxin-binding motif in domain II is conserved in domain IV. Increasing our understanding of the molecular determinants of toxin interactions with voltage-gated sodium channels may permit development of enhanced isoform-specific voltage-gating modifiers.

  13. An Integrated Safety Assessment Methodology for Generation IV Nuclear Systems

    SciTech Connect

    Timothy J. Leahy

    2010-06-01

    The Generation IV International Forum (GIF) Risk and Safety Working Group (RSWG) was created to develop an effective approach for the safety of Generation IV advanced nuclear energy systems. Early work of the RSWG focused on defining a safety philosophy founded on lessons learned from current and prior generations of nuclear technologies, and on identifying technology characteristics that may help achieve Generation IV safety goals. More recent RSWG work has focused on the definition of an integrated safety assessment methodology for evaluating the safety of Generation IV systems. The methodology, tentatively called ISAM, is an integrated “toolkit” consisting of analytical techniques that are available and matched to appropriate stages of Generation IV system concept development. The integrated methodology is intended to yield safety-related insights that help actively drive the evolving design throughout the technology development cycle, potentially resulting in enhanced safety, reduced costs, and shortened development time.

  14. Virtual Pediatric Hospital

    MedlinePlus

    ... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

  15. [Music in the hospital].

    PubMed

    Bouteloup, Philippe

    2010-01-01

    Occasional events, regular workshops, concerts, shows, artists in residence, cultural outings...Hospital does not necessarily have to be a place of silence and sadness. But this situation has not always been so straightforward as on the face of it, nothing is more incompatible with a hospital environment than music, which, by definition, is festive and noisy.

  16. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

    Designed for both hospital personnel interested in television and audiovisual personnel entering the medical field, this handbook is a verbal and pictorial survey of what is being done with TV within the medical profession. After an introduction which answers technical questions about medical TV posed during the American Hospital Association's…

  17. Hospitality Occupations. Curriculum Guide.

    ERIC Educational Resources Information Center

    California State Dept. of Education, Sacramento. Bureau of Homemaking Education.

    This curriculum guide on the hospitality occupations was developed to help secondary and postsecondary home economics teachers prepare individuals for entry-level jobs in the hospitality industry. The content is in seven sections. The first section presents organizational charts of a medium-size hotel, food and beverage division, housekeeping and…

  18. Hospitality, Tourism, and Recreation.

    ERIC Educational Resources Information Center

    Novachek, James

    The Northern Arizona Hospitality Education Program is an exemplary three-year project designed to help students, mainly Indian, obtain job skills and attitudes necessary for successful employment in the hospitality industry. Nine high schools from Apache, Coconino, and Navajo Counties participated in the project. Objectives included providing an…

  19. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

  20. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

  1. Hospitality Services. Curriculum Guide.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

  2. Hospitality Services Reference Book.

    ERIC Educational Resources Information Center

    Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

    This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

  3. Hospitals are dangerous places.

    PubMed

    de Richemond, Albert L

    2010-01-01

    Hospital fire dangers are real, widespread, and ever present, the article demonstrates, spelling out the locations, conditions, and ignition potentials which exist in such a setting. Knowledge of codes and standards, good maintenance practices, and frequent drills in fire prevention and suppression are among the practices recommended for keeping a hospital fire from becoming a disaster, the author says.

  4. Handbook on Hospital Television.

    ERIC Educational Resources Information Center

    Prynne, T. A.

    Designed for both hospital personnel interested in television and audiovisual personnel entering the medical field, this handbook is a verbal and pictorial survey of what is being done with TV within the medical profession. After an introduction which answers technical questions about medical TV posed during the American Hospital Association's…

  5. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-01-04

    Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 per day, according to the Royal College of Physicians (RCP).

  6. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-01-31

    Essential facts Falls are the most frequently reported adverse events in hospitals, especially among older patients. According to the Royal College of Physicians (RCP) more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wale.

  7. Hospitality services generate revenue.

    PubMed

    Bizouati, S

    1993-01-01

    An increasing number of hospitals are undertaking external revenue-generating activities to supplement their shrinking budgets. Written at the request of Leadership, this article outlines an example of a successful catering service -- a money-generating business that more Canadian hospitals could profitably consider.

  8. Leading a hospital closure.

    PubMed

    Lucey, Paula A

    2002-01-01

    Hospital closures have become more common. The challenges facing a nursing leader in this situation are complex and difficult. This author suggests that looking for new beginnings rather than focusing on endings created an approach to closing a public hospital. The article includes approaches to employee morale, staffing, and patient care.

  9. Hospital benefit segmentation.

    PubMed

    Finn, D W; Lamb, C W

    1986-12-01

    Market segmentation is an important topic to both health care practitioners and researchers. The authors explore the relative importance that health care consumers attach to various benefits available in a major metropolitan area hospital. The purposes of the study are to test, and provide data to illustrate, the efficacy of one approach to hospital benefit segmentation analysis.

  10. Intravenous lacosamide in seizure emergencies: Observations from a hospitalized in-patient adult population.

    PubMed

    d'Orsi, Giuseppe; Pascarella, Maria Grazia; Martino, Tommaso; Carapelle, Elena; Pacillo, Francesca; Di Claudio, Maria Teresa; Mancini, Daniela; Trivisano, Marina; Avolio, Carlo; Specchio, Luigi M

    2016-11-01

    to evaluate the efficacy and safety of intravenous (IV) lacosamide (LCM) in the treatment of seizure clusters (SC) and status epilepticus (SE) in hospitalized adult patients. we prospectively analyzed treatment response, seizure outcome, and adverse effects of IV LCM in 38 patients with seizure emergencies (15 with SC, 23 with SE) during a hospital stay. The loading dose of IV LCM was 200-400mg and the maintenance dose was 200-400mg daily. Response to IV LCM was evaluated within 20min, 4h and 24h of LCM infusion. an acute anti-seizure effect after IV LCM was especially evident when it was first used - (SC) or second line (established SE) treatment. In particular, 87% of SC patients (13/15) and 80% of established SE (8/10) demonstrated response to LCM treatment, while no patients with super-refractory SE (0/8) responded to IV LCM according to our criteria. The loading of IV LCM was well tolerated, with mild adverse effects (2/38 temporary dizziness). In most patients, during and after administration of the loading dose of IV LCM a temporary (30min-1h) sedation was observed. No ECG and laboratory values-changes were documented in any of the patients. LCM is an effective and well-tolerated treatment when used to treat SC in hospitalized adult patients. As add-on therapy, it may be useful to stop seizure activity in patients with focal SE not responding to first/second-line intravenous AEDs. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  11. IV access in bleeding trauma patients: a performance review.

    PubMed

    Engels, Paul T; Passos, Edward; Beckett, Andrew N; Doyle, Jeffrey D; Tien, Homer C

    2014-01-01

    Exsanguinating haemorrhage is a leading cause of death in severely injured trauma patients. Management includes achieving haemostasis, replacing lost intravascular volume with fluids and blood, and treating coagulopathy. The provision of fluids and blood products is contingent on obtaining adequate vascular access to the patient's venous system. We sought to examine the nature and timing of achieving adequate intravenous (IV) access in trauma patients requiring uncrossmatched blood in the trauma bay. We performed a retrospective chart review of all patients admitted to our trauma centre from 2005 to 2009 who were transfused uncrossmatched blood in the trauma bay. We examined the impact of IV access on prehospital times and time to first PRBC transfusion. Of 208 study patients, 168 (81%) received prehospital IV access, and the on-scene time for these patients was 5 min longer (16.1 vs 11.4, p<0.01). Time to achieving adequate IV access in those without any prehospital IVs occurred on average 21 min (6.6-30.5) after arrival to the trauma bay. A central venous catheter was placed in 92 (44%) of patients. Time to first blood transfusion correlated most strongly with time to achieving central venous access (Pearson correlation coefficient 0.94, p<0.001) as opposed to time to achieving adequate peripheral IV access (Pearson correlation coefficient 0.19, p=0.12). We found that most bleeding patients received a prehospital IV; however, we also found that obtaining prehospital IVs was associated with longer EMS on-scene times and longer prehospital times. Interestingly, we found that obtaining a prehospital IV was not associated with more rapid initiation of blood product transfusion. Obtaining optimal IV access and subsequent blood transfusion in severely injured patients continues to present a challenge. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Development of Methodologies for IV and V of Neural Networks

    NASA Technical Reports Server (NTRS)

    Taylor, Brian; Darrah, Marjorie

    2003-01-01

    Non-deterministic systems often rely upon neural network (NN) technology to "lean" to manage flight systems under controlled conditions using carefully chosen training sets. How can these adaptive systems be certified to ensure that they will become increasingly efficient and behave appropriately in real-time situations? The bulk of Independent Verification and Validation (IV&V) research of non-deterministic software control systems such as Adaptive Flight Controllers (AFC's) addresses NNs in well-behaved and constrained environments such as simulations and strict process control. However, neither substantive research, nor effective IV&V techniques have been found to address AFC's learning in real-time and adapting to live flight conditions. Adaptive flight control systems offer good extensibility into commercial aviation as well as military aviation and transportation. Consequently, this area of IV&V represents an area of growing interest and urgency. ISR proposes to further the current body of knowledge to meet two objectives: Research the current IV&V methods and assess where these methods may be applied toward a methodology for the V&V of Neural Network; and identify effective methods for IV&V of NNs that learn in real-time, including developing a prototype test bed for IV&V of AFC's. Currently. no practical method exists. lSR will meet these objectives through the tasks identified and described below. First, ISR will conduct a literature review of current IV&V technology. TO do this, ISR will collect the existing body of research on IV&V of non-deterministic systems and neural network. ISR will also develop the framework for disseminating this information through specialized training. This effort will focus on developing NASA's capability to conduct IV&V of neural network systems and to provide training to meet the increasing need for IV&V expertise in such systems.

  13. Development of Methodologies for IV and V of Neural Networks

    NASA Technical Reports Server (NTRS)

    Taylor, Brian; Darrah, Marjorie

    2003-01-01

    Non-deterministic systems often rely upon neural network (NN) technology to "lean" to manage flight systems under controlled conditions using carefully chosen training sets. How can these adaptive systems be certified to ensure that they will become increasingly efficient and behave appropriately in real-time situations? The bulk of Independent Verification and Validation (IV&V) research of non-deterministic software control systems such as Adaptive Flight Controllers (AFC's) addresses NNs in well-behaved and constrained environments such as simulations and strict process control. However, neither substantive research, nor effective IV&V techniques have been found to address AFC's learning in real-time and adapting to live flight conditions. Adaptive flight control systems offer good extensibility into commercial aviation as well as military aviation and transportation. Consequently, this area of IV&V represents an area of growing interest and urgency. ISR proposes to further the current body of knowledge to meet two objectives: Research the current IV&V methods and assess where these methods may be applied toward a methodology for the V&V of Neural Network; and identify effective methods for IV&V of NNs that learn in real-time, including developing a prototype test bed for IV&V of AFC's. Currently. no practical method exists. lSR will meet these objectives through the tasks identified and described below. First, ISR will conduct a literature review of current IV&V technology. TO do this, ISR will collect the existing body of research on IV&V of non-deterministic systems and neural network. ISR will also develop the framework for disseminating this information through specialized training. This effort will focus on developing NASA's capability to conduct IV&V of neural network systems and to provide training to meet the increasing need for IV&V expertise in such systems.

  14. Group IV photonics for the mid infrared

    NASA Astrophysics Data System (ADS)

    Soref, Richard

    2013-02-01

    This paper outlines the challenges and benefits of applying silicon-based photonic techniques in the 2 to 5 μm midinfrared (MIR) wavelength range for chem.-bio-physical sensing, medical diagnostics, industrial process control, environmental monitoring, secure communications, Ladar, active imaging, and high-speed communications at 2 μm. Onchip passive and active components, mostly waveguided, will enable opto-electronic CMOS or BiCMOS integrated "circuits" for system-on-a-chip applications such as spectroscopy and lab-on-a-chip. Volume manufacture in a silicon foundry is expected to yield low-cost (or even disposable) chips with benefits in size-weight-power and ruggedness. This is "long-wavelength optoelectronic integration on silicon" which we call LIOS. Room temperature operation appears feasible, albeit with performance compromises at 4 to 5 μm. In addition to the electronics layer (which may include RF wireless), a 3-D LIOS chip can include several inter-communicating layers utilizing the photonic, plasmonic, photoniccrystal and opto-electro-mechanical technologies. The LIOS challenge can be met by (1) discovering new physics, (2) employing "new" IV and III-V alloys, (3) scaling-up and modifying telecom components, and (4) applying nonlinearoptical wavelength conversion in some cases. This paper presents proposals for MIR chip spectrometers employing frequency-comb and Ge blackbody sources. Active heterostructures employing Si, Ge, SiGe, GeSn and SiGeSn are key for laser diodes, photodetectors, LEDs, switches, amplifiers, and modulators that provide totally monolithic foundry integration, while numerous III-V semiconductor MIR devices within the InGaAsSb and InGaAsP families offer practical hybrid integration on Si PICs. Interband cascade and quantum cascade lasers on Ge waveguides are important in this context.

  15. Titanium(IV) and vitamin C: aqueous complexes of a bioactive form of Ti(IV).

    PubMed

    Buettner, Katherine M; Collins, Joseph M; Valentine, Ann M

    2012-10-15

    Ascorbic acid is among the biorelevant ligands that render Ti(IV) stable in aqueous solution. A series of pH-dependent titanium(IV) coordination complexes of L-ascorbic acid is described. Directed by spectropotentiometric methods, important aspects of the aqueous interactions in this system are investigated, including ligand binding mode, pH-dependent metal-ligand stoichiometry, and the importance of metal ion-promoted hydrolysis and the binding of hydroxide. Stability constants are determined for all metal ion-ligand-proton complexes by a process of model optimization and nonlinear least-squares fitting of the combined spectropotentiometric titration data to the log β(MLH) values in the model. A speciation diagram is generated from the set of stability constants described in the model. In the range pH 3-10, the aqueous speciation is characterized by the sequential appearance of the following complexes as a function of added base: Ti(asc)(2)(0) → Ti(asc)(3)(2-) → Ti(asc)(2)(OH)(2)(2-) → Ti(asc)(OH)(4)(2-). These species dominate the speciation at pH < 3, pH 4-5, pH ~ 8, and pH > 10, respectively, with minimum log stability constants (β values) of 25.70, 36.91, 16.43, and -6.91. Results from electrospray mass spectrometry, metal-ligand binding experiments, and kinetics measurements support the speciation, which is characterized by bidentate chelation of the ascorbate dianion to the titanium(IV) ion via proton displacement, and a pH-dependent metal-ligand binding motif of ligand addition followed by metal ion-promoted hydrolysis, stepwise ligand dissociation, and the concomitant binding of hydroxide ion. Additionally, the kinetics of ligand exchange of titanium ascorbate with citrate are reported to understand better the possible fate of titanium ascorbate under biologically relevant conditions.

  16. Intravenous drug preparation practices: a survey in a French university hospital.

    PubMed

    Tilleul, Patrick; Mons, Bisserka; Schmitt, Claude; Laporte, Jean-Marie; Begue, Dominique

    2003-12-01

    To describe current practices for i.v. drug admixture preparation, to identify potential improvements for the enhancement of patient safety. A survey was conducted in a University hospital in Paris. Nurse practices were explored through the evaluation of five i.v. drug delivery systems: reconstituted freeze-dried drugs administered by syringe or i.v. bags, reconstituted drugs from vials administered by syringe or i.v. bags Ready to Use (RtU). i.v. drug preparation practices were documented by a representative sample of nurses in the following departments: intensive care, emergency, abdominal surgery, cardiology, infectious diseases, hepatology. Data were collected regarding: existence of written procedures for preparations, sources of information, labelling, methods of preparation and calculation of doses, nurse satisfaction regarding safety and ease of use of the different i.v. systems. A total of 299 questionnaires were completed and 100 nurses from the chosen wards were surveyed. The study highlighted a lack of procedure (71-85%) and a lack of labelling (37%). This survey highlighted areas for improvement in the preparation of i.v. drugs. It may contribute to raising awareness among nurses and physicians about the risks of medication errors. This survey also helped the pharmacy department in supporting the development of pharmaceutical procedures, the development of satellite pharmacy, the set up of training sessions for i.v. preparation and the switch toward ready to use packages when these are available.

  17. Competition among hospitals.

    PubMed

    Gaynor, Martin; Vogt, William B

    2003-01-01

    We examine competition in the hospital industry, in particular the effect of ownership type (for-profit, not-for-profit, government). We estimate a structural model of demand and pricing in the hospital industry in California, then use the estimates to simulate the effect of a merger. California hospitals in 1995 face an average price elasticity of demand of -4.85. Not-for-profit hospitals face less elastic demand and act as if they have lower marginal costs. Their prices are lower than those of for-profits, but markups are higher. We simulate the effects of the 1997 merger of two hospital chains. In San Luis Obispo County, where the merger creates a near monopoly, prices rise by up to 53%, and the predicted price increase would not be substantially smaller were the chains not-for-profit.

  18. Medication safety in hospitals.

    PubMed

    Kirke, C

    2009-01-01

    Medication error and adverse drug reactions occur frequently, leading to a high burden of patient harm in the hospital setting. Many Irish hospitals have established medication safety initiatives, designed to encourage reporting and learning to improve medication use processes and therefore patient safety. Eight Irish hospitals or hospital networks provided data from voluntary medication safety incident and near miss reporting programmes for pooled analysis of events occurring between 1st January 2006 and 30th June 2007. 6179 reports were received in total (mean 772 per hospital; range 96-1855). 95% of reports did not involve patient harm. Forty seven percent of reports related to the prescribing stage of the medication use process, 40% to the administration stage and 9% to the pharmacy dispensing stage. This data is published to increase awareness of this key patient safety issue, to share learning from these incidents and near misses and to encourage a more open patient safety culture.

  19. [Infections in hospitalized patients with cirrhosis].

    PubMed

    Mathurin, Sebastián; Chapelet, Adrián; Spanevello, Valeria; Sayago, Gabriel; Balparda, Cecilia; Virga, Eliana; Beraudo, Nora; Bartolomeo, Mirta

    2009-01-01

    We evaluated the prevalence and the clinical relevance of bacterial and nonbacterial infections in predominantly alcoholic cirrhotic patients, admitted to an intermediate complexity hospital, and we also compared the clinical characteristics, laboratory and evolution of these patients with and without bacterial infection in a prospective study of cohort. A total of 211 consecutive admissions in 132 cirrhotic patients, between April 2004 and July 2007, were included. The mean age was 51.8 (+/-8) years, being 84.8% male. The alcoholic etiology of cirrhosis was present in 95.4%. One hundred and twenty nine episodes of bacterial infections were diagnosed in 99/211 (46.9%) admissions, community-acquired in 79 (61.2%) and hospital-acquired in 50 (38.8%): spontaneous bacterial peritonitis (23.3%); urinary tract infection (21.7%); pneumonia (17.8%); infection of the skin and soft parts (17.1%), sepsis by spontaneous bacteremia (7.7%); other bacterial infections (12.4%). Gram-positive organisms were responsible for 52.2% of total bacterial infections documented cases. There were eight serious cases of tuberculosis, fungal and parasitic infections; the prevalence of tuberculosis was 6% with an annual mortality of 62.5%; 28.1% (9/32) of the coproparasitological examination had Strongyloides stercolaris. The in-hospital mortality was significantly higher in patients with bacterial infection than in non-infected patients (32.4% vs. 13.2%; p=0.02). The independent factors associated with mortality were bacterial infections, the score of Child-Pügh and creatininemia > 1.5 mg/dl. By the multivariate analysis, leukocytosis and hepatic encephalopathy degree III/IV were independent factors associated to bacterial infection. This study confirms that bacterial and nonbacterial infections are a frequent and severe complication in hospitalized cirrhotic patients, with an increase of in-hospital mortality.

  20. Expanding the Ecological Validity of WAIS-IV and WMS-IV with the Texas Functional Living Scale

    ERIC Educational Resources Information Center

    Drozdick, Lisa Whipple; Cullum, C. Munro

    2011-01-01

    Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The…

  1. Means of Instruction Variables. Comparative Study of Phase IV IGE Evaluation Project. Phase IV Project Paper, 80-8.

    ERIC Educational Resources Information Center

    Nerenz, Anne G.; Webb, Norman L.

    This is one of a series of reports which provide definitions of and descriptive data on the variables used in the Comparative Study of Phase IV of the Individually Guided Education (IEG) Evaluation Project. Phase IV investigated three curriculum programs specifically designed to be compatible with instructional programming for the individual…

  2. Expanding the Ecological Validity of WAIS-IV and WMS-IV with the Texas Functional Living Scale

    ERIC Educational Resources Information Center

    Drozdick, Lisa Whipple; Cullum, C. Munro

    2011-01-01

    Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The…

  3. Actinide Corroles: Synthesis and Characterization of Thorium(IV) and Uranium(IV) bis(-chloride) Dimers

    SciTech Connect

    Ward, Ashleigh L.; Buckley, Heather L.; Gryko, Daniel T.; Lukens, Wayne W.; Arnold, John

    2013-12-01

    The first synthesis and structural characterization of actinide corroles is presented. Thorium(IV) and uranium(IV) macrocycles of Mes2(p-OMePh)corrole were synthesised and characterized by single-crystal X-ray diffraction, UV-Visible spectroscopy, variable-temperature 1H NMR, ESI mass spectrometry and cyclic voltammetry.

  4. Search for alpha variation in UVES spectra: Analysis of C IV and Si IV doublets towards QSO 1101-264

    NASA Astrophysics Data System (ADS)

    Martínez Fiorenzano, A. F.; Vladilo, G.; Bonifacio, P.

    Motivated by previous studies of QSO spectra that reported a variation of the fine structure constant alpha , a search for C IV and Si IV doublets was conducted in the absorption spectrum toward QSO 1101-264, obtained by VLT-UVES during the Science Verification. Seven C IV and two Si IV systems were identified and accurate measurements of wavelengths over the redshift range 1.1862 < z < 1.8377 were performed. After a careful selection of pairs of lines, the ``Alkali Doublet" method with a derived analitical expression for the error analysis was applied to compute the alpha variation. The result according in magnitud order with previous doublets measurements, corresponds to one Si IV system: Delta alpha /alpha = (- 3.09 +/- 8.46) x 10-5. Data from UVES-VLT.

  5. Variability in inpatient management of children hospitalized with bronchiolitis.

    PubMed

    Macias, Charles G; Mansbach, Jonathan M; Fisher, Erin S; Riederer, Mark; Piedra, Pedro A; Sullivan, Ashley F; Espinola, Janice A; Camargo, Carlos A

    2015-01-01

    To determine the variability between hospitals in diagnostic testing and management interventions for children with bronchiolitis admitted to inpatient wards and identify its association with patient characteristics. A prospective, multicenter (16 hospitals), multiyear (2007-2010) observational study of children (age <2 years) hospitalized with bronchiolitis. Outcomes included variability in diagnostic testing (complete blood count, chest radiographs) and medications or interventions (bronchodilator, systemic corticosteroid, antibiotic, IV placement) by hospital. A modified Respiratory Distress Severity Score was utilized to assess severity of illness. For all outcomes, intraclass correlation coefficient (ICC) was calculated from a model to estimate the random effects of hospital without added covariates and compared to ICCs from a second model that adjusted for demographic and clinical patient characteristics. A second unadjusted and adjusted model was created for age ≥ 2 months. Of 2207 subjects, 1715 were identified as admitted to inpatient wards. We observed wide variations in the proportion of patients who received diagnostic testing (complete blood count 21-75%, chest radiograph 36-85%) and medications/interventions (bronchodilators 19-91%, systemic corticosteroids 8-44%, antibiotics 17-43%, IV placement 38-93%). Adjusting for demographic and clinical patient characteristics did not materially affect the proportion of variability attributable to hospitals (differences in ICCs with and without model adjustment <4%). Wide variations in diagnostic test utilization and management interventions seen among children with bronchiolitis treated on the inpatient wards at 16 US hospitals were not attributable to demographic or clinical patient characteristics. These results further support efforts to standardize care for bronchiolitis through active quality improvement strategies. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights

  6. A comparison of outcomes according to different diagnostic systems for delirium (DSM-5, DSM-IV, CAM, and DRS-R98).

    PubMed

    Adamis, Dimitrios; Meagher, David; Rooney, Siobhan; Mulligan, Owen; McCarthy, Geraldine

    2017-09-14

    Studies indicate that DSM-5 criteria for delirium are relatively restrictive, and identify different cases of delirium compared with previous systems. We evaluate four outcomes of delirium (mortality, length of hospital stay, institutionalization, and cognitive improvement) in relation to delirium defined by different DSM classification systems. Prospective, longitudinal study of patients aged 70+ admitted to medical wards of a general hospital. Participants were assessed up to a maximum of four times during two weeks, using DSM-5 and DSM-IV criteria, DRS-R98 and CAM scales as proxies for DSM III-R and DSM III. Of the 200 assessed patients (mean age 81.1, SD = 6.5; and 50% female) during hospitalization, delirium was identified in 41 (20.5%) using DSM-5, 45 (22.5%) according to DSM-IV, 46 (23%) with CAM positive, and 37 (18.5%) with DRS-R98 severity score >15. Mortality was significantly associated with delirium according to any classification system, but those identified with DSM-5 were at greater risk. Length of stay was significantly longer for those with DSM-IV delirium. Discharge to a care home was associated only with DRS-R98 defined delirium. Cognitive improvement was only associated with CAM and DSM-IV. Different classification systems for delirium identify populations with different outcomes.

  7. Structure activity relationship modelling of milk protein-derived peptides with dipeptidyl peptidase IV (DPP-IV) inhibitory activity.

    PubMed

    Nongonierma, Alice B; FitzGerald, Richard J

    2016-05-01

    Quantitative structure activity type models were developed in an attempt to predict the key features of peptide sequences having dipeptidyl peptidase IV (DPP-IV) inhibitory activity. The models were then employed to help predict the potential of peptides, which are currently reported in the literature to be present in the intestinal tract of humans following milk/dairy product ingestion, to act as inhibitors of DPP-IV. Two models (z- and v-scale) for short (2-5 amino acid residues) bovine milk peptides, behaving as competitive inhibitors of DPP-IV, were developed. The z- and the v-scale models (p<0.05, R(2) of 0.829 and 0.815, respectively) were then applied to 56 milk protein-derived peptides previously reported in the literature to be found in the intestinal tract of humans which possessed a structural feature of DPP-IV inhibitory peptides (P at the N2 position). Ten of these peptides were synthetized and tested for their in vitro DPP-IV inhibitory properties. There was no agreement between the predicted and experimentally determined DPP-IV half maximal inhibitory concentrations (IC50) for the competitive peptide inhibitors. However, the ranking for DPP-IV inhibitory potency of the competitive peptide inhibitors was conserved. Furthermore, potent in vitro DPP-IV inhibitory activity was observed with two peptides, LPVPQ (IC50=43.8±8.8μM) and IPM (IC50=69.5±8.7μM). Peptides present within the gastrointestinal tract of human may have promise for the development of natural DPP-IV inhibitors for the management of serum glucose.

  8. The soft, fluctuating UVB at z ˜ 6 as traced by C IV, Si IV, and C II

    NASA Astrophysics Data System (ADS)

    Finlator, Kristian; Oppenheimer, B. D.; Davé, Romeel; Zackrisson, E.; Thompson, Robert; Huang, Shuiyao

    2016-07-01

    The sources that drove cosmological reionization left clues regarding their identity in the slope and inhomogeneity of the ultraviolet ionizing background (UVB): bright quasars (QSOs) generate a hard UVB with predominantly large-scale fluctuations while Population II stars generate a softer one with smaller scale fluctuations. Metal absorbers probe the UVB's slope because different ions are sensitive to different energies. Likewise, they probe spatial fluctuations because they originate in regions where a galaxy-driven UVB is harder and more intense. We take a first step towards studying the reionization-epoch UVB's slope and inhomogeneity by comparing observations of 12 metal absorbers at z ˜ 6 versus predictions from a cosmological hydrodynamic simulation using three different UVBs: a soft, spatially inhomogeneous `galaxies+QSOs' UVB; a homogeneous `galaxies+QSOs' UVB, and a `QSOs-only' model. All UVBs reproduce the observed column density distributions of C II, Si IV, and C IV reasonably well although high-column, high-ionization absorbers are underproduced, reflecting numerical limitations. With upper limits treated as detections, only a soft, fluctuating UVB reproduces both the observed Si IV/C IV and C II/C IV distributions. The QSOs-only UVB overpredicts both C IV/C II and C IV/Si IV, indicating that it is too hard. The Haardt & Madau (2012) UVB underpredicts C IV/Si IV, suggesting that it lacks amplifications near galaxies. Hence current observations prefer a soft, fluctuating UVB as expected from a predominantly Population II background although they cannot rule out a harder one. Future observations probing a factor of 2 deeper in metal column density will distinguish between the soft, fluctuating and QSOs-only UVBs.

  9. Guide to Choosing a Hospital

    MedlinePlus

    ... you visit Hospital Compare, finding information about the quality of hospitals is just a few steps away: • Click on “Find and Compare Hospitals,” and decide if you want to look for hospitals by the hospital name, or by ZIP Code, City, State or Territory, or County. • Select General Search, ...

  10. Hospitality as an Environmental Metaphor.

    ERIC Educational Resources Information Center

    Horwood, Bert

    1991-01-01

    Compares stewardship and hospitality as they relate to the biosphere. Traces the origin of the word "hospitality," discusses cultural traditions of hospitality, and applies the concept of hospitality to the natural world. Considers forms of symbiosis in nature: commensals, mutualism, and parasitism. Hospitality promotes respect,…

  11. Philanthropy and hospital financing.

    PubMed Central

    Smith, D G; Clement, J P; Wheeler, J R

    1995-01-01

    OBJECTIVE. This study explores the relationships among donations to not-for-profit hospitals, the returns provided by these hospitals, and fund-raising efforts. It tests a model of hospital behavior and addresses an earlier debate regarding the supply price of donations. DATA SOURCES. The main data source is the California Office of Statewide Health Planning data tapes of hospital financial disclosure reports for fiscal years 1980/1981 through 1986/1987. Complete data were available for 160 hospitals. STUDY DESIGN. Three structural equations (donations, returns, and fund-raising) are estimated as a system using a fixed-effects, pooled cross-section, time-series least squares regression. PRINCIPAL FINDINGS. Estimation results reveal the expected positive relation between donations and returns. The reverse relation between returns and donations is insignificant. The estimated effect of fund-raising on donations is insignificantly different from zero, and the effect of donations on fund-raising is negative. Fund-raising and returns are negatively associated with one another. CONCLUSION. The empirical results presented here suggest a positive donations-returns relations and are consistent with a positive supply price for donations. Hospitals appear to view a trade-off between providing returns and soliciting donations, but donors do not respond equally to these two activities. Attempts to increase free cash flow through expansion of community returns or fund-raising activity, at least in the short run, are not likely to be highly successful financing strategies for many hospitals. PMID:8537223

  12. Hospitals' Internal Accountability

    PubMed Central

    Kraetschmer, Nancy; Jass, Janak; Woodman, Cheryl; Koo, Irene; Kromm, Seija K.; Deber, Raisa B.

    2014-01-01

    This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements. PMID:25305387

  13. PREFACE: Progress in Nonequilibrium Green's Functions IV

    NASA Astrophysics Data System (ADS)

    Bonitz, Michael; Balzer, Karsten

    2010-04-01

    This is the fourth volume1 of articles on the theory of Nonequilibrium Green's functions (NEGF) and their modern application in various fields such as plasma physics, semiconductor physics, molecular electronics and high energy physics. It contains 23 articles written by experts in many-body theory and quantum transport who summarize recent progress in their respective area of research. The articles are based on talks given at the interdisciplinary conference Progress in Nonequilibrium Green's functions IV which was held 17-21 August 2009 at the University of Glasgow, Scotland. This conference continues the tradition of the previous meetings which started in 1999 and which aimed at an informal exchange across field boundaries. The previous meetings and the earlier proceedings proved to be very stimulating not only for young researchers but also for experienced scientists, and we are convinced that this fourth volume will be as successful as the previous ones. As before, this volume includes only extended review-type papers which are written in a way that they are understandable to a broad interdisciplinary audience. All papers published in this volume of Journal of Physics: Conference Series have been peer reviewed through processes administrated by the Editors assuring highest scientific standards. In the review process some papers were substantially revised and improved and some were rejected. This conference would not have been possible without the remarkable work of the local organizing team around John Barker and Scott Roy and the generous financial support from the University of Glasgow and the Deutsche Forschungsgemeinschaft via SFB-Transregio 24. Michael Bonitz and Karsten Balzer Kiel, February 2010 1 The first two volumes are Progress in Nonequilibrium Green's functions, M Bonitz (ed) and Progress in Nonequilibrium Green's functions II, M Bonitz and D Semkat (eds), which were published by World Scientific (Singapore), in 2000 and 2003, respectively (ISBN

  14. Hospitalizations for pediatric anaphylaxis.

    PubMed

    Calvani, M; Di Lallo, D; Polo, A; Spinelli, A; Zappalà, D; Zicari, A M

    2008-01-01

    The aim of the study is to examine the epidemiology of anaphylaxis in hospitalized children in Lazio (Central Italy) and to evaluate the incidence and case fatality rate. We also verified the concordance of diagnosis between the Emergency Department and Ordinary hospitalizations. In order to obtain these results, we reviewed all ICD-9 codes indicative of anaphylaxis in all primary and secondary diagnoses from 2000 to 2003 in all Emergency Departments, Ordinary Hospitalizations and Day Hospitals in Lazio. We then identified 203 ICD-9 diagnoses of anaphylaxis in children aged between 0 and 17 years. Anaphylactic shock (995.0) accounted for 109 (53.7%) of cases. Food anaphylaxis (995.60 onwards) accounted for 87 (43.0%) of cases. Food anaphylaxis was more frequent in the first years of life. In fact, it decreased from 12.5/100,000 resident children/year in the first year of life to 6.1/100,000 resident children/year in the first two years of life, and less than 3/100,000 resident children/year after the seventh year (p <0.001). Only 12.5% of cases of anaphylaxis diagnosed in Ordinary Hospitalizations were subsequently diagnosed by the Emergency Department as anaphylaxis. Moreover, only 42.3% of the diagnoses of anaphylaxis made in the Emergency Department were later confirmed during ordinary hospitalization. In the four years of study, one child died from anaphylaxis. Thus, mortality was 0.038 cases/100,000 resident children/year. In conclusion, the incidence of hospitalization was highest in the first years of life, during which food anaphylaxis accounted for most hospitalizations. The inconsistency of diagnoses between Emergency Departments and Ordinary Hospitalizations suggests the need to increase awareness of anaphylaxis among health workers.

  15. Dissimilatory Fe(III) and Mn(IV) reduction.

    PubMed Central

    Lovley, D R

    1991-01-01

    The oxidation of organic matter coupled to the reduction of Fe(III) or Mn(IV) is one of the most important biogeochemical reactions in aquatic sediments, soils, and groundwater. This process, which may have been the first globally significant mechanism for the oxidation of organic matter to carbon dioxide, plays an important role in the oxidation of natural and contaminant organic compounds in a variety of environments and contributes to other phenomena of widespread significance such as the release of metals and nutrients into water supplies, the magnetization of sediments, and the corrosion of metal. Until recently, much of the Fe(III) and Mn(IV) reduction in sedimentary environments was considered to be the result of nonenzymatic processes. However, microorganisms which can effectively couple the oxidation of organic compounds to the reduction of Fe(III) or Mn(IV) have recently been discovered. With Fe(III) or Mn(IV) as the sole electron acceptor, these organisms can completely oxidize fatty acids, hydrogen, or a variety of monoaromatic compounds. This metabolism provides energy to support growth. Sugars and amino acids can be completely oxidized by the cooperative activity of fermentative microorganisms and hydrogen- and fatty-acid-oxidizing Fe(III) and Mn(IV) reducers. This provides a microbial mechanism for the oxidation of the complex assemblage of sedimentary organic matter in Fe(III)- or Mn(IV)-reducing environments. The available evidence indicates that this enzymatic reduction of Fe(III) or Mn(IV) accounts for most of the oxidation of organic matter coupled to reduction of Fe(III) and Mn(IV) in sedimentary environments. Little is known about the diversity and ecology of the microorganisms responsible for Fe(III) and Mn(IV) reduction, and only preliminary studies have been conducted on the physiology and biochemistry of this process. PMID:1886521

  16. Molecular Characterization of Methicillin Resistant Staphylococcus aureus Strains Isolated from Intensive Care Units in Iran: ST22-SCCmec IV/t790 Emerges as the Major Clone.

    PubMed

    Goudarzi, Mehdi; Goudarzi, Hossein; Sá Figueiredo, Agnes Marie; Udo, Edet E; Fazeli, Maryam; Asadzadeh, Mohammad; Seyedjavadi, Sima Sadat

    2016-01-01

    The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in different patient populations is a major public health concern. This study determined the prevalence and distribution of circulating molecular types of MRSA in hospitalized patients in ICU of hospitals in Tehran. A total of 70 MRSA isolates were collected from patients in eight hospitals. Antimicrobial resistance patterns were determined using the disk diffusion method. The presence of toxin encoding genes and the vancomycin resistance gene were determined by PCR. The MRSA isolates were further analyzed using multi-locus sequence, spa, SCCmec, and agr typing. The MRSA prevalence was 93.3%. Antimicrobial susceptibility testing revealed a high resistance rate (97.1%) to ampicillin and penicillin. The rate of resistance to the majority of antibiotics tested was 30% to 71.4%. Two isolates belonging to the ST22-SCCmec IV/t790 clone (MIC ≥ 8 μg/ml) had intermediate resistance to vancomycin. The majority of MRSA isolates (24.3%) were associated with the ST22-SCCmec IV/t790 clone; the other MRSA clones were ST859-SCCmec IV/t969 (18.6%), ST239-SCCmec III/t037 (17.1%), and ST291-SCCmec IV/t030 (8.6%). The circulating MRSA strains in Iranian hospitals were genetically diverse with a relatively high prevalence of the ST22-SCCmec IV/t790 clone. These findings support the need for future surveillance studies on MRSA to better elucidate the distribution of existing MRSA clones and detect emergence of new MRSA clones.

  17. Molecular Characterization of Methicillin Resistant Staphylococcus aureus Strains Isolated from Intensive Care Units in Iran: ST22-SCCmec IV/t790 Emerges as the Major Clone

    PubMed Central

    Goudarzi, Mehdi; Goudarzi, Hossein; Sá Figueiredo, Agnes Marie; Udo, Edet E.; Fazeli, Maryam; Asadzadeh, Mohammad; Seyedjavadi, Sima Sadat

    2016-01-01

    Introduction The emergence of methicillin-resistant Staphylococcus aureus (MRSA) in different patient populations is a major public health concern. This study determined the prevalence and distribution of circulating molecular types of MRSA in hospitalized patients in ICU of hospitals in Tehran. Materials and Methods A total of 70 MRSA isolates were collected from patients in eight hospitals. Antimicrobial resistance patterns were determined using the disk diffusion method. The presence of toxin encoding genes and the vancomycin resistance gene were determined by PCR. The MRSA isolates were further analyzed using multi-locus sequence, spa, SCCmec, and agr typing. Results The MRSA prevalence was 93.3%. Antimicrobial susceptibility testing revealed a high resistance rate (97.1%) to ampicillin and penicillin. The rate of resistance to the majority of antibiotics tested was 30% to 71.4%. Two isolates belonging to the ST22-SCCmec IV/t790 clone (MIC ≥ 8 μg/ml) had intermediate resistance to vancomycin. The majority of MRSA isolates (24.3%) were associated with the ST22-SCCmec IV/t790 clone; the other MRSA clones were ST859-SCCmec IV/t969 (18.6%), ST239-SCCmec III/t037 (17.1%), and ST291-SCCmec IV/t030 (8.6%). Conclusions The circulating MRSA strains in Iranian hospitals were genetically diverse with a relatively high prevalence of the ST22-SCCmec IV/t790 clone. These findings support the need for future surveillance studies on MRSA to better elucidate the distribution of existing MRSA clones and detect emergence of new MRSA clones. PMID:27171373

  18. Predicting hospital accounting costs

    PubMed Central

    Newhouse, Joseph P.; Cretin, Shan; Witsberger, Christina J.

    1989-01-01

    Two alternative methods to Medicare Cost Reports that provide information about hospital costs more promptly but less accurately are investigated. Both employ utilization data from current-year bills. The first attaches costs to utilization data using cost-charge ratios from the previous year's cost report; the second uses charges from current year's bills. The first method is the more accurate of the two, but even using it, only 40 percent of hospitals had predicted costs within plus or minus 5 percent of actual costs. The feasibility and cost of obtaining cost reports from a small, fast-track sample of hospitals should be investigated. PMID:10313352

  19. Hospital service recovery.

    PubMed

    Gutbezahl, Cary; Haan, Perry

    2006-01-01

    An organization's ability to correct service errors is an important factor in achieving success in today's service economy. This paper examines service recovery in hospitals in the U.S. First is a general review of service recovery theories. Next is a discussion of specific service issues related to the hospital environment. The literature on service recovery is used to make specific recommendations to hospitals for ways to improve their ability to remedy service errors when they occur. Suggestions for future research in the field of service recovery are also made.

  20. Hospital capital funding.

    PubMed

    Hebert, M

    1992-01-01

    It is critical that hospitals have a long-range plan in place to ensure that buildings and equipment are replaced when necessary. A study undertaken in British Columbia contrasted the Greater Vancouver Regional Hospital District's capital plan (past and future) to a proposed capital replacement model. The model, developed using accepted industry standards and criteria, provided an asset value that was used for comparison purposes. Building and equipment expenditures of the Surrey Memorial Hospital were also compared against the model. Findings from both studies are presented in this article.

  1. Spectrophotometric determination of uranium(IV) with Arsenazo III

    SciTech Connect

    Baumann, E.W.

    1980-07-01

    A spectrophotometric procedure was developed for determining U(IV) in the presence of U(VI) by forming a colored complex with Arsenazo III in 4M HCl. The results compare satisfactorily with U(IV) determinations by ceric titration. Total uranium can be determined after reduction of U(VI) with metallic zinc. The concentration range for the absorbance cell solution is 0 to 2 ..mu..g U(IV)/mL. Other tetravalent ions, such as thorium, zirconium, hafnium, plutonium, and neptunium, will interfere.

  2. Understanding Humic Acid / Zr(IV) Interaction - A Spectromicroscopy Approach

    SciTech Connect

    Rothe, Joerg; Plaschke, Markus; Denecke, Melissa A.

    2007-02-02

    Complexation of Zr(IV) by humic acid (HA) and polyacrylic acid (PAA) is investigated from the point of view of the organic ligand. STXM Spectromicroscopy and C 1s-NEXAFS point to different interaction mechanisms between Zr(IV) cations and oxo/hydroxo colloids and PAA. Under conditions where the metal aquo ion is stable, strong complexes are formed. In contrast, unspecific surface coating is identified when PAA is contacted with Zr(IV) oxo/hydroxide colloids. HA exhibits similar C 1s-NEXAFS features indicating a complexation reaction.

  3. 17 CFR Table IV to Subpart E of... - Civil Monetary Penalty Inflation Adjustments

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Inflation Adjustments IV Table IV to Subpart E of Part 201 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION RULES OF PRACTICE Adjustment of Civil Monetary Penalties Pt. 201, Subpt. E, Table IV Table IV to Subpart E of Part 201—Civil Monetary Penalty Inflation Adjustments Table IV to Subpart E U.S...

  4. Role of the Hospital Library Within the Hospital System *†

    PubMed Central

    Lorenzi, Nancy M.

    1969-01-01

    The results of a survey of hospital administrators, attending staff and house staff physicians, librarians, library committee chairmen, and nursing staff in five Northeastern Ohio hospitals concerning the status of the hospital library within the total hospital system are related. Results indicate that hospital libraries operate in the “fringe” area of the hospital system. A concentric-circle figure indicates the present position of the majority of hospital libraries surveyed. The future relationship of the library within the hospital system has also been represented by a concentric-circle figure. PMID:5778727

  5. 78 FR 21491 - DeltaPoint Capital IV, L.P., DeltaPoint Capital IV (New York), L.P.; Notice Seeking Exemption...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... was contemplated for working capital and general corporate purposes. The financing is brought within... ADMINISTRATION DeltaPoint Capital IV, L.P., DeltaPoint Capital IV (New York), L.P.; Notice Seeking Exemption... that DeltaPoint Capital IV, L.P. and DeltaPoint Capital IV (New York), L.P., 45 East Avenue, 6th Floor...

  6. 78 FR 21491 - DeltaPoint Capital IV, L.P., DeltaPoint Capital IV (New York), L.P.; Notice Seeking Exemption...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... contemplated for working capital and general corporate purposes. The financing is brought within the purview of... ADMINISTRATION DeltaPoint Capital IV, L.P., DeltaPoint Capital IV (New York), L.P.; Notice Seeking Exemption... that DeltaPoint Capital IV, L.P. and DeltaPoint Capital IV (New York), L.P., 45 East Avenue, 6th Floor...

  7. Long-Term IQ Stability Using the WISC-IV and WAIS-IV among a Sample of Special Education Students

    ERIC Educational Resources Information Center

    Spector, Hayley

    2013-01-01

    The present study investigated the stability of scores on the WISC-IV and WAIS-IV over an approximate six-year period. Previous research using older versions of the WISC and WAIS have suggested that these scales demonstrate strong stability of scores. Since research that has compared the stability of scores between the WISC-IV and the WAIS-IV is…

  8. Titration of vanadium(IV) with cerium(IV) sulphate, with ferroin as indicator, in aqueous acetone as facile reaction medium An analytical and mechanistic study.

    PubMed

    Sriramam, K; Sarma, B S; Sundar, B S; Sastry, N R

    1981-05-01

    A new procedure for the titration of vanadium(IV) with cerium(IV) sulphate, with ferroin as indicator, in aqueous acetone medium is reported. A differential determination of iron(II) and vanadium(IV) is also possible. A probable mechanism for the fast ferriin-vanadium(IV) reaction in acetone medium is given.

  9. Long-Term IQ Stability Using the WISC-IV and WAIS-IV among a Sample of Special Education Students

    ERIC Educational Resources Information Center

    Spector, Hayley

    2013-01-01

    The present study investigated the stability of scores on the WISC-IV and WAIS-IV over an approximate six-year period. Previous research using older versions of the WISC and WAIS have suggested that these scales demonstrate strong stability of scores. Since research that has compared the stability of scores between the WISC-IV and the WAIS-IV is…

  10. Hospital free cash flow.

    PubMed

    Kauer, R T; Silvers, J B

    1991-01-01

    Hospital managers may find it difficult to admit their investments have been suboptimal, but such investments often lead to poor returns and less future cash. Inappropriate use of free cash flow produces large transaction costs of exit. The relative efficiency of investor-owned and tax-exempt hospitals in the product market for hospital services is examined as the free cash flow theory is used to explore capital-market conditions of hospitals. Hypotheses concerning the current competitive conditions in the industry are set forth, and the implications of free cash flow for risk, capital-market efficiency, and the cost of capital to tax-exempt institution is compared to capital-market norms.

  11. American Hospital Association

    MedlinePlus

    ... Educational Trust HRET Main page HRET Hospital Improvement Innovation Network Equity of Care Huddle for Care The Symposium for Leaders in Healthcare Quality SLHQ Main page Research & Trends Research & Trends AHA Policy Research Reports Chartbook Financial ...

  12. General Practitioners in Hospital

    PubMed Central

    Smith, J. Weston; O'Donovan, J. B.

    1970-01-01

    An acute general hospital of 68 beds at Tamworth, a Midland town of 50,000 people, is staffed by general practitioners for both inpatient and casualty work. During the period 1967-8 there were 889 general practitioner admissions to the hospital for intermediate surgical and medical care, the average length of stay being 6·3 days and the average cost per case £44·3. Of these patients 96 were transferred to other hospitals. The patients, doctors, and standard of medical care have benefited from this kind of service. A “satellite” hospital of this type therefore has an important role in the community for carefully selected types of cases. PMID:5429111

  13. Home versus hospital confinement

    PubMed Central

    Barry, C. N.

    1980-01-01

    The case for hospital rather than home delivery has been powerfully argued, especially in and since the Report of the Peel Committee. Nevertheless, evidence of comparison with other countries, notably the Netherlands, suggests the choice is not necessarily simple. Some general practitioner units are now reporting perinatal mortality rates which are consistently lower than those of specialist units, and recent statistical analyses suggest that the presence of more high risk cases in consultant units does not explain this. The only big controlled home-versus-hospital trial did not lead to a significantly lower perinatal mortality rate in the hospital group. The onus of proof now seems to lie with those who advocate 100 per cent hospital confinement. PMID:7373581

  14. Objections to hospital philosophers.

    PubMed Central

    Ruddick, W; Finn, W

    1985-01-01

    Like morally sensitive hospital staff, philosophers resist routine simplification of morally complex cases. Like hospital clergy, they favour reflective and principled decision-making. Like hospital lawyers, they refine and extend the language we use to formulate and defend our complex decisions. But hospital philosophers are not redundant: they have a wider range of principles and categories and a sharper eye for self-serving presuppositions and implicit contradictions within our practices. As semi-outsiders, they are often best able to take an 'external point of view,' unburdened by routine, details, and departmental loyalties. Their clarifications can temporarily disrupt routine, but can eventually improve staff morale, hence team practice and patient welfare. PMID:3981573

  15. Hospital-acquired thrombocytopenia.

    PubMed

    McMahon, Christine M; Cuker, Adam

    2014-10-01

    The development of thrombocytopenia is common in hospitalized patients and is associated with increased mortality. Frequent and important causes of thrombocytopenia in hospitalized patients include etiologies related to the underlying illness for which the patient is admitted, such as infection and disseminated intravascular coagulation, and iatrogenic etiologies such as drug-induced immune thrombocytopenia, heparin-induced thrombocytopenia, posttransfusion purpura, hemodilution, major surgery, and extracorporeal circuitry. This review presents a brief discussion of the pathophysiology, distinguishing clinical features, and management of these etiologies, and provides a diagnostic approach to hospital-acquired thrombocytopenia that considers the timing and severity of the platelet count fall, the presence of hemorrhage or thrombosis, the clinical context, and the peripheral blood smear. This approach may offer guidance to clinicians in distinguishing among the various causes of hospital-acquired thrombocytopenia and providing management appropriate to the etiology.

  16. Practice Hospital Bed Safety

    MedlinePlus

    ... 1, 1985 and January 1, 2013, FDA received reports of 901 incidents of patients caught, trapped, entangled, or strangled in ... Use Todd says there have been very few reports of safety incidents with hospital beds used in private residences. "This ...

  17. Crystal structure of ammonium octacyanomolybdate(IV) and rubidium octacyanomolybdate(IV)

    SciTech Connect

    Semenishin, D.I.; Glovyak, T.; Mys'kiv, M.G.

    1985-11-01

    The crystal structure of ammonium octacyanomolybdate(IV) and rubidium octacyanomolybdate(IV) has been determined by the single-crystal method on a Syntex P2/sub 1/ automatic diffractometer: ((NH/sub 4/)/sub 4/ Mo(CN)/sub 4/) 0.5H/sub 2/O (I) (space group Pma2, a = 15.550(3), b = 14.118(3), c = 7.438(1) A, Z = 4, R = 0.062) and Rb/sub 4/(Mo(CN)/sub 8/). 3H/sub 2/O (II) (space group P4/sub 1/2/sub 1/2, a = 9.300(10, c = 21.807(3) A, Z = 4, R = 0.065). The Mo atoms in structure I occupy two special positions (2(b) and 2(c)) and are each surrounded by eight CN ligands. The mean value of the Mo-C distances for Mo(1) is equal to 2.216 A, and the corresponding value for Mo(2) is 2.235 A. The mean Mo-N lengths are practically identical in both molybdenum anions and are equal to 3.353 A. The mean values of the C identical with N bond lengths in the Mo(1) and Mo(2) anions are 1.118 and 1.137 A, respectively. The MoCn angles vary from 175.0 to 178.4/sup 0/. The coordination sphere of the Mo(1) atom corresponds to a dodecahedron with a single twofold symmetry axis, and the coordination polyhedron of the Mo(2) atom in an antiprism of m symmetry. In structure II the Mo-C distances are within the 2.130-2.160-A range, and the Mo-N distances range from 3.290 to 3.307 A. The MoCN angles vary from 176.0 to 179.3/sup 0/, and the coordination polyhedron of (MoC/sub 8/) is a dodecahedron of 2 symmetry. The existence of two types of coordination of Mo in structure I is presently the only example among the structurally studied octahyanomolybdates(IV).

  18. Fast tracking hospital construction.

    PubMed

    Quirk, Andrew

    2013-03-01

    Hospital leaders should consider four factors in determining whether to fast track a hospital construction project: Expectations of project length, quality, and cost. Whether decisions can be made quickly as issues arise. Their own time commitment to the project, as well as that of architects, engineers, construction managers, and others. The extent to which they are willing to share with the design and construction teams how and why decisions are being made.

  19. Managing diversity in hospitals.

    PubMed

    Schwartz, R H; Sullivan, D B

    1993-01-01

    Hospital work force diversity, although potentially a source of creativity and improved problem solving, is often a source of political strife and the mistreatment of people based on their identification with one or another of the diverse groups that are employed in hospitals. Factors linked to these phenomena are discussed and are the basis for suggestions about how administrators can deal with the organizational pathologies that are often associated with unmanaged work force diversity.

  20. [Hospital organizational structure].

    PubMed

    Bittar, O J

    1994-01-01

    The basic point for an Institution to work is the existence of a definite organizational structure that puts together similar areas allowing decisions and the operationalization of different tasks. Knowledge and analysis of structures of private and public hospitals and a bibliography review about the issue is the purpose of this paper. Suggestions are given about the elaboration of small structures and the utilization of matrix management in order to accomplish the hospitals objectives.

  1. Salaries in psychiatric hospitals.

    PubMed

    Pope, D W

    1989-01-01

    The National Association of Private Psychiatric Hospitals has been surveying hospitals for the past several years. This paper focuses on the salary levels and average annual rates of increase for a few selected positions. Comparisons are made with data from surveys covering similar positions in other settings and with the Consumer Price Index. Annual rates of increase are reported for five- and ten-year periods.

  2. Preventing falls in hospital.

    PubMed

    Pearce, Lynne

    2017-02-27

    Essential facts Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 a day, according to the Royal College of Physicians (RCP). But research shows that when nurses, doctors and therapists work together, falls can be reduced by 20-30%.

  3. Recurrent psychiatric hospitalization.

    PubMed Central

    Voineskos, G.; Denault, S.

    1978-01-01

    Undue emphasis has been placed on rising rates of readmission to psychiatric facilities. After a decade of preoccupation with discharge rates, readmission statistics have been singled out in the last 15 years as the key factor for assessing hospital effectiveness. A study of a group of patients at high risk for recurrent hospitalization revealed that these patients were characterized more by features relating to environmental supports than by diagnosis. The operational definition for recurrent hospitalization (five or more admissions during the 2-year period preceding the latest admission) was effective in identifying this group; this is the first reported instance in which the definition has specified a certain number of admissions within a time-limited period. The findings of this study, as well as of an analysis of case histories and consumer opinion, led to the design of a pilot program for persons undergoing recurrent hospitalization. Readmission statistics are useless or misleading as measures of hospital effectiveness and efficiency; what matters is the way the former patients function in the community after discharge. Rather than simply trying to reduce the readmission rate psychiatric facilities should be examining the types of persons who are hospitalized recurrently to develop programs aimed at improving the functioning of these people in the community. PMID:630483

  4. Neonatal presentation of lethal neuromuscular glycogen storage disease type IV.

    PubMed

    Escobar, L F; Wagner, S; Tucker, M; Wareham, J

    2012-10-01

    A total of 11 types of glycogen storage disorders have been recognized with variable clinical presentations. Type IV, also known as Andersen disease, represents a rare subtype that can induce severe clinical findings early in life. We report on a patient with early fetal onset of symptoms with severe neuromuscular findings at birth. The pregnancy was further complicated by polyhydramnios and depressed fetal movement. At birth severe hypotonia was noticed requiring active resuscitation and then mechanical ventilation. His lack of expected course for hypoxic ischemic encephalopathy prompted genetic testing, including a muscle biopsy, which confirmed the diagnosis of glycogen storage disease IV (GSD IV). Mutation analysis of the glycogen branching enzyme 1 gene demonstrated a previously unrecognized mutation. We review recent information on early presentation of GSD IV with particular interest in the presentation of the neonatal lethal neuromuscular form of this rare disorder.

  5. Two distinct variants of erythrocyte spectrin beta IV domain.

    PubMed

    Pothier, B; Alloisio, N; Morlé, L; Maréchal, J; Barthélemy, H; Ducluzeau, M T; Dorier, A; Delaunay, J

    1989-11-01

    We report two distinct variants affecting the beta IV domain of erythrocyte spectrin, designated spectrin Saint-Chamond and spectrin Tlemcen. They were discovered in a French family and an Algerian individual, respectively. They appeared clinically and morphologically asymptomatic in the heterozygous state. In two-dimensional maps of spectrin partial digests, both mutants were manifested by cathodic shifts (with no change of the molecular weights) of the peptides that cover the N-terminal region of spectrin beta IV domain. The relevance of the abnormal peptides to the beta IV domain was established by quantitative analysis and by Western blotting using anti-beta IV domain-specific antibodies. These two variants are thus far the most distal variants of spectrin to be defined on an unequivocal structural basis.

  6. Astronaut James van Hoften working with Syncom IV-3 satellite

    NASA Technical Reports Server (NTRS)

    1985-01-01

    Astronaut James D. van Hoften, dwarfed by the large Syncom IV-3 satellite, moves in for initial contact. Dr. van Hoften stands on a foot restraint/extension to the remote manipulator system (RMS) arm.

  7. RNA polymerase IV functions in paramutation in Zea mays.

    PubMed

    Erhard, Karl F; Stonaker, Jennifer L; Parkinson, Susan E; Lim, Jana P; Hale, Christopher J; Hollick, Jay B

    2009-02-27

    Plants have distinct RNA polymerase complexes (Pol IV and Pol V) with largely unknown roles in maintaining small RNA-associated gene silencing. Curiously, the eudicot Arabidopsis thaliana is not affected when either function is lost. By use of mutation selection and positional cloning, we showed that the largest subunit of the presumed maize Pol IV is involved in paramutation, an inherited epigenetic change facilitated by an interaction between two alleles, as well as normal maize development. Bioinformatics analyses and nuclear run-on transcription assays indicate that Pol IV does not engage in the efficient RNA synthesis typical of the three major eukaryotic DNA-dependent RNA polymerases. These results indicate that Pol IV employs abnormal RNA polymerase activities to achieve genome-wide silencing and that its absence affects both maize development and heritable epigenetic changes.

  8. Phase IV Land Disposal Restrictions Rule - Clarification of Effective Dates

    EPA Pesticide Factsheets

    Memo to clarify the effective dates for the major provisions of the Phase IV rule. It is supplemental to the final rule preamble at page 28556 (“Effective Dates”) and pages 28634-5 (“State Authority”).

  9. [Mucolipidoses type IV in a patient with mapuche ancestry].

    PubMed

    Hernández Ch, Marta; Méndez C, José Ignacio; Concha G, María José; Huete L, Isidro; González B, Sergio; Durán S, Gloria P

    2008-07-01

    We report a 7 year-old girl with mapuche ancestors, diagnosed as a cerebral palsy since infancy and on active rehabilitation. She acquired motor and cognitive skills at 3 years of age. At 5 years of age, a slow neurological deterioration started, associated to visual impairment. Optic atrophy was added to the typical neurological exam of ataxic cerebral palsy and the diagnosis was re-considered. Neuroimaging showed a slow and progressive atrophy of intracerebral structures and ultramicroscopy revealed intracytoplasmatic inclusions in conjunctiva and skin, compatible with mucolipidoses type IV (ML-IV). ML-IV must be included in the differential diagnosis of cerebral palsy associated with loss of acquired skills and progressive visual impairment. Electron microscopy of skin or conjunctiva is a useful diagnostic test. Suspicion of ML-IV must not be restricted to Ashkenazi Jewish population.

  10. Level III and IV Ecoregions of the Continental United States

    EPA Pesticide Factsheets

    Information and downloadable maps and datasets for Level III and IV ecoregions of the continental United States. Ecoregions are areas of general similarity in the type, quality, and quantity of environmental resources.

  11. Level III and IV Ecoregions by EPA Region

    EPA Pesticide Factsheets

    Information and downloadable maps and datasets for Level III and IV ecoregions, listed by EPA region. Ecoregions are areas of general similarity in the type, quality, and quantity of environmental resources.

  12. Genetics Home Reference: glycogen storage disease type IV

    MedlinePlus

    ... and can lead to joint stiffness (arthrogryposis) after birth. Infants with the fatal perinatal neuromuscular type of GSD IV have very low muscle tone (severe hypotonia) and muscle wasting (atrophy). ...

  13. GALLEX solar neutrino observations: results for GALLEX IV.

    NASA Astrophysics Data System (ADS)

    Hampel, W.; Handt, J.; Heusser, G.; Kiko, J.; Kirsten, T.; Laubenstein, M.; Pernicka, E.; Rau, W.; Wojcik, M.; Zakharov, Yu.; von Ammon, R.; Ebert, K. H.; Fritsch, T.; Heidt, D.; Henrich, E.; Stieglitz, L.; Weirich, F.; Balata, M.; Sann, M.; Hartmann, F. X.; Bellotti, E.; Cattadori, C.; Cremonesi, O.; Ferrari, N.; Fiorini, E.; Zanotti, L.; Altmann, M.; von Feilitzsch, F.; Mössbauer, R.; Wanninger, S.; Berthomieu, G.; Schatzman, E.; Carmi, I.; Dostrovsky, I.; Bacci, C.; Belli, P.; Bernabei, R.; D'Angelo, S.; Paoluzi, L.; Cribier, M.; Rich, J.; Spiro, M.; Tao, C.; Vignaud, D.; Boger, J.; Hahn, R. L.; Rowley, J. K.; Stoenner, R. W.; Weneser, J.

    1999-02-01

    The authors report the GALLEX solar neutrino results for the measuring period GALLEX IV, from 14 February 1996 until 23 January 1997. Counting for the GALLEX IV runs was completed on 19 June 1997. The GALLEX IV result from 12 solar runs is [118.4±17.8 (stat.)±6.6 (sys.)] SNU (1σ). The combined result for GALLEX I+II+III+IV, which comprises 65 solar runs, is 77.5±6.2(-4.7, +4.3)(1σ) SNU. The GALLEX experimental program to register solar neutrinos has now been completed. In April 1998, GALLEX was succeeded by a new project, the Gallium Neutrino Observatory (GNO), with newly defined motives and goals.

  14. Complexation of Plutonium (IV) with Fluoride at Variable Temperatures

    SciTech Connect

    Xia, Yuanxian; Rao, Linfeng; Friese, Judah I.; Moore, Dean A.; Bachelor, Paula P.

    2010-02-02

    The complexation of Pu(IV) with fluoride at elevated temperatures was studied by solvent extraction technique. A solution of NaBrO3 was used as holding oxidant to maintain the oxidation state of plutonium throughout the experiments. The distribution ratio of Pu(IV) between the organic and aqueous phases was found to decrease as the concentrations of fluoride were increased. Stability constants of the 1:1 and 1:2 Pu(IV)-F- complexes, dominant in the aqueous phase under the experimental conditions, were calculated from the effect of fluoride ions on the distribution ratio. The thermodynamic parameters, including enthalpy and entropy of complexation between Pu(IV) and fluoride at 25 degrees C - 55 degrees C were calculated from the stability constants at different temperatures by using the Van’t Hoff equation.

  15. Complexation of Plutonium (IV) With Sulfate At Variable Temperatures

    SciTech Connect

    Y. Xia; J.I. Friese; D.A> Moore; P.P. Bachelor; L. Rao

    2006-10-05

    The complexation of plutonium(IV) with sulfate at variable temperatures has been investigated by solvent extraction method. A NaBrO{sub 3} solution was used as holding oxidant to maintain the plutonium(IV) oxidation state throughout the experiments. The distribution ratio of Pu(IV) between the organic and aqueous phases was found to decrease as the concentrations of sulfate were increased. Stability constants of the 1:1 and 1:2 Pu(IV)-HSO{sub 4}{sup -} complexes, dominant in the aqueous phase, were calculated from the effect of [HSO{sub 4}{sup -}] on the distribution ratio. The enthalpy and entropy of complexation were calculated from the stability constants at different temperatures using the Van't Hoff equation.

  16. Significant errors and misdirection in class IV laser therapy study.

    PubMed

    Carroll, James D

    2014-04-01

    This Correspondence relates to the article by Ottaviani et al (Effect of Class IV Laser Therapy on Chemotherapy-Induced Oral Mucositis: A Clinical and Experimental Study. Am J Pathol 2013, 183:1747-1757.).

  17. Anticancer platinum (IV) prodrugs with novel modes of activity.

    PubMed

    Chin, Chee Fei; Wong, Daniel Yuan Qiang; Jothibasu, Ramasamy; Ang, Wee Han

    2011-01-01

    Over the past four decades, the search for improved platinum drugs based on the classical platinum (II)-diam(m)ine pharmacophore has yielded only a handful of successful candidates. New methodologies centred on platinum (IV) complexes, with better stability and expanded coordination spheres, offer the possibility of overcoming limitations inherent to platinum (II) drugs. In this review, novel strategies of targeting and killing cancer cells using platinum (IV) constructs are discussed. These approaches exploit the unique electrochemical characteristics and structural attributes of platinum (IV) complexes as a means of developing anticancer prodrugs that can target and selectively destroy cancer cells. Anticancer platinum (IV) prodrugs represent promising new strategies as targeted chemotherapeutic agents in the ongoing battle against cancer.

  18. 28. Photocopy of engineering drawing. CASTOR IV MODIFICATIONS LAUNCH COMPLEX ...

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

    28. Photocopy of engineering drawing. CASTOR IV MODIFICATIONS LAUNCH COMPLEX 17A: LEVEL 1A PLATFORMS-STRUCTURAL, 1973. - Cape Canaveral Air Station, Launch Complex 17, Facility 28416, East end of Lighthouse Road, Cape Canaveral, Brevard County, FL

  19. 29. Photocopy of engineering drawing. CASTOR IV MODIFICATIONS LAUNCH COMPLEX ...

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

    29. Photocopy of engineering drawing. CASTOR IV MODIFICATIONS LAUNCH COMPLEX 17A: LEVEL 17A PLATFORMS-STRUCTURAL, 1973. - Cape Canaveral Air Station, Launch Complex 17, Facility 28416, East end of Lighthouse Road, Cape Canaveral, Brevard County, FL

  20. History into Drama: The Perspective of "1 Henry IV."

    ERIC Educational Resources Information Center

    Champion, Larry S.

    1978-01-01

    Contrasts Shakespeare's "Henry V" and "Henry IV" series, in which human interaction becomes history, with plays such as "Julius Caesar," which focus on psychological analysis and the internalized protagonist. (MB)

  1. History into Drama: The Perspective of "1 Henry IV."

    ERIC Educational Resources Information Center

    Champion, Larry S.

    1978-01-01

    Contrasts Shakespeare's "Henry V" and "Henry IV" series, in which human interaction becomes history, with plays such as "Julius Caesar," which focus on psychological analysis and the internalized protagonist. (MB)

  2. Report for 2012 from the Bordeaux IVS Analysis Center

    NASA Technical Reports Server (NTRS)

    Charlot, Patrick; Bellanger, Antoine; Bouffet, Romuald; Bourda, Geraldine; Collioud, Arnaud; Baudry, Alain

    2013-01-01

    This report summarizes the activities of the Bordeaux IVS Analysis Center during the year 2012. The work focused on (i) regular analysis of the IVS-R1 and IVS-R4 sessions with the GINS software package; (ii) systematic VLBI imaging of the RDV sessions and calculation of the corresponding source structure index and compactness values; (iii) investigation of the correlation between astrometric position instabilities and source structure variations; and (iv) continuation of our VLBI observational program to identify optically-bright radio sources suitable for the link with the future Gaia frame. Also of importance is the 11th European VLBI Network Symposium, which we organized last October in Bordeaux and which drew much attention from the European and International VLBI communities.

  3. Hospital Waste Management in Nonteaching Hospitals of Lucknow City, India

    PubMed Central

    Manar, Manish Kumar; Sahu, Krishna Kumar; Singh, Shivendra Kumar

    2014-01-01

    Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW) management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices. PMID:25657950

  4. Characteristics and influence factors of pathologic transformation in the subclasses of class IV lupus nephritis.

    PubMed

    Gao, Jian-jun; Cai, Guang-yan; Liu, Shu-wen; Tang, Li; Zhang, Xue-guang; Yang, Yang; Chen, Pu; Liu, Shu-xin; Ji, Jia-yao; Shi, Suo-zhu; Yin, Zhong; Chen, Xiang-mei

    2012-06-01

    The study explored the characteristics and correlation factors of transformation in subclasses of class IV lupus nephritis. Patients with class IV lupus nephritis were subjected to repeat biopsies after 6 months of induction treatment. Transformation rate between two subclasses, class IV-S and class IV-G, was compared. Influence Factors of transformation were evaluated. Class IV-G had more severe hypertension and higher score of immunofluorescence index, glomerular active lesions, tubular and vascular lesions. Class IV-S had a higher percentage of glomerular fibrinoid necrosis. Class IV-S appeared a higher rate of transformation to class II than class IV-G (57% vs. 27%). In each subclass, active lesion also showed a higher rate of transformation to class II than active/chronic lesion (IV-G: 41.2% vs. 12.5%; IV-S: 71.4% vs. 42.8%). Patients who maintained class IV had higher blood pressure, obvious proteinuria, declined kidney function, and lower C3 level. Immunosuppressive therapy, urine protein, and vascular lesions were independent risk factors for the pathologic transformation. The rate of transformation in class IV-S was higher than that in class IV-G. The transformation is most likely to benefit from immunosuppressive therapy. Urine protein and vascular lesions are correlated with the transformation in class IV lupus nephritis.

  5. Synthesis and Characterization of Cerium(IV) Metallocenes

    SciTech Connect

    Sutton, Andrew; Clark, David Lewis; Scott, Brian Lindley; Gordon, John Cameron

    2015-12-11

    In this study, by applying a salt metathesis approach between Ce(OtBu3)2(NO3)2(THF)2 and the potassium salts of mono- and ditrimethylsilyl substituted cyclopentadienes, we were able to isolate two new Ce(IV) metallocenes, including to the best of our knowledge, the first structurally characterized bis-cyclopentadiene Ce(IV) compound.

  6. Perfiles de luminosidad en galaxias con núcleo tipo Seyfert 1

    NASA Astrophysics Data System (ADS)

    Boris, N.; Rodriguez-Ardilla, A. A.; Pastoriza, M. G.

    Presentamos imágenes CCD en los filtros BVI y Hα de una muestra de 10 galaxias Seyfert 1 y Narrow Line Seyfert 1. Recientes observaciones muestran que hay una diferencia significante en el índice espectral óptico entre NLS1s y Sy1 normales, siendo para las primeras del orden de 2. Otra característica importante es que la mayor parte de las NLS1s muestran tasas de FeII/Hβ mayores que las observadas en otras Sy1s. Desde el punto de vista fotométrico, estas galaxias no tienenningún tipo de estudio previo. Presentamos magnitudes totales, perfiles de luminosidad y mapas de color junto con un detallado análisis de la formación estelar en estos objetos. Encontramos que la descomposición en bulbo + disco representa adecuadamente los perfiles de luminosidad de las galaxias de la muestra. Sin embargo, en todos los casos es necesario que el disco tenga un agujero en su centro. El radio de este agujero va desde los 3 a los 9 kpc. Si bien no tenemos aún una explicación para este hecho, los agujeros parecen estar asociados a anillos circumnucleares de alto oscurecimiento E(B-V) ~1. Los perfiles presentan también un fuerte gradiente de color, siendo notablemente más azules hacia la región nuclear. Los objetos de la muestra cubren todo el rango de tipos morfológicos, no obstante, no encontramos regiones de formación estelar en las regiones exteriores de las galaxias. La formación estelar está confinada a la región nuclear y se data en alrededor de 5 x 107 años.

  7. Evolution of iv iron compounds over the last century.

    PubMed

    Macdougall, Iain C

    2009-12-01

    Administration of intravenous (IV) iron has become pivotal in the management of anaemia in patients with chronic kidney disease (CKD). Since parenteral iron was first introduced for human use in the 1930s, things have come a long way. Seventy years ago, iron was toxic, administered as an iron oxyhydroxide complex. This problem was circumvented with the introduction of compounds containing iron in a core surrounded by a carbohydrate shell. The carbohydrate shell consists of molecules such as dextran, sucrose, dextrin or gluconate. The first dextran-containing IV iron preparations carried a small risk of anaphylaxis, but the more recently introduced low molecular weight iron dextran preparation has significantly less risk of this. Iron reactions occur with all IV iron preparations, but are generally not thought to be immune based. Recently, newer IV iron preparations have appeared in the market, including Ferumoxytol (Feraheme) and ferric carboxymaltose (Ferinject). These latest IV iron preparations do not contain a requirement for a test dose, and a much higher dose of iron can be delivered as a single administration. Thus, giving supplemental iron to man has come a long way since 1930s; we are now in an era when we are able to administer higher doses of iron with acceptable safety and without significant adverse effects. However, the long-term safety of the newer IV iron preparations is not yet established.

  8. Psychological variables and Wechsler Adult Intelligence Scale-IV performance.

    PubMed

    Gass, Carlton S; Gutierrez, Laura

    2016-06-07

    The MMPI-2 and WAIS-IV are commonly used together in neuropsychological evaluations yet little is known about their interrelationships. This study explored the potential influence of psychological factors on WAIS-IV performance in a sample of 180 predominantly male veteran referrals that underwent a comprehensive neuropsychological examination in a VA Medical Center. Exclusionary criteria included failed performance validity testing and self-report distortion on the MMPI-2. A Principal Components Analysis was performed on the 15 MMPI-2 content scales, yielding three broader higher-order psychological dimensions: Internalized Emotional Dysfunction (IED), Externalized Emotional Dysfunction (EED), and Fear. Level of IED was not related to performance on the WAIS-IV Full Scale IQ or its four indexes: (Verbal Comprehension, Perceptual Reasoning, Working Memory, and Processing Speed). EED was not related to WAIS-IV performance. Level of Fear, which encompasses health preoccupations (HEA) and distorted perceptions (BIZ), was significantly related to WAIS-IV Full Scale IQ and Verbal Comprehension. These results challenge the common use of high scores on the MMPI-2 IED measures (chiefly depression and anxiety) to explain deficient WAIS-IV performance. In addition, they provide impetus for further investigation of the relation between verbal intelligence and Fear.

  9. Assembling filamentous phage occlude pIV channels.

    PubMed

    Marciano, D K; Russel, M; Simon, S M

    2001-07-31

    Filamentous phage f1 is exported from its Escherichia coli host without killing the bacterial cell. Phage-encoded protein pIV, which is required for phage assembly and secretion, forms large highly conductive channels in the outer membrane of E. coli. It has been proposed that the phage are extruded across the bacterial outer membrane through pIV channels. To test this prediction, we developed an in vivo assay by using a mutant pIV that functions in phage export but whose channel opens in the absence of phage extrusion. In E. coli lacking its native maltooligosacharride transporter LamB, this pIV variant allowed oligosaccharide transport across the outer membrane. This entry of oligosaccharide was decreased by phage production and still further decreased by production of phage that cannot be released from the cell surface. Thus, exiting phage block the pIV-dependent entry of oligosaccharide, suggesting that phage occupy the lumen of pIV channels. This study provides the first evidence, to our knowledge, for viral exit through a large aqueous channel.

  10. Oxidation Resistance of Monolayer Group-IV Monochalcogenides.

    PubMed

    Guo, Yu; Zhou, Si; Bai, Yizhen; Zhao, Jijun

    2017-03-21

    Ridged, orthorhombic two-dimensional (2D) group-V elemental and group IV-VI compound analogues of phosphorene provide a versatile platform for nanoelectronics, optoelectronics, and clean energy. However, phosphorene is vulnerable to oxygen in ambient air, which is a major obstacle for its applications. Regarding this issue, here we explore the oxidation behavior of monolayer group-IV monochalcogenides (GeS, GeSe, SnS, and SnSe), in comparison to that of phosphorene and arsenene by first-principles calculations. We find superior oxidation resistance of the monolayer group-IV monochalcogenides, with activation energies for the chemisorption of O2 on the 2D sheets in the range of 1.26-1.60 eV, about twice of the values of phosphorene and arsenene. The distinct oxidation behaviors of monolayer group-IV monochalcogenides and group-V phosphorene analogues originate from their different bond natures. Moreover, the chemisorption of a moderate amount of oxygen atoms does not severely deteriorate the electronic band structures of the monolayer group-IV monochalcogenides. These results shine light on the utilization of the monolayer group-IV monochalcogenides for next-generation 2D electronics and optoelectronics with high performance and stability.

  11. Degradation of type IV collagen by neoplastic human skin fibroblasts

    SciTech Connect

    Sheela, S.; Barrett, J.C.

    1985-02-01

    An assay for the degradation of type IV (basement membrane) collagen was developed as a biochemical marker for neoplastic cells from chemically transformed human skin fibroblasts. Type IV collagen was isolated from basement membrane of Syrian hamster lung and type I collagen was isolated from rat tails; the collagens were radioactively labelled by reductive alkylation. The abilities of normal (KD) and chemically transformed (Hut-11A) human skin fibroblasts to degrade the collagens were studied. A cell-associated assay was performed by growing either normal or transformed cells in the presence of radioactively labelled type IV collagen and measuring the released soluble peptides in the medium. This assay also demonstrated that KD cells failed to synthesize an activity capable of degrading type IV collagen whereas Hut-11A cells degraded type IV collagen in a linear manner for up to 4 h. Human serum at very low concentrations, EDTA and L-cysteine inhibited the enzyme activity, whereas protease inhibitors like phenylmethyl sulfonyl fluoride, N-ethyl maleimide or soybean trypsin inhibitor did not inhibit the enzyme from Hut-11A cells. These results suggest that the ability to degrade specifically type IV collagen may be an important marker for neoplastic human fibroblasts and supports a role for this collagenase in tumor cell invasion.

  12. 77 FR 16508 - National Emission Standards for Hazardous Air Pollutant Emissions: Group IV Polymers and Resins...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-21

    ...: Group IV Polymers and Resins; Pesticide Active Ingredient Production; and Polyether Polyols Production... pollutants: National Emission Standards for Hazardous Air Pollutant Emissions: Group IV Polymers and Resins...: Group IV Polymers and Resins; Pesticide Active Ingredient Production; and Polyether Polyols...

  13. Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids

    PubMed Central

    Jeong, Hyeonseok; Ryu, Kil O; Lim, Jiyong; Kim, Hyun Tae; Yu, Hye Mi; Yoon, Jihoon; Lee, Ju-Young; Kim, Hyoung Rae; Choi, Young Gil

    2017-01-01

    Purpose Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. Methods We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. Results Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. Conclusion PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids. PMID:28289661

  14. Effect of Hospital Ownership on Outcomes of Heart Failure Hospitalization.

    PubMed

    Akintoye, Emmanuel; Briasoulis, Alexandros; Egbe, Alexander; Orhurhu, Vwaire; Ibrahim, Walid; Kumar, Kartik; Alliu, Samson; Nas, Hala; Levine, Diane; Weinberger, Jarrett

    2017-09-01

    This study aimed to evaluate the impact of hospital ownership on heart failure (HF) hospitalization outcomes in the United States using data from the National Inpatient Sample of the Agency for Healthcare Research and Quality. Hospital ownership was classified into three, namely, nonfederal government, not-for-profit, and for-profit hospitals. Participants were adults hospitalized with a primary diagnosis of HF (2013 to 2014). End points included inpatient mortality, length-of-stay, cost and charge of hospitalization, and disposition at discharge. Of the estimated 1.9 million HF hospitalizations in the United States between 2013 and 2014, 73% were in not-for-profit hospitals, 15% were in for-profit hospitals, and 12% were in nonfederal government hospitals. Overall, mortality rate was 3%, mean length of stay was 5.3 days, median cost of hospitalization was USD 7,248, and median charge was USD 25,229, and among those who survived to hospital discharge, 51% had routine home discharge. There was no significant difference in inpatient mortality between hospital ownership among male patients, but there was a significant difference for female patients. Compared with government hospitals, mortality in female patients was lower in not-for-profit (odds ratio: 0.85 [95% confidence interval: 0.77 to 0.94]) and for-profit hospitals (odds ratio: 0.77 [0.68 to 0.87]). In addition, mean length of stay was highest in not-for-profit hospitals (5.4 days) and lowest in for-profit hospitals (5 days). Although cost of hospitalization was highest in not-for-profit hospitals (USD 7462) and lowest in for-profit hospitals (USD 6,290), total charge billed was highest in for-profit hospitals (USD 35,576) and lowest in government hospitals (USD 19,652). The average charge-to-cost ratio was 3:1 for government hospitals, 3.5:1 for not-for-profit hospitals, and 5.9:1 for for-profit hospitals. In conclusion, there exist significant disparities in HF hospitalization outcomes between hospital

  15. 3. Hospital Point, general view toward Portsmouth Naval Hospital Building ...

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

    3. Hospital Point, general view toward Portsmouth Naval Hospital Building showing cannon (at left) and Saunders Monument (at right in distance), view to southwest - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  16. Hospitals look to hospitality service firms to meet TQM goals.

    PubMed

    Hard, R

    1992-05-20

    Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

  17. PREFACE: IV Nanotechnology International Forum (RUSNANOTECH 2011)

    NASA Astrophysics Data System (ADS)

    Dvurechenskii, Anatoly; Alfimov, Mikhail; Suzdalev, Igor; Osiko, Vyacheslav; Khokhlov, Aleksey; Son, Eduard; Skryabin, Konstantin; Petrov, Rem; Deev, Sergey

    2012-02-01

    Logo The RUSNANOTECH 2011 International Forum on Nanotechnology was held from 26-28 October 2011, in Moscow, Russia. It was the fourth forum organized by RUSNANO (Russian Corporation of Nanotechnologies) since 2008. In March 2011 RUSNANO was established as an open joint-stock company through the reorganization of the state corporation Russian Corporation of Nanotechnologies. RUSNANO's mission is to develop the Russian nanotechnology industry through co-investment in nanotechnology projects with substantial economic potential or social benefit. Within the framework of the Forum Science and Technology Program, presentations on key trends of nanotechnology development were given by foreign and Russian scientists, R&D officers of leading international companies, universities and scientific centers. The science and technology program of the Forum was divided into four sections as follows (by following hyperlinks you may find each section's program including videos of all oral presentations): Nanoelectronics and Nanophotonics Nanomaterials Nanotechnology and Green Energy Nanotechnology in Healthcare and Pharma (United business and science & technology section on 'RUSNANOTECH 2011') The scientific program of the forum included more than 50 oral presentations by leading scientists from 15 countries. Among them were world-known specialists such as Professor S Bader (Argonne National Laboratory, USA), Professor O Farokzhad (Harvard Medical School, USA), Professor K Chien (Massachusetts General Hospital, USA), Professor L Liz-Marzan (University of Vigo), A Luque (Polytechnic University of Madrid) and many others. The poster session consisted of over 120 presentations, 90 of which were presented in the framework of the young scientists' nanotechnology papers competition. This volume of Journal of Physics: Conference Series includes a selection of 47 submissions. Section editors of the proceedings: Nanoelectronics and nanophotonics Corresponding Member of Russian Academy of

  18. Zirconium(IV) and Hafnium(IV) Porphyrin and Phthalocyanine Complexes as New Dyes for Solar Cell Devices

    PubMed Central

    Radivojevic, Ivana; Bazzan, Giorgio; Burton-Pye, Benjamin P.; Ithisuphalap, Kemakorn; Saleh, Raihan; Durstock, Michael F.; Francesconi, Lynn C.; Drain, Charles Michael

    2012-01-01

    Metalloporphyrin and metallophthalocyanine dyes ligating Hf(IV) and Zr(IV) ions bind to semiconductor oxide surfaces such as TiO2 via the protruding group IV metal ions. The use of oxophylic metal ions with large ionic radii that protrude from the macrocycle is a unique mode of attaching chromophores to oxide surfaces in the design of dye-sensitized solar cells (DSSCs). Our previous report on the structure and physical properties of ternary complexes wherein the Hf(IV) and Zr(IV) ions are ligated to both a porphyrinoid and to a defect site on a polyoxometalate (POM) represents a model for this new way of binding dyes to oxide surfaces. The Zr(IV) and Hf(IV) complexes of 5,10,15,20-tetraphenylporphyrin (TPP) with two ligated acetates, (TPP)Hf(OAc)2 and (TPP)Zr(OAc)2, and the corresponding metallophthalocyanine (Pc) diacetate complexes, (Pc)Hf(OAc)2 and (Pc)Zr(OAc)2, were evaluated as novel dyes for the fabrication of dye-sensitized solar cells. Similarly to the ternary complexes with the POM, the oxide surface replaces the acetates to affect binding. In DSSCs the Zr(IV) phthalocyanine dye performs better than the Zr(IV) porphyrin dye, and reaches an overall efficiency of ~ 1.0%. The Hf(IV) dyes are less efficient. The photophysical properties of these complexes in solution suggested energetically favorable injection of electrons into the conduction band of TiO2 semiconductor nanoparticles, as well as a good band gap match with I3−/I− pair in liquid 1-butyl-3-methyl imidazolium iodide. The combination of blue absorbing TPP with the red absorbing Pc complexes can increase the absorbance of solar light in the device; however, the overall conversion efficiency of DSSCs using TiO2 nanoparticles treated with a mixture of both Zr(IV) complexes is comparable, but not greater than, the single (Pc)Zr. Thus, surface bound (TPP)Zr increases the absorbance in blue region of the spectra, but at the cost of diminished absorbance in the red in this DSSC architecture. PMID

  19. Al III, Si IV, and C IV absorption toward zeta Ophiuchi: Evidence for photionized and collisionally ionized gas

    NASA Technical Reports Server (NTRS)

    Sembach, Kenneth R.; Savage, Blair D.; Jenkins, Edward B.

    1994-01-01

    We present Goddard High-Resolution Spectrograph observations at 3.5 km/s resolution and signal-to-noise ratios of 30 to 60 for the Al III, Si IV, and N V absorption lines in the far-ultraviolet spectrum of the O9.5 V star zeat Ophiuchi. The measurement reveal three types of highly ionized gas along the 140 pc line of sight. (1) Narrow components of Al III (b = 4.3 km/s, the mean value of (v(helio)) = -7.8 km/s; b = 3.2 km/s, the mean value of (v(sub helio)) = -14.4 km/s) and Si IV (b = 5.3 km/s, the mean value of (v(sub helio)) = -15.0 km/s) trace photionized gas in the expanding H II region surrounding zeta Oph. The observed magnitude and direction of the velocity offset between the Al III and Si IV profiles can be explained by models of H II regions that incorporate expansion. Narrow C IV absorption associated with the H II region is not detected. Predictions of the expected amounts of Si IV and C IV overestimate the column densities of these ions by factors of 30 and more than 10, respectively. The discrepancy may be due to the effects of elemental depletions in the gas and/or to the interaction of the stellar wind with surrounding matter. (2) Broad (b = 15 to 18 km/s) and weak Si IV and C IV absorption components are detected near the mean value of (v(sub helio)) = -26 km/s. The high-ionization species associated with these absorption components are probably produced by electron collisional ionization in a heated gas. This absorption may be physically related to the zeta Oph bow shock ot to a cloud complex situated within the local interstellar medium at d less than 60 pc. The C IV to Si IV column density ratio in this gas is 8, a factor of 6 less than conductive interface models predict, but this discrepancy may be removed by considering the effects of self-photoionization within the cooling gas in the model calculations. (3) A broad (b = 13 km/s) and weak C IV absorption feature detected at the mean value of (v(sub helio)) = -61 km/s is not seen in other

  20. The impact of hospital discharge on inappropriate hospital stay.

    PubMed

    Panis, Lambert J G G; Verheggen, Frank W S M; Pop, Peter; Prins, Martin H

    2004-01-01

    Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine-tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P-charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.

  1. Mitochondrial respiratory chain complex IV deficiency complicated with chronic intestinal pseudo-obstruction in a neonate.

    PubMed

    Hashimura, Yuya; Morioka, Ichiro; Hisamatsu, Chieko; Yokoyama, Naoki; Taniguchi-Ikeda, Mariko; Yokozaki, Hiroshi; Murayama, Kei; Ohtake, Akira; Itoh, Kyoko; Takeshima, Yasuhiro; Iijima, Kazumoto

    2016-07-01

    A female infant born at 36 weeks gestational age with birthweight 2135 g, and who developed respiratory disorder, hyperlactacidemia and hypertrophic cardiomyopathy after birth, was admitted to hospital at 3 days of age. After admission, bilious emesis, abdominal distention, and passage disorder of the gastrointestinal tract were resistant to various drugs. Exploratory laparotomy was performed at 93 days of age, but no organic lesions were identified and normal Meissner/Auerbach nerve plexus was confirmed, which led to a clinical diagnosis of chronic intestinal pseudo-obstruction (CIPO). She was diagnosed with mitochondrial respiratory chain complex IV deficiency on histopathology of the abdominal rectus muscle and enzyme activity measurement. This is the first report of a neonate with mitochondrial respiratory chain complex deficiency with intractable CIPO. CIPO can occur in neonates with mitochondrial respiratory chain disorder, necessitating differential diagnosis from Hirschsprung disease.

  2. Errors Associated with IV Infusions in Critical Care

    PubMed Central

    Summa-Sorgini, Claudia; Fernandes, Virginia; Lubchansky, Stephanie; Mehta, Sangeeta; Hallett, David; Bailie, Toni; Lapinsky, Stephen E; Burry, Lisa

    2012-01-01

    Background All medication errors are serious, but those associated with the IV route of administration often result in the most severe outcomes. According to the literature, IV medications are associated with 54% of potential adverse events, and 56% of medication errors. Objectives To determine the type and frequency of errors associated with prescribing, documenting, and administering IV infusions, and to also determine if a correlation exists between the incidence of errors and either the time of day (day versus night) or the day of the week (weekday versus weekend) in an academic medicosurgical intensive care unit without computerized order entry or documentation. Methods As part of a quality improvement initiative, a prospective, observational audit was conducted for all IV infusions administered to critically ill patients during 40 randomly selected shifts over a 7-month period in 2007. For each IV infusion, data were collected from 3 sources: direct observation of administration of the medication to the patient, the medication administration record, and the patient’s medical chart. The primary outcome was the occurrence of any infusion-related errors, defined as any errors of omission or commission in the context of IV medication therapy that harmed or could have harmed the patient. Results It was determined that up to 21 separate errors might occur in association with a single dose of an IV medication. In total, 1882 IV infusions were evaluated, and 5641 errors were identified. Omissions or discrepancies related to documentation accounted for 92.7% of all errors. The most common errors identified via each of the 3 data sources were incomplete labelling of IV tubing (1779 or 31.5% of all errors), omission of infusion diluent from the medication administration record (474 or 8.4% of all errors), and discrepancy between the medication order as recorded in the patient’s chart and the IV medication that was being infused (105 or 1.9% of all errors

  3. Pazopanib Hydrochloride in Treating Patients With Stage IV or Recurrent Nasopharyngeal Cancer

    ClinicalTrials.gov

    2015-11-16

    Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx

  4. Investigating the reasons of variability in Si IV and C IV broad absorption line troughs of quasars

    NASA Astrophysics Data System (ADS)

    Stathopoulos, Dimitrios; Lyratzi, Evangelia; Danezis, Emmanuel; Antoniou, Antonios; Tzimeas, Dimitrios

    2017-09-01

    In this paper we analyze the C IV and Si IV broad absorption troughs of two BALQSOs (J101056.69+355833.3, J114548.38+393746.6) to the individual components they consist of. By analyzing a BAL trough to its components we have the advantage to study the variations of the individual absorbing systems in the line of sight and not just the variations of the whole absorption trough or the variations of selected portions of BAL troughs exhibiting changes. We find that the velocity shifts and FWHMs (Full Width at Half Maximum) of the individual components do not vary between an interval of six years. All variable components show changes in the optical depths at line centers which are manifested as variations in the EW (Equivalent Width) of the components. In both BALQSOs, over corresponding velocities, Si IV has higher incidence of variability than C IV. From our analysis, evidence is in favour of different covering fractions between C IV and Si IV. Finally, although most of our results favour the crossing cloud scenario as the cause of variability, there is also strong piece of evidence indicating changing ionization as the source of variability. Thus, a mixed situation where both physical mechanisms contribute to BAL variability is the most possible scenario.

  5. Quercetin diacylglycoside analogues showing dual inhibition of DNA gyrase and topoisomerase IV as novel antibacterial agents.

    PubMed

    Hossion, Abugafar M L; Zamami, Yoshito; Kandahary, Rafiya K; Tsuchiya, Tomofusa; Ogawa, Wakano; Iwado, Akimasa; Sasaki, Kenji

    2011-06-09

    A structure-guided molecular design approach was used to optimize quercetin diacylglycoside analogues that inhibit bacterial DNA gyrase and topoisomerase IV and show potent antibacterial activity against a wide spectrum of relevant pathogens responsible for hospital- and community-acquired infections. In this paper, such novel 3,7-diacylquercetin, quercetin 6''-acylgalactoside, and quercetin 2'',6''-diacylgalactoside analogues of lead compound 1 were prepared to assess their target specificities and preferences in bacteria. The significant enzymatic inhibition of both Escherichia coli DNA gyrase and Staphylococcus aureus topoIV suggest that these compounds are dual inhibitors. Most of the investigated compounds exhibited pronounced inhibition with MIC values ranging from 0.13 to 128 μg/mL toward the growth of multidrug-resistant Gram-positive methicillin-resistant S. aureus, methicillin sensitive S. aureus, vancomycin-resistant enterococci (VRE), vancomycin intermediate S. aureus, and Streptococcus pneumoniae bacterial strains. Structure-activity relationship studies revealed that the acyl moiety was absolutely essential for activity against Gram-positive organisms. The most active compound 5i was 512-fold more potent than vancomycin and 16-32-fold more potent than 1 against VRE strains. It also has realistic in situ intestinal absorption in rats and showed very low acute toxicity in mice. So far, this compound can be regarded as a leading antibacterial agent.

  6. A 12-year survey of methicillin-resistant Staphylococcus aureus infections in Greece: ST80-IV epidemic?

    PubMed

    Drougka, E; Foka, A; Liakopoulos, A; Doudoulakakis, A; Jelastopulu, E; Chini, V; Spiliopoulou, A; Levidiotou, S; Panagea, T; Vogiatzi, A; Lebessi, E; Petinaki, E; Spiliopoulou, I

    2014-11-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of both healthcare-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) infections. Severe MRSA infections have been associated with the virulence factor Panton-Valentine leukocidin (PVL). The aim of this study was to investigate susceptibility patterns, the presence of toxin genes, including that encoding PVL, and clonality among MRSA isolates collected from patients in Greece over a 12-year period. MRSA isolates were collected from January 2001 to December 2012 from six different hospitals. Antibiotic susceptibility was determined with the disk diffusion method and the Etest. The presence of the toxic shock syndrome toxin-1 gene (tst), the enterotoxin gene cluster (egc) and the PVL gene was tested with PCR. The genotypic characteristics of the strains were analysed by SCCmec and agr typing, and clonality was determined with pulsed-field gel electrophoresis and multilocus sequence typing. An increasing rate of MRSA among S. aureus infections was detected up to 2008. The majority of PVL-positive MRSA isolates belonged to a single clone, sequence type (ST)80-IV, which was disseminated both in the community and in hospitals, especially during the warmest months of the year. Carriage of tst was associated with ST30-IV, whereas egc was distributed in different clones. CA-MRSA isolates were recovered mainly from skin and soft tissue infections, whereas HA-MRSA isolates were associated with surgical and wound infections. During the period 2001-2012, ST80-IV predominated in the community and infiltrated the hospital settings in Greece, successfully replacing other PVL-positive clones. The predominance of ST239-III in HA-MRSA infections was constant, whereas new clones have also emerged. Polyclonality was statistically significantly higher among CA-MRSA isolates and isolates from adult patients. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical

  7. Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

    PubMed

    Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

    2010-03-01

    The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

  8. Parkin promotes proteasomal degradation of synaptotagmin IV by accelerating polyubiquitination.

    PubMed

    Kabayama, Hiroyuki; Tokushige, Naoko; Takeuchi, Makoto; Kabayama, Miyuki; Fukuda, Mitsunori; Mikoshiba, Katsuhiko

    2017-04-01

    Parkin is an E3 ubiquitin ligase whose mutations cause autosomal recessive juvenile Parkinson's disease (PD). Unlike the human phenotype, parkin knockout (KO) mice show no apparent dopamine neuron degeneration, although they demonstrate reduced expression and activity of striatal mitochondrial proteins believed to be necessary for neuronal survival. Instead, parkin-KO mice show reduced striatal evoked dopamine release, abnormal synaptic plasticity, and non-motor symptoms, all of which appear to mimic the preclinical features of Parkinson's disease. Extensive studies have screened candidate synaptic proteins responsible for reduced evoked dopamine release, and synaptotagmin XI (Syt XI), an isoform of Syt family regulating membrane trafficking, has been identified as a substrate of parkin in humans. However, its expression level is unaltered in the striatum of parkin-KO mice. Thus, the target(s) of parkin and the molecular mechanisms underlying the impaired dopamine release in parkin-KO mice remain unknown. In this study, we focused on Syt IV because of its highly homology to Syt XI, and because they share an evolutionarily conserved lack of Ca(2+)-binding capacity; thus, Syt IV plays an inhibitory role in Ca(2+)-dependent neurotransmitter release in PC12 cells and neurons in various brain regions. We found that a proteasome inhibitor increased Syt IV protein, but not Syt XI protein, in neuron-like, differentiated PC12 cells, and that parkin interacted with and polyubiquitinated Syt IV, thereby accelerating its protein turnover. Parkin overexpression selectively degraded Syt IV protein, but not Syt I protein (indispensable for Ca(2+)-dependent exocytosis), thus enhancing depolarization-dependent exocytosis. Furthermore, in parkin-KO mice, the level of striatal Syt IV protein was increased. Our data indicate a crucial role for parkin in the proteasomal degradation of Syt IV, and provide a potential mechanism of parkin-regulated, evoked neurotransmitter release

  9. Intestinal apolipoprotein A-IV gene expression in the piglet.

    PubMed

    Black, D D; Rohwer-Nutter, P L; Davidson, N O

    1990-03-01

    Fetal, newborn, and suckling piglets were used to study the intestinal expression of the apoA-IV gene in the immature mammal. Swine apoA-IV (42 kD) was isolated from fat-fed piglet lipoprotein-deficient plasma by adsorption to Intralipid followed by preparative sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and electroelution. Rabbit anti-swine apoA-IV antibodies were raised, and apoA-IV was immunoprecipitated from small intestinal homogenates after in vivo radiolabeling with [3H]leucine. ApoA-IV synthesis was expressed as a percentage of total protein synthesis from trichloroacetic acid-precipitable counts. Fetal (40 day gestation) whole small intestine synthesis was 2.1%. Postnatally, 2-day-old newborn piglets given high triglyceride and low triglyceride duodenal infusions, as well as bile diversion, were studied. Synthesis rates in jejunal mucosa in all groups were comparable to the fetal whole intestinal value except in the jejunum of the high-triglyceride group, where synthesis was increased sevenfold. In 1- to 2-week-old fasting, cream-fed, and bile-diverted piglets synthesis was again unchanged except in the fat-fed jejunum, where synthesis doubled. Ileal synthesis rates in newborn and suckling animals were lower than jejunal rates and did not increase with lipid absorption or decrease with bile diversion. Northern blot hybridization of intestinal RNA samples from the newborn groups with an authentic cross-hybridizing human apoA-IV cDNA probe revealed a 1.8 kb signal which was strongest in the high-triglyceride jejunal samples. Slot blot hybridization showed eightfold increased apoA-IV mRNA levels in high-triglyceride jejunal samples as compared to low-triglyceride and bile-diverted jejunum with no differences in beta actin mRNA abundance.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. DNA gyrase, topoisomerase IV, and the 4-quinolones.

    PubMed Central

    Drlica, K; Zhao, X

    1997-01-01

    For many years, DNA gyrase was thought to be responsible both for unlinking replicated daughter chromosomes and for controlling negative superhelical tension in bacterial DNA. However, in 1990 a homolog of gyrase, topoisomerase IV, that had a potent decatenating activity was discovered. It is now clear that topoisomerase IV, rather than gyrase, is responsible for decatenation of interlinked chromosomes. Moreover, topoisomerase IV is a target of the 4-quinolones, antibacterial agents that had previously been thought to target only gyrase. The key event in quinolone action is reversible trapping of gyrase-DNA and topoisomerase IV-DNA complexes. Complex formation with gyrase is followed by a rapid, reversible inhibition of DNA synthesis, cessation of growth, and induction of the SOS response. At higher drug concentrations, cell death occurs as double-strand DNA breaks are released from trapped gyrase and/or topoisomerase IV complexes. Repair of quinolone-induced DNA damage occurs largely via recombination pathways. In many gram-negative bacteria, resistance to moderate levels of quinolone arises from mutation of the gyrase A protein and resistance to high levels of quinolone arises from mutation of a second gyrase and/or topoisomerase IV site. For some gram-positive bacteria, the situation is reversed: primary resistance occurs through changes in topoisomerase IV while gyrase changes give additional resistance. Gyrase is also trapped on DNA by lethal gene products of certain large, low-copy-number plasmids. Thus, quinolone-topoisomerase biology is providing a model for understanding aspects of host-parasite interactions and providing ways to investigate manipulation of the bacterial chromosome by topoisomerases. PMID:9293187

  11. [Marianne in hospital].

    PubMed

    Weium, Frode

    2003-12-23

    In 1948 Norwegian architect and author Odd Brochmann (1909-92) published his popular children's book Marianne in hospital (Marianne på sykehus). Two years later the book was filmed on the initiative of the Ministry of Social Affairs. This article considers the question of what were the purposes of the film. Officially, it was presented as an attempt to teach children not to be afraid of hospitals. However, in internal notes and letters the health authorities stressed that the film should be an educational film about the social benefits and health services of the welfare state. Furthermore, I will argue that the film was the result of a wish to present the nation's modern hospital care and, by way of conclusion, discuss the characterisation of the film as educational.

  12. [Stress management in hospitals].

    PubMed

    Miki, Akiko

    2002-11-01

    Job stress in employees in hospitals has been recognized as a key issue in the workplace. In this paper, characteristics of job stress in the medical profession, especially in doctors and nurses, and the effectiveness of stress management are overviewed. The important points in stress management in hospitals are summarized as follows: 1) improvement of work environment, 2) assurance of participation and autonomy, 3) education or training to reduce job stress (ex. coping behavior, self-care, relaxation), 4) career development, 5) total support among medical professions. Some reports have demonstrated that the establishment of constant meetings is an effective method of reducing job stress and improving mental health in the medical profession, but few prospective intervention studies have been carried out. Further research is necessary to evaluate the effectiveness of stress reduction and to develop effective intervention programs for medical professions in hospitals.

  13. Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.

    PubMed

    Barber, Emma L; Dusetzina, Stacie B; Stitzenberg, Karyn B; Rossi, Emma C; Gehrig, Paola A; Boggess, John F; Garrett, Joanne M

    2017-06-01

    To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%-55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23-55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5-17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83-0.97 and HR 0.85 95% CI 0.75-0.95). Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Appropriateness of hospitalization for CAP-affected pediatric patients: report from a Southern Italy General Hospital

    PubMed Central

    Antonelli, Fabio; De Brasi, Daniele; Siani, Paolo

    2009-01-01

    Background Community-acquired pneumonia (CAP) is a common disease, responsible for significant healthcare expenditures, mostly because of hospitalization. Many practice guidelines on CAP have been developed, including admission criteria, but a few on appropriate hospitalization in children. The aim of this study was to evaluate appropriate hospital admission for CAP in a pediatric population. Methods We evaluated appropriate admission to a Pediatric Unit performing a retrospective analysis on CAP admitted pediatric patients from a Southern Italy area. Diagnosis was made based on clinical and radiological signs. Appropriate hospital admission was evaluated following clinical and non-clinical international criteria. Family ability to care children was assessed by evaluating social deprivation status. Results In 2 winter seasons 120 pediatric patients aged 1-129 months were admitted because of CAP. Median age was 28.7 months. Raised body temperature was scored in 68.3% of patients, cough was present in 100% of cases, and abdominal pain was rarely evidenced. Inflammatory indices (ESR and CRP) were found elevated in 33.3% of cases. Anti-Mycoplasma pneumoniae antibodies were found positive in 20.4%. Trans-cutaneous (TC) SaO2 was found lower than 92% in 14.6%. Dyspnoea was present in 43.3%. Dehydration requiring i.v. fluid supplementation was scored in 13.3%. Evaluation of familial ability to care their children revealed that 76% of families (derived from socially depressed areas) were "at social risk", thus not able to appropriately care their children. Furthermore, analysis of CAP patients revealed that "at social risk" people accessed E.D. and were hospitalized more frequently than "not at risk" patients (odds ratio = 3.59, 95% CI: 1,15 to 11,12; p = 0.01), and that admitted "at social risk" people presented without clinical signs of severity (namely dyspnoea, and/or SaO2 ≤ 92%, and/or dehydration) more frequently than "not at risk" population (p = 0.005). Conclusion

  15. [Standardization of hospital feeding].

    PubMed

    Caracuel García, Ángel Manuel

    2015-05-07

    Normalization can be understood as the establishing measures against repetitive situations through the development, dissemination, and application of technical design documents called standards. In Andalusia there are 45 public hospitals with 14,606 beds, and in which 11,700 full pensions / day are served. The Working Group on Hospital Food Standardization of the Andalusian Society for Clinical Nutrition and Dietetics, started in 2010, working on the certification of suppliers, product specifications, and meals technical card. - Develop a specific tool to help improving food safety through the certification of their suppliers. - Develop a standardized technical specifications of foodstuffs necessary for the development of menus established codes diets Andalusian hospitals document. - Develop a catalog of data sheets plates of hospital meals, to homogenize menus, respecting local and unifying criteria for qualitative and quantitative ingredients. - Providing documentation and studying of several public hospitals in Andalusia: • Product specifications and certification of suppliers. • International standards certification and distribution companies. • Legislation. • Data sheets for the menu items. • Specifications of different product procurement procedures. - Development of the draft standard HOSPIFOOD®, and approval of the version “0.0”. - Training course for auditors to this standard. - Development of a raw materials catalog as technical cards. - Meals Technical cards review and election of the ones which will be part of the document. After nearly three years of work, we have achieved the following products: - Standardized database of technical specifications for the production of food dietary codes for: fish, seafood, meat and meat products, meats and pates, ready meals, bread and pastries, preserves, milk and dairy products, oils, cereals, legumes , vegetables, fruits, fresh and frozen vegetables, condiments and spices. - Standardized database of

  16. Tiered hospital networks.

    PubMed

    Yegian, Jill M

    2003-01-01

    As a result of rising health care costs, health plans are experimenting with insurance products that shift greater financial responsibility for medical care to consumers and create incentives for consumers to consider cost differences when choosing among providers. Based on an October 2002 roundtable discussion, this paper discusses insurance product trends, particularly tiered hospital networks. Issues addressed include these product features' potential to reduce system costs, the effect on the hospital-health plan relationship, consumers' ability to consider cost and quality in decision making, and financial barriers to care for the chronically ill.

  17. Marketing the hospital library.

    PubMed

    Bridges, Jane

    2005-01-01

    Many librarians do not see themselves as marketers, but marketing is an essential role for hospital librarians. Library work involves education, and there are parallels between marketing and education as described in this article. It is incumbent upon hospital librarians actively to pursue ways of reminding their customers about library services. This article reinforces the idea that marketing is an element in many of the things that librarians already do, and includes a list of suggested marketing strategies intended to remind administrators, physicians, and other customers that they have libraries in their organizations.

  18. Telecommunications and the hospital.

    PubMed

    Tobias, T; Levine, J

    1986-04-01

    Telecommunications is a rapidly changing industry which currently offers the hospital administrator an opportunity to cut costs in the short run while providing for future needs. Like any important resource, this technology must be managed by skilled personnel who can recommend solutions consistent with the hospital's business philosophy and strategic plan. Three specific actions were recommended: first, consider modernizing your PBX; second, train an inhouse person or hire a telecommunications analyst to conduct the review of available systems and options and to supervise installation and operation; and third, when replacing computer systems and PBXs, develop a plan which will provide for current needs and future growth.

  19. Toward healthier hospitals.

    PubMed

    Mintzberg, H

    1997-01-01

    This article builds around a framework of cure, care, control, and community, with collaboration at the center, to consider 12 issues common to many hospitals. These include, among others, the fragmentation of efforts, confusion in mission (and in mission statements), the problems of bundling research with clinical work, selectivity in informing board members, the dangers of professional management, and the difficulties of combining external advocacy with internal reconciliation in the senior manager's job. The article concludes that hospitals could better learn how to solve systemic problems systemically, and that to do so will require not the wish lists of strategic planning and structural reorganizing, but tangible changes in their collective behavior.

  20. Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.

    PubMed

    Lien, Hsien-Ming; Chou, Shin-Yi; Liu, Jin-Tan

    2008-09-01

    This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits.