The Kaiser Permanente Northern California Adult Member Health Survey.

PubMed

Gordon, Nancy; Lin, Teresa

2016-01-01

The Kaiser Permanente Northern California (KPNC) Member Health Survey (MHS) is used to describe sociodemographic and health-related characteristics of the adult membership of this large, integrated health care delivery system to monitor trends over time, identify health disparities, and conduct research. To provide an overview of the KPNC MHS and share findings that illustrate how survey statistics and data have been and can be used for research and programmatic purposes. The MHS is a large-scale, institutional review board-approved survey of English-speaking KPNC adult members. The confidential survey has been conducted by mail triennially starting in 1993 with independent age-sex and geographically stratified random samples, with an option for online completion starting in 2005. The full survey sample and survey data are linkable at the individual level to Health Plan and geocoded data. Respondents are assigned weighting factors for their survey year and additional weighting factors for analysis of pooled survey data. Statistics from the 1999, 2002, 2005, 2008, and 2011 surveys show trends in sociodemographic and health-related characteristics and access to the Internet and e-mail for the adult membership aged 25 to 79 years and for 6 age-sex subgroups. Pooled data from the 2008 and 2011 surveys show many significant differences in these characteristics across the 5 largest race/ethnic groups in KPNC (non-Hispanic whites, blacks, Latinos, Filipinos, and Chinese). The KPNC MHS has yielded unique insights and provides an opportunity for researchers and public health organizations outside of KPNC to leverage our survey-generated statistics and collaborate on epidemiologic and health services research studies.

The Kaiser Permanente Clinician Cultural and Linguistic Assessment Initiative: Research and Development in Patient–Provider Language Concordance

PubMed Central

MSN, Gayle Tang; Lanza, Oscar; Rodriguez, Fátima Marinely; Chang, Annie

2011-01-01

Patient–clinician language concordance is a critical component of the language access equation and is considered the gold standard for communication. As a result of lack of validated testing standards, measures, and tools, Kaiser Permanente developed the Clinician Cultural and Linguistic Assessment Initiative to ensure verifiable linguistic proficiency in clinical encounters and has established a standard level whereby the clinician is deemed to have a qualifying level of proficiency in communicating directly with patients independent of an interpreter. Our benchmarking efforts in language concordance have been rooted with the key aim to identify talented bilingual and bicultural clinician workforce and to establish the systems foundation to coordinate appropriate language services. We share accomplishments, lessons learned, and promising practices to inform future efforts in language concordance. PMID:21228282

Kaiser Permanente implant registries benefit patient safety, quality improvement, cost-effectiveness.

PubMed

Paxton, Elizabeth W; Kiley, Mary-Lou; Love, Rebecca; Barber, Thomas C; Funahashi, Tadashi T; Inacio, Maria C S

2013-06-01

In response to the increased volume, risk, and cost of medical devices, in 2001 Kaiser Permanente (KP) developed implant registries to enhance patient safety and quality, and to evaluate cost-effectiveness. Using an integrated electronic health record system, administrative databases, and other institutional databases, orthopedic, cardiology, and vascular implant registries were developed in 2001, 2006, and 2011, respectively. These registries monitor patients, implants, clinical practices, and surgical outcomes for KP's 9 million members. Critical to registry success is surgeon leadership and engagement; each geographical region has a surgeon champion who provides feedback on registry initiatives and disseminates registry findings. The registries enhance patient safety by providing a variety of clinical decision tools such as risk calculators, quality reports, risk-adjusted medical center reports, summaries of surgeon data, and infection control reports to registry stakeholders. The registries are used to immediately identify patients with recalled devices, evaluate new and established device technology, and identify outlier implants. The registries contribute to cost-effectiveness initiatives through collaboration with sourcing and contracting groups and confirming adherence to device formulary guidelines. Research studies based on registry data have directly influenced clinical best practices. Registries are important tools to evaluate longitudinal device performance and safety, study the clinical indications for and outcomes of device implantation, respond promptly to recalls and advisories, and contribute to the overall high quality of care of our patients.

Internet Infrastructures and Health Care Systems: a Qualitative Comparative Analysis on Networks and Markets in the British National Health Service and Kaiser Permanente

PubMed Central

2002-01-01

Background The Internet and emergent telecommunications infrastructures are transforming the future of health care management. The costs of health care delivery systems, products, and services continue to rise everywhere, but performance of health care delivery is associated with institutional and ideological considerations as well as availability of financial and technological resources. Objective To identify the effects of ideological differences on health care market infrastructures including the Internet and telecommunications technologies by a comparative case analysis of two large health care organizations: the British National Health Service and the California-based Kaiser Permanente health maintenance organization. Methods A qualitative comparative analysis focusing on the British National Health Service and the Kaiser Permanente health maintenance organization to show how system infrastructures vary according to market dynamics dominated by health care institutions ("push") or by consumer demand ("pull"). System control mechanisms may be technologically embedded, institutional, or behavioral. Results The analysis suggests that telecommunications technologies and the Internet may contribute significantly to health care system performance in a context of ideological diversity. Conclusions The study offers evidence to validate alternative models of health care governance: the national constitution model, and the enterprise business contract model. This evidence also suggests important questions for health care policy makers as well as researchers in telecommunications, organizational theory, and health care management. PMID:12554552

Questioning the claims from Kaiser

PubMed Central

Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

2004-01-01

Background: The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. Aim: To assess the accuracy of Feachem et al's comparison and conclusions. Method: Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. Results: Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are $1161 and $1951 for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

PubMed

Otte-Trojel, Terese; Rundall, Thomas G; de Bont, Antoinette; van de Klundert, Joris; Reed, Mary E

2015-12-16

Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited. This paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development? We identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of

The Kaiser Permanente implant registries: effect on patient safety, quality improvement, cost effectiveness, and research opportunities.

PubMed

Paxton, Elizabeth W; Inacio, Maria Cs; Kiley, Mary-Lou

2012-01-01

Considering the high cost, volume, and patient safety issues associated with medical devices, monitoring of medical device performance is critical to ensure patient safety and quality of care. The purpose of this article is to describe the Kaiser Permanente (KP) implant registries and to highlight the benefits of these implant registries on patient safety, quality, cost effectiveness, and research. Eight KP implant registries leverage the integrated health care system's administrative databases and electronic health records system. Registry data collected undergo quality control and validation as well as statistical analysis. Patient safety has been enhanced through identification of affected patients during major recalls, identification of risk factors associated with outcomes of interest, development of risk calculators, and surveillance programs for infections and adverse events. Effective quality improvement activities included medical center- and surgeon-specific profiles for use in benchmarking reports, and changes in practice related to registry information output. Among the cost-effectiveness strategies employed were collaborations with sourcing and contracting groups, and assistance in adherence to formulary device guidelines. Research studies using registry data included postoperative complications, resource utilization, infection risk factors, thromboembolic prophylaxis, effects of surgical delay on concurrent injuries, and sports injury patterns. The unique KP implant registries provide important information and affect several areas of our organization, including patient safety, quality improvement, cost-effectiveness, and research.

Kaiser Permanente Northern California pregnancy database: Description and proof of concept study.

PubMed

Zerbo, Ousseny; Chan, Berwick; Goddard, Kristin; Lewis, Ned; Bok, Karin; Klein, Nicola P; Baxter, Roger

2016-11-04

We describe the establishment of a dynamic database linking mothers to newborns with the goal of studying vaccine safety in both pregnant women and their children and provide results of a study utilizing this database as a proof of concept. All Kaiser Permanente Northern California (KPNC) live births and their mothers were eligible for inclusion in the pregnancy database. We used the medical record number (MRN), a unique identifier, to retrieve information about events that occurred during the pregnancy and at delivery and linked this same MRN to newborns for post-partum follow up. We conducted a retrospective cohort study to evaluate the association between receipt of tetanus, diphtheria and acellular pertussis (Tdap) vaccine during pregnancy and fever 0-3days after the first dose of diphtheria tetanus and acellular pertussis (DTaP) vaccine in the infant. The study included infants who were born at ⩾37weeks gestation from January 1, 2009 - October 1, 2015 and who received their first DTaP vaccine between 6 and 10weeks of age. We utilized diagnostic codes from inpatient, emergency department, outpatient clinics, and telephone calls. We identified fever using ICD 9 code 780.6, recorded temperature ⩾101 degree Fahrenheit, or parental report. The database contained the starting and ending date of each pregnancy and basic demographic characteristics of mothers and infants. There were 859,699 women and 873,753 children in the database as of January 2016. The proof of concept study included 148,699 infants. In a multivariable logistic regression analysis, Tdap vaccination during pregnancy was not associated with infant fever 0-3daysafter first dose of DTaP (adjusted odds ratio=0.92, 95% CI 0.82-1.04). The KPNC pregnancy database can be used for studies investigating exposure during pregnancy and outcomes in mothers and/or infants, particularly monitoring vaccine safety and effectiveness. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching.

PubMed

Bouhaddou, Omar; Bennett, Jamie; Cromwell, Tim; Nixon, Graham; Teal, Jennifer; Davis, Mike; Smith, Robert; Fischetti, Linda; Parker, David; Gillen, Zachary; Mattison, John

2011-01-01

The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better informs providers, improves decisions and efficiency, and helps meet the meaningful use criteria.

Comparative health systems research among Kaiser Permanente and other integrated delivery systems: a systematic literature review.

PubMed

Maeda, Jared Lane K; Lee, Karen M; Horberg, Michael

2014-01-01

Because of rising health care costs, wide variations in quality, and increased patient complexity, the US health care system is undergoing rapid changes that include payment reform and movement toward integrated delivery systems. Well-established integrated delivery systems, such as Kaiser Permanente (KP), should work to identify the specific system-level factors that result in superior patient outcomes in response to policymakers' concerns. Comparative health systems research can provide insights into which particular aspects of the integrated delivery system result in improved care delivery. To provide a baseline understanding of comparative health systems research related to integrated delivery systems and KP. Systematic literature review. We conducted a literature search on PubMed and the KP Publications Library. Studies that compared KP as a system or organization with other health care systems or across KP facilities internally were included. The literature search identified 1605 articles, of which 65 met the study inclusion criteria and were examined by 3 reviewers. Most comparative health systems studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP with other US (n = 15) or international (n = 12) health care systems. Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems. Of all studies published by or about KP, only a small proportion of articles (4%) was identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the integrated delivery system model with other systems of care are needed to better understand the "system-level" factors that result in improved and/or diminished care delivery.

The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network Exchange in San Diego: Patient Selection, Consent, and Identity Matching

PubMed Central

Bouhaddou, Omar; Bennett, Jamie; Cromwell, Tim; Nixon, Graham; Teal, Jennifer; Davis, Mike; Smith, Robert; Fischetti, Linda; Parker, David; Gillen, Zachary; Mattison, John

2011-01-01

The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better informs providers, improves decisions and efficiency, and helps meet the meaningful use criteria. PMID:22195064

Kaiser Permanente Georgia's Experience with Operation Zero: A Group Medical Appointment to Address Pediatric Overweight

PubMed Central

Hinchman, Josephine; Beno, Luke; Mims, Adrienne

2006-01-01

Context: The rate of overweight (OW) in children in the United States has more than tripled since 1980. The health consequences of pediatric OW include type 2 diabetes and significant illness later in life. Treating pediatric OW is a necessity; however, health care clinicians have minimal access to successful and comprehensive treatment modalities for addressing it. Objective: Kaiser Permanente of Georgia (KPGA) offers a group medical appointment clinic, Operation Zero (O.Z.), as a referral program for preadolescent and adolescent patients who are in the 85th or higher percentile for body mass index (BMI) for their age. The eight-session clinic uses a family-oriented approach and provides a supportive group environment with interactive learning, games, physical activity, and creative problem solving. The goal of the program is to improve lifestyle behaviors for nutrition and physical activity. Clinically, meeting these goals can manifest as reductions in body fat (BF), waist size, and BMI-for-age percentile. Two implementation models help improve dissemination of the program within KPGA. Design: Baseline and eight-week postclinical outcomes for O.Z. participants were analyzed to determine program effectiveness. A retrospective analysis with a control group looked at long-term clinical outcomes to determine weight maintenance. Main outcome measures were weight, BMI-for-age percentile, waist size, and percentage of body fat (%BF). Results: At eight weeks after program completion compared with baseline, there were significant reductions in %BF and waist size for the total sample and specifically for adolescents, preteens, and participants who attended six or more sessions. Among O.Z. participants, there were insignificant increases in weight at six months after program participation and BMI-for-age percentile at one year after participation. At six months, the mean change in weight and BMI in the O.Z. group was statistically less than the mean change in the control

The fetal heart rate collaborative practice project: situational awareness in electronic fetal monitoring-a Kaiser Permanente Perinatal Patient Safety Program Initiative.

PubMed

MacEachin, S Rachel; Lopez, Connie M; Powell, Kimberly J; Corbett, Nancy L

2009-01-01

Electronic fetal monitoring has historically been interpreted with wide variation between and within disciplines on the obstetric healthcare team. This leads to inconsistent decision making in response to tracing interpretation. To implement a multidisciplinary electronic fetal monitoring training program, utilizing the best evidence available, enabling standardization of fetal heart rate interpretation to promote patient safety. Local multidisciplinary expertise along with an outside consultant collaborated over a series of meetings to create a multimedia instructional electronic fetal monitoring training program. After production was complete, a series of conferences attended by nurses, certified nurse midwives, and physician champions, from each hospital, attended to learn how to facilitate training at their own perinatal units. All healthcare personnel across the Kaiser Permanente perinatal program were trained in NICHD nomenclature, emergency response, interpretation guidelines, and how to create local collaborative practice agreements. Metrics for program effectiveness were measured through program evaluations from attendees, the Safety Attitudes Questionnaire. Program evaluations rendered very positive scores from both physicians and clinicians. Comparing baseline to 4 years later, the perception of safety from the staff has increased over 10% in 5 out of the 6 factors analyzed. Active participation from all disciplines in this training series has highlighted the importance of teamwork and communication. The Fetal Heart Rate Collaborative Practice Project continues to evolve utilizing other educational modalities, such as online EFM education and unit-based interdisciplinary tracing reviews.

C-A1-02: Evaluating Kaiser Permanente Georgia’s Worksite Wellness Programs in the Atlanta Area

PubMed Central

Roblin, Douglas; Robinson, Brandi; Benjamin-Stone, Staycee

2010-01-01

Background/Aims: There are few prospective evaluations of the effectiveness of worksite wellness programs in achieving improved lifestyle and health. Our study has two objectives: to assess the cross-sectional associations of biometric status, lifestyle, and health obtained at a wellness program’s enrollment session, and to assess changes in biometric status, lifestyle, and health between the enrollment and 6-month disenrollment sessions. Methods: For this prospective cohort study, participants were recruited from Kaiser Permanente Georgia (KPG) subscribers who were employed at a mid-sized private employer group. Participants completed a biometric assessment and written survey. The biometric measures included height, weight, blood pressure, hip/waist ratio, and total cholesterol. The written survey included measures of: health (SF-12), patient activation (PAM-13), leisure physical activity (BRFSS), food screeners (Block), and work presenteeism (SPS-6) and absenteeism. Over the next 6 months, participants will attend seminars on exercise, weight loss, and healthy cooking and eating. The biometric assessment and survey be repeated in February 2010. Results: Of the 63 eligible KPG subscribers, 60 (41 females and 19 males) consented to participate. Participant ages ranged from 28–77 years. Overall, physical and emotional health, activation, leisure physical activity, dietary intake, and BMI were comparable to results obtained among relatively healthy, low risk working age adults in a 2005 survey of KPG subscribers in large group employers. Total cholesterol was significantly (p<0.05), positively associated with percent fat in diet; and, percent fat in diet was significantly, inversely associated with activation. Participants with 1 or more days absent from work in the most recent 4-week period reported significantly higher total cholesterol and percent fat in diet and significantly lower activation. Participants with high levels of presenteeism were significantly

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve

PubMed Central

Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

2017-01-01

Objectives: The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Methods: Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Results: Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p < 0.001). Screening with the Chronic Kidney Disease Epidemiology Collaboration (vs Modification Diet in Renal Diseases) equation would capture 44% fewer individuals and have a higher predictive value for CKD. Of those who had repeated creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Conclusion: Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening. PMID:28241912

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve.

PubMed

Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

2017-01-01

The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p < 0.001). Screening with the Chronic Kidney Disease Epidemiology Collaboration (vs Modification Diet in Renal Diseases) equation would capture 44% fewer individuals and have a higher predictive value for CKD. Of those who had repeated creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

Evaluation of a surveillance case definition for anogenital warts, Kaiser Permanente northwest.

PubMed

Naleway, Allison L; Weinmann, Sheila; Crane, Brad; Gee, Julianne; Markowitz, Lauri E; Dunne, Eileen F

2014-08-01

Most studies of anogenital wart (AGW) epidemiology have used large clinical or administrative databases and unconfirmed case definitions based on combinations of diagnosis and procedure codes. We developed and validated an AGW case definition using a combination of diagnosis codes and other information available in the electronic medical record (provider type, laboratory testing). We calculated the positive predictive value (PPV) of this case definition compared with manual medical record review in a random sample of 250 cases. Using this case definition, we calculated the annual age- and sex-stratified prevalence of AGW among individuals 11 through 30 years of age from 2000 through 2005. We identified 2730 individuals who met the case definition. The PPV of the case definition was 82%, and the average annual prevalence was 4.16 per 1000. Prevalence of AGW was higher in females compared with males in every age group, with the exception of the 27- to 30-year-olds. Among females, prevalence peaked in the 19- to 22-year-olds, and among males, the peak was observed in 23- to 26-year-olds. The case definition developed in this study is the first to be validated with medical record review and has a good PPV for the detection of AGW. The prevalence rates observed in this study were higher than other published rates, but the age- and sex-specific patterns observed were consistent with previous reports.

75 FR 21041 - Notice of Determinations Terminating Investigations of Petitions Regarding Eligibility To Apply...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... Slingsby Systems, Inc., Jupiter, Florida. TA-W-72,372: Kaiser Permanente, Corona, California, covered by TA-W- 71,894: Kaiser Permanente, Corona, California. TA-W-72,432: Matthew Bender and Company, Inc...

Malignant melanoma slide review project: Patients from non-Kaiser hospitals in the San Francisco Bay Area. Final report

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

Reynolds, P.

This project was initiated, in response to concerns that the observed excess of malignant melanoma among employees of Lawrence Livermore National Laboratory (LLNL) might reflect the incidence of disease diagnostically different than that observed in the general population. LLNL sponsored a slide review project, inviting leading dermatopathology experts to independently evaluate pathology slides from LLNL employees diagnosed with melanoma and those from a matched sample of Bay Area melanoma patients who did not work at the LLNL. The study objectives were to: Identify all 1969--1984 newly diagnosed cases of malignant melanoma among LLNL employees resident in the San Francisco-Oakland Metropolitanmore » Statistical Area, and diagnosed at facilities other than Kaiser Permanente; identify a comparison series of melanoma cases also diagnosed between 1969--1984 in non-Kaiser facilities, and matched as closely as possible to the LLNL case series by gender, race, age at diagnosis, year of diagnosis, and hospital of diagnosis; obtain pathology slides for the identified (LLNL) case and (non-LLNL) comparison patients for review by the LLNL-invited panel of dermatopathology experts; and to compare the pathologic characteristics of the case and comparison melanoma patients, as recorded by the dermatopathology panel.« less

Clinical pharmacy travel medicine services: a new frontier.

PubMed

Jackson, Adam B; Humphries, Tammy L; Nelson, Kent M; Helling, Dennis K

2004-12-01

Travel to remote destinations has increased dramatically in recent years. The Clinical Pharmacy International Travel Clinic (CPITC) was established in 1991 in the Kaiser Permanente Colorado Region to provide pre-travel advice to members to decrease their risk of travel-related diseases. The CPITC is unique from other travel medicine clinics because it is a pharmacist-run telepharmacy service. The team includes an infectious diseases physician, an infectious diseases clinical pharmacy specialist, 4 clinical pharmacists, and a pharmacy technician. The clinical pharmacists provide consultations via telephone. Both patient- and trip-related information are gathered to assess the traveler's health risks. Recommendations are provided regarding food- and water-borne diseases, insect-borne diseases, sexually transmitted diseases, and diseases related to animal bites. Additionally, detailed information is provided on vaccines that may be needed to protect travelers against various diseases. The travel consult is documented electronically. A copy of the consult, along with a booklet that provides travel information, is mailed to the patient. Success of the CPITC is demonstrated in several ways. The clinic initially served Kaiser Permanente members in the Colorado Region. The service has expanded and now also provides travel consults to Kaiser Permanente members in the Northwest and Ohio Regions. Patient satisfaction is high, and significant cost-savings have been realized secondary to avoiding the use of unnecessary vaccinations and medications. The CPITC allows resources to be leveraged and provides one center where individuals trained in travel medicine provide information to members, thus improving efficiency and decreasing cost.

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-02-02

This is a false color image of Kaiser Crater. In this combination of filters "blue" typically means basaltic sand. This VIS image crosses 3/4 of the crater and demonstrates how extensive the dunes are on the floor of Kaiser Crater. Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southern part of the crater floor. The THEMIS VIS camera contains 5 filters. The data from different filters can be combined in multiple ways to create a false color image. These false color images may reveal subtle variations of the surface not easily identified in a single band image. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 71,000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 66602 Latitude: -47.0551 Longitude: 19.446 Instrument: VIS Captured: 2016-12-18 21:42 https://photojournal.jpl.nasa.gov/catalog/PIA22265

Prevalence of prostatitis-like symptoms in a managed care population.

PubMed

Clemens, J Quentin; Meenan, Richard T; O'Keeffe-Rosetti, Maureen C; Gao, Sara Y; Brown, Sheila O; Calhoun, Elizabeth A

2006-08-01

We calculated the prevalence of symptoms typically associated with chronic prostatitis/chronic pelvic pain syndrome in men in a managed care population in the Pacific Northwest. A questionnaire mailing to 5,000 male enrollees 25 to 80 years old in the Kaiser Permanente Northwest (Portland, Oregon) health plan was performed. The questionnaires included screening questions about the presence, duration and severity of pelvic pain, and the National Institutes of Health Chronic Prostatitis Symptom Index. Chronic prostatitis/chronic pelvic pain syndrome symptoms were defined in 2 ways: 1) presence of any of the following for a duration of 3 or more months: pain in the perineum, testicles, tip of penis, pubic or bladder area, dysuria, ejaculatory pain; and 2) perineal and/or ejaculatory pain, and a National Institutes of Health Chronic Prostatitis Symptom Index total pain score of 4 or more. Prevalence estimates were age adjusted to the total Kaiser Permanente Northwest male population. A total of 1,550 questionnaires were returned. The prevalence of chronic prostatitis/chronic pelvic pain syndrome symptoms was 7.5% for definition 1 and 5.9% for definition 2. Mean National Institutes of Health Chronic Prostatitis Symptom Index scores were 17 for definitions 1 and 2. Of those with prostatitis-like symptoms, 30% met criteria for having both definitions present. The prevalence of prostatitis-like symptoms using either of the 2 diagnoses was 11.2%. This population based study indicates that approximately 1 in 9 men have prostatitis-like symptoms. Application of 2 different definitions for prostatitis-like symptoms identified unique groups of men, with limited overlap in the groups.

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-02-01

This VIS image of the floor of Kaiser Crater contains several sand dune shapes and sizes. The "whiter" material is the hard crater floor surface. Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southern part of the crater floor. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 71,000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 39910 Latitude: -46.9063 Longitude: 19.8112 Instrument: VIS Captured: 2010-12-13 11:17 https://photojournal.jpl.nasa.gov/catalog/PIA22264

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-01-31

This VIS image of the floor of Kaiser Crater contains a large variety of sand dune shapes and sizes. The "whiter" material is the hard crater floor surface. Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southern part of the crater floor. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 71,000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 35430 Latitude: -46.8699 Longitude: 19.4731 Instrument: VIS Captured: 2009-12-09 14:09 https://photojournal.jpl.nasa.gov/catalog/PIA22263

Collaboration in health services research: on developing relationships between VA researchers and those in other institutions.

PubMed Central

Greenlick, M R; Freeborn, D K

1986-01-01

This article explores the potential for collaboration between investigators in institutions outside of the VA and those engaged in research within the VA. The focus is on the potential for collaborative work in health services research; our perspective is that of researchers in a freestanding HMO research center affiliated with the Veterans Administration's Northwest Health Services Research and Development Field Program. The paper begins with a review of the reasons that make collaboration between VA researchers and other health services researchers so appropriate at this time. An example of collaboration is presented, drawing on the experience of the Northwest Field Program and the Kaiser Permanente Center for Health Research. Finally, some difficulties inherent in collaboration between VA and other health services researchers are discussed. PMID:3512485

Frederik Kaiser (1808-1872) and the Modernisation of Dutch Astronomy

NASA Astrophysics Data System (ADS)

van der Heijden, Petra

Frederik Kaiser was the director of Leiden Observatory from 1837 until his death in 1872. Educated by his German-born uncle Johan Frederik Keyser (1766-1823), who was a proficient amateur astronomer, Kaiser proved to be a real observational talent. Despite the poor conditions in which he worked, his observations soon rivalled with the best in the world. Kaiser's contributions to astronomical practice include the foundation of a new, completely up-to-date observatory building in Leiden, and the introduction of statistics and precision measurements in daily practice at the observatory. Moreover he was the author of several bestselling books on popular astronomy. Kaiser had an extensive correspondence with colleagues all over Europe, mostly in Germany. Correpondents include Airy, Argelander, Von Auwers, Bessel, Encke, John Herschel, LeVerrier, Von Littrow, Schumacher, Otto W. Struve, as well as several geodesists and instrument makers. Preliminary research indicates that Frederik Kaiser played a crucial role in the revival of Dutch astronomy in the second half of the 19th century. This project aims at analysing and explaining Kaiser's activities in science, institutionalisation and popularisation, in the context of national and international developments in 19th-century astronomy and scientific culture.

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-01-23

Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southeastern part of the crater floor. Most of the individual dunes in Kaiser Crater are barchan dunes. Barchan dunes are crescent shaped with the points of the crescent pointing downwind. The sand is blown up the low angle side of the dune and then tumbles down the steep slip face. This dune type forms on hard surfaces where there is limited amounts of sand. Barchan dunes can merge together over time with increased sand in the local area. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 69000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 1036 Latitude: -46.7795 Longitude: 20.2075 Instrument: VIS Captured: 2002-03-09 20:07 https://photojournal.jpl.nasa.gov/catalog/PIA22172

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-01-29

This VIS image of Kaiser Crater shows a region of the dunes with varied appearances. The different dune forms developed due to different amounts of available sand, different wind directions, and the texture of the crater floor. The dune forms change from the bottom to the top of the image - large long connected dunes, to large individual dunes, to the very small individual dunes at the top of the image. Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southern part of the crater floor. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 71,000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 17686 Latitude: -46.6956 Longitude: 19.8394 Instrument: VIS Captured: 2005-12-09 13:25 https://photojournal.jpl.nasa.gov/catalog/PIA22261

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-01-24

This VIS image of Kaiser Crater shows individual dunes and where the dunes have coalesced into longer dune forms. The addition of sand makes the dunes larger and the intra-dune areas go from sand-free to complete coverage of the hard surface of the crater floor. With a continued influx of sand the region will transition from individual dunes to a sand sheet with surface dune forms. Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southern part of the crater floor. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 69000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 1423 Latitude: -46.9573 Longitude: 18.6192 Instrument: VIS Captured: 2002-04-10 16:44 https://photojournal.jpl.nasa.gov/catalog/PIA22173

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012-2013.

PubMed

Grytdal, Scott P; DeBess, Emilio; Lee, Lore E; Blythe, David; Ryan, Patricia; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D; Hall, Aron J

2016-01-01

Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children <5 years of age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1

75 FR 70689 - Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum-Greenwood Forge Division; Currently...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-18

... Fabricated Products, LLC; Kaiser Aluminum- Greenwood Forge Division; Currently Known As Contech Forgings, LLC..., South Carolina; Amended Certification Regarding Eligibility To Apply or Worker Adjustment Assistance In... Labor issued a Certification of Eligibility to Apply for Worker Adjustment Assistance on October 2, 2009...

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

PubMed Central

Grytdal, Scott P.; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D.; Hall, Aron J.

2016-01-01

Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children <5 years of age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per

Observation of the Kaiser Effect Using Noble Gas Release Signals

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

Bauer, Stephen J.

The Kaiser effect was defined in the early 1950s (Kaiser 1953) and was extensively reviewed and evaluated by Lavrov (2002) with a view toward understanding stress estimations. The Kaiser effect is a stress memory phenomenon which has most often been demonstrated in rock using acoustic emissions. During cyclic loading–unloading–reloading, the acoustic emissions are near zero until the load exceeds the level of the previous load cycle. Here, we sought to explore the Kaiser effect in rock using real-time noble gas release. Laboratory studies using real-time mass spectrometry measurements during deformation have quantified, to a degree, the types of gases releasedmore » (Bauer et al. 2016a, b), their release rates and amounts during deformation, estimates of permeability created from pore structure modifications during deformation (Gardner et al. 2017) and the impact of mineral plasticity upon gas release. We found that noble gases contained in brittle crystalline rock are readily released during deformation.« less

Observation of the Kaiser Effect Using Noble Gas Release Signals

DOE PAGES

Bauer, Stephen J.

2017-10-24

The Kaiser effect was defined in the early 1950s (Kaiser 1953) and was extensively reviewed and evaluated by Lavrov (2002) with a view toward understanding stress estimations. The Kaiser effect is a stress memory phenomenon which has most often been demonstrated in rock using acoustic emissions. During cyclic loading–unloading–reloading, the acoustic emissions are near zero until the load exceeds the level of the previous load cycle. Here, we sought to explore the Kaiser effect in rock using real-time noble gas release. Laboratory studies using real-time mass spectrometry measurements during deformation have quantified, to a degree, the types of gases releasedmore » (Bauer et al. 2016a, b), their release rates and amounts during deformation, estimates of permeability created from pore structure modifications during deformation (Gardner et al. 2017) and the impact of mineral plasticity upon gas release. We found that noble gases contained in brittle crystalline rock are readily released during deformation.« less

75 FR 43885 - Proposed Amendment of Class E Airspace; Kaiser/Lake Ozark, MO

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

...-0604; Airspace Docket No. 10-ACE-5] Proposed Amendment of Class E Airspace; Kaiser/Lake Ozark, MO...: This action proposes to amend Class E airspace for the Kaiser/ Lake Ozark, MO, area. Additional... for the Kaiser/Lake Ozark, MO area, to accommodate SIAPs at Camdenton Memorial Airport, Camdenton, MO...

An HMO-based prospective pilot study of energy medicine for chronic headaches: whole-person outcomes point to the need for new instrumentation.

PubMed

Sutherland, Elizabeth G; Ritenbaugh, Cheryl; Kiley, Susan J; Vuckovic, Nancy; Elder, Charles

2009-08-01

The purpose of this study was to evaluate an energy healing treatment for possible inclusion as a Kaiser Permanente Northwest (KPNW) Pain Clinic provided therapy, and to identify the appropriate number of treatment sessions for a Pain Clinic protocol, should the intervention prove successful. In addition, our intent was to document the full range of outcomes experienced by patients undergoing energy healing, including whole-person and transformative outcomes should they occur. The setting for this study was Kaiser Permanente Northwest Pain Clinic. Thirteen (13) patients with chronic headache who were members of the KPNW Health Plan were recruited through flyers or mailings. Thirteen (13) participants received at least three energy healing sessions at approximately weekly intervals. Assessments were based on pre- and post-treatment qualitative interviews. The treatment consisted of three Healing Touch sessions provided by a Certified Healing Touch Practitioner. Treatments contained elements common to all sessions, and elements that were tailored to the individual subject. Twelve (12) of 13 participants experienced improvement in frequency, intensity, or duration of pain after three treatments. In addition, 11 of 13 participants experienced profound shifts in their view of themselves, their lives, and their potential for healing and transformation. These changes lasted from 24 hours to more than 6 months at follow-up. Energy healing can be an important addition to pain management services. More in-depth qualitative research is needed to explore the diversity of outcomes facilitated by energy healing treatments. Furthermore, the development of new instrumentation is warranted to capture outcomes that reflect transformative change and changes at the level of the whole person.

An HMO-Based Prospective Pilot Study of Energy Medicine for Chronic Headaches: Whole-Person Outcomes Point to the Need for New Instrumentation

PubMed Central

Ritenbaugh, Cheryl; Kiley, Susan J.; Vuckovic, Nancy; Elder, Charles

2009-01-01

Abstract Objectives The purpose of this study was to evaluate an energy healing treatment for possible inclusion as a Kaiser Permanente Northwest (KPNW) Pain Clinic provided therapy, and to identify the appropriate number of treatment sessions for a Pain Clinic protocol, should the intervention prove successful. In addition, our intent was to document the full range of outcomes experienced by patients undergoing energy healing, including whole-person and transformative outcomes should they occur. Setting The setting for this study was Kaiser Permanente Northwest Pain Clinic. Participants Thirteen (13) patients with chronic headache who were members of the KPNW Health Plan were recruited through flyers or mailings. Methods Thirteen (13) participants received at least three energy healing sessions at approximately weekly intervals. Assessments were based on pre- and post-treatment qualitative interviews. Intervention The treatment consisted of three Healing Touch sessions provided by a Certified Healing Touch Practitioner. Treatments contained elements common to all sessions, and elements that were tailored to the individual subject. Results Twelve (12) of 13 participants experienced improvement in frequency, intensity, or duration of pain after three treatments. In addition, 11 of 13 participants experienced profound shifts in their view of themselves, their lives, and their potential for healing and transformation. These changes lasted from 24 hours to more than 6 months at follow-up. Conclusions Energy healing can be an important addition to pain management services. More in-depth qualitative research is needed to explore the diversity of outcomes facilitated by energy healing treatments. Furthermore, the development of new instrumentation is warranted to capture outcomes that reflect transformative change and changes at the level of the whole person. PMID:19678772

Energy Assessment Helps Kaiser Aluminum Save Energy and Improve Productivity

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

None

2008-07-01

The Kaiser Aluminum plant in Sherman, Texas, adjusted controls and made repairs to a furnace for a simple payback of 1 month. Kaiser adopted DOE's Process Heating Assessment and Survey Tool (PHAST) software as the corporate diagnostic tool and has used it to evaluate process heating systems at five other aluminum plants.

Investigating Mars: Kaiser Crater Dunes

NASA Image and Video Library

2018-01-30

At the top of this VIS image crescent shaped dunes are visible. As the dunes approach a break in elevation the forms change to connect the crescents together forming long aligned dune forms. Kaiser Crater is located in the southern hemisphere in the Noachis region west of Hellas Planitia. Kaiser Crater is just one of several large craters with extensive dune fields on the crater floor. Other nearby dune filled craters are Proctor, Russell, and Rabe. Kaiser Crater is 207 km (129 miles) in diameter. The dunes are located in the southern part of the crater floor. The Odyssey spacecraft has spent over 15 years in orbit around Mars, circling the planet more than 71,000 times. It holds the record for longest working spacecraft at Mars. THEMIS, the IR/VIS camera system, has collected data for the entire mission and provides images covering all seasons and lighting conditions. Over the years many features of interest have received repeated imaging, building up a suite of images covering the entire feature. From the deepest chasma to the tallest volcano, individual dunes inside craters and dune fields that encircle the north pole, channels carved by water and lava, and a variety of other feature, THEMIS has imaged them all. For the next several months the image of the day will focus on the Tharsis volcanoes, the various chasmata of Valles Marineris, and the major dunes fields. We hope you enjoy these images! Orbit Number: 34157 Latitude: -46.9336 Longitude: 18.9272 Instrument: VIS Captured: 2009-08-26 18:49 https://photojournal.jpl.nasa.gov/catalog/PIA22262

Association between personal health record enrollment and patient loyalty.

PubMed

Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne

2012-07-01

To examine the association between patient loyalty, as measured by member retention in the health plan, and access to My Health Manager (MHM), Kaiser Permanente's PHR, which is linked to its electronic health record, KP HealthConnect. We conducted a retrospective cohort observational quality improvement project from the third quarter of 2005 to the fourth quarter of 2008 for approximately 394,000 Kaiser Permanente Northwest members. To control for self-selection bias, we used propensity scores to perform exact 1-to-1 matching without replacement between MHM users and nonusers. We estimated retention rates of the matched data and assessed the association between MHM use and retention versus voluntary termination. We also estimated odds ratios of significant variables impacting member retention. The probability of remaining a member or being involuntarily terminated versus voluntary termination was 96.7% for users (95% confidence interval [CI], 96.6%-96.7%) and 92.2% for nonusers (95% CI, 92.1%-92.4%; P <.001). In the logistic model, MHM use was a significant predictor; only tenure and illness burden were stronger predictors. Users were 2.578 (95% CI, 2.487%-2.671%) times more likely to choose to remain members than were nonusers. The impact was more substantial among newer members. MHM use was significantly associated with voluntary membership retention. An indicator of patient loyalty, retention is critical to healthcare organizations.

A new class of weight and WA systems of the Kravchenko-Kaiser functions

NASA Astrophysics Data System (ADS)

Kravchenko, V. F.; Pustovoit, V. I.; Churikov, D. V.

2014-05-01

A new class of weight and WA-systems of the Kravchenko-Kaiser functions which showed its efficiency in various physical applications is proposed and substantiated. This publication consists of three parts. In the first the Kravchenko-Kaiser weight functions are constructed on basis of the theory of atomic functions (AFs) and the Kaiser windows for the first time. In the second part new constructions of analytic WA-systems of the Kravchenko-Kaiser functions are costructed. In the third part their applications to problems of weight averaging of the difference frequency signals are considered. The numerical experiment and the physical analysis of the results for concrete physical models confirmed their efficiency. This class of functions can find wide physical applications in problems of digital signal processing, restoration of images, radar, radiometry, radio astronomy, remote sensing, etc.

Protocol: changes in rates of opioid overdose and poisoning events in an integrated health system following the introduction of a formulation of OxyContin® with abuse-deterrent properties.

PubMed

Janoff, Shannon L; Perrin, Nancy A; Coplan, Paul M; Chilcoat, Howard D; Campbell, Cynthia I; Green, Carla A

2016-05-14

Addiction, overdoses and deaths resulting from prescription opioids have increased dramatically over the last decade. In response, several manufacturers have developed formulations of opioids with abuse-deterrent properties. For many of these products, the Food and Drug Administration (FDA) recognized the formulation with labeling claims and mandated post-marketing studies to assess the abuse-deterrent effects. In response, we assess differences in rates of opioid-related overdoses and poisonings prior to and following the introduction of a formulation of OxyContin® with abuse-deterrent properties. To assess effects of this formulation, electronic medical record (EMR) data from Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Northern California (KPNC) are linked to state death data and compared to chart audits. Overdose and poisoning events will be categorized by intentionality and number of agents involved, including illicit drugs and alcohol. Using 6-month intervals over a 10-year period, trends will be compared in rates of opioid-related overdoses and poisoning events associated with OxyContin® to rates of events associated with other oxycodone and opioid formulations. Qualitative interviews with patients and relatives of deceased patients will be conducted to capture circumstances surrounding events. This study assesses and tracks changes in opioid-related overdoses and poisoning events prior to and following the introduction of OxyContin® with abuse-deterrent properties. Public health significance is high because these medications are designed to reduce abuse-related behaviors that lead to important adverse outcomes, including overdoses and deaths.

Measuring integrated care.

PubMed

Strandberg-Larsen, Martin

2011-02-01

The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were

Prepaid group practice staffing and U.S. physician supply: lessons for workforce policy.

PubMed

Weiner, Jonathan P

2004-01-01

This paper describes staffing at eight large prepaid group practices (PGPs) serving more than eight million enrollees at Kaiser Permanente and two other health maintenance organizations (HMOs). Even after characteristics of the patient populations and outside referrals are accounted for, these PGPs have a physician-to-population ratio that is 22-37 percent below the national rate. Two decades of historical data at Kaiser Permanente indicate that its rate of specialist growth was far higher than that of primary care. The study suggests that efficient systems of care can readily meet the demands of patient populations with workforce staffing ratios below current U.S. levels.

Epidemiology and healthcare costs of incident Clostridium difficile infections identified in the outpatient healthcare setting.

PubMed

Kuntz, Jennifer L; Johnson, Eric S; Raebel, Marsha A; Petrik, Amanda F; Yang, Xiuhai; Thorp, Micah L; Spindel, Steven J; Neil, Nancy; Smith, David H

2012-10-01

To describe the epidemiology and healthcare costs of Clostridium difficile infection (CDI) identified in the outpatient setting. Population-based, retrospective cohort study. Kaiser Permanente Colorado and Kaiser Permanente Northwest members between June 1, 2005, and September 30, 2008. We identified persons with incident CDI and classified CDI by whether it was identified in the outpatient or inpatient healthcare setting. We collected information about baseline variables and follow-up healthcare utilization, costs, and outcomes among patients with CDI. We compared characteristics of patients with CDI identified in the outpatient versus inpatient setting. We identified 3,067 incident CDIs; 56% were identified in the outpatient setting. Few strong, independent predictors of diagnostic setting were identified, although a previous stay in a nonacute healthcare institution (odds ratio [OR], 1.45 [95% confidence interval (CI), 1.13-1.86]) was statistically associated with outpatient-identified CDI, as was age from 50 to 59 years (OR, 1.64 [95% CI, 1.18-2.29]), 60 to 69 years (OR, 1.37 [95% CI, 1.03-1.82]), and 70 to 79 years (OR, 1.36 [95% CI, 1.06-1.74]), when compared with persons aged 80-89 years. We found that more than one-half of incident CDIs in this population were identified in the outpatient setting. Patients with outpatient-identified CDI were younger with fewer comorbidities, although they frequently had previous exposure to healthcare. These data suggest that practitioners should be aware of CDI and obtain appropriate diagnostic testing on outpatients with CDI symptoms.

20. Photocopy of drawing (1961 mechanical drawing by Kaiser Engineers) ...

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

20. Photocopy of drawing (1961 mechanical drawing by Kaiser Engineers) ELECTRICAL LAYOUTS FOR VEHICLE SUPPORT BUILDING, SHEET E-2 - Vandenberg Air Force Base, Space Launch Complex 3, Vehicle Support Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

18. Photocopy of drawing (1961 architectural drawing by Kaiser Engineers) ...

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

18. Photocopy of drawing (1961 architectural drawing by Kaiser Engineers) FLOOR PLAN, ELEVATIONS, AND SCHEDULE FOR VEHICLE SUPPORT BUILDING, SHEET A-1 - Vandenberg Air Force Base, Space Launch Complex 3, Vehicle Support Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

19. Photocopy of drawing (1961 piping drawing by Kaiser Engineers) ...

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

19. Photocopy of drawing (1961 piping drawing by Kaiser Engineers) PIPING PLANS AND DETAILS FOR VEHICLE SUPPORT BUILDING, SHEET P-1 - Vandenberg Air Force Base, Space Launch Complex 3, Vehicle Support Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

17. Photocopy of drawing (1961 civil engineering drawing by Kaiser ...

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

17. Photocopy of drawing (1961 civil engineering drawing by Kaiser Engineers) SITE PLAN, PLOT PLAN, AND LOCATION MAP FOR VEHICLE SUPPORT BUILDING, SHEET C-1 - Vandenberg Air Force Base, Space Launch Complex 3, Vehicle Support Building, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

The Dilemma of Campus Upkeep: An Interview with Harvey Kaiser.

ERIC Educational Resources Information Center

Christian, Roslyn Stewart

1984-01-01

Deferred maintenance is reaching crisis proportion on many campuses. An overview of this priority for governing boards and a look at how trustees should be involved is presented in an interview of Harvey Kaiser, vice president for facilities administration at Syracuse University. (Author/MLW)

Bedrock Outcrops in Kaiser Crater

NASA Image and Video Library

2017-03-13

This enhanced-color image from NASA Mars Reconnaissance Orbiter shows a patch of well-exposed bedrock on the floor of Kaiser Crater. The wind has stripped off the overlying soil, and created grooves and scallops in the bedrock. The narrow linear ridges are fractures that have been indurated, probably by precipitation of cementing minerals from groundwater flow. The rippled dark blue patches consist of sand. The map is projected here at a scale of 25 centimeters (9.8 inches) per pixel. [The original image scale is 25.3 centimeters (9.9 inches) per pixel (with 1 x 1 binning); objects on the order of 76 centimeters (29.9 inches) across are resolved.] North is up. http://photojournal.jpl.nasa.gov/catalog/PIA21559

Information Placement and Retrieval Through NHIN (InfoPRN)

DTIC Science & Technology

2011-05-01

and FISMA.  Dr. Steffensen will contact NMDS (Captain Bensic), JTF CapMed , and perhaps Kaiser Permanente to ascertain their interest in...activities, project stakeholders, critical project deliverables and milestones were defined and agreed upon. Therefore, the Integrated Master

A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California.

PubMed

Yu, Junhua; Shah, Bijal M; Ip, Eric J; Chan, James

2013-03-01

It has been demonstrated in previous studies that pharmacist management of patients with type 2 diabetes mellitus (T2DM) in the outpatient setting not only improves diabetes-related clinical outcomes such as hemoglobin A1c but also blood pressure (BP), total cholesterol (TC), and quality of life. Improved control of BP and TC has been shown to reduce the risks of cardiovascular disease (CVD), which has placed a heavy economic burden on the health care system. However, no study has evaluated the cost-effectiveness of pharmacist intervention programs with respect to the long-term preventive effects on CVD outcomes among T2DM patients. To (a) quantify the long-term preventive effects of pharmacist intervention on CVD outcomes among T2DM patients using evidence from a matched cohort study in the outpatient primary care setting and (b) assess the relative cost-effectiveness of adding a clinical pharmacist to the primary care team for the management of patients with T2DM based on improvement in CVD risks with the aid of an economic model. Clinical data between the periods of June 2007 to February 2010 were collected from electronic medical records at 2 separate clinics at Kaiser Permanente (KP) Northern California, 1 with primary care physicians only (control group) and the other with the addition of a pharmacist (enhanced care group). Patients in the enhanced care group were matched 1:1 with patients in the control group according to baseline characteristics that included age, gender, A1c, and Charlson comorbidity score. The estimated 10-year CVD risk for both groups was calculated by the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine (version 2) based on age, sex, race, smoking status, atrial fibrillation, duration of diabetes, levels of A1c, systolic BP (SBP) and TC, and high-density lipoprotein cholesterol (HDL-C) observed at 12 months. There was no statistical difference in the baseline clinical inputs to the Risk Engine (A1c [P=0.115], SBP [P=0

Observations of the Kaiser effect under multiaxial stress states: Implications for its use in determining in situ stress

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

Holcomb, D.J.

1993-10-08

Experimental tests of the Kaiser effect, the stress-history dependence of acoustic emission production, show that interactions between principal stresses cannot be ignored as is commonly done when trying to use the Kaiser effect to determine in situ stress. Experimental results obtained under multiaxial stress states are explained in terms of a qualitative model. The results show that the commonly-used technique of loading uniaxially along various directions to determine stress history must be reevaluated as it cannot be justified in terms of the laboratory experiments. One possible resolution of the conflict between laboratory and field results is that the Kaiser effectmore » phenomenon observed in cores retrieved from the earth is not the same phenomenon as is observed in rock loaded under laboratory conditions.« less

Meet your senior's online needs to compete in Medicare marketplace.

PubMed

1997-12-01

As more seniors turn to the Internet for health care information and services, is your organization prepared to meet their needs? Kaiser Permanente is reaching the cyber-senior market on the World Wide Web with interactive online services, including discussion groups with providers.

Physician involvement in disease management as part of the CCM.

PubMed

Wallace, Paul J

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I.

Physician Involvement in Disease Management as Part of the CCM

PubMed Central

Wallace, Paul J.

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I. PMID:17288075

TPMG Northern California appointments and advice call center.

PubMed

Conolly, Patricia; Levine, Leslie; Amaral, Debra J; Fireman, Bruce H; Driscoll, Tom

2005-08-01

Kaiser Permanente (KP) has been developing its use of call centers as a way to provide an expansive set of healthcare services to KP members efficiently and cost effectively. Since 1995, when The Permanente Medical Group (TPMG) began to consolidate primary care phone services into three physical call centers, the TPMG Appointments and Advice Call Center (AACC) has become the "front office" for primary care services across approximately 89% of Northern California. The AACC provides primary care phone service for approximately 3 million Kaiser Foundation Health Plan members in Northern California and responds to approximately 1 million calls per month across the three AACC sites. A database records each caller's identity as well as the day, time, and duration of each call; reason for calling; services provided to callers as a result of calls; and clinical outcomes of calls. We here summarize this information for the period 2000 through 2003.

75 FR 66302 - Establishment of Class E Airspace; Kaiser/Lake Ozark, MO

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

... Class E airspace for the Kaiser/Lake Ozark, MO, area to accommodate Area Navigation (RNAV) Standard Instrument Approach Procedures (SIAP) at Camdenton Memorial Airport, Camdenton, MO. The FAA is taking this action to enhance the safety and management of Instrument Flight Rule (IFR) operations at the airport...

Pathways: improving outcomes, not just 'cookbook medicine'.

PubMed

O'Malley, S

1997-04-01

A Kaiser Permanente medical director cites four benefits to be derived from using clinical guidelines: better outcomes, faster patient recovery, reduced costs, and increased physician accountability. And, he notes, physicians are free to deviate from the guidelines--so long as they can justify their actions.

Experience using radio frequency laptops to access the electronic medical record in exam rooms.

PubMed Central

Dworkin, L. A.; Krall, M.; Chin, H.; Robertson, N.; Harris, J.; Hughes, J.

1999-01-01

Kaiser Permanente, Northwest, evaluated the use of laptop computers to access our existing comprehensive Electronic Medical Record in exam rooms via a wireless radiofrequency (RF) network. Eleven of 22 clinicians who were offered the laptops successfully adopted their use in the exam room. These clinicians were able to increase their exam room time with the patient by almost 4 minutes (25%), apparently without lengthening their overall work day. Patient response to exam room computing was overwhelmingly positive. The RF network response time was similar to the hardwired network. Problems cited by some laptop users and many of the eleven non-adopters included battery issues, different equipment layout and function, and inadequate training. IT support needs for the RF laptops were two to four times greater than for hardwired desktops. Addressing the reliability and training issues should increase clinician acceptance, making a successful general roll-out for exam room computing more likely. PMID:10566458

The global diabetes model: user friendly version 3.0.

PubMed

Brown, J B; Russell, A; Chan, W; Pedula, K; Aickin, M

2000-11-01

The attributes of Release 3.0 of the user friendly version (UFV) of the global diabetes model (GDM) are described and documented in detail. The GDM is a continuous, stochastic microsimulation model of type 2 diabetes. Suitable for predicting the medical futures of both individuals with diabetes and representative diabetic populations, the GDM predicts medical events (complications of diabetes), survival, utilities, and medical care costs. Incidence rate functions for microvascular and macrovascular complications are based on a combination of published studies and analyses of data describing diabetic members of Kaiser Permanente Northwest Region, a non-profit group-model health maintenance organization. Active risk factors include average blood glucose (HbAlc), systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides, smoking status, and use of prophylactic aspirin. Events predicted include diabetic eye disease, diabetic nephropathy, peripheral neuropathy amputation, myocardial infarction, stroke, peripheral artery disease, congestive heart failure, coronary artery surgery, coronary angioplasty, and death.

Site support program plan for ICF Kaiser Hanford Company, Revision 1

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

NONE

1995-10-01

This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units.

DM programs take different roads to CHF success.

PubMed

2001-02-01

Improving CHF outcomes: There's no single right way. But there are some elements in common, as suggested by the experience of Duke, Kaiser Permanente, and First Priority Health. The challenge is to identify high-risk patients and provide as comprehensive an array of services as possible.

Maternal Infection during Pregnancy and Autism Spectrum Disorders

ERIC Educational Resources Information Center

Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K.; Van de Water, Judy; Croen, Lisa A.

2015-01-01

We conducted a nested case-control study including 407 cases and 2,075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No…

Developing a data infrastructure for a learning health system: the PORTAL network

PubMed Central

McGlynn, Elizabeth A; Lieu, Tracy A; Durham, Mary L; Bauck, Alan; Laws, Reesa; Go, Alan S; Chen, Jersey; Feigelson, Heather Spencer; Corley, Douglas A; Young, Deborah Rohm; Nelson, Andrew F; Davidson, Arthur J; Morales, Leo S; Kahn, Michael G

2014-01-01

The Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) network engages four healthcare delivery systems (Kaiser Permanente, Group Health Cooperative, HealthPartners, and Denver Health) and their affiliated research centers to create a new national network infrastructure that builds on existing relationships among these institutions. PORTAL is enhancing its current capabilities by expanding the scope of the common data model, paying particular attention to incorporating patient-reported data more systematically, implementing new multi-site data governance procedures, and integrating the PCORnet PopMedNet platform across our research centers. PORTAL is partnering with clinical research and patient experts to create cohorts of patients with a common diagnosis (colorectal cancer), a rare diagnosis (adolescents and adults with severe congenital heart disease), and adults who are overweight or obese, including those with pre-diabetes or diabetes, to conduct large-scale observational comparative effectiveness research and pragmatic clinical trials across diverse clinical care settings. PMID:24821738

Leveraging Geographic Information Systems in an Integrated Health Care Delivery Organization

PubMed Central

Clift, Kathryn; Scott, Luther; Johnson, Michael; Gonzalez, Carlos

2014-01-01

A handful of the many changes resulting from the Affordable Care Act underscore the need for a geographic understanding of existing and prospective member communities. Health exchanges require that health provider networks are geographically accessible to underserved populations, and nonprofit hospitals nationwide are required to conduct community health needs assessments every three years. Beyond these requirements, health care providers are using maps and spatial analysis to better address health outcomes that are related in complex ways to social and economic factors. Kaiser Permanente is applying geographic information systems, with spatial analytics and map-based visualizations, to data sourced from its electronic medical records and from publicly and commercially available datasets. The results are helping to shape an understanding of the health needs of Kaiser Permanente members in the context of their communities. This understanding is part of a strategy to inform partnerships and interventions in and beyond traditional care delivery settings. PMID:24694317

Joint Venture Arrangement for RN to BSN: A Model of Synergy between Academia and Service.

ERIC Educational Resources Information Center

Bargagliotti, L. Antoinette; And Others

1991-01-01

Joint venture among educational and practice institutions is well on its way toward becoming the norm in nursing education and practice. Kaiser Permanente and the University of San Francisco School of Nursing offer a venture that allows registered nurses to pursue a bachelor of science in nursing degree. (JOW)

Community Resources for Promoting Youth Nutrition and Physical Activity

ERIC Educational Resources Information Center

Moore, Kelly R.; McGowan, Melissa K.; Donato, Karen A.; Kollipara, Sobha; Roubideaux, Yvette

2009-01-01

Childhood obesity is a national public health crisis. The National Diabetes Education Program (NDEP), the National Institutes of Health and Kaiser Permanente have developed community tools and resources for children and families to lower their risk for obesity through healthier, active lifestyles. The authors describe innovative practices and…

Crack Identification in CFRP Laminated Beams Using Multi-Resolution Modal Teager–Kaiser Energy under Noisy Environments

PubMed Central

Xu, Wei; Cao, Maosen; Ding, Keqin; Radzieński, Maciej; Ostachowicz, Wiesław

2017-01-01

Carbon fiber reinforced polymer laminates are increasingly used in the aerospace and civil engineering fields. Identifying cracks in carbon fiber reinforced polymer laminated beam components is of considerable significance for ensuring the integrity and safety of the whole structures. With the development of high-resolution measurement technologies, mode-shape-based crack identification in such laminated beam components has become an active research focus. Despite its sensitivity to cracks, however, this method is susceptible to noise. To address this deficiency, this study proposes a new concept of multi-resolution modal Teager–Kaiser energy, which is the Teager–Kaiser energy of a mode shape represented in multi-resolution, for identifying cracks in carbon fiber reinforced polymer laminated beams. The efficacy of this concept is analytically demonstrated by identifying cracks in Timoshenko beams with general boundary conditions; and its applicability is validated by diagnosing cracks in a carbon fiber reinforced polymer laminated beam, whose mode shapes are precisely acquired via non-contact measurement using a scanning laser vibrometer. The analytical and experimental results show that multi-resolution modal Teager–Kaiser energy is capable of designating the presence and location of cracks in these beams under noisy environments. This proposed method holds promise for developing crack identification systems for carbon fiber reinforced polymer laminates. PMID:28773016

Mineralogical control on thermal damage and the presence of a thermal Kaiser effect during temperature-cycling experiments

NASA Astrophysics Data System (ADS)

Browning, J.; Daoud, A.; Meredith, P. G.; Mitchell, T. M.

2017-12-01

Volcanic and geothermal systems are in part controlled by the mechanical and thermal stresses acting on them and so it is important to understand the response of volcanic rocks to thermo-mechanical loading. One such response is the well-known `Kaiser stress-memory' effect observed under cyclic mechanical loading. By contrast, the presence of an analogous `Kaiser temperature-memory effect' during cyclic thermal loading has received little attention. We have therefore explored the possibility of a Kaiser temperature-memory effect using three igneous rocks of different composition, grain size and origin; Slaufrudalur Granophyre (SGP), Nea Kameni Andesite (NKA) and Seljadalur Basalt (SB). We present results from a series of thermal stressing experiments in which acoustic emissions (AE) were recorded contemporaneously with changing temperature. Samples of each rock were subjected to both a single heating and cooling cycle to a maximum temperature of 900 °C and multiple heating/cooling cycles to peak temperatures of 350°C, 500°C, 700°C and 900 °C (all at a constant rate of 1°C/min on heating and a natural cooling rate of <1°C/min). Porosity, permeability and P-wave velocity measurements were made on each sample both before and after thermal treatment. We use the onset of AEs as a proxy for the onset of thermal cracking. This clearly demonstrates the presence of a Kaiser temperature-memory effect in SGP, but not in either NKA and SB. We further find that the vast majority of thermal crack damage is generated upon cooling in the finer grained materials (NKA and SB), but that substantial thermal crack damage is generated during heating in the coarser grained SGP. The total amount of crack damage generated due to heating or cooling is dependent on the mineral composition and, most importantly, the grain size and arrangement, as well as the maximum temperature to which the rock is exposed. Knowledge of thermal stress history and the presence of a Kaiser temperature

Restorative Integral Support (RIS) for Older Adults Experiencing Co-Occurring Disorders

ERIC Educational Resources Information Center

Larkin, Heather; MacFarland, Nicole S.

2012-01-01

The Restorative Integral Support (RIS) model is a whole person response that assists people to overcome adversity. The Adverse Childhood Experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems.…

A Single Subject Evaluation of the K-P Diet for Hyperkinesis.

ERIC Educational Resources Information Center

Burlton-Bennet, Jocelyn A.; Robinson, Viviane M. J.

1987-01-01

A single subject ABAB design was employed to determine the effectiveness of the Feingold Kaiser Permanente (K-P) diet in the treatment of a six-year-old hyperkinetic male. Results indicated the K-P diet was effective in controlling the subject's hyperkinesis, nutritionally adequate, and moderately difficult to implement. (Author/DB)

75 FR 61246 - Kaiser Federal Financial Group, Inc., Covina, CA; Approval of Conversion Application

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-04

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision [AC-51: OTS No. H-4729] Kaiser Federal Financial Group, Inc., Covina, CA; Approval of Conversion Application Notice is hereby given that on September 28, 2010, the Office of Thrift Supervision approved the application of K-Fed Mutual Holding...

Diagnosing the Kaiser: Psychiatry, Wilhelm II and the Question of German War Guilt The William Bynum Prize Essay 2016.

PubMed

Freis, David

2018-07-01

After his abdication in November 1918, the German emperor Wilhelm II continued to haunt the minds of his people. With the abolition of the lese-majesty laws in the new republic, many topics that were only discussed privately or obliquely before could now be broached openly. One of these topics was the mental state of the exiled Kaiser. Numerous psychiatrists, physicians and laypeople published their diagnoses of Wilhelm in high-circulation newspaper articles, pamphlets, and books shortly after the end of the war. Whether these diagnoses were accurate and whether the Kaiser really was mentally ill became the issue of a heated debate.This article situates these diagnoses of Wilhelm II in their political context. The authors of these diagnoses - none of whom had met or examined Wilhelm II in person - came from all political camps and they wrote with very different motives in mind. Diagnosing the exiled Kaiser as mentally ill was a kind of exorcism of the Hohenzollern rule, opening the way for either a socialist republic or the hoped-for rule of a new leader. But more importantly, it was a way to discuss and allocate political responsibility and culpability. Psychiatric diagnoses were used to exonerate both the Emperor (for whom the treaty of Versailles provided a tribunal as war criminal) and the German nation. They were also used to blame the Kaiser's entourage and groups that had allegedly manipulated the weak-willed monarch. Medical concepts became a vehicle for a debate on the key political questions in interwar Germany.

Vincristine-associated Neuropathy With Antifungal Usage: A Kaiser Northern California Experience.

PubMed

Nikanjam, Mina; Sun, Aida; Albers, Mark; Mangalindin, Kristine; Song, Eyun; Vempaty, Hyma; Sam, Danny; Capparelli, Edmund V

2018-05-16

The dose-limiting toxicity for vincristine is peripheral neuropathy which can be potentiated with concurrent usage of azole antifungals. The current retrospective study assessed the incidence of concurrent vincristine and azole antifungal usage to determine if it led to increased neurotoxicity for the Kaiser Northern California pediatric acute lymphoblastic leukemia (ALL) and Hodgkin lymphoma patient population. Data were obtained from the electronic medical record (2007 to 2014). In total, 130 subjects received at least one dose of vincristine for ALL or Hodgkin lymphoma (median age 9, 88% ALL, 58% male, 47% Caucasian). Thirty one percent of patients received concurrent antifungal usage (fluconazole, 78%; voriconazole, 10%; fluconazole/voriconazole, 12%); however, concurrent antifungal usage accounted for <15% of vincristine doses. Grade 2 or greater neuropathy occurred in 51% of patients; grade 3 neuropathy was present in 8% of patients. No difference in the incidence of grade 2 or greater neuropathy was observed with the concurrent use of antifungal therapy (P=0.35), sex (P=0.59), type of cancer (P=0.41), ethnicity (P=0.29), or age (P=0.39), but was higher with increasing amount of vincristine doses (P=0.004). These results suggest that concurrent azole antifungal usage with vincristine for patients with ALL and Hodgkin lymphoma was low in the Kaiser Northern California population and limited usage as needed may be reasonable and safe.

Antenatal Ultrasound and Risk of Autism Spectrum Disorders

ERIC Educational Resources Information Center

Grether, Judith K.; Li, Sherian Xu; Yoshida, Cathleen K.; Croen, Lisa A.

2010-01-01

We evaluated antenatal ultrasound (U/S) exposure as a risk factor for autism spectrum disorders (ASD), comparing affected singleton children and control children born 1995-1999 and enrolled in the Kaiser Permanente health care system. Among children with ASD (n = 362) and controls (n = 393), 13% had no antenatal exposure to U/S examinations;…

Developing a data infrastructure for a learning health system: the PORTAL network.

PubMed

McGlynn, Elizabeth A; Lieu, Tracy A; Durham, Mary L; Bauck, Alan; Laws, Reesa; Go, Alan S; Chen, Jersey; Feigelson, Heather Spencer; Corley, Douglas A; Young, Deborah Rohm; Nelson, Andrew F; Davidson, Arthur J; Morales, Leo S; Kahn, Michael G

2014-01-01

The Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) network engages four healthcare delivery systems (Kaiser Permanente, Group Health Cooperative, HealthPartners, and Denver Health) and their affiliated research centers to create a new national network infrastructure that builds on existing relationships among these institutions. PORTAL is enhancing its current capabilities by expanding the scope of the common data model, paying particular attention to incorporating patient-reported data more systematically, implementing new multi-site data governance procedures, and integrating the PCORnet PopMedNet platform across our research centers. PORTAL is partnering with clinical research and patient experts to create cohorts of patients with a common diagnosis (colorectal cancer), a rare diagnosis (adolescents and adults with severe congenital heart disease), and adults who are overweight or obese, including those with pre-diabetes or diabetes, to conduct large-scale observational comparative effectiveness research and pragmatic clinical trials across diverse clinical care settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Personal health record use and association with immunizations and well-child care visits recommendations.

PubMed

Tom, Jeffrey O; Chen, Chuhe; Zhou, Yi Yvonne

2014-01-01

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations. For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P < .05). PHR use was associated with better adherence to WCC visit recommendations for both KP Hawaii (OR 1.9, 95% CI 1.3-2.9, P < .001) and KP Northwest (OR 2.5, 95% CI 2.1-2.9, P < .001). Young children whose parents used a PHR were more likely to adhere to the recommended WCC visits in both regions but immunizations in only 1 region. Copyright © 2014 Mosby, Inc. All rights reserved.

Consider outsourcing IT projects when cutting-edge technology, specialized focus are needed.

PubMed

1999-05-01

Looking outside to meet information technology needs proves a smart way to avert extra staffing costs. Kaiser Permanente saves thousands each year by contracting out cutting-edge IT projects instead of hiring more full-time staff it doesn't need. Learn how the organization incorporates outsourcing and other temporary work methods into its IT staffing strategy.

Surveillance lessons from first-wave pandemic (H1N1) 2009, Northern California, USA.

PubMed

Baxter, Roger

2010-03-01

After the appearance of pandemic (H1N1) 2009 in April 2009, influenza activity was monitored within the Kaiser Permanente Northern California division by using laboratory, pharmacy, telephone calls, and utilization (services patients received) data. A combination of testing and utilization data showed a pattern of disease activity, but this pattern may have been affected by public perception of the epidemic.

Using a High-Performance Planning Model to Increase Levels of Functional Effectiveness Within Professional Development.

PubMed

Winter, Peggi

2016-01-01

Nursing professional practice models continue to shape how we practice nursing by putting families and members at the heart of everything we do. Faced with enormous challenges around healthcare reform, models create frameworks for practice by unifying, uniting, and guiding our nurses. The Kaiser Permanente Practice model was developed to ensure consistency for nursing practice across the continuum. Four key pillars support this practice model and the work of nursing: quality and safety, leadership, professional development, and research/evidence-based practice. These four pillars form the foundation that makes transformational practice possible and aligns nursing with Kaiser Permanente's mission. The purpose of this article is to discuss the pillar of professional development and the components of the Nursing Professional Development: Scope and Standards of Practice model (American Nurses Association & National Nursing Staff Development Organization, 2010) and place them in a five-level development framework. This process allowed us to identify the current organizational level of practice, prioritize each nursing professional development component, and design an operational strategy to move nursing professional development toward a level of high performance. This process is suggested for nursing professional development specialists.

Physician-Owned Surgical Hospitals Outperform Other Hospitals in Medicare Value-Based Purchasing Program.

PubMed

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-10-01

The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals and creates financial incentives for quality improvement and fosters increased transparency. Limited information is available comparing hospital performance across health care business models. The 2015 Hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Of 3,089 hospitals with total performance scores, categories of representative health care business models included 104 physician-owned surgical hospitals, 111 University HealthSystem Consortium, 14 US News & World Report Honor Roll hospitals, 33 Kaiser Permanente, and 124 Pioneer accountable care organization affiliated hospitals. Estimated mean total performance scores for physician-owned surgical hospitals (64.4; 95% CI, 61.83-66.38) and Kaiser Permanente (60.79; 95% CI, 56.56-65.03) were significantly higher compared with all remaining hospitals, and University HealthSystem Consortium members (36.8; 95% CI, 34.51-39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included physician-owned surgical hospitals (mean 2.32; p < 0.0001), US News & World Report honorees (mean 2.24; p = 0.0140), and University HealthSystem Consortium members (mean 1.99; p < 0.0001), and Kaiser Permanente hospitals had lower case mix value (mean 1.54; p < 0.0001). Re-estimation of total performance scores did not change the original results after adjustment for differences in hospital case mix index. The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals can guide value improvement and policy-making decisions for all Medicare Value

Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System.

PubMed

Nguyen-Huynh, Mai N; Klingman, Jeffrey G; Avins, Andrew L; Rao, Vivek A; Eaton, Abigail; Bhopale, Sunil; Kim, Anne C; Morehouse, John W; Flint, Alexander C

2018-01-01

Faster treatment with intravenous alteplase in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California redesigned its acute stroke workflow across all 21 Kaiser Permanente Northern California stroke centers to (1) follow a single standardized version of a modified Helsinki model and (2) have all emergency stroke cases managed by a dedicated telestroke neurologist. We examined the effect of Kaiser Permanente Northern California's Stroke EXpediting the PRrocess of Evaluating and Stopping Stroke program on door-to-needle (DTN) time, alteplase use, and symptomatic intracranial hemorrhage rates. The program was introduced in a staggered fashion from September 2015 to January 2016. We compared DTN times for a seasonally adjusted 9-month period at each center before implementation to the corresponding 9-month calendar period from the start of implementation. The primary outcome was the DTN time for alteplase administration. Secondary outcomes included rate of alteplase administrations per month, symptomatic intracranial hemorrhage, and disposition at time of discharge. This study included 310 patients treated with alteplase in the pre-EXpediting the PRrocess of Evaluating and Stopping Stroke period and 557 patients treated with alteplase in the EXpediting the PRrocess of Evaluating and Stopping Stroke period. After implementation, alteplase administrations increased to 62/mo from 34/mo at baseline ( P <0.001). Median DTN time decreased to 34 minutes after implementation from 53.5 minutes prior ( P <0.001), and DTN time of <60 minutes was achieved in 87.1% versus 61.0% ( P <0.001) of patients. DTN times <30 minutes were much more common in the Stroke EXpediting the PRrocess of Evaluating and Stopping Stroke period (40.8% versus 4.2% before implementation). There was no significant difference in symptomatic intracranial hemorrhage rates in the 2 periods (3.8% versus 2.2% before implementation; P =0.29). Introduction

The greatest challenges reported by long-term colorectal cancer survivors with stomas.

PubMed

McMullen, Carmit K; Hornbrook, Mark C; Grant, Marcia; Baldwin, Carol M; Wendel, Christopher S; Mohler, M Jane; Altschuler, Andrea; Ramirez, Michelle; Krouse, Robert S

2008-04-01

This paper presents a qualitative analysis of the greatest challenges reported by long-term colorectal cancer survivors with ostomies. Surveys that included an open-ended question about challenges of living with an ostomy were administered at three Kaiser Permanente regions: Northern California, Northwest, and Hawaii. The study was coordinated at the Southern Arizona Veterans Affairs Health Care System in Tucson. The City of Hope Quality of Life Model for Ostomy Patients provided a framework for the study's design, measures, data collection, and data analysis. The study's findings may be generalized broadly to community settings across the United States. Results replicate those of previous research among veterans, California members of the United Ostomy Association, Koreans with ostomies, and colorectal cancer survivors with ostomies residing in the United Kingdom. The greatest challenges reported by 178 colorectal cancer survivors with ostomies confirmed the Institute of Medicine's findings that survivorship is a distinct, chronic phase of cancer care and that cancer's effects are broad and pervasive. The challenges reported by study participants should inform the design, testing and integration of targeted education, early interventions, and ongoing support services for colorectal cancer patients with ostomies.

The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties.

PubMed

Dillon, Mark T; Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

2015-06-01

Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.

Marijuana use and mortality.

PubMed Central

Sidney, S; Beck, J E; Tekawa, I S; Quesenberry, C P; Friedman, G D

1997-01-01

OBJECTIVES: The purpose of this study was to examine the relationship of marijuana use to mortality. METHODS: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. RESULTS: Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. CONCLUSIONS: Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women. PMID:9146436

Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

PubMed Central

Leutz, Walter; Nonnenkamp, Lucy; Dickinson, Lynn; Brody, Kathleen

2005-01-01

Abstract Purpose Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO) demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB) care at Kaiser Permanente Northwest (KPNW), serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC). Methods We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180) and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day care

Application of the Teager-Kaiser energy operator in bearing fault diagnosis.

PubMed

Henríquez Rodríguez, Patricia; Alonso, Jesús B; Ferrer, Miguel A; Travieso, Carlos M

2013-03-01

Condition monitoring of rotating machines is important in the prevention of failures. As most machine malfunctions are related to bearing failures, several bearing diagnosis techniques have been developed. Some of them feature the bearing vibration signal with statistical measures and others extract the bearing fault characteristic frequency from the AM component of the vibration signal. In this paper, we propose to transform the vibration signal to the Teager-Kaiser domain and feature it with statistical and energy-based measures. A bearing database with normal and faulty bearings is used. The diagnosis is performed with two classifiers: a neural network classifier and a LS-SVM classifier. Experiments show that the Teager domain features outperform those based on the temporal or AM signal. Copyright © 2012 ISA. Published by Elsevier Ltd. All rights reserved.

1. View from the northwest of the bridge's northwest (upstream) ...

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

1. View from the northwest of the bridge's northwest (upstream) elevation - Big Cottonwood River Bridge No. 246, Spanning Big Cottonwood River at Cottonwood Street (City Road No. 165), New Ulm, Brown County, MN

Similar Risk Patterns After Cervical Screening in Two Large U.S. Populations: Implications for Clinical Guidelines.

PubMed

Gage, Julia C; Hunt, William C; Schiffman, Mark; Katki, Hormuzd A; Cheung, Li A; Myers, Orrin; Cuzick, Jack; Wentzensen, Nicolas; Kinney, Walter; Castle, Philip E; Wheeler, Cosette M

2016-12-01

To compare the risks of histologic high-grade cervical intraepithelial neoplasia (CIN) or worse after different cervical cancer screening test results between two of the largest U.S. clinical practice research data sets. The New Mexico Human Papillomavirus (HPV) Pap Registry is a statewide registry representing a diverse population experiencing varied clinical practice delivery. Kaiser Permanente Northern California is a large integrated health care delivery system practicing routine HPV cotesting since 2003. In this retrospective cohort study, a logistic-Weibull survival model was used to estimate and compare the cumulative 3- and 5-year risks of histologic CIN 3 or worse among women aged 21-64 years screened in 2007-2011 in the New Mexico HPV Pap Registry and 2003-2013 in Kaiser Permanente Northern California. Results were stratified by age and baseline screening result: negative cytology, atypical squamous cells of undetermined significance (ASC-US) (with or without HPV triage), low-grade squamous intraepithelial lesion, and high-grade squamous intraepithelial lesion. There were 453,618 women in the New Mexico HPV Pap Registry and 1,307,528 women at Kaiser Permanente Northern California. The 5-year CIN 3 or worse risks were similar within screening results across populations: cytology negative (0.52% and 0.30%, respectively, P<.001), HPV-negative and ASC-US (0.72% and 0.49%, respectively, P=.5), ASC-US (3.4% and 3.4%, respectively, P=.8), HPV-positive and ASC-US (7.7% and 7.1%, respectively, P=.3), low-grade squamous intraepithelial lesion (6.5% and 5.4%, respectively, P=.009), and high-grade squamous intraepithelial lesion (53.1% and 50.4%, respectively, P=.2). Cervical intraepithelial neoplasia grade 2 or worse risks and 3-year risks had similar trends across populations. Age-stratified analyses showed more variability, especially among women aged younger than 30 years, but patterns of risk stratification were comparable. Current U.S. cervical screening and

Genetics as a modernization program: biological research at the Kaiser Wilhelm Institutes and the political economy of the Nazi State.

PubMed

Gausemeier, Bernd

2010-01-01

During the Third Reich, the biological institutes of the Kaiser Wilhelm Society (KWG, Kaiser-Wilhelm-Gesellschaft) underwent a substantial reorganization and modernization. This paper discusses the development of projects in the fields of biochemical genetics, virus research, radiation genetics, and plant genetics that were initiated in those years. These cases exemplify, on the one hand, the political conditions for biological research in the Nazi state. They highlight how leading scientists advanced their projects by building close ties with politicians and science-funding organizations and companies. On the other hand, the study examines how the contents of research were shaped by, and how they contributed to, the aims and needs of the political economy of the Nazi system. This paper therefore aims not only to highlight basic aspects of scientific development under Nazism, but also to provide general insights into the structure of the Third Reich and the dynamics of its war economy.

Northwester upstairs room of northwest wing looking southeast through stair ...

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

Northwester upstairs room of northwest wing looking southeast through stair landing and hallway to southeast room. note far floorboard with smoke damage between historic joists; modern joists in stair landing. - Scheetz Farm, House, 7161 Camp Hill Road, Fort Washington, Montgomery County, PA

Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

PubMed

Monroe, C Douglas; Chin, Karen Y

2013-05-01

The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

Comparison of paper and electronic surveys for measuring patient-reported outcomes after anterior cruciate ligament reconstruction.

PubMed

Bojcic, Jamie L; Sue, Valerie M; Huon, Tomy S; Maletis, Gregory B; Inacio, Maria C S

2014-01-01

This study compared response rates of paper and electronic versions of the Knee injury Osteoarthritis and Outcome Score questionnaire and examined the characteristics of patients who responded to each survey method. A total of 1486 patients registered by the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry between 2005 and 2010 were included in this study. Response rates by survey modality for the overall cohort, by the specific time periods, and by age and sex at time of anterior cruciate ligament reconstruction were compared using χ(2) tests or the Fisher exact test when appropriate. Independent Student t tests were used to compare the Knee injury Osteoarthritis and Outcome Scores of survey respondents. The overall survey response rate was 42%. The 36% response rate in the electronic-survey group was significantly higher than the 22% response rate in the paper-survey group (p < 0.001). The electronic response rate was also significantly higher than the paper response rate at all follow-up times (35% vs 25% at 1 year, p = 0.004, 38% vs 20% at 2 years, p < 0.001, and 35% vs 21% at 3 years; p < 0.001) and among all age groups 19 years and older. Although the electronic survey produced higher response rates, it is not sufficient alone to replace the traditional paper version among this Kaiser Permanente population.

Using Population Dose to Evaluate Community-level Health Initiatives.

PubMed

Harner, Lisa T; Kuo, Elena S; Cheadle, Allen; Rauzon, Suzanne; Schwartz, Pamela M; Parnell, Barbara; Kelly, Cheryl; Solomon, Loel

2018-05-01

Successful community-level health initiatives require implementing an effective portfolio of strategies and understanding their impact on population health. These factors are complicated by the heterogeneity of overlapping multicomponent strategies and availability of population-level data that align with the initiatives. To address these complexities, the population dose methodology was developed for planning and evaluating multicomponent community initiatives. Building on the population dose methodology previously developed, this paper operationalizes dose estimates of one initiative targeting youth physical activity as part of the Kaiser Permanente Community Health Initiative, a multicomponent community-level obesity prevention initiative. The technical details needed to operationalize the population dose method are explained, and the use of population dose as an interim proxy for population-level survey data is introduced. The alignment of the estimated impact from strategy-level data analysis using the dose methodology and the data from the population-level survey suggest that dose is useful for conducting real-time evaluation of multiple heterogeneous strategies, and as a viable proxy for existing population-level surveys when robust strategy-level evaluation data are collected. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Physician-owned Surgical Hospitals Outperform Other Hospitals in the Medicare Value-based Purchasing Program

PubMed Central

Ramirez, Adriana G; Tracci, Margaret C; Stukenborg, George J; Turrentine, Florence E; Kozower, Benjamin D; Jones, R Scott

2016-01-01

Background The Hospital Value-Based Purchasing Program measures value of care provided by participating Medicare hospitals while creating financial incentives for quality improvement and fostering increased transparency. Limited information is available comparing hospital performance across healthcare business models. Study Design 2015 hospital Value-Based Purchasing Program results were used to examine hospital performance by business model. General linear modeling assessed differences in mean total performance score, hospital case mix index, and differences after adjustment for differences in hospital case mix index. Results Of 3089 hospitals with Total Performance Scores (TPS), categories of representative healthcare business models included 104 Physician-owned Surgical Hospitals (POSH), 111 University HealthSystem Consortium (UHC), 14 US News & World Report Honor Roll (USNWR) Hospitals, 33 Kaiser Permanente, and 124 Pioneer Accountable Care Organization affiliated hospitals. Estimated mean TPS for POSH (64.4, 95% CI 61.83, 66.38) and Kaiser (60.79, 95% CI 56.56, 65.03) were significantly higher compared to all remaining hospitals while UHC members (36.8, 95% CI 34.51, 39.17) performed below the mean (p < 0.0001). Significant differences in mean hospital case mix index included POSH (mean 2.32, p<0.0001), USNWR honorees (mean 2.24, p 0.0140) and UHC members (mean =1.99, p<0.0001) while Kaiser Permanente hospitals had lower case mix value (mean =1.54, p<0.0001). Re-estimation of TPS did not change the original results after adjustment for differences in hospital case mix index. Conclusions The Hospital Value-Based Purchasing Program revealed superior hospital performance associated with business model. Closer inspection of high-value hospitals may guide value improvement and policy-making decisions for all Medicare Value-Based Purchasing Program Hospitals. PMID:27502368

Somatic mutations in benign breast disease tissue and risk of subsequent invasive breast cancer.

PubMed

Rohan, Thomas E; Miller, Christopher A; Li, Tiandao; Wang, Yihong; Loudig, Olivier; Ginsberg, Mindy; Glass, Andrew; Mardis, Elaine

2018-06-06

Insights into the molecular pathogenesis of breast cancer might come from molecular analysis of tissue from early stages of the disease. We conducted a case-control study nested in a cohort of women who had biopsy-confirmed benign breast disease (BBD) diagnosed between 1971 and 2006 at Kaiser Permanente Northwest and who were followed to mid-2015 to ascertain subsequent invasive breast cancer (IBC); cases (n = 218) were women with BBD who developed subsequent IBC and controls, individually matched (1:1) to cases, were women with BBD who did not develop IBC in the same follow-up interval as that for the corresponding case. Targeted sequence capture and sequencing were performed for 83 genes of importance in breast cancer. There were no significant case-control differences in mutation burden overall, for non-silent mutations, for individual genes, or with respect either to the nature of the gene mutations or to mutational enrichment at the pathway level. For seven subjects with DNA from the BBD and ipsilateral IBC, virtually no mutations were shared. This study, the first to use a targeted multi-gene sequencing approach on early breast cancer precursor lesions to investigate the genomic basis of the disease, showed that somatic mutations detected in BBD tissue were not associated with breast cancer risk.

[The Internet and shared decision-making between patients and healthcare providers].

PubMed

Silber, Denise

2009-10-01

Insurance companies like Kaiser Permanente in the United States remunerate physicians for their email correspondence with patients, increasing the efficiency of office visits. A survey by the French National Board of Physicians regarding the computerization of medical practices in April 2009, confirms that both physicians and patients in France are very favorable to the development of these tools. When patients can manage and/or access their medical files and determine which providers can access them, they become a true partner.

Resistance Tests of a 1/16 Size Model of the Hughes-kaiser Flying Boat, NACA Model 183

NASA Technical Reports Server (NTRS)

Posner, Jack; Woodward, David R.; Olson, Roland E.

1944-01-01

Tank tests were made of a hull model of the Hughes-Kaiser cargo airplane for estimates of take-off performance and maximum gross load for take-off. At hump speeds, with the model free to trim, the trim and resistance were high, which resulted in a load-resistance ratio of approximately 4.0 for a gross load coefficient of 0.75. With a 4000,000-lb load, the full size craft may take off in 69 sec over a distance of 5600 ft.

Type C investigation of electrical fabrication projects in ICF Kaiser shops

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

Huckfeldt, R.A.

1995-06-01

A Type C Investigation Board was convened to investigate an electrical miswiring problem found during the operation of the electrical distribution trailer for the TWRS Rotary Mode Core Sampling Truck {number_sign}2. The trailer was designed by WHC and fabricated ICF KH on site for use in the Characterization Program. This problem resulted in a serious safety hazard since the support truck frame/chassis became electrically energized. This final report provides results of the ``Type C Investigation, Electrical Fabrication Projects in ICF KH Shops, June, 1995.`` It contains the investigation scope, executive summary, relevant facts, analysis, conclusions and corrective actions. DOE Ordermore » 5484.1, ``Environmental Protection, Safety and Health Protection Information Reporting Requirements,`` was followed in preparation of this report. Because the incident was electrical in nature and involved both Westinghouse Hanford Company and ICF Kaiser Hanford organizations, the board included members from both contractors and members with considerable electrical expertise.« less

Kaiser and Felicity effects and their application for evaluation of concrete by acoustic emission method

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

Nesvijski, E.; Nesvijski, T.

1996-12-31

Concrete as one of the main construction materials, which is used for building of industrial and civil structures, highways, bridges, etc. requires periodical evaluation of its properties by different nondestructive methods. Application of acoustic emission (AE) for these purposes occupies a modest place among other nondestructive methods. But the AE methods proved to be very effective for testing of concrete and reinforced concrete elements and structures under load. This work is devoted to an important, from methodological point of view, problem connected with two opposite effects: of Kaiser and of Felicity, and their application for evaluation of concrete by themore » AE method.« less

Rapid spread of complex change: a case study in inpatient palliative care.

PubMed

Della Penna, Richard; Martel, Helene; Neuwirth, Esther B; Rice, Jennifer; Filipski, Marta I; Green, Jennifer; Bellows, Jim

2009-12-29

Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC). Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

Effect of direct physician involvement on tobacco abstinence rates and other variables affecting participants of a freedom from tobacco class.

PubMed

Ismail, Mohamed H; Ho, Ngoc J; Lara, Nancy Irazu

2013-01-01

Kaiser Permanente measures how often tobacco users are offered strategies to quit but not the success of such strategies. To compare tobacco abstinence rates for participants of the Kaiser Permanente Riverside (California) Medical Center's Freedom from Tobacco Class in 2008, before direct physician involvement, and in 2009, after direct physician involvement, and to compare other variables affecting these rates. In a retrospective study, participants were divided into two groups based on year of participation. Data were collected using electronic medical records and phone interviews. Tobacco use status between both groups at 1, 3, 6, and 12 months after the classes started and within groups by sex, number of classes attended, medication received, and class teacher. The 12-month abstinence rates were 27% in 2008 and 33% in 2009 (p = 0.3). The abstinence rate for men improved from 23% to 38% (2008 vs 2009; p = 0.05), whereas for women it was 30% vs 27% (p = 0.7). Abstinence rates decreased over time for the group as a whole (p < 0.001). Attendance of 6 or more classes was associated with higher abstinence rates. There was no significant impact on abstinence rates due to age, body mass index, class teacher, or medications used. Direct physician involvement improved men's but not women's abstinence rates among class participants. The relapse rate was significant over the first year after the class. Further research is needed to study the difference between sexes and the factors affecting relapse.

Achieving performance breakthroughs in an HMO business process through quality planning.

PubMed

Hanan, K B

1993-01-01

Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

Does Consuming Sugar and Artificial Sweeteners Change Taste Preferences?

PubMed

Bartolotto, Carole

2015-01-01

Americans consume 22.3 teaspoons of added caloric sweeteners a day. Sweeteners range from 180 to 13,000 times sweeter than sugar. In summer 2014, 20 people from Kaiser Permanente California facilities cut out all added sugars and artificial sweeteners for 2 weeks: 95% of participants found that sweet foods and drinks tasted sweeter or too sweet, 75% found that other foods tasted sweeter, and 95% said moving forward they would use less or even no sugar. Additionally, 86.6% of participants stopped craving sugar after 6 days.

Energy Assessment Helps Kaiser Aluminum Save Energy and Improve Productivity; DOE Software Adopted as Standard for Analyzing Plant Process Heating Systems Company-Wide

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

Not Available

2008-07-01

This case study describes how the Kaiser Aluminum plant in Sherman, Texas, achieved annual savings of $360,000 and 45,000 MMBtu, and improved furnace energy intensity by 11.1% after receiving a DOE Save Energy Now energy assessment and implementing recommendations to improve the efficiency of its process heating system.

Selection bias between 2 Medicare capitated benefit programs.

PubMed

Leutz, Walter; Brody, Kathleen K; Nonnenkamp, Lucy L; Perrin, Nancy A

2007-04-01

To assess enrollment selection bias between a standard Medicare health maintenance organization (HMO) and a higher-priced social health maintenance organization (SHMO) offering full prescription drug and unique home-based and community-based benefits and to assess how adverse selection was handled through SHMO finances. Kaiser Permanente Northwest offered the dual-choice option in the greater Portland region from 1985 to 2002. Analysis focused on 3 "choice points" when options were clear and highlighted for beneficiaries. Data collected included age and sex, utilization 1 year before and after the choice points, health status data at enrollment (1999-2002 only), mortality, and cost and revenues. Data were extracted from health plan databases. Hospital, pharmacy, and nursing facility utilization for 1 year before and after the choice points are compared for HMO and SHMO choosers. Health and functional status data are compared from 1999 to 2002. Utilization and mortality data are controlled by age and sex. SHMO joiners evidenced adverse selection, while healthier members tended to stay in the HMO, with leaner benefits. Despite adverse selection, the health plan maintained margins in the SHMO, assisted by frailty-adjusted Medicare payments and member premiums. This high-low option strategy sought to offer the "right care at the right time" and may be a model for managed care organizations to serve aging and disabled beneficiaries under Medicare's new special needs plan option.

PACIFIC NORTHWEST CYBER SUMMIT

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

Lesperance, Ann M.; Matlock, Gordon W.; Becker-Dippmann, Angela S.

2013-08-07

On March 26, 2013, the Snohomish County Public Utility District (PUD) and the U.S. Department of Energy’s (DOE’s) Pacific Northwest National Laboratory (PNNL) jointly hosted the Pacific Northwest Cyber Summit with the DOE’s Office of Electricity Delivery and Energy Reliability, the White House, Washington State congressional delegation, Washington State National Guard, and regional energy companies.

Caregiver involvement in a large clinical systems project.

PubMed Central

Sales, S.; Mathews, P.; Gamblin, D.; Gee, S.

1994-01-01

The Kaiser Permanente Northern California Region (KPNCR) CareGiver Workstation (CGW) Project's mission is to develop and implement a clinical workstation system that will enhance each caregiver-member interaction and aid in the decision-making processes of direct patient care in the inpatient and outpatient settings. The requirements analysis approach for CareGiver Workstation (CGW) is based on the belief that extensive caregiver involvement will provide a better understanding of the diverse needs of Kaiser Permanente Northern California Region (KPNCR). In order to involve as many caregivers as reasonably possible, CGW included a 16 member caregiver core team and 6 different Medical Centers in the requirements definition process. The Medical Centers are referred to as "focus facilities". A "focus group" (caregiver team) at each selected focus facility consisted of a site coordinator and a 24-30 person multidisciplinary team involving physicians, nurses, therapists and other caregivers. The Medical Center selection process identified facilities that provided the best cross-sectional representation of KPNCR. The Lead Focus Facility participated in the initial round of requirements definition activities. These sessions assisted in the design of a simulation that was used at five additional Medical Centers to validate requirements. The five additional Focus Facilities participated in simulation review sessions. Feedback from these sessions was used to revise the simulation and update the requirements document. Caregivers from all six focus facilities and other identified groups participated in a requirements survey to assist CGW with identification of high priority features. Caregiver commitment and continuing involvement are essential for the success of CGW.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7949953

Effect of Direct Physician Involvement on Tobacco Abstinence Rates and Other Variables Affecting Participants of a Freedom from Tobacco Class

PubMed Central

Ismail, Mohamed H; Ho, Ngoc J; Lara, Nancy Irazu

2013-01-01

Context Kaiser Permanente measures how often tobacco users are offered strategies to quit but not the success of such strategies. Objective: To compare tobacco abstinence rates for participants of the Kaiser Permanente Riverside (California) Medical Center’s Freedom from Tobacco Class in 2008, before direct physician involvement, and in 2009, after direct physician involvement, and to compare other variables affecting these rates. Design: In a retrospective study, participants were divided into two groups based on year of participation. Data were collected using electronic medical records and phone interviews. Main Outcome Measures: Tobacco use status between both groups at 1, 3, 6, and 12 months after the classes started and within groups by sex, number of classes attended, medication received, and class teacher. Results: The 12-month abstinence rates were 27% in 2008 and 33% in 2009 (p = 0.3). The abstinence rate for men improved from 23% to 38% (2008 vs 2009; p = 0.05), whereas for women it was 30% vs 27% (p = 0.7). Abstinence rates decreased over time for the group as a whole (p < 0.001). Attendance of 6 or more classes was associated with higher abstinence rates. There was no significant impact on abstinence rates due to age, body mass index, class teacher, or medications used. Conclusion: Direct physician involvement improved men’s but not women’s abstinence rates among class participants. The relapse rate was significant over the first year after the class. Further research is needed to study the difference between sexes and the factors affecting relapse. PMID:23704836

Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity.

PubMed

Van Den Eeden, Stephen K; Tanner, Caroline M; Bernstein, Allan L; Fross, Robin D; Leimpeter, Amethyst; Bloch, Daniel A; Nelson, Lorene M

2003-06-01

The goal of this study was to estimate the incidence of Parkinson's disease by age, gender, and ethnicity. Newly diagnosed Parkinson's disease cases in 1994-1995 were identified among members of the Kaiser Permanente Medical Care Program of Northern California, a large health maintenance organization. Each case met modified standardized criteria/Hughes diagnostic criteria as applied by a movement disorder specialist. Incidence rates per 100,000 person-years were calculated using the Kaiser Permanente membership information as the denominator and adjusted for age and/or gender using the direct method of standardization. A total of 588 newly diagnosed (incident) cases of Parkinson's disease were identified, which gave an overall annualized age- and gender-adjusted incidence rate of 13.4 per 100,000 (95% confidence interval (CI): 11.4, 15.5). The incidence rapidly increased over the age of 60 years, with only 4% of the cases being under the age of 50 years. The rate for men (19.0 per 100,000, 95% CI: 16.1, 21.8) was 91% higher than that for women (9.9 per 100,000, 95% CI: 7.6, 12.2). The age- and gender-adjusted rate per 100,000 was highest among Hispanics (16.6, 95% CI: 12.0, 21.3), followed by non-Hispanic Whites (13.6, 95% CI: 11.5, 15.7), Asians (11.3, 95% CI: 7.2, 15.3), and Blacks (10.2, 95% CI: 6.4, 14.0). These data suggest that the incidence of Parkinson's disease varies by race/ethnicity.

e-Measures: insight into the challenges and opportunities of automating publicly reported quality measures

PubMed Central

Garrido, Terhilda; Kumar, Sudheen; Lekas, John; Lindberg, Mark; Kadiyala, Dhanyaja; Whippy, Alan; Crawford, Barbara; Weissberg, Jed

2014-01-01

Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and is one of the promises of EHR implementation. Kaiser Permanente has fully or partly automated six of 13 the joint commission measure sets. We describe our experience with automation and the resulting time savings: a reduction by approximately 50% of abstractor time required for one measure set alone (surgical care improvement project). However, our experience illustrates the gap between the current and desired states of automated public quality reporting, which has important implications for measure developers, accrediting entities, EHR vendors, public/private payers, and government. PMID:23831833

Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder.

PubMed

Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Fireman, Bruce H; Klein, Nicola P; Croen, Lisa A

2017-01-02

Maternal infections and fever during pregnancy are associated with increased risk for autism spectrum disorders (ASDs). To our knowledge, no study has investigated the association between influenza vaccination during pregnancy and ASD. To investigate the association between influenza infection and vaccination during pregnancy and ASD risk. This cohort study included 196 929 children born at Kaiser Permanente Northern California from January 1, 2000 to December 31, 2010, at a gestational age of at least 24 weeks. Data on maternal influenza infection and vaccination from conception date to delivery date, obtained from Kaiser Permanente Northern California inpatient and outpatient databases. Influenza infection was defined by the International Classification of Diseases, Ninth Revision, Clinical Modification codes or positive influenza laboratory test results. Clinical diagnoses of ASDs identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes 299.0, 299.8, or 299.9 recorded in Kaiser Permanente Northern California electronic medical records on at least 2 occasions any time from birth through June 2015. Within this cohort of 196 929 children, influenza was diagnosed in 1400 (0.7%) mothers and 45 231 (23%) received an influenza vaccination during pregnancy. The mean (SD) ages of vaccinated and unvaccinated women were 31.6 (5.2) and 30.4 (5.6) years, respectively. A total number of 3101 (1.6%) children were diagnosed with ASD. After adjusting for covariates, we found that maternal influenza infection (adjusted hazard ratio, 1.04; 95% CI, 0.68-1.58) or influenza vaccination (adjusted hazard ratio, 1.10; 95% CI, 1.00-1.21) anytime during pregnancy was not associated with increased ASD risk. In trimester-specific analyses, first-trimester influenza vaccination was the only period associated with increased ASD risk (adjusted hazard ratio, 1.20; 95% CI, 1.04-1.39). However, this association could be due to chance (P = 0.1) if

Guest editorial: Aquatic science in the Northwest

USGS Publications Warehouse

Sepulveda, Adam; Ray, Andrew M.

2017-01-01

In recent years, Northwest Science has seen a significant increase in the number of submissions representing aquatic science. Our region is punctuated by aquatic systems. The current issue in particular, presents a number of new aquatic science contributions. Accordingly, Northwest Science invited the authors of this guest editorial to address the question, why is aquatic science so important in the Northwest?

A novel power harmonic analysis method based on Nuttall-Kaiser combination window double spectrum interpolated FFT algorithm

NASA Astrophysics Data System (ADS)

Jin, Tao; Chen, Yiyang; Flesch, Rodolfo C. C.

2017-11-01

Harmonics pose a great threat to safe and economical operation of power grids. Therefore, it is critical to detect harmonic parameters accurately to design harmonic compensation equipment. The fast Fourier transform (FFT) is widely used for electrical popular power harmonics analysis. However, the barrier effect produced by the algorithm itself and spectrum leakage caused by asynchronous sampling often affects the harmonic analysis accuracy. This paper examines a new approach for harmonic analysis based on deducing the modifier formulas of frequency, phase angle, and amplitude, utilizing the Nuttall-Kaiser window double spectrum line interpolation method, which overcomes the shortcomings in traditional FFT harmonic calculations. The proposed approach is verified numerically and experimentally to be accurate and reliable.

Physics Northwest: An Academic Alliance

ERIC Educational Resources Information Center

Hicks, James L.

2007-01-01

It's a weekday in mid-October, late at night and with another teaching assignment not far below the horizon. Yet 40 teachers are laughing, joking, and sharing in the fun that is associated with physics teaching. The event: a Physics Northwest (PNW) meeting, an organization that is in its 20th year and thriving. "Physics Northwest meetings are…

Changing Sea Ice Conditions in the Northwest Passage

NASA Astrophysics Data System (ADS)

Tivy, A. C.; Howell, S.; Agnew, T.; Derksen, C.

2010-12-01

The Northwest Passage lies in the middle of Canadian Arctic Archipelago providing a potential deepwater route that links the Atlantic and Pacific Oceans. Discovered by Sir Robert M’Clure in the 1850s, ever-present multi-year ice (MYI) has always prevented its practical navigation. 2007 marked extreme low MYI conditions in the Arctic and temporarily cleared the Northwest Passage. However, is one single clearing event within the Northwest Passage over the past 40 years indicative of future clearings? This analysis addressed two inter-related questions: i) why has the Northwest Passage contained historically heavy amounts of MYI? and ii) will decreases in MYI within the Northwest Passage continue into the future? Results indicate that for nearly 4 decades, the southern regions of the Canadian Arctic Archipelago have continuously operated as a drain-trap for MYI and this mechanism is responsible for maintaining the heavy MYI conditions within the Northwest Passage. The oldest and thickest MYI in the world resides along the northern flank of the Canadian Arctic Archipelago therefore, as the transition to a sea ice-free Arctic continues, MYI from this region will continue to migrate southward to the channels of the Northwest Passage. Results also find that 2007 was indeed an anomalously light sea ice year in the Northwest Passage but record low ice conditions have since been observed as of mid-August 2010.

Case studies of orthopedic surgery in California: the virtues of care coordination versus specialization.

PubMed

Robinson, James C

2013-05-01

Two overarching frameworks compete to address the organizational ills of the health care system. One framework diagnoses lack of coordination and prescribes integration and global payment. The other diagnoses loss of focus and prescribes specialization and episode payment. This article, based on research and interviews, assesses how the two frameworks manifest themselves at two high-volume orthopedic hospitals in Irvine, California. The Kaiser Permanente Irvine Medical Center is part of a large and diversified health system. The Hoag Orthopedic Institute is a single-specialty facility jointly owned by the physicians and the hospital. Market outcomes, such as the merger of the Hoag specialty hospital into a larger diversified health system, suggest that Kaiser's focus on coordination of patient care from preadmission to postdischarge is a key factor in its success. But Hoag's specialization also leads to improved efficiencies. The integrated approach appears to be prevailing. At the same time, large diversified organizations might obtain further efficiencies by pursuing service-line strategies as described in this article--for instance, by providing incentives for efficiency and quality for each specialty and type of care.

Physics Northwest: An Academic Alliance

NASA Astrophysics Data System (ADS)

Hicks, James L.

2007-10-01

It's a weekday in mid-October, late at night and with another teaching assignment not far below the horizon. Yet 40 teachers are laughing, joking, and sharing in the fun that is associated with physics teaching. The event: a Physics Northwest (PNW) meeting, an organization that is in its 20th year and thriving. "Physics Northwest meetings are not only interesting, educational, and a source of great ideas for physics demonstrations, they are also Phun," says David Thiessen. David's response appears to be universal among PNW members and he continues to attend PNW meetings even though he is into his ninth year of retirement. Patti Sievert of Northern Illinois University tells us, "I'm here tonight to learn how to form a Physics Northwest in the Rock River Valley," and immediately three people from PNW volunteer to be there to help with her first meeting. Yes, this happened and continues to happen monthly in many northwest Illinois suburban high schools. The history of this prosperous organization and its sister organization, the Illinois State Physics Project (ISPP), can be gleaned from the website in Ref. 2.

External Validation of Early Weight Loss Nomograms for Exclusively Breastfed Newborns.

PubMed

Schaefer, Eric W; Flaherman, Valerie J; Kuzniewicz, Michael W; Li, Sherian X; Walsh, Eileen M; Paul, Ian M

2015-12-01

Nomograms that show hour-by-hour percentiles of weight loss during the birth hospitalization were recently developed to aid clinical care of breastfeeding newborns. The nomograms for breastfed neonates were based on a sample of 108,907 newborns delivered at 14 Kaiser Permanente medical centers in Northern California (United States). The objective of this study was to externally validate the published nomograms for newborn weight loss using data from a geographically distinct population. Data were compiled from the Penn State Milton S. Hershey Medical Center located in Hershey, PA. For singleton neonates delivered at ≥36 weeks of gestation between January 2013 and September 2014, weights were obtained between 6 hours and 48 hours (vaginal delivery) or 60 hours (cesarean delivery) for neonates who were exclusively breastfeeding. Quantile regression methods appropriate for repeated measures were used to estimate 50th, 75th, 90th, and 95th percentiles of weight loss as a function of time after birth. These percentile estimates were compared with the published nomograms. Of the 1,587 newborns who met inclusion criteria, 1,148 were delivered vaginally, and 439 were delivered via cesarean section. These newborns contributed 1,815 weights for vaginal deliveries (1.6 per newborn) and 893 weights for cesarean deliveries (2.0 per newborn). Percentile estimates from this Penn State sample were similar to the published nomograms. Deviations in percentile estimates for the Penn State sample were similar to deviations observed after fitting the same model separately to each medical center that made up the Kaiser Permanente sample. The published newborn weight loss nomograms for breastfed neonates were externally validated in a geographically distinct population.

Neonatal hyperbilirubinemia and risk of autism spectrum disorders.

PubMed

Croen, Lisa A; Yoshida, Cathleen K; Odouli, Roxana; Newman, Thomas B

2005-02-01

To investigate the association between neonatal hyperbilirubinemia and autism spectrum disorders (ASD). We conducted a large case-control study nested within the cohort of singleton term infants born between 1995 and 1998 at a northern California Kaiser Permanente hospital. Case subjects (n = 338) were children with an ASD diagnosis recorded in Kaiser Permanente outpatient databases; control subjects (n = 1817) were children without an ASD diagnosis, who were randomly sampled and frequency-matched to case subjects according to gender, birth year, and birth hospital. Approximately 28% of case and control subjects received > or =1 bilirubin test in the first 30 days of life. No case-control differences were observed for maximal bilirubin levels of > or =15 mg/dL (10.1% vs 12.1%), > or =20 mg/dL (2.1% vs 2.5%), or > or =25 mg/dL (0.3% vs 0.2%). Compared with children whose maximal neonatal bilirubin levels were <15 mg/dL or not measured, children with any degree of bilirubin level elevation were not at increased risk of ASD, after adjustment for gender, birth facility, maternal age, maternal race/ethnicity, maternal education, and gestational age (for bilirubin levels of 15-19.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.5-1.2; for bilirubin levels of 20-24.9 mg/dL: odds ratio: 0.7; 95% confidence interval: 0.3-1.6; for bilirubin levels of > or =25 mg/dL: odds ratio: 1.1; 95% confidence interval: 0.1-11.2). These data suggest that neonatal hyperbilirubinemia is not a risk factor for ASD.

Rectal Cancer Survivors' Participation in Productive Activities.

PubMed

Hornbrook, Mark C; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna E; Mcmullen, Carmit K; Altschuler, Andrea; Temple, Larissa Kf; Herrinton, Lisa J; Krouse, Robert S

2017-01-01

Rectal cancer and its treatment impair survivors' productivity. To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011. Productive activities, functional health status, and bowel management at the time of the survey. Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex. Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors' medical care access, comorbidities, health-related quality of life, and productive activities.

Clinician’s use of automated reports of estimated glomerular filtration rate: A qualitative study

PubMed Central

2012-01-01

Background There is a growing awareness in primary care of the importance of identifying patients with chronic kidney disease (CKD) so that they can receive appropriate clinical care; one method that has been widely embraced is the use of automated reporting of estimated glomerular filtration rate (eGFR) by clinical laboratories. We undertook a qualitative study to examine how clinicians use eGFR in clinical decision making, patient communication issues, barriers to use of eGFR, and suggestions to improve the clinical usefulness of eGFR reports. Methods Our study used qualitative methods with structured interviews among primary care clinicians including both physicians and allied health providers, recruited from Kaiser Permanente Northwest, a non-profit health maintenance organization. Results We found that clinicians generally held favorable views toward eGFR reporting but did not use eGFR to replace serum creatinine in their clinical decision-making. Clinicians used eGFR as a tool to help identify CKD, educate patients about their kidney function and make treatment decisions. Barriers noted by several clinicians included a desire for greater education regarding care for patients with CKD and tools to facilitate discussion of eGFR findings with patients. Conclusions The manner in which clinicians use eGFRs appears to be more complex than previously understood, and our study illustrates some of the efforts that might be usefully undertaken (e.g. specific clinician education) when encouraging further promulgation of eGFR reporting and usage. PMID:23173944

Family Characteristics Associated with Likelihood of Varicella Vaccination.

PubMed

Weinmann, Sheila; Mullooly, John P; Drew, Lois; Chun, Colleen S

2016-01-01

The introduction of the varicella vaccine as a routine pediatric immunization in the US, in 1995, provided an opportunity to assess factors associated with uptake of new vaccines in the member population of the Kaiser Permanente Northwest (KPNW) Health Plan. Identify factors associated with varicella vaccination in the KPNW population in the first five years after varicella vaccine was introduced. A retrospective cohort of children under age 13 years between June 1995 and December 1999, without a history of varicella disease was identified using KPNW automated data. Membership records were linked to vaccine databases. Cox regression was used to estimate likelihood of varicella vaccination during the study period in relation to age, sex, primary clinician's specialty, and Medicaid eligibility. For a subset whose parents answered a behavioral health survey, additional demographic and behavioral characteristics were evaluated. Varicella vaccination. We identified 88,646 children under age 13 years without a history of varicella; 22% were vaccinated during the study period. Varicella vaccination was more likely among children who were born after 1995, were not Medicaid recipients, or had pediatricians as primary clinicians. In the survey-linked cohort, positively associated family characteristics included smaller family size; higher socioeconomic status; and parents who were older, were college graduates, reported excellent health, and received influenza vaccination. Understanding predictors of early varicella vaccine-era vaccine acceptance may help in planning for introduction of new vaccines to routine schedules.

Family Characteristics Associated with Likelihood of Varicella Vaccination

PubMed Central

Weinmann, Sheila; Mullooly, John P; Drew, Lois; Chun, Colleen S

2016-01-01

Context: The introduction of the varicella vaccine as a routine pediatric immunization in the US, in 1995, provided an opportunity to assess factors associated with uptake of new vaccines in the member population of the Kaiser Permanente Northwest (KPNW) Health Plan. Objective: Identify factors associated with varicella vaccination in the KPNW population in the first five years after varicella vaccine was introduced. Design: A retrospective cohort of children under age 13 years between June 1995 and December 1999, without a history of varicella disease was identified using KPNW automated data. Membership records were linked to vaccine databases. Cox regression was used to estimate likelihood of varicella vaccination during the study period in relation to age, sex, primary clinician’s specialty, and Medicaid eligibility. For a subset whose parents answered a behavioral health survey, additional demographic and behavioral characteristics were evaluated. Main Outcome Measure: Varicella vaccination. Results: We identified 88,646 children under age 13 years without a history of varicella; 22% were vaccinated during the study period. Varicella vaccination was more likely among children who were born after 1995, were not Medicaid recipients, or had pediatricians as primary clinicians. In the survey-linked cohort, positively associated family characteristics included smaller family size; higher socioeconomic status; and parents who were older, were college graduates, reported excellent health, and received influenza vaccination. Conclusion: Understanding predictors of early varicella vaccine-era vaccine acceptance may help in planning for introduction of new vaccines to routine schedules. PMID:27104589

Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders.

PubMed

Musser, Erica D; Hawkey, Elizabeth; Kachan-Liu, Svetlana S; Lees, Paul; Roullet, Jean-Baptiste; Goddard, Katrina; Steiner, Robert D; Nigg, Joel T

2014-07-01

To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. Among children aged 6-12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p < .0001) and at 2.5-fold risk of ASD alone (OR = 2.52, p < .01). Results were not accounted for by maternal age, child gestational age, child gender, and child race. Autism spectrum disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

Association of Proteinuria with Central Venous Catheter Use at Initial Hemodialysis.

PubMed

Park, Ken J; Johnson, Eric S; Smith, Ning; Mosen, David M; Thorp, Micah L

2017-01-01

Central venous catheter (CVC) use is associated with increased mortality and complications in hemodialysis recipients. Although prevalent CVC use has decreased, incident use remains high. To examine characteristics associated with CVC use at initial dialysis, specifically looking at proteinuria as a predictor of interest. Retrospective cohort of 918 hemodialysis recipients from Kaiser Permanente Northwest who started hemodialysis from January 1, 2004, to January 1, 2014. Multivariable logistic regression was used to examine an association of proteinuria with the primary outcome of CVC use. More than one-third (36%) of patients in our cohort started hemodialysis with an arteriovenous fistula, and 64% started with a CVC. Proteinuria was associated with starting hemodialysis with a CVC (likelihood ratio test, p < 0.001) after adjustment for age, peripheral vascular disease, congestive heart failure, diabetes, sex, race, and length of predialysis care. However, on pairwise comparison, only patients with midgrade proteinuria (0.5-3.5 g) had lower odds of starting hemodialysis with a CVC (odds ratio = 0.39, 95% confidence interval = 0.24-0.65). Proteinuria was associated with use of CVC at initial hemodialysis. However, a graded association did not exist, and only patients with midgrade proteinuria had significantly lower odds of CVC use. Our findings suggest that proteinuria is an explanatory finding for CVC use but may not have pragmatic value for decision making. Patients with lower levels of proteinuria may have a higher risk of starting dialysis with a CVC.

Case-control study of medical comorbidities in women with interstitial cystitis.

PubMed

Clemens, J Quentin; Meenan, Richard T; O'Keeffe Rosetti, Maureen C; Kimes, Teresa A; Calhoun, Elizabeth A

2008-06-01

We used physician assigned diagnoses in an electronic medical record to assess comorbidities associated with interstitial cystitis. A computer search of the administrative database at Kaiser Permanente Northwest, Portland, Oregon was performed for May 1, 1998 to April 30, 2003. All women with a medical record diagnosis of interstitial cystitis (ICD-9 code 595.1) were identified. These cases were then matched with 3 controls each based on age and duration in the health plan. The medical diagnoses (using ICD-9 codes restricted to 3 digits) assigned to these 2 groups were compared using the OR. A total of 239 cases and 717 matched controls were analyzed. There were 23 diagnoses that were significantly more common in cases than in controls (p < or = 0.005). Seven of these 23 diagnoses were other urological or gynecological codes used to describe pelvic symptoms. Additional specific conditions associated with interstitial cystitis were gastritis (OR 12.2), child abuse (OR 9.3), fibromyalgia (OR 3.0), anxiety disorder (OR 2.8), headache (OR 2.5), esophageal reflux (OR 2.2), unspecified back disorder (OR 2.2) and depression (OR 2.0). A diagnosis of interstitial cystitis was associated with multiple other unexplained physical symptoms and certain psychiatric conditions. Studies to explore the possible biological explanations for these associations are needed. Interstitial cystitis was also associated with a history of child abuse, although 96% of patients with IC did not have this diagnosis.

7 CFR 319.8-13 - From Northwest Mexico.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false From Northwest Mexico. 319.8-13 Section 319.8-13... for the Entry of Cotton and Covers from Mexico § 319.8-13 From Northwest Mexico. Contingent upon continued freedom of Northwest Mexico and of the West Coast of Mexico from infestations of the pink bollworm...

7 CFR 319.8-13 - From Northwest Mexico.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 5 2012-01-01 2012-01-01 false From Northwest Mexico. 319.8-13 Section 319.8-13... for the Entry of Cotton and Covers from Mexico § 319.8-13 From Northwest Mexico. Contingent upon continued freedom of Northwest Mexico and of the West Coast of Mexico from infestations of the pink bollworm...

7 CFR 319.8-13 - From Northwest Mexico.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 5 2014-01-01 2014-01-01 false From Northwest Mexico. 319.8-13 Section 319.8-13... for the Entry of Cotton and Covers from Mexico § 319.8-13 From Northwest Mexico. Contingent upon continued freedom of Northwest Mexico and of the West Coast of Mexico from infestations of the pink bollworm...

7 CFR 319.8-13 - From Northwest Mexico.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 5 2013-01-01 2013-01-01 false From Northwest Mexico. 319.8-13 Section 319.8-13... for the Entry of Cotton and Covers from Mexico § 319.8-13 From Northwest Mexico. Contingent upon continued freedom of Northwest Mexico and of the West Coast of Mexico from infestations of the pink bollworm...

7 CFR 319.8-13 - From Northwest Mexico.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 5 2011-01-01 2011-01-01 false From Northwest Mexico. 319.8-13 Section 319.8-13... for the Entry of Cotton and Covers from Mexico § 319.8-13 From Northwest Mexico. Contingent upon continued freedom of Northwest Mexico and of the West Coast of Mexico from infestations of the pink bollworm...

Systematic review of economic evaluation studies and budget impact on ambulatory monitoring of capillary glucose in type 2 diabetics.

PubMed

Olry de Labry Lima, Antonio; Moya Garrido, María Natividad; Espín Balbino, Jaime

2014-04-01

Realise a review of studies of economic evaluation about the ambulatory monitoring of capillary glucose (AMGC) in diabetic type II persons. A review of the literature was conducted, in MedLine, various websites, referenced paper and provided by expert's persons. Five studies concluded that the AMGC was a cost-effective strategic, of this papers use Kaiser Permanente data base, its make that these studies could be considered a solely one study. The rest of the papers did not find difference in the AMGC use. The use of AMGC has an uncertainty efficiency. More studies are needed. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Secure e-mailing between physicians and patients: transformational change in ambulatory care.

PubMed

Garrido, Terhilda; Meng, Di; Wang, Jian J; Palen, Ted E; Kanter, Michael H

2014-01-01

Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization.

Transforming care delivery through health information technology.

PubMed

Wheatley, Benjamin

2013-01-01

The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas.

Secure E-mailing Between Physicians and Patients

PubMed Central

Garrido, Terhilda; Meng, Di; Wang, Jian J.; Palen, Ted E.; Kanter, Michael H.

2014-01-01

Secure e-mailing between Kaiser Permanente physicians and patients is widespread; primary care providers receive an average of 5 e-mails from patients each workday. However, on average, secure e-mailing with patients has not substantially impacted primary care provider workloads. Secure e-mail has been associated with increased member retention and improved quality of care. Separate studies associated patient portal and secure e-mail use with both decreased and increased use of other health care services, such as office visits, telephone encounters, emergency department visits, and hospitalizations. Directions for future research include more granular analysis of associations between patient-physician secure e-mail and health care utilization. PMID:24887522

The Northern California Perinatal Research Unit: A Hybrid Model Bridging Research, Quality Improvement and Clinical Practice

PubMed Central

Garrido, Terhilda; Barbeau, Rosemarie

2010-01-01

Kaiser Permanente (KP) has a long-standing commitment to conduct research and report publicly. Simultaneously, it faces a different imperative: harnessing information systems to leverage internal improvements in outcomes, efficiency, and costs. Now that KP HealthConnect, the KP electronic health record, is fully implemented, research challenges at KP are moving away from issues of data access and toward the mechanisms through which raw data create meaningful clinical knowledge that is based on rigorous research. In this report we describe a model for research—the Northern California Division of Research Perinatal Research Unit—that leverages internal and external resources to fulfill these twin missions. PMID:20844705

Successful practices in the use of secure e-mail.

PubMed

Johnson, Laura W; Garrido, Terhilda; Christensen, Kate; Handley, Matt

2014-01-01

Physician use of secure e-mail with patients is anticipated to increase under Stage 2 Meaningful Use requirements, but little is known about how physicians can successfully incorporate it into daily work. We interviewed 27 "super user" physicians at Kaiser Permanente and Group Health who were identified by leaders as being technologically, operationally, and clinically adept and as having high levels of secure e-mail use with patients. They highly valued the use of secure e-mail with patients, despite concerns about a lack of adequate time to respond, and provided tips for using it successfully. They identified benefits that included better care and improved relationships with their patients.

It pays to be Herr Kaiser: Germans with noble-sounding surnames more often work as managers than as employees.

PubMed

Silberzahn, Raphael; Uhlmann, Eric Luis

2013-12-01

In the field study reported here (N = 222,924), we found that Germans with noble-sounding surnames, such as Kaiser ("emperor"), König ("king"), and Fürst ("prince"), more frequently hold managerial positions than Germans with last names that either refer to common everyday occupations, such as Koch ("cook"), Bauer ("farmer"), and Becker/Bäcker ("baker"), or do not refer to any social role. This phenomenon occurs despite the fact that noble-sounding surnames never indicated that the person actually held a noble title. Because of basic properties of associative cognition, the status linked to a name may spill over to its bearer and influence his or her occupational outcomes.

Health assessment for Kaiser Steel Corporation Fontana, San Nernadino County, California, Region 9. CERCLIS No. CAD008274938. Preliminary report

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

Not Available

1989-10-25

The Kaiser Steel Corporation (KSC) site was included in the Update 7, proposed National Priorities List (NPL). The site was subsequently dropped from the proposed NPL on October 4, 1989. The site is located near Fontana, California, in San Bernardino County, approximately 45 miles east of Los Angeles. The on-site environmental contamination in groundwater and soil consisted of volatile organic compounds, organic acids, aluminum, barium, iron, lead, manganese, cadmium, and chromium compounds. The site is of potential health concern because of the risk to human health resulting from possible exposure to hazardous substances at concentrations that may result in adversemore » health effects.« less

What Does Professionalism Mean to the Physician?

PubMed Central

Kanter, Michael H; Nguyen, Miki; Klau, Marc H; Spiegel, Nancy H; Ambrosini, Virginia L

2013-01-01

Professionalism, which is a core competency for physicians, can be described as a spectrum of behaviors and may have a significant impact on the problems in today’s changing health care climate. In this article, we discuss the meaning of professionalism and its role in the Southern California Permanente Medical Group (SCPMG) and consider how it may be applied to integrated care delivery systems such as Kaiser Permanente. To understand professionalism, one must consider Stern’s definition, which consists of four principles: excellence, humanism, accountability, and altruism. SCPMG has taken three of these principles—excellence, accountability, and altruism—and divided the fourth, humanism, into another three principles similar to those identified by the University of California Los Angeles Task Force on Professionalism: humanitarianism, respect for others, and honor and integrity. SCPMG has a rich history and culture of promoting clinical excellence and professionalism, as evidenced by the programs and initiatives described throughout this article. Indeed, the SCPMG experience validates professionalism as a core physician competency comprising a set of behaviors that are continually refined. PMID:24355895

Delimiting communities in the Pacific Northwest.

Treesearch

Ellen M. Donoghue

2003-01-01

The paper presents an approach for delimiting communities in the Northwest Forest Plan (NWFP) region of the Pacific Northwest that responds to the need to assess impacts and issues associated with broad-scale ecosystem management. Census block groups are aggregated to provide an alternative to more commonly used geographic delimitations of communities, specifically...

Parents and the V-Chip: A Kaiser Family Foundation Survey. How Parents Feel (and What They Know) about TV, the V-Chip, and the TV Ratings System. Toplines.

ERIC Educational Resources Information Center

1999

This report presents the data from a national, random sample survey designed by the Kaiser Family Foundation and Princeton Survey Research Associates (PSRA) and conducted by PSRA by telephone between April 6-26, 1999, when 1001 parents of children ages 2-17 were interviewed about their opinions of television, the V-Chip, and the TV ratings system.…

Best Pears for the Western Pacific Northwest

USDA-ARS?s Scientific Manuscript database

A "Favorite Pears" panel was held at the Northwest Washington Research and Extension Center in Mount Vernon, Washington in March 2017 featuring 6 Pacific Northwest pear experts. The panelists selected and described pear varieties they recommend for planting in the most western parts of Oregon and Wa...

FEATURE 4, ARMCO HUT, INTERIOR , VIEW FACING NORTHWEST. ...

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

FEATURE 4, ARMCO HUT, INTERIOR , VIEW FACING NORTHWEST. - Naval Air Station Barbers Point, Anti-Aircraft Battery Complex-ARMCO Hut, East of Coral Sea Road, northwest of Hamilton Road, Ewa, Honolulu County, HI

Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD.

PubMed

Davignon, Meghan N; Qian, Yinge; Massolo, Maria; Croen, Lisa A

2018-04-01

Children with autism spectrum disorder (ASD) have a variety of medical and psychiatric conditions and an increased use of health care services. There is limited information about the prevalence of psychiatric and medical conditions in adolescents and young adults with ASD. Our objective was to describe the frequency of medical and psychiatric conditions in a large population of diverse, insured transition-aged individuals with ASD. Participants included Kaiser Permanente Northern California members who were enrolled from 2013 to 2015 and who were 14 to 25 years old. Individuals with ASD ( n = 4123) were compared with peers with attention-deficit/hyperactivity disorder ( n = 20 615), diabetes mellitus ( n = 2156), and typical controls with neither condition ( n = 20 615). Over one-third (34%) of individuals with ASD had a co-occurring psychiatric condition; the most commonly reported medical conditions included infections (42%), obesity (25%), neurologic conditions (18%), allergy and/or immunologic conditions (16%), musculoskeletal conditions (15%), and gastrointestinal (11%) conditions. After controlling for sex, age, race, and duration of Kaiser Permanente Northern California membership, most psychiatric conditions were significantly more common in the ASD group than in each comparison group, and most medical conditions were significantly more common in the ASD group than in the attention-deficit/hyperactivity disorder and typical control groups but were similar to or significantly less common than the diabetes mellitus group. Although more research is needed to identify factors contributing to this excess burden of disease, there is a pressing need for all clinicians to approach ASD as a chronic health condition requiring regular follow-up and routine screening and treatment of medical and psychiatric issues. Copyright © 2018 by the American Academy of Pediatrics.

The Risk of Dupuytren Diagnosis in Obese Individuals.

PubMed

Hacquebord, Jacques H; Chiu, Vicki Y; Harness, Neil G

2017-03-01

Dupuytren disease is a common benign fibroproliferative disorder causing thickening and shortening of the palmar fascia of the hand. The exact etiology of the disease is unclear but known risk factors such as increased age, male sex, and northern European ethnicity have been established. A link between body mass index (BMI) and Dupuytren disease has not been established previously. The purpose of this study was to test the hypothesis that lower BMI is associated with increased risk for Dupuytren disease diagnosis. After we obtained institutional review board approval, we performed a retrospective review using an electronic medical record and an administrative database from Kaiser Permanente Southern California to identify all enrolled patients there between 2007 and 2014 who were diagnosed with Dupuytren disease. Basic demographic data including age, sex, ethnicity, and BMI were collected. Bivariate and multivariable logistical regression analyses were performed to evaluate for associations between Dupuytren disease and BMI. A total of 2,049,803 patients aged 18 years and older were enrolled in Kaiser Permanente Southern California from 2007 to 2014. During that period, 14,844 patients were identified as having Dupuytren disease. The data were consistent with well-defined demographic trends in Dupuytren disease, with increased rates seen in males, Caucasians, and patients aged 50 years and older. In the multivariable analysis, when controlling for age, race, and sex, the risk of Dupuytren disease was inversely proportional to BMI. The current study showed that higher BMI is associated with decreased odds of having Dupuytren disease. Further work will be required to determine the cause for the apparent relationship between Dupuytren disease and BMI and whether physiologic factors related to obesity may be protective against the development of Dupuytren disease. Prognostic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All

The Effect of Guided Care Teams on the Use of Health Services

PubMed Central

Boult, Chad; Reider, Lisa; Leff, Bruce; Frick, Kevin D.; Boyd, Cynthia M.; Wolff, Jennifer L.; Frey, Katherine; Karm, Lya; Wegener, Stephen T.; Mroz, Tracy; Scharfstein, Daniel O.

2015-01-01

Background The effect of interdisciplinary primary care teams on the use of health services by patients with multiple chronic conditions is uncertain. This study aimed to measure the effect of guided care teams on multimorbid older patients’ use of health services. Methods Eligible patients from 3 health care systems in the Baltimore, Maryland–Washington, DC, area were cluster-randomized to receive guided care or usual care for 20 months between November 1, 2006, and June 30, 2008. Eight services of a guided care nurse working in partnership with patients’ primary care physicians were provided: comprehensive assessment, evidence-based care planning, monthly monitoring of symptoms and adherence, transitional care, coordination of health care professionals, support for self-management, support for family caregivers, and enhanced access to community services. Outcome measures were frequency of use of emergency departments, hospitals, skilled nursing facilities, home health agencies, primary care physician services, and specialty physician services. Results The study included 850 older patients at high risk for using health care heavily in the future. The only statistically significant overall effect of guided care in the whole sample was a reduction in episodes of home health care (odds ratio, 0.70; 95% confidence interval, 0.53–0.93). In a preplanned analysis, guided care also reduced skilled nursing facility admissions (odds ratio, 0.53; 95% confidence interval,0.31–0.89) and days (0.48; 0.28–0.84) among Kaiser-Permanente patients. Conclusions Guided care reduces the use of home health care but has little effect on the use of other health services in the short run. Its positive effect on Kaiser-Permanente patients’ use of skilled nursing facilities and other health services is intriguing. Trial Registration clinicaltrials.gov Identifier: NCT00121940 PMID:21403043

Code-based Diagnostic Algorithms for Idiopathic Pulmonary Fibrosis. Case Validation and Improvement.

PubMed

Ley, Brett; Urbania, Thomas; Husson, Gail; Vittinghoff, Eric; Brush, David R; Eisner, Mark D; Iribarren, Carlos; Collard, Harold R

2017-06-01

Population-based studies of idiopathic pulmonary fibrosis (IPF) in the United States have been limited by reliance on diagnostic code-based algorithms that lack clinical validation. To validate a well-accepted International Classification of Diseases, Ninth Revision, code-based algorithm for IPF using patient-level information and to develop a modified algorithm for IPF with enhanced predictive value. The traditional IPF algorithm was used to identify potential cases of IPF in the Kaiser Permanente Northern California adult population from 2000 to 2014. Incidence and prevalence were determined overall and by age, sex, and race/ethnicity. A validation subset of cases (n = 150) underwent expert medical record and chest computed tomography review. A modified IPF algorithm was then derived and validated to optimize positive predictive value. From 2000 to 2014, the traditional IPF algorithm identified 2,608 cases among 5,389,627 at-risk adults in the Kaiser Permanente Northern California population. Annual incidence was 6.8/100,000 person-years (95% confidence interval [CI], 6.1-7.7) and was higher in patients with older age, male sex, and white race. The positive predictive value of the IPF algorithm was only 42.2% (95% CI, 30.6 to 54.6%); sensitivity was 55.6% (95% CI, 21.2 to 86.3%). The corrected incidence was estimated at 5.6/100,000 person-years (95% CI, 2.6-10.3). A modified IPF algorithm had improved positive predictive value but reduced sensitivity compared with the traditional algorithm. A well-accepted International Classification of Diseases, Ninth Revision, code-based IPF algorithm performs poorly, falsely classifying many non-IPF cases as IPF and missing a substantial proportion of IPF cases. A modification of the IPF algorithm may be useful for future population-based studies of IPF.

A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

PubMed

Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

2016-03-01

Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (<17.0 years old with open physes) were identified using the Kaiser Permanente ACLR registry. Multi-ligament reconstructions and physeal-sparing ACLRs were excluded. Aseptic revision and same-knee re-operation were the outcomes of interest. Exposure of interest was graft type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

Multi-Center, Community-Based Cardiac Implantable Electronic Devices Registry: Population, Device Utilization, and Outcomes.

PubMed

Gupta, Nigel; Kiley, Mary Lou; Anthony, Faith; Young, Charlie; Brar, Somjot; Kwaku, Kevin

2016-03-09

The purpose of this study is to describe key elements, clinical outcomes, and potential uses of the Kaiser Permanente-Cardiac Device Registry. This is a cohort study of implantable cardioverter defibrillators (ICD), pacemakers (PM), and cardiac resynchronization therapy (CRT) devices implanted between January 1, 2007 and December 31, 2013 by ≈400 physicians in 6 US geographical regions. Registry data variables, including patient characteristics, comorbidities, indication for procedures, complications, and revisions, were captured using the healthcare system's electronic medical record. Outcomes were identified using electronic screening algorithms and adjudicated via chart review. There were 11 924 ICDs, 33 519 PMs, 4472 CRTs, and 66 067 leads registered. A higher proportion of devices were implanted in males: 75.1% (ICD), 55.0% (PM), and 66.7% (CRT), with mean patient age 63.2 years (ICD), 75.2 (PM), and 67.2 (CRT). The 30-day postoperative incidence of tamponade, hematoma, and pneumothorax were ≤0.3% (ICD), ≤0.6% (PM), and ≤0.4% (CRT). Device failures requiring revision occurred at a rate of 2.17% for ICDs, 0.85% for PMs, and 4.93% for CRTs, per 100 patient observation years. Superficial infection rates were <0.03% for all devices; deep infection rates were 0.6% (ICD), 0.5% (PM), and 1.0% (CRT). Results were used to monitor vendor-specific variations and were systematically shared with individual regions to address potential variations in outcomes, utilization, and to assist with the management of device recalls. The Kaiser Permanente-Cardiac Device Registry is a robust tool to monitor postprocedural patient outcomes and postmarket surveillance of implants and potentially change practice patterns. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Nurse Knowledge Exchange Plus: Human-Centered Implementation for Spread and Sustainability.

PubMed

Lin, Mike; Heisler, Scott; Fahey, Linda; McGinnis, Juli; Whiffen, Teri L

2015-07-01

Kaiser Permanente implemented a new model of nursing communication at shift change-in the bedside nursing report known as the Nurse Knowledge Exchange (NKE) in 2004-but noted variations in its spread and sustainability across medical centers five years later. The six core elements of NKEplus were as follows: team rounding in the last hour before shift changes, pre-shift patient assignments that limit the number of departing nurses at shift change, unit support for uninterrupted bedside reporting, standardization for report and safety check formats, and collaboration with patients to update in-room care boards. In January 2011 Kaiser Permanente Southern California (KPSC; Pasadena) began implementing NKEplus in 125 nursing units across 14 hospitals, with the use of human-centered design principles: creating shared understanding of the need for change, minimum specifications, and customization by frontline staff. Champion teams on each nursing unit designed and pilot tested unit-specific versions of NKEplus for four to eight weeks. Implementation occurred in waves and proceeded from medical/surgical units to specialty units. Traditional performance improvement strategies of accountability, measurement, and management were also applied. By the end of 2012, 100% of the 64 medical/surgical units and 47 (77.0%) of the 61 specialty units in KPSC medical centers implemented NKEplus-as had all but 1 of the specialty units by May 2013. The mean KPSC score on the NKEplus nursing behavior bundle improved from 65.9% in 2010 to 71.3% in the first quarter of 2014. The mean KPSC Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for nurse communication improved from 73.1% in 2010 to 76.4% in the first quarter of 2014 (p < . 001). Human-centered implementation appeared to help spread a new model of nursing handoffs and change the culture of professional nursing practice related to shift change.

Birth outcomes following immunization of pregnant women with pandemic H1N1 influenza vaccine 2009-2010.

PubMed

Eaton, Abigail; Lewis, Ned; Fireman, Bruce; Hansen, John; Baxter, Roger; Gee, Julianne; Klein, Nicola P

2018-05-03

Following the H1N1 influenza pandemic in 2009, pregnant women were recommended to receive both seasonal (TIV) and H1N1 influenza vaccines. This study presents incidence of adverse birth and pregnancy outcomes among a population of pregnant women immunized with TIV and H1N1 vaccines at Kaiser Permanente Northern California during 2009-2010. We telephone surveyed pregnant Kaiser Permanente Northern California members to assess non-medically-attended reactions following H1N1, TIV or both vaccines during 2009-2010 (n=5365) in a separate study. Here we assessed preterm birth (<37weeks), very preterm birth (<32weeks), low birth weight (<2500 g, LBW), very low birth weight (<1500g), small for gestational age, spontaneous abortions, stillbirths and congenital anomalies among this cohort by comparing incidence and 95% confidence intervals between the following immunization groups: TIV only, H1N1 only, H1N1 prior to TIV immunization, TIV prior to H1N1 and both immunizations given at the same time. Results did not vary significantly between groups. Comparing H1N1 with TIV, incidence were similar for preterm births (6.37vs 6.28/100 births), very preterm births (5.30vs 8.29/1000 births), LBW (4.19vs 2.90/100 births), very LBW (4.54vs 5.52/1000 births), small for gestational age (9.99vs 9.24/1000 births), spontaneous abortion (7.10vs 6.83/1000 pregnancies), stillbirths (7.10vs 4.57/1000 pregnancies), and congenital anomalies (2.66vs 2.43/100 births). Although constrained by small sample size, complex vaccine groups, and differential vaccine availability during 2009-2010, this study found no difference in adverse birth outcomes between H1N1 vaccine and TIV. Copyright © 2017 Elsevier Ltd. All rights reserved.

Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009

PubMed Central

Harrold, Leslie R.; Salman, Craig; Shoor, Stanford; Curtis, Jeffrey R.; Asgari, Maryam M.; Gelfand, Joel M.; Wu, Jashin J.; Herrinton, Lisa J.

2017-01-01

Objective Few studies based in well-defined North American populations have examined the occurrence of juvenile idiopathic arthritis (JIA), and none has been based in an ethnically diverse population. We used computerized healthcare information from the Kaiser Permanente Northern California membership to validate JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population. Methods We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases, 9th edition, diagnosis code of 696.0, 714, or 720 in computerized clinical encounter data during 1996–2009. In a random sample, we then reviewed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms. Finally, we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA. Results A diagnosis of JIA was confirmed in 69% of individuals with at least 1 relevant code. Forty-five percent were newly diagnosed during the study period. The age- and sex-standardized incidence rate of JIA per 100,000 person-years was 11.9 (95% CI 10.9–12.9). It was 16.4 (95% CI 14.6–18.1) in girls and 7.7 (95% CI 6.5–8.9) in boys. The peak incidence rate occurred in children aged 11–15 years. The prevalence of JIA per 100,000 persons was 44.7 (95% CI 39.1–50.2) on December 31, 2009. Conclusion The incidence rate of JIA observed in the Kaiser Permanente population, 1996–2009, was similar to that reported in Rochester, Minnesota, USA, but 2 to 3 times higher than Canadian estimates. PMID:23588938

Disparities in outpatient and home health service utilization following stroke: results of a 9-year cohort study in Northern California.

PubMed

Chan, Leighton; Wang, Hua; Terdiman, Joe; Hoffman, Jeanne; Ciol, Marcia A; Lattimore, Bernadette Ford; Sidney, Steven; Quesenberry, Charles; Lu, Qi; Sandel, M Elizabeth

2009-11-01

To examine whether there are disparities in utilization of outpatient and home care services after stroke. Retrospective cohort study. The Kaiser Permanente of Northern California health care system, which provides health care for approximately 3.3 million members. A total of 11,119 patients hospitalized for a stroke between 1996 and 2003 and followed for 1 year. Receipt of outpatient rehabilitation (physical therapy, occupational therapy, speech pathology, or physical medicine and rehabilitation/physiatry visits), and/or home health care. There were significant differences in outpatient rehabilitation visits and home health enrollment during the year after acute care discharge for all the parameters under study. Older age and female gender were associated with less outpatient rehabilitation treatment, but these subpopulations were more likely to be enrolled in home health care. Non-whites, patients from urban areas, those with ischemic strokes, and those with longer acute care hospital stays had relatively more outpatient rehabilitation and were also more likely to be enrolled in the home health program. In addition, patients living in geographic areas with a median household income of $80,000 or more had significantly more outpatient rehabilitation visits than did patients living in lower income areas. Variations in outpatient rehabilitation visits and in home health care exist in this large integrated health system in terms of age, gender, race/ethnicity, residence area, type of stroke, and length of stay in an acute care hospital. The Kaiser Permanente integrated health care system seems to have outpatient stroke rehabilitation and home health programs that are providing care without disparities in relation to non-white populations, but other disparities appear to exist that may be related to socioeconomic factors, referral patterns, family support systems, or other cultural factors that have not been identified.

Successful Practices in the Use of Secure E-mail

PubMed Central

Johnson, Laura W; Garrido, Terhilda; Christensen, Kate; Handley, Matt

2014-01-01

Physician use of secure e-mail with patients is anticipated to increase under Stage 2 Meaningful Use requirements, but little is known about how physicians can successfully incorporate it into daily work. We interviewed 27 “super user” physicians at Kaiser Permanente and Group Health who were identified by leaders as being technologically, operationally, and clinically adept and as having high levels of secure e-mail use with patients. They highly valued the use of secure e-mail with patients, despite concerns about a lack of adequate time to respond, and provided tips for using it successfully. They identified benefits that included better care and improved relationships with their patients. PMID:24937149

Career ladder program for registered nurses in ambulatory care.

PubMed

Nelson, Joan; Sassaman, Becky; Phillips, Alison

2008-01-01

RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.

Irradiation of northwest agricultural products

NASA Astrophysics Data System (ADS)

Eakin, D. E.; Tingey, G. I.

1985-02-01

Irradiation of food for disinfestation and preservation is increasing in importance because of increasing restrictions on various chemical treatments. Irradiation treatment is of particular interest in the Northwest because of a growing supply of agricultural products and the need to develop new export markets. Several products have, or could potentially have, significant export markets if stringent insect ocntrol procedures are developed and followed. Due to the recognized potential benefits of irradiation, this program was conducted to evaluate the benefits of using irradiation on Northwest agricultural products. Commodities currently included in the program are cherries, apples, asparagus, spices, hay, and hides.

Heart rate calculation from ensemble brain wave using wavelet and Teager-Kaiser energy operator.

PubMed

Srinivasan, Jayaraman; Adithya, V

2015-01-01

Electroencephalogram (EEG) signal artifacts are caused by various factors, such as, Electro-oculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG), movement artifact and line interference. The relatively high electrical energy cardiac activity causes EEG artifacts. In EEG signal processing the general approach is to remove the ECG signal. In this paper, we introduce an automated method to extract the ECG signal from EEG using wavelet and Teager-Kaiser energy operator for R-peak enhancement and detection. From the detected R-peaks the heart rate (HR) is calculated for clinical diagnosis. To check the efficiency of our method, we compare the HR calculated from ECG signal recorded in synchronous with EEG. The proposed method yields a mean error of 1.4% for the heart rate and 1.7% for mean R-R interval. The result illustrates that, proposed method can be used for ECG extraction from single channel EEG and used in clinical diagnosis like estimation for stress analysis, fatigue, and sleep stages classification studies as a multi-model system. In addition, this method eliminates the dependence of additional synchronous ECG in extraction of ECG from EEG signal process.

7 CFR 1124.2 - Pacific Northwest marketing area.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 9 2011-01-01 2011-01-01 false Pacific Northwest marketing area. 1124.2 Section 1124.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE PACIFIC NORTHWEST...

7 CFR 1124.2 - Pacific Northwest marketing area.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 9 2013-01-01 2013-01-01 false Pacific Northwest marketing area. 1124.2 Section 1124.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE MILK IN THE PACIFIC NORTHWEST...

7 CFR 1124.2 - Pacific Northwest marketing area.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 9 2012-01-01 2012-01-01 false Pacific Northwest marketing area. 1124.2 Section 1124.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE PACIFIC NORTHWEST...

NorthWest view; Station Building south (front) elevation, oblique ...

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

North-West view; Station Building - south (front) elevation, oblique - North Philadelphia Station, 2900 North Broad Street, on northwest corner of Broad Street & Glenwood Avenue, Philadelphia, Philadelphia County, PA

77 FR 73635 - Northwest Storage GP, LLC; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-11

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. CP13-18-000; PF12-2-000] Northwest Storage GP, LLC; Notice of Application Take notice that on November 21, 2012, Northwest Storage GP..., Northwest Storage GP, LLC., 295 Chipeta Way, Salt Lake City, Utah 84108, by phone at 801-584-6857 or by...

Rectal Cancer Survivors’ Participation in Productive Activities

PubMed Central

Hornbrook, Mark C; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna E; McMullen, Carmit K; Altschuler, Andrea; Temple, Larissa KF; Herrinton, Lisa J; Krouse, Robert S

2018-01-01

Context Rectal cancer and its treatment impair survivors’ productivity. Objective To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. Design We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011. Main Outcome Measures Productive activities, functional health status, and bowel management at the time of the survey. Results Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex. Conclusion Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors’ medical care access, comorbidities, health-related quality of life, and productive activities. PMID:29236653

Predicting the Risk of Clostridium difficile Infection upon Admission: A Score to Identify Patients for Antimicrobial Stewardship Efforts.

PubMed

Kuntz, Jennifer L; Smith, David H; Petrik, Amanda F; Yang, Xiuhai; Thorp, Micah L; Barton, Tracy; Barton, Karen; Labreche, Matthew; Spindel, Steven J; Johnson, Eric S

2016-01-01

Increasing morbidity and health care costs related to Clostridium difficile infection (CDI) have heightened interest in methods to identify patients who would most benefit from interventions to mitigate the likelihood of CDI. To develop a risk score that can be calculated upon hospital admission and used by antimicrobial stewards, including pharmacists and clinicians, to identify patients at risk for CDI who would benefit from enhanced antibiotic review and patient education. We assembled a cohort of Kaiser Permanente Northwest patients with a hospital admission from July 1, 2005, through December 30, 2012, and identified CDI in the six months following hospital admission. Using Cox regression, we constructed a score to identify patients at high risk for CDI on the basis of preadmission characteristics. We calculated and plotted the observed six-month CDI risk for each decile of predicted risk. We identified 721 CDIs following 54,186 hospital admissions-a 6-month incidence of 13.3 CDIs/1000 patient admissions. Patients with the highest predicted risk of CDI had an observed incidence of 53 CDIs/1000 patient admissions. The score differentiated between patients who do and do not develop CDI, with values for the extended C-statistic of 0.75. Predicted risk for CDI agreed closely with observed risk. Our risk score accurately predicted six-month risk for CDI using preadmission characteristics. Accurate predictions among the highest-risk patient subgroups allow for the identification of patients who could be targeted for and who would likely benefit from review of inpatient antibiotic use or enhanced educational efforts at the time of discharge planning.

Association between mandibular retrognathia and TMJ disorders in adult females.

PubMed

Miller, James R; Burgess, Jeffrey A; Critchlow, Cathy W

2004-01-01

This study assesses the association between temporomandibular joint (TMJ) disorders and mandibular retrognathia. We conducted a case-control study among women, aged 18-70 years, recruited from Kaiser Permanente Northwest Division (KPNW, Portland, OR) and Group Health Cooperative of Puget Sound (GHC, Seattle, WA). Cases (N= 160) were women seeking treatment for TMJ disorders at KPNW and GHC clinics. Controls (N=151) were women without TMJ disorders, selected from among adult female dental hygiene patients at KPNW or GHC enrollees. Case status was determined by questionnaire; mandibular sagittal position (orthognathic, mildly retrognathic, severely retrognathic, or prognathic) was measured using digitized facial photographs. Odds ratios (OR) and associated 95 percent confidence intervals (CI) estimated the magnitude of the association between TMJ disorders and mandibular sagittal position. Women with TMJ disorders were 4.0 times (95% CI=1.5, 10.8) more likely than controls to have severe retrognathia; no association with mild retrognathia or prognathia was seen. Results were similar when cases were restricted to those with recent onset of TMJ pain (OR=6.3; 95% CI=1.8, 21.8). We found a strong association between TMJ disorders and severe mandibular retrognathia in adult females. In some women this likely resulted from TMJ disorders influencing mandibular development over time. However, among a subset of women, our data support the reverse hypothesis--that severe mandibular retrognathia may influence the development of TMJ disorders. Despite this strong association, abnormal mandibular position contributed only a small portion to the overall rate at which women sought treatment for TMJ disorders.

Association of Proteinuria with Central Venous Catheter Use at Initial Hemodialysis

PubMed Central

Park, Ken J; Johnson, Eric S; Smith, Ning; Mosen, David M; Thorp, Micah L

2018-01-01

Context Central venous catheter (CVC) use is associated with increased mortality and complications in hemodialysis recipients. Although prevalent CVC use has decreased, incident use remains high. Objective To examine characteristics associated with CVC use at initial dialysis, specifically looking at proteinuria as a predictor of interest. Design Retrospective cohort of 918 hemodialysis recipients from Kaiser Permanente Northwest who started hemodialysis from January 1, 2004, to January 1, 2014. Main Outcome Measures Multivariable logistic regression was used to examine an association of proteinuria with the primary outcome of CVC use. Results More than one-third (36%) of patients in our cohort started hemodialysis with an arteriovenous fistula, and 64% started with a CVC. Proteinuria was associated with starting hemodialysis with a CVC (likelihood ratio test, p < 0.001) after adjustment for age, peripheral vascular disease, congestive heart failure, diabetes, sex, race, and length of predialysis care. However, on pairwise comparison, only patients with midgrade proteinuria (0.5–3.5 g) had lower odds of starting hemodialysis with a CVC (odds ratio = 0.39, 95% confidence interval = 0.24–0.65). Conclusion Proteinuria was associated with use of CVC at initial hemodialysis. However, a graded association did not exist, and only patients with midgrade proteinuria had significantly lower odds of CVC use. Our findings suggest that proteinuria is an explanatory finding for CVC use but may not have pragmatic value for decision making. Patients with lower levels of proteinuria may have a higher risk of starting dialysis with a CVC. PMID:29236655

A study of the prevalence of significant increases in serum creatinine following angiotension-converting enzyme inhibitor administration.

PubMed

Thorp, M L; Ditmer, D G; Nash, M K; Wise, R; Jaderholm, P L; Smith, J D; Chan, W

2005-05-01

Angiontension-converting enzyme inhibitors (ACEIs) are beneficial in the treatment of diabetic and nondiabetic kidney disease, coronary artery disease and congestive heart failure. One adverse effect of ACEIs use is a rise in serum creatinine and potential renal failure. This paper attempts to quantify this risk and assess the need for pre- and post-ACEI serum creatinine measurements. A computerized search of Kaiser Permanente Northwest's electronic medical record was conducted to find patients over the age of 40 years taking lisinopril between July 1, 2000 and June 30, 2002. Patient demographic information and presence in diabetes and coronary artery disease registries was collected. A subsequent search for pre- and postlisinopril serum creatinine levels within 6 months of initial lisinopril prescription was conducted. Patients with prelisinopril creatinine < or = 1.2 mg/dl and postlisinopril creatinine > 2.5 mg/dl underwent chart review to discern adverse events associated with the rise in serum creatinine. A total of 18,977 patients were prescribed lisinopril between July 1, 2000 and June 30, 2002. In all 13 166 patients had a pre- and postlisinopril creatinine checked. In all, 31 patients had a rise in creatinine from < or = 1.2 mg/dl to > 2.5 mg/dl (0.2%). Possible contributors to rise in creatinine included congestive heart failure, dehydration and infection. No patients developed end-stage renal disease, although three died. In conclusion, end-stage renal disease is an unlikely outcome among patients prescribed lisinopril and is most likely associated with other events.

Association between lifestyle, menstrual/reproductive history, and histological factors and risk of breast cancer in women biopsied for benign breast disease.

PubMed

Arthur, Rhonda; Wang, Yihong; Ye, Kenny; Glass, Andrew G; Ginsberg, Mindy; Loudig, Olivier; Rohan, Thomas

2017-10-01

Women with benign breast disease (BBD) have an increased risk of subsequent breast cancer. However, whether conventional breast cancer risk factors influence risk of breast cancer among women with BBD is unclear. In this study, we investigated the associations of lifestyle, menstrual/reproductive, and histological factors with risk of breast cancer among women biopsied for BBD. We conducted a case-control study, nested within a cohort of 15,395 women biopsied for BBD at Kaiser Permanente Northwest between 1971 and 2006. Cases were women who developed a subsequent invasive breast cancer during follow-up; controls were individually matched to cases on age at BBD diagnosis. A total of 526 case-control pairs were included in the study. We calculated crude and multivariable OR and 95% CI for the associations between lifestyle, menstrual/reproductive, and histological factors and breast cancer risk using conditional logistic regression. Compared to premenopausal women, postmenopausal women had reduced risk of subsequent breast cancer (OR 0.60; 95% CI 0.39-0.94), whereas women who ever used hormone replacement therapy (HRT) had increased risk (OR 3.61; 95% CI 1.68-7.75), as did women whose BBD lesion showed atypical hyperplasia (OR 5.56; 95% CI 2.05-15.06). Smoking, BMI, early menarche, multiparity (≥4), history of oophorectomy, and extent of lobular involution were not associated with risk of breast cancer. This study suggests that use of HRT and having atypical hyperplasia are associated with increased risk of breast cancer among women with BBD, while postmenopausal women with BBD have a reduced risk.

7 CFR 1124.2 - Pacific Northwest marketing area.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 9 2014-01-01 2013-01-01 true Pacific Northwest marketing area. 1124.2 Section 1124.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS AND ORDERS; MILK), DEPARTMENT OF AGRICULTURE MILK IN THE PACIFIC NORTHWEST MARKETING AREA Order...

7 CFR 1124.2 - Pacific Northwest marketing area.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 9 2010-01-01 2009-01-01 true Pacific Northwest marketing area. 1124.2 Section 1124.2 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE PACIFIC NORTHWEST MARKETING AREA Order...

40 CFR 81.244 - Northwest Minnesota Intrastate Air Quality Control Region.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 18 2013-07-01 2013-07-01 false Northwest Minnesota Intrastate Air... Air Quality Control Regions § 81.244 Northwest Minnesota Intrastate Air Quality Control Region. The Northwest Minnesota Intrastate Air Quality Control Region consists of the territorial area encompassed by...

40 CFR 81.244 - Northwest Minnesota Intrastate Air Quality Control Region.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 18 2012-07-01 2012-07-01 false Northwest Minnesota Intrastate Air... Air Quality Control Regions § 81.244 Northwest Minnesota Intrastate Air Quality Control Region. The Northwest Minnesota Intrastate Air Quality Control Region consists of the territorial area encompassed by...

40 CFR 81.244 - Northwest Minnesota Intrastate Air Quality Control Region.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Northwest Minnesota Intrastate Air... Air Quality Control Regions § 81.244 Northwest Minnesota Intrastate Air Quality Control Region. The Northwest Minnesota Intrastate Air Quality Control Region consists of the territorial area encompassed by...

40 CFR 81.244 - Northwest Minnesota Intrastate Air Quality Control Region.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 17 2011-07-01 2011-07-01 false Northwest Minnesota Intrastate Air... Air Quality Control Regions § 81.244 Northwest Minnesota Intrastate Air Quality Control Region. The Northwest Minnesota Intrastate Air Quality Control Region consists of the territorial area encompassed by...

1. OVERVIEW OF DECK AND EAST ELEVATION. Looking northwest. ...

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

1. OVERVIEW OF DECK AND EAST ELEVATION. Looking northwest. - Edwards Air Force Base, Air Force Rocket Propulsion Laboratory, Test Stand 1-5, Test Area 1-115, northwest end of Saturn Boulevard, Boron, Kern County, CA

40 CFR 81.249 - Northwest Oregon Intrastate Air Quality Control Region.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Northwest Oregon Intrastate Air... Air Quality Control Regions § 81.249 Northwest Oregon Intrastate Air Quality Control Region. The Northwest Oregon Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

40 CFR 81.249 - Northwest Oregon Intrastate Air Quality Control Region.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 18 2013-07-01 2013-07-01 false Northwest Oregon Intrastate Air... Air Quality Control Regions § 81.249 Northwest Oregon Intrastate Air Quality Control Region. The Northwest Oregon Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

40 CFR 81.249 - Northwest Oregon Intrastate Air Quality Control Region.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Northwest Oregon Intrastate Air... Air Quality Control Regions § 81.249 Northwest Oregon Intrastate Air Quality Control Region. The Northwest Oregon Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

40 CFR 81.249 - Northwest Oregon Intrastate Air Quality Control Region.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 17 2011-07-01 2011-07-01 false Northwest Oregon Intrastate Air... Air Quality Control Regions § 81.249 Northwest Oregon Intrastate Air Quality Control Region. The Northwest Oregon Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

40 CFR 81.249 - Northwest Oregon Intrastate Air Quality Control Region.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 18 2012-07-01 2012-07-01 false Northwest Oregon Intrastate Air... Air Quality Control Regions § 81.249 Northwest Oregon Intrastate Air Quality Control Region. The Northwest Oregon Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

2. Southeast side of addition. View to northwest. Offutt ...

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

2. Southeast side of addition. View to northwest. - Offutt Air Force Base, Looking Glass Airborne Command Post, Aerospace Ground Equipment (AGE) Storage Facility, Far Northwest end of Project Looking Glass Historic District, Bellevue, Sarpy County, NE

40 CFR 81.202 - Northwest Ohio Intrastate Air Quality Control Region.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Northwest Ohio Intrastate Air Quality... Quality Control Regions § 81.202 Northwest Ohio Intrastate Air Quality Control Region. The Northwest Ohio Intrastate Air Quality Control Region (Ohio) consists of the territorial area encompassed by the boundaries...

6. General interior overview of addition. View to northwest. ...

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

6. General interior overview of addition. View to northwest. - Offutt Air Force Base, Looking Glass Airborne Command Post, Aerospace Ground Equipment (AGE) Storage Facility, Far Northwest end of Project Looking Glass Historic District, Bellevue, Sarpy County, NE

Interactions of Northwest forest canopies and arboreal mammals.

Treesearch

A.B. Carey

1996-01-01

The interactions among Northwest forest canopies and the mammals that inhabit them have been poorly studied. My purpose was to identify interactions among arboreal mammals and canopies that have implications for managers seeking to conserve biodiversity in the Pacific Northwest. I constructed a comprehensive, but parsimonious list of canopy attributes that could be...

POLICY CONUNDRUM: RESTORING WILD SALMON TO THE PACIFIC NORTHWEST

EPA Science Inventory

Across the Pacific Northwest region of North America, many runs of wild (in contrast to hatchery-bred) salmon have declined and some have been extirpated. Restoring wild salmon runs to the Pacific Northwest is technically challenging, politically nasty, socially divisive, and ...

Searching for the optimal renal prescription. Fresenius, Kaiser Permanente team up to offer new options in dialysis care.

PubMed

Neumann, M E

1999-01-01

The goals are simple: Improve well-being of the dialysis patient and reduce hospitalizations. The tools are diverse: Ultrapure dialysate. On-line blood monitoring. Biocompatible membranes. No reuse. Daily, in-center dialysis and possibly nocturnal dialysis at home. Reimbursement: Full-risk capitation, With Medicare and commercial payor rates varying on a patient-by-patient basis. Create an incubator with approximately 1,000 end-stage renal disease patients, treated at both capitated payment-exclusive dialysis units and mingled in at traditional fee-for-service clinics. Establish a team of nurses and renal care staff to direct the care plan, and put the program in place. After the first year, analyze the data and see if the end--hopefully, improved outcomes and resulting reduced hospitalizations--justifies the means--the higher cost for "optimal technologies."

50 CFR 600.520 - Northwest Atlantic Ocean fishery.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Northwest Atlantic Ocean fishery. 600.520... Northwest Atlantic Ocean fishery. (a) Purpose. Sections 600.520 and 600.525 regulate all foreign fishing conducted under a GIFA within the EEZ in the Atlantic Ocean north of 35°00′ N. lat. (b) Authorized fishery...

50 CFR 600.520 - Northwest Atlantic Ocean fishery.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 12 2014-10-01 2014-10-01 false Northwest Atlantic Ocean fishery. 600.520... Northwest Atlantic Ocean fishery. (a) Purpose. Sections 600.520 and 600.525 regulate all foreign fishing conducted under a GIFA within the EEZ in the Atlantic Ocean north of 35°00′ N. lat. (b) Authorized fishery...

50 CFR 600.520 - Northwest Atlantic Ocean fishery.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 12 2012-10-01 2012-10-01 false Northwest Atlantic Ocean fishery. 600.520... Northwest Atlantic Ocean fishery. (a) Purpose. Sections 600.520 and 600.525 regulate all foreign fishing conducted under a GIFA within the EEZ in the Atlantic Ocean north of 35°00′ N. lat. (b) Authorized fishery...

50 CFR 600.520 - Northwest Atlantic Ocean fishery.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 10 2011-10-01 2011-10-01 false Northwest Atlantic Ocean fishery. 600.520... Northwest Atlantic Ocean fishery. (a) Purpose. Sections 600.520 and 600.525 regulate all foreign fishing conducted under a GIFA within the EEZ in the Atlantic Ocean north of 35°00′ N. lat. (b) Authorized fishery...

Original blackandwhite print, VIEW OF TYPICAL STAIRWAY WINDOW AT NORTHWEST ...

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

Original black-and-white print, VIEW OF TYPICAL STAIRWAY WINDOW AT NORTHWEST CORNER OF EXTENSION - Internal Revenue Service Headquarters Building, 1111 Constitution Avenue Northwest, Washington, District of Columbia, DC

Northwest Africa 8535 and Northwest Africa 10463: New Insights into the Angrite Parent Body

NASA Technical Reports Server (NTRS)

Santos, A. R.; Agee, C. B.; Shearer, C. K.; McCubbin, F. M.

2016-01-01

The angrite meteorites are valuable samples of igneous rocks formed early in Solar System history (approx.4.56 Ga, summarized in [1]). This small meteorite group (approx.24 individually named specimens) consists of rocks with somewhat exotic mineral compositions (e.g., high Ca olivine, Al-Ti-bearing diopside-hedenbergite, calcium silico-phosphates), resulting in exotic bulk rock compositions. These mineral assemblages remain fairly consistent among angrite samples, which suggests they formed due to similar processes from a single mantle source. There is still debate over the formation process for these rocks (see summary in [1]), and analysis of additional angrite samples may help to address this debate. Toward this end, we have begun to study two new angrites, Northwest Africa 8535, a dunite, and Northwest Africa 10463, a basaltic angrite.

Use of electronic health records can improve the health care industry's environmental footprint.

PubMed

Turley, Marianne; Porter, Catherine; Garrido, Terhilda; Gerwig, Kathy; Young, Scott; Radler, Linda; Shaber, Ruth

2011-05-01

Electronic health records have the potential to improve the environmental footprint of the health care industry. We estimate that Kaiser Permanente's electronic health record system, which covers 8.7 million beneficiaries, eliminated 1,000 tons of paper records and 68 tons of x-ray film, and that it has lowered gasoline consumption among patients who otherwise would have made trips to the doctor by at least three million gallons per year. However, the use of personal computers resulted in higher energy consumption and generated an additional 250 tons of waste. We conclude that electronic health records have a positive net effect on the environment, and that our model for evaluating their impact can be used to determine whether their use can improve communities' health.

5. SHAFT HOUSE, EAST ELEVATION; VIEW TO THE NORTHWEST; (WASTE ...

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

5. SHAFT HOUSE, EAST ELEVATION; VIEW TO THE NORTHWEST; (WASTE ROCK/SPOIL PILE IN THE FOREGROUND). - Joker Mine, Shafthouse, Medicine Bow National Forest, Northwest of Keystone, Keystone, Albany County, WY

40 CFR 81.74 - Northwest Pennsylvania-Youngstown Interstate Air Quality Control Region.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Northwest Pennsylvania-Youngstown... Designation of Air Quality Control Regions § 81.74 Northwest Pennsylvania-Youngstown Interstate Air Quality Control Region. The Northwest Pennsylvania-Youngstown Interstate Air Quality Control Region (Pennsylvania...

Health assessment for Kaiser Aluminum and Chemical Corporation, Mead, Spokane County, Washington, Region 10. CERCLIS No. WAD000065508. Preliminary report

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

Not Available

1989-04-12

The 240-acre Kaiser Aluminum Site is on the National Priorities List. The plant was built in 1942 as an aluminum-reduction facility. Concentrations of cyanide (total) in the river range from 0.011 to 1.7 parts per million (ppm) and free cyanide concentrations ranged from non-detected (ND) to 0.58 ppm. Soils on-site are contaminated with cyanide and fluoride; total cyanide levels range from ND to 985 ppm. The site is considered to be of potential public health concern because of the risk to human health caused by the possibility of exposure to hazardous substances via ingestion of contaminated ground water, dermal absorptionmore » of contaminants found in the surface soils on-site, and inhalation of and dermal contact with reentrained contaminated dust.« less

4. VIEW LOOKING NORTHWEST OF FUEL HANDLING BUILDING (CENTER), REACTOR ...

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

4. VIEW LOOKING NORTHWEST OF FUEL HANDLING BUILDING (CENTER), REACTOR SERVICE BUILDING (RIGHT), MACHINE SHOP (LEFT) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

14. UPPER THREE SISTERS FALLS, LOOKING NORTHWEST Photocopy of photograph, ...

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

14. UPPER THREE SISTERS FALLS, LOOKING NORTHWEST Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

[The history of the Kaiser Wilhelm Society during the Third Reich. Interim reports of the president's commission of the Max Planck Society].

PubMed

Weber, M M

2002-11-01

In 1997 the Max Planck Society set up a presidential commission to do research on the historical development of its precursor organization, the Kaiser Wilhelm Society (KWG), during the Third Reich. This paper presents some of the important results given in the interim reports of this commission that are relevant to psychiatry. It focuses on brain research, anthropology, psychiatric genetics, and the role of the well-known biochemist Adolf Butenandt. In general, the interim reports reflect the numerous links between the biomedical research of the KWG and the institutions of the National Socialist (Nazi) state. However, they do not yet allow a final historical assessment as to the complex situation of this field of research during National Socialism.

11. LAUREL POOL, LOOKING NORTHWEST FROM HAZEL WALK Photocopy of ...

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

11. LAUREL POOL, LOOKING NORTHWEST FROM HAZEL WALK Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

24. STREAM AND THREE MEADOW FALLS, LOOKING NORTHWEST Photocopy of ...

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

24. STREAM AND THREE MEADOW FALLS, LOOKING NORTHWEST Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

View of the northwest corner of the Justice Department Building ...

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

View of the northwest corner of the Justice Department Building at Tenth Street and Pennsylvania Avenue - United States Department of Justice, Constitution Avenue between Ninth & Tenth Streets, Northwest, Washington, District of Columbia, DC

Age and correlation of the Calera Limestone in the Permanente terrane of northern California

USGS Publications Warehouse

Sliter, William V.; McGann, Mary

1992-01-01

Planktonic foraminifers indicate that outcrops of Calera Limestone from the Permanente terrane in the Franciscan Complex of northern California range in age from possibly as old as Barremian to late Turonian. Underlying black limestone, which is devoid of planktonic foraminifers, presumably is Barremian in age or older. The top of the sequence exposed in major quarries is always faulted. Improved biostratigraphic resolution shows two patterns of missing time intervals. The primary pattern, which is found at all localities and involves missing planktonic foraminiferal zones in the late Aptian to early Albian and the late Albian, is linked to paleoceanographic changes in the Cretaceous Pacific Ocean. The secondary pattern, which is found at the scattered outcrops outside the major quarries and involves missing zones in the Albian and Cenomanian, suggests the results of a common tectonic history related to the accretion of a large seamount.

69. TURBINE BUILDING (LOCATION N), THIRD LEVEL LOOKING NORTHWEST SHOWING ...

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

69. TURBINE BUILDING (LOCATION N), THIRD LEVEL LOOKING NORTHWEST SHOWING BASE OF CONDENSOR AND RIVER WATER OUTLET PIPE - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

Photocopy of original blackandwhite silver gelatin print, VIEW FROM NORTHWEST ...

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

Photocopy of original black-and-white silver gelatin print, VIEW FROM NORTHWEST CORNER, April 1, 1929, photographer Commercial Photo Company - Internal Revenue Service Headquarters Building, 1111 Constitution Avenue Northwest, Washington, District of Columbia, DC

10. CLIFTON HILL, LOOKING NORTHWEST ACROSS STREAM FROM HAZEL WALK ...

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

10. CLIFTON HILL, LOOKING NORTHWEST ACROSS STREAM FROM HAZEL WALK Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

26. LOOKING NORTHWEST AT BEND DUE NORTH OF STONE MILL ...

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

26. LOOKING NORTHWEST AT BEND DUE NORTH OF STONE MILL Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

Navigable windows of the Northwest Passage

NASA Astrophysics Data System (ADS)

Liu, Xing-he; Ma, Long; Wang, Jia-yue; Wang, Ye; Wang, Li-na

2017-09-01

Artic sea ice loss trends support a greater potential for Arctic shipping. The information of sea ice conditions is important for utilizing Arctic passages. Based on the shipping routes given by ;Arctic Marine Shipping Assessment 2009 Report;, the navigable windows of these routes and the constituent legs were calculated by using sea ice concentration product data from 2006 to 2015, by which a comprehensive knowledge of the sea ice condition of the Northwest Passage was achieved. The results showed that Route 4 (Lancaster Sound - Barrow Strait - Prince Regent Inlet and Bellot Strait - Franklin Strait - Larsen Sound - Victoria Strait - Queen Maud Gulf - Dease Strait - Coronation Gulf - Dolphin and Union Strait - Amundsen Gulf) had the best navigable expectation, Route 2 (Parry Channel - M'Clure Strait) had the worst, and the critical legs affecting the navigation of Northwest Passage were Viscount Melville Sound, Franklin Strait, Victoria Strait, Bellot Strait, M'Clure Strait and Prince of Wales Strait. The shortest navigable period of the routes of Northwest Passage was up to 69 days. The methods used and the results of the study can help the selection and evaluation of Arctic commercial routes.

Use of the Teager-Kaiser Energy Operator for Muscle Activity Detection in Children

PubMed Central

Lauer, Richard T.; Prosser, Laura A.

2009-01-01

The purpose of this study was to demonstrate the usefulness of the Teager-Kaiser Energy (TKE) operator to assess surface electromyographic (sEMG) activity from the hip and trunk muscles during pediatric gait in children with and without cerebral palsy (CP). Muscle activity was recorded from the trapezius, erector spinae, rectus abdominus, external oblique, gluteus maximus and medius, rectus femoris, and semitendinosus bilaterally in ten children with typical development (TD) and five children with CP ages 44.4 ± 18.6 months. Duration of muscle activity was calculated as a percentage of the gait cycle, and compared to two common onset detection methods, a standard deviation (SD) amplitude threshold method, and the visual inspection from two raters (R1, R2). Relative and absolute agreement was determined using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Of the two automated methods, the TKE method demonstrated better agreement with visual inspection (0.45–0.89) than the SD (0.11–0.76) method. The Bland-Altman plots indicated a smaller bias and 95% confidence interval for the TKE method in comparison to the raters (TKE to R1: −5, 113%; TKE to R2: 4, 95%; SD to R1: −24, 170%; SD to R2: −15, 151%). The use of the TKE operator may better detect sEMG activity in children than the standard amplitude method. PMID:19484385

46. AUXILIARY CHAMBER (EAST END), LOOKING NORTHWEST AT STEAM AND ...

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

46. AUXILIARY CHAMBER (EAST END), LOOKING NORTHWEST AT STEAM AND FEEDWATER PIPING AND PRESSURIZER AND FLASH/BLOWOFF TANK ROOMS (LOCATION EEE) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

View of northwest elevation of Building No. 42. Parking Area ...

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

View of northwest elevation of Building No. 42. Parking Area No. 28 at front right. Looking southeast - Easter Hill Village, Building No. 42, Northwest corner of Foothill Avenue & South Twenty-eighth Street, Richmond, Contra Costa County, CA

11. FIRST FLOOR, NORTHWEST ROOM, GENERAL VIEW OF PARLOR LOOKING ...

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

11. FIRST FLOOR, NORTHWEST ROOM, GENERAL VIEW OF PARLOR LOOKING NORTHWEST TOWARDS CORNER FIREPLACE (THERE WAS ORIGINALLY A WALL BETWEEN THESE FIREPLACES) - Open Gate Farm, House, Ridge Road, 1 mile East of Elephant Road, Perkasie, Bucks County, PA

2. Northwest circular bastion, seen from edge of southwest circular ...

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

2. Northwest circular bastion, seen from edge of southwest circular bastion wall. Metal roof beams extend up to form peak. World War II gun installation at right. - Fort Hamilton, Northwest Circular Bastion, Rose Island, Newport, Newport County, RI

1. Aerial view of northwest circular bastion showing ruins of ...

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

1. Aerial view of northwest circular bastion showing ruins of metal roof added in 20th century. Torpedo filling station in background and barracks to the right. - Fort Hamilton, Northwest Circular Bastion, Rose Island, Newport, Newport County, RI

3. Northwest side and southwest rear of addition. View to ...

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

3. Northwest side and southwest rear of addition. View to east. - Offutt Air Force Base, Looking Glass Airborne Command Post, Aerospace Ground Equipment (AGE) Storage Facility, Far Northwest end of Project Looking Glass Historic District, Bellevue, Sarpy County, NE

8. VIEW FROM NORTHWEST OF CONDENSATE STORAGE TANK (LEFT), PRIMARY ...

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

8. VIEW FROM NORTHWEST OF CONDENSATE STORAGE TANK (LEFT), PRIMARY WATER STORAGE TANK (CENTER), CANAL WATER STORAGE TANK (RIGHT) (LOCATIONS E,F,D) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

3. Historic American Buildings Survey Russell Jones, Photographer June 1963NORTHWEST ...

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

3. Historic American Buildings Survey Russell Jones, Photographer June 1963NORTHWEST VIEW - Abner Cloud House, Intersection of Canal Road & Reservoir Road Northwest, Washington, District of Columbia, DC

5. View of northwest corner of East Ward Street and ...

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

5. View of northwest corner of East Ward Street and Dewey Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

The aquatic conservation strategy of the Northwest Forest Plan.

Treesearch

Gordon H. Reeves; Jack E. Williams; Kelly M. Burnett; Kirsten Gallo

2006-01-01

Implemented in 1994, the Aquatic Conservation Strategy of the Northwest Forest Plan was designed to restore and maintain ecological processes for aquatic and riparian area conservation on federal lands in the western portion of the Pacific Northwest. We used decision support models to quantitatively evaluate changes in the condition of selected watersheds. In the...

Meeting the challenge: invasive plants in Pacific Northwest ecosystems.

Treesearch

Timothy B. Harrington; Sarah H. Reichard

2007-01-01

During September 19-20, 2006, a conference was held at the University of Washington Botanic Gardens, Seattle, WA, with the title "Meeting the challenge: invasive plants in Pacific Northwest Ecosystems." The mission of the conference was to create strategies and partnerships to understand and manage invasions of non-native plants in the Pacific Northwest. The...

42. INTERIOR, FIRST FLOOR, NORTHWEST CORNER OF GRAND STAIRCASE (STAIRS ...

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

42. INTERIOR, FIRST FLOOR, NORTHWEST CORNER OF GRAND STAIRCASE (STAIRS G), SIDE AISLE, WEST WALL, THE NEGRO'S CONTRIBUTION IN THE SOCIAL AND CULTURAL DEVELOPMENT OF AMERICA: SCIENCE MURAL - U.S. Department of the Interior, Eighteenth & C Streets Northwest, Washington, District of Columbia, DC

23. General view of the top gundeck looking northwest from ...

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

23. General view of the top gundeck looking northwest from Austria Bastion showing ramp down and parapet wall of the Plaza de Armas on lower level - Castillo de San Felipe del Morro, Northwest end of San Juan, San Juan, San Juan Municipio, PR

75 FR 49518 - Northwest Area Water Supply Project, North Dakota

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-13

... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Northwest Area Water Supply Project, North Dakota... Area Water Supply Project (NAWS Project), a Federal reclamation project, located in North Dakota. A... CONTACT: Alicia Waters, Northwest Area Water Supply Project EIS, Bureau of Reclamation, Dakotas Area...

75 FR 48986 - Northwest Area Water Supply Project, North Dakota

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Northwest Area Water Supply Project, North Dakota... Area Water Supply Project (NAWS Project), a Federal reclamation project, located in North Dakota. A... CONTACT: Alicia Waters, Northwest Area Water Supply Project EIS, Bureau of Reclamation, Dakotas Area...

4. Northeast front and northwest side of original section and ...

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

4. Northeast front and northwest side of original section and addition. View to south. - Offutt Air Force Base, Looking Glass Airborne Command Post, Aerospace Ground Equipment (AGE) Storage Facility, Far Northwest end of Project Looking Glass Historic District, Bellevue, Sarpy County, NE

13. LAUREL POOL, LOOKING NORTHWEST Photocopy of photograph, 1930s National ...

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

13. LAUREL POOL, LOOKING NORTHWEST Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

20. STREAM ARBOR, LOOKING NORTHWEST Photocopy of photograph, 1930s National ...

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

20. STREAM ARBOR, LOOKING NORTHWEST Photocopy of photograph, 1930s National Park Service, National Capital Region files - Dumbarton Oaks Park, Thirty-second & R Streets Northwest, Washington, District of Columbia, DC

Northwest Forest Plan: outcomes and lessons learned from the Northwest economic adjustment initiative: Proceedings of a forum; 1997 July 29-30; Portland, OR.

Treesearch

Harriet H. Christensen; Terry L. Raettig; Paul Sommers; [tech. eds.].

1999-01-01

This monograph is an examination of the experience in the Pacific Northwest implementing the Northwest Forest Plan, Economic Adjustment Initiative (NWEAI). First, a brief description of the NWEAI background and framework, and a socioeconomic overview of the region prior to the NWEAI provide the setting. Next, accounts of the NWEAI experience in each of the three states...

Northwest Climate Risk Assessment

NASA Astrophysics Data System (ADS)

Mote, P.; Dalton, M. M.; Snover, A. K.

2012-12-01

As part of the US National Climate Assessment, the Northwest region undertook a process of climate risk assessment. This process included an expert evaluation of previously identified impacts, their likelihoods, and consequences, and engaged experts from both academia and natural resource management practice (federal, tribal, state, local, private, and non-profit) in a workshop setting. An important input was a list of 11 risks compiled by state agencies in Oregon and similar adaptation efforts in Washington. By considering jointly the likelihoods, consequences, and adaptive capacity, participants arrived at an approximately ranked list of risks which was further assessed and prioritized through a series of risk scoring exercises to arrive at the top three climate risks facing the Northwest: 1) changes in amount and timing of streamflow related to snowmelt, causing far-reaching ecological and socioeconomic consequences; 2) coastal erosion and inundation, and changing ocean acidity, combined with low adaptive capacity in the coastal zone to create large risks; and 3) the combined effects of wildfire, insect outbreaks, and diseases will cause large areas of forest mortality and long-term transformation of forest landscapes.

Timber resources of northwest Oregon.

Treesearch

Mary A. Mei

1979-01-01

This report presents statistics from a 1976 timber resource inventory of 10 counties in northwest Oregon: Clackamas, Clatsop, Columbia, Hood River, Marion, Multnomah, Polk, Tillamook, Washington, and Yamhill. Tables presented are of forest area, timber volume, growth, mortality, and harvest.

Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?

PubMed

Powell, C Bethan; Littell, Ramey; Hoodfar, Elizabeth; Sinclair, Fiona; Pressman, Alice

2013-03-01

Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral guidelines within this health system. Chart review was performed to identify patients with cancer who met the following pathology-based Kaiser Permanente Northern California guidelines for referral for genetic counseling: invasive breast cancer, younger than age 40; nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer, younger than age 60; women with synchronous or metachronous primary cancers of the breast and ovaries; and male breast cancer. We assessed compliance with referral guidelines. An electronic notice was sent to the managing physician of patients with newly diagnosed cancer to assess the feasibility of this intervention. A total of 340 patients were identified with breast cancer at younger than age 40 or with ovarian, peritoneal, or tubal cancer between January and June, 2008. Upon chart review, 105 of these patients met pathology-based criteria for referral to genetic counseling, of whom 47 (45%) were referred within the 2-year study period. Of the 67 subjects with breast cancer, 40 subjects (60%) were referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer were referred (P < 0.001). A pilot study was performed to test the feasibility of notifying managing oncologists with an electronic letter alerting them of eligibility for genetic referral of patients with new diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of these 21 patients were referred for counseling including 5 of 7 patients with a diagnosis of ovarian cancer. There is a missed opportunity for referring patients to genetic counseling, especially among patients with ovarian cancer. A pilot study suggests that alerting treating physicians is a feasible

Prevention of Vertical Transmission of Hepatitis B: An Observation Study

PubMed Central

Kubo, Ai; Shlager, Lyle; Marks, Amy R.; Lakritz, Dena; Beaumont, Colette; Gabellini, Kim; Corley, Douglas A.

2014-01-01

Background For mothers with chronic hepatitis B virus (HBV) infection, the US Centers for Disease Control recommend immunoprophylaxis to decrease perinatal transmission; however, its effectiveness and risk factors for failure have not been well studied in community practice. Objective To investigate the effectiveness of a contemporary immunoprophylaxis protocol. Design Observational study. Setting HBV perinatal immunoprophylaxis program within Kaiser Permanente Northern California, an integrated health services delivery organization. Patients 4,446 infants born to 3,253 HBV positive mothers, between 1997-2010. Measurements Compliance with immunoprophylaxis, follow-up testing rates, maternal risk factors for HBV transmission and transmission rates. Results The infant infection rate was 0.75 per 100 births for 1997-2010 (Poisson 95% confidence interval (CI): 0.48-1.10)]. Rates were 3.37 per 100 (95% CI 2.08-5.14) for e-antigen positive mothers; and 0.04 (95% CI 0.001-0.24) for e-antigen negative mothers. Among mothers with viral load testing, the lowest level associated with transmission was 63,200,000 IU/ml. Infection rates per 100 were 3.61 (95% CI 0.75-10.56) among the 83 births to mothers with viral loads ≥50,000,000 IU/mL and 0.00 among the 831 births to mothers with viral loads <50,000,000 IU/mL, regardless of e-antigen status. Limitations Testing for HBV immunity and infection was somewhat less complete in earlier years. Viral load testing was only consistently available starting in 2007. Conclusion Pre-natal HBV screening followed by post-natal prophylaxis is highly effective in preventing vertical transmission of HBV. A negative e-antigen status or a viral load of <50,000,000 IU/mL (90.9% of women tested) identifies women at extremely low risk of transmission after immunoprophylaxis who are unlikely to benefit from further interventions. Primary Funding Source Kaiser Permanente Community Benefit Grant (CN-09LShla-01-H); National Institute of Health (K07CA

Manual dexterity aptitude testing: a soap carving study.

PubMed

Tang, Christopher G; Hilsinger, Raymond L; Cruz, Raul M; Schloegel, Luke J; Byl, Fred M; Rasgon, Barry M

2014-03-01

Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. Surveys were sent to the 62 individuals' residency programs to evaluate those individuals on a 5-point Likert scale in various categories as well as to rank those individuals as being in the top 50% or bottom 50% of their graduating class. All else being equal, we hypothesized that applicants who had the manual dexterity and visuospatial skills to accurately carve a bar of soap would more likely possess the skills necessary to become a good surgeon. There was no difference between individuals with the best soap carvings and those with the worst soap carvings in all categories: cognitive knowledge, visuospatial ability, manual dexterity, decision making, and overall score (P > .10 for all categories). There was a 95% response rate, with 35 of 37 residency programs responding and 59 of 62 surveys returned. Manual dexterity aptitude testing in the form of soap carving does not appear to correlate with surgical skill at the time of graduation. Further studies need to be conducted to determine the role of manual dexterity and visuospatial

Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people.

PubMed

Quinn, Virginia P; Nash, Rebecca; Hunkeler, Enid; Contreras, Richard; Cromwell, Lee; Becerra-Culqui, Tracy A; Getahun, Darios; Giammattei, Shawn; Lash, Timothy L; Millman, Andrea; Robinson, Brandi; Roblin, Douglas; Silverberg, Michael J; Slovis, Jennifer; Tangpricha, Vin; Tolsma, Dennis; Valentine, Cadence; Ward, Kevin; Winter, Savannah; Goodman, Michael

2017-12-27

The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to

Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people

PubMed Central

Quinn, Virginia P; Nash, Rebecca; Hunkeler, Enid; Contreras, Richard; Cromwell, Lee; Becerra-Culqui, Tracy A; Getahun, Darios; Giammattei, Shawn; Lash, Timothy L; Millman, Andrea; Robinson, Brandi; Roblin, Douglas; Silverberg, Michael J; Slovis, Jennifer; Tangpricha, Vin; Tolsma, Dennis; Valentine, Cadence; Ward, Kevin; Winter, Savannah; Goodman, Michael

2017-01-01

Purpose The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. Participants A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. Findings to date About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%–5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. Future plans STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg

Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives.

PubMed

Liles, Elizabeth G; Schneider, Jennifer L; Feldstein, Adrianne C; Mosen, David M; Perrin, Nancy; Rosales, Ana Gabriela; Smith, David H

2015-03-29

Few studies describe system-level challenges or facilitators to implementing population-based colorectal cancer (CRC) screening outreach programs. Our qualitative study explored viewpoints of multilevel stakeholders before, during, and after implementation of a centralized outreach program. Program implementation was part of a broader quality-improvement initiative. During 2008-2010, we conducted semi-structured, open-ended individual interviews and focus groups at Kaiser Permanente Northwest (KPNW), a not-for-profit group model health maintenance organization using the practical robust implementation and sustainability model to explore external and internal barriers to CRC screening. We interviewed 55 stakeholders: 8 health plan leaders, 20 primary care providers, 4 program managers, and 23 endoscopy specialists (15 gastroenterologists, 8 general surgeons), and analyzed interview transcripts to identify common as well as divergent opinions expressed by stakeholders. The majority of stakeholders at various levels consistently reported that an automated telephone-reminder system to contact patients and coordinate mailing fecal tests alleviated organizational constraints on staff's time and resources. Changing to a single-sample fecal immunochemical test (FIT) lessened patient and provider concerns about feasibility and accuracy of fecal testing. The centralized telephonic outreach program did, however, result in some screening duplication and overuse. Higher rates of FIT completion and a higher proportion of positive results with FIT required more colonoscopies. Addressing barriers at multiple levels of a health system by changing the delivery system design to add a centralized outreach program, switching to a more accurate and easier-to-use fecal test, and providing educational and electronic support had both benefits and problematic consequences. Other health care organizations can use our results to understand the complexities of implementing centralized

Early Colorectal Cancer Detected by Machine Learning Model Using Gender, Age, and Complete Blood Count Data.

PubMed

Hornbrook, Mark C; Goshen, Ran; Choman, Eran; O'Keeffe-Rosetti, Maureen; Kinar, Yaron; Liles, Elizabeth G; Rust, Kristal C

2017-10-01

Machine learning tools identify patients with blood counts indicating greater likelihood of colorectal cancer and warranting colonoscopy referral. To validate a machine learning colorectal cancer detection model on a US community-based insured adult population. Eligible colorectal cancer cases (439 females, 461 males) with complete blood counts before diagnosis were identified from Kaiser Permanente Northwest Region's Tumor Registry. Control patients (n = 9108) were randomly selected from KPNW's population who had no cancers, received at ≥1 blood count, had continuous enrollment from 180 days prior to the blood count through 24 months after the count, and were aged 40-89. For each control, one blood count was randomly selected as the pseudo-colorectal cancer diagnosis date for matching to cases, and assigned a "calendar year" based on the count date. For each calendar year, 18 controls were randomly selected to match the general enrollment's 10-year age groups and lengths of continuous enrollment. Prediction performance was evaluated by area under the curve, specificity, and odds ratios. Area under the receiver operating characteristics curve for detecting colorectal cancer was 0.80 ± 0.01. At 99% specificity, the odds ratio for association of a high-risk detection score with colorectal cancer was 34.7 (95% CI 28.9-40.4). The detection model had the highest accuracy in identifying right-sided colorectal cancers. ColonFlag ® identifies individuals with tenfold higher risk of undiagnosed colorectal cancer at curable stages (0/I/II), flags colorectal tumors 180-360 days prior to usual clinical diagnosis, and is more accurate at identifying right-sided (compared to left-sided) colorectal cancers.

COSTS OF INTERSTITAL CYSTITIS IN A MANAGED CARE POPULATION

PubMed Central

Clemens, J. Quentin; Meenan, Richard T.; O’Keeffe Rosetti, Maureen C.; Kimes, Terry; Calhoun, Elizabeth A.

2008-01-01

Objective This study assessed the direct medical costs, medication and procedure use associated with interstitial cystitis (IC) in women in the Kaiser Permanente Northwest (KPNW) managed care population. Methods The KPNW electronic medical record was utilized to identify women diagnosed with interstitial cystitis (n=239). Each of these cases was matched with three controls based on age and duration in the health plan. Health plan cost accounting data were used to determine inpatient, outpatient, and pharmacy costs for 1998-2003. An analysis of prescription medication use, cystoscopic and urodynamic procedures commonly associated with IC was also performed. To evaluate for comorbidities, an automated risk-adjustment model (RxRisk) linked to 28 chronic medical conditions was applied to the administrative datasets from both groups. Results The mean duration from the date of IC diagnosis to the end of the study period was 36.6 months (range 1.4-60). Mean yearly costs were 2.4-fold greater in cases than controls ($7100 vs. $2994), and median yearly costs were 3.8-fold greater ($5000 vs. $1304). These cost differences were predominantly due to outpatient and pharmacy expenses. Medication and procedure use were significantly greater in cases than controls. These findings were consistent across RxRisk categories, which suggest that the observed cost differences are IC-specific. Conclusions The direct per-person costs of IC are high, with average yearly costs approximately $4000 greater than age-matched controls. This cost differential is an underestimate, as costs preceding the diagnosis, use of alternative therapies, indirect costs and costs of those with IC that is not diagnosed are not included. PMID:18329077

Costs of interstitial cystitis in a managed care population.

PubMed

Clemens, J Quentin; Meenan, Richard T; Rosetti, Maureen C O'Keeffe; Kimes, Terry; Calhoun, Elizabeth A

2008-05-01

To assess the direct medical costs, medication, and procedure use associated with interstitial cystitis (IC) in women in the Kaiser Permanente Northwest (KPNW) managed care population. The KPNW electronic medical record was used to identify women diagnosed with IC (n = 239). Each of these patients was matched with three controls according to age and duration in the health plan. Health plan cost accounting data were used to determine the inpatient, outpatient, and pharmacy costs for 1998 to 2003. An analysis of the prescription medication use and cystoscopic and urodynamic procedures commonly associated with IC was also performed. To evaluate for co-morbidities, an automated risk-adjustment model linked to 28 chronic medical conditions was applied to the administrative data sets from both groups. The mean duration from the date of IC diagnosis to the end of the study period was 36.6 months (range 1.4 to 60). The mean yearly costs were 2.4-fold greater for the patients than for the controls ($7100 versus $2994), and the median yearly costs were 3.8-fold greater ($5000 versus $1304). These cost differences were predominantly due to outpatient and pharmacy expenses. Medication and procedure use were significantly greater for the patients than for the controls. These findings were consistent across risk-adjustment model categories, which suggest that the observed cost differences are IC specific. The direct per-person costs of IC are high, with average yearly costs approximately $4000 greater than for the age-matched controls. This cost differential is an underestimate, because the costs preceding the diagnosis, the use of alternative therapies, indirect costs, and the costs of those with IC that is not diagnosed were not included.

The Impact of Telephonic Wellness Coaching on Weight Loss: A “Natural Experiments for Translation in Diabetes (NEXT-D)” Study

PubMed Central

Schmittdiel, Julie A.; Adams, Sara R.; Goler, Nancy; Sanna, Rashel S.; Boccio, Mindy; Bellamy, David J.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira

2016-01-01

Objective To evaluate the impact of a population-based telephonic wellness coaching program on weight loss. Methods Individual-level segmented regression analysis of interrupted time series data comparing the BMI trajectories in the 12 months before vs. the 12 months after initiating coaching among a cohort of Kaiser Permanente Northern California (KPNC) members (n=954) participating in The Permanente Medical Group (TPMG) Wellness Coaching program in 2011. The control group was a 20:1 propensity-score matched control group (n=19,080) matched with coaching participants based on baseline demographic and clinical characteristics. Results Wellness coaching participants had a significant upward trend in BMI in the 12 months before their first Wellness coaching session, and a significant downward trend in BMI in the 12 months after their first session equivalent to a clinically significant reduction of greater than one unit of baseline BMI (p<.01 for both). The control group did not have statistically significant decreases in BMI during the post-period. Conclusions Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. Future research and quality improvement efforts should focus on disseminating Wellness coaching for weight loss in diabetes patients and those at risk for developing the disease. PMID:28124501

71. TILE WORKS FROM NORTHWEST, 191215. SL/BCHS, POSTCARD SN035. ...

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

71. TILE WORKS FROM NORTHWEST, 1912-15. SL/BCHS, POSTCARD SN-035. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

1. VIEW LOOKING NORTHWEST AT BUILDING 701. BUILDING 701 WAS ...

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

1. VIEW LOOKING NORTHWEST AT BUILDING 701. BUILDING 701 WAS USED TO DESIGN, BUILD, AND EVALUATE BENCH-SCALE TECHNOLOGIES USED IN ROCKY FLATS WASTE TREATMENT PROCESSES. (1/98) - Rocky Flats Plant, Design Laboratory, Northwest quadrant of Plant, between buildings 776-777 & 771, Golden, Jefferson County, CO

Interior view of the northwest end corridor, showing doors and ...

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

Interior view of the northwest end corridor, showing doors and barred openings to former fan and engine rooms (now garage) and entry to northwest gun chamber (labeled "Gun Turret No. One") - U.S. Naval Base, Pearl Harbor, Battery Adair, Princeton Place, Pearl City, Honolulu County, HI

The historical development of modern virus research in Germany, especially in the Kaiser-Wilhelm-/Max-Planck-Society, 1936--1954.

PubMed

Butenandt, A

1977-01-01

This is lecture on the historical development of modern virus research in Germany to introduce a symposium dedicated to Prof. Werner Schäfer, Tübingen, on the occasion of his 65th birthday. The author was set the task of relating from his memories the beginning of modern virus research in Germany. This research has, since 1936, essentially taken place in the Kaiser-Wilhelm/Max-Planck-Society and in 1954 led to the founding of the Max-Planck-Institute for Virus Research in Tübingen, an institute which to the present day owes its scientific reputation in considerable part to the activity of Werner Schäfer. Since the author personally experienced and participated in the Institute's development from 1936-1954, his remarks are predominantly influenced by personal recollections, which have been sharpended by a renewed study of old records in the 'Library and Archive of the History of the Max-Planck-Gesellschaft', Berlin-Dahlem.

15. INTERIOR OF NORTHWEST BEDROOM SHOWING OPEN DOORS TO ATTIC ...

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

15. INTERIOR OF NORTHWEST BEDROOM SHOWING OPEN DOORS TO ATTIC ACCESS AT PHOTO LEFT AND BATHROOM AT PHOTO CENTER. ORIGINAL 1-LIGHT OVER 1-LIGHT, DOUBLE HUNG WINDOW AT PHOTO RIGHT. VIEW TO NORTHWEST. - Bishop Creek Hydroelectric System, Plant 4, Worker Cottage, Bishop Creek, Bishop, Inyo County, CA

Maternal Infection during Pregnancy and Autism Spectrum Disorders

PubMed Central

Zerbo, Ousseny; Qian, Yinge; Yoshida, Cathleen; Grether, Judith K.; Van de Water, Judy; Croen, Lisa A.

2014-01-01

We conducted a nested case-control study including 407 cases and 2075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases. No overall association between diagnoses of any maternal infection during pregnancy and ASD (adjusted odds ratio [ORadj] = 1.15, 95% confidence interval [CI] 0.92 – 1.43). However, women with infections diagnosed during a hospital admission (ORadj= 1.48, 95% CI1.07 – 2.04), particularly bacterial infections (ORadj = 1.58, 95% CI 1.06 – 2.37), were at increased risk of delivering a child with ASD. Multiple infections during pregnancy were associated with ASD (ORadj = 1.36, 95% CI 1.05 – 1.78). PMID:24366406

2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

PubMed Central

Handler, Joel

2015-01-01

The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

Declining Effectiveness of Herpes Zoster Vaccine in Adults Aged ≥60 Years.

PubMed

Tseng, Hung Fu; Harpaz, Rafael; Luo, Yi; Hales, Craig M; Sy, Lina S; Tartof, Sara Y; Bialek, Stephanie; Hechter, Rulin C; Jacobsen, Steven J

2016-06-15

Understanding long-term effectiveness of herpes zoster (HZ) vaccine is critical for determining vaccine policy. 176 078 members of Kaiser Permanente ≥60 years vaccinated with HZ vaccine and three matched unvaccinated members were included. Hazard ratios and 95% confidence intervals (CIs) associated with vaccination at each year following vaccination were estimated by Cox regression model. The effectiveness of HZ vaccine decreased from 68.7% (95% CI, 66.3%-70.9%) in the first year to 4.2% (95% CI, -24.0% to 25.9%) in the eighth year. This rapid decline in effectiveness of HZ vaccine suggests that a revaccination strategy may be needed, if feasible. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

61. STABLE/RESTROOM, FROM THE NORTHWEST. SHOWING PROXIMITY TO THE MORAVIAN ...

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

61. STABLE/RESTROOM, FROM THE NORTHWEST. SHOWING PROXIMITY TO THE MORAVIAN POTTERY AND TILE WORKS. - Moravian Pottery & Tile Works, Southwest side of State Route 313 (Swamp Road), Northwest of East Court Street, Doylestown, Bucks County, PA

Northwest Outward Bound Instructor's Manual.

ERIC Educational Resources Information Center

Northwest Outward Bound School, Portland, OR.

Instructor responsibilities, procedures for completing activities safely, and instructional methods and techniques are outlined to assist instructors in the Northwest Outward Bound School (Portland, Oregon) as they strive for teaching excellence. Information is organized into six chapters addressing: history and philosophy of Outward Bound; course…

The northwest Arkansas transit assessment study

DOT National Transportation Integrated Search

2000-03-01

Providing adequate public transportation, including transportation services for the disadvantaged in Northwest Arkansas is an ongoing challenge. Unmet transit needs for the four-county area (Washington, Benton, Carroll and Madison Counties) included ...

Acid Precipitation in the Pacific Northwest.

ERIC Educational Resources Information Center

Baldwin, John; Kozak, David

1988-01-01

Discusses the causes, sources, and problems associated with acid deposition in the Pacific Northwest. Includes a learning activity about acid rain, "Deadly Skies," which was adapted from the Project WILD Aquatic Supplement. (TW)

A three-dimensional `Kaiser damage-memory' effect through true-triaxial loading

NASA Astrophysics Data System (ADS)

Meredith, P. G.; Browning, J.; Harland, S. R.; Healy, D.; Stuart, C.; Mitchell, T. M.

2017-12-01

Microcrack damage leading to failure in rocks evolves in response to differential loading. The vast majority of experimental studies investigate damage evolution, the `Kaiser damage-memory' effect, and rock failure using conventional triaxial stress states (σ1 > σ2 = σ3). Such stress states develop a crack population that displays cylindrical transverse isotropy. However, in nature the stress state is in general truly triaxial (σ1 > σ2 > σ3) and experiments that utilise such loading conditions can generate crack populations that display planar transverse isotropy which in turn influences properties such as permeability and strength. We investigate the evolution of crack damage under both conventional and true triaxial stress conditions using results from measurements made on cubic samples of sandstone deformed in three orthogonal directions with independently controlled stress paths. We have measured, simultaneously with stress and strain, the changes in ultrasonic compressional and shear wave velocities in the three principal directions, together with the bulk acoustic emission (AE) output. Changes in acoustic wave velocities are associated with both elastic closure and opening of pre-existing cracks, and the inelastic formation of new cracks. By contrast, AE is only associated with the inelastic growth of new crack damage and as such, we use the onset of AE to determine the initiation of new crack damage. By mapping these damage onsets under both conventional triaxial and true triaxial sequential cyclic loading, we have shown that `damage envelopes' evolve dynamically and can be pushed closer to the failure envelope. Whether a stress state has been `visited' before is key to determining and understanding damage states. Crack damage populations can be generated with multiple orientations depending on the arrangement of loading directions and hence principal stress directions. The sequential cyclic loading tests show that further damage in any one population

Northwest Angle, Minnesota

NASA Image and Video Library

2017-10-02

Minnesota's Northwest Angle is the northernmost point of the continental United States. The Angle became part of the US due to a map error during the 1783 Treaty of Paris. Located in the Lake of the Woods, driving there requires crossing the US-Canada border twice. The image was acquired September 22, 2013, covers an area of 40 by 55 km, and is located at 49.2 degrees north, 95.1 degrees west. https://photojournal.jpl.nasa.gov/catalog/PIA21997

WashWise cleans up the Northwest: Lessons learned from the Northwest high-efficiency clothes washer initiative

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

Gordon, L.M.; Banks, D.L.; Brenneke, M.E.

1998-07-01

WashWise is a regional market transformation program designed to promote the sale and acceptance or resource-efficient clothes washers (RECWs) in the Northwest through financial incentives, education, and marketing. The Program is sponsored by the Northwest Energy Efficiency Alliance (the Alliance), a non-profit regional consortium of utilities, government, public interest groups, and private sector organizations. WashWise started in May 1997 and will continue through the end of 1999. WashWise works to transform the clothes washer market primarily at the retail level through an in-store instant rebate and a retailer bonus. In addition to financial incentives, WashWise has undertaken a collaborative marketingmore » and promotional campaign to educate consumers about the financial savings and other benefits of RECWs. The program promotes only RECWs that meet strict energy and water savings criteria. WashWise has far exceeded initial expectations; annual program sales goals were met in the first three months. As of June 1998, 30,000 RECWs have been sold through the program (representing approximately 13 percent of the Northwest residential clothes washer market). In addition, over 540 retailers, including national and regional chains, are participating in the program. Preliminary survey results also have also provided evidence of broad customer satisfaction. This paper reviews the key elements that have contributed to the success of the WashWise program. In addition, the paper provides program results and indicates future directions for WashWise and the RECW market.« less

Climate change and health effects in Northwest Alaska.

PubMed

Brubaker, Michael; Berner, James; Chavan, Raj; Warren, John

2011-01-01

This article provides examples of adverse health effects, including weather-related injury, food insecurity, mental health issues, and water infrastructure damage, and the responses to these effects that are currently being applied in two Northwest Alaska communities. In Northwest Alaska, warming is resulting in a broad range of unusual weather and environmental conditions, including delayed freeze-up, earlier breakup, storm surge, coastal erosion, and thawing permafrost. These are just some of the climate impacts that are driving concerns about weather-related injury, the spread of disease, mental health issues, infrastructure damage, and food and water security. Local leaders are challenged to identify appropriate adaptation strategies to address climate impacts and related health effects. IMPLEMENTATION PROCESS: The tribal health system is combining local observations, traditional knowledge, and western science to perform community-specific climate change health impact assessments. Local leaders are applying this information to develop adaptation responses. The Alaska Native Tribal Health Consortium will describe relationships between climate impacts and health effects and provide examples of community-scaled adaptation actions currently being applied in Northwest Alaska. Climate change is increasing vulnerability to injury, disease, mental stress, food insecurity, and water insecurity. Northwest communities are applying adaptation approaches that are both specific and appropriate. The health impact assessment process is effective in raising awareness, encouraging discussion, engaging partners, and implementing adaptation planning. With community-specific information, local leaders are applying health protective adaptation measures.

Climate change and health effects in Northwest Alaska

PubMed Central

Brubaker, Michael; Berner, James; Chavan, Raj; Warren, John

2011-01-01

This article provides examples of adverse health effects, including weather-related injury, food insecurity, mental health issues, and water infrastructure damage, and the responses to these effects that are currently being applied in two Northwest Alaska communities. Background In Northwest Alaska, warming is resulting in a broad range of unusual weather and environmental conditions, including delayed freeze-up, earlier breakup, storm surge, coastal erosion, and thawing permafrost. These are just some of the climate impacts that are driving concerns about weather-related injury, the spread of disease, mental health issues, infrastructure damage, and food and water security. Local leaders are challenged to identify appropriate adaptation strategies to address climate impacts and related health effects. Implementation process The tribal health system is combining local observations, traditional knowledge, and western science to perform community-specific climate change health impact assessments. Local leaders are applying this information to develop adaptation responses. Objective The Alaska Native Tribal Health Consortium will describe relationships between climate impacts and health effects and provide examples of community-scaled adaptation actions currently being applied in Northwest Alaska. Findings Climate change is increasing vulnerability to injury, disease, mental stress, food insecurity, and water insecurity. Northwest communities are applying adaptation approaches that are both specific and appropriate. Conclusion The health impact assessment process is effective in raising awareness, encouraging discussion, engaging partners, and implementing adaptation planning. With community-specific information, local leaders are applying health protective adaptation measures. PMID:22022304

A program of forest soils research for the Pacific Northwest.

Treesearch

Robert F. Tarrant

1949-01-01

Pacific Northwest" and "great forests" are closely associated terms in the minds of most people. A great share of the regional income is derived from forest products, many towns in Oregon and Washington being established squarely on a base of forest harvests. A prosperous Northwest depends heavily on continued growth of trees on its large forest areas....

Northwest Energy Efficient Manufactured Housing Program Specification Development

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

Hewes, Tom; Peeks, Brady

2013-02-01

The DOE research team Building America Partnership for Improved Residential Construction (BA-PIRC), Bonneville Power Administration (BPA), and Northwest Energy Works (NEW), the current Northwest Energy Efficient Manufactured Home Program (NEEM) program administrator, collaborated to research a new specification that would reduce the energy requirements of a NEEM home.This research identified and developed combinations of cost-effective high performance building assemblies and mechanical systems that can readily can be deployed in the manufacturing setting that reduce energy used for space conditioning, water heating and lighting by 50% over the present NEEM specifications.

40 CFR 81.115 - Northwest Nevada Intrastate Air Quality Control Region.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Quality Control Region. 81.115 Section 81.115 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.115 Northwest Nevada Intrastate Air Quality Control Region. The Northwest Nevada Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

40 CFR 81.115 - Northwest Nevada Intrastate Air Quality Control Region.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Quality Control Region. 81.115 Section 81.115 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Air Quality Control Regions § 81.115 Northwest Nevada Intrastate Air Quality Control Region. The Northwest Nevada Intrastate Air Quality Control Region consists of the territorial area encompassed by the...

Acute Uterine Bleeding Unrelated to Pregnancy: A Southern California Permanente Medical Group Practice Guideline

PubMed Central

Munro, Malcolm G

2013-01-01

Acute uterine bleeding unrelated to pregnancy has been defined as bleeding “sufficient in volume as to, in the opinion of the treating clinician, require urgent or emergent intervention.” The Southern California Permanente Medical Group updated its guidelines for the management of this condition on the basis of the best available evidence, as identified in a systematic review of the available literature. Given the paucity of studies evaluating this condition, the guidelines, by necessity, include recommendations largely based on opinion or other sources such as case series that are, in general, categorized as low-quality evidence. Medical interventions with single or combined gonadal steroidal agents administered parenterally or orally show promise, but more high-quality studies are needed to better define the appropriate drugs, dose, and administrative scheduling. There is also some evidence that intrauterine tamponade may be useful in at least selected cases. Special attention must be paid to both diagnosing and treating inherited disorders of hemostasis, such as von Willebrand disease, that may otherwise be underdiagnosed in both adolescent and adult women. PMID:24355890

14. INTERIOR OF ROOM 101 LOOKING NORTHWEST. SIX OVER SIX ...

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

14. INTERIOR OF ROOM 101 LOOKING NORTHWEST. SIX OVER SIX LITE WOOD FRAME WINDOWS ARE CENTERED ON NORTHEAST AND NORTHWEST WALLS. ADDED TREATMENT TO WALLS IS A GYPSUM BOARD FINISH WITH WOOD TRIM, BOTH PAINTED. ADDED FLOOR TREATMENT IS VINYL COMPOSITION TILE. - Presidio of San Francisco, Cavalry Stables, Cowles Street, between Lincoln Boulevard & McDowell Street, San Francisco, San Francisco County, CA

Serving the People of the Northwest

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

None, None

IF YOU LIVE IN THE PACIFIC NORTHWEST, CHANCES ARE YOU USE ELECTRICITY THAT’S MARKETED BY THE BONNEVILLE POWER ADMINISTRATION OR IS TRANSMITTED OVER BPA POWER LINES. Headquartered in Portland, Ore., BPA is a federal agency that markets wholesale electricity and transmission to the region’s utilities as well as to some large industries. BPA provides about one-third of the electricity used in the Northwest and operates over three-fourths of the region’s high-voltage transmission. BPA does not rely on annual appropriations from Congress for its financing. Instead, the agency recovers all of its costs through sales of electricity and transmission services andmore » repays the U.S. Treasury in full with interest for any money it borrows. BPA sells wholesale power at cost rather than charging market prices. The bulk of the power BPA sells is generated at federal hydroelectric dams on the Columbia River, thus providing some of the lowest-cost electricity in the nation. This low-cost, clean power has been a cornerstone of the Northwest economy for decades, stimulating growth and new jobs. As concerns about global climate change are placing a new premium on clean energy, the federal hydro system has become an increasingly valuable resource. In addition to being low cost, electricity produced by the federal hydro system has no greenhouse gas emissions. And this power source is renewable — replenished each year by the region’s rainfall and snowmelt.« less

Sediment Evaluation Framework for the Pacific Northwest

EPA Pesticide Factsheets

The Sediment Evaluation Framework provides a regional framework for assessment, characterization and management of sediments in the Pacific Northwest to determine suitability for unconfined in-water disposal.

Links Related to Northwest Indiana Area (Indiana)

EPA Pesticide Factsheets

Northwest Indiana of the Urban Waters Federal Partnership (UWFP) reconnects urban communities with their waterways by improving coordination among federal agencies and collaborating with community-led efforts.

71. VIEW OF FUEL APRON FROM THE NORTHWEST. LEFT TO ...

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

71. VIEW OF FUEL APRON FROM THE NORTHWEST. LEFT TO RIGHT: HELIUM TANKS, GASEOUS NITROGEN TANKS, DIESEL FUEL TANK AND BACKUP GENERATOR, AND ROCKET FUEL TANKS. NORTHWEST CORNER OF THE LSB (BLDG. 751) AND LAUNCHER IN BACKGROUND ON LEFT; SOUTH CAMERA TOWER IN BACKGROUND ON RIGHT. - Vandenberg Air Force Base, Space Launch Complex 3, Launch Pad 3 East, Napa & Alden Roads, Lompoc, Santa Barbara County, CA

The Pacific Northwest Research Station.

Treesearch

Forest Service U.S. Department of Agriculture

1937-01-01

The research organization of the United States Forest Service in the North Pacific Region is the Pacific Northwest Forest and Range Experiment Station, one of the 12 regional experiment stations maintained by the service. This station, which has headquarters in Portland, Oregon, is making studies and surveys in the fields of economics, forest management, forest...

Program Contacts for Northwest Indiana Area (Indiana)

EPA Pesticide Factsheets

Northwest Indiana Area (Indiana) of the Urban Waters Federal Partnership (UWFP) reconnects urban communities with their waterways by improving coordination among federal agencies and collaborating with community-led efforts.

Photo Gallery for Northwest Indiana Area (Indiana)

EPA Pesticide Factsheets

Northwest Indiana Area (Indiana) of the Urban Waters Federal Partnership (UWFP) reconnects urban communities with their waterways by improving coordination among federal agencies and collaborating with community-led efforts.

Recent population decline of the Marbled Murrelet in the Pacific Northwest

Treesearch

Sherri L. Miller; Martin G. Raphael; Gary A. Falxa; Craig Strong; Jim Baldwin; Thomas Bloxton; Beth M. Galleher; Monique Lance; Deanna Lynch; Scott F. Pearson; C. John Ralph; Richard D. Young

2012-01-01

We document here a decline of nearly 30% in the Marbled Murrelet (Brachyramphus marmoratus) population of Washington, Oregon, and northern California between 2000 and 2010. The Northwest Forest Plan is an ecosystem-management plan for federal forest lands in the Pacific Northwest of the United States that incorporates monitoring to determine if...

The Mamook Book: Activities for Learning About the Northwest Coast Indians.

ERIC Educational Resources Information Center

Mathers, Sharon; And Others

A student activity book about the Northwest Coast provides "to-do" activities, such as reading, coloring, cutting out and putting together, while learning about the Northwest Coast tribes, their language, legends, clothing and ways of living. A map identifies the tribes and their location along the shores of Alaska, British Columbia,…

Verticillium wilt in the Pacific Northwest

USDA-ARS?s Scientific Manuscript database

Verticillium wilt is a serious disease of many economically important agricultural and horticultural crops in the Pacific Northwest (PNW). The disease affects herbaceous annuals and perennials as well as woody trees and shrubs. Plants affected by Verticillium wilt exhibit chlorosis, wilting, defolia...

The Pacific northwest stream quality assessment

USGS Publications Warehouse

Van Metre, Peter C.; Morace, Jennifer L.; Sheibley, Rich W.

2015-01-01

The Pacific Northwest study will be the third regional study by the NAWQA program, and it will be of similar design and scope as the first two—the Midwest in 2013 and the Southeast in 2014 (Van Metre and others, 2012, 2014).

Endangered Species in the Pacific Northwest.

ERIC Educational Resources Information Center

Clearing: Nature and Learning in the Pacific Northwest, 1985

1985-01-01

Suggests that students can learn how society works by studying threatened and endangered plant and animal species which occur in the local environments. Pictures, descriptions, habitats, and niche information are given for 21 threatened or endangered species of the Pacific Northwest. (DH)

Forest statistics for northwest Oregon.

Treesearch

Melvin E. Metcalf; John W. Hazard

1964-01-01

This publication summarizes the results of the latest reinventory of 10 counties in northwest Oregon: Clackamas, Clatsop, Columbia, Hood River, Marion, Multnomah, Polk, Tillamook, Washington, and Yamhill. This block of counties is one of 10 such blocks set up in the States of Oregon and Washington by the Forest Survey to facilitate orderly reinventories of the timber...

Northwest Forest Plan research synthesis.

Treesearch

Richard W. Haynes; Gloria E. Perez; [tech. eds.].

2000-01-01

This document synthesizes research accomplishments initiated and funded under the Northwest Forest Plan or the President’s Forest Plan (hereafter referred to as the Forest Plan) since its inception in 1994. Three major parts in this document cover, the context for this effort, eight Forest Plan research accomplishments, and a synthesis. The eight accomplishments...

Socioeconomic change in planning provinces of the Northwest Forest Plan region.

Treesearch

Ellen M. Donoghue; N. Lynnae Sutton

2006-01-01

The Northwest Forest Plan's 1994 Record of Decision (ROD) established a framework for a new ecosystem approach to federal land management across 24 million acres of the Pacific Northwest. One strategy outlined in the ROD combined ecosystem management and civic involvement in the creation of planning provinces, consisting of 12 contiguous multi-ownership areas...

Quality of Care for Work-associated Carpal Tunnel Syndrome

PubMed Central

Nuckols, Teryl; Conlon, Craig; Robbins, Michael; Dworsky, Michael; Lai, Julie; Roth, Carol P.; Levitan, Barbara; Seabury, Seth; Seelam, Rachana; Asch, Steven M.

2017-01-01

Objective To evaluate the quality of care provided to individuals with workers’ compensation claims related to CTS and identify patient characteristics associated with receiving better care. Methods We recruited subjects with new claims for CTS from 30 occupational clinics affiliated with Kaiser Permanente Northern California. We applied 45 process-oriented quality measures to 477 subjects’ medical records, and performed multivariate logistic regression to identify patient characteristics associated with quality. Results Overall, 81.6% of care adhered to recommended standards. Certain tasks related to assessing and managing activity were underused. Patients with classic/probable Katz diagrams, positive electrodiagnostic tests, and higher incomes received better care. However, age, gender, and race/ethnicity were not associated with quality. Conclusions Care processes for work-associated CTS frequently adhered to quality measures. Clinical factors were more strongly associated with quality than demographic and socioeconomic ones. PMID:28045797

Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

PubMed Central

Krall, M. A.; Sittig, D. F.

2001-01-01

There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use". PMID:11825206

Subjective assessment of usefulness and appropriate presentation mode of alerts and reminders in the outpatient setting.

PubMed

Krall, M A; Sittig, D F

2001-01-01

There is very little known about the limits of alerting in the setting of the outpatient Electronic Medical Record (EMR). We are interested in how users value and prefer such alerts. One hundred Kaiser Permanente primary care clinicians were sent a four-page questionnaire. It contained questions related to the usability and usefulness of different approaches to presenting reminder and alert information. The survey also contained questions about the desirability of six categories of alerts. Forty-three of 100 questionnaires were returned. Users generally preferred an active, more intrusive interaction model for "alerts" and a passive, less intrusive model for order messages and other types of reminders and notifications. Drug related alerts were more highly rated than health maintenance or disease state reminders. Users indicated that more alerts would make the system "more useful" but "less easy to use".

Decadal Variability of Temperature and Salinity in the Northwest Atlantic Ocean

NASA Astrophysics Data System (ADS)

Mishonov, A. V.; Seidov, D.; Reagan, J. R.; Boyer, T.; Parsons, A. R.

2017-12-01

There are only a few regions in the World Ocean where the density of observations collected over the past 60 years is sufficient for reliable data mapping with spatial resolutions finer than one-degree. The Northwest Atlantic basin is one such regions where a spatial resolution of gridded temperature and salinity fields, comparable to those generated by eddy-resolving numerical models of ocean circulation, has recently becomes available. Using the new high-resolution Northwest Atlantic Regional Climatology, built on quarter-degree and one-tenth-degree resolution fields, we analyzed decadal variability and trends of temperature and salinity over 60 years in the Northwest Atlantic, and two 30-year ocean climates of 1955-1984 and 1985-2012 to evaluate the oceanic climate shift in this region. The 30-year climate shift is demonstrated using an innovative 3-D visualization of temperature and salinity. Spatial and temporal variability of heat accumulation found in previous research of the entire North Atlantic Ocean persists in the Northwest Atlantic Ocean. Salinity changes between two 30-year climates were also computed and are discussed.

Study on site selection of cold chain logistics in northwest territories

NASA Astrophysics Data System (ADS)

Liu, Yubin; Ren, Zongwei

2017-08-01

In this research, we mainly studied the Site selection problem of cold chain logistics in northwest of China. In the first place, we counted the demands of cold chain products in northwest territories, and then classified it into the Site selection problem in five provinces in northwest territories(Xinjiang, Qinghai, Gansu, Ningxia, Shanxi); Next, we used the Center of gravity Method to select initial location; Finally, we established the location of distribution by using Analytic Hierarchy Process (AHP)and fuzzy comprehensive evaluation method. Comparing with the traditional method, this method not only considered the cost of transportation and distance, but also deliberated the physical condition, social environment and economics condition which associated with Site selection problem.

2013 White Book, Pacific Northwest Loads and Resources Study (summary)

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

None

The 2013 Pacific Northwest Loads and Resources Study (2013 White Book) is BPA's latest projection of the Pacific Northwest regional retail loads, contract obligations, contract purchases, and resource capabilities. The 2013 White Book is a snapshot of conditions as of October 1, 2013, documenting the loads and resources for the Federal system and region for the 10-year study period OY 2014 through 2023. The White Book contains projections of regional and Federal system load and resource capabilities, along with relevant definitions and explanations. The White Book also contains information obtained from formalized resource planning reports and data submittals including thosemore » from individual utilities, the Northwest Power and Conservation Council (Council), and the Pacific Northwest Utilities Conference Committee (PNUCC). Starting with the 2012 White Book, BPA changed the annual production schedule for future White Books. BPA is scheduled to publish a complete White Book, which includes a Federal System Needs Assessment analysis, every other year (even years). In the odd-numbered years, BPA will publish a biennial summary update (Supplement) that only contains major changes to the Federal System and Regional System analyses that have occurred since the last White Book. http://www.bpa.gov/power/pgp/whitebook/2013/index.shtml.« less

Andes Altiplano, Northwest, Argentina

NASA Technical Reports Server (NTRS)

1992-01-01

This view of the Andean Altiplano in northwest Argentina (25.5S, 68.0W) is dominated by heavily eroded older and inactive volcano peaks. Snow is more apparent on the south faces of the slopes where the sunlight is less direct and therefore, cooler. The Altiplano is a high altitude cold desert like the Tibetan Plateau but smaller in area. It is the inland extension of the hyperarid Atacama Desert of the west coast of South America.

The impact of telephonic wellness coaching on weight loss: A "Natural Experiments for Translation in Diabetes (NEXT-D)" study.

PubMed

Schmittdiel, Julie A; Adams, Sara R; Goler, Nancy; Sanna, Rashel S; Boccio, Mindy; Bellamy, David J; Brown, Susan D; Neugebauer, Romain S; Ferrara, Assiamira

2017-02-01

To evaluate the impact of a population-based telephonic wellness coaching program on weight loss. Individual-level segmented regression analysis of interrupted time series data comparing the BMI trajectories in the 12 months before versus the 12 months after initiating coaching among a cohort of Kaiser Permanente Northern California members (n = 954) participating in The Permanente Medical Group Wellness Coaching program in 2011. The control group was a 20:1 propensity-score matched control group (n = 19,080) matched with coaching participants based on baseline demographic and clinical characteristics. Wellness coaching participants had a significant upward trend in BMI in the 12 months before their first wellness coaching session and a significant downward trend in BMI in the 12 months after their first session equivalent to a clinically significant reduction of greater than one unit of baseline BMI (P < 0.01 for both). The control group did not have statistically significant decreases in BMI during the post-period. Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. Future research and quality improvement efforts should focus on disseminating wellness coaching for weight loss in patients with diabetes and those at risk for developing the disease. © 2017 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

Raindrop Characteristics in the Pacific Northwest

USDA-ARS?s Scientific Manuscript database

The U.S. Pacific Northwest, influenced by maritime air masses for most of the year, generally exhibits low rainfall intensities. The drop-size characteristics of such low-intensity storms are rarely studied. An investigation of natural drop sizes and their distribution was conducted at the Palouse ...

More comprehensive discussion of CRC screening associated with higher screening.

PubMed

Mosen, David M; Feldstein, Adrianne C; Perrin, Nancy A; Rosales, A Gabriella; Smith, David H; Liles, Elizabeth G; Schneider, Jennifer L; Meyers, Ronald E; Elston-Lafata, Jennifer

2013-04-01

Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening. Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization. A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening. receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression. Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening. More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.

Feasibility of a pilot intervention to reduce pain and syncope during adolescent vaccination.

PubMed

Henninger, Michelle L; Kuntz, Jennifer L; Firemark, Alison J; Varga, Alexandra M; Bok, Karin; Naleway, Allison L

2018-05-24

Vaccines recommended for adolescents are considered safe and effective, however administration may occasionally result in acute pain at the injection site or syncope (fainting). These adverse effects pose a risk to patient safety and are potential barriers to adherence to future vaccinations. We assessed a novel intervention designed to help prevent acute pain and syncope associated with adolescent vaccinations. We conducted a 3-month pilot study to assess the feasibility and acceptability of a vaccination comfort menu within two Kaiser Permanente Northwest pediatric clinics. The menu offered a variety of comfort items (e.g., cold packs, squeeze balls) that children could select prior to their vaccination. We surveyed parents of recently vaccinated adolescents and interviewed providers to assess the implementation and effectiveness of the intervention. Response rate for the parent survey was 33% (378/1136). Only 20% of the parents reported that their provider offered the comfort menu during the vaccination visit. Approximately 50% of the adolescents who were offered the menu selected a comfort item and most of these participants reported that the item was very (35%) or somewhat (38%) helpful in improving their vaccination experience. Per provider interviews, common barriers to implementing the intervention included lack of time and convenience, and the brevity of the pilot period. The comfort menu may improve the vaccination experience of youth and increase the likelihood of adherence with future vaccinations. However, only 20% of the parents reported that their provider offered the menu during the vaccination visit. Additional research is needed to determine the feasibility of implementing this intervention on a larger scale, as well as assessing whether the intervention has a significant impact on reducing adverse events. Copyright © 2018. Published by Elsevier Ltd.

Prevalence and incidence of urinary tract and genital infections among patients with and without type 2 diabetes.

PubMed

Nichols, Gregory A; Brodovicz, Kimberly G; Kimes, Teresa M; Déruaz-Luyet, Anouk; Bartels, Dorothee B

2017-11-01

Epidemiological data on genitourinary infections (GUIs) comparing patients with and without type 2 diabetes (T2DM) is scant. We aimed to estimate the incidence of urinary tract infections (UTIs), genital infections (GIs), or any GUI in total and stratified by history of GUI and sex. We identified 39,295 patients in the Kaiser Permanente Northwest health plan with T2DM and an equal number of age and sex matched patients without diabetes. The cohort was followed for up to 9years (2006-2014). We calculated incidence rates and corresponding 95% confidence intervals (CI) of any GUI, UTIs and GIs adjusting for age, sex, race, BMI, presence of chronic kidney disease, annual number of outpatient visits, and diuretic use. Adjusted incidence of any GUI was 97.2/1000person-years (p-y) (95% CI 95.5-98.8) among the T2DM cohort vs. 79.7/1000 p-y (78.3-81.2) among those without diabetes. T2DM was associated with an adjusted 25% increased risk of UTI (rate ratio 1.25, 95% CI 1.22-1.29), a 26% increased risk of GI (1.26, 1.22-1.31) and a 22% increased risk of any GUI (1.22, 1.19-1.25). Incidence rates were lower among those with no GUI history, but the relative risks were similar. Women in both groups had higher incidence rates of GUIs than men. T2DM was associated with increased risks of any GUI, UTIs and GIs. Incidence rates of UTIs were higher than rates of GIs, but the relative risk of GIs was essentially identical. A similar pattern was observed when stratifying by sex. RESEARCH QUESTIONS. Copyright © 2017 Elsevier Inc. All rights reserved.

Forest Management Policy and Community Well-Being in the Pacific Northwest

Treesearch

Susan Charnley; Ellen M. Donoghue; Cassandra Moseley

2008-01-01

This study uses a multiscale, multimethods approach to examine the effects of declining timber harvests on the well-being of forest communities in the Pacific Northwest as a result of the Northwest Forest Plan (the Plan). We found that the effects of declining timber harvests were variable and depended on the importance of the timber sector in a community in the late...

Forest management policy and community well-being in the Pacific Northwest

Treesearch

Susan Charnley; Ellen M. Donoghue; Cassandra Moseley

2008-01-01

This study uses a multiscale, multimethods approach to examine the effects of declining timber harvests on the well-being of forest communities in the Pacific Northwest as a result of the Northwest Forest Plan (the Plan). We found that the effects of declining timber harvests were variable and depended on the importance of the timber sector in a community in the late...

Cognitive styles of Forest Service scientists and managers in the Pacific Northwest.

Treesearch

Andrew B. Carey

1997-01-01

Preferences of executives, foresters, and biologists of the Pacific Northwest Research Station and executives, District Rangers, foresters, engineers, and biologists of the Pacific Northwest Region, National Forest System (USDA Forest Service), were compared for various thinking styles. Herrmann brain dominance profiles from 230 scientists and managers were drawn from...

Characterising weak layers that accommodate submarine landslides on the Northwest African continental slope

NASA Astrophysics Data System (ADS)

Urlaub, M.; Krastel, S.; Geersen, J.; Schwenk, T.

2017-12-01

Numerous studies invoke weak layers to explain the occurrence of large submarine landslides (>100 km³), in particular those on very gentle slopes (<3°). Failure conditions are thought to be met only within this layer, which is embedded between stable sediments. Although key to understanding failure mechanisms, little is known about the nature and composition of such weak layers, mainly because they are (1) often destroyed with the landslide and (2) difficult to reach with ship-based gravity and piston coring. The Northwest African continental slope hosts numerous large submarine landslides that are translational, such that failure takes place along bedding-parallel surfaces at different stratigraphic depths. This suggests that failure occurs along weak layers, which are deposited repeatedly over time. Using high resolution seismic reflection data we trace several failure surfaces of the Cap Blanc Slide complex offshore Northwest Africa to ODP-Site 658. Core-seismic integration shows that the failure surfaces coincide with diatom oozes that are topped by clay. Along Northwest Africa diatom-rich sediments are typically deposited at the end of glacial periods. In the seismic data these oozes show up as distinct high amplitude reflectors due to their characteristic low densities. Similar high-amplitude reflectors embedded into low-reflective seismic units are commonly observed in shallow sediments (<100 m below seafloor) along the entire Northwest African continental slope. The failure surfaces of at least three large landslides coincide with such reflectors. As the most recent Pleistocene glacial periods likely influenced sediment deposition along the entire Northwest African margin in a similar manner we hypothesize that diatom oozes play a critical role for the generation of submarine landslides off Northwest Africa as well as globally within subtropical regions. An initiative to drill the Northwest African continental slope with IODP is ongoing, within which this

Evaluation of a Therapeutic Interchange from Fluticasone/Salmeterol to Mometasone/Formoterol in Patients with Chronic Obstructive Pulmonary Disease.

PubMed

Yip, Elaine; Karimi, Sahar; Pien, Linda T

2016-04-01

Combination treatment with an inhaled corticosteroid and long-acting beta2-agonist is among the many treatment options for chronic obstructive pulmonary disease (COPD) that has been shown to improve clinical outcomes. While mometasone/formoterol does not currently have an FDA-approved indication for COPD, evidence from 2 phase 3 trials demonstrated that mometasone/formoterol can improve lung function and was well tolerated in patients with moderate-to-very severe COPD. Based on these data, a therapeutic interchange was implemented in the Kaiser Permanente Mid-Atlantic States region to convert patients with a COPD diagnosis from fluticasone/salmeterol to mometasone/formoterol. To evaluate the impact of a therapeutic interchange from fluticasone/salmeterol to mometasone/formoterol on health outcomes in patients with COPD in a large ambulatory and managed care setting. The investigators retrospectively reviewed the electronic medical records of patients with a COPD diagnosis who had a prescription for fluticasone/salmeterol converted to mometasone/formoterol between March 6, 2011, to March 6, 2013. Kaiser Permanente's Pharmacy and Therapeutics Committee provided recommended equivalent doses for conversion from fluticasone/salmeterol to mometasone/formoterol. Nonetheless, the final approval for the change in medication and selection of the dose was left to each physician's clinical judgment. Patients were excluded if they were (a) prescribed fluticasone/salmeterol 100/50 mcg, which has no equivalent mometasone/formoterol dose; (b) less than aged 18 years; or (c) prescribed fluticasone/salmeterol for a duration of less than 6 months preconversion to mometasone/formoterol. In addition, patients who left the Kaiser Permanente network or became deceased during the study period of interest were excluded. After the application of the inclusion and exclusion criteria, 521 patients were included in the data analysis. The primary endpoint was the determination of the difference

Climate signature of Northwest U.S. precipitation Extremes

NASA Astrophysics Data System (ADS)

Kushnir, Y.; Nakamura, J.

2017-12-01

The climate signature of precipitation extremes in the Northwest U.S. - the region that includes Oregon, Washington, Idaho, Montana and Wyoming - is studied using composite analysis of atmospheric fields leading to and associated with extreme rainfall events. A K-Medoids cluster analysis is applied to winter (November-February) months, maximum 5-day precipitation amounts calculated from 1-degree gridded daily rainfall between 1950/51 and 2013/14. The clustering divides the region into three sub-regions: one over the far eastern part of the analysis domain, includeing most of Montana and Wyoming. Two other sub-regions are in the west, lying north and south of the latitude of 45N. Using the time series corresponding to the Medoid centers, we extract the largest (top 5%) monthly extreme events to form the basis for the composite analysis. The main circulation feature distinguishing a 5-day extreme precipitation event in the two western sub-regions of the Northwest is the presence of a large, blocking, high pressure anomaly over the Gulf of Alaska about a week before the beginning of the 5-day intense precipitation event. The high pressure center intensifies considerably with time, drifting slowly westward, up to a day before the extreme event. During that time, a weak low pressure centers appears at 30N, to the southwest of the high, deepening as it moves east. As the extreme rainfall event is about to begin, the now deep low is encroaching on the Northwest coast while its southern flank taps well south into the subtropical Pacific, drawing moisture from as south as 15N. During the 5-day extreme precipitation event the high pressure center moves west and weakens while the now intense low converges large amounts of subtropical moisture to precipitate over the western Northwest. The implication of this analysis for extended range prediction is assessed.

Fluvial processes in Puget Sound rivers and the Pacific Northwest [Chapter 3

Treesearch

John M. Buffington; Richard D. Woodsmith; Derek B. Booth; David R. Montgomery

2003-01-01

The variability of topography, geology, climate; vegetation, and land use in the Pacific Northwest creates considerable spatial and temporal variability of fluvial processes and reach-scale channel type. Here we identify process domains of typical Pacific Northwest watersheds and examine local physiographic and geologic controls on channel processes and response...

Pb concentrations and isotopic record preserved in northwest Greenland snow.

PubMed

Kang, Jung-Ho; Hwang, Heejin; Han, Changhee; Hur, Soon Do; Kim, Seong-Joong; Hong, Sungmin

2017-11-01

We present high-resolution lead (Pb) concentrations and isotopic ratios from a northwest Greenland snow pit covering a six-year period between 2003 and 2009. Pb concentrations ranged widely from 2.7 pg g -1 to 97.3 pg g -1 , with a mean concentration of 21.6 pg g -1 . These values are higher than those recorded for the pre-industrial period. Pb concentrations exhibit seasonal spikes in winter-spring layers. Crustal Pb enrichment factors (EF) suggest that the northwest Greenland snow pit is highly enriched with Pb of predominantly anthropogenic origin. The 206 Pb/ 207 Pb ratios ranged from 1.144 to 1.169 with a mean value of 1.156, which fall between less radiogenic Eurasian-type and more radiogenic Canadian-type signatures. This result suggests that several potential source areas of Pb impact on northwest Greenland. Abrupt changes in Pb concentrations and Pb isotope ratios were observed and related to seasonal shifts in source regions of aerosol transport. The 206 Pb/ 207 Pb isotope ratio increased gradually between 2003 and 2009. The similarity of the three-isotope plot ( 206 Pb/ 207 Pb versus 208 Pb/ 207 Pb) between some of our samples and Chinese urban aerosols suggests a steadily increasing contribution of Chinese Pb to northwest Greenland snow. Copyright © 2017. Published by Elsevier Ltd.

The Northwest Indiana Center for Data and Analysis: A Case Study of Academic Library Community Engagement

ERIC Educational Resources Information Center

Sandberg, Scott; Morris, Cele; Sutherland, Timothy

2013-01-01

This paper details community engagement activity of an academic library coordinated within a broader university strategic plan. The Anderson Library at Indiana University Northwest (IU-Northwest) supports a service called the Northwest Indiana Center for Data and Analysis. Created in 1996 with funding made available from the Indiana University…

Final Scientific/Technical Report Carbon Capture and Storage Training Northwest - CCSTNW

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

Workman, James

This report details the activities of the Carbon Capture and Storage Training Northwest (CCSTNW) program 2009 to 2013. The CCSTNW created, implemented, and provided Carbon Capture and Storage (CCS) training over the period of the program. With the assistance of an expert advisory board, CCSTNW created curriculum and conducted three short courses, more than three lectures, two symposiums, and a final conference. The program was conducted in five phases; 1) organization, gap analysis, and form advisory board; 2) develop list serves, website, and tech alerts; 3) training needs survey; 4) conduct lectures, courses, symposiums, and a conference; 5) evaluation surveysmore » and course evaluations. This program was conducted jointly by Environmental Outreach and Stewardship Alliance (dba. Northwest Environmental Training Center – NWETC) and Pacific Northwest National Laboratories (PNNL).« less

Northwest Area Science

USGS Publications Warehouse

Fuentes, Tracy L.; van Heeswijk, Marijke; Grossman, Eric E.

2010-01-01

Northwest Area Facts * Population about 12 million * 43 federally recognized Tribes * Hydropower provides about two-thirds of electricity supply * 78 federally listed threatened and endangered species * 12 active or potentially active volcanoes * Columbia River system drains more than 260,000 square miles, an area about the size of Texas * More than 175 square miles covered by glaciers * More than 900 miles of Pacific Ocean coastline * More than 2,300 miles of greater Puget Sound coastline * Some forests store more carbon per unit area than any other area in the world, including the tropics * 51 percent federal lands * Significant lead, zinc, silver, and phosphate deposits

A research framework for natural resource-based communities in the Pacific Northwest.

Treesearch

Harriet H. Christensen; Ellen M. Donoghue

2001-01-01

The Pacific Northwest (PNW) Research Station developed a problem analysis to direct the research on natural resource-based communities in the Pacific Northwest over the next 5 years. The problem analysis identifies four problem areas: (1) social values related to rural peoples, communities, and development, and their ties to resource management are largely unknown; (2...

ANIMAL-HABITAT ASSOCIATIONS IN PACIFIC NORTHWEST ESTUARIES

EPA Science Inventory

The mission of the Pacific Coastal Ecology Branch (EPA, Newport, OR) is to determine the effects of habitat alteration by stressors on ecological resources in Pacific Northwest (PNW) estuaries. Research being conducted in support of this mission includes identifying critical hab...

Chip prices as a proxy for nonsawtimber prices in the Pacific Northwest.

Treesearch

Richard W. Haynes

1999-01-01

The heavy focus on Pacific Northwest saw-log prices makes it difficult for land managers to develop price expectations for stands that contain both sawtimber and nonsawtimber logs. This raises the question: What is a reasonable proxy (or measure) for nonsawtimber prices in the Pacific Northwest? One such proxy is export chip prices, which serve as a reasonable measure...

Forest resources in Northwest Florida

Treesearch

I.F. Eldredge

1938-01-01

Northwest Florida is the long arm of the State that extends along the Gulf Coast south of Georgia and Alabama and includes the 16 counties west of the Aucilla River (see map, fig. 1). It is a rather sparsely settled area in which only 26 percent of the total population of 254,000 (1930 Census) live in cities of 2,500 population or larger; most of the inhabitants live...

Changes in School Food Preparation Methods Result in Healthier Cafeteria Lunches in Elementary Schools.

PubMed

Behrens, Timothy K; Liebert, Mina L; Peterson, Hannah J; Howard Smith, Jennifer; Sutliffe, Jay T; Day, Aubrey; Mack, Jodi

2018-05-01

The purpose of this study is to examine the impact of a districtwide food best practices and preparation changes in elementary schools lunches, implemented as part of the LiveWell@School childhood obesity program, funded by LiveWell Colorado/Kaiser Permanente Community Health Initiative. Longitudinal study examining how school changes in best practices for food preparation impacted the types of side items offered from 2009 to 2015 in elementary school cafeterias in a high-need school district in southern Colorado. Specifically, this study examined changes in side items (fruits, vegetables, potatoes, breads, and desserts). In Phase 1 (2009-2010), baseline data were collected. During Phase 2 (2010-2011), breaded and processed foods (e.g., frozen nuggets, pre-packaged pizza) were removed and school chefs were trained on scratch cooking methods. Phase 3 (2011-2012) saw an increased use of fresh/frozen fruits and vegetables after a new commodity order. During Phase 4 (2013-2015), chef consulting and training took place. The frequency of side offerings was tracked across phases. Analyses were completed in Fall 2016. Because of limited sample sizes, data from Phases 2 to 4 (intervention phases) were combined for potatoes and desserts. Descriptive statistics were calculated. After adjusting for length of time for each phase, Pearson chi-square tests were conducted to examine changes in offerings of side items by phase. Fresh fruit offerings increased and canned fruit decreased in Phases 1-4 (p=0.001). A significant difference was observed for vegetables (p=0.001), with raw and steamed vegetables increasing and canned vegetables decreasing from Phase 1 to 4. Fresh potatoes (low in sodium) increased and fried potatoes (high in sodium) decreased from Phase 1 to Phases 2-4 (p=0.001). Breads were eliminated entirely in Phase 2, and dessert changes were not significant (p=0.927). This approach to promoting healthier lunch sides is a promising paradigm for improving elementary

Northwest Persian Gulf Region

NASA Technical Reports Server (NTRS)

1983-01-01

An oblique view of the northwest Persian Gulf Region (29.5N, 48.0E) with Iraq and Iran at the north end of the Gulf separated by the Tigres-Euphrates river system. The hazy nature of the photo is because of a dust storm blowing across Iraq and Iran as well as smoke from oil well fires seen in the tiny but oil rich nation of Kuwait at upper right. Over the years, other out of control oil wells have spilled millions of barrels of oil into the Gulf.

Forest statistics for Northwest Louisiana Parishes

Treesearch

James F. Rosson; Daniel F. Bertelson

1985-01-01

These tables were derived from data obtained during a 1984 inventory of 13 parishes comprising the Northwest unit of Louisiana (fig. 1). The data on forest acreage and timber volume were secured by a systematic sampling method involving a forest-nonforest classification on aerial photographs and on-the-ground measurements of trees at sample locations. The sample...

Solar Energy for Pacific Northwest Buildings.

ERIC Educational Resources Information Center

Reynolds, John S.

Data presented in this report indicate that solar space and water heating are possible in the Pacific Northwest. The first section of the report contains solar records from several stations in the region illustrating space heating needs that could be met, on an average daily basis, by solar energy. The data are summarized, and some preliminary…

Monitoring late-successional forest biodiversity in the Pacific Northwest, U.S.A.

Treesearch

Thomas A. Spies; Jon R. Martin

2006-01-01

The era of ecosystem management for federal forest lands in the Pacific Northwest began in 1994 with the adoption of the Northwest Forest Plan. This plan was designed to maintain and restore species and ecosystems associated with late successional and old-growth forests on over 10 million ha. of federal lands in Washington, Oregon and California. The plan called for...

2. VIEW, LOOKING NORTHWEST, FROM INSIDE THE PROTECTED AREA AT ...

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

2. VIEW, LOOKING NORTHWEST, FROM INSIDE THE PROTECTED AREA AT THE BASE OF TOWER 901. THE BUILDINGS IN THE FOREGROUND INCLUDE 984, 992, 991, 989, AND 968. THESE BUILDINGS MAKE UP THE BUILDING 991 COMPLEX. BUILDING 991, PLANT D, WAS THE FIRST OPERATIONAL BUILDING ON SITE, CONSTRUCTED IN 1951 AS THE FINAL ASSEMBLY AND SHIPPING AND RECEIVING BUILDING. TO THE NORTH AND NORTHWEST OF BUILDING 991 ARE THE UNDERGROUND VAULTS AND TUNNELS USED TO STORAGE WEAPONS COMPONENTS. - Rocky Flats Plant, Bounded by Indiana Street & Routes 93, 128 & 72, Golden, Jefferson County, CO

Data That Drive: Closing the Loop in the Learning Hospital System

PubMed Central

Liu, Vincent X.; Morehouse, John W.; Baker, Jennifer M.; Greene, John D.; Kipnis, Patricia; Escobar, Gabriel J.

2017-01-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson—sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system—to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. PMID:27805797

Outcomes in Treatment for Intradural Spinal Cord Ependymomas

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

Volpp, P. Brian; Han, Khanh; Kagan, A. Robert

2007-11-15

Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be themore » initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy.« less

The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults

PubMed Central

2012-01-01

Background Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs) and adult smoking. Method Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used. Results Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce). Among men, the associations between ACEs and smoking were not significant. Conclusions These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma. PMID:22788356

The intertwining paths of the density managment and riparian buffer study and the Northwest Forest Plan

Treesearch

Kenneth J. Ruzicka; Deanna H. Olson; Klaus J. Puettmann

2013-01-01

Initiated simultaneously, the Density Management and Riparian Buff er Study of western Oregon and the Northwest Forest Plan have had intertwining paths related to federal forest management and policy changes in the Pacifi c Northwest over the last 15 to 20 years. We briefl y discuss the development of the Northwest Forest Plan and how it changed the way forest policy...

REALITY, DELUSIONS, AND OTHER ASSORTED TRUTHS: THE FUTURE OF SALMON IN THE PACIFIC NORTHWEST

EPA Science Inventory

Are professional fisheries scientists collectively guilty of encouraging delusions about the possibilities for restoring wild salmon to the Pacific Northwest? Do they perpetuate the fantasy that the Pacific Northwest will (or could, absent pervasive life-style changes) support w...

PIK3CA gene mutations in Northwest Chinese esophageal squamous cell carcinoma

PubMed Central

Liu, Shi-Yuan; Chen, Wei; Chughtai, Ehtesham Annait; Qiao, Zhe; Jiang, Jian-Tao; Li, Shao-Min; Zhang, Wei; Zhang, Jin

2017-01-01

AIM To evaluate PIK3CA gene mutational status in Northwest Chinese esophageal squamous cell carcinoma (ESCC) patients, and examine the associations of PIK3CA gene mutations with clinicopathological characteristics and clinical outcome. METHODS A total of 210 patients with ESCC who underwent curative resection were enrolled in this study. Pyrosequencing was applied to investigate mutations in exons 9 and 20 of PIK3CA gene in 210 Northwest Chinese ESCCs. The associations of PIK3CA gene mutations with clinicopathological characteristics and clinical outcome were examined. RESULTS PIK3CA gene mutations in exon 9 were detected in 48 cases (22.9%) of a non-biased database of 210 curatively resected Northwest Chinese ESCCs. PIK3CA gene mutations were not associated with sex, tobacco use, alcohol use, tumor location, stage, or local recurrence. When compared with wild-type PIK3CA gene cases, patients with PIK3CA gene mutations in exons 9 experienced significantly better disease-free survival and overall survival rates. CONCLUSION The results of this study suggest that PIK3CA gene mutations could act as a prognostic biomarker in Northwest Chinese ESCC patients. PMID:28465643

78 FR 70858 - Safety Zones; Pacific Northwest Grain Handlers Association Facilities; Columbia and Willamette...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-27

... 1625-AA00 Safety Zones; Pacific Northwest Grain Handlers Association Facilities; Columbia and... establishing temporary safety zones around the following Pacific Northwest Grain Handlers Association... Commodities facility on the Willamette River in Portland, OR. These safety zones extend approximately between...

Patterns of admixture and population structure in native populations of Northwest North America.

PubMed

Verdu, Paul; Pemberton, Trevor J; Laurent, Romain; Kemp, Brian M; Gonzalez-Oliver, Angelica; Gorodezky, Clara; Hughes, Cris E; Shattuck, Milena R; Petzelt, Barbara; Mitchell, Joycelynn; Harry, Harold; William, Theresa; Worl, Rosita; Cybulski, Jerome S; Rosenberg, Noah A; Malhi, Ripan S

2014-08-01

The initial contact of European populations with indigenous populations of the Americas produced diverse admixture processes across North, Central, and South America. Recent studies have examined the genetic structure of indigenous populations of Latin America and the Caribbean and their admixed descendants, reporting on the genomic impact of the history of admixture with colonizing populations of European and African ancestry. However, relatively little genomic research has been conducted on admixture in indigenous North American populations. In this study, we analyze genomic data at 475,109 single-nucleotide polymorphisms sampled in indigenous peoples of the Pacific Northwest in British Columbia and Southeast Alaska, populations with a well-documented history of contact with European and Asian traders, fishermen, and contract laborers. We find that the indigenous populations of the Pacific Northwest have higher gene diversity than Latin American indigenous populations. Among the Pacific Northwest populations, interior groups provide more evidence for East Asian admixture, whereas coastal groups have higher levels of European admixture. In contrast with many Latin American indigenous populations, the variance of admixture is high in each of the Pacific Northwest indigenous populations, as expected for recent and ongoing admixture processes. The results reveal some similarities but notable differences between admixture patterns in the Pacific Northwest and those in Latin America, contributing to a more detailed understanding of the genomic consequences of European colonization events throughout the Americas.

Patterns of Admixture and Population Structure in Native Populations of Northwest North America

PubMed Central

Verdu, Paul; Pemberton, Trevor J.; Laurent, Romain; Kemp, Brian M.; Gonzalez-Oliver, Angelica; Gorodezky, Clara; Hughes, Cris E.; Shattuck, Milena R.; Petzelt, Barbara; Mitchell, Joycelynn; Harry, Harold; William, Theresa; Worl, Rosita; Cybulski, Jerome S.; Rosenberg, Noah A.; Malhi, Ripan S.

2014-01-01

The initial contact of European populations with indigenous populations of the Americas produced diverse admixture processes across North, Central, and South America. Recent studies have examined the genetic structure of indigenous populations of Latin America and the Caribbean and their admixed descendants, reporting on the genomic impact of the history of admixture with colonizing populations of European and African ancestry. However, relatively little genomic research has been conducted on admixture in indigenous North American populations. In this study, we analyze genomic data at 475,109 single-nucleotide polymorphisms sampled in indigenous peoples of the Pacific Northwest in British Columbia and Southeast Alaska, populations with a well-documented history of contact with European and Asian traders, fishermen, and contract laborers. We find that the indigenous populations of the Pacific Northwest have higher gene diversity than Latin American indigenous populations. Among the Pacific Northwest populations, interior groups provide more evidence for East Asian admixture, whereas coastal groups have higher levels of European admixture. In contrast with many Latin American indigenous populations, the variance of admixture is high in each of the Pacific Northwest indigenous populations, as expected for recent and ongoing admixture processes. The results reveal some similarities but notable differences between admixture patterns in the Pacific Northwest and those in Latin America, contributing to a more detailed understanding of the genomic consequences of European colonization events throughout the Americas. PMID:25122539

Watershed restoration, jobs-in-the woods, and community assistance: Redwood National Park and the Northwest Forest Plan.

Treesearch

Christopher E. DeForest

1999-01-01

There are many parallels between the 1978 legislation to expand Redwood National Park and the Northwest Forest Plan, which together with the Northwest Economic Adjustment Initiative formed the 1993 Pacific Northwest Initiative. In both situations, the Federal Government sought to promote retraining for displaced workers, to undertake watershed assessment and...

Northwest forest plants defeat pests and diseases!

Treesearch

Natasha Vizcarra; Rick Kelsey; Joe Karchesy

2017-01-01

Societies use biologically active chemicals as medicines and pesticides to protect human and agricultural health. But widespread use of synthetic compounds raises concerns about their safety, and resistance development in targeted pests.To find safer alternatives, scientists turned to native plants and trees in Pacific Northwest forests...

SCIENCE, POLICY, AND PACIFIC NORTHWEST SALMON RECOVERY

EPA Science Inventory

Throughout the Pacific Northwest, since 1850, all wild salmon runs have declined and some have disappeared. Billions of dollars have been spent in a so-far failed attempt to reverse the long-term decline. Each year, hundreds of millions of dollars continue to be spent in variou...

SCIENCE, POLITICS, AND PACIFIC NORTHWEST SALMON RECOVERY

EPA Science Inventory

Throughout the Pacific Northwest, since 1850, all wild salmon runs have declined and some have disappeared. Billions of dollars have been spent in a so-far failed attempt to reverse the long-term decline. Each year, hundreds of millions of dollars continue to be spent in variou...

Forest statistics for Northwest Florida, 1969

Treesearch

Herbert A. Knight

1969-01-01

This report highlights the principal findings of the fourth Forest survey of the timber resource in Northwest Florida. The survey was started in July 19 68 and completed in March 1969. Findings of the three previous surveys, completed in 1934, 1949, and 1959, provide the basis for measuring changes that have occurred and trends that have developed over the past 35...

Forest statistics for Northwest Florida, 1979

Treesearch

Raymond M. Sheffield

1979-01-01

This report highlights the principal findings of the fifth forest survey of Northwest Florida. Fieldwork began in September 1978 and was completed in June 1979. Four previous surveys, completed in 1934, 1949, 1959, and 1969, provide statistics for measuring changes and trends over the past 45 years. The primary emphasis in this report is on the changes and trends since...

Pulse crop diseases in the Pacific Northwest

USDA-ARS?s Scientific Manuscript database

The United Nations declared that 2016 is the International Year of Pulses (IYP). This UN declaration of IYP will certainly increase awareness of pulses and likely position pulses as a primary source of protein and other essential nutrients for human diets. The US Pacific Northwest region (Idaho, Or...

Fire and birds in maritime Pacific Northwest

Treesearch

Mark H. Huff; Nathaniel E. Seavy; John D. Alexander; C. John Ralph

2005-01-01

Resource managers face the challenge of understanding how numerous factors, including fire and fire suppression, influence habitat composition and animal communities. We summarize information on fire effects on major vegetation types and bird/fire relations within the maritime Pacific Northwest, and pose management related questions and research considerations....

9. FIRST FLOOR CAR BARN SPACE. VIEW TO NORTHWEST. ...

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

9. FIRST FLOOR CAR BARN SPACE. VIEW TO NORTHWEST. - Commercial & Industrial Buildings, Key City Electric Street Railroad, Powerhouse & Storage Barn, Eighth & Washington Streets, Dubuque, Dubuque County, IA

7. View looking northwest along Cedar Avenue Bridge. Delaware, ...

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

7. View looking northwest along Cedar Avenue Bridge. - Delaware, Lackawanna & Western Railroad, Scranton Yards, Cedar Avenue Bridge, Spanning Cedar Avenue at Railroad Alley, Scranton, Lackawanna County, PA

Oblique view of Gale Crater from the Northwest

NASA Image and Video Library

2011-07-22

This computer-generated view based on multiple orbital observations shows Mars Gale crater as if seen from an aircraft northwest of the crater. NASA has selected Gale as the landing site for the Mars Science Laboratory mission.

1995 Pacific Northwest Loads and Resources Study, Technical Appendix: Volume 1.

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

United States. Bonneville Power Administration.

1995-12-01

The Pacific Northwest Loads and Resources Study (WhiteBook), is published annually by BPA, and establishes the planning basis for supplying electricity to customers. It serves a dual purpose. First, the White Book presents projections of regional and Federal system load and resource capabilities, along with relevant definitions and explanations. Second, the White Book serves as a benchmark for annual BPA determinations made pursuant to the 1981 regional power sales contracts. Specifically, BPA uses the, information in the White Book for determining the notice required when customers request to increase or decrease the amount of power purchased from BPA. Aside frommore » these purposes, the White Book is used for input to BPA`s resource planning process. The White Book compiles information obtained from several formalized resource planning reports and data submittals, including those from the Northwest Power Planning Council (Council) and the Pacific Northwest Utilities Conference Committee (PNUCC).« less

GARAGE, SOUTH (REAR) AND EAST SIDE, LOOKING NORTHWEST Irvine ...

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

GARAGE, SOUTH (REAR) AND EAST SIDE, LOOKING NORTHWEST - Irvine Ranch Agricultural Headquarters, Carillo Tenant House, Southwest of Intersection of San Diego & Santa Ana Freeways, Irvine, Orange County, CA

GARDEN (FOREGROUND), GARAGE (CENTER), AND PUMPHOUSE, LOOKING NORTHWEST Irvine ...

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

GARDEN (FOREGROUND), GARAGE (CENTER), AND PUMPHOUSE, LOOKING NORTHWEST - Irvine Ranch Agricultural Headquarters, Carillo Tenant House, Southwest of Intersection of San Diego & Santa Ana Freeways, Irvine, Orange County, CA

Oblique view of southeast corner; camera facing northwest. Mare ...

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

Oblique view of southeast corner; camera facing northwest. - Mare Island Naval Shipyard, Defense Electronics Equipment Operating Center, I Street, terminus west of Cedar Avenue, Vallejo, Solano County, CA

8. STATIC TEST TOWER NORTHWEST ELEVATION FROM THE POWER ...

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

8. STATIC TEST TOWER - NORTHWEST ELEVATION FROM THE POWER PLANT TEST STAND. - Marshall Space Flight Center, Saturn Propulsion & Structural Test Facility, East Test Area, Huntsville, Madison County, AL

1956 bibliography of Pacific Northwest forest soils publications.

Treesearch

Robert F. Tarrant

1957-01-01

In 1956, a summary of references on Pacific Northwest forest soils research was developed to begin a systematic annual recording of regionally published material in this comparatively new field. This summary included references for all years through 1955.

MODIS water quality algorithms for northwest Florida estuaries

EPA Science Inventory

Synoptic and frequent monitoring of water quality parameters from satellite is useful for determining the health of aquatic ecosystems and development of effective management strategies. Northwest Florida estuaries are classified as optically-complex, or waters influenced by chlo...

Streamflow Duration Assessment Method for the Pacific Northwest

EPA Pesticide Factsheets

The Streamflow Duration Assessment Method for the Pacific Northwest is a scientific tool developed by EPA and the U.S. Army Corps of Engineers to provide a rapid assessment framework to distinguish between ephemeral, intermittent and perennial streams.

Executive summary: Climate change in the northwest: Implications for our landscapes, waters, and communities

USGS Publications Warehouse

Dalton, Meghan M.; Bethel, Jeffrey; Capalbo, Susan M.; Cuhaciyan, J.E.; Eigenbrode, Sanford D.; Glick, Patty; Houston, Laurie L.; Littell, Jeremy S.; Lynn, Kathy; Mote, Philip W.; Raymondi, Rick R.; Reeder, W. Spencer; Shafer, Sarah L.; Snover, Amy K.

2013-01-01

Climate Change in the Northwest: Implications for Our Landscapes, Waters, and Communities is aimed at assessing the state of knowledge about key climate impacts and consequences to various sectors and communities in the northwest United States. It draws on a wealth of peer-reviewed literature, earlier state-level assessment reports conducted for Washington (2009) and Oregon (2010), as well as a risk-framing workshop. As an assessment, it aims to be representative (though not exhaustive) of the key climate change issues as reflected in the growing body of Northwest climate change science, impacts, and adaptation literature now available. This report will serve as an updated resource for scientists, stakeholders, decision makers, students, and community members interested in understanding and preparing for climate change impacts on Oregon, Washington, and Idaho. This more detailed, foundational report is intended to support the key findings presented in the Northwest chapter of the Third National Climate Assessment.

Planting native oak in the Pacific Northwest

Treesearch

Warren D. Devine; Constance A. Harrington

2010-01-01

The extent of oak woodland and savanna habitat in the Pacific Northwest has been dramatically reduced since settlement in the mid-1800s. This report presents a practical guide for landowners and managers who are interested in reestablishing native oak by planting seedlings. Keys to successful establishment are (1) planting quality...

The Northwest Territories. Reference Series No. 35.

ERIC Educational Resources Information Center

Department of External Affairs, Ottawa (Ontario).

This booklet, one of a series featuring the Canadian provinces, presents a brief overview of Northwest Territories and is suitable for teacher reference or student reading. Separate sections discuss geography, history and people, land claims, the economy, the government, and recreation and the arts. Specific topics include the expansive size and…

2. GENERAL VIEW, EAST FRONT, NORTHWEST VIEW Kingsway Center ...

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

2. GENERAL VIEW, EAST FRONT, NORTHWEST VIEW - Kingsway Center Commercial Area, Bounded by Kings Highway, Doctor Martin Luther King Boulevard, Page Avenue, & Euclid Avenue, Saint Louis, Independent City, MO

Marguerite Arnet Residence, exterior roof structure detail, looking northwest. ...

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

Marguerite Arnet Residence, exterior roof structure detail, looking northwest. - Adam & Bessie Arnet Homestead, Marguerite Arnet Residence, 560 feet northeast of Adam & Bessie Arnet Residence, Model, Las Animas County, CO

30. Second floor, room north of staircase, looking northwest ...

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

30. Second floor, room north of staircase, looking northwest - Veterans Administration Center, Officers Duplex Quarters, 5302 East Kellogg (Legal Address); 5500 East Kellogg (Common Address), Wichita, Sedgwick County, KS

16. Detail of southeast corner of Gwing, looking northwest ...

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

16. Detail of southeast corner of G-wing, looking northwest - Offutt Air Force Base, Strategic Air Command Headquarters & Command Center, Headquarters Building, 901 SAC Boulevard, Bellevue, Sarpy County, NE

39. Turnstile Gates and guard station, Cwing, looking northwest ...

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

39. Turnstile Gates and guard station, C-wing, looking northwest - Offutt Air Force Base, Strategic Air Command Headquarters & Command Center, Headquarters Building, 901 SAC Boulevard, Bellevue, Sarpy County, NE

5. View northwest of south (partial) and east elevations. ...

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

5. View northwest of south (partial) and east elevations. - Natick Research & Development Laboratories, Climatic Chambers Building, U.S. Army Natick Research, Development & Engineering Center (NRDEC), Natick, Middlesex County, MA

INTERIOR OF BRIEFING ROOM A. view TO NORTHWEST Plattsburgh ...

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

INTERIOR OF BRIEFING ROOM A. view TO NORTHWEST - Plattsburgh Air Force Base, Target Intelligence Training Building-Combat Center, Off Connecticut Road, east of Idaho Avenue, Plattsburgh, Clinton County, NY

6. FLAME DEFLECTOR, VIEW TOWARDS NORTHWEST. Glenn L. Martin ...

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

6. FLAME DEFLECTOR, VIEW TOWARDS NORTHWEST. - Glenn L. Martin Company, Titan Missile Test Facilities, Captive Test Stand D-2, Waterton Canyon Road & Colorado Highway 121, Lakewood, Jefferson County, CO

PACIFIC NORTHWEST SALMON: FORECASTING THEIR STATUS IN 2100

EPA Science Inventory

Throughout the Pacific Northwest (northern California, Oregon, Idaho, Washington, and the Columbia Basin portion of British Columbia), many wild salmon stocks (a group of interbreeding individuals that is roughly equivalent to a "population") have declined and some have disappear...

Forest statistics for Northwest Florida, 1994

Treesearch

Robert F. Clark; Raymond M. Sheffield

1994-01-01

Since 1987, area of timberland in Northwest Florida has increased by 3 percent and now totals almost 5.5 million acres. Area of nonindustrial private forest land increased 19 percent to 2.3 million acres. Area in pine forest types increased 5 percent to 3.1 million acres Area harvested annually and retained in timberland averaged 99,000 acres, whereas 148,000 acres of...

Remediation System Evaluation, Northwest Pipe and Casing Site

EPA Pesticide Factsheets

The Northwest Pipe and Casing Site is located in Clackamas, Oregon, approximately 20 miles southeastof Portland. The site consists of approximately 53 acres, and has historically been divided into two parcels(Parcel A to the north and Parcel B to the..

1. Overview of site, looking northwest Naval Air Station ...

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

1. Overview of site, looking northwest - Naval Air Station Chase Field, Building 1001, Independence Street, .45 mile south of intersection of Texas State Highway & Independence Street, Beeville, Bee County, TX

View northwest; south and east facades and context Naval ...

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

View northwest; south and east facades and context - Naval Base Philadelphia-Philadelphia Naval Shipyard, Foundry-Propeller Shop, North of Porter Avenue, west of Third Street West, Philadelphia, Philadelphia County, PA

5. SOUTHEAST FLAME DEFLECTOR, VIEW TOWARDS NORTHWEST. Glenn L. ...

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

5. SOUTHEAST FLAME DEFLECTOR, VIEW TOWARDS NORTHWEST. - Glenn L. Martin Company, Titan Missile Test Facilities, CaptiveTest Stand D-3, Waterton Canyon Road & Colorado Highway 121, Lakewood, Jefferson County, CO

Highlights of science contributions to implementing the Northwest Forest Plan—1994 to 1998.

Treesearch

Nancy M. Diaz; Richard W. Haynes

2002-01-01

During 5 years of research (1994-98) in support of the Northwest Forest Plan (NWFP), Pacific Northwest Research Station scientists and their collaborators have made significant progress in both validating some of the NWFP’s major assumptions and providing research that sets the stage for further evolution of the plan. Studies have provided new information in the areas...

Evaluation of electrical power alternatives for the Pacific Northwest

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

Not Available

This study evaluates the concept of implementation of large-scale energy conservation to reduce end-use demand for electrical energy as an alternative to the need for continued construction of new power plants to meet projected energy requirements for the Pacific Northwest. In particular, the numerical accuracy, economic feasibility, and institutional impact of a conservation-oriented scenario developed by the Natural Resources Defense Council, Inc., is assessed, relative to the energy forecast prepared by the Pacific Northwest Utilities Conference Commission. The results of this study are presented in four detailed sections following an introductory and summary section: Reconstruction and Numerical Evaluation of Alternativemore » Scenario; Economic Analysis; Institutional Impact; and Impact of New National Energy Policy.« less

A TWO CENTURY HISTORY OF PACIFIC NORTHWEST SALMON: LESSONS LEARNED FOR ACHIEVING A SUSTAINABLE FUTURE

EPA Science Inventory

Achieving ecological sustainability is a daunting challenge. In the Pacific Northwest one of the most highly visible public policy debates concerns the future of salmon populations. Throughout the Pacific Northwest, many wild salmon stocks have declined and some have disappeare...

Northwest side view showing 3 windows and security light ...

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

Northwest side view showing 3 windows and security light - U.S. Naval Base, Pearl Harbor, Naval Hospital, Animal House, Near intersection of Hospital Way & Third Street, Pearl City, Honolulu County, HI

Detail of sheet steel bulkhead, wharf A, looking northwest ...

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

Detail of sheet steel bulkhead, wharf A, looking northwest - U.S. Coast Guard Sandy Hook Station, Western Docking Structure, West of intersection of Canfield Road & Hartshorne Drive, Highlands, Monmouth County, NJ

4. NORTHWEST FRONT, WITH FOUR BULLET GLASS WINDOWS. Edwards ...

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

4. NORTHWEST FRONT, WITH FOUR BULLET GLASS WINDOWS. - Edwards Air Force Base, South Base Sled Track, Observation Block House, Station "O" area, east end of Sled Track, Lancaster, Los Angeles County, CA

South (side) and east (rear) elevations, view to northwest ...

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

South (side) and east (rear) elevations, view to northwest - Bureau of Mines Boulder City Experimental Station, Titanium Development Plant, Date Street north of U.S. Highway 93, Boulder City, Clark County, NV

8. Small boathouse, view northwest, south and east sides ...

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

8. Small boathouse, view northwest, south and east sides - Great Duck Island Light Station, At southern tip of Great Duck Island southeast of Bass Harbor & northeast of Frenchboro, Frenchboro, Hancock County, ME

9. Large boathouse, view northwest, south and east sides ...

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

9. Large boathouse, view northwest, south and east sides - Great Duck Island Light Station, At southern tip of Great Duck Island southeast of Bass Harbor & northeast of Frenchboro, Frenchboro, Hancock County, ME

Building 931, oblique view to northwest, 210 mm lens. ...

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

Building 931, oblique view to northwest, 210 mm lens. - Travis Air Force Base, Central Battery Charging Building, North of W Street, Armed Forces Special Weapons Project Q Area, Fairfield, Solano County, CA

Pacific Northwest National Laboratory Annual Site Environmental Report for Calendar Year 2013

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

Duncan, Joanne P.; Sackschewsky, Michael R.; Tilden, Harold T.

2014-09-30

Pacific Northwest National Laboratory (PNNL), one of the U.S. Department of Energy (DOE) Office of Science’s 10 national laboratories, provides innovative science and technology development in the areas of energy and the environment, fundamental and computational science, and national security. DOE’s Pacific Northwest Site Office (PNSO) is responsible for oversight of PNNL at its Campus in Richland, Washington, as well as its facilities in Sequim, Seattle, and North Bonneville, Washington, and Corvallis and Portland, Oregon.

FY 1999 Annual Self-Evaluation Report of the Pacific Northwest National Laboratory

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

Randy R. LaBarge

1999-11-05

This is a report of the Pacific Northwest National Laboratory's (Pacific Northwest's) FY1999 Annual Self-Evaluation Report. This report summarizes our progress toward accomplishment of the critical outcomes, objectives, and performance indicators as delineated in the FY1999 Performance Evaluation & Fee Agreement. It also summarizes our analysis of the results of Pacific Northwest's Division and Directorate annual self-assessments, and the implementation of our key operational improvement initiatives. Together, these provide an indication of how well we have used our Integrated Assessment processes to identify and plan improvements for FY2000. As you review the report you will find areas of significantly positivemore » progress; you will also note areas where I believe the Laboratory could make improvements. Overall, however, I believe you will be quite pleased to note that we have maintained, or exceeded, the high standards of performance we have set for the Laboratory.« less

Identifying block structure in the Pacific Northwest, USA

USGS Publications Warehouse

Savage, James C.; Wells, Ray E.

2015-01-01

We have identified block structure in the Pacific Northwest (west of 116°W between 38°N and 49°N) by clustering GPS stations so that the same Euler vector approximates the velocity of each station in a cluster. Given the total number k of clusters desired, the clustering procedure finds the best assignment of stations to clusters. Clustering is calculated for k= 2 to 14. In geographic space, cluster boundaries that remain relatively stable as k is increased are tentatively identified as block boundaries. That identification is reinforced if the cluster boundary coincides with a geologic feature. Boundaries identified in northern California and Nevada are the Central Nevada Seismic Belt, the west side of the Northern Walker Lane Belt, and the Bartlett Springs Fault. Three blocks cover all of Oregon and Washington. The principal block boundary there extends west-northwest along the Brothers Fault Zone, then north and northwest along the eastern boundary of Siletzia, the accreted oceanic basement of the forearc. East of this boundary is the Intermountain block, its eastern boundary undefined. A cluster boundary at Cape Blanco subdivides the forearc along the faulted southern margin of Siletzia. South of Cape Blanco the Klamath Mountains-Basin and Range block extends east to the Central Nevada Seismic Belt and south to the Sierra Nevada-Great Valley block. The Siletzia block north of Cape Blanco coincides almost exactly with the accreted Siletz terrane. The cluster boundary in the eastern Olympic Peninsula may mark permanent shortening of Siletzia against the Intermountain block.

Overall view, looking northwest Thomas Murphy Homestead, North of ...

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

Overall view, looking northwest - Thomas Murphy Homestead, North of John Moulton Homestead, approximately 1,000 feet west of Mormon Row Road, and .25 mile north of Antelope Flats Road, Kelly, Teton County, WY

Northwest Ports Achievements in Reducing Emissions and Improving Performance

EPA Pesticide Factsheets

Case history on the status of the Northwest Ports Clean Air Strategy for the Port of Seattle, Port of Tacoma, and Port Metro Vancouver. Presents key objectives, emission and performance goals and outcomes.

Trestle #1, northwest elevation. View to southeast Promontory Route ...

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

Trestle #1, northwest elevation. View to southeast - Promontory Route Railroad Trestles, S.P. Trestle 779.91, One mile southwest of junction of State Highway 83 and Blue Creek, Corinne, Box Elder County, UT

Trestle #1, southeast elevation. View to northwest Promontory Route ...

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

Trestle #1, southeast elevation. View to northwest - Promontory Route Railroad Trestles, S.P. Trestle 779.91, One mile southwest of junction of State Highway 83 and Blue Creek, Corinne, Box Elder County, UT

1. BUILDING 321. VIEW TO NORTHWEST. Rocky Mountain Arsenal, ...

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

1. BUILDING 321. VIEW TO NORTHWEST. - Rocky Mountain Arsenal, Boiler Plant-Central Gas Heat Plant, 1022 feet South of December Seventh Avenue; 525 feet West of D Street, Commerce City, Adams County, CO

Building 904, oblique view to northwest, 135 mm lens ...

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

Building 904, oblique view to northwest, 135 mm lens - Travis Air Force Base, Base Spares Warehouse No. 1, Dixon Avenue & W Street, Armed Forces Special Weapons Project Q Area, Fairfield, Solano County, CA

Northwest Forest Plan—the first 10 years (1994–2003): first-decade results of the Northwest Forest Plan.

Treesearch

Valerie Rapp

2008-01-01

The Northwest Forest Plan (the Plan) was developed in 1994 to resolve debates over old-growth forests and endangered species on federal forests in the range of the northern spotted owl. In 2005, federal agencies reviewed the first 10 years under the Plan to learn what worked and what did not, what changed, and what new information or surprises might influence these...

Northwest Basin and Range tectonic deformation observed with the Global Positioning System, 1999-2003

USGS Publications Warehouse

Hammond, W.C.; Thatcher, W.

2005-01-01

We use geodetic velocities obtained with the Global Positioning System (GPS) to quantify tectonic deformation of the northwest Basin and Range province of the western United States. The results are based on GPS data collected in 1999 and 2003 across five new quasi-linear networks in northern Nevada, northeast California, and southeast Oregon. The velocities show ???3 mm/yr westward movement of northern Nevada with respect to stable North America. West of longitude 119??W the velocities increase and turn northwest, parallel to Sierra Nevada/Great Valley microplate motion, and similar to velocities previously obtained to the south. The observations are explained by a kinematic model with three domains that rotate around Euler poles in eastern Oregon and western Idaho. Northeast California experiences internal dextral shear deformation (11.2 ?? 3.6 nstrain/yr) subparallel to Pacific/North America motion. Relative motions of the domains imply 2-5 mm/yr approximately east-west extension in northwest Nevada and 1-4 mm/yr approximately north-south contraction near the California/Oregon border. The northward decreasing approximately east-west extension in northwest Nevada is consistent with the northern termination of Basin and Range deformation, faulting and characteristic topography. No significant extension is detected in the Oregon Basin and Range. The Oregon Cascade arc moves north at ???3.5 mm/yr and is possibly influenced by the approximately eastward motion of the Juan de Fuca plate. These results disagree with secular northwest trenchward motion of the Oregon forearc inferred from paleomagnetic rotations. South of latitude 43??, however, trenchward motion exists and is consistent with block rotations, approximately east-west Basin and Range extension, and northwest Sierra Nevada translation. Copyright 2005 by the American Geophysical Union.

1958 bibliography of Pacific Northwest forest soils publications.

Treesearch

Robert F. Tarrant

1959-01-01

This fourth annual summary of references is compiled to maintain a systematic recording of publications in the comparatively new field of forest soils research in the Pacific Northwest. It is intended to serve both as a checklist and as a record of development of knowledge.

6. Monitoring and the Northwest Forest Plan

Treesearch

Leslie M. Reid

1994-01-01

Abstract - Monitoring will ensure that the Northwest Forest Plan is implemented as intended, determine whether the plan is achieving its intended objectives, and provide information needed to improve the plan. The credibility of the Forest Plan rests on the credibility of its monitoring program. If the monitoring program is to succeed, it must focus on well-defined...

Alprazolam use and dependence. A retrospective analysis of 30 cases of withdrawal.

PubMed Central

Dickinson, B; Rush, P A; Radcliffe, A B

1990-01-01

From 1986 to 1989, the Chemical Dependency Recovery Program at Kaiser Permanente Hospital, Fontana, California, admitted an increasing number of patients for alprazolam dependence. Severe withdrawal reactions and adverse consequences with use were reported in the literature. In this review of 30 cases of alprazolam dependence and subsequent withdrawal, there was a statistically significant increase in the number of patient hospital days, the subjective symptoms, and staff time spent with patients compared with those in alcoholic controls. Most patients with diagnosed alprazolam dependence used doses in the range recommended by the package information at the time of admission. Patients with low preadmission doses of 1 mg or less per day showed notable withdrawal symptoms. The average duration of use was 29.9 months, considerably longer than suggested effective ranges. Most patients (28) had a chemical dependence history before being placed on alprazolam therapy; 24 had a positive family history of chemical dependence; and 24 had previous or current psychiatric care. PMID:2349800

Health and loyalty promotion visits for new enrollees: results of a randomized controlled trial.

PubMed

Thompson, M; Gee, S; Larson, P; Kotz, K; Northrop, L

2001-01-01

Managed care needs effective and efficient ways to orient new members, enhance trust and loyalty, and offer prevention and self-care education and services. Recent adult enrollees of Kaiser Permanente (Northern California) were randomly assigned to one of three intervention conditions (n = 286) (individual visit with a physician, physician visit plus a visit with a health educator, a group visit of eight new members led by a physician and health educator) or a random control group (n = 278). Outcomes were gauged via pre- and post-visit questionnaires and a 20-min telephone survey at baseline and at a 6-month follow-up. Compared to controls, attendees of the three interventions had higher satisfaction, self-rated prevention knowledge, acceptance of health plan guidelines, and were more likely to plan to remain in the health plan. Group visit attendees stood out as experiencing the greatest benefits and were especially likely to report saving a telephone call or visit to their doctor by using a self-care handbook.

Acceptance of direct physician access to a computer-based patient record in a managed care setting.

PubMed

Dewey, J B; Manning, P; Brandt, S

1993-01-01

Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.

Design and coverage of high throughput genotyping arrays optimized for individuals of East Asian, African American, and Latino race/ethnicity using imputation and a novel hybrid SNP selection algorithm.

PubMed

Hoffmann, Thomas J; Zhan, Yiping; Kvale, Mark N; Hesselson, Stephanie E; Gollub, Jeremy; Iribarren, Carlos; Lu, Yontao; Mei, Gangwu; Purdy, Matthew M; Quesenberry, Charles; Rowell, Sarah; Shapero, Michael H; Smethurst, David; Somkin, Carol P; Van den Eeden, Stephen K; Walter, Larry; Webster, Teresa; Whitmer, Rachel A; Finn, Andrea; Schaefer, Catherine; Kwok, Pui-Yan; Risch, Neil

2011-12-01

Four custom Axiom genotyping arrays were designed for a genome-wide association (GWA) study of 100,000 participants from the Kaiser Permanente Research Program on Genes, Environment and Health. The array optimized for individuals of European race/ethnicity was previously described. Here we detail the development of three additional microarrays optimized for individuals of East Asian, African American, and Latino race/ethnicity. For these arrays, we decreased redundancy of high-performing SNPs to increase SNP capacity. The East Asian array was designed using greedy pairwise SNP selection. However, removing SNPs from the target set based on imputation coverage is more efficient than pairwise tagging. Therefore, we developed a novel hybrid SNP selection method for the African American and Latino arrays utilizing rounds of greedy pairwise SNP selection, followed by removal from the target set of SNPs covered by imputation. The arrays provide excellent genome-wide coverage and are valuable additions for large-scale GWA studies. Copyright © 2011 Elsevier Inc. All rights reserved.

Companies commit to emergency contraception -- have you?

PubMed

1999-12-01

Despite the efforts of the medical community, as well as promotional efforts by pharmaceutical companies, relatively few women in the US have heard of emergency contraceptives (ECs). Gynetics, marketer of Preven, plans to file a new drug application for a levonorgestrel EC by the end of 1999, with an anticipated approval in the second half of 2000. Women's Capital Corp., marketer of Plan B, is also aiming for a national commercial launch of its product. According to a recently published acceptability study, women will use ECs when they are made available. A survey among 235 women at 13 Kaiser Permanente medical offices in San Diego, California, regarding their experiences with ECs showed that 91% were satisfied with ECs, and 97% said they would use ECs for emergencies only--dispelling fears that women would forego use of ongoing contraception. About 70% of the women who participated in the study were using a contraceptive method when they requested ECs.

Incidence and clinical characteristics of interstitial cystitis in the community.

PubMed

Patel, Ronak; Calhoun, Elizabeth A; Meenan, Richard T; O'Keeffe Rosetti, Maureen C; Kimes, Terry; Clemens, J Quentin

2008-08-01

We utilized physician-coded diagnoses and chart reviews to estimate the incidence of interstitial cystitis (IC) in women. A computer search of the Kaiser Permanente database was performed to identify newly coded diagnoses of IC (ICD-9 code 595.1) between May 2002 and May 2005. Chart reviews were performed and patient demographics, diagnosing physicians, and symptom characteristics were recorded. The IC incidence rate was 15 per 100,000 women per year. The mean age of the patients was 51 years (range 31-81 years). The most common presenting symptoms were frequency (70%), dysuria (52%), urgency (50%), suprapubic pain (50%), nocturia (35%), and dyspareunia (13%). Cases diagnosed by primary care physicians had a shorter median symptom duration (9 months) compared with those diagnosed by urologists (1 year) and gynecologists (3 years). IC is an uncommon diagnosis in the community setting, with an incidence rate of 15 per 100,000 women per year.

Ten strategies to lower costs, improve quality, and engage patients: the view from leading health system CEOs.

PubMed

Cosgrove, Delos M; Fisher, Michael; Gabow, Patricia; Gottlieb, Gary; Halvorson, George C; James, Brent C; Kaplan, Gary S; Perlin, Jonathan B; Petzel, Robert; Steele, Glenn D; Toussaint, John S

2013-02-01

Patient-centeredness--the idea that care should be designed around patients' needs, preferences, circumstances, and well-being--is a central tenet of health care delivery. For CEOs of health care organizations, patient-centered care is also quickly becoming a business imperative, with payments tied to performance on measures of patient satisfaction and engagement. In A CEO Checklist for High-Value Health Care, we, as executives of eleven leading health care delivery institutions, outlined ten key strategies for reducing costs and waste while improving outcomes. In this article we describe how implementation of these strategies benefits both health care organizations and patients. For example, Kaiser Permanente's Healthy Bones Program resulted in a 30 percent reduction in hip fracture rates for at-risk patients. And at Virginia Mason Health System in Seattle, nurses reorganized care patterns and increased the time they spent on direct patient care to 90 percent. Our experiences show that patient-engaged care can be delivered in ways that simultaneously improve quality and reduce costs.

Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department With Pregnancy Loss.

PubMed

Catlin, Anita

In April 2016, the National Perinatal Association and Kaiser Permanente Northern California Nursing Research Community Benefits Grant sponsored an interdisciplinary summit to explore the needs of women who present with actual or potential pregnancy loss to the emergency department (ED). Thirty-two experts in the field of pregnancy loss, 17 of whom represented their professional organizations, participated. These experts, which included nurses, physicians, social workers, counselors, authors, and parents, worked together to create guidelines for care of women with a pregnancy loss in the ED. Recommendations for ED healthcare providers are included. Emergency department personnel agreed that improvements in care could be offered and were willing to endorse education for their staff. The guidelines delineate how to better provide physical, emotional, and bereavement support at any stage of gestational loss. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.

Adverse events associated with apremilast use and withdrawal for psoriasis in a real-world setting.

PubMed

Lee, Erica B; Amin, Mina; Egeberg, Alexander; Wu, Jashin J

2018-05-06

Apremilast, a phosphodiesterase-4 inhibitor, is an oral therapy for treatment of psoriasis. Its safety profile is favorable, with side effects including diarrhea, nausea, vomiting, depression, and weight decrease, primarily based on clinical trial data. However, limited research exists on the side effect frequency and subsequent adverse events (AEs) in real-world practice. This retrospective chart review included patients who presented to the dermatology clinic at Kaiser Permanente Los Angeles Medical Center and were treated with apremilast at any time between January 1, 2015 and January 11, 2018. Patients were not included if they did not have at least one follow-up by clinic visit, telephone, or email correspondence after being prescribed apremilast. A total of 77 patients were included. AEs and withdrawal due to AEs were assessed throughout the treatment period from each patient's respective medical record. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The dissemination of clinical practice guidelines over an intranet: an evaluation.

PubMed Central

Stolte, J. J.; Ash, J.; Chin, H.

1999-01-01

This study compares two clinical practice guideline dissemination systems. It was hypothesized that placing guidelines on an intranet would make this information easier to retrieve. Retrieval time, retrieval accuracy, and ease of use were empirically evaluated. Sixteen clinicians from Kaiser Permanente volunteered to complete tasks that measured these variables. Time values were significantly longer for tasks completed with intranet guidelines (Intranet = 6.7 minutes, Paper = 5.7 minutes). Tasks completed with paper guidelines had a significantly higher percentage of perfect scores than those completed with the intranet (Paper = 85%, Intranet = 59%). There was no significant difference in reported ease of use. Simply placing clinical information on an electronic system does not guarantee that the information will be easier to retrieve. Such information needs to be fully integrated into the clinical decision making process. Computerizing guidelines may provide a necessary initial step toward this goal, but it does not represent the final solution. PMID:10566503

3. Light tower, view northwest, south side Ram Island ...

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

3. Light tower, view northwest, south side - Ram Island Light Station, Ram Island, south of Ocean Point & just north of Fisherman Island, marking south side of Fisherman Island Passage, Ocean Point, Lincoln County, ME

NORTHWEST FRONT AND SOUTHWEST SIDE, BUILDING 1933 Edwards Air ...

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

NORTHWEST FRONT AND SOUTHWEST SIDE, BUILDING 1933 - Edwards Air Force Base, X-15 Engine Test Complex, Observation Bunker Types, Rogers Dry Lake, east of runway between North Base & South Base, Boron, Kern County, CA

Partial Opening of the Northwest Passage

NASA Image and Video Library

2017-12-08

There was a time when the Northwest Passage was a sort of maritime Holy Grail, a route so desired and sought after, but so elusive. For most of the recorded history of North America, the Passage has been nearly impassable and often deadly. But with the modernization of ships and the warming of the Earth, cruising and sailing through the Canadian Archipelago from Baffin Bay to the Beaufort Sea has grown more common and easier. But it’s not necessarily easy. The top image above shows the Northwest Passage as it appeared on August 31, 2015, to the Visible Infrared Imaging Radiometer Suite (VIIRS) on the Suomi-NPP satellite. Read more: earthobservatory.nasa.gov/IOTD/view.php?id=86589 NASA Earth Observatory images by Jesse Allen, using VIIRS data from the Suomi National Polar-orbiting Partnership. Suomi NPP is the result of a partnership between NASA, the National Oceanic and Atmospheric Administration, and the Department of Defense. NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Northwest Region Clean Energy Application Center

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

Sjoding, David

2013-09-30

The main objective of the Northwest Clean Energy Application Center (NW CEAC) is to promote and support implementation of clean energy technologies. These technologies include combined heat and power (CHP), district energy, waste heat recovery with a primary focus on waste heat to power, and other related clean energy systems such as stationary fuel cell CHP systems. The northwest states include AK, ID, MT, OR, and WA. The key aim/outcome of the Center is to promote and support implementation of clean energy projects. Implemented projects result in a number of benefits including increased energy efficiency, renewable energy development (when usingmore » opportunity fuels), reduced carbon emissions, improved facility economics helping to preserve jobs, and reduced criteria pollutants calculated on an output-based emissions basis. Specific objectives performed by the NW CEAC fall within the following five broad promotion and support categories: 1) Center management and planning including database support; 2) Education and Outreach including plan development, website, target market workshops, and education/outreach materials development 3) Identification and provision of screening assessments & feasibility studies as funded by the facility or occasionally further support of Potential High Impact Projects; 4) Project implementation assistance/trouble shooting; and 5) Development of a supportive clean energy policy and initiative/financing framework.« less

Debate continues on northwest's merits

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

Stremel, K.

1984-07-01

Estimates of northwest Montana's petroleum reserves range from barren Precambrian rock to reserves exceeding those of Alaska's Prudhoe Bay. Geological debates concerning the merits of the vast areas continues. Seismic data and geological studies indicate that the area holds considerable promise. Several large structures have been identified, and oil and gas seeps have been reported. The area's true potential, however, will be revealed only by drilling, which is both risky and expensive. Several wildcat drilling operations are underway but the area's hydrocarbon potential may not be released for several years.

2. Southeast side of Building 1042 (brig), looking northwest ...

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

2. Southeast side of Building 1042 (brig), looking northwest - Naval Air Station Chase Field, Building 1042, Ofstie Road, .6 mile South-Southeast of intersection of Texas State Highway 202 & Independence Street, Beeville, Bee County, TX

Multiphase Aqueous Alteration of the Nakhlite Northwest Africa 817

NASA Astrophysics Data System (ADS)

Lee, M. R.; Cohen, B. E.; Mark, D. F.; Boyce, A.

2017-07-01

The nakhlite meteorite Northwest Africa 817 has been aqueously altered on both Mars and Earth, producing clays, carbonates, sulphates and oxides. The challenge is to see through the terrestrial overprint to understand the martian signature.

Bench seating in northwest corner of the building Fitzsimons ...

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

Bench seating in northwest corner of the building - Fitzsimons General Hospital, Golf Course Waiting Shelter, Southwest area of Golf Course, 700 feet Northeast of intersection of West Harlow Avenue & Peoria Street, Aurora, Adams County, CO

9. Boat house, detail of boat winch, looking northwest ...

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

9. Boat house, detail of boat winch, looking northwest - Doubling Point Light Station, End of Doubling Point Road, off State Highway 127, 1.8 miles south of U.S. Route 1, Arrowsic, Sagadahoc County, ME

Ritual drinks in the pre-Hispanic US Southwest and Mexican Northwest.

PubMed

Crown, Patricia L; Gu, Jiyan; Hurst, W Jeffrey; Ward, Timothy J; Bravenec, Ardith D; Ali, Syed; Kebert, Laura; Berch, Marlaina; Redman, Erin; Lyons, Patrick D; Merewether, Jamie; Phillips, David A; Reed, Lori S; Woodson, Kyle

2015-09-15

Chemical analyses of organic residues in fragments of pottery from 18 sites in the US Southwest and Mexican Northwest reveal combinations of methylxanthines (caffeine, theobromine, and theophylline) indicative of stimulant drinks, probably concocted using either cacao or holly leaves and twigs. The results cover a time period from around A.D. 750-1400, and a spatial distribution from southern Colorado to northern Chihuahua. As with populations located throughout much of North and South America, groups in the US Southwest and Mexican Northwest likely consumed stimulant drinks in communal, ritual gatherings. The results have implications for economic and social relations among North American populations.

Progress and prospects of climate change impacts on hydrology in the arid region of northwest China.

PubMed

Chen, Yaning; Li, Zhi; Fan, Yuting; Wang, Huaijun; Deng, Haijun

2015-05-01

The arid region of Northwest China, located in the central Asia, responds sensitively to global climate change. Based on the newest research results, this paper analyzes the impacts of climate change on hydrology and the water cycle in the arid region of Northwest China. The analysis results show that: (1) In the northwest arid region, temperature and precipitation experienced "sharply" increasing in the past 50 years. The precipitation trend changed in 1987, and since then has been in a state of high volatility, during the 21st century, the increasing rate of precipitation was diminished. Temperature experienced a "sharply" increase in 1997; however, this sharp increasing trend has turned to an apparent hiatus since the 21st century. The dramatic rise in winter temperatures in the northwest arid region is an important reason for the rise in the average annual temperature, and substantial increases in extreme winter minimum temperature play an important role in the rising average winter temperature; (2) There was a significant turning point in the change of pan evaporation in the northwest arid area in 1993, i.e., in which a significant decline reversed to a significant upward trend. In the 21st century, the negative effects of global warming and increasing levels of evaporation on the ecology of the northwest arid region have been highlighted; (3) Glacier change has a significant impact on hydrology in the northwest arid area, and glacier inflection points have appeared in some rivers. The melting water supply of the Tarim River Basin possesses a large portion of water supplies (about 50%). In the future, the amount of surface water will probably remain at a high state of fluctuation. Copyright © 2015 Elsevier Inc. All rights reserved.

1. NORTHWEST SIDE AND SOUTHWEST FRONT. Looking east. Edwards ...

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

1. NORTHWEST SIDE AND SOUTHWEST FRONT. Looking east. - Edwards Air Force Base, Air Force Rocket Propulsion Laboratory, Firing Control Building, Test Area 1-100, northeast end of Test Area 1-100 Road, Boron, Kern County, CA

Analysis of computer capabilities of Pacific Northwest paratransit providers

DOT National Transportation Integrated Search

1996-07-01

The major project objectives are to quantify the computer capabilities and to determine the computerization needs of paratransit operators in the Northwest, and to create a training program to assist paratransit operators in developing realistic spec...

5. SOUTH SIDE OF BUILDING 514. VIEW TO NORTHWEST. ...

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

5. SOUTH SIDE OF BUILDING 514. VIEW TO NORTHWEST. - Rocky Mountain Arsenal, Lewisite Reactor & Distilled Mustard Distillation Building, 420 feet South of December Seventh Avenue; 1070 feet East of D Street, Commerce City, Adams County, CO

7. VIEW OF BOOSTER STATION 3, FACING NORTHWEST Nevada ...

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

7. VIEW OF BOOSTER STATION 3, FACING NORTHWEST - Nevada Test Site, Frenchman Flat Test Facility, Well Five Booster Stations, Intersection of 5-03 Road & Short Pole Line Road, Area 5, Frenchman Flat, Mercury, Nye County, NV

10. VIEW OF BOOSTER STATION 4, FACING NORTHWEST Nevada ...

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

10. VIEW OF BOOSTER STATION 4, FACING NORTHWEST - Nevada Test Site, Frenchman Flat Test Facility, Well Five Booster Stations, Intersection of 5-03 Road & Short Pole Line Road, Area 5, Frenchman Flat, Mercury, Nye County, NV

4. VIEW OF BOOSTER STATION 2, FACING NORTHWEST Nevada ...

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

4. VIEW OF BOOSTER STATION 2, FACING NORTHWEST - Nevada Test Site, Frenchman Flat Test Facility, Well Five Booster Stations, Intersection of 5-03 Road & Short Pole Line Road, Area 5, Frenchman Flat, Mercury, Nye County, NV

26. VIEW, LOOKING NORTHWEST INSIDE TRANSFORMER ROOM, SHOWING OIL FILLED ...

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

26. VIEW, LOOKING NORTHWEST INSIDE TRANSFORMER ROOM, SHOWING OIL- FILLED TRANSFORMER POTS - Sacramento River Bridge, Spanning Sacramento River at California State Highway 275, Sacramento, Sacramento County, CA

24. CONSTRUCTION PROGRESS VIEW TO NORTHWEST, SHOWING BLOWER BUILDING. INEEL ...

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

24. CONSTRUCTION PROGRESS VIEW TO NORTHWEST, SHOWING BLOWER BUILDING. INEEL PHOTO NUMBER NRTS-60-4407. - Idaho National Engineering Laboratory, Old Waste Calcining Facility, Scoville, Butte County, ID

Early hominins in north-west Europe: A punctuated long chronology?

NASA Astrophysics Data System (ADS)

Hosfield, Rob; Cole, James

2018-06-01

In light of changing views regarding the identity and evolutionary positions of Europe's Lower Palaeolithic hominins, a re-consideration of the hominin occupation of north-west Europe from c. 1 million years ago (mya) to c. 400 thousand years ago (kya) is timely. A change in the scale and character of the overall European Palaeolithic record around c. 800-600 kya has been well documented and argued over since the mid-1990s. Hominin expansion into the European north-west, potentially from southern Europe, Africa or south-western Asia, has been linked to the introduction of a new lithic technology in the form of the biface. We evaluate three potential drivers for this northern range expansion: changing palaeo-climatic conditions, the emergence of an essentially modern human life history, and greater hominin behavioural plasticity. Our evaluation suggests no major changes in these three factors during the c. 800-600 kya period other than enhanced behavioural plasticity suggested by the appearance of the biface. We offer here a model of hominin occupation for north-west Europe termed the 'punctuated long chronology' and suggest that the major changes in the European Lower Palaeolithic record that occur at a species-wide level may post-date, rather than precede, the Anglian Glaciation (marine isotope stage (MIS) 12).

6. BUILDING 8768, NORTHWEST SIDE AND SOUTHWEST FRONT. Edwards ...

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

6. BUILDING 8768, NORTHWEST SIDE AND SOUTHWEST FRONT. - Edwards Air Force Base, Air Force Rocket Propulsion Laboratory, Observation Bunkers for Test Stand 1-A, Test Area 1-120, north end of Jupiter Boulevard, Boron, Kern County, CA

Oblique view to the northwest of the Antenna Array ...

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

Oblique view to the northwest of the Antenna Array - Over-the-Horizon Backscatter Radar Network, Christmas Valley Radar Site Transmit Sector Six Antenna Array, On unnamed road west of Lost Forest Road, Christmas Valley, Lake County, OR

General view to the northwest of the antenna array ...

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

General view to the northwest of the antenna array - Over-the-Horizon Backscatter Radar Network, Christmas Valley Radar Site Transmit Sector Five Antenna Array, On unnamed road west of Lost Forest Road, Christmas Valley, Lake County, OR

6. DETAIL OF FRONT ENTRANCE IN NORTHWEST CORNER. VIEW TO ...

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

6. DETAIL OF FRONT ENTRANCE IN NORTHWEST CORNER. VIEW TO EAST. - Commercial & Industrial Buildings, International Harvester Company Showroom, Office & Warehouse, 10 South Main Street, Dubuque, Dubuque County, IA

11. Photo image looking northwest of the relocation office and ...

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

11. Photo image looking northwest of the relocation office and other administrative buildings. - Fort Benjamin Harrison, East Fifty-sixth Street (Aultman Avenue) & Glenn Road, Lawrence, Marion County, IN

Looking Northwest at Office Building Boiler Room, Including Cinderblock Walls, ...

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

Looking Northwest at Office Building Boiler Room, Including Cinderblock Walls, Fuel Tank and Scale Weights - Hematite Fuel Fabrication Facility, Office, 3300 State Road P, Festus, Jefferson County, MO

HUNT STABLE COMPLEX LOOKING NORTHWEST TOWARD DOG KENNEL RUINS ACROSS ...

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

HUNT STABLE COMPLEX LOOKING NORTHWEST TOWARD DOG KENNEL RUINS ACROSS THE GREAT CIRCUS - Overhills, Fort Bragg Military Reservation, Approximately 15 miles NW of Fayetteville, Overhills, Harnett County, NC

Northwest side, northeast part, looking southeast, note fire alarm box ...

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

Northwest side, northeast part, looking southeast, note fire alarm box at right - Mare Island Naval Shipyard, Guard House & Barracks, Railroad Avenue near Eighteenth Street, Vallejo, Solano County, CA

View northwest; south and east facades Naval Base PhiladelphiaPhiladelphia ...

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

View northwest; south and east facades - Naval Base Philadelphia-Philadelphia Naval Shipyard, Foundry-Propeller Shop, North of Porter Avenue, west of Third Street West, Philadelphia, Philadelphia County, PA

15. PERSPECTIVE VIEW (NORTHWEST) OF WEST RETAINING WALL IN SOUTHWEST ...

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

15. PERSPECTIVE VIEW (NORTHWEST) OF WEST RETAINING WALL IN SOUTHWEST DEMI-BASTION SHOWING GLACIS - Fort Washington, Fort, 13551 Fort Washington Road, Fort Washington Forest, Prince George's County, MD

1. General context view of Express Building, looking northwest with ...

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

1. General context view of Express Building, looking northwest with railroad tracks in foreground - American Railway Express Company Freight Building, 1060 Northeast Division Street, Bend, Deschutes County, OR

75 FR 70026 - Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Pacific Northwest...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-16

... DEPARTMENT OF THE INTERIOR National Park Service [2253-665] Notice of Inventory Completion: U.S. Department of Agriculture, Forest Service, Pacific Northwest Region, Gifford Pinchot National Forest... the U.S. Department of Agriculture, Forest Service, Pacific Northwest Region, Gifford Pinchot National...

Secondary Climate Change Education in the Pacific Northwest

ERIC Educational Resources Information Center

White, P. Troy; Wolf, Kattlyn J.; Johnson-Maynard, Jodi L.; Velez, Jonathan J.; Eigenbrode, Sanford D.

2014-01-01

Climate change (CC) is an important issue students should understand to be productive members of society. The objectives were to evaluate the instruction and teacher perceptions relating to CC in the Inland Pacific Northwest (IPNW) secondary (7-12) classes across disciplines. The teacher perceptions, instructional frequency, perceived barriers to…

Timber resource of Wisconsin's Northwest Survey Unit, 1983.

Treesearch

W. Brad Smith

1984-01-01

The fourth inventory of the timber resource of the Northwest Wisconsin Survey Unit shows a 1.8% decline in commercial forest area and a 36% gain in growing-stock volume between 1968 and 1983. Presented are highlights and statistics on area, volume, growth, mortality, removals, utilization, and biomass.

Unpacking the impact of adverse childhood experiences on adult mental health.

PubMed

Merrick, Melissa T; Ports, Katie A; Ford, Derek C; Afifi, Tracie O; Gershoff, Elizabeth T; Grogan-Kaylor, Andrew

2017-07-01

Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts. Copyright © 2017. Published by Elsevier Ltd.

ENTRY ON SOUTHEAST SIDE (WILLISTON AVENUE ENTRY), VIEW FACING NORTHWEST. ...

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

ENTRY ON SOUTHEAST SIDE (WILLISTON AVENUE ENTRY), VIEW FACING NORTHWEST. - Schofield Barracks Military Reservation, Quadrangle I Administration Building, Williston Avenue between Wright-Smith & Reilly Avenues, Wahiawa, Honolulu County, HI

17. INTERIOR VIEW, LOOKING NORTHWEST, SHOWING STRUCTURAL SYSTEM, POSTS ENCASED ...

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

17. INTERIOR VIEW, LOOKING NORTHWEST, SHOWING STRUCTURAL SYSTEM, POSTS ENCASED IN CONCRETE, AND SERVICE PIT - Chesapeake Beach Railroad Engine House, 21 Yost Place, Seat Pleasant, Prince George's County, MD

2. EXTERIOR SOUTHEAST CORNER VIEW, FACING NORTHWEST. BUILDING NO 42 ...

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

2. EXTERIOR SOUTHEAST CORNER VIEW, FACING NORTHWEST. BUILDING NO 42 GARAGE & TRANSPORTATION MAINTENANCE FACILITY - NASA Industrial Plant, Garage & Transportation Maintenance Facility, 12214 Lakewood Boulevard, Downey, Los Angeles County, CA

4. EXTERIOR NORTHWEST CORNER VIEW, FACING SOUTHEAST. BUILDING NO 42 ...

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

4. EXTERIOR NORTHWEST CORNER VIEW, FACING SOUTHEAST. BUILDING NO 42 GARAGE & TRANSPORTATION MAINTENANCE FACILITY - NASA Industrial Plant, Garage & Transportation Maintenance Facility, 12214 Lakewood Boulevard, Downey, Los Angeles County, CA

22. INTERIOR, FIRST FLOOR, EAST SECTION, NORTHEAST ROOM, NORTHWEST CORNER ...

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

22. INTERIOR, FIRST FLOOR, EAST SECTION, NORTHEAST ROOM, NORTHWEST CORNER (NOTE EXPOSED BRICK NOGGING) - Peter Burr House, Vicinity of State Route 9 & Ridge Road, Shenandoah Junction, Jefferson County, WV

Pacific Northwest National Laboratory institutional plan FY 1997--2002

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

NONE

1996-10-01

Pacific Northwest National Laboratory`s core mission is to deliver environmental science and technology in the service of the nation and humanity. Through basic research fundamental knowledge is created of natural, engineered, and social systems that is the basis for both effective environmental technology and sound public policy. Legacy environmental problems are solved by delivering technologies that remedy existing environmental hazards, today`s environmental needs are addressed with technologies that prevent pollution and minimize waste, and the technical foundation is being laid for tomorrow`s inherently clean energy and industrial processes. Pacific Northwest National Laboratory also applies its capabilities to meet selected nationalmore » security, energy, and human health needs; strengthen the US economy; and support the education of future scientists and engineers. Brief summaries are given of the various tasks being carried out under these broad categories.« less

Andes Altiplano, Northwest Argentina, South America

NASA Technical Reports Server (NTRS)

1993-01-01

This view of the Andes Altiplano in northwest Argentina (25.5S, 68.0W) is dominated by heavily eroded older and inactive volcano peaks. The altiplano is a high altitude cold desert like the Tibetan Plateau but smaller in area. It is an inland extension of the hyperarid Atacama Desert of the west coast of South America and includes hundreds of volcanic edifices (peaks, cinder cones, lava flows, debris fields, lakes and dry lake beds (salars).

The Use of Oral Literature to Provide Community Health Education on the Southern Northwest Coast

ERIC Educational Resources Information Center

Thompson, Nile Robert; Sloat, C. Dale

2004-01-01

Among the American Indians of western Washington State and northwest Oregon, stories have served as educational tools by presenting lessons concerning the traditional culture. Several types of instruction have been noted in the oral literature of these Indians of the Southern Northwest Coast. Today these stories present another type of insight and…

POLICY CONUNDRUM: RESTORING WILD SALMON TO THE PACIFIC NORTHWEST

EPA Science Inventory

Restoring wild salmon runs to the Pacific Northwest is technically challenging, politically nasty, and socially divisive. Past restoration efforts have been largely unsuccessful. Society's failure to reverse the continuing decline of wild salmon has the characteristics of a pol...

Teacher Certification: The Problem in the Pacific Northwest.

ERIC Educational Resources Information Center

Leonard, Leo D.

1985-01-01

Teacher certification procedures in the Pacific Northwest are used to illustrate the kinds of problems facing the nation in terms of teacher certification and program accreditation. Proposals for change include: cooperation between public schools and universities; five year programs; and use of research to study the teacher education process. (DF)

5. VIEW NORTHWEST FROM LEFT TO RIGHT: COLD CALIBRATION OBSERVATION ...

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

5. VIEW NORTHWEST FROM LEFT TO RIGHT: COLD CALIBRATION OBSERVATION BUNKER BACKGROUND, COLD CALIBRATION TOWER. - Marshall Space Flight Center, East Test Area, Cold Calibration Test Stand, Huntsville, Madison County, AL

7. VIEW NORTHWEST OF SUBSONIC WIND TUNNEL BUILDING TO TRANSONIC ...

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

7. VIEW NORTHWEST OF SUBSONIC WIND TUNNEL BUILDING TO TRANSONIC WIND TUNNEL BUILDING - Naval Surface Warfare Center, Bounded by Clara Barton Parkway & McArthur Boulevard, Silver Spring, Montgomery County, MD

5. VIEW NORTHWEST OF SUBSONIC WIND TUNNEL BUILDING TO TRANSONIC ...

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

5. VIEW NORTHWEST OF SUBSONIC WIND TUNNEL BUILDING TO TRANSONIC WIND TUNNEL BUILDING - Naval Surface Warfare Center, Bounded by Clara Barton Parkway & McArthur Boulevard, Silver Spring, Montgomery County, MD

FOUNDRY LANDSCAPE LOOKING NORTHWEST FROM MALLEABLE STOCK YARD CRANE SHOWING ...

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

FOUNDRY LANDSCAPE LOOKING NORTHWEST FROM MALLEABLE STOCK YARD CRANE SHOWING THE MALLEABLE ANNEALING BUILDING AND THE BRASS FOUNDRY. - Stockham Pipe & Fittings Company, 4000 Tenth Avenue North, Birmingham, Jefferson County, AL

4. VIEW NORTHWEST OF SUPERSONIC WIND TUNNEL BUILDING TO TRANSONIC ...

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

4. VIEW NORTHWEST OF SUPERSONIC WIND TUNNEL BUILDING TO TRANSONIC WIND TUNNEL BUILDING - Naval Surface Warfare Center, Bounded by Clara Barton Parkway & McArthur Boulevard, Silver Spring, Montgomery County, MD

Northwest corner, showing arcade at ground level, and triple leaded ...

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

Northwest corner, showing arcade at ground level, and triple leaded glass windows of bender room high on north elevation. - Stanford University Library, Stanford University, Palo Alto, Santa Clara County, CA

1. VIEW TO SOUTHEAST (NORTHWEST CORNER OF EDIBLE FATS FACTORY) ...

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

1. VIEW TO SOUTHEAST (NORTHWEST CORNER OF EDIBLE FATS FACTORY) - Wilson's Oil House, Lard Refinery, & Edible Fats Factory, Edible Fats Factory, 2801 Southwest Fifteenth Street, Oklahoma City, Oklahoma County, OK

10. VIEW TO NORTHEAST ALONG NORTHWEST SPILLWAY ABUTMENT; SERVICE VEHICLE ...

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

10. VIEW TO NORTHEAST ALONG NORTHWEST SPILLWAY ABUTMENT; SERVICE VEHICLE GARAGE IN BACKGROUND. - Prado Dam, Spillway, Santa Ana River near junction of State Highways 71 & 91, Corona, Riverside County, CA

2. PERSPECTIVE VIEW (NORTH) INTO ESPLANADE OF NORTHWEST DEMIBASTION SHOWING ...

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

2. PERSPECTIVE VIEW (NORTH) INTO ESPLANADE OF NORTHWEST DEMI-BASTION SHOWING REVETMENTS, COUNTERFORTS, GLACIS AND STAIRS - Fort Washington, Fort, 13551 Fort Washington Road, Fort Washington Forest, Prince George's County, MD

3. PERSPECTIVE VIEW (SOUTH) INTO ESPLANADE OF NORTHWEST DEMIBASTION SHOWING ...

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

3. PERSPECTIVE VIEW (SOUTH) INTO ESPLANADE OF NORTHWEST DEMI-BASTION SHOWING REVETMENTS, COUNTERFORTS, GLACIS AND STAIRS - Fort Washington, Fort, 13551 Fort Washington Road, Fort Washington Forest, Prince George's County, MD

Looking Northwest at Uranium Dryers Along North Side of Green ...

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

Looking Northwest at Uranium Dryers Along North Side of Green Room in Recycle Recovery Building - Hematite Fuel Fabrication Facility, Recycle Recovery Building, 3300 State Road P, Festus, Jefferson County, MO

5. Detail of underside of Cedar Avenue Bridge at northwest ...

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

5. Detail of underside of Cedar Avenue Bridge at northwest end. - Delaware, Lackawanna & Western Railroad, Scranton Yards, Cedar Avenue Bridge, Spanning Cedar Avenue at Railroad Alley, Scranton, Lackawanna County, PA

Perspective view looking from the northwest from approximately the same ...

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

Perspective view looking from the northwest from approximately the same vantage point as in MD-1109-19 - National Park Seminary, Colonial House, 2745 Dewitt Circle, Silver Spring, Montgomery County, MD

8. INTERIOR NORTHWEST VIEW OF TOWER (1992). WrightPatterson Air ...

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

8. INTERIOR NORTHWEST VIEW OF TOWER (1992). - Wright-Patterson Air Force Base, Area B, Building 8, Operations & Flight Test Building, Northeast corner of Tenth & C Streets, Dayton, Montgomery County, OH

9. LOOKING NORTHWEST TOWARD SOUTHERN SIDES OF BUILDING 1. GARAGE ...

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

9. LOOKING NORTHWEST TOWARD SOUTHERN SIDES OF BUILDING 1. GARAGE ADDITION AT RIGHT. - Chollas Heights Naval Radio Transmitting Facility, Transmitter Building, 6410 Zero Road, San Diego, San Diego County, CA

6. VIEW SHOWING DETAILS OF ENCLOSED FRONT PORCH ON NORTHWEST ...

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

6. VIEW SHOWING DETAILS OF ENCLOSED FRONT PORCH ON NORTHWEST CORNER OF BUILDING. - Chollas Heights Naval Radio Transmitting Facility, Officer's Quarters, 6410 Zero Road, San Diego, San Diego County, CA

10. SINUOUS EARTH BERMS ALONG CONTOUR LINE. VIEW TO NORTHWEST. ...

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

10. SINUOUS EARTH BERMS ALONG CONTOUR LINE. VIEW TO NORTHWEST. - Natomas Ditch System, Rhoades' Branch Ditch, Approximately 7 miles between Nesmith Court and White Rock Road, Folsom, Sacramento County, CA

Ritual drinks in the pre-Hispanic US Southwest and Mexican Northwest

PubMed Central

Crown, Patricia L.; Gu, Jiyan; Hurst, W. Jeffrey; Ward, Timothy J.; Bravenec, Ardith D.; Ali, Syed; Kebert, Laura; Berch, Marlaina; Redman, Erin; Lyons, Patrick D.; Merewether, Jamie; Phillips, David A.; Reed, Lori S.; Woodson, Kyle

2015-01-01

Chemical analyses of organic residues in fragments of pottery from 18 sites in the US Southwest and Mexican Northwest reveal combinations of methylxanthines (caffeine, theobromine, and theophylline) indicative of stimulant drinks, probably concocted using either cacao or holly leaves and twigs. The results cover a time period from around A.D. 750–1400, and a spatial distribution from southern Colorado to northern Chihuahua. As with populations located throughout much of North and South America, groups in the US Southwest and Mexican Northwest likely consumed stimulant drinks in communal, ritual gatherings. The results have implications for economic and social relations among North American populations. PMID:26372965

The Indian Reading Series: Stories and Legends of the Northwest. Level IV. Books 1-21.

ERIC Educational Resources Information Center

Northwest Regional Educational Lab., Portland, OR.

Designed as supplementary reading material for Indian and non-Indian children in the elementary grades, this series of 21 booklets presents 36 stories and legends of Northwest tribes. Stories in this fourth level of the six-level series were developed cooperatively by Indian people of reservations in the Pacific Northwest. Booklets range from 7 to…

7. VIEW OF NORTHWEST PYLONS ON NORTH ABUTMENT, SUSPENSION CABLE ...

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

7. VIEW OF NORTHWEST PYLONS ON NORTH ABUTMENT, SUSPENSION CABLE AND 'U'-BOLT CONNECTIONS, LOOKING SOUTH - San Rafael Bridge, Spanning San Rafael River near Buckhorn Wash, Castle Dale, Emery County, UT

8. DETAIL VIEW NORTHWEST OF SOUTH TURBINE SHAFT AND PULLEY ...

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

8. DETAIL VIEW NORTHWEST OF SOUTH TURBINE SHAFT AND PULLEY WHEEL - Willimantic Linen Company, Mill No. 2, South Main Street opposite Durham Street, North bank Willimantic River, Windham, Windham County, CT

4. VIEW OF NORTHWEST SIDE OF GERMAN VILLAGE LOOKING SOUTHEAST. ...

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

4. VIEW OF NORTHWEST SIDE OF GERMAN VILLAGE LOOKING SOUTHEAST. - Dugway Proving Ground, German-Japanese Village, German Village, South of Stark Road, in WWII Incendiary Test Area, Dugway, Tooele County, UT

Planar view of northwest side of coffee processing structure No. ...

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

Planar view of northwest side of coffee processing structure No. 1, view towards the southeast - Finca Silem, Coffee Processing Structure No. 1, Highway 139, Kilometer 9.3, Maraguez, Ponce Municipio, PR

18. Threequarter view of southeast corner of Hwing, looking northwest ...

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

18. Three-quarter view of southeast corner of H-wing, looking northwest - Offutt Air Force Base, Strategic Air Command Headquarters & Command Center, Headquarters Building, 901 SAC Boulevard, Bellevue, Sarpy County, NE

17. View northwest of Tropic Chamber refrigeration equipment, in machine ...

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

17. View northwest of Tropic Chamber refrigeration equipment, in machine area. - Natick Research & Development Laboratories, Climatic Chambers Building, U.S. Army Natick Research, Development & Engineering Center (NRDEC), Natick, Middlesex County, MA

3. Southeast corner of Building 202, looking northwest from steps ...

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

3. Southeast corner of Building 202, looking northwest from steps on hillside near water tank. - Rocket Engine Testing Facility, GRC Building No. 202, NASA Glenn Research Center, Cleveland, Cuyahoga County, OH

16. Detail, looking northwest, of the concrete structure of Trestle ...

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

16. Detail, looking northwest, of the concrete structure of Trestle 16. - Lake Hodges Flume, Along San Dieguito River between Lake Hodges & San Dieguito Reservoir, Rancho Santa Fe, San Diego County, CA

17. Oblique view of northwest corner of main plant looking ...

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

17. Oblique view of northwest corner of main plant looking southeast with railroad tracks in foreground - Skinner Meat Packing Plant, Main Plant, 6006 South Twenty-seventh Street, Omaha, Douglas County, NE

2. Oil House, Southern Pacific Railroad Carlin Shops, northwest elevation, ...

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

2. Oil House, Southern Pacific Railroad Carlin Shops, northwest elevation, view to southeast (135mm lens). - Southern Pacific Railroad, Carlin Shops, Oil House, Foot of Sixth Street, Carlin, Elko County, NV

29. NORTHWEST VIEW OF BOILER FEEDWATER CHEMICAL REACTION TANKS, WITH ...

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

29. NORTHWEST VIEW OF BOILER FEEDWATER CHEMICAL REACTION TANKS, WITH FORMER GENERAL OFFICE BUILDING IN BACKGROUND. - U.S. Steel Duquesne Works, Fuel & Utilities Plant, Along Monongahela River, Duquesne, Allegheny County, PA

10. VIEW, LOOKING NORTHWEST, SHOWING DETAIL OF RAILS IN PREPARATION ...

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

10. VIEW, LOOKING NORTHWEST, SHOWING DETAIL OF RAILS IN PREPARATION FOR BRIDGE OPENING - New York, New Haven & Hartford Railroad, Shaw's Cove Bridge, Spanning Shaw's Cove, New London, New London County, CT

21. Launch Area, Missile Assembly Building VIEW NORTHWEST, SOUTH AND ...

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

21. Launch Area, Missile Assembly Building VIEW NORTHWEST, SOUTH AND EAST ELEVATION - NIKE Missile Battery PR-79, Launch Area, East Windsor Road south of State Route 101, Foster, Providence County, RI

1. PERSPECTIVE VIEW (NORTHEAST) FROM ESPLANADE OF NORTHWEST DEMIBASTION SHOWING ...

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

1. PERSPECTIVE VIEW (NORTHEAST) FROM ESPLANADE OF NORTHWEST DEMI-BASTION SHOWING GLACIS AND RELATIONSHIP TO MAIN GATE - Fort Washington, Fort, 13551 Fort Washington Road, Fort Washington Forest, Prince George's County, MD

South (front) wall, looking northwest U.S. Veterans Hospital, Jefferson ...

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

South (front) wall, looking northwest - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

6. VIEW TO THE NORTH NORTHWEST FROM GROUND LEVEL. STRUCTURAL ...

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

6. VIEW TO THE NORTH NORTHWEST FROM GROUND LEVEL. STRUCTURAL MEMBERS AT INTERSECTION OF RANDOLPH-WELLS STREET. - Union Elevated Railroad, Randolph-Wells Street Station, Randall & Wells Street, Chicago, Cook County, IL

25. VIEW TO NORTHWEST, ENGINE PUMP EXTENSION, DETAIL OF SHEET ...

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

25. VIEW TO NORTHWEST, ENGINE PUMP EXTENSION, DETAIL OF SHEET METAL MOLDING TO OPENING BETWEEN ENGINE/PUMP HOUSE AND ENGINE/PUMP HOUSE EXTENSION - Deer Island Pumping Station, Boston, Suffolk County, MA

20. INTERIOR OF SOUTHERN ROOM. VIEW LOOKING NORTHWEST TOWARD HALL ...

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

20. INTERIOR OF SOUTHERN ROOM. VIEW LOOKING NORTHWEST TOWARD HALL CONNECTING WITH CENTRAL ROOM. - Chollas Heights Naval Radio Transmitting Facility, Transmitter Building, 6410 Zero Road, San Diego, San Diego County, CA

Pacific Northwest regional AGU meeting

NASA Astrophysics Data System (ADS)

Hyndman, Roy

The 27th Annual Pacific Northwest Regional American Geophysical Union Meeting, held September 25 and 26, 1980, was hosted by the Pacific Geoscience Centre at the Institute of Ocean Sciences, near Victoria, British Columbia. A total of 79 papers was presented to the 150 registrants in six general sessions: seismology; electromagnetic induction; general geophysics; volcanology; hydrology; and oceanography, and in three special symposia: ‘The Queen Charlotte-Fairweather fault system and other active faults of the Pacific Northwest’ ‘Coastal circulation in the northeast Pacific’ and ‘Studies of the eruption of Mount St. Helens.’

Northwest Energy Efficient Manufactured Housing Program: High Performance Manufactured Home Prototyping and Construction Development

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

Hewes, Tom; Peeks, Brady

2013-11-01

The Building America Partnership for Improved Residential Construction, the Bonneville Power Administration (BPA), and Northwest Energy Works (NEW), the current Northwest Energy Efficient Manufactured Housing Program (NEEM) administrator, have been collaborating to conduct research on new specifications that would improve on the energy requirements of a NEEM home. In its role as administrator, NEW administers the technical specs, performs research and engineering analysis, implements ongoing construction quality management procedures, and maintains a central database with home tracking. This project prototyped and assessed the performances of cost-effective high performance building assemblies and mechanical systems that are not commonly deployed in themore » manufacturing setting. The package of measures is able to reduce energy used for space conditioning, water heating and lighting by 50% over typical manufactured homes produced in the northwest.« less

7. WEST DAM STRUCTURE, LOOKING NORTHWEST. QUARRIES AT BOTTOM; OUTLET ...

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

7. WEST DAM STRUCTURE, LOOKING NORTHWEST. QUARRIES AT BOTTOM; OUTLET STRUCTURE UNDER CONSTRUCTION CUTTING INTO HILL AT TOP OF PICTURE. - Eastside Reservoir, Diamond & Domenigoni Valleys, southwest of Hemet, Hemet, Riverside County, CA

GENERAL PERSPECTIVE VIEW OF THE COMPLEX, VIEW LOOKING NORTHWEST AT ...

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

GENERAL PERSPECTIVE VIEW OF THE COMPLEX, VIEW LOOKING NORTHWEST AT THE OREGON FORESTER'S OFFICE BUILDING, WITH MILL CREEK IN THE FOREGROUND. - Oregon State Forester's Office Complex, 2600 State Street, Salem, Marion, OR

7. Southeast elevation showing building in setting; view to northwest; ...

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

7. Southeast elevation showing building in setting; view to northwest; Highway 101 in foreground, State Street at right. - V.E. Wood Auto Building, 315 State Street, Santa Barbara, Santa Barbara County, CA