Behavioral Impact of Graduated Driver Licensing on Teenage Driving Risk and Exposure1

PubMed Central

Karaca-Mandic, Pinar; Ridgeway, Greg

2009-01-01

Graduated Driver Licensing (GDL) is a critical policy tool for potentially improving teenage driving while reducing teen accident exposure. While previous studies demonstrated that GDL reduces teenage involvement in fatal crashes, much remains unanswered. We explore the mechanisms through which GDL influences accident rates as well as its long term effectiveness on teen driving. In particular, we investigate; 1) whether GDL policies improve teenage driving behavior, or simply reduce teenage prevalence on the roads; 2) whether GDL exposed teens become better drivers in later years. We employ a unique data source, the State Data System, which contains all police reported accidents (fatal and non-fatal) during 1990–2005 for twelve states. We estimate a structural model that separately identifies GDL s effect on relative teenage prevalence and relative teenage riskiness. Identification of the model is driven by the relative numbers of crashes between two teenagers, two adults, or a teenager and an adult. We find that the GDL policies reduce the number of 15–17 year-old accidents by limiting the amount of teenage driving rather than by improving teenage driving. This prevalence reduction primarily occurs at night and stricter GDL policies, especially those with nighttime driving restrictions, are the most effective. Finally, we find that teen driving quality does not improve ex-post GDL exposure. PMID:19942310

Impact of graduated driver licensing restrictions on crashes involving young drivers in New Zealand

PubMed Central

Begg, D; Stephenson, S; Alsop, J; Langley, J

2001-01-01

Objective—To determine the impact on young driver crashes of the three main driving restrictions in the New Zealand graduated driver licensing (GDL) system: night-time curfew, no carrying of young passengers, and a blood alcohol limit of 30 mg/100 ml. Method—The database for this study was created by linking police crash reports to hospital inpatient records (1980–95). Multivariate logistic regression was used to compare car crashes involving a young driver licensed before GDL (n=2252) with those who held a restricted graduated licence (n=980) and with those who held a full graduated licence (n=1273), for each of the main driving restrictions. Results—Compared with the pre-GDL group, the restricted licence drivers had fewer crashes at night (p=0.003), fewer involving passengers of all ages (p=0.018), and fewer where alcohol was suspected (p=0.034), but not fewer involving young casualties (p=0.980). Compared with the pre-GDL drivers, those with the full graduated licence had fewer night crashes (p=0.042) but did not differ significantly for any of the other factors examined. Conclusion—These results suggest that some of the GDL restrictions, especially the night-time curfew, have contributed to a reduction in serious crashes involving young drivers. PMID:11770654

Impact of graduated driver licensing restrictions on crashes involving young drivers in New Zealand.

PubMed

Begg, D J; Stephenson, S; Alsop, J; Langley, J

2001-12-01

To determine the impact on young driver crashes of the three main driving restrictions in the New Zealand graduated driver licensing (GDL) system: night-time curfew, no carrying of young passengers, and a blood alcohol limit of 30 mg/100 ml. The database for this study was created by linking police crash reports to hospital inpatient records (1980-95). Multivariate logistic regression was used to compare car crashes involving a young driver licensed before GDL (n=2,252) with those who held a restricted graduated licence (n=980) and with those who held a full graduated licence (n=1,273), for each of the main driving restrictions. Compared with the pre-GDL group, the restricted licence drivers had fewer crashes at night (p=0.003), fewer involving passengers of all ages (p=0.018), and fewer where alcohol was suspected (p=0.034), but not fewer involving young casualties (p=0.980). Compared with the pre-GDL drivers, those with the full graduated licence had fewer night crashes (p=0.042) but did not differ significantly for any of the other factors examined. These results suggest that some of the GDL restrictions, especially the night-time curfew, have contributed to a reduction in serious crashes involving young drivers.

Health care utilization and charges following the enactment of the 2007 Graduated Drivers Licensing Law in Massachusetts.

PubMed

Sangji, Naveen F; Ramly, Elie P; Kaafarani, Haytham M A; Seethala, Raghu; Raybould, Toby; Camargo, Carlos A; Velmahos, George; Masiakos, Peter T; Lee, Jarone

2015-10-01

Graduated Drivers Licensing (GDL) programs phase in driving privileges for teenagers. In 2007, Massachusetts implemented a stricter version of the 1998 GDL law, with increased fines and education. This study evaluated the impact of the law on motor vehicle crash (MVC)-related health care utilization and charges. Massachusetts government and US Census Bureau data were analyzed to compare the rates of MVC-related emergency department (ED) visits and hospital charges before (2002-2006) and after (2007-2011) the 2007 GDL law. Three driver age groups were studied: 16-17 (evaluating the law effect), 18-20 (evaluating the sustainability of the effect), and 25-29 years old (control group). MVC-related ED visits per population decreased after the law for all three age groups (16-17: 2326 to 713; 18-20: 2110 to 1304; 25-29: 1694 to 1228; per 100,000, p<0.001), but the decrease was greater amongst teenagers (16-17: -69%; 18-20: -38%) compared to the control group (-27%); p<0.001. MVC-related hospital charges per population also decreased for teenagers but increased for the control group (16-17: $2.70 m to $1.45 m; 18-20: $3.52 m to $2.26 m; 25-29: $1.86 m to $1.92 m; per 100,000, p<0.001). The 2007 GDL law in Massachusetts was associated with significant decreases in MVC-related health care utilization and hospital charges among teenage drivers. Copyright © 2015 Elsevier Inc. All rights reserved.

Graduated driver licensing and motor vehicle crashes involving teenage drivers: an exploratory age-stratified meta-analysis.

PubMed

Zhu, Motao; Cummings, Peter; Chu, Haitao; Coben, Jeffrey H; Li, Guohua

2013-02-01

Graduated Driver Licensing (GDL) has been implemented in Australia, Canada, New Zealand, USA and Israel. We conducted an exploratory summary of available data to estimate whether GDL effects varied with age. We searched MEDLINE and other sources from 1991-2011. GDL evaluation studies with crashes resulting in injuries or deaths were eligible. They had to provide age-specific incidence rate ratios with CI or information for calculating these quantities. We included studies from individual states or provinces, but excluded national studies. We examined rates based on person-years, not license-years. Of 1397 papers, 144 were screened by abstract and 47 were reviewed. Twelve studies from 11 US states and one Canadian province were selected for meta-analysis for age 16, eight were selected for age 17, and four for age 18. Adjusted rate ratios were pooled using random effects models. The pooled adjusted rate ratios for the association of GDL presence with crash rates was 0.78 (95% CI 0.72 to 0.84) for age 16 years, 0.94 (95% CI 0.93 to 0.96) for 17 and 1.00 (95% CI 0.95 to 1.04) for 18. The difference between these three rate ratios was statistically significant: p<0.001. GDL policies were associated with a 22% reduction in crash rates among 16-year-old drivers, but only a 6% reduction for 17-year-old drivers. GDL showed no association with crashes among 18-year-old drivers. Because we had few studies to summarise, particularly for older adolescents, our findings should be considered exploratory.

Teen driving in rural North Dakota: a qualitative look at parental perceptions.

PubMed

Gill, Simerpal K; Shults, Ruth A; Cope, Jennifer Rittenhouse; Cunningham, Timothy J; Freelon, Brandi

2013-05-01

Motor vehicle crashes are the leading cause of death among teens in the United States. Graduated driver licensing (GDL) programs allow new drivers to gain driving experience while protecting them from high-risk situations. North Dakota was one of the last states to implement GDL, and the current program does not meet all of the best practice recommendations. This study used qualitative techniques to explore parents' perceptions of the role teen driving plays in the daily lives of rural North Dakota families, their understanding of the risks faced by their novice teen drivers, and their support for GDL. A total of 28 interviews with parents of teens aged 13-16 years were conducted in four separate rural areas of the state. During the face-to-face interviews, parents described their teens' daily lives as busy, filled with school, sports, and other activities that often required traveling considerable distances. Participation in school-sponsored sports and other school-related activities was highly valued. There was nearly unanimous support for licensing teens at age 14½, as was permitted by law at the time of the interviews. Parents expressed that they were comfortable supervising their teen's practice driving, and few reported using resources to assist them in this role. Although few parents expressed concerns over nighttime driving, most parents supported a nighttime driving restriction with exemptions for school, work or sports-related activities. Despite many parents expressing concern over distracted driving, there was less consistent support among parents for passenger restrictions, especially if there would be no exemptions for family members or school activities. These findings can assist in planning policies and programs to reduce crashes among novice, teen drivers, while taking into account the unique perspectives and lifestyles of families living in rural North Dakota. Published by Elsevier Ltd.

Teen driving in rural North Dakota: A qualitative look at parental perceptions☆

PubMed Central

Gill, Simerpal K.; Shults, Ruth A.; Cope, Jennifer Rittenhouse; Cunningham, Timothy J.; Freelon, Brandi

2017-01-01

Motor vehicle crashes are the leading cause of death among teens in the United States. Graduated driver licensing (GDL) programs allow new drivers to gain driving experience while protecting them from high-risk situations. North Dakota was one of the last states to implement GDL, and the current program does not meet all of the best practice recommendations. This study used qualitative techniques to explore parents’ perceptions of the role teen driving plays in the daily lives of rural North Dakota families, their understanding of the risks faced by their novice teen drivers, and their support for GDL. A total of 28 interviews with parents of teens aged 13–16 years were conducted in four separate rural areas of the state. During the face-to-face interviews, parents described their teens’ daily lives as busy, filled with school, sports, and other activities that often required traveling considerable distances. Participation in school-sponsored sports and other school-related activities was highly valued. There was nearly unanimous support for licensing teens at age 14½, as was permitted by law at the time of the interviews. Parents expressed that they were comfortable supervising their teen’s practice driving, and few reported using resources to assist them in this role. Although few parents expressed concerns over nighttime driving, most parents supported a nighttime driving restriction with exemptions for school, work or sports-related activities. Despite many parents expressing concern over distracted driving, there was less consistent support among parents for passenger restrictions, especially if there would be no exemptions for family members or school activities. These findings can assist in planning policies and programs to reduce crashes among novice, teen drivers, while taking into account the unique perspectives and lifestyles of families living in rural North Dakota. PMID:23499983

An Evaluation of Graduated Driver Licensing Effects on Fatal Crash Involvements of Young Drivers in the United States

PubMed Central

Fell, James C.; Jones, Kristina; Romano, Eduardo; Voas, Robert

2013-01-01

Objective Graduated driver licensing (GDL) systems are designed to reduce the high crash risk of young novice drivers. Almost all states in the United States have some form of a three-phased GDL system with various restrictions in the intermediate phase. Studies of the effects of GDL in various states show significant reductions in fatal crash involvements of 16- and 17-year-old drivers; however, only a few national studies of GDL effects have been published. The objective of this national panel study was to evaluate the effect of GDL laws on the fatal crash involvements of novice drivers while controlling for possible confounding factors not accounted for in prior studies. Methods The Fatality Analysis Reporting System (FARS) was used to examine 16- and 17-year-old driver involvement in fatal crashes (where GDL laws are applied) relative to two young driver age groups (19-20, 21-25) where GDL would not be expected to have an effect. Dates when various GDL laws were adopted in the states between 1990 and 2007 were coded from a variety of sources. Covariates in the longitudinal panel regression analyses conducted included four laws that could have an effect on 16- and 17-year-old drivers: primary enforcement seat belt laws, zero-tolerance (ZT) alcohol laws for drivers younger than age 21, lowering the blood alcohol concentration limit for driving to .08, and so-called “use and lose” laws where drivers aged 20 and younger lose their licenses for underage drinking violations. Results The adoption of a GDL law of average strength was associated with a significant decrease in fatal crash involvements of 16- and 17-year-old drivers relative to fatal crash involvements of one of the two comparison groups. GDL laws rated as “good” showed stronger relationships to fatal crash reductions, and laws rated as “less than good” showed no reductions in crash involvements relative to the older driver comparison groups. Conclusions States that adopt a basic GDL law can expect a decrease of 8 to 14% in the proportion of 16- and 17-year-old drivers involved in fatal crashes (relative to 21- to 25-year-old drivers), depending upon their other existing laws that affect novice drivers, such as those used in these analyses. This finding is consistent with recent national studies that used different outcome measures and covariates. The results of this study provide additional support for states to adopt, maintain, and upgrade GDL systems to reduce youthful traffic crash fatalities. PMID:21972851

Graduated driver licensing and motor vehicle crashes involving teenage drivers: an exploratory age-stratified meta-analysis

PubMed Central

Zhu, Motao; Cummings, Peter; Chu, Haitao; Coben, Jeffrey H; Li, Guohua

2014-01-01

Objective Graduated Driver Licensing (GDL) has been implemented in Australia, Canada, New Zealand, USA and Israel. We conducted an exploratory summary of available data to estimate whether GDL effects varied with age. Methods We searched MEDLINE and other sources from 1991–2011. GDL evaluation studies with crashes resulting in injuries or deaths were eligible. They had to provide age-specific incidence rate ratios with CI or information for calculating these quantities. We included studies from individual states or provinces, but excluded national studies. We examined rates based on person-years, not license-years. Results Of 1397 papers, 144 were screened by abstract and 47 were reviewed. Twelve studies from 11 US states and one Canadian province were selected for meta-analysis for age 16, eight were selected for age 17, and four for age 18. Adjusted rate ratios were pooled using random effects models. The pooled adjusted rate ratios for the association of GDL presence with crash rates was 0.78 (95% CI 0.72 to 0.84) for age 16 years, 0.94 (95% CI 0.93 to 0.96) for 17 and 1.00 (95% CI 0.95 to 1.04) for 18. The difference between these three rate ratios was statistically significant: p<0.001. Conclusions GDL policies were associated with a 22% reduction in crash rates among 16-year-old drivers, but only a 6% reduction for 17-year-old drivers. GDL showed no association with crashes among 18-year-old drivers. Because we had few studies to summarise, particularly for older adolescents, our findings should be considered exploratory. PMID:23211352

A National Evaluation of the Nighttime and Passenger Restriction Components of Graduated Driver Licensing

PubMed Central

Fell, James C.; Todd, Michael; Voas, Robert B.

2011-01-01

Introduction The high crash rate of youthful novice drivers has been recognized for half a century. Over the last decade, graduated driver licensing (GDL) systems, which extend the period of supervised driving and limit the novice’s exposure to higher-risk conditions (such as nighttime driving) has effectively reduced crash involvements of novice drivers. Method This study used data from the Fatality Analysis Reporting System (FARS) and the implementation dates of GDL laws in a state-by-year panel study to evaluate the effectiveness of two key elements of GDL laws: nighttime restrictions and passenger limitations. Results Nighttime restrictions were found to reduce 16- and 17-year-old driver involvements in nighttime fatal crashes by an estimated 10% and 16- and 17-year-old drinking drivers in nighttime fatal crashes by 13%. Passenger restrictions were found to reduce 16- and 17-year-old driver involvements in fatal crashes with teen passengers by an estimated 9%. Conclusions These results confirm the effectiveness of these provisions in GDL systems. Impact on Public Health The results of this study indicate that nighttime restrictions and passenger limitations are very important components of any GDL law. PMID:22017831

Graduated driver license compliant teens involved in fatal motor vehicle crashes.

PubMed

Pressley, Joyce C; Addison, Diane; Dawson, Patrick; Nelson, Sharifa S

2015-09-01

Significant reductions in motor vehicle injury mortality have been reported for teen drivers after passage of graduated driver licensing (GDL), seat belt, and no tolerance alcohol and drug laws. Despite this, teen drivers remain a vulnerable population with elevated fatal crash involvement. This study examines driver, vehicle, and crash characteristics of GDL-compliant, belted, and unimpaired teen drivers with the goal of identifying areas where further improvements might be realized. The Fatality Analysis Reporting System (FARS) for 2007 to 2009 was used to examine and classify driver violations/errors in compliant teen drivers (n = 1,571) of passenger vehicles involved in a fatal collision. Teens driving unbelted, non-GDL compliant, or impaired by alcohol or drugs were excluded. Statistical analysis used χ, Fisher's exact and multivariable logistic regression. Odds ratios are reported with 95% confidence intervals. Significance was defined as p < 0.05. Nearly one third (n = 1,571) of teen drivers involved in a fatal motor vehicle crash were GDL compliant, unimpaired, and belted. The majority held an intermediate GDL license (90.6%). Crash-related factors were identified for 63.1% of fatal crashes. Age- and sex-adjusted odds identified overcorrecting, speeding, lane errors, school morning crashes, distractions, and driving on slippery surfaces as having increased odds of fatality for the teen driver as well as newer vehicle models and heavier vehicle weight as protective. Among compliant drivers, weekday crashes before and after school and committing a driving violation at the time of crash were associated with increased risk of driver death and higher incidence of incapacitating injury in surviving drivers. Therapeutic study, level V.

Permission to park: A statewide study of high school parking permits to determine compliance with graduated driver licensing law.

PubMed

Apanovitch, Audrey; Champany, Victoria; Wilson, Meghan; Emam, Hadeer; Ruiz, Kelly; Borrup, Kevin; Lapidus, Garry

2015-09-01

Motor vehicle crashes are the leading cause of fatality among teens in the United States. Beginning in the 1990s, many states enacted graduated driver licensing (GDL) systems to delay full licensure while allowing beginners to obtain experience under lower-risk conditions. Many high schools require parent and guardians of newly licensed teen drivers to complete a student parking pass application (PPA) for their son/daughter to drive, park, and transport themselves to and from school activities. The objective of this study was to describe the content of these PPAs for compliance with Connecticut's GDL law. PPAs were requested via e-mail, fax, or telephone from all Connecticut's high schools (n = 233). PPA variables included school demographics, parking rules, prohibitions and sanctions for violations, as well as reference to GDL law. Seventy-four schools were excluded because students were not allowed to park and schools did not require PPAs or declined to send us a copy of their PPAs. Of the remaining 159 schools, 122 (76.7%) sent us their PPAs. Responding schools were more likely to be suburban or rural. Most PPAs included a section on prohibitions and sanctions for driving misbehavior. Forty-three percent prohibited students from going to car during school hours, and 34% prohibited driving off campus/parking lot. Seventy percent warned of consequences for dangerous driving in parking lot, and 88% included the possibility of revocation for infractions. Only 14% had any reference to Connecticut's GDL law on their PPAs. A small percentage of Connecticut high schools include information about GDL laws on their PPAs. All states should examine their PPA content and adopt a uniform high school PPA that includes key provisions of their state's GDL laws in an effort to promote teen driving safety. Therapeutic study, level V.

Space Missions: Long Term Preservation of IDL-based Software using GDL

NASA Astrophysics Data System (ADS)

Coulais, A.; Schellens, M.; Arabas, S.; Lenoir, M.; Noreskal, L.; Erard, S.

2012-09-01

GNU Data Language (GDL) is a free software clone of IDL, an interactive language widely used in Astronomy and space missions since decades. Proprietary status, license restrictions, price, sustainability and continuity of support for particular platforms are recurrent concerns in the Astronomy community, especially concerning space missions, which require long-term support. In this paper, we describe the key features of GDL and the main achievements from recent development work. We illustrate the maturity of GDL by presenting two examples of application: reading spectral cubes in PDS format and use of the HEALPix library. These examples support the main argument of the paper: that GDL has reached a level of maturity and usability ensuring long term preservation of analysis capabilities for numerous ground experiments and spaces missions based on IDL.

The association between graduated driver licensing laws and travel behaviors among adolescents: an analysis of US National Household Travel Surveys.

PubMed

Zhu, Motao; Cummings, Peter; Zhao, Songzhu; Rice, Thomas

2016-07-27

Young novice drivers have crash rates higher than any other age group. To address this problem, graduated driver licensing (GDL) laws have been implemented in the United States to require an extended learner permit phase, and create night time driving or passenger restrictions for adolescent drivers. GDL allows adolescents to gain experience driving under low-risk conditions with the aim of reducing crashes. The restricted driving might increase riding with parents or on buses, which might be safer, or walking or biking, which might be more dangerous. We examined whether GDL increases non-driver travels, and whether it reduces total travels combining drivers and non-drivers. We used data from the US National Household Travel Survey for the years 1995-1996, 2001-2002, and 2008-2009 to estimate the adjusted ratio for the number of trips and trip kilometers made by persons exposed to a GDL law, compared with those not exposed. Adolescents aged 16 years had fewer trips and kilometers as drivers when exposed to a GDL law: ratio 0.84 (95 % confidence interval (CI) 0.71, 1.00) for trips; 0.79 (0.63, 0.98) for kilometers. For adolescents aged 17 years, the trip ratio was 0.94 (0.83, 1.07) and the kilometers ratio 0.80 (0.63, 1.03). There was little association between GDL laws and trips or kilometers traveled by other methods: ratio 1.03 for trips and 1.00 for kilometers for age 16 years, 0.94 for trips and 1.07 for kilometers for age 17. If these associations are causal, GDL laws reduced driving kilometers by about 20 % for 16 and 17 year olds, and reduced the number of driving trips by 16 % among 16 year olds. GDL laws showed little relationship with trips by other methods.

Testing and evaluation of graduated driver license marker : summary report.

DOT National Transportation Integrated Search

2008-01-01

The objective of this project was to assist New Jersey Motor Vehicle Commission in determining the feasibility of a removable visual marker for Graduated Drivers License (GDL) drivers. The NJ Teen Driver Safety Study Commission issued a report to the...

Graduated Driver Licensing

PubMed Central

Bates, Lyndel J.; Allen, Siobhan; Armstrong, Kerry; Watson, Barry; King, Mark J.; Davey, Jeremy

2014-01-01

Graduated driver licensing (GDL) aims to gradually increase the exposure of new drivers to more complex driving situations and typically consists of learner, provisional and open licence phases. The first phase, the learner licence, is designed to allow novice drivers to obtain practical driving experience in lower risk situations. The learner licence can delay licensure, encourage novice drivers to learn under supervision, mandate the number of hours of practice required to progress to the next phase and encourage parental involvement. The second phase, the provisional licence, establishes various driving restrictions and thereby reduces exposure to situations of higher risk, such as driving at night, with passengers or after drinking alcohol. Parental involvement with a GDL system appears essential in helping novices obtain sufficient practice and in enforcing compliance with restrictions once the new driver obtains a provisional licence. Given the significant number of young drivers involved in crashes within Oman, GDL is one countermeasure that may be beneficial in reducing crash risk and involvement for this group. PMID:25364543

Preliminary evaluation of the North Carolina graduated driver licensing system : effects on young driver crashes

DOT National Transportation Integrated Search

2000-07-01

In December 1997, North Carolina became the second state to enact a comprehensive Graduated Driver Licensing (GDL) system. The purpose of the GSL is to reduce young driver crashes by introducing beginning drivers to the full range of driving experien...

Motor vehicle injury, mortality, and hospital charges by strength of graduated driver licensing laws in 36 States.

PubMed

Pressley, Joyce C; Benedicto, Camilla B; Trieu, Lisa; Kendig, Tiffany; Barlow, Barbara

2009-07-01

To assess the relation between strength of graduated driver licensing (GDL) laws and motor vehicle (MV) injury burden, this study examined injury mortality, hospitalizations and related charges for 15 year to 17 year olds in 36 states by strength of GDL legislation. Data sources include the CDC's Web-Based Injury Statistics Query and Reporting System (WISQARS) and the 2003 Healthcare Cost and Utilization Kids' Inpatient database (KID). Hospital admissions for injuries in 15 year to 17 year olds (n = 49,520) are unweighted. Injury severity was assessed using ICDMAP-90 and International Classification of Injury Severity Scores. The Insurance Institute for Highway Safety rating system was used to categorize legislative strength: good, fair, marginal/poor, and none. Logistic regression was used to assess independent predictors of MV injury. MV injury accounted for 14.6% of all-cause injury-related hospital admissions with 47.7% classified as drivers. Total MV occupant mortality was 14.6% lower after enactment of GDL with greater improvement observed in the good law category (26.0%). In multivariate models for hospitalized injury, all GDL law categories were protective for MV driver injury in 16 year olds. Compared with whites, black and Hispanic teens were more frequently injured as passengers than drivers. The contribution of MV occupant to all-cause injury-related hospital charges was 16.0% lower in good versus no-GDL categories and 39.5% lower for MV drivers. These findings suggest that the presence of any GDL legislation is associated with a lower burden of MV-related injury and expenditures with the largest differences observed for 16-year-old drivers.

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes.

PubMed

Carpenter, Dustin; Pressley, Joyce C

2013-07-01

Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates. Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n=3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11. Given coverage under nighttime GDL laws, drivers aged 15-17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15-17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat-Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR=4.97, 3.85-6.40), unbelted (OR=1.58, 1.25-1.99), driving on the weekend (OR=1.82, 1.47-2.24), and killed (OR=1.31, 1.04-1.65). GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality. Copyright © 2012 Elsevier Ltd. All rights reserved.

The effect of the learner license Graduated Driver Licensing components on teen drivers' crashes.

PubMed

Ehsani, Johnathon Pouya; Bingham, C Raymond; Shope, Jean T

2013-10-01

Most studies evaluating the effectiveness of Graduated Driver Licensing (GDL) have focused on the overall system. Studies examining individual components have rarely accounted for the confounding of multiple, simultaneously implemented components. The purpose of this paper is to quantify the effects of a required learner license duration and required hours of supervised driving on teen driver fatal crashes. States that introduced a single GDL component independent of any other during the period 1990-2009 were identified. Monthly and quarterly fatal crash rates per 100,000 population of 16- and 17-year-old drivers were analyzed using single-state time series analysis, adjusting for adult crash rates and gasoline prices. Using the parameter estimates from each state's time series model, the pooled effect of each GDL component on 16- and 17-year-old drivers' fatal crashes was estimated using a random effects meta-analytic model to combine findings across states. In three states, a six-month minimum learner license duration was associated with a significant decline in combined 16- and 17-year-old drivers' fatal crash rates. The pooled effect of the minimum learner license duration across all states in the sample was associated with a significant change in combined 16- and 17-year-old driver fatal crash rates of -.07 (95% Confidence Interval [CI] -.11, -.03). Following the introduction of 30 h of required supervised driving in one state, novice drivers' fatal crash rates increased 35%. The pooled effect across all states in the study sample of having a supervised driving hour requirement was not significantly different from zero (.04, 95% CI -.15, .22). These findings suggest that a learner license duration of at least six-months may be necessary to achieve a significant decline in teen drivers' fatal crash rates. Evidence of the effect of required hours of supervised driving on teen drivers' fatal crash rates was mixed. Copyright © 2013 Elsevier Ltd. All rights reserved.

Graduated driver licensing decal law: effect on young probationary drivers.

PubMed

Curry, Allison E; Pfeiffer, Melissa R; Localio, Russell; Durbin, Dennis R

2013-01-01

Decal laws have been implemented internationally to facilitate police enforcement of graduated driver licensing (GDL) restrictions (e.g., passenger limit, nighttime curfew) but have not been evaluated. New Jersey implemented the first decal law in the U.S. on May 1, 2010. The aim of this study was to evaluate the effect of New Jersey's law on the rate of citations issued for violation of GDL restrictions and police-reported crashes among probationary drivers aged <21 years and to estimate the number of probationary drivers whose crashes were prevented by the law. New Jersey's licensing and crash databases were linked from January 1, 2008 to May 31, 2011, and each driver's license status, age, and outcome status were ascertained for each month. Monthly rates were calculated as the proportion of probationary drivers who experienced the outcome in that month. The pre-law period was defined as January 2008-January 2010 and the post-law period as May 2010-May 2011. Negative binomial regression models with robust SEs were used to determine the law's effect on crash and citation rates (adjusted for gender, seasonal trends, and overall trends) and estimate prevented crashes. Analyses were conducted in 2012. In the first year post-law, there was a 14% increase in the GDL citation rate (adjusted rate ratio 1.14 [95% CI=1.05, 1.24]); a 9% reduction in the police-reported crash rate (adjusted rate ratio 0.91 [95% CI=0.86, 0.97]), and an estimated 1624 young probationary drivers for whom a crash was prevented. Findings suggest that the law is positively affecting probationary drivers' safety. Results contribute to building the evidence base for the effectiveness of decal laws and provide valuable information to U.S. and international policymakers who are considering adding decal laws to enhance existing GDL laws. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Mileage, car ownership, experience of punishment avoidance, and the risky driving of young drivers.

PubMed

Scott-Parker, B; Watson, B; King, M J; Hyde, M K

2011-12-01

Young drivers are at greatest risk of injury or death from a car crash in the first 6 months of independent driving. In Queensland, the graduated driver licensing (GDL) program was extensively modified in July 2007 in order to reduce this risk. Increased mileage and car ownership have been found to play a role in risky driving, offenses, and crashes; however, GDL programs typically do not consider these variables. In addition, young novice drivers' experiences of punishment avoidance have not previously been examined. This article explores the mileage (duration and distance), car ownership, and punishment avoidance behaviors of young newly licensed intermediate (provisional) drivers and their relationship to risky driving, crashes, and offenses. Drivers (n = 1032) aged 17 to 19 years recruited from across Queensland for longitudinal research completed survey 1 exploring prelicense and learner experiences and sociodemographic characteristics. survey 2 explored the same variables with a subset of these drivers (n = 341) after they had completed their first 6 months of independent driving. Most young drivers in survey 2 reported owning a vehicle and paying attention to police presence. Drivers who had their own cars reported significantly greater mileage and more risky driving. Novices who drove more kilometers, spent more hours each week driving, or avoided actual and anticipated police presence were more likely to report risky driving. These drivers were also more likely to report being detected by police for a driving-related offense. The media, parents, friends, and other drivers play a pivotal role in informing novices of on-road police enforcement operations. GDL programs should incorporate education for the parent and novice driver regarding the increased risks associated with greater driving, particularly when the novice driver owns a vehicle. Parents should be encouraged to delay exclusive access to a vehicle. Parents should also consider whether their young novices will deliberately avoid police if they are aware of their location. This may reinforce not only the risky behavior but also young novices' beliefs that their parents condone this behavior.

Saving Teenage Lives: The Case for Graduated Driver Licensing.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This manual explains what graduated driver licensing (GDL) is and why the National Highway Traffic Safety Administration believes it is so important for every jurisdiction to take steps towards its implementation. Section I introduces the need by defining the teen driving problem: inexperience, risk-taking behavior and immaturity, and greater risk…

The association of graduated driver licensing with miles driven and fatal crash rates per miles driven among adolescents.

PubMed

Zhu, Motao; Cummings, Peter; Zhao, Songzhu; Coben, Jeffrey H; Smith, Gordon S

2015-04-01

Graduated driver licensing (GDL) laws are associated with reduced crash rates per person-year among adolescents. It is unknown whether adolescents crash less per miles driven or drive less under GDL policies. We used data from the US National Household Travel Survey and Fatality Analysis Reporting System for 1995-1996, 2001-2002 and 2008-2009. We compared adolescents subject to GDL laws with those not by estimating adjusted IRRs for being a driver in a crash with a death per person-year (aIRRpy) and per miles driven (aIRRm), and adjusted miles driven ratios (aMR) controlling for changes in rates over time. Comparing persons subject to GDL policies with those not, 16 year olds had fewer fatal crashes per person-year (aIRRpy 0.63, 95% CI 0.47 to 0.91), drove fewer miles (aMR 0.79, 95% CI 0.63 to 0.98) and had lower crash rates per miles driven (aIRRm 0.83, 95% CI 0.65 to 1.06). For age 17, the aIRRpy was 0.83 (95% CI 0.60 to 1.17), the aMR 0.80 (95% CI 0.63 to 1.03) and the aIRRm 1.03 (95% CI 0.80 to 1.35). For age 18, the aIRRpy was 0.93 (95% CI 0.72 to 1.19), the aMR 0.92 (95% CI 0.77 to 1.09) and the aIRRm 1.01 (95% CI 0.84 to 1.23). If these associations are causal, GDL laws reduced crashes per person-year by about one-third among 16 year olds; half the reduction was due to fewer crashes per miles driven and half to less driving. For ages 17 and 18, there was no evidence of reduced crash rates per miles driven. 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.

Did Ontario's Zero Tolerance & Graduated Licensing Law Reduce Youth Drunk Driving?

ERIC Educational Resources Information Center

Carpenter, Christopher

2006-01-01

On April 1, 1994, Ontario, Canada, instituted a new graduated driver license (GDL) system that effectively set the legal blood alcohol content (BAC) threshold at zero for the first few years of a youth's driving eligibility. I use data from the 1983-2001 Ontario Student Drug Use Surveys (OSDUS) to examine whether the Zero Tolerance (ZT) policy…

Comparison of older and younger novice driver crash rates: Informing the need for extended Graduated Driver Licensing restrictions.

PubMed

Curry, Allison E; Metzger, Kristina B; Williams, Allan F; Tefft, Brian C

2017-11-01

Few previous studies have directly compared crash rates of older and younger novice drivers. To inform discussion about whether Graduated Driver Licensing (GDL) policies that are applied in the US for younger novice drivers should be applied to older novice drivers, we conducted a longitudinal study to examine overall, nighttime, and multiple passenger crash rates over the initial four years of licensure differ for novice drivers licensed at different ages. Using data from the New Jersey Traffic Safety Outcomes (NJ-TSO) data warehouse, we selected all NJ drivers who obtained their initial intermediate driver's license from 2006 through 2014 and had at least one month of follow-up from the date of licensure to study end or death (n=1,034,835). Novice drivers were grouped based on age at licensure: age 17; 18-20; 21-24; and 25 or older. We estimated monthly rates for overall crashes (per 10,000 licensed drivers) as well as: late night crashes (11:01 p.m.-4:59 a.m.); early night crashes (9:00 p.m.-11:00 p.m.); and multiple passenger crashes (two or more passengers). Average monthly rates were calculated for specific relevant time periods and Poisson regression models were used to compare rates: (1) between novice driver groups with the same time since licensure; (2) over the first 48 months of licensure within each novice driver group; and (3) between same-aged 21-year-old drivers with varying lengths of licensure. Although initial (three months post-licensure) overall crash rates of novice NJ drivers age 21 and older were higher than rates of same-aged experienced drivers, they were substantially lower than initial rates for 17- to 20-year-old novice drivers, who are licensed under GDL policies. Moreover, older novice drivers experience much less steep crash reductions over the first year of licensure than younger novice drivers. Nighttime crash rates among the 21- to 24-year old and aged 25 and older novice driver groups were stable over the first year of licensure. For novice drivers under age 21, early night crash rates declined rapidly over the course of licensure, while changes in late night crashes were much smaller. First-year multiple passenger crash rates were highest for drivers licensed at age 18-20, and novice driver groups experienced varying amounts of reduction in multiple passenger crashes over time. Study findings support NJ's current GDL policies for 17- to 20-year-old novice drivers and the potential for added benefits from beginning the nighttime restriction at 9:00 p.m. Conversely, there was a lack of compelling evidence for additional policies for drivers licensed at age 21-24 and no evidence to indicate a need for additional GDL policies for NJ novices aged 25 years and older. Copyright © 2017 Elsevier Ltd. All rights reserved.

Graduated driver licensing and differential deterrence: The effect of license type on intentions to violate road rules.

PubMed

Poirier, Brigitte; Blais, Etienne; Faubert, Camille

2018-01-01

In keeping with the differential deterrence theory, this article assesses the moderating effect of license type on the relationship between social control and intention to violate road rules. More precisely, the article has two objectives: (1) to assess the effect of license type on intentions to infringe road rules; and (2) to pinpoint mechanisms of social control affecting intentions to violate road rules based on one's type of driver license (a restricted license or a full license). This effect is examined among a sample of 392 young drivers in the province of Quebec, Canada. Drivers taking part in the Graduated Driver Licensing (GDL) program have limited demerit points and there is zero tolerance for drinking-and-driving. Propensity score matching techniques were used to assess the effect of the license type on intentions to violate road rules and on various mechanisms of social control. Regression analyses were then conducted to estimate the moderating effect of license type. Average treatment effects from propensity score matching analyses indicate that respondents with a restricted license have lower levels of intention to infringe road rules. While moral commitment and, to a lesser extent, the perceived risk of arrest are both negatively associated with intentions to violate road rules, the license type moderates the relationship between delinquent peers and intentions to violate road rules. The effect of delinquent peers is reduced among respondents with a restricted driver license. Finally, a diminished capability to resist peer pressure could explain the increased crash risk in months following full licensing. Copyright © 2017 Elsevier Ltd. All rights reserved.

Impact of a graduated driver's license law on crashes involving young drivers in New York State.

PubMed

Cheng, Julius D; Schubmehl, Heidi; Kahn, Steven A; Gestring, Mark L; Sangosanya, Ayodele; Stassen, Nicole A; Bankey, Paul E

2012-08-01

Motor vehicle crashes constitute the greatest risk of injury for young adults. Graduated driver licensing (GDL) laws have been used to reduce the number of injuries and deaths in the young driver population. The New York State GDL law increased supervision of young driver and limited both time-of-day driven and number of passengers. This review examines the impact of a GDL enacted in New York in September 2003. A retrospective review of New York State administrative databases from 2001 to 2009 was performed. During this period, a state-wide GDL requirement was implemented. Database review included all reported crashes to the New York State Department of Motor Vehicles by cause and driver age as well as motor fuel tax receipts by the New York State Comptroller's Office. Motor fuel tax receipts and consumption information were used as a proxy for overall miles driven. Before 2003, drivers younger than 18 years were involved in 90 fatal crashes and 10,406 personal-injury (PI) crashes, constituting 4.49% and 3.38% of all fatal and PI crashes in New York State, respectively. By 2009, the number of fatal and PI crashes involving drivers who are younger than 18 years decreased to 44 (2.87%) and 5,246 (2.24%), respectively. Of note, the number of crashes experienced by the age group 18 years to 20 years during this period also declined, from 192 (9.59% of all fatal crashes) and 25,407 (8.24% of all PI crashes) to 135 (8.81%) and 18,114 (7.73%), respectively. Overall numbers of crashes reported remained relatively stable, between 549,000 in 2001 and 520,000 in 2009. Motor fuel use during this period also declined, but to a lesser degree ($552 million to $516 million or 6.6%). The use of a GDL law in New York State has shown a large decrease in the number of fatalities and PI crashes involving young drivers. The delay in full driver privileges from the GDL did not result in an increase in fatal or PI crashes in the next older age group.

Impact of Connecticut's graduated driver licensing system on teenage motor vehicle crash rates.

PubMed

Rogers, Steven C; Bentley, George C; Campbell, Brendan; Borrup, Kevin; Saleheen, Hassan; Wang, Zhu; Lapidus, Garry

2011-11-01

In response to high rates of teen motor vehicle crashes (MVCs) many states have enacted graduated driver licensing (GDL) systems. GDL delays full licensure and allows beginners to obtain experience under lower risk conditions. The purpose of this study is to evaluate the impact over the past 10 years to determine its effect on teen MVCs. Connecticut MVC data from 1999 to 2008 were analyzed. Percent change (1999 vs. 2008) in MVC rates per 10,000 registered drivers was calculated by age, gender, during the night restriction (11:00 pm and 5:00 am), and MVCs with passengers. Linear regression analysis estimated the decrease of MVC rates each year. The MVC rate decreased by 40% for 16-year-old and 30% for 17-year-old drivers. In comparison, rates among 18-year-old, 19-year-old, 25- to 29-year-old, and 30- to 59-year-old drivers were reduced by 16%, 7%, 8%, and 11%, respectively. The MVC rate for 20- to 24-year-old drivers increased by 1%. During nighttime restricted driving times, MVC rates decreased by 54% among 16-year-old and 49% among 17-year-old drivers. The MVC rate with passengers decreased by 65% for 16-year-old and 53% for 17-year-old drivers. In comparison, rates of nighttime and with passenger MVCs among older drivers were significantly less. Implementation of Connecticut's GDL system has resulted in significant reductions in MVC rates among novice drivers. This analysis provides a method for other states to examine the impact of their GDL system.

Effectiveness of two interventions in preventing traffic accidents: a systematic review.

PubMed

Porchia, B R; Baldasseroni, A; Dellisanti, C; Lorini, C; Bonaccorsi, G

2014-01-01

The prevention of road traffic accidents should be considered a serious public health concern, since they are the eighth leading cause of death globally and the main cause of death for young people aged 15-29. Evidences from many countries show that successes in preventing road traffic injuries can be achieved through concerted efforts at national level. The aim of our study was to assess the effectiveness of two interventions to prevent road traffic accidents: the introduction of graduated driver licensing (GDL) and the interventions to improve pedestrian and cyclist visibility. Our search started with a scoping review on the interventions to prevent road traffic accidents to allow the development of a logical framework of traffic accidents. Specific and answerable questions formulated according to PICO scheme and combinations of keywords were used to perform a systematic search in the following databases: Pubmed, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Evidence, Transport Research International Documentation (TRID) and Google. References of selected papers were searched. Only systematic reviews and meta-analyses were eligible. No temporal limits or linguistic filters were applied. 160 systematic reviews and meta-analyses were found for the question of the introduction of GDL program and 188 on the improvement of visibility in cyclists and pedestrians. After selection, four papers were included in qualitative synthesis for each question. All included studies underwent quality evaluation. GDL programs seem to be effective in reducing crash rates among young drivers, in particular in 16 year-old. Programs with more restrictions seem also to reduce fatal events. To improve visibility of pedestrians and cyclists, street lighting has been suggested as an intervention able to improve driver's visual capabilities and ability to detect roadway hazards and to prevent car crashes. Visibility aids (fluorescent materials, lamps, flashing lights and retroreflective materials) have the potential to increase visibility and enable drivers to detect pedestrians and cyclists earlier. The two interventions seem to be effective, but further examinations are needed to measure long-term effects. It is necessary to provide feasible studies in local context to estimate the impact of introduction of GDL programs or of some of their components and to improve interventions to increase visibility of pedestrians and cyclists.

The association of graduated driver licensing with miles driven and fatal crash rates per miles driven among adolescents

PubMed Central

Zhu, Motao; Cummings, Peter; Zhao, Songzhu; Coben, Jeffrey H.; Smith, Gordon S.

2014-01-01

Background Graduated driver licensing (GDL) laws are associated with reduced crash rates per person-year among adolescents. It is unknown whether adolescents crash less per miles driven or drive less under GDL policies. Methods We used data from the US National Household Travel Survey and Fatality Analysis Reporting System for 1995–1996, 2001–2002, and 2008–2009. We compared adolescents subject to GDL laws with those not, by estimating adjusted incidence rate ratios for being a driver in a crash with a death per person-year (aIRRpy) and per miles driven (aIRRm), and adjusted miles driven ratios (aMR) controlling for changes in rates over time. Results Comparing persons subject to GDL policies with those not, 16-year-olds had fewer fatal crashes per person-year (aIRRpy 0.63, 95% confidence interval [CI] 0.47, 0.91), drove fewer miles (aMR 0.79, 95% CI 0.63, 0.98), and had lower crash rates per miles driven (aIRRm 0.83, 95% CI 0.65, 1.06). For age 17, the aIRRpy was 0.83 (95% CI 0.60, 1.17), the aMR 0.80 (95% CI 0.63, 1.03), and the aIRRm 1.03 (95% CI 0.80, 1.35). For age 18, the aIRRpy was 0.93 (95% CI 0.72, 1.19), the aMR 0.92 (95% CI 0.77, 1.09), and the aIRRm 1.01 (95% CI 0.84, 1.23). Conclusions If these associations are causal, GDL laws reduced crashes per person-year by about one-third among 16-year-olds; half the reduction was due to fewer crashes per miles driven and half to less driving. For ages 17 and 18, there was no evidence of reduced crash rates per miles driven. PMID:24525908

Examination of supplemental driver training and online basic driver education courses : traffic tech.

DOT National Transportation Integrated Search

2012-08-01

The first six months of unsupervised driving are the most : hazardous in a novice drivers driving experience. Most : States adopted graduated driver licensing (GDL) systems : to give novice drivers experience in a protective environment, : gradual...

2007 motor vehicle occupant safety survey : driver education and graduated driver licensing

DOT National Transportation Integrated Search

2008-12-01

This Research Note summarizes selected results from the 2007 MVOSS. It focuses primarily on information collected regarding driver education and GDL. This was a new module introduced in 2007. The data are weighted to yield national estimates.

Impacts of public policy on safety : graduated driver's license

DOT National Transportation Integrated Search

2008-12-01

This study evaluated the effectiveness of Missouris GDL policy. This study found a substantial decrease in crash involvement rates among drivers aged 15-18 in Missouri while drivers aged 19 or older have a moderate decrease in the rates. This stud...

Associations between selected state laws and teenagers' drinking and driving behaviors.

PubMed

Cavazos-Rehg, Patricia A; Krauss, Melissa J; Spitznagel, Edward L; Chaloupka, Frank J; Schootman, Mario; Grucza, Richard A; Bierut, Laura Jean

2012-09-01

We examined the associations between selected state-level graduated driving licensing (GDL) laws and use-and-lose laws (laws that allow for the suspension of a driver's license for underage alcohol violations including purchase, possession, or consumption) with individual-level alcohol-related traffic risk behaviors among high school youth. Logistic regression models with fixed effects for state were used to examine the associations between the selected state-level laws and drinking and driving behaviors youth aged 16 to 17 years (obtained from the Youth Risk Behavior Surveillance System (YRBSS); responses dichotomized as "0 times" or "1 or more times") over an extended period of time (1999 to 2009). A total of 11.7% of students reported having driven after drinking any alcohol and 28.2% reported riding in a car with a driver who had been drinking on 1 or more occasions in the past 30 days. Restrictive GDL laws and use-and-lose laws were associated with decreased driving after drinking any alcohol and riding in a car with a driver who had been drinking alcohol. Restrictive GDL and use-and-lose laws may help to bolster societal expectations and values about the hazards of drinking and driving behaviors and are therefore partly responsible for the decline in these alcohol-related traffic risk behaviors. Copyright © 2012 by the Research Society on Alcoholism.

Fatal Traffic Crashes Involving Drinking Drivers: What have we Learned?

PubMed Central

Fell, James C.; Tippetts, A. Scott; Voas, Robert B.

2009-01-01

Alcohol involvement in fatal crashes (any driver with a blood alcohol concentration [BAC] = .01g/dL or greater) in 2007 was more than three times higher at night (6 p.m.–6 a.m.) than during the day (6 a.m.–6 p.m.) (62% versus 19%). Alcohol involvement was 35% during weekdays compared to 54% on weekends. Nearly one in four drivers (23%) of personal vehicles (e.g., passenger cars or light trucks) and more than one in four motorcyclists (27%) in fatal crashes were intoxicated (i.e., had a BAC equal to or greater than the .08 g/dL illegal limit in the United States). In contrast, only 1% of the commercial drivers of heavy trucks had BACs equal to .08 g/dL or higher. More than a quarter (26%) of the drivers with high BACs (≥.15 g/dL) did not have valid licenses. The 21- to 24-age group had the highest proportion (35%) of drivers with BACs≥.08 g/dL, followed by the 25- to 34-age group (29%). The oldest and the youngest drivers had the lowest percentages of BACs≥ .08 g/dL: those aged 75 or older were at 4%, and those aged 16 to 20 were at 17%. Utah had the lowest rate of intoxicated drivers in fatal crashes at one in every eight drivers (12%), followed by Kentucky, Indiana, Iowa, New Hampshire, and Kansas, all at 17%. Montana (31%), South Carolina (31%), and North Dakota (39%) all had more than 3 in 10 drivers in fatal crashes who were intoxicated in 2007. The United States enjoyed a remarkable downward trend in alcohol-related crashes between 1982 and 1995, which has since leveled off. That trend coincided with a period during which per capita national alcohol consumption declined, the number of young drivers decreased, and the proportion of female drivers increased. Those factors alone, however, did not appear to account for the overall reduction. This provides further evidence that impaired-driving laws and safety program activity may have been responsible for at least some of the decline. However, there was a general worldwide decline in alcohol-related crashes during the same period, and other socioeconomic factors may have played a role. Proven effective strategies that could reduce impaired driving further in the United States include more frequent highly publicized enforcement efforts, such as sobriety checkpoints; lowering the illegal BAC limit for driving to .05g/dL; and mandating alcohol ignition interlocks for all convicted impaired drivers. PMID:20184833

Teen Driver Safety: Additional Research Could Help States Strengthen Graduated Driver Licensing Systems. Report to the Committee on Transportation and Infrastructure and Its Subcommittee on Highways and Transit, House of Representatives. GAO-10-544

ERIC Educational Resources Information Center

Fleming, Susan A.

2010-01-01

Teen drivers ages 16 to 20 have the highest fatality rate of any age group in the United States. As a result, states have increasingly adopted laws to limit teen driving exposure, such as Graduated Driver Licensing (GDL) systems, which consist of three stages: a learner's permit allowing driving only under supervision; intermediate licensure…

Parent attitudes toward integrating parent involvement into teenage driver education courses.

PubMed

Hartos, Jessica; Huff, David C

2008-01-01

The widespread adoption of graduated driver licensing (GDL) policies has effectively reduced crash risk for young drivers; however, parents must support, reinforce, and enforce GDL for it to be effective, and research indicates that parents need better information and instruction for adhering to GDL requirements, conducting supervised practice driving, and restricting independent teenage driving. Because teenagers in most states must take driver education to enter the licensing process prior to age 18, integrating parent involvement into driver education may be an effective way to inform and instruct parents on a large scale about teen driver safety. This study assessed parent attitudes (overall and by rural status, minority status, and income level) toward integrating parent involvement into teenage driver education classes. In this study, 321 parents of teenagers enrolled in driver education classes across the state of Montana completed surveys about current involvement in driver education and attitudes toward required involvement. The results indicated that parents were not very involved currently in their teenagers' driver education classes, but 76% reported that parents should be required to be involved. If involvement were required, parents would prefer having written materials sent home, access to information over the Internet, or discussions in person with the instructor; far fewer would prefer to attend classes or behind-the-wheel driving instruction. There were few differences in parent attitudes by rural or minority status but many by income level. Compared to higher income parents, lower income parents were more likely to endorse required parent involvement in teenage driver education classes and to want parent information from driver education about many teen driving issues. That the majority of parents are open to required involvement in their teenagers' driver education classes is promising because doing so could better prepare parents to understand and adhere to GDL policies, supervise teenagers' practice driving, and manage teen independent driving, all of which could further increase teen driver safety.

JUDE: An Ultraviolet Imaging Telescope pipeline

NASA Astrophysics Data System (ADS)

Murthy, J.; Rahna, P. T.; Sutaria, F.; Safonova, M.; Gudennavar, S. B.; Bubbly, S. G.

2017-07-01

The Ultraviolet Imaging Telescope (UVIT) was launched as part of the multi-wavelength Indian AstroSat mission on 28 September, 2015 into a low Earth orbit. A 6-month performance verification (PV) phase ended in March 2016, and the instrument is now in the general observing phase. UVIT operates in three channels: visible, near-ultraviolet (NUV) and far-ultraviolet (FUV), each with a choice of broad and narrow band filters, and has NUV and FUV gratings for low-resolution spectroscopy. We have written a software package (JUDE) to convert the Level 1 data from UVIT into scientifically useful photon lists and images. The routines are written in the GNU Data Language (GDL) and are compatible with the IDL software package. We use these programs in our own scientific work, and will continue to update the programs as we gain better understanding of the UVIT instrument and its performance. We have released JUDE under an Apache License.

Impact of Georgia's teenage and adult driver responsibility act: 15-year follow-up.

PubMed

Thompson, Nancy J; McGee, Robin E; Feng, Jia

2016-01-01

This study was designed to investigate the 15-year impact of Georgia's graduated drivers' licensing (GDL) law, the "Teenage and Adult Driver Responsibility Act" (TADRA), on fatality crashes among young drivers. Fatality Analysis Reporting System (FARS) data for Georgia and Census denominators were used to determine fatal crash rates (FCRs) of drivers ages 16 through 19 who passed through the Georgia GDL system during the 5.5 years prior to through 15.5 years after TADRA's implementation. FCRs of younger drivers were compared to those of drivers ages 20-54 and 55-75 and compared by gender. Attention was given to speeding- and alcohol-related crashes, 2 foci of TADRA. The decline in FCRs has been maintained and even increased through 15.5 years after passage of the law. Extending the curfew and further limiting passengers (passed in 2001) and driver's education and supervised driving requirements (added in 2007) may have contributed. The greatest declines were among 16- and 17-year-olds; most of the gains were among male drivers. The changes were greatest for alcohol- and speeding-related crashes. Those 18 and 19 years old did not demonstrate an increase in FCR over the period studied. Georgia's graduated licensing law, TADRA, has maintained and in some instances increased in effectiveness over the 15.5 years since its inception. Though national research suggests that GDL laws are associated with increased crash rates among 18- to 19-year-old drivers, this has not occurred in Georgia; 18- and 19-year-olds demonstrated no change or reductions in FCR over the 20.5-year period evaluated. Declines were greatest for those driving behaviors targeted by the law.

GNU Data Language (GDL) - a free and open-source implementation of IDL

NASA Astrophysics Data System (ADS)

Arabas, Sylwester; Schellens, Marc; Coulais, Alain; Gales, Joel; Messmer, Peter

2010-05-01

GNU Data Language (GDL) is developed with the aim of providing an open-source drop-in replacement for the ITTVIS's Interactive Data Language (IDL). It is free software developed by an international team of volunteers led by Marc Schellens - the project's founder (a list of contributors is available on the project's website). The development is hosted on SourceForge where GDL continuously ranks in the 99th percentile of most active projects. GDL with its library routines is designed as a tool for numerical data analysis and visualisation. As its proprietary counterparts (IDL and PV-WAVE), GDL is used particularly in geosciences and astronomy. GDL is dynamically-typed, vectorized and has object-oriented programming capabilities. The library routines handle numerical calculations, data visualisation, signal/image processing, interaction with host OS and data input/output. GDL supports several data formats such as netCDF, HDF4, HDF5, GRIB, PNG, TIFF, DICOM, etc. Graphical output is handled by X11, PostScript, SVG or z-buffer terminals, the last one allowing output to be saved in a variety of raster graphics formats. GDL is an incremental compiler with integrated debugging facilities. It is written in C++ using the ANTLR language-recognition framework. Most of the library routines are implemented as interfaces to open-source packages such as GNU Scientific Library, PLPlot, FFTW, ImageMagick, and others. GDL features a Python bridge (Python code can be called from GDL; GDL can be compiled as a Python module). Extensions to GDL can be written in C++, GDL, and Python. A number of open software libraries written in IDL, such as the NASA Astronomy Library, MPFIT, CMSVLIB and TeXtoIDL are fully or partially functional under GDL. Packaged versions of GDL are available for several Linux distributions and Mac OS X. The source code compiles on some other UNIX systems, including BSD and OpenSolaris. The presentation will cover the current status of the project, the key accomplishments, and the weaknesses - areas where contributions and users' feedback are welcome! While still being in beta-stage of development, GDL proved to be a useful tool for classroom work on data analysis. Its usage for teaching meteorological-data processing at the University of Warsaw will serve as an example.

A Novel Strategy for Controlling the Metastatic Phenotype: Targeting the SNAG Repression Domain in the SNAIL Zinc-Finger Protein

DTIC Science & Technology

2007-07-01

interacts with nuclear receptors and can inhibit betaFTZ-F1-dependent transcription. Mol. Cell, 7, 753–765. 29. Dupont , S., Zacchigna, L., Cordenonsi, M...Washington University/ Pfizer Biomedical Research Program to GDL. GDL was an Established Investigator of the American Heart Association. 26...Cell 11, 1043-1054. Hecker, C. M., Rabiller, M., Haglund, K., Bayer , P., and Dikic, I. (2006). Specification of SUMO1- and SUMO2-interacting motifs. J

Selected state policies and associations with alcohol use behaviors and risky driving behaviors among youth: Findings from the Monitoring the Future study

PubMed Central

Cavazos-Rehg, Patricia A.; Housten, Ashley J.; Krauss, Melissa J.; Sowles, Shaina J.; Spitznagel, Edward L.; Chaloupka, Frank J.; Grucza, Ricard; Johnston, Lloyd D.; O'Malley, Patrick M.; Bierut, Laura J.

2016-01-01

Background Effective policies that can reduce alcohol use behaviors and impaired driving among young people at a population-level are needed. Graduated driver licensing (GDL) laws increase the driving privileges of young novice drivers as they age and gain more driving experience. In this study we seek to determine the effects of GDLs on risky driving behaviors of youth and to assess if GDLs have an unintended effect on underage drinking behaviors. Methods We utilized 2000-2013 data on 12th grade students from the Monitoring the Future (MTF) study, an ongoing, annual national survey (since 1975) that studies the substance use behaviors of adolescents, as well as data on GDL laws obtained via the Insurance Institute for Highway Safety (IIHS). We conducted a series of regular logistic regression models that included fixed effects for year and state, and adjusted for demographic characteristics, school characteristics, and other state alcohol policies. Results Total weighted sample size was 129,289 12th graders. Past month alcohol use and binge drinking (i.e., ≥5 drinks on one occasion) in the past two weeks were 45% and 26%, respectively. Seventeen percent of respondents reported riding with a driver who drank alcohol. Nearly 12% reported driving in the past two weeks after drinking alcohol, and 7% reported driving after binge drinking. Over half of students lived in a state with a “good” GDL law. The logistic regression models suggest a link between restrictive GDL policies and a reduction of alcohol use behaviors and risky driving behaviors among youth. Conclusions Our findings indicate that the effects of GDLs extend beyond driving-related risks and into other drinking-related behaviors that pose immediate or delayed health risks for young people. We speculate that GDLs may dictate social norms and expectations for youth risk behaviors, and should be maximized throughout the U.S. PMID:27018985

Selected State Policies and Associations With Alcohol Use Behaviors and Risky Driving Behaviors Among Youth: Findings from Monitoring the Future Study.

PubMed

Cavazos-Rehg, Patricia A; Housten, Ashley J; Krauss, Melissa J; Sowles, Shaina J; Spitznagel, Edward L; Chaloupka, Frank J; Grucza, Richard; Johnston, Lloyd D; O'Malley, Patrick M; Bierut, Laura J

2016-05-01

Effective policies that can reduce alcohol use behaviors and impaired driving among young people at a population level are needed. Graduated driver licensing (GDL) laws increase the driving privileges of young novice drivers as they age and gain more driving experience. In this study, we seek to determine the effects of GDLs on risky driving behaviors of youth and to assess if GDLs have an unintended effect on underage drinking behaviors. We utilized 2000 to 2013 data on 12th grade students from the Monitoring the Future (MTF) study, an ongoing, annual national survey (since 1975) that studies the substance use behaviors of adolescents, as well as data on GDL laws obtained via the Insurance Institute for Highway Safety (IIHS). We conducted a series of regular logistic regression models that included fixed effects for year and state, and adjusted for demographic characteristics, school characteristics, and other state alcohol policies. Total weighted sample size was 129,289 12th graders. Past month alcohol use and binge drinking (i.e., ≥5 drinks on one occasion) in the past 2 weeks were 45 and 26%, respectively. Seventeen percent of respondents reported riding with a driver who drank alcohol. Nearly 12% reported driving in the past 2 weeks after drinking alcohol, and 7% reported driving after binge drinking. Over half of the students lived in a state with a "good" GDL law. The logistic regression models suggest a link between restrictive GDL policies and a reduction of alcohol use behaviors and risky driving behaviors among youth. Our findings indicate that the effects of GDLs extend beyond driving-related risks and into other drinking-related behaviors that pose immediate or delayed health risks for young people. We speculate that GDLs may dictate social norms and expectations for youth risk behaviors, and should be maximized throughout the United States. Copyright © 2016 by the Research Society on Alcoholism.

Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage.

PubMed

Carson, Jeffrey L; Guyatt, Gordon; Heddle, Nancy M; Grossman, Brenda J; Cohn, Claudia S; Fung, Mark K; Gernsheimer, Terry; Holcomb, John B; Kaplan, Lewis J; Katz, Louis M; Peterson, Nikki; Ramsey, Glenn; Rao, Sunil V; Roback, John D; Shander, Aryeh; Tobian, Aaron A R

2016-11-15

More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes. It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dL (strong recommendation, moderate quality evidence). A restrictive RBC transfusion threshold of 8 g/dL is recommended for patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease (strong recommendation, moderate quality evidence). The restrictive transfusion threshold of 7 g/dL is likely comparable with 8 g/dL, but RCT evidence is not available for all patient categories. These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion-dependent anemia (not recommended due to insufficient evidence). Recommendation 2: patients, including neonates, should receive RBC units selected at any point within their licensed dating period (standard issue) rather than limiting patients to transfusion of only fresh (storage length: <10 days) RBC units (strong recommendation, moderate quality evidence). Research in RBC transfusion medicine has significantly advanced the science in recent years and provides high-quality evidence to inform guidelines. A restrictive transfusion threshold is safe in most clinical settings and the current blood banking practices of using standard-issue blood should be continued.

Iodine deficiency in Saudi Arabia.

PubMed

Al-Nuaim, A R; Al-Mazrou, Y; Kamel, M; Al-Attas, O; Al-Daghari, N; Sulimani, R

1997-05-01

Data on the status of iodine deficiency in the Arabian peninsula is scarce. We have conducted a cross-sectional national epidemiological survey in Saudi Arabia to study the iodine status of Saudi schoolchildren, between eight and ten years, who were randomly selected, after taking into consideration the gender, provincial population and area distribution. Casual urine samples were collected and sent to the central laboratory for analysis. Clinical assessment for the presence of goiter was conducted in four areas with different geographical natures. The survey included 4638 subjects, and their median and mean (SD) of urinary iodine concentration was 18 and 17 m g/dL, respectively. We found provincial differences with respect to urinary iodine concentration and the percentage of subjects with urinary iodine concentration <10 m g/dL. The Southern province had the lowest median (11 m g/dL) and the highest percentage (45%) of subjects with urinary iodine concentration <10 m g/dL. On the other hand, subjects of the Western province had the highest median (24 m g/dL) and the lowest percentage (8%) of subjects with urinary iodine concentration <10 m g/dL. The clinical assessment revealed that the highest prevalence and more advanced grade of goiter (22%, 95% CI 19-25, grade 1; 8%, 95% CI 6-10, grade 2) was found in the Asir region, a high-altitude area in the Southern province. The lowest prevalence of goiter (4%, 95% CI 0.8-7.2, grade 1) was found in Gizan, an urban coastal community. There was a significant relationship between the prevalence of goiter and the urinary iodine concentration. The survey for iodine deficiency disorder (IDD) in Saudi Arabia has shown a mild degree of iodine deficiency in the Southern province. Odds ratio (OR) was used to study the statistical relationship between the prevalence of goiter and the urinary iodine concentration. There is a need to launch a control program to ensure the exclusive availability of iodized salt in Saudi Arabia, especially in the Southern province.

Factors Associated with Haemoglobin Concentration among Timor-Leste Children Aged 6–59 Months

PubMed Central

Agho, K.E.; Dibley, M.J.; D'Este, C.; Gibberd, R.

2008-01-01

The study was conducted to assess the prevalence of and factors associated with haemoglobin (Hb) concentrations among children aged 6–59 months in Timor-Leste. The 2003 Demographic and Health Survey was a multi-stage cluster survey of 4,320 households from four different geographic regions in Timor-Leste. In total, 4,514 children aged 6–59 months were included in the analysis. The prevalence of anaemia (Hb concentration <11.0g/dL) was 38.2% (638/1,668) for children aged 6–23 months and 22.6% (644/2,846) for older children (p<0.001). Girls had a higher mean Hb concentration than boys (11.9g/dL vs 11.7g/dL, p<0.006) and children who had diarrhoea in the previous two weeks had a lower Hb concentration than children without diarrhoea (11.5g/dL vs 11.9g/dL, p<0.001). Children from the richest and middle-class households had a lower average Hb concentration than those from the poorest households (11.8g/dL, 11.7g/dL vs 12.0g/dL, p<0.001). Children of mothers with some secondary or more education had a lower mean Hb concentration than children of mothers with completed primary, some primary and no education (11.7 g/dL vs 11.9 g/dL, 11.8 g/dL, and 11.9 g/dL, p=0.002). Children from severely-anaemic mothers had a lower mean Hb concentration than children from moderately-, mild and not anaemic mothers (10.5 g/dL vs 11.1 g/dL, 11.6 g/dL, 12.0 g/dL, p<0.001). After backward stepwise hierarchical multiple regression, wasting, male sex, recent diarrhoea, household wealth index (richest and middle-class), maternal educational status (some secondary or more and some primary), and maternal anaemic status were significantly associated with a lower Hb concentration in children and increased age of child and duration of breastfeeding (6 months) with a higher Hb concentration. Anaemia-prevention programmes among children in Timor-Leste should focus on those children aged less than two years, children with recent diarrhoea, wasted children, high socioeconomic status, and anaemic mothers. PMID:18686553

Association between oral nutritional supplementation and clinical outcomes among patients with ESRD.

PubMed

Cheu, Christine; Pearson, Jeffrey; Dahlerus, Claudia; Lantz, Brett; Chowdhury, Tania; Sauer, Peter F; Farrell, Robert E; Port, Friedrich K; Ramirez, Sylvia P B

2013-01-01

Oral nutritional supplementation (ONS) was provided to ESRD patients with hypoalbuminemia as part of Fresenius Medical Care Health Plan's (FMCHP) disease management. This study evaluated the association between FMCHP's ONS program and clinical outcomes. Analyses included FMCHP patients with ONS indication (n=470) defined as 2-month mean albumin <3.8 g/dl until reaching a 3-month mean ≥3.8 g/dl from February 1, 2006 to December 31, 2008. Patients did not receive ONS if deemed inappropriate or refused. Patients on ONS were compared with patients who were not, despite meeting ONS indication. Patients with ONS indication regardless of use were compared with Medicare patients with similar serum albumin levels from the 2007 Centers for Medicare and Medicaid Services Clinical Performance Measures Project (CPM). Cox models calculated adjusted hospitalization and mortality risks at 1 year. Among patients with indication for ONS, 276 received supplements and 194 did not. ONS use was associated with 0.058 g/dl higher serum albumin overall (P=0.02); this difference decreased by 0.001 g/dl each month (P=0.05) such that the difference was 0.052 g/dl (P=0.04) in month 6 and the difference was no longer significant in month 12 . In analyses based on ONS use, ONS patients had lower hospitalization at 1 year (68.4%; P<0.01) versus patients without ONS (88.7%), but there was no significant reduction in mortality risk (P=0.29). In analyses based on ONS indication, patients with indication had lower mortality at 1 year (16.2%) compared with CPM patients (23.4%; P<0.01). These findings suggest that ONS use was associated with significantly lower hospitalization rates but had no significant effect on mortality in a disease management setting.

Association between anemia and subclinical infection in children in Paraíba State, Brazil

PubMed Central

Sales, Márcia Cristina; de Queiroz, Everton Oliveira; Paiva, Adriana de Azevedo

2011-01-01

Background With subclinical infection, serum iron concentrations are reduced, altering the synthesis of hemoglobin, the main indicator of anemia. Objective To evaluate the association between subclinical infection and anemia in children of Paraíba State. Methods This is a cross-sectional study involving 1116 children aged 6 to 59 months from nine municipalities of Paraíba State. Demographic and socioeconomic data were collected by means of a specific questionnaire. The C-reactive protein and hemoglobin levels were determined by the latex agglutination technique and automated counter, respectively. C-reactive protein values ≥ 6 mg/L were used as indicative of subclinical infection, while the presence of anemia was determined by hemoglobin values < 11.0 g/dL. The data were analyzed using the Epi Info computer program, with significance being set at 5%. Results Data from this research showed that 80.1% of the children belonged to families that were below the bread line, with per capita income < ½ of the minimum wage at that time (R$ 350.00 approximately US$ 175.00). The prevalences of subclinical infection and anemia were 11.3% and 36.3%, respectively. Subclinical infection was significantly associated with anemia (p-value < 0.05). There were lower levels of hemoglobin in children with C-reactive protein ≥ 6 mg/L, with a mean hemoglobin level in children with subclinical infection of 10.93 g/dL (standard deviation - SD = 1.21 g/dL) and without infection of 11.26 g/dL (SD = 1.18 g/dL) (p-value < 0.05). Conclusion Anemia is associated with subclinical infection in this population, indicating that this is an important variable to be considered in studies of the prevalence of anemia in children. PMID:23284254

CUTEX: CUrvature Thresholding EXtractor

NASA Astrophysics Data System (ADS)

Molinari, S.; Schisano, E.; Faustini, F.; Pestalozzi, M.; di Giorgio, A. M.; Liu, S.

2017-08-01

CuTEx analyzes images in the infrared bands and extracts sources from complex backgrounds, particularly star-forming regions that offer the challenges of crowding, having a highly spatially variable background, and having no-psf profiles such as protostars in their accreting phase. The code is composed of two main algorithms, the first an algorithm for source detection, and the second for flux extraction. The code is originally written in IDL language and it was exported in the license free GDL language. CuTEx could be used in other bands or in scientific cases different from the native case. This software is also available as an on-line tool from the Multi-Mission Interactive Archive web pages dedicated to the Herschel Observatory.

Parent Involvement in Novice Teen Driving: Rationale, Evidence of Effects, and Potential for Enhancing Graduated Driver Licensing Effectiveness

PubMed Central

Simons-Morton, Bruce

2007-01-01

Motor vehicle crash rates are highly elevated immediately after licensure and then decline gradually over a period of years. Young age, risk taking, and inexperience contribute to the problem, but inexperience is particularly important early on. Driving is like other complex, skilled behaviors in which subtle improvements in perception and judgment develop gradually over a period of years. After all, safe driving is more a matter of attention and perception than physical management of the vehicle. Inexperience is particularly linked to driving performance and safety outcomes under certain driving conditions, with driving at night and with teen passengers as the most important cases. Surprisingly, driving outcomes do not appear to be affected by the pre-license training or supervised practice driving. Given the limits of training, safety effects can best be achieved by countermeasures that delay licensure or limit driving novice teen driving under high risk driving conditions while novices gain experience and develop safety competence. The two complementary approaches of Graduated Driver Licensing policies and parent management have been shown to provide safety effects by limiting the driving conditions of novice teenagers. Impact on Research, Practice, Policy, and Industry: Advances in GDL and improvements in parent management practices have the potential to reduce crashes and save lives. PMID:17478190

Study of effective transport properties of fresh and aged gas diffusion layers

NASA Astrophysics Data System (ADS)

Bosomoiu, Magdalena; Tsotridis, Georgios; Bednarek, Tomasz

2015-07-01

Gas diffusion layers (GDLs) play an important role in proton exchange membrane fuel cells (PEMFCs) for the diffusion of reactant and the removal of product water. In the current study fresh and aged GDLs (Sigracet® GDL34BC) were investigated by X-ray computed tomography to obtain a representative 3D image of the real GDL structure. The examined GDL samples are taken from areas located under the flow channel and under the land. Additionally, a brand new Sigracet® GDL34BC was taken as a reference sample in order to find out the impact of fuel cell assembly on GDL. The produced 3D image data were used to calculate effective transport properties such as thermal and electrical conductivity, diffusivity, permeability and capillary pressure curves of the dry and partially saturated GDL. The simulation indicates flooding by product water occurs at contact angles lower than 125° depending on sample porosity. In addition, GDL anisotropy significantly affects the permeability as well as thermal and electrical conductivities. The calculated material bulk properties could be next used as input for CFD modelling of PEM fuel cells where GDL is usually assumed layer-like and homogeneous. Tensor material parameters allow to consider GDL anisotropy and lead to more realistic results.

Management of anaemia in haemodialysis and peritoneal dialysis patients (chapter 8).

PubMed

Richardson, Donald; Hodsman, Alex; van Schalkwyk, Dirk; Tomson, Charlie; Warwick, Graham

2007-08-01

Forty-one percent of UK patients commence RRT with an Hb < 10.0 g/dl. The mean Hb at commencement of RRT is 10.3 g/dl. Eighty-five percent of patients on dialysis in the UK have an Hb > or = 10.0 g/dl by 6 months after commencement of RRT. The median Hb on haemodialysis in the UK is 11.8 g/dl with an IQR of 10.7-12.8 g/dl. Eighty-six percent of haemodialysis patients in the UK have a Hb > or = 10.0 g/dl. The median Hb on peritoneal dialysis in the UK is 12.0 g/dl with an IQR of 11.0-12.9 g/dl. Ninety percent of peritoneal dialysis patients in the UK have an Hb > or = 10.0 g/dl. In the UK, 49% of patients on PD and 48% of patients on haemodialysis have an Hb between 10.5-12.5 g/dl. The median ferritin in UK haemodialysis patients is 413 microg/l (IQR 262-623), 95% of UK haemodialysis patients have a ferritin > or =100 microg/l. The median ferritin in UK PD patients is 256 microg/l (IQR 147-421), 86% of UK peritoneal dialysis patients have a ferritin > or = 100 microg/l. A higher proportion of HD patients than PD patients receive ESA therapy (88% vs 76%). The ESA dose is higher for HD than PD patients (9204 vs 6080 IU/week).

Comparison of refractometry and biuret assay for measurement of total protein concentration in canine abdominal and pleural fluid specimens.

PubMed

Rose, Alexandra; Funk, Deborah; Neiger, Reto

2016-04-01

To compare total protein (TP) concentrations in canine pleural and abdominal fluid specimens as measured by refractometry and biuret assay. Diagnostic test evaluation. Data regarding 92 pleural and 148 abdominal fluid specimens from dogs with various diseases. TP concentrations in fluid specimens as measured by refractometry and biuret assay were recorded. Strength of association between sets of measurements was assessed by Spearman rank correlations and Bland-Altman plots. Optimal concentration cutoff for diagnostic discrimination between exudate and nonexudate was identified by construction of receiver operating characteristic curves. Median TP concentration in pleural fluid specimens was 2.7 g/dL (range, 0.3 to 4.8 g/dL) for refractometry and 2.9 g/dL (range, 0.7 to 5.8 g/dL) for biuret assay. Median TP concentration in abdominal fluid specimens was 3.5 g/dL (range, 0.1 to 6.0 g/dL) for refractometry and 3.5 g/dL (range, 0.6 to 5.7 g/dL) for biuret assay. Correlation was significant between refractometric and biuret results for pleural (ρ = 0.921) and abdominal (ρ = 0.908) fluid. Bland-Altman plots revealed bias of -0.18 g/dL for pleural fluid and -0.03 g/dL for abdominal fluid for refractometry versus biuret assay. With a TP concentration of ≥ 3 g/dL used to distinguish exudate from nonexudate, sensitivity of refractometry was 77% for pleural fluid and 80% for abdominal fluid. Specificity was 100% and 94%, respectively. Refractometry yielded acceptable results for measurement of TP concentration in canine pleural and abdominal fluid specimens, providing a more rapid and convenient method than biuret assay.

Factors associated with haemoglobin concentration among Timor-Leste children aged 6-59 months.

PubMed

Agho, K E; Dibley, M J; D'Este, C; Gibberd, R

2008-06-01

The study was conducted to assess the prevalence of and factors associated with haemoglobin (Hb) concentrations among children aged 6-59 months in Timor-Leste. The 2003 Demographic and Health Survey was a multi-stage cluster survey of 4,320 households from four different geographic regions in Timor-Leste. In total, 4,514 children aged 6-59 months were included in the analysis. The prevalence of anaemia (Hb concentration <11.0g/dL) was 38.2% (638/1,668) for children aged 6-23 months and 22.6% (644/2,846) for older children (p<0.001). Girls had a higher mean Hb concentration than boys (11.9g/dL vs 11.7g/ dL, p<0.006) and children who had diarrhoea in the previous two weeks had a lower Hb concentration than children without diarrhoea (11.5g/dL vs 11.9g/dL, p<0.001). Children from the richest and middle-class households had a lower average Hb concentration than those from the poorest households (11.8g/ dL, 11.7g/dL vs 12.0g/dL, p<0.001). Children of mothers with some secondary or more education had a lower mean Hb concentration than children of mothers with completed primary, some primary and no education (11.7 g/dL vs 11.9 g/dL, 11.8 g/dL, and 11.9 g/dL, p=0.002). Children from severely-anaemic mothers had a lower mean Hb concentration than children from moderately-, mild and not anaemic mothers (10.5 g/dL vs 11.1 g/dL, 11.6 g/dL, 12.0 g/dL, p<0.001). After backward stepwise hierarchical multiple regression, wasting, male sex, recent diarrhoea, household wealth index (richest and middle-class), maternal educational status (some secondary or more and some primary), and maternal anaemic status were significantly associated with a lower Hb concentration in children and increased age of child and duration of breastfeeding (6 months) with a higher Hb concentration. Anaemia-prevention programmes among children in Timor-Leste should focus on those children aged less than two years, children with recent diarrhoea, wasted children, high socioeconomic status, and anaemic mothers.

A Coordination Chemistry Approach to Fine-Tune the Physicochemical Parameters of Lanthanide Complexes Relevant to Medical Applications.

PubMed

Le Fur, Mariane; Molnár, Enikő; Beyler, Maryline; Kálmán, Ferenc K; Fougère, Olivier; Esteban-Gómez, David; Rousseaux, Olivier; Tripier, Raphaël; Tircsó, Gyula; Platas-Iglesias, Carlos

2018-03-02

The geometric features of two pyclen-based ligands possessing identical donor atoms but different site organization have a profound impact in their complexation properties toward lanthanide ions. The ligand containing two acetate groups and a picolinate arm arranged in a symmetrical fashion (L1) forms a Gd 3+ complex being two orders of magnitude less stable than its dissymmetric analogue GdL2. Besides, GdL1 experiences a much faster dissociation following the acid-catalyzed mechanism than GdL2. On the contrary, GdL1 exhibits a lower exchange rate of the coordinated water molecule compared to GdL2. These very different properties are related to different strengths of the Gd-ligand bonds associated to steric effects, which hinder the coordination of a water molecule in GdL2 and the binding of acetate groups in GdL1. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Building Chronic Kidney Disease Clinical Practice Guidelines Using the openEHR Guideline Definition Language.

PubMed

Lin, Ching-Heng; Lo, Ying-Chih; Hung, Pei-Yuan; Liou, Der-Ming

2016-12-07

As a result of the disease's high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety. The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality. Using the Kidney Disease Improving Global Outcomes (KDIGO) anemia guideline as material, we designed a development workflow in order to establish a series of GDL guidelines. Focus group discussions were conducted in order to identify important issues related to GDL implementation. Ten GDL guidelines and 37 archetypes were established using the KDIGO guideline document. For the focus group discussions, 16 clinicians and 22 IT experts were recruited and their perceptions, opinions and attitudes towards the GDL approach were explored. Both groups provided positive feedback regarding the GDL approach, but raised various concerns about GDL implementation. Based on the findings of this study, we identified some potential gaps that might exist during implementation between the GDL concept and reality. Three directions remain to be investigated in the future. Two of them are related to the openEHR GDL approach. Firstly, there is a need for the editing tool to be made more sophisticated. Secondly, there needs to be integration of the present approach into non openEHR-based hospital information systems. The last direction focuses on the applicability of guidelines and involves developing a method to resolve any conflicts that occur with insurance payment regulations.

Chapter 8 Haemoglobin, ferritin and erythropoietin amongst UK adult dialysis patients in 2010: national and centre-specific analyses.

PubMed

Webb, Lynsey; Gilg, Julie; Wilkie, Martin

2012-01-01

The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published clinical practice guidelines which include recommendations for management of anaemia in established renal failure. To determine the extent to which the guidelines for anaemia management are met in the UK. Quarterly data were obtained regarding haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (EWNI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2010. In the UK, in 2010 53.6% of patients commenced dialysis therapy with Hb ≥ 10.0 g/dl (median Hb 10.1 g/dl). The median Hb of haemodialysis (HD) patients was 11.5 g/dl with an interquartile range (IQR) of 10.5-12.3 g/dl. Of HD patients 84.6% had Hb ≥ 10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.6 g/dl (IQR 10.6-12.5 g/dl). Of UK PD patients, 87.2% had Hb ≥ 10.0 g/dl. The median ferritin in HD patients in EWNI was 444 µg/L (IQR 299-635) and 96% of HD patients had a ferritin ≥ 100 µg/L. The median ferritin in PD patients was 264 µg/L (IQR 148-426) with 86% of PD patients having a ferritin ≥ 100 µg/L. In EWNI the mean Erythropoietin Stimulating Agent (ESA) dose was higher for HD than PD patients (9,020 vs. 6,202 IU/week). Of prevalent HD patients, 52.7% had Hb ≥ 10 and ≤ 12 g/dl. Of prevalent PD patients, 54.3% had Hb 10.5-12.5 g/dl. Copyright © 2012 S. Karger AG, Basel.

PLASMA ELECTROPHORETIC PROFILES IN THE EASTERN MASSASAUGA (SISTRURUS CATENATUS) AND INFLUENCES OF AGE, SEX, YEAR, LOCATION, AND SNAKE FUNGAL DISEASE.

PubMed

Allender, Matthew C; Junge, Randall E; Baker-Wylie, Sarah; Hileman, Eric T; Faust, Lisa J; Cray, Carolyn

2015-12-01

The purpose of this study was to establish reference intervals of the protein electrophoretic fractions and the acute-phase proteins hemoglobin binding protein (as determined by the haptoglobin assay) and C-reactive protein (CRP) and assess any possible correlations between varying age class, sex, location (Illinois or Michigan), year, or presence of snake fungal disease (SFD). Banked plasma samples were assayed from 130 eastern massasaugas from 2009 to 2014 in Illinois and Michigan. Snakes from Michigan had higher total protein (mean: 5.50 g/dl), albumin/globulin ratio (0.42), albumin (1.59 g/dl), and gamma globulins (0.55 g/dl) than from snakes in Illinois (4.72 g/dl, 0.29, 1.03 g/dl, 0.38 g/dl, respectively). Snakes in Illinois (22.19 g/ml) had higher CRP than snakes in Michigan (10.89 mg/ml). Adults had higher gamma globulins (0.47 g/dl) than juveniles (0.28 g/dl). Males had higher alpha-2 globulins (0.98 g/dl) and CRP (21.4 mg/ml) than females (0.85, 11.6, respectively). There were no significant differences in absolute plasma proteins in SFD-positive snakes, but the percentage of gamma globulins was significantly higher in positive snakes. Future research in this area can now build on this data to determine changes in population health over time or due to specific environmental or disease threats.

Three-dimensional numerical simulation of water droplet emerging from a gas diffusion layer surface in micro-channels

NASA Astrophysics Data System (ADS)

Ding, Y.; Bi, H. T.; Wilkinson, D. P.

The dynamic formation of water droplets emerging from a gas diffusion layer (GDL) surface in micro-channels was simulated using the volume of fluid (VOF) method. The influence of GDL surface microstructure was investigated by changing the pore diameter and the number of pore openings on the GDL surface. Simulation results show that the microstructure of the GDL surface has a significant impact on the two-phase flow patterns in gas flow channels. For a non-uniform GDL surface, three stages were identified, namely emergence and merging on the GDL surface, accumulation on the channel sidewalls and detachment from the top wall. It was also found that if the pore size is small enough, the flow pattern in the channel does not change with further reduction in the pore diameter. However, the two-phase flow patterns change significantly with the wettability of the GDL surface and sidewalls, but remain the same when the liquid flow rate is reduced by two orders of magnitude from the reference case.

Bulk and contact resistances of gas diffusion layers in proton exchange membrane fuel cells

NASA Astrophysics Data System (ADS)

Ye, Donghao; Gauthier, Eric; Benziger, Jay B.; Pan, Mu

2014-06-01

A multi-electrode probe is employed to distinguish the bulk and contact resistances of the catalyst layer (CL) and the gas diffusion layer (GDL) with the bipolar plate (BPP). Resistances are compared for Vulcan carbon catalyst layers (CL), carbon paper and carbon cloth GDL materials, and GDLs with microporous layers (MPL). The Vulcan carbon catalyst layer bulk resistance is 100 times greater than the bulk resistance of carbon paper GDL (Toray TG-H-120). Carbon cloth (CCWP) has bulk and contact resistances twice those of carbon paper. Compression of the GDL decreases the GDL contact resistance, but has little effect on the bulk resistance. Treatment of the GDL with polytetrafluoroethylene (PTFE) increases the contact resistance, but has little effect on the bulk resistance. A microporous layer (MPL) added to the GDL decreases the contact resistance, but has little effect on the bulk resistance. An equivalent circuit model shows that for channels less than 1 mm wide the contact resistance is the major source of electronic resistance and is about 10% of the total ohmic resistance associated with the membrane electrode assembly.

Ferric maltol is effective in correcting iron deficiency anemia in patients with inflammatory bowel disease: results from a phase-3 clinical trial program.

PubMed

Gasche, Christoph; Ahmad, Tariq; Tulassay, Zsolt; Baumgart, Daniel C; Bokemeyer, Bernd; Büning, Carsten; Howaldt, Stefanie; Stallmach, Andreas

2015-03-01

Iron deficiency anemia (IDA) is frequently seen in inflammatory bowel disease. Traditionally, oral iron supplementation is linked to extensive gastrointestinal side effects and possible disease exacerbation. This multicenter phase-3 study tested the efficacy and safety of ferric maltol, a complex of ferric (Fe) iron with maltol (3-hydroxy-2-methyl-4-pyrone), as a novel oral iron therapy for IDA. Adult patients with quiescent or mild-to-moderate ulcerative colitis or Crohn's disease, mild-to-moderate IDA (9.5-12.0 g/dL and 9.5-13.0 g/dL in females and males, respectively), and documented failure on previous oral ferrous products received oral ferric maltol capsules (30 mg twice a day) or identical placebo for 12 weeks according to a randomized, double-blind, placebo-controlled study design. The primary efficacy endpoint was change in hemoglobin (Hb) from baseline to week 12. Safety and tolerability were assessed. Of 329 patients screened, 128 received randomized therapy (64 ferric maltol-treated and 64 placebo-treated patients) and comprised the intent-to-treat efficacy analysis: 55 ferric maltol patients (86%) and 53 placebo patients (83%) completed the trial. Significant improvements in Hb were observed with ferric maltol versus placebo at weeks 4, 8, and 12: mean (SE) 1.04 (0.11) g/dL, 1.76 (0.15) g/dL, and 2.25 (0.19) g/dL, respectively (P < 0.0001 at all time-points; analysis of covariance). Hb was normalized in two-thirds of patients by week 12. The safety profile of ferric maltol was comparable with placebo, with no impact on inflammatory bowel disease severity. Ferric maltol provided rapid clinically meaningful improvements in Hb and showed a favorable safety profile, suggesting its possible use as an alternative to intravenous iron in IDA inflammatory bowel disease.

Association between Oral Nutritional Supplementation and Clinical Outcomes among Patients with ESRD

PubMed Central

Cheu, Christine; Pearson, Jeffrey; Dahlerus, Claudia; Lantz, Brett; Chowdhury, Tania; Sauer, Peter F.; Farrell, Robert E.; Port, Friedrich K.

2013-01-01

Summary Background and objectives Oral nutritional supplementation (ONS) was provided to ESRD patients with hypoalbuminemia as part of Fresenius Medical Care Health Plan’s (FMCHP) disease management. This study evaluated the association between FMCHP’s ONS program and clinical outcomes. Design, setting, participants, & measurements Analyses included FMCHP patients with ONS indication (n=470) defined as 2-month mean albumin <3.8 g/dl until reaching a 3-month mean ≥3.8 g/dl from February 1, 2006 to December 31, 2008. Patients did not receive ONS if deemed inappropriate or refused. Patients on ONS were compared with patients who were not, despite meeting ONS indication. Patients with ONS indication regardless of use were compared with Medicare patients with similar serum albumin levels from the 2007 Centers for Medicare and Medicaid Services Clinical Performance Measures Project (CPM). Cox models calculated adjusted hospitalization and mortality risks at 1 year. Results Among patients with indication for ONS, 276 received supplements and 194 did not. ONS use was associated with 0.058 g/dl higher serum albumin overall (P=0.02); this difference decreased by 0.001 g/dl each month (P=0.05) such that the difference was 0.052 g/dl (P=0.04) in month 6 and the difference was no longer significant in month 12 . In analyses based on ONS use, ONS patients had lower hospitalization at 1 year (68.4%; P<0.01) versus patients without ONS (88.7%), but there was no significant reduction in mortality risk (P=0.29). In analyses based on ONS indication, patients with indication had lower mortality at 1 year (16.2%) compared with CPM patients (23.4%; P<0.01). Conclusions These findings suggest that ONS use was associated with significantly lower hospitalization rates but had no significant effect on mortality in a disease management setting. PMID:23085729

[Nitrogen and protein content analysis of human milk, diurnality vs nocturnality].

PubMed

Sánchez López, C L; Hernández, A; Rodríguez, A B; Rivero, M; Barriga, C; Cubero, J

2011-01-01

Breast milk is changing with the progression of lactation and during a 24-h period. To determine the effect of diurnality or nocturnality on total nitrogen and protein content of the breast milk. We collected human milk samples from health mothers living throughout Community of Extremadura (Spain) from January 2008 to December 2008 with less than two months of lactation. We divided the samples in three groups: calostral group (1-5 days postpartum), transitional group (6-15 days postpartum) and mature group (> 15 days postpartum). All samples were stored in a freezer at -80 ºC. We considered as day period between 08:00-20:00 h and night period 20:00-08:00 h. Analysis of the human milk samples was based on the Kjeldahl method. Protein contents were calculated from total nitrogen x 6,25. The statistical analysis of the data was descriptive (mean ± standard deviation) and inferential (T-Student test). No differences (P > 0,05) were found to exist among the contents of individual human milk samples. The mean contents of each component were as follows: Total nitrogen of calostral, transitional and mature group was 0,30 ± 0,06 g/dL (night period), 0,29 ± 0,05 g/dL (day period); 0,26 ± 0,04 g/dL (night period), 0,25 ± 0,04 g/dL (day period); 0,22 ± 0,05 g/dL (night period), 0,20 ± 0,04 g/dL (day period) respectively, in this mature group with a statistical variation (P < 0,05). Protein content of calostral, transitional and mature group was 1,88 ± 0,4 g/dL (night period), 1,81 ± 0,3 g/dL (day period); 1,62 ± 0,3 g/dL (night period), 1,59 ± 0,3 g/dL (day period); 1,35 ± 0,3 g/dL (night period), 1,26 ± 0,3 g/dL (day period) respectively, in this mature group with a statistical variation (P < 0,05). Although we observed differences in the nitrogen and protein content during the individual stages of lactation, it is just in the population of mature lactating women, where the components analyzed varied significantly between day and night.

UK Renal Registry 15th annual report: Chapter 6 haemoglobin, ferritin and erythropoietin amongst UK adult dialysis patients in 2011: national and centre-specific analyses.

PubMed

Rao, Anirudh; Gilg, Julie; Williams, Andrew

2013-01-01

The UK Renal Association (RA) and National Institute for Health and Care Excellence (NICE) have published Clinical Practice Guidelines which include recommendations for management of anaemia in established renal failure. To determine the extent to which the guidelines for anaemia management are met in the UK. Quarterly data were obtained for haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (E, W, NI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2011. In the UK, in 2011 51% of patients commenced dialysis therapy with Hb ≥10.0 g/dl (median Hb 10 g/dl). Of patients in the early presentation group, 55% started dialysis with Hb ≥10.0 g/dl whilst 37% of patients presenting late started dialysis with Hb ≥10.0 g/dl. The UK median Hb of haemodialysis (HD) patients was 11.2 g/dl with an inter-quartile range (IQR) of 10.3-12.1 g/dl. Of UK HD patients, 82% had Hb ≥10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.4 g/dl (IQR 10.5-12.3 g/dl). Of UK PD patients, 85% had Hb ≥10.0 g/dl. The median ferritin in HD patients in the UK was 436 mg/L (IQR 292-625) and 96% of HD patients had a ferritin ≥100 mg/ L. In EW&NI the median ferritin in PD patients was 273 mg/ L (IQR 153-446) with 86% of PD patients having a ferritin ≥100 mg/L. In EW&NI the mean erythropoietin stimulating agent (ESA) dose was higher for HD than PD patients (8,740 vs. 6,624 IU/week). Prevalent HD and PD patients had 56% and 53% respectively within the Hb ≥10 and ≤12 g/dl target. Copyright © 2013 S. Karger AG, Basel.

Prognostic implications of baseline anaemia and changes in haemoglobin concentrations with amphotericin B therapy for cryptococcal meningitis.

PubMed

Tugume, L; Morawski, B M; Abassi, M; Bahr, N C; Kiggundu, R; Nabeta, H W; Hullsiek, K H; Taseera, K; Musubire, A K; Schutz, C; Muzoora, C; Williams, D A; Rolfes, M A; Meintjes, G; Rhein, J; Meya, D B; Boulware, D R

2017-01-01

Anaemia represents a common toxicity with amphotericin B-based induction therapy in HIV-infected persons with cryptococcal meningitis. We sought to examine the impact of amphotericin-related anaemia on survival. We used data from Ugandan and South African trial participants to characterize the variation of haemoglobin concentrations from diagnosis to 12 weeks post-diagnosis. Anaemia severity was classified based on the haemoglobin concentration at cryptococcal meningitis diagnosis, and nadir haemoglobin values during amphotericin induction. Cox proportional hazard models were used to estimate 2- and 10-week mortality risk. We also estimated 10-week mortality risk among participants with nadir haemoglobin < 8.5 g/dL during amphotericin induction and who survived ≥ 2 weeks post-enrolment. The median haemoglobin concentration at meningitis diagnosis was 11.5 g/dL [interquartile range (IQR) 9.7-13 g/dL; n = 311] with a mean decline of 4.2 g/dL [95% confidence interval (CI) -4.6 to -3.8; P < 0.001; n = 148] from diagnosis to nadir value among participants with baseline haemoglobin ≥ 8.5 g/dL. The median haemoglobin concentration was 8.1 g/dL (IQR 6.5-9.5 g/dL) at 2 weeks, increasing to 9.4 g/dL (IQR 8.2-10.9 g/dL) by 4 weeks and continuing to increase to 12 weeks. Among participants with haemoglobin < 8.5 g/dL at diagnosis, mortality risk was elevated at 2 weeks [hazard ratio (HR) 2.7; 95% CI 1.5-4.9; P < 0.01] and 10 weeks (HR 1.8; 95% CI 1.1-2.2; P = 0.03), relative to those with haemoglobin ≥ 8.5 g/dL. New-onset anaemia occurring with amphotericin therapy did not have a statistically significant association with 10-week mortality (HR 2.0; 95% CI 0.5-9.1; P = 0.4). Amphotericin induced significant haemoglobin declines, which were mostly transient and did not impact 10-week mortality. Individuals with moderate to life-threatening anaemia at baseline had a higher mortality risk at 2 and 10 weeks post-enrolment. © 2016 British HIV Association.

UK Renal Registry 13th Annual Report (December 2010): Chapter 9: haemoglobin, ferritin and erythropoietin amongst UK adult dialysis patients in 2009: national and centre-specific analyses.

PubMed

Gilg, Julie; Webb, Lynsey; Feest, Terry; Fogarty, Damian

2011-01-01

The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published Clinical Practice Guidelines which include recommendations for management of anaemia in established renal failure. To determine the extent to which the guidelines for anaemia management are met in the UK. Quarterly data were obtained regarding haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (EWNI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2009. In the UK, in 2009 55% of patients commenced dialysis therapy with Hb x10.0 g/dl (median Hb 10.2 g/dl). The median Hb of haemodialysis (HD) patients was 11.6 g/dl with an interquartile range (IQR) of 10.6 - 12.4 g/dl. Of HD patients 85% had Hb ≥ 10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.7 g/dl (IQR 10.7-12.6 g/dl). Of UK PD patients, 88% had Hb ≥ 10.0 g/dl. The median ferritin in HD patients in EWNI was 441 mg/L (IQR 289-629) and 96% of HD patients had a ferritin ≥ 100 mg/L. The median ferritin in PD patients was 249 mg/L (IQR 142-412) with 86% of PD patients having a ferritin 5100 mg/L. In EWNI the mean Erythropoietin Stimulating Agent (ESA) dose was higher for HD than PD patients (9,507 vs. 6,212 IU/week). In 2009, 56% of prevalent HD patients had a Hb ≥ 10.5 and ≤ 12.5 g/dl compared with 54% in 2008 and 53% in 2007. Fifty-four percent of prevalent PD patients had a Hb ≥10.5 and ≤12.5 g/dl compared to 55% in 2008. Copyright © 2011 S. Karger AG, Basel.

Anemia and mortality in hemodialysis patients: accounting for morbidity and treatment variables updated over time.

PubMed

Robinson, Bruce M; Joffe, Marshall M; Berns, Jeffrey S; Pisoni, Ronald L; Port, Friedrich K; Feldman, Harold I

2005-11-01

The objective of this study was to gain insight into the associations of anemia with mortality among maintenance hemodialysis (HD) patients and patient subgroups by an analysis that more comprehensively represents hemoglobin (Hb) level, morbidity, and treatment characteristics over time than was possible in prior observational studies. A cohort study was conducted among 5517 subjects in the American arm of the Dialysis Outcomes and Practice Patterns Study Phase I. We used proportional hazard analysis to model all-cause mortality as a function of Hb level measured 1, 3, and 6 months previously. Forty-five potentially confounding patient-level characteristics were considered, including demographics, comorbidities, and time-updated levels of erythropoietin and parenteral iron dosing, medical events, and laboratory and dialysis measures. Compared to Hb 11 to <12 g/dL, subjects with Hb <11 g/dL had increased mortality [adjusted hazard ratios (95% confidence interval) in the 3-month-lagged model = 1.74 (1.24 to 2.43) for <9 g/dL, 1.25 (0.96 to 1.63) for 9 to <10 g/dL, and 1.22 (0.99 to 1.49) for 10 to <11 g/dL categories]. Mortality rates for subjects with Hb 12 to <13 g/dL and > or = 13 g/dL did not differ significantly from those with Hb 11 to <12 g/dL. The relationships between Hb and mortality varied modestly with changes in the time interval between Hb measurement and the time at risk for mortality, but did not vary according to ESRD vintage or health status indicators. Our findings confirm the associations of Hb levels > or =11 g/dL with longer survival among maintenance HD patients, but show no additional survival advantage for patients with Hb levels > or =12 g/dL. Further investigation of the relationships among anemia, treatment of anemia, and survival is warranted.

47 CFR 5.305 - Program license not permitted.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 1 2013-10-01 2013-10-01 false Program license not permitted. 5.305 Section 5.305 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EXPERIMENTAL RADIO SERVICE Program Experimental Radio Licenses § 5.305 Program license not permitted. Experiments are not permitted under this...

47 CFR 5.305 - Program license not permitted.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 1 2014-10-01 2014-10-01 false Program license not permitted. 5.305 Section 5.305 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EXPERIMENTAL RADIO SERVICE Program Experimental Radio Licenses § 5.305 Program license not permitted. Experiments are not permitted under this...

Should the Centers for Disease Control and Prevention's childhood lead poisoning intervention level be lowered?

PubMed

Bernard, Susan M

2003-08-01

The US Centers for Disease Control and Prevention (CDC) in 1991 chose 10 micro g/dL as an initial screening level for lead in children's blood. Current data on health risks and intervention options do not support generally lowering that level, but federal lead poisoning prevention efforts can be improved by revising the follow-up testing schedule for infants aged 1 year or less with blood lead levels of 5 micro g/dL or higher; universal education about lead exposure risks; universal administration of improved, locally validated risk-screening questionnaires; enhanced compliance with targeted screening recommendations and federal health program requirements; and development by regulatory agencies of primary prevention criteria that do not use the CDC's intervention level as a target "safe" lead exposure.

Thermodynamic stability, kinetic inertness and relaxometric properties of monoamide derivatives of lanthanide(III) DOTA complexes.

PubMed

Tei, Lorenzo; Baranyai, Zsolt; Gaino, Luca; Forgács, Attila; Vágner, Adrienn; Botta, Mauro

2015-03-28

A complete thermodynamic and kinetic solution study on lanthanide(III) complexes with monoacetamide (DOTAMA, L1) and monopropionamide (DOTAMAP, L2) derivatives of DOTA (DOTA = 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid) was undertaken with the aim to elucidate their stability and inertness in aqueous media. The stability constants of GdL1 and GdL2 are comparable, whereas a more marked difference is found in the kinetic inertness of the two complexes. The formation of the Eu(III) and Ce(III) complexes takes place via the formation of the protonated intermediates which can deprotonate and transform into the final complex through a OH(-) assisted pathway. GdL2 shows faster rates of acid catalysed decomplexation with respect to GdL1, which has a kinetic inertness comparable to GdDOTA. Nevertheless, GdL2 is one order of magnitude more inert than GdDO3A. A novel DOTAMAP-based bifunctional chelating ligand and its deoxycholic acid derivative (L5) were also synthesized. Since the coordinated water molecule in GdL2 is characterized by an exchange rate ca. two orders of magnitude greater than in GdL1, the relaxivity of the macromolecular derivatives of L5 should not be limited by the slow water exchange process. The relaxometric properties of the supramolecular adduct of GdL5 with human serum albumin (HSA) were investigated in aqueous solution by measuring the magnetic field dependence of the (1)H relaxivity which, at 20 MHz and 298 K, shows a 430% increase over that of the unbound GdL5 chelate. Thus, Gd(III) complexes with DOTAMAP macrocyclic ligands can represent good candidates for the development of stable and highly effective bioconjugate systems for molecular imaging applications.

Application of a self-supporting microporous layer to gas diffusion layers of proton exchange membrane fuel cells

NASA Astrophysics Data System (ADS)

Ito, Hiroshi; Heo, Yun; Ishida, Masayoshi; Nakano, Akihiro; Someya, Satoshi; Munakata, Tetsuo

2017-02-01

The intrinsic effect of properties of a self-supporting microporous layer (MPL) on the performance of proton exchange membrane fuel cells (PEMFCs) is identified. First, a self-supporting MPL is fabricated and applied to a gas diffusion layer (GDL) of a PEMFC, when the GDL is either an integrated sample composed of a gas diffusion backing (GDB, i.e., carbon paper) combined with MPL or a sample with only MPL. Cell performance tests reveal that, the same as the MPL fabricated by the coating method, the self-supporting MPL on the GDB improves the cell performance at high current density. Furthermore, the GDL composed only of the MPL (i.e., GDB-free GDL) shows better performance than does the integrated GDB/MPL GDL. These results along with literature data strongly suggest that the low thermal conductivity of MPL induces a high temperature throughout the GDL, and thus vapor diffusion is dominant in the transport of product water through the MPL.

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR’s Guideline Definition Language

PubMed Central

2014-01-01

Background Providing scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care. Methods We extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases’ compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data. Results We successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for 49 mock patients were a complete match versus the automated compliance results. Conclusions Shareable guideline knowledge for use in automated retrospective checking of guideline compliance may be achievable using GDL. Whether the same GDL rules can be used for at-the-point-of-care CDS remains unknown. PMID:24886468

Scaling GDL for Multi-cores to Process Planck HFI Beams Monte Carlo on HPC

NASA Astrophysics Data System (ADS)

Coulais, A.; Schellens, M.; Duvert, G.; Park, J.; Arabas, S.; Erard, S.; Roudier, G.; Hivon, E.; Mottet, S.; Laurent, B.; Pinter, M.; Kasradze, N.; Ayad, M.

2014-05-01

After reviewing the majors progress done in GDL -now in 0.9.4- on performance and plotting capabilities since ADASS XXI paper (Coulais et al. 2012), we detail how a large code for Planck HFI beams Monte Carlo was successfully transposed from IDL to GDL on HPC.

Effect of the PTFE content in the gas diffusion layer on water transport in polymer electrolyte fuel cells (PEFCs)

NASA Astrophysics Data System (ADS)

Mortazavi, Mehdi; Tajiri, Kazuya

2014-01-01

The dynamic behavior of a liquid water droplet emerging and detaching from the surface of the gas diffusion layer (GDL) is investigated. The droplet growth and detachment are studied for different polytetrafluoroethylene (PTFE) contents within the GDL and for different superficial gas velocities flowing in the gas channel. To simulate the droplet behavior in the cathode and anode of an operating polymer electrolyte fuel cell, separate experiments are conducted with air and hydrogen being supplied in the gas channel, respectively. Both the superficial gas velocity and the PTFE content within the GDL are found to impact the droplet detachment diameter. Increasing the superficial gas velocity increases the drag force applied on the droplet sitting on the GDL surface. It is observed that the droplet detaches at a smaller diameter for higher superficial gas velocities. The droplets also detach at smaller diameters from GDLs with a higher amount of PTFE. Such observation is justified according to two different points of view: (1) heterogeneous through-plane PTFE distribution through the GDL and (2) reduced GDL surface roughness caused by PTFE loading.

Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness.

PubMed

Edwards, Jason; Morrison, Chris; Mohiuddin, Maleeha; Tchatalbachev, Vladislav; Patel, Charmi; Schwickerath, Vicki L; Menitove, Jay E; Singh, Gurmukh

2012-11-01

Blood transfusion management strategies minimize transfusion-associated risks, enhance outcomes, and reduce costs. We explored an association of discharge hemoglobin (Hb) with pretransfusion Hb, transfusion indications, and red blood cell (RBC) transfusions. We stipulate that patients with discharge Hb concentrations greater than 10.0 g/dL, or even 9.0 g/dL, received excessive RBC transfusions. We examined aggregate data from five hospitals and for one of the hospitals, the focus hospital, we reviewed patient records for a period of 6 months. Data analyses included number of RBC units transfused and Hb values before transfusion, after transfusion, and at discharge. In aggregate, 27% to 47% patients had discharge Hb levels greater than 10.0 g/dL. At the focus hospital, 27% had a discharge Hb level greater than 10 g/dL and 50.3% had a discharge Hb level greater than 9.0 g/dL. At the focus hospital, the mean Hb trigger for transfusion was a Hb level of 7.3 g/dL; the mean posttransfusion Hb level was 9.3 g/dL and mean discharge Hb level was 9.2 g/dL. Overall, 76% of the transfusions were of an even number of RBC units. In aggregate, overutilization exceeded 20%. At the focus hospital, approximately one-quarter of patients receiving transfusions had a Hb concentration greater than 10.0 g/dL at discharge. Transfused patients' discharge Hb concentration represents an effective indicator for retrospective monitoring of transfusion appropriateness. In light of the large number of patients receiving even number transfusions, reviewing Hb levels after transfusion of each RBC unit could reduce unnecessary transfusions. Retrospective review of discharge Hb data focuses providers on transfusion outcomes and affords an educational opportunity for blood utilization management. © 2012 American Association of Blood Banks.

The accuracy of noninvasive hemoglobin monitoring using the radical-7 pulse CO-Oximeter in children undergoing neurosurgery.

PubMed

Park, Yong-Hee; Lee, Ji-Hyun; Song, Hyun-Gul; Byon, Hyo-Jin; Kim, Hee-Soo; Kim, Jin-Tae

2012-12-01

The most common method for determining the hemoglobin concentration is to draw blood from a patient. However, the Radical-7 Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) can noninvasively provide continuous hemoglobin concentration (SpHb). In our study we compared noninvasive measurements of SpHb with simultaneous laboratory measurements of total hemoglobin in arterial blood samples taken from children (tHb). Arterial blood samples were analyzed using a laboratory CO-oximeter, and SpHb was simultaneously recorded in pediatric patients undergoing neurosurgery. When patients met the criteria for hypovolemia, 10 mL/kg of colloids or red blood cells were administered over 10 minutes. SpHb and tHb data were collected before and after intravascular volume resuscitation. The relationship between SpHb and tHb was assessed using a 4-quadrant plot, linear regression, mixed-effect model, and modified Bland-Altman analyses. One hundred nineteen paired samples were analyzed. The correlation coefficient between SpHb and tHb was 0.53 (P < 0.001), whereas that of change in SpHb versus change in tHb was 0.75 (P < 0.001). The average difference (bias) between tHb and SpHb was 0.90 g/dL (95% confidence interval [CI], 0.48-1.32 g/dL) and 1 standard deviation of the difference (sd) was 1.35 g/dL. The concordance rate (a measure of the number of data points that are in 1 of the 2 quadrants of agreement) determined using a 4-quadrant plot was 93%. The correlation coefficient between SpHb and tHb after intravascular volume resuscitation was 0.58 (P < 0.001), whereas that of changes in SpHb and tHb was 0.87 (P < 0.001). The bias immediately after volume resuscitation was 1.18 g/dL (95% CI, 0.81-1.55 g/dL), and sd was 1.28 g/dL with a concordance rate of 94.4%. The bias was -0.03 g/dL when tHb was ≥11 g/dL, which was significantly lower in comparison with biases when tHb <9 g/dL (1.24 g/dL) and tHb was 9-11 g/dL (1.17 g/dL) (P = 0.004). The Radical-7 Pulse CO-Oximeter can be useful as a trend monitor in children during surgery even immediately after intravascular volume expanders are administered. However, it is advisable to confirm the baseline hemoglobin level and to consider the influence of tHb level on the bias. In addition, one should be cautious with regard to using SpHb alone when making transfusion decisions.

Disintegration of collagen fibrils by Glucono-δ-lactone: An implied lead for disintegration of fibrosis.

PubMed

Jayamani, Jayaraman; Ravikanth Reddy, R; Madhan, Balaraman; Shanmugam, Ganesh

2018-02-01

Excess accumulation of collagen (fibrosis) undergoes self-aggregation, which leads to fibrillar collagen, on the extracellular matrix is the hallmark of a number of diseases such as keloids, hypertrophic scars, and systemic scleroderma. Direct inhibition or disintegration of collagen fibrils by small molecules offer a therapeutic approach to prevent or treat the diseases related to fibrosis. Herein, the anti-fibrotic property of Glucono-δ-lactone (GdL), known as acidifier, on the fibrillation and its disintegration of collagen was investigated. As collagen fibrillation is pH dependent, the pH modulation property of GdL is attractive to inhibit self-association of collagen. Optical density and microscopic data indicate that GdL elicits concentration-dependent fibril inhibition and also disintegrates pre-formed collagen fibrils. The simultaneous pH analysis showed that the modulation(lowering) of pH by GdL is the primary cause for its anti-fibrotic activity. The intact triple helical structure of collagen upon treatment of GdL suggests that collagen fibril disintegration can be achieved without affecting the native structure of collagen which is essential for any anti-fibrotic agents. Saturation transfer difference (STD) NMR result reveals that GdL is in proximity to collagen. The present results thus suggest that GdL provides a lead to design novel anti-fibrotic agents for the pathologies related to collagen deposition. Copyright © 2017 Elsevier B.V. All rights reserved.

Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data

PubMed Central

2013-01-01

Background Anaemia is a known risk factor for cardiovascular disease and treating anaemia in chronic kidney disease (CKD) may improve outcomes. However, little is known about the scope to improve primary care management of anaemia in CKD. Methods An observational study (N = 1,099,292) with a nationally representative sample using anonymised routine primary care data from 127 Quality Improvement in CKD trial practices (ISRCTN5631023731). We explored variables associated with anaemia in CKD: eGFR, haemoglobin (Hb), mean corpuscular volume (MCV), iron status, cardiovascular comorbidities, and use of therapy which associated with gastrointestinal bleeding, oral iron and deprivation score. We developed a linear regression model to identify variables amenable to improved primary care management. Results The prevalence of Stage 3–5 CKD was 6.76%. Hb was lower in CKD (13.2 g/dl) than without (13.7 g/dl). 22.2% of people with CKD had World Health Organization defined anaemia; 8.6% had Hb ≤ 11 g/dl; 3% Hb ≤ 10 g/dl; and 1% Hb ≤ 9 g/dl. Normocytic anaemia was present in 80.5% with Hb ≤ 11; 72.7% with Hb ≤ 10 g/dl; and 67.6% with Hb ≤ 9 g/dl; microcytic anaemia in 13.4% with Hb ≤ 11 g/dl; 20.8% with Hb ≤ 10 g/dl; and 24.9% where Hb ≤ 9 g/dl. 82.7% of people with microcytic and 58.8% with normocytic anaemia (Hb ≤ 11 g/dl) had a low ferritin (<100ug/mL). Hypertension (67.2% vs. 54%) and diabetes (30.7% vs. 15.4%) were more prevalent in CKD and anaemia; 61% had been prescribed aspirin; 73% non-steroidal anti-inflammatory drugs (NSAIDs); 14.1% warfarin 12.4% clopidogrel; and 53.1% aspirin and NSAID. 56.3% of people with CKD and anaemia had been prescribed oral iron. The main limitations of the study are that routine data are inevitably incomplete and definitions of anaemia have not been standardised. Conclusions Medication review is needed in people with CKD and anaemia prior to considering erythropoietin or parenteral iron. Iron stores may be depleted in over >60% of people with normocytic anaemia. Prescribing oral iron has not corrected anaemia. PMID:23351270

Maternal hemoglobin concentration and adverse pregnancy outcomes at low and moderate altitudes in Peru.

PubMed

Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos E

2012-07-01

To identify associations of maternal hemoglobin (Hb) with perinatal outcomes at low and moderate altitudes in Peru. Study of records with sequential information using perinatal database system. The study included 295 651 pregnant women with their products. Using multiple logistic regression analysis, we estimated the probability of stillbirths, preterm and small for gestational age (SGA) births associated with maternal Hb levels at low (0-1999 m) and moderate altitudes (2000-2999 m). Maternal Hb decreased as pregnancy progressed from first to third trimester at both altitudes. Hb was higher at moderate than at low altitude (p < 0.001). Risks for stillbirths increased with low maternal Hb (odds ratio [OR]: 1.39 for Hb 9-9.9; OR: 1.84 for Hb 8-8.9; OR: 3.25 for Hb 7-7.9; and OR: 7.8 for Hb <7 g/dl); with Hb higher than 14.5 g/dl (OR: 1.31) and with altitudes ≥ 2000 m (OR: 1.2). High preterm rates were also observed with low Hbs (OR: 1.16 for Hb 9-9.9; OR: 1.64 for Hb 8-8.9; OR: 2.25 for Hb 7-7.9; and OR:2.87 for Hb<7 g/dl) and with Hb higher than 14.5 g/dl (OR: 1.14). High SGA rates were observed in neonates with maternal Hb of 7-7.9 (OR: 1.35) and <7 g/dl (OR:1.57), and higher than 14.5 g/dl (OR: 1.33), and with moderate altitudes (OR: 1.12). The cut-off points for lower risks of stillbirth and preterm births was 10 g/dl, and for SGA 9 g/dl of hemoglobin. Low and high maternal Hb levels and moderate altitude were independent risk factors for adverse perinatal outcomes.

Bedside hemoglobinometry in hemodialysis patients: lessons from point-of-care testing.

PubMed

Agarwal, R; Heinz, T

2001-01-01

The HemoCue B-hemoglobin test system (HemoCue, Inc., Mission Viejo, CA) is a photometric method for rapid bedside determination of hemoglobin (Hb). We compared the performance of HemoCue measured Hb against Coulter STK-S (CSTK) measured Hb in chronic hemodialysis (HD) patients in two different settings. In the first setting, Hemocue analysis was performed by multiple HD technicians (n = 132). In the second setting, a nurse trained in proper specimen handling performed the HemoCue analysis (n = 74). Simultaneous measurement of Hb by the CSTK method was performed. First setting: Hb was 11.1+/-1.66 (SD) g/dl by CSTK and 11.7+/-2.29 g/dl by HemoCue. The HemoCue method consistently overestimated Hb by an average (SD) of 0.63 (1.267) g/dl (95% CI = 0.42 to 0.85). Hb was overestimated in 25.7% and underestimated in 2.3% of the patients by 1 g/dl or more. Thus, the HemoCue system was accurate within 1 g/dl only 72% of the time. Second setting: HemoCue overestimated Hb by an average (SD) of 0.29 (0.52) g/dl (95% CI, 0.17 to 0.41). Only 4% of all patients had errors in estimation of 1 g/dl or more. Thus, HemoCue was accurate in 96% of the patients within 1 g/dl. After reviewing the two protocols, the primary difference in the two studies was the technique used to obtain the specimens. When performed properly, Hb testing using the HemoCue testing system had a high level of agreement with CSTK. Appropriate training in specimen handling, as well as test performance, will increase accuracy and reliability of bedside hemoglobinometry.

A 1-year trial of repeated high-dose intravenous iron isomaltoside 1000 to maintain stable hemoglobin levels in inflammatory bowel disease.

PubMed

Reinisch, Walter; Altorjay, Istvan; Zsigmond, Ferenc; Primas, Christian; Vogelsang, Harald; Novacek, Gottfried; Reinisch, Sieglinde; Thomsen, Lars L

2015-01-01

Iron isomaltoside 1000 (Monofer®) is a high-dose intravenous (IV) iron, which in a recent 8 weeks trial in inflammatory bowel disease (IBD) subjects with iron deficiency anemia (IDA) demonstrated good tolerability and efficacy. The present trial is an extension to this trial, which evaluates the need for additional high IV iron doses to maintain a stable hemoglobin (Hb) ≥12.0 g/dl. This was a prospective, open-label, 12 months trial of European IBD subjects willing to participate after completing the lead-in trial. Subjects were allowed re-dosing with 500-2000 mg single doses of iron isomaltoside 1000 infused over ∼15 min at 3 months intervals depending on a predefined algorithm. Outcome measures included Hb, safety parameters and need for additional iron dosing. A total of 39 subjects were enrolled of which 34 subjects required re-dosing with a median cumulative 1-year dose of 1.8 g (mean cumulative dose 2.2 g). The mean (SD) Hb was 12.3 (1.5) g/dl at baseline, 12.8 (1.6) g/dl at 3 months, 12.8 (1.6) g/dl at 6 months, 12.9 (1.4) g/dl at 9 months and 12.9 (1.6) g/dl at 12 months. Seventy-four percent of subjects who had an Hb ≥12.0 g/dl at baseline were able to maintain Hb ≥12.0 g/dl till the end of the trial at 12 months. Nonserious probably related hypersensitivity reactions without significant hypotension were reported at the beginning of the infusion in two subjects, who recovered without sequelae. Repeated treatment of iron deficiency with iron isomaltoside 1000 could avoid episodes of IDA without major safety issues.

Template-directed fabrication of porous gas diffusion layer for magnesium air batteries

NASA Astrophysics Data System (ADS)

Xue, Yejian; Miao, He; Sun, Shanshan; Wang, Qin; Li, Shihua; Liu, Zhaoping

2015-11-01

The uniform micropore distribution in the gas diffusion layers (GDLs) of the air-breathing cathode is very important for the metal air batteries. In this work, the super-hydrophobic GDL with the interconnected regular pores is prepared by a facile silica template method, and then the electrochemical properties of the Mg air batteries containing these GDLs are investigated. The results indicate that the interconnected and uniform pore structure, the available water-breakout pressure and the high gas permeability coefficient of the GDL can be obtained by the application of 30% silica template. The maximum power density of the Mg air battery containing the GDL with 30% regular pores reaches 88.9 mW cm-2 which is about 1.2 times that containing the pristine GDL. Furthermore, the GDL with 30% regular pores exhibits the improved the long term hydrophobic stability.

A 2-year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina Faso reduces anemia, wasting, and diarrhea in children 3-12.9 months of age at baseline: a cluster-randomized controlled trial.

PubMed

Olney, Deanna K; Pedehombga, Abdoulaye; Ruel, Marie T; Dillon, Andrew

2015-06-01

Among young children in Burkina Faso, anemia and chronic and acute undernutrition are widespread. This study assessed the impact of Helen Keller International's (HKI) 2-y integrated agriculture [homestead food production (HFP)] and nutrition and health behavior change communication (BCC) program, targeted to women, on children's (3-12.9 mo old at baseline) anthropometry (stunting, wasting, and underweight), mean hemoglobin (Hb), anemia (Hb < 11 g/dL), and diarrhea prevalence. We used a cluster-randomized controlled trial, with 55 villages randomly assigned to a control group (n = 25) or 1 of 2 treatment groups (n = 15 each), which differed by who delivered the BCC messages [older women leaders or health committee (HC) members]. We used difference-in-difference (DID) estimates to assess impacts on child outcomes. We found marginally significant (P < 0.10) impacts on Hb (DID: 0.51 g/dL; P = 0.07) and wasting [DID: -8.8 percentage point (pp); P = 0.08] and statistically significant (P < 0.05) impacts on diarrhea (-15.9 pp; P = 0.00) in HC compared with control villages among children aged 3-12.9 mo and larger impacts for anemia (DID: -14.6 pp; P = 0.03) and mean Hb (DID: 0.74 g/dL; P = 0.03) among younger children (aged 3-5.9 mo). However, we found no significant impacts on stunting or underweight prevalence. Plausibility was supported by greater improvements in women's agricultural production and maternal infant and young child feeding and care knowledge and practices in HC compared with control villages. HKI's 2-y integrated HFP+BCC program (HC group) significantly improved several child outcomes, including wasting (marginal), diarrhea, Hb, and anemia, especially among the youngest children. This is the first cluster-randomized controlled trial of an HFP program that documents statistically significant positive effects on these child nutrition outcomes. This trial was registered at clinicaltrials.gov as NCT01825226. © 2015 American Society for Nutrition.

Serum protein electrophoretic pattern in one-humped camels (Camelus dromedarius) in Tripoli, Libya.

PubMed

Abdoslam, Omran; Bayt-Almal, Mahmoud; Almghrbe, Abdullah; Algriany, Omran

2018-01-01

The aim of this study was to characterize serum protein capillary electrophoretic pattern in apparently healthy adult male (age: 3-7 years) dromedary camels and also evaluate total protein and albumin levels using automated analyzer. Blood samples were taken from 20 camels. 5ml of blood was collected from the jugular vein and serum was separated from samples by centrifugation. Capillary electrophoresis of serum proteins identified six protein fractions in adult camels, including albumin, alpha1, alpha2, beta1, beta2 and gamma globulins, serum levels of these parameters were 3.9±0.04 g/dl, 0.16±0.01 g/dl, 0.39±0.03 g/dl, 0.515±0.03 g/dl, 0.205±0.01 g/dl and 0.61±0.04 g/dl, and 65.42±0.62 g/l, respectively. The total protein concentration was 65.42±0.62 g/L, while, the albumin/globulin (A/G) ratio was 2.4±0.14. The present study indicates six peaks with minicapillary electrophoresis and the results obtained were compared and interpreted in the light of finding reported by other investigators in camels.

Novel electrospun gas diffusion layers for polymer electrolyte membrane fuel cells: Part I. Fabrication, morphological characterization, and in situ performance

NASA Astrophysics Data System (ADS)

Chevalier, S.; Lavielle, N.; Hatton, B. D.; Bazylak, A.

2017-06-01

In this first of a series of two papers, we report an in-depth analysis of the impact of the gas diffusion layer (GDL) structure on the polymer electrolyte membrane (PEM) fuel cell performance through the use of custom GDLs fabricated in-house. Hydrophobic electrospun nanofibrous gas diffusion layers (eGDLs) are fabricated with controlled fibre diameter and alignment. The eGDLs are rendered hydrophobic through direct surface functionalization, and this molecular grafting is achieved in the absence of structural alteration. The fibre diameter, chemical composition, and electrical conductivity of the eGDL are characterized, and the impact of eGDL structure on fuel cell performance is analysed. We observe that the eGDL facilitates higher fuel cell power densities compared to a commercial GDL (Toray TGP-H-60) at highly humidified operating conditions. The ohmic resistance of the fuel cell is found to significantly increase with increasing inter-fiber distance. It is also observed that the addition of a hydrophobic treatment enhances membrane hydration, and fibres perpendicularly aligned to the channel direction may enhance the contact area between the catalyst layer and the GDL.

Clinical experience with ferric carboxymaltose in the treatment of cancer- and chemotherapy-associated anaemia

PubMed Central

Steinmetz, T.; Tschechne, B.; Harlin, O.; Klement, B.; Franzem, M.; Wamhoff, J.; Tesch, H.; Rohrberg, R.; Marschner, N.

2013-01-01

Background Intravenous (i.v.) iron can improve anaemia of chronic disease and response to erythropoiesis-stimulating agents (ESAs), but data on its use in practice and without ESAs are limited. This study evaluated effectiveness and tolerability of ferric carboxymaltose (FCM) in routine treatment of anaemic cancer patients. Patients and methods Of 639 patients enrolled in 68 haematology/oncology practices in Germany, 619 received FCM at the oncologist's discretion, 420 had eligible baseline haemoglobin (Hb) measurements, and 364 at least one follow-up Hb measurement. Data of transfused patients were censored from analysis before transfusion. Results The median total iron dose was 1000 mg per patient (interquartile range 600–1500 mg). The median Hb increase was comparable in patients receiving FCM alone (1.4 g/dl [0.2–2.3 g/dl; N = 233]) or FCM + ESA (1.6 g/dl [0.7–2.4 g/dl; N = 46]). Patients with baseline Hb up to 11.0 g/dl and serum ferritin up to 500 ng/ml benefited from FCM treatment (stable Hb ≥11.0 g/dl). Also patients with ferritin >500 ng/ml but low transferrin saturation benefited from FCM treatment. FCM was well tolerated, 2.3% of patients reported putative drug-related adverse events. Conclusions The substantial Hb increase and stabilisation at 11–12 g/dl in FCM-treated patients suggest a role for i.v. iron alone in anaemia correction in cancer patients. PMID:23071262

Perception of Preparedness of Novice Teachers from Alternative and Traditional Licensing Programs

ERIC Educational Resources Information Center

Buchanan, Tenielle; Lang, Nathan; Morin, Laura-Lee

2013-01-01

Alternative teacher licensing programs have become very popular; however, very little research has been conducted on the efficacy of the programs. Alternative licensing programs (ALPs) have evolved and multiplied rapidly over the last few decades. The Tennessee Independent Colleges and Universities Association (TICUA) is attempting to determine…

Pretreatment anemia is correlated with the reduced effectiveness of radiation and concurrent chemotherapy in advanced head and neck cancer

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

Prosnitz, Robert G.; Yao, Bin M.S.; Farrell, Catherine L.

2005-03-15

Purpose: Pretreatment anemia is an adverse prognostic variable in squamous cell head-and-neck cancer (HNC) patients treated with radiotherapy (RT) alone. Tumor hypoxia is an adverse parameter for treatment with RT alone or with RT and concurrent chemotherapy (CCT). Tumor hypoxia is more prevalent in patients who present with pretreatment hemoglobin (Hgb) concentrations less than 13 g/dL. RT/CCT improves survival over RT alone in advanced HNC, and its use is becoming more widespread. This study was performed to evaluate whether pretreatment Hgb less than 13 g/dL was correlated with treatment outcome in patients with advanced HNC treated with a uniform regimenmore » of RT/CCT. Methods and materials: The study population consisted of patients with AJCC Stage III or IV, M0 HNC who were treated with 70 to 72.5 Gy accelerated hyperfractionated RT (1.25 Gy b.i.d.) and CCT consisting of 2 cycles of CDDP (12-20 mg/m{sup 2}/d x 5 days) and continuous infusion 5-FU (600 mg/m{sup 2}/d x 5 days) during Week 1 and Week 6. A planned break in RT occurred during Week 4. These patients were enrolled on the experimental arm of a prospective randomized trial that compared this regimen to hyperfractionated irradiation alone from 1990 to 1996. RT/CCT was delivered as standard therapy from 1996 to 2000. The primary endpoint was failure-free survival (FFS). Secondary endpoints included local-regional control and overall survival. Results: One hundred and fifty-nine patients were treated from 1990 to 2000. The median (25-75%) pretreatment Hgb was 13.6 (12.2-13.5) g/dL. Hgb was 13 g/dL or higher in 105 patients and less than 13 g/dL in 54 patients. Primary tumor sites included oropharynx (43%), hypopharynx/larynx (36%), oral cavity (9%), and nasopharynx (6%). Seventy-eight percent of the patients with Hgb 13 g/dL or higher and 92% of the patients with Hgb less than 13 g/dL had a primary tumor stage of T3 or T4 (p = 0.01). Node-positive disease was present in 74 of 105 (70%) of patients with Hgb 13 g/dL or higher patients and in 36/54 (67%) of patients with Hgb less than 13 g/dL patients. Median follow-up of surviving patients was 42 months (range, 4-128 months). Five-year FFS was 75% for patients with Hgb 13 g/dL or higher vs. 50% for patients with Hgb less than 13 g/dL had a (p < 0.01). A total of 49 failures occurred in both patient cohorts. The median (25-75%) decrease in Hgb during RT/CCT was 2.2 (1.3-3.1) g/dL, both in patients who failed and in those who remained disease-free. Conclusion: Pretreatment Hgb less than 13 g/dL is correlated with adverse outcomes in advanced HNC patients treated with RT/CCT. Whether anemia actually causes poor outcomes remains unknown. The therapeutic effect of anemia correction is being evaluated in prospective trials.« less

X-Ray-Based Imaging for Characterizing Heterogeneous Gas Diffusion Layers for Polymer Electrolyte Membrane Fuel Cells

NASA Astrophysics Data System (ADS)

George, Michael G.

Characterization of gas diffusion layers (GDLs) for polymer electrolyte membrane (PEM) fuel cells informs modeling studies and the manufacturers of next generation fuel cell materials. Identifying the physical properties related to the primary functions of the modern GDL (thermal, electrical, and mass transport) is necessary for understanding the impact of GDL design choices. X-ray micro-computed tomographic reconstructions of GDLs were studied to isolate GDL surface morphologies. Surface roughness was measured for a wide variety of samples and a sensitivity study highlighted the scale-dependence of surface roughness measurements. Furthermore, a spatially resolved distribution map of polytetrafluoroethylene (PTFE) in the microporous layer (MPL), critical for water management and mass transport, was identified and the existence of PTFE agglomerations was highlighted. Finally, the impact of accelerated degradation on GDL wettability and water transport increases in liquid water accumulation and oxygen mass transport resistance were quantified as a result of accelerated GDL degradation.

Contextual Approach with Guided Discovery Learning and Brain Based Learning in Geometry Learning

NASA Astrophysics Data System (ADS)

Kartikaningtyas, V.; Kusmayadi, T. A.; Riyadi

2017-09-01

The aim of this study was to combine the contextual approach with Guided Discovery Learning (GDL) and Brain Based Learning (BBL) in geometry learning of junior high school. Furthermore, this study analysed the effect of contextual approach with GDL and BBL in geometry learning. GDL-contextual and BBL-contextual was built from the steps of GDL and BBL that combined with the principles of contextual approach. To validate the models, it uses quasi experiment which used two experiment groups. The sample had been chosen by stratified cluster random sampling. The sample was 150 students of grade 8th in junior high school. The data were collected through the student’s mathematics achievement test that given after the treatment of each group. The data analysed by using one way ANOVA with different cell. The result shows that GDL-contextual has not different effect than BBL-contextual on mathematics achievement in geometry learning. It means both the two models could be used in mathematics learning as the innovative way in geometry learning.

Gas diffusion layers coated with a microporous layer containing hydrophilic carbon nanotubes for performance enhancement of polymer electrolyte fuel cells under both low and high humidity conditions

NASA Astrophysics Data System (ADS)

Kitahara, Tatsumi; Nakajima, Hironori; Okamura, Kosuke

2015-06-01

Gas diffusion layers (GDLs) coated with a hydrophobic microporous layer (MPL) composed of carbon black and polytetrafluoroethylene (PTFE) have been commonly used to improve the water management characteristics of polymer electrolyte fuel cells (PEFCs). However, the hydrophobic MPL coated GDL designed to prevent dehydration of the membrane under low humidity conditions is generally inferior at reducing flooding under high humidity conditions. It is therefore important to develop a robust MPL coated GDL that can enhance the PEFC performance regardless of the humidity conditions. In the present study, a GDL coated with an MPL containing hydrophilic carbon nanotubes (CNTs) was developed. The less hydrophobic pores incorporating CNTs are effective at conserving the membrane humidity under low humidity conditions. The MPL with CNTs is also effective at expelling excess water from the catalyst layer while maintaining oxygen flow pathways from the GDL substrate, allowing the mean flow pore diameter to be decreased to 2 μm without reducing the ability of the MPL to prevent flooding under high humidity conditions. An MPL coated GDL with a CNT content of 4 mass% exhibits significantly higher performance under both low and high humidity conditions than a hydrophobic MPL coated GDL.

Effective NiMn Nanoparticles-Functionalized Carbon Felt as an Effective Anode for Direct Urea Fuel Cells.

PubMed

Barakat, Nasser A M; Alajami, Mohannad; Ghouri, Zafar Khan; Al-Meer, Saeed

2018-05-16

The internal resistances of fuel cells strongly affect the generated power. Basically, in the fuel cell, the anode can be prepared by deposition of a film from the functional electrocatalyst on a proper gas diffusion layer. Accordingly, an interfacial resistance for the electron transport is created between the two layers. Electrocatalyst-functionalized gas diffusion layer (GDL) can distinctly reduce the interfacial resistance between the catalyst layer and the GDL. In this study, NiMn nanoparticles-decorated carbon felt is introduced as functionalized GDL to be exploited as a ready-made anode in a direct urea fuel cell. The proposed treated GDL was prepared by calcination of nickel acetate/manganese acetate-loaded carbon felt under an argon atmosphere at 850 °C. The physiochemical characterizations confirmed complete reduction for the utilized precursors and deposition of pristine NiMn nanoparticles on the carbon felt fiber. In passive direct urea fuel cells, investigation the performance of the functionalized GDLs indicated that the composition of the metal nanoparticles has to be optimized as the GDL obtained from 40 wt % manganese acetate reveals the maximum generated power density; 36 mW/m² at room temperature and 0.5 M urea solution. Moreover, the electrochemical measurements proved that low urea solution concentration is preferred as utilizing 0.5 M solution resulted into generating higher power compared to 1.0 and 2.0 M solution. Overall, this study opens a new avenue toward functionalization of the GDL as a novel strategy to overcome the interfacial resistance between the electrocatalyst and the GDL.

Effective NiMn Nanoparticles-Functionalized Carbon Felt as an Effective Anode for Direct Urea Fuel Cells

PubMed Central

Barakat, Nasser A. M.; Alajami, Mohannad; Ghouri, Zafar Khan; Al-Meer, Saeed

2018-01-01

The internal resistances of fuel cells strongly affect the generated power. Basically, in the fuel cell, the anode can be prepared by deposition of a film from the functional electrocatalyst on a proper gas diffusion layer. Accordingly, an interfacial resistance for the electron transport is created between the two layers. Electrocatalyst-functionalized gas diffusion layer (GDL) can distinctly reduce the interfacial resistance between the catalyst layer and the GDL. In this study, NiMn nanoparticles-decorated carbon felt is introduced as functionalized GDL to be exploited as a ready-made anode in a direct urea fuel cell. The proposed treated GDL was prepared by calcination of nickel acetate/manganese acetate-loaded carbon felt under an argon atmosphere at 850 °C. The physiochemical characterizations confirmed complete reduction for the utilized precursors and deposition of pristine NiMn nanoparticles on the carbon felt fiber. In passive direct urea fuel cells, investigation the performance of the functionalized GDLs indicated that the composition of the metal nanoparticles has to be optimized as the GDL obtained from 40 wt % manganese acetate reveals the maximum generated power density; 36 mW/m2 at room temperature and 0.5 M urea solution. Moreover, the electrochemical measurements proved that low urea solution concentration is preferred as utilizing 0.5 M solution resulted into generating higher power compared to 1.0 and 2.0 M solution. Overall, this study opens a new avenue toward functionalization of the GDL as a novel strategy to overcome the interfacial resistance between the electrocatalyst and the GDL. PMID:29772710

A 1-year trial of repeated high-dose intravenous iron isomaltoside 1000 to maintain stable hemoglobin levels in inflammatory bowel disease

PubMed Central

Reinisch, Walter; Altorjay, Istvan; Zsigmond, Ferenc; Primas, Christian; Vogelsang, Harald; Novacek, Gottfried; Reinisch, Sieglinde; Thomsen, Lars L.

2015-01-01

Abstract Objective. Iron isomaltoside 1000 (Monofer®) is a high-dose intravenous (IV) iron, which in a recent 8 weeks trial in inflammatory bowel disease (IBD) subjects with iron deficiency anemia (IDA) demonstrated good tolerability and efficacy. The present trial is an extension to this trial, which evaluates the need for additional high IV iron doses to maintain a stable hemoglobin (Hb) ≥12.0 g/dl. Material and methods. This was a prospective, open-label, 12 months trial of European IBD subjects willing to participate after completing the lead-in trial. Subjects were allowed re-dosing with 500–2000 mg single doses of iron isomaltoside 1000 infused over ∼15 min at 3 months intervals depending on a predefined algorithm. Outcome measures included Hb, safety parameters and need for additional iron dosing. Results. A total of 39 subjects were enrolled of which 34 subjects required re-dosing with a median cumulative 1-year dose of 1.8 g (mean cumulative dose 2.2 g). The mean (SD) Hb was 12.3 (1.5) g/dl at baseline, 12.8 (1.6) g/dl at 3 months, 12.8 (1.6) g/dl at 6 months, 12.9 (1.4) g/dl at 9 months and 12.9 (1.6) g/dl at 12 months. Seventy-four percent of subjects who had an Hb ≥12.0 g/dl at baseline were able to maintain Hb ≥12.0 g/dl till the end of the trial at 12 months. Nonserious probably related hypersensitivity reactions without significant hypotension were reported at the beginning of the infusion in two subjects, who recovered without sequelae. Conclusion. Repeated treatment of iron deficiency with iron isomaltoside 1000 could avoid episodes of IDA without major safety issues. PMID:25900645

The silent burden of anaemia in Tanzanian children: a community-based study.

PubMed Central

Schellenberg, D.; Schellenberg, J. R. M. Armstrong; Mushi, A.; Savigny, D. de; Mgalula, L.; Mbuya, C.; Victora, C. G.

2003-01-01

OBJECTIVE: To document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old, thereby assisting in the development of effective strategies for controlling anaemia. METHODS: Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed. FINDINGS: Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6-11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1-5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was not associated with risk of anaemia. CONCLUSION: Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria. PMID:14576890

Driver License Examiner Supervisors; Basic Training Program. Trainee Study Guide.

ERIC Educational Resources Information Center

Pendleton, John T.; Patton, C. Duane

This is the third part of a four-part systematized training program intended for driver license examiner supervisors. The purpose of this study guide is to act as a program compendium to aid the trainee in successfully completing the program. The lesson material presented, apart from the introduction, is: orientation to license examiner…

Examining the influence of aggressive driving behavior on driver injury severity in traffic crashes.

PubMed

Paleti, Rajesh; Eluru, Naveen; Bhat, Chandra R

2010-11-01

In this paper, we capture the moderating effect of aggressive driving behavior while assessing the influence of a comprehensive set of variables on injury severity. In doing so, we are able to account for the indirect effects of variables on injury severity through their influence on aggressive driving behavior, as well as the direct effect of variables on injury severity. The methodology used in the paper to accommodate the moderating effect of aggressive driving behavior takes the form of two models--one for aggressive driving and another for injury severity. These are appropriately linked to obtain the indirect and direct effects of variables. The data for estimation is obtained from the National Motor Vehicle Crash Causation Study (NMVCCS). From an empirical standpoint, we consider a fine age categorization until 20 years of age when examining age effects on aggressive driving behavior and injury severity. There are several important results from the empirical analysis undertaken in the current paper based on post-crash data collection on aggressive behavior participation just prior to the crash and injury severity sustained in a crash. Young drivers (especially novice drivers between 16 and 17 years of age), drivers who are not wearing seat belt, under the influence of alcohol, not having a valid license, and driving a pick-up are found to be most likely to behave aggressively. Situational, vehicle, and roadway factors such as young drivers traveling with young passengers, young drivers driving an SUV or a pick-up truck, driving during the morning rush hour, and driving on roads with high speed limits are also found to trigger aggressive driving behavior. In terms of vehicle occupants, the safest situation from a driver injury standpoint is when there are two or more passengers in the vehicle, at least one of whom is above the age of 20 years. These and many other results are discussed, along with implications of the result for graduated driving licensing (GDL) programs. 2010 Elsevier Ltd. All rights reserved.

Driver education and teen crashes and traffic violations in the first two years of driving in a graduated licensing system.

PubMed

Shell, Duane F; Newman, Ian M; Córdova-Cazar, Ana Lucía; Heese, Jill M

2015-09-01

Our primary research question was whether teens obtaining their intermediate-level provisional operators permit (POP) in a graduated driver licensing (GDL) environment through driver education differed in crashes and traffic violations from teens who obtained their POP by completing a supervised driving certification log without taking driver education. A descriptive epidemiological study examining a census of all teen drivers in Nebraska (151,880 teens, 48.6% girls, 51.4% boys) during an eight year period from 2003 to 2010 was conducted. The driver education cohort had significantly fewer crashes, injury or fatal crashes, violations, and alcohol-related violations than the certification log cohort in both years one and two of driving following receipt of the POP. Hierarchical logistic regression was conducted, controlling for gender, race/ethnicity, median household income, urban-rural residence, and age receiving the POP. In both year one and two of driving, teens in the certification log cohort had higher odds of a crash, injury or fatal crash, violation, or alcohol-related violation. Findings support that relative to a supervised driving certification log approach, teens taking driver education are less likely to be involved in crashes or to receive a traffic violation during their first two years of driving in an intermediate stage in a graduated driver licensing system. Because teen crash and fatality rates are highest at ages 16-18, these reductions are especially meaningful. Driver education appears to make a difference in teen traffic outcomes at a time when risk is highest. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

42 CFR 431.701 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home... a State program for licensing administrators of nursing homes, in a State that does not have a... agency or board as meeting all of the requirements for a licensed nursing home administrator specified in...

42 CFR 431.701 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home... a State program for licensing administrators of nursing homes, in a State that does not have a... agency or board as meeting all of the requirements for a licensed nursing home administrator specified in...

Characteristics of Single Vehicle Crashes with a Teen Driver in South Carolina, 2005-2008.

PubMed

Shults, Ruth A; Bergen, Gwen; Smith, Tracy J; Cook, Larry; Kindelberger, John; West, Bethany

2017-09-22

Teens' crash risk is highest in the first years of independent driving. Circumstances surrounding fatal crashes have been widely documented, but less is known about factors related to nonfatal teen driver crashes. This study describes single vehicle nonfatal crashes involving the youngest teen drivers (15-17 years), compares these crashes to single vehicle nonfatal crashes among adult drivers (35-44 years) and examines factors related to nonfatal injury producing crashes for teen drivers. Police crash data linked to hospital inpatient and emergency department data for 2005-2008 from the South Carolina Crash Outcomes Data Evaluation System (CODES) were analyzed. Nonfatal, single vehicle crashes involving passenger vehicles occurring on public roadways for teen (15-17 years) drivers were compared with those for adult (35-44 years) drivers on temporal patterns and crash risk factors per licensed driver and per vehicle miles traveled. Vehicle miles traveled by age group was estimated using data from the 2009 National Household Travel Survey. Multivariable log-linear regression analysis was conducted for teen driver crashes to determine which characteristics were related to crashes resulting in a minor/moderate injury or serious injury to at least one vehicle occupant. Compared with adult drivers, teen drivers in South Carolina had 2.5 times the single vehicle nonfatal crash rate per licensed driver and 11 times the rate per vehicle mile traveled. Teen drivers were nearly twice as likely to be speeding at the time of the crash compared with adult drivers. Teen driver crashes per licensed driver were highest during the afternoon hours of 3:00-5:59 pm and crashes per mile driven were highest during the nighttime hours of 9:00-11:59 pm. In 66% of the teen driver crashes, the driver was the only occupant. Crashes were twice as likely to result in serious injury when teen passengers were present than when the teen driver was alone. When teen drivers crashed while transporting teen passengers, the passengers were >5 times more likely to all be restrained if the teen driver was restrained. Crashes in which the teen driver was unrestrained were 80% more likely to result in minor/moderate injury and 6 times more likely to result in serious injury compared with crashes in which the teen driver was restrained. Despite the reductions in teen driver crashes associated with Graduated Driver Licensing (GDL), South Carolina's teen driver crash rates remain substantially higher than those for adult drivers. Established risk factors for fatal teen driver crashes, including restraint nonuse, transporting teen passengers, and speeding also increase the risk of nonfatal injury in single vehicle crashes. As South Carolina examines strategies to further reduce teen driver crashes and associated injuries, the state could consider updating its GDL passenger restriction to either none or one passenger <21years and dropping the passenger restriction exemption for trips to and from school. Surveillance systems such as CODES that link crash data with health outcome data provide needed information to more fully understand the circumstances and consequences of teen driver nonfatal crashes and evaluate the effectiveness of strategies to improve teen driver safety. Published by Elsevier Ltd.

Plasma electrophoretogram in feline immunodeficiency virus (FIV) and/or feline leukaemia virus (FeLV) infections.

PubMed

Miró, G; Doménech, A; Escolar, E; Collado, V M; Tejerizo, G; De Las Heras, A; Gómez-Lucía, E

2007-05-01

The electrophoretogram of 89 cats, including those infected by feline immunodeficiency virus (FIV+), feline leukaemia virus (FeLV+) and non-infected, showed statistically significant differences in several of the fractions. FIV+ cats had very high protein values (mean, 8.10 g/dl), mostly because of hypergammaglobulinemia (mean, 2.81 g/dl) as compared with non-infected animals and FeLV+. In addition, in these FIV+ animals, the albumin/globulins ratio (A/G) was very low (mean, 0.72). Statistically significant differences in A/G and alpha2-globulin fraction were observed in FeLV+ group (A/G mean, 0.88 +/- 0.08; alpha2-globulin, mean, 0.84 +/- 0.07 g/dl) when compared with non-infected group (A/G mean, 1.06 +/- 0.08; alpha2-globulin mean, 0.68 +/- 0.04 g/dl). The alpha1-globulin fraction was higher in double infected animals (FIV and FeLV positive, F-F) (3.55 g/dl), than in FeLV+ or FIV+ cats (3.10 and 3.07 g/dl respectively), but no statistical conclusions may be drawn from this fact because of the low number of F-F animals. This technique may help to assess the initial clinical status of retrovirus-infected cats, and the clinical course of these chronic diseases, specifically during and after suitable therapy.

Systematic review and meta-analysis of method comparison studies of Masimo pulse co-oximeters (Radical-7™ or Pronto-7™) and HemoCue® absorption spectrometers (B-Hemoglobin or 201+) with laboratory haemoglobin estimation.

PubMed

Hiscock, R; Kumar, D; Simmons, S W

2015-05-01

We assessed agreement in haemoglobin measurement between Masimo pulse co-oximeters (Rad-7™ and Pronto-7™) and HemoCue® photometers (201+ or B-Hemoglobin) with laboratory-based determination and identified 39 relevant studies (2915 patients in Masimo group and 3084 patients in HemoCue group). In the Masimo group, the overall mean difference was -0.03 g/dl (95% prediction interval -0.30 to 0.23) and 95% limits of agreement -3.0 to 2.9 g/dl compared to 0.08 g/dl (95% prediction interval -0.04 to 0.20) and 95% limits of agreement -1.3 to 1.4 g/dl in the HemoCue group. Only B-Hemoglobin exhibited bias (0.53, 95% prediction interval 0.27 to 0.78). The overall standard deviation of difference was larger (1.42 g/dl versus 0.64 g/dl) for Masimo pulse co-oximeters compared to HemoCue photometers. Masimo devices and HemoCue 201+ both provide an unbiased, pooled estimate of laboratory haemoglobin. However, Masimo devices have lower precision and wider 95% limits of agreement than HemoCue devices. Clinicians should carefully consider these limits of agreement before basing transfusion or other clinical decisions on these point-of-care measurements alone.

Measurement of effective bulk and contact resistance of gas diffusion layer under inhomogeneous compression - Part II: Thermal conductivity

NASA Astrophysics Data System (ADS)

Roy Chowdhury, Prabudhya; Vikram, Ajit; Phillips, Ryan K.; Hoorfar, Mina

2016-07-01

The gas diffusion layer (GDL) is a thin porous layer sandwiched between a bipolar plate (BPP) and a catalyst coated membrane in a fuel cell. Besides providing passage for water and gas transport from and to the catalyst layer, it is responsible for electron and heat transfer from and to the BPP. In this paper, a method has been developed to measure the GDL bulk thermal conductivity and the contact resistance at the GDL/BPP interface under inhomogeneous compression occurring in an actual fuel cell assembly. Toray carbon paper GDL TGP-H-060 was tested under a range of compression pressure of 0.34 to 1.71 MPa. The results showed that the thermal contact resistance decreases non-linearly (from 3.8 × 10-4 to 1.17 × 10-4 Km2 W-1) with increasing pressure due to increase in microscopic contact area between the GDL and BPP; while the effective bulk thermal conductivity increases (from 0.56 to 1.42 Wm-1 K-1) with increasing the compression pressure. The thermal contact resistance was found to be greater (by a factor of 1.6-2.8) than the effective bulk thermal resistance for all compression pressure ranges applied here. This measurement technique can be used to identify optimum GDL based on minimum bulk and contact resistances measured under inhomogeneous compression.

On the effects of assembly compression on the performance of liquid-feed DMFCs under methanol-limiting conditions: A 2D numerical study

NASA Astrophysics Data System (ADS)

García-Salaberri, P. A.; Vera, M.

2015-07-01

The influence of assembly compression on the performance of liquid-feed DMFCs under methanol-limiting conditions is explored by means of a 2D/1D multiphysics across-the-channel model. The numerical formulation incorporates a comprehensive 2D description of the anode GDL, including two-phase phenomena, non-uniform anisotropic transport properties, and electrical contact resistances at the GDL/BPP interface. GDL effective properties are evaluated using empirical data corresponding to Toray® carbon paper. A simplified but physically sound 1D description, locally coupled to the 2D anode GDL model, is adopted to describe transport processes in the MPLs, membrane and cathode GDL, whereas the catalyst layers are treated as infinitely thin surfaces. Good agreement is found between the numerical results and previous experimental data. The interplay between assembly compression, bipolar plate material, and channel configuration is also investigated. The results show that there is an optimum GDL compression ratio in terms of overall power density, the optimal compression level being strongly dependent on bipolar plate material. Beyond the optimum, the detrimental effect of compression is larger in non-parallel flow fields due to the additional reduction of methanol transported by under-rib convection. The results suggest that, under certain conditions, this transport mechanism could be more important than diffusion in the anode of liquid-feed DMFCs.

Guided discovery learning in geometry learning

NASA Astrophysics Data System (ADS)

Khasanah, V. N.; Usodo, B.; Subanti, S.

2018-03-01

Geometry is a part of the mathematics that must be learned in school. The purpose of this research was to determine the effect of Guided Discovery Learning (GDL) toward geometry learning achievement. This research had conducted at junior high school in Sukoharjo on academic years 2016/2017. Data collection was done based on student’s work test and documentation. Hypothesis testing used two ways analysis of variance (ANOVA) with unequal cells. The results of this research that GDL gave positive effect towards mathematics learning achievement. GDL gave better mathematics learning achievement than direct learning. There was no difference of mathematics learning achievement between male and female. There was no an interaction between sex differences and learning models toward student’s mathematics learning achievement. GDL can be used to improve students’ mathematics learning achievement in geometry.

Status of GDL - GNU Data Language

NASA Astrophysics Data System (ADS)

Coulais, A.; Schellens, M.; Gales, J.; Arabas, S.; Boquien, M.; Chanial, P.; Messmer, P.; Fillmore, D.; Poplawski, O.; Maret, S.; Marchal, G.; Galmiche, N.; Mermet, T.

2010-12-01

Gnu Data Language (GDL) is an open-source interpreted language aimed at numerical data analysis and visualisation. It is a free implementation of the Interactive Data Language (IDL) widely used in Astronomy. GDL has a full syntax compatibility with IDL, and includes a large set of library routines targeting advanced matrix manipulation, plotting, time-series and image analysis, mapping, and data input/output including numerous scientific data formats. We will present the current status of the project, the key accomplishments, and the weaknesses - areas where contributions are welcome!

42 CFR 431.703 - Licensing requirement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Licensing Nursing Home Administrators § 431.703 Licensing requirement. The State licensing program must provide that only nursing homes supervised by an administrator licensed in accordance with the...

Hematologic and serum biochemical reference intervals for Florida panthers.

USGS Publications Warehouse

Dunbar, M.R.; Nol, P.; Linda, S.B.

1997-01-01

Ninety-four blood samples were collected from 48 (29 males and 19 females) free-ranging Florida panthers (Felis concolor coryi) captured in southern Florida (USA) from 1983 to 1994 for routine hematological and serum biochemical analysis. Florida panthers in the northern portion of their range had significantly higher red blood cell (mean +/- SD = 7.923 x 10(6) +/- 0.854 x 10(6)/microliter), hemoglobin (12.53 +/- 1.66 g/dl), and packed cell volume (36.97 +/- 4.27%) values compared to those of panthers localized in more southern parts of Florida (7.148 x 10(6) +/- 1.045 x 10(6)/microliter, 11.60 +/- 1.62 g/dl, and 34.82 +/- 5.99%, respectively). Adults had significantly higher mean serum total protein (7.50 +/- 0.59 g/dl) and packed cell volume (36.90 +/- 4.97%) values than juveniles (6.88 +/- 0.49 g/dl and 34.54 +/- 5.30%). However, mean serum albumin concentrations were significantly higher in juveniles (3.80 +/- 0.26 g/dl) when compared to adult values (3.58 +/- 0.26 g/dl). Mean serum calcium concentrations were significantly higher in juveniles (10.33 +/- 0.39 mg/dl) than in adults (9.66 +/- 0.45 mg/dl). Additionally, mean serum iron concentrations were significantly higher in those panthers of intergrade genetic stock compared to values in those of authentic genetic stock (105.6 +/- 72.1 micrograms/dl versus 59.3 +/- 19.7 micrograms/dl, respectively).

Transfusion-Free Cardiopulmonary Bypass in Jehovah’s Witness Patients Weighing Less Than 5 kg

PubMed Central

Boettcher, Wolfgang; Merkle, Frank; Huebler, Michael; Koster, Andreas; Schulz, Fritz; Kopitz, Michael; Kuppe, Hermann; Lange, Peter; Hetzer, Roland

2005-01-01

Abstract: Performing cardiac surgery on pediatric Jehovah’s Witness patients is a great challenge for the surgical team and especially for the perfusionist. Jehovah’s Witnesses reject blood transfusions on the grounds of their literal interpretation of passages of the Bible. In accordance with this belief, Jehovah’s Witnesses feel that it is also forbidden to retransfuse autologous blood that has been separated from their own circulatory system. We report the use of cardiopulmonary bypass (CPB) during open-heart surgery in three infants with a body weight of 4.5 kg, 3.5 kg, and 3.1 kg, respectively, without transfusion of blood components. A small-volume CPB circuit with a priming volume of 200 mL, including the arterial line filter, was designed to decrease the degree of hemodilution. A dedicated pediatric heart lung machine console with remote pump heads and intensive blood conservation efforts allowed the operation without the use of donor blood. The CPB circuits were primed with crystalloid solution only. The procedures were performed in normothermia or in moderate hypothermia. Pre-CPB hemoglobin levels were 10.8 g/dL, 10.6 g/dL, and 8.5 g/dL. The hemoglobin concentrations measured during CPB ranged from 5.9 to 6.5 g/dL, 6.4 to 6.8 g/dL, and 5.5 to 5.9 g/dL, respectively. The patients did not receive any blood or blood products during their entire hospital stay. PMID:16350381

Graduated driver licensing programs and fatal crashes of 16-year-old drivers: a national evaluation.

PubMed

Chen, Li-Hui; Baker, Susan P; Li, Guohua

2006-07-01

Implementation of graduated driver licensing programs is associated with reductions in crash rates of young drivers, but graduated driver licensing programs vary in their components. The impact of programs with different components is unknown. The purpose of this work was to determine which graduated driver licensing programs are associated with the greatest reductions in fatal motor vehicle crashes involving 16-year-old drivers. We conducted a retrospective study of all 16-year-old drivers involved in fatal crashes in the United States from 1994 through 2004 using data from the Fatality Analysis Reporting System and the US Census Bureau. We measured incidence rate ratios of fatal motor vehicle crashes involving 16-year-old drivers according to graduated driver licensing programs, adjusted for state and year. Compared with state quarters with no graduated driver licensing program components, reductions of 16% to 21% in fatal crash involvement rates of 16-year-old drivers occurred with programs that included > or = 3-month mandatory waiting period, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction. Reductions of 18% to 21% occurred in state quarters with programs that included > or = 5 of the 7 components examined. Drivers aged 20 to 24 or 25 to 29 years did not experience significant reductions. Comprehensive graduated driver licensing programs are associated with reductions of approximately 20% in 16-year-old drivers' fatal crash involvement rates. The greatest benefit seems to be associated with programs that include age requirements and > or = 3 months of waiting before the intermediate stage, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction.

Predictors of anemia among haitian children aged 6 to 59 months and women of childbearing age and their implications for programming.

PubMed

Heidkamp, Rebecca A; Ngnie-Teta, Ismael; Ayoya, Mohamed Ag A; Stoltzfus, Rebecca J; Mamadoultaibou, Aissa; Durandisse, Emmanuela Blain; Pierre, Joseline Marhone

2013-12-01

The Haitian National Nutrition Policy prioritizes prevention and treatment of anemia among mothers and young children, but there are few available data to support planning for scale-up of anemia interventions. To describe the prevalence and predictors of anemia among Haitian women (15 to 49 years) and children (6 to 59 months) and to draw implications for national nutrition programming. Descriptive and univariate analyses and multivariate logistic regression models were performed using data from the nationally representative Haitian Demographic Health Survey 2005/06. The prevalence of mild (hemoglobin 11.0 to 11.9 g/dL), moderate (hemoglobin 8.0 to 10.9 g/dL), and severe (hemoglobin < 8.0 g/dL) anemia was 19.2%, 21.7%, and 4.4%, respectively, among women aged 15 to 49 years and 22.9%, 33.9%. and 2.2% among children aged 6 to 59 months. Unexpectedly anemia was more prevalent in urban women (54.4 %) and children (65.1%) than in rural women (43.1%, p < .001) and children (55.7%, p = .004). In multivariate regression models, factors associated with anemia among urban women (birth spacing, p = .027; overweight BMI, p < .001; education level, p = .022) were different from those in rural women (wealth quintile, p < .05; employment, p = .003). Anemia in urban and rural children aged 6 to 59 months increased with child age (p < .05) and maternal anemia status (p = .004; p < .001). Female sex (p = .007) and maternal overweight (p = .009) were associated with reduced risk of anemia in rural children only. Anemia among Haitian young children and women of childbearing age is a severe public health problem. The findings suggest the need for context-specific rural and urban strategies, reinforcement of anemia prevention in health services reaching women of childbearing age, and targeted interventions for young children.

Precipitating Circumstances of Suicide and Alcohol Intoxication among U.S. Ethnic Groups

PubMed Central

Caetano, Raul; Kaplan, Mark S.; Huguet, Nathalie; Conner, Kenneth; McFarland, Bentson H.; Giesbrecht, Norman; Nolte, Kurt B.

2015-01-01

Background To assess the prevalence of nine different types of precipitating circumstances among suicide decedents, and examine the association between circumstances and post-mortem blood alcohol content (BAC ≥ 0.08 g/dl.) across U.S. ethnic groups. Methods Data come from the restricted 2003-2011 National Violent Death Reporting System (NVDRS), with post-mortem information on 59,384 male and female suicide decedents for 17 states of the U.S. Results Among men, precipitating circumstances statistically associated with a BAC ≥ 0.08 g/dl were physical health and job problems for Blacks, and experiencing a crisis, physical health problems and intimate partner problem for Hispanics. Among women, the only precipitating circumstance associated with a BAC ≥ 0.08 g/dl was substance abuse problems other than alcohol for Blacks. The number of precipitating circumstances present before the suicide was negatively associated with a BAC ≥ 0.08 g/dl for Whites, Blacks and Hispanics. Conclusions Selected precipitating circumstances were associated with a BAC ≥ 0.08 g/dl, and the strongest determinant of this level of alcohol intoxication prior to suicide among all ethnic groups was the presence of an alcohol problem. PMID:26173709

Calculation of effective transport properties of partially saturated gas diffusion layers

NASA Astrophysics Data System (ADS)

Bednarek, Tomasz; Tsotridis, Georgios

2017-02-01

A large number of currently available Computational Fluid Dynamics numerical models of Polymer Electrolyte Membrane Fuel Cells (PEMFC) are based on the assumption that porous structures are mainly considered as thin and homogenous layers, hence the mass transport equations in structures such as Gas Diffusion Layers (GDL) are usually modelled according to the Darcy assumptions. Application of homogenous models implies that the effects of porous structures are taken into consideration via the effective transport properties of porosity, tortuosity, permeability (or flow resistance), diffusivity, electric and thermal conductivity. Therefore, reliable values of those effective properties of GDL play a significant role for PEMFC modelling when employing Computational Fluid Dynamics, since these parameters are required as input values for performing the numerical calculations. The objective of the current study is to calculate the effective transport properties of GDL, namely gas permeability, diffusivity and thermal conductivity, as a function of liquid water saturation by using the Lattice-Boltzmann approach. The study proposes a method of uniform water impregnation of the GDL based on the "Fine-Mist" assumption by taking into account the surface tension of water droplets and the actual shape of GDL pores.

Measurement of effective bulk and contact resistance of gas diffusion layer under inhomogeneous compression - Part I: Electrical conductivity

NASA Astrophysics Data System (ADS)

Vikram, Ajit; Chowdhury, Prabudhya Roy; Phillips, Ryan K.; Hoorfar, Mina

2016-07-01

This paper describes a measurement technique developed for the determination of the effective electrical bulk resistance of the gas diffusion layer (GDL) and the contact resistance distribution at the interface of the GDL and the bipolar plate (BPP). The novelty of this study is the measurement and separation of the bulk and contact resistance under inhomogeneous compression, occurring in an actual fuel cell assembly due to the presence of the channels and ribs on the bipolar plates. The measurement of the electrical contact resistance, contributing to nearly two-third of the ohmic losses in the fuel cell assembly, shows a non-linear distribution along the GDL/BPP interface. The effective bulk resistance of the GDL under inhomogeneous compression showed a decrease of nearly 40% compared to that estimated for homogeneous compression at different compression pressures. Such a decrease in the effective bulk resistance under inhomogeneous compression could be due to the non-uniform distribution of pressure under the ribs and the channels. This measurement technique can be used to identify optimum GDL, BPP and channel-rib structures based on minimum bulk and contact resistances measured under inhomogeneous compression.

Geometric Design Laboratory Fact Sheet

DOT National Transportation Integrated Search

2006-08-02

This fact sheet provides concise information about the Geometric Design Laboratory (GDL) at the Turner-Fairbank Highway Research Center. The mission of the GDL is to provide technical support to the Federal Highway Administration's Office of Safety R...

Online data analysis using Web GDL

NASA Astrophysics Data System (ADS)

Jaffey, A.; Cheung, M.; Kobashi, A.

2008-12-01

The ever improving capability of modern astronomical instruments to capture data at high spatial resolution and cadence is opening up unprecedented opportunities for scientific discovery. When data sets become so large that they cannot be easily transferred over the internet, the researcher must find alternative ways to perform data analysis. One strategy is to bring the data analysis code to where the data resides. We present Web GDL, an implementation of GDL (GNU Data Language, open source incremental compiler compatible with IDL) that allows users to perform interactive data analysis within a web browser.

Development and Field Test of Competency Based Instructional Material for a Career Mobility Program for Licensed Practical Nurses. Final Report.

ERIC Educational Resources Information Center

Bergen Community Coll., Paramus, NJ.

The Associate Degree Nursing Program at Bergen Community College developed and field tested competency-based instructional modules in a program designed to allow licensed practical nurses to qualify to take the certification examination for registered nurses after a year of study. Thirteen licensed practical nurses were enrolled in the first class…

Interactions between liquid-water and gas-diffusion layers in polymer-electrolyte fuel cells

DOE PAGES

Das, Prodip K.; Santamaria, Anthony D.; Weber, Adam Z.

2015-06-11

Over the past few decades, a significant amount of research on polymer-electrolyte fuel cells (PEFCs) has been conducted to improve performance and durability while reducing the cost of fuel cell systems. However, the cost associated with the platinum (Pt) catalyst remains a barrier to their commercialization and PEFC durability standards have yet to be established. An effective path toward reducing PEFC cost is making the catalyst layers (CLs) thinner thus reducing expensive Pt content. The limit of thin CLs is high gas-transport resistance and the performance of these CLs is sensitive to the operating temperature due to their inherent lowmore » water uptake capacity, which results in higher sensitivity to liquid-water flooding and reduced durability. Therefore, reducing PEFC's cost by decreasing Pt content and improving PEFC's performance and durability by managing liquid-water are still challenging and open topics of research. An overlooked aspect nowadays of PEFC water management is the gas-diffusion layer (GDL). While it is known that GDL's properties can impact performance, typically it is not seen as a critical component. In this work, we present data showing the importance of GDLs in terms of water removal and management while also exploring the interactions between liquid-water and GDL surfaces. The critical interface of GDL and gas-flow-channel in the presence of liquid-water was examined through systematic studies of adhesion forces as a function of water-injection rate for various GDLs of varying thickness. GDL properties (breakthrough pressure and adhesion force) were measured experimentally under a host of test conditions. Specifically, the effects of GDL hydrophobic (PTFE) content, thickness, and water-injection rate were examined to identify trends that may be beneficial to the design of liquid-water management strategies and next-generation GDL materials for PEFCs.« less

Liquid Water Saturation and Oxygen Transport Resistance in Polymer Electrolyte Membrane Fuel Cell Gas Diffusion Layers

NASA Astrophysics Data System (ADS)

Muirhead, Daniel

In this thesis, the relative humidity (RH) of the cathode reactant gas was investigated as a factor which influences gas diffusion layer (GDL) liquid water accumulation and mass transport-related efficiency losses over a range of operating current densities in a polymer electrolyte membrane (PEM) fuel cell. Limiting current measurements were used to characterize fuel cell oxygen transport resistance while simultaneous measurements of liquid water accumulation were conducted using synchrotron X-ray radiography. GDL porosity distributions were characterized with micro-computed tomography (microCT). The work presented here can be used by researchers to develop improved numerical models to predict GDL liquid water accumulation and to inform the design of next-generation GDL materials to mitigate mass transport-related efficiency losses. This work also contributes an extensive set of concurrent performance and liquid water visualization data to the PEM fuel cell field that can be used for validating multiphase transport models.

Automobile-dependency as a barrier to vision zero, evidence from the states in the USA.

PubMed

Ahangari, Hamed; Atkinson-Palombo, Carol; Garrick, Norman W

2017-10-01

With a traffic fatality rate of 10.6 per 100,000 as of 2013-more than triple that in the UK, the Netherlands, and Sweden-the United States has the worst traffic safety performance of all developed countries. Statewide variations are even more pronounced. North Dakota registers more than twice the national average and five times the rate of Massachusetts. We used panel models and annual data from 1997 to 2013 to capture the effect of seven separate sets of factors that influence traffic safety: exposure, travel behavior, socioeconomics, macroeconomics, safety policies, and mitigating factors such as health care. The results of our panel models and supplementary analysis of state effects show that two variables - Vehicle Miles Traveled and Vehicles per Capita-have the strongest impact on traffic fatality rates. This is closely followed by Infant Mortality Rates, the proxy that we used to represent the quality of health care. Policy levers such as Graduated Driver's Licenses (GDL) have improved safety, but to a limited extent. We also found that states with higher urban density and more walking are associated with lower traffic fatality rates. Taken as a whole, our findings suggest that if additional progress is to be made in reducing traffic fatalities, emphasis needs to move beyond simply focusing on policies such as GDL and seat belt laws, which have already been adopted by almost all jurisdictions across the United States. We need to also consider factors that focus on the type of urban form that we are creating to ensure that we are fostering environments that encourage multi-modal transportation such as walking to reduce the VMT and Vehicles per Capita, the two strongest predictors of traffic fatalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

42 CFR 431.703 - Licensing requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Licensing Nursing Home Administrators § 431.703 Licensing requirement. The State licensing program must provide that only nursing homes supervised by an administrator licensed in accordance with the... 42 Public Health 4 2010-10-01 2010-10-01 false Licensing requirement. 431.703 Section 431.703...

75 FR 62692 - Dairy Import Licensing Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-13

... intended to improve program administration and reflect ongoing changes in the markets for cheese and other... the markets for cheese and other dairy products subject to import licensing requirements. The historical licenses provide for orderly importation of a wide variety of cheeses and permit companies to...

The importance of context in logic model construction for a multi-site community-based Aboriginal driver licensing program.

PubMed

Cullen, Patricia; Clapham, Kathleen; Byrne, Jake; Hunter, Kate; Senserrick, Teresa; Keay, Lisa; Ivers, Rebecca

2016-08-01

Evidence indicates that Aboriginal people are underrepresented among driver licence holders in New South Wales, which has been attributed to licensing barriers for Aboriginal people. The Driving Change program was developed to provide culturally responsive licensing services that engage Aboriginal communities and build local capacity. This paper outlines the formative evaluation of the program, including logic model construction and exploration of contextual factors. Purposive sampling was used to identify key informants (n=12) from a consultative committee of key stakeholders and program staff. Semi-structured interviews were transcribed and thematically analysed. Data from interviews informed development of the logic model. Participants demonstrated high level of support for the program and reported that it filled an important gap. The program context revealed systemic barriers to licensing that were correspondingly targeted by specific program outputs in the logic model. Addressing underlying assumptions of the program involved managing local capacity and support to strengthen implementation. This formative evaluation highlights the importance of exploring program context as a crucial first step in logic model construction. The consultation process assisted in clarifying program goals and ensuring that the program was responding to underlying systemic factors that contribute to inequitable licensing access for Aboriginal people. Copyright © 2016 Elsevier Ltd. All rights reserved.

Randomized double-blind trial of darbepoetin alfa in patients with symptomatic heart failure and anemia.

PubMed

Ghali, Jalal K; Anand, Inder S; Abraham, William T; Fonarow, Gregg C; Greenberg, Barry; Krum, Henry; Massie, Barry M; Wasserman, Scott M; Trotman, Marie-Louise; Sun, Yan; Knusel, Beat; Armstrong, Paul

2008-01-29

Substantial evidence suggests that anemia is an independent risk factor for worse outcomes in patients with heart failure (HF). The Study of Anemia in Heart Failure Trial (STAMINA-HeFT) is the largest multicenter, randomized, double-blind, placebo-controlled trial to date evaluating the effect of treating anemia in HF. Patients (N=319) with symptomatic HF, left ventricular ejection fraction < or = 40%, and hemoglobin > or = 9.0 g/dL and < or = 12.5 g/dL were randomized (double-blind) to placebo (N=157) or darbepoetin alfa (N=162) subcutaneously every 2 weeks for 1 year (target hemoglobin, 14.0+/-1.0 g/dL). The primary end point was change from baseline to week 27 in treadmill exercise time. Secondary end points were change from baseline in New York Heart Association class and quality of life at week 27. An additional prespecified efficacy analysis included the time to death by any cause or first HF-related hospitalization by 1 year. At baseline, the median (interquartile range) hemoglobin was 11.4 (10.9, 12.0) g/dL. At week 27, darbepoetin alfa treatment increased median (interquartile range) hemoglobin by 1.8 (1.1, 2.5) g/dL (placebo, 0.3 [-0.2, 1.0] g/dL; P<0.001). Of the patients treated with darbepoetin alfa, 85% achieved 2 consecutive hemoglobin levels of 14.0+/-1.0 g/dL during the study and experienced a hemoglobin increase of > or = 1.0 g/dL from baseline. By intent-to-treat analysis, darbepoetin alfa treatment did not significantly improve exercise duration, New York Heart Association class, or quality of life score compared with placebo. A nonsignificant trend was observed toward a lower risk of all-cause mortality or first HF hospitalization in darbepoetin alfa-treated patients compared with placebo (hazard ratio, 0.68; 95% CI, 0.43, 1.08; P=0.10). Occurrences of adverse events were similar in both treatment groups. In this study of patients with symptomatic HF and anemia, treatment with darbepoetin alfa was not associated with significant clinical benefits. Darbepoetin alfa treatment was well tolerated and effectively raised hemoglobin. A trend of lower risk of morbidity and mortality was observed.

The role of albumin and endoplasmic reticulum in pathogenesis Preeclampsia. Changes of GRP78 and placental VEGF in preeclampsia.

PubMed

Aditiawarman

2014-07-01

Preeclampsia remains the highest causes of maternal mortality in Indonesia. This disease is known as "the disease of theories" since the etiology of this disease still obscure, but it is clearly accepted that this disease is correlated with placenta. The incidence of this disease increased in dr. Soetomo General Hospital during economic crisis in Indonesia, as nutritional problem occurred, but correlation between nutrition to preeclampsia still unclear. This study was conducted to find out the influence of hypoalbuminemia caused by alteration of amino acids and changes of GRP78 and placental VEGF in preeclampsia. It was cross-sectional study among 10 patients with preeclampsia albumin ⩽ gram/dL and 9 patients with preeclampsia albumin >3g/dL. Placenta collected was homogenized and blood was separated from the cells. Placental lysat, serum and plasma were stored -87°C until laboratory analysis for GRP78 and VEGF. Data were analyzed using student t test, Manova. Pearson correlation, simple and multiple regressions. There were alterations of amino acid's profile among albumin ⩽3g/dL compare with albumin >3g/dL. GRP78 concentration on albumin ⩽3g/dL group was higher, but were not significant. Weak negative correlation between albumins to GRP78 was found. Negative correlation were found in the groups of albumin ⩽3g/dL - GRP⩽425μg/dL, but significant result only on albumin ⩽3g/dL - GRP⩽425μg/dL. Positive correlation were found in the group of albumin >3g/dL - GRP>425μg/dL. Response of Endoplasmic Reticulum Stress appeared different depends on levels of albumin (stressor) and GRP78 (stress response protein). Placental VEGF were significantly lower in albumin ⩽3g/dL (p<0.05). Correlation between GRP78 on placental VEGF was negative with coefficient correlation was 3.8%. Placental VEGF profoundly decreased as correlation between albumin and GRP78 stronger. Alteration of amino acids profile influenced Albumin concentration. Hypoalbuminemia was a stressor that induced reticulum endoplasmic response by increasing GRP78, decreasing placental VEGF. Responses of Endoplasmic Reticulum Stress depend on levels of stressor (albumin) and stress response protein (GRP78). Copyright © 2014 International Society for the Study of Hypertension in Pregnancy.

Diffusion coefficients of oxygen and hemoglobin measured by facilitated oxygen diffusion through hemoglobin solutions.

PubMed

Bouwer, S T; Hoofd, L; Kreuzer, F

1997-03-07

Diffusion coefficients of oxygen (DO2) and hemoglobin (DHb) were obtained from measuring the oxygen flux through thin layers of hemoglobin solutions at 20 degrees C. The liquid layers were supported by a membrane and not soaked in any filter material. Oxygen fluxes were measured from the changes in oxygen partial pressure in the gas phases at both sides of the layer. A mathematical treatment is presented for correct evaluation of the measurements. Measurements were done for bovine and for human hemoglobin. Hemoglobin concentrations (CHb) were between 11 and 42 g/dl, which covers the concentrations in the erythrocyte. Both DO2 and DHb could be fitted to the empirical equation D = D0(1-CHb/C1)10-CHb/C2. The following parameters were obtained: DO = 1.80 x 10(-9) m2/s, C1 = 100 g/dl, C2 = 119 g/dl, for oxygen and D0 = 7.00 x 10(-11) m2/s, C1 = 46 g/dl, C2 = 128 g/dl, for hemoglobin. No difference between the diffusion coefficients of bovine or human hemoglobin was found. The diffusion coefficients of hemoglobin were higher than most values reported in the literature, probably because in this study the mobility of hemoglobin was not hindered by surrounding filter material.

42 CFR 431.705 - Licensing authority.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Nursing Home Administrators § 431.705 Licensing authority. (a) The State licensing program must provide for licensing of nursing home administrators by— (1) The agency designated under the healing arts act...

Family Day Care Training Curriculum (Lao).

ERIC Educational Resources Information Center

Nakatsu, Gail

California's Family Day Care Training Program was designed to recruit and train, in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses for family day care, state licensing requirements for family…

Family Day Care Training Curriculum.

ERIC Educational Resources Information Center

Nakatsu, Gail

California's Family Day Care Training Program was designed to recruit and train in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses for family day care, state licensing requirements for family…

Delayed hemolytic transfusion reaction presenting as a painful crisis in a patient with sickle cell anemia.

PubMed

Fabron, A; Moreira, G; Bordin, J O

1999-01-07

Patients with sickle cell anemia (SCA) are frequently transfused with red blood cells (RBC). Recently we reported that the calculated risk of RBC alloimmunization per transfussed unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR) presenting as a painful crisis in a patient with SCA. A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb) was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39 degrees C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient's extended RBC phenotype was CDe, K-k+, Kp(a-b+), Fy(a-b-), M+N+s+, Le(a+b-), Di(a-). An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.

Impact of Anemia in Critically Ill Burned Casualties Evacuated From Combat Theater via US Military Critical Care Air Transport Teams.

PubMed

Hamilton, Joshua A; Mora, Alejandra G; Chung, Kevin K; Bebarta, Vikhyat S

2015-08-01

US military Critical Care Air Transport Teams (CCATT) transport critically ill burn patients out of theater. Blood transfusion may incur adverse effects, and studies report lower hemoglobin (Hgb) value may be safe for critically ill patients. There are no studies evaluating the optimal Hgb value for critically ill burn patients prior to CCATT evacuation. The aim of the study was to determine if critically ill burn casualties with an Hgb of 10 g/dL or less, transported via CCATT, have similar clinical outcomes at 30 days as compared with patients with an Hgb of greater than 10 g/dL. We conducted an institutional review board-approved retrospective cohort study involving patients transported via CCATT. We separated our study population into two cohorts based on Hgb levels at the time of theater evacuation: Hgb ≤10 g/dL or Hgb ≥10 g/dL. We compared demographics, injury description, physiologic parameters, and clinical outcomes. Of the 140 subjects enrolled, 29 were Hgb ≤10, and 111 were Hgb ≥10. Both groups were similar in age and percent total body surface area burned. Those Hgb ≤10 had a higher injury severity score (34 ± 19.8 vs. 25 ± 16.9, P = 0.02) and were more likely to have additional trauma (50% vs. 25%, P = 0.04). Modeling revealed no persistent differences in mortality, and other clinical outcomes measured. Critical Care Air Transport Teams transport of critically ill burn patients with an Hgb of 10 g/dL or less had no significant differences in complications or mortality as compared with patients with an Hgb of greater than 10 g/dL. In this study, lower hemoglobin levels did not confer greater risk for worse outcomes.

Low Diagnostic Utility of Rechecking Hemoglobins Within 24 Hours in Hospitalized Patients.

PubMed

Rajkomar, Alvin; McCulloch, Charles E; Fang, Margaret C

2016-11-01

Clinicians often repeat hemoglobin tests within a 24 hour period to detect or monitor anemia. We sought to determine the percentage of hemoglobin tests repeated within a single hospital day that were at least 1.0 g/dL lower than the first test. We performed a retrospective cross-sectional analysis of hospitalized adults on medical or surgical services over 1 year at a single academic hospital. Using patient and laboratory data in the electronic health record, we analyzed the proportion of repeated hemoglobin test results that were at least 1 g/dL less than the initial hemoglobin value of that day, excluding days when transfusions were administered. A total of 88,722 hemoglobin tests were obtained from 12,877 unique patients, who contributed a total of 86,859 hospitalization days. In 12,230 (14.1%) of those days, 2 or more hemoglobin tests were obtained within a single day. In the 6969 days with 2 hemoglobin tests obtained and no transfusions given, 949 (13.5%) were ≥1 g/dL lower than the initial hemoglobin value of that day, and 260 (3.7%) were ≥2 g/dL lower. Repeated tests did not often reach transfusion thresholds: 482 (6.9%) of repeat hemoglobin values were <8 g/dL, and 64 (0.9%) were <7 g/dL. Hemoglobin tests were repeated in 14% of hospital days. For patients who had 2 hemoglobin tests obtained on the same day, 13.5% demonstrated a clinically significant drop. This information may be helpful to clinicians when considering whether repeat testing is appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.

Relationship between the degree of perineal trauma at vaginal birth and change in haemoglobin concentration.

PubMed

Rubio-Álvarez, Ana; Molina-Alarcón, Milagros; Hernández-Martínez, Antonio

2017-10-01

Postpartum anaemia is a problem with high prevalence that significantly affects maternal recovery. Among the causal factors is perineal trauma. However, it is still not known what degree of perineal trauma produces a greater reduction of haemoglobin. To assess the relationship between the degree of perineal trauma and change in haemoglobin concentration at vaginal birth. An observational, analytical retrospective cohort study was performed at the Mancha-Centro Hospital (Spain) during the period 2010-2014. Data were collected regarding 3479 women who gave birth vaginally. The main outcome variable was the change in haemoglobin concentration. Multivariate analysis by means of multiple linear regression was performed to control possible confounding factors and to determine the net effect of each degree of perineal trauma on haemoglobin reduction. Of the total sample, 20.1% of women (699) had an intact perineum, 41.6% (1446) experienced some form of perineal trauma, but not episiotomy, and the remaining 38.3% of women (1334) underwent an episiotomy. The average reduction of haemoglobin was 1.46g/dL (Standard Deviation (SD)=1.09g/dL) for women without episiotomy with a second degree tear and 2.07g/dL (SD=1.24g/dL) for women who had an episiotomy and no perineal tear. The greatest reduction occurred among women with episiotomy and a third or fourth degree tear with a decrease of 3.10g/dL (SD=1.32g/dL). Episiotomy is related to greater reduction of haemoglobin concentration in comparison with all degrees of spontaneous perineal trauma. The use of episiotomy should be strictly limited. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Transfusion-free management of gastrointestinal bleeding: the experience of a bloodless institute.

PubMed

Sharma, Prabin; Barajas, Francisco J; Krishnamoorthy, Parasuram; Campo, Lyna M; Blumenthal, Ezra; Spinnell, Mitchell

2015-03-01

The Institute for Patient Blood Management and Bloodless Medicine at the Englewood Hospital has considerable experience in managing patients with gastrointestinal bleeding who do not accept blood-derived products. We present our data and experience over the last 8 years in managing such patients. There is paucity of data on management and outcomes of gastrointestinal bleeding in patients who do not accept blood-derived products. We performed a retrospective study of patients from 2003 to 2011 presenting with gastrointestinal bleeding who do not accept blood-derived products. Inclusion criteria were either overt bleeding with a presenting hemoglobin (Hb) of <12 g/dL or a decrease in Hb of >1.5 g/dL. Ninety-six patients who met the inclusion criteria were included. Forty-one upper and 48 lower gastrointestinal bleeding sources were identified. Mean Hb was 8.8 g/dL and mean nadir was 6.9 g/dL. Among 37 patients (80.5%) with Hb ≤6.0 g/dL, 30 (81%) survived. Four of 7 patients (57%) with a Hb <3 g/dL survived. The overall mortality rate was 10.4%. In unadjusted logistic regression models, age [1.06 (1.01-1.12 y)], admission to ICU [6.37(1.27-31.9)], and anticoagulation use [6.95 (1.57-30.6)] were associated with increased mortality. Initial Hb [0.68 (0.51-0.92)] and nadir Hb [0.48 (0.29-0.78)] inversely predicted mortality. These results suggest that transfusion-free management of gastrointestinal hemorrhage can be effective with mortality comparable with the general population accepting medically indicated transfusion. Management of these patients is challenging and requires a dedicated multidisciplinary team approach knowledgeable in techniques of blood conservation.

Development and validation of a competitive enzyme-linked immunosorbent assay for the measurement of total plasma immunoglobulins in healthy loggerhead sea (Caretta caretta) and green turtles (Chelonia mydas).

PubMed

Kaplan, Amy J; Stacy, Nicole I; Jacobson, Elliott; Le-Bert, Carolina R; Nollens, Hendrik H; Origgi, Francesco C; Green, Linda G; Bootorabi, Shadi; Bolten, Alan; Hernandez, Jorge A

2016-01-01

The quantification of circulating plasma immunoglobulins represents a valuable diagnostic tool in human and veterinary immunology, although its application is very limited in reptile medicine to date. The objectives of our study were the development and standardization of a competitive enzyme-linked immunosorbent assay (cELISA) for the measurement of total plasma immunoglobulins (Igs; both IgM and IgY) in loggerhead sea turtles (LST; Caretta caretta; n = 254) and green turtles (GT; Chelonia mydas; n = 111), the establishment of reference intervals for Ig for both species, and the examination of associations between Ig and total protein (TP), condition index, and water temperature. The cELISA for Ig was successfully developed and optimized. Reference intervals for Ig were 0.38-0.94 g/dL in LST (median: 0.59 g/dL; range: 0.16-2.15 g/dL) and 0.40-0.85 g/dL in GT (median: 0.58 g/dL; range: 0.18-1.80 g/dL). In LST, there were positive linear relationships of Ig with TP, and TP with Ig and condition index, and a negative relationship of Ig with condition index. The positive linear relationships of Ig with TP, and TP with Ig were also identified in GT. These positive associations of Ig and TP were expected, as Ig represents fractions of TP, and TP reportedly increases with straight carapace length and weight. The negative association of Ig with condition index may indicate potential biological variations. The cELISA and reference intervals for total Ig of LST and GT presented herein have the potential to be useful as a diagnostic and research tool for sea turtle immunology. © 2015 The Author(s).

Variability in blood and blood component utilization as assessed by an anesthesia information management system.

PubMed

Frank, Steven M; Savage, Will J; Rothschild, Jim A; Rivers, Richard J; Ness, Paul M; Paul, Sharon L; Ulatowski, John A

2012-07-01

Data can be collected for various purposes with anesthesia information management systems. The authors describe methods for using data acquired from an anesthesia information management system to assess intraoperative utilization of blood and blood components. Over an 18-month period, data were collected on 48,086 surgical patients at a tertiary care academic medical center. All data were acquired with an automated anesthesia recordkeeping system. Detailed reports were generated for blood and blood component utilization according to surgical service and surgical procedure, and for individual surgeons and anesthesiologists. Transfusion hemoglobin trigger and target concentrations were compared among surgical services and procedures, and between individual medical providers. For all patients given erythrocytes, the mean transfusion hemoglobin trigger was 8.4 ± 1.5, and the target was 10.2 ± 1.5 g/dl. Variation was significant among surgical services (trigger range: 7.5 ± 1.2-9.5 ± 1.1, P = 0.0001; target range: 9.1 ± 1.2-11.3 ± 1.4 g/dl, P = 0.002), surgeons (trigger range: 7.2 ± 0.7-9.8 ± 1.0, P = 0.001; target range: 8.8 ± 0.9-11.8 ± 1.3 g/dl, P = 0.001), and anesthesiologists (trigger range: 7.2 ± 0.8-9.6 ± 1.2, P = 0.001; target range: 9.0 ± 0.9-11.7 ± 1.3 g/dl, P = 0.0004). The use of erythrocyte salvage, fresh frozen plasma, and platelets varied threefold to fourfold among individual surgeons compared with their peers performing the same surgical procedure. The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.

Capillary-scale direct measurement of hemoglobin concentration of erythrocytes using photothermal angular light scattering.

PubMed

Kim, Uihan; Song, Jaewoo; Lee, Donghak; Ryu, Suho; Kim, Soocheol; Hwang, Jaehyun; Joo, Chulmin

2015-12-15

We present a direct, rapid and chemical-free detection method for hemoglobin concentration ([Hb]), based on photothermal angular light scattering. The iron oxides contained in hemoglobin molecules exhibit high absorption of 532-nm light and generate heat under the illumination of 532-nm light, which subsequently alters the refractive index of blood. We measured this photothermal change in refractive index by employing angular light scattering spectroscopy with the goal of quantifying [Hb] in blood samples. Highly sensitive [Hb] measurement of blood samples was performed by monitoring the shifts in angularly dispersed scattering patterns from the blood-loaded microcapillary tubes. Our system measured [Hb] over the range of 0.35-17.9 g/dL with a detection limit of ~0.12 g/dL. Our sensor was characterized by excellent correlation with a reference hematology analyzer (r>0.96), and yielded a precision of 0.63 g/dL for a blood sample of 9.0 g/dL. Copyright © 2015 Elsevier B.V. All rights reserved.

Study on the water flooding in the cathode of direct methanol fuel cells.

PubMed

Im, Hun Suk; Kim, Sang-Kyung; Lim, Seongyop; Peck, Dong-Hyun; Jung, Doohwan; Hong, Won Hi

2011-07-01

Water flooding phenomena in the cathode of direct methanol fuel cells were analyzed by using electrochemical impedance spectroscopy. Two kinds of commercial gas diffusion layers with different PTFE contents of 5 wt% (GDL A5) and 20 wt% (GDL B20) were used to investigate the water flooding under various operating conditions. Water flooding was divided into two types: catalyst flooding and backing flooding. The cathode impedance spectra of each gas diffusion layer was obtained and compared under the same conditions. The diameter of the capacitive semicircle became larger with increasing current density for both, and this increase was greater for GDL B20 than GDL A5. Catalyst flooding is dominant and backing flooding is negligible when the air flow rate is high and current density is low. An equivalent model was suggested and fitted to the experimental data. Parameters for catalyst flooding and backing flooding were individually obtained. The capacitance of the catalyst layer decreases as the air flow rate decreases when the catalyst flooding is dominant.

Evaluation of citric acid and GDL in the recovery at different pH levels of Clostridium sporogenes PA 3679 spores subjected to HTST treatment conditions.

PubMed

Silla Santos, M H; Torres Zarzo, J

1996-04-01

Spores of Clostridium sporogenes PA 3679 were treated at different temperatures (121, 126, 130 and 135 degrees C) in white asparagus purée (pH 5.8) and acidified with glucono-delta-lactone (GDL) and citric acid to pH levels of 5.5, 5.0 and 4.5. Afterwards, the spores were recovered in MPA3679 medium in various conditions: unacidified (pH 7.5), acidified with GDL (500 ppm) and acidified with citric acid (500 and 250 ppm) to pH levels of 6.5, 6.0 and 5.0. The results indicated that the pH levels, concentration and type of acid used act synergistically rather than independently. Citric acid has a stronger inhibiting effect than GDL on the recovery of C. sporogenes PA 3679 spores. At the higher heat treatments (130 and 135 degrees C) the major injury on the spores sensitize more than against the acids and low pH values.

Changing trends in blood transfusion in children and neonates admitted in Kilifi District Hospital, Kenya.

PubMed

Pedro, Rosalon; Akech, Samuel; Fegan, Greg; Maitland, Kathryn

2010-10-30

Severe anaemia is a common cause for hospitalization in children in sub-Saharan Africa. Malaria plays an important aetiological role, resulting in a substantial burden of paediatric transfusion in hospitals. A decline in malaria and paediatric admissions to the Kilifi District Hospital has been reported recently. This study aimed to investigate whether this trend affected clinical burden, clinical severity of anaemia and requirements for paediatric transfusion. Eight-year retrospective review of paediatric admissions to Kilifi District Hospital, Kenya describing the frequency of moderate and severe anaemia, blood transfusion and case fatality over time. Definitions for severe anaemia were Hb <8 g/dl for newborns and <5 g/dl for other age groups and for moderate anaemia was Hb 8 to <11 g/dl for newborns and 5 to <9.3 g/dl for other age groups. Life threatening anaemia was defined as severe anaemia (Hb <5 g/dl) complicated by either deep breathing or prostration or profound anaemia (Hb <4 g/dl) alone. Of the 35,139 admissions 13,037 (37%) had moderate anaemia and 2,265 (6%) had severe anaemia; respiratory distress complicated 35% of cases with Hb <5 g/dl. Concurrent with the decline in malaria there was a marked decline in the prevalence of severe anaemia between 2002 (8%) and 2009 (< 4%) (chi2 for trend = 134, P < 0.0001). The number and proportion of admissions transfused also declined significantly over this time (chi2 for trend = 152, P < 0.0001). Of the 2,265 children with severe anaemia 191 (8%) died. Case fatality remained unchanged during this period (P < 0.26) and was largely explained by the unchanged proportion with life-threatening anaemia, present in 58-65% of cases throughout the study period. The impact of reduced malaria transmission on child morbidity has positive public benefits on the demand and use of blood for paediatric transfusion. Despite an overall reduction in paediatric transfusion requirement, case fatality of severe anaemia remained unchanged over this decade. Further research is required to improve outcome from severe anaemia, particularly in the high-risk group with life threatening features.

Common hand sanitizer may distort readings of breathalyzer tests in the absence of acute intoxication.

PubMed

Ali, Syed S; Wilson, Michael P; Castillo, Edward M; Witucki, Peter; Simmons, Todd T; Vilke, Gary M

2013-02-01

The use of alcohol-based hand sanitizers has recently become widespread. To the authors' knowledge, no previous study has examined whether application of ethanol-based hand sanitizers by the person operating a common breathalyzer machine will affect the accuracy of the readings. This was a prospective study investigating whether the use of hand sanitizer applied according to manufacturer's recommendations (Group I), applied improperly at standard doses (Group II), or applied improperly at high doses (Group III) had an effect on breathalyzer readings of individuals who had not ingested alcohol. The participants of the prospective study were divided into three groups to assess the effect of hand sanitizer on breathalyzer readings. Group I used one pump (1.5 mL) of hand sanitizer (Purell), allowing the hands to dry per manufacturer's recommendations; Group II used one pump (1.5 mL), without allowing the hands to dry; and Group III used two pumps (3 mL), without allowing the hands to dry. Breathalyzer measures for each group are presented as medians with interquartile ranges (IQR) and ranges. Differences between each sequential group (I vs. II and II vs. III) were assessed using a Mann-Whitney U-test (p < 0.05 significant). There were 25 study participants in each group for a total of 75 participants. The initial breathalyzer readings of all study participants were 0.000 g/dL. The median breathalyzer reading was 0.004 g/dL in Group I (IQR = 0.001 to 0.008 g/dL), 0.051 g/dL in Group II (IQR = 0.043 to 0.064 g/dL), and 0.119 g/dL in Group III (IQR = 0.089 to 0.134 g/dL). Measures between each subsequent group were all statistically different (p < 0.001). The use of common alcohol-based hand sanitizer may cause false-positive readings with a standard hospital breathalyzer when the operator uses the hand sanitizer correctly. The breathalyzer readings are further elevated if more sanitizer is used or if it is not allowed to dry appropriately. © 2013 by the Society for Academic Emergency Medicine.

The Gamma Gap and All-Cause Mortality

PubMed Central

Juraschek, Stephen P.; Moliterno, Alison R.; Checkley, William; Miller, Edgar R.

2015-01-01

Background The difference between total serum protein and albumin, i.e. the gamma gap, is a frequently used clinical screening measure for both latent infection and malignancy. However, there are no studies defining a positive gamma gap. Further, whether it is an independent risk factor of mortality is unknown. Methods and Findings This study examined the association between gamma gap, all-cause mortality, and specific causes of death (cardiovascular, cancer, pulmonary, or other) in 12,260 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999–2004. Participants had a comprehensive metabolic panel measured, which was linked with vital status data from the National Death Index. Cause of death was based on ICD10 codes from death certificates. Analyses were performed with Cox proportional hazards models adjusted for mortality risk factors. The mean (SE) age was 46 (0.3) years and the mean gamma gap was 3.0 (0.01) g/dl. The population was 52% women and 10% black. During a median follow-up period of 4.8 years (IQR: 3.3 to 6.2 years), there were 723 deaths. The unadjusted 5-year cumulative incidences across quartiles of the gamma gap (1.7–2.7, 2.8–3.0, 3.1–3.2, and 3.3–7.9 g/dl) were 5.7%, 4.2%, 5.5%, and 7.8%. After adjustment for risk factors, participants with a gamma gap of ≥3.1 g/dl had a 30% higher risk of death compared to participants with a gamma gap <3.1 g/dl (HR: 1.30; 95%CI: 1.08, 1.55; P = 0.006). Gamma gap (per 1.0 g/dl) was most strongly associated with death from pulmonary causes (HR 2.22; 95%CI: 1.19, 4.17; P = 0.01). Conclusions The gamma gap is an independent risk factor for all-cause mortality at values as low as 3.1 g/dl (in contrast to the traditional definition of 4.0 g/dl), and is strongly associated with death from pulmonary causes. Future studies should examine the biologic pathways underlying these associations. PMID:26629820

Multiphase transport in polymer electrolyte membrane fuel cells

NASA Astrophysics Data System (ADS)

Gauthier, Eric D.

Polymer electrolyte membrane fuel cells (PEMFCs) enable efficient conversion of fuels to electricity. They have enormous potential due to the high energy density of the fuels they utilize (hydrogen or alcohols). Power density is a major limitation to wide-scale introduction of PEMFCs. Power density in hydrogen fuel cells is limited by accumulation of water in what is termed fuel cell `flooding.' Flooding may occur in either the gas diffusion layer (GDL) or within the flow channels of the bipolar plate. These components comprise the electrodes of the fuel cell and balance transport of reactants/products with electrical conductivity. This thesis explores the role of electrode materials in the fuel cell and examines the fundamental connection between material properties and multiphase transport processes. Water is generated at the cathode catalyst layer. As liquid water accumulates it will utilize the largest pores in the GDL to go from the catalyst layer to the flow channels. Water collects to large pores via lateral transport at the interface between the GDL and catalyst layer. We have shown that water may be collected in these large pores from several centimeters away, suggesting that we could engineer the GDL to control flooding with careful placement and distribution of large flow-directing pores. Once liquid water is in the flow channels it forms slugs that block gas flow. The slugs are pushed along the channel by a pressure gradient that is dependent on the material wettability. The permeable nature of the GDL also plays a major role in slug growth and allowing bypass of gas between adjacent channels. Direct methanol fuel cells (DMFCs) have analogous multiphase flow issues where carbon dioxide bubbles accumulate, `blinding' regions of the fuel cell. This problem is fundamentally similar to water management in hydrogen fuel cells but with a gas/liquid phase inversion. Gas bubbles move laterally through the porous GDL and emerge to form large bubbles within the flow channel. We have compared the role of GDL materials in liquid drop and gas bubble formation and movement within fuel cells.

Driving decisions when leaving electronic music dance events: driver, passenger, and group effects.

PubMed

Johnson, Mark B; Voas, Robert B; Miller, Brenda A

2012-01-01

The goal of this article was to identify characteristics of drivers and passengers that predicted peer groups whose drivers exit dance clubs with alcohol levels indicative of impairment (blood alcohol content [BAC] ≥ 0.05 g/dL). We used the portal survey methodology to randomly sample groups of electronic music dance event (EMDE) patrons as they entered and exited a club. From May through November 2010, data were collected from 38 EMDEs hosted by 8 clubs in the San Francisco Bay area. Data included in these analyses are results from breath samples for measuring BAC and self-report data on demographics, recent drinking history drinking, drinking intentions, travel to and from the clubs, and the familiarity/experience with other group members. These data were collected from a subset of 175 drivers and 272 passengers. Although drivers drank less than passengers, one driver in 5 groups had a BAC indicative of elevated crash risk (BAC ≥ 0.05 g/dL). Groups of drivers and/or passengers with a recent history of binge drinking were more likely to have drivers with BACs ≥ 0.05 g/dL. One unanticipated finding was that drivers who knew more group members relatively well were more likely to exit the club with a BAC ≥ 0.05 g/dL. Additionally, we found that groups with all female passengers were at greater risk for having a driver whose BAC was ≥ 0.05 g/dL. Some group characteristics predicted drivers who exit clubs with BACs ≥ 0.05 g/dL. One intervention strategy to promote safety might be to encourage group members to reconsider who is sober enough to drive away from the club; for some groups, a change of drivers would be a safer choice, because a passenger may have a relatively safe BAC. Groups of females appear to have a particularly elevated risk of having a driver whose BAC exceeds 0.05 g/dL, and new intervention efforts should be particularly directed to these at-risk groups.

Haemoglobin dynamics in Papuan and non-Papuan adults in northeast Papua, Indonesia, with acute, uncomplicated vivax or falciparum malaria

PubMed Central

2013-01-01

Background Haemoglobin (Hb) recovers slowly in malaria and may be influenced by naturally acquired immunity. Hb recovery was compared in malaria immune, indigenous Papuan and non-Papuan adults with limited malaria exposure. Methods Hb concentrations were measured on Days (D) 0, 3, 7, and 28 in 57 Papuans and 105 non-Papuans treated with chloroquine, doxycycline or both drugs for acute, uncomplicated Plasmodium vivax (n?=?64) or Plasmodium falciparum (n?=?98). Results Mean (SD, range) D0 Hb was 12.7 (2.2, 7–21.3) g/dL and was similar in P. falciparum infected Papuans and non-Papuans: 12.2 vs. 12.8 g/dL (P?=?0.15) but significantly lower in: (i) P. vivax-infected Papuans vs. P. vivax-infected non-Papuans: 11.4 vs. 13.47 g/dL [∆?=?−2.07 (95% CI: –3.3 – –0.8), P?=?0.0018], (ii) all patients with splenomegaly (vs. those without splenomegaly): 12.16 vs. 13.01 g/dL [∆?=?−0.85 (−1.6– –0.085), P?=?0.029], and (iii) all females vs. all males: 10.18 vs. 13.01 g/dL [∆?=?−2.82 (−3.97 – –1.67), P?

The effects of drinking and driving laws on car crashes, injuries, and deaths: Evidence from Chile.

PubMed

Otero, Sebastián; Rau, Tomás

2017-09-01

This paper analyzes the effects of lowering the legal blood alcohol content limit for drivers from 0.05 to 0.03 grams of alcohol per deciliter of blood (g/dL) and increasing license suspension periods for offenders. We take advantage of a rich data set of administrative records that allow us to identify direct measures of accidents involving alcohol including fatalities and injuries. Results show a significant decrease of 32% in alcohol-related car accidents right after the law was approved but the effects moderate over time (15% after three years). There is also a significant reduction in injuries (31% right after the approval and 11% after three years) but no statistically significant effects on deaths. Complementary analysis of blood samples shows that the law had an effect on blood alcohol content (BAC) of male drivers up to the 90th percentile of the BAC distribution. Copyright © 2017 Elsevier Ltd. All rights reserved.

Full-body gestures and movements recognition: user descriptive and unsupervised learning approaches in GDL classifier

NASA Astrophysics Data System (ADS)

Hachaj, Tomasz; Ogiela, Marek R.

2014-09-01

Gesture Description Language (GDL) is a classifier that enables syntactic description and real time recognition of full-body gestures and movements. Gestures are described in dedicated computer language named Gesture Description Language script (GDLs). In this paper we will introduce new GDLs formalisms that enable recognition of selected classes of movement trajectories. The second novelty is new unsupervised learning method with which it is possible to automatically generate GDLs descriptions. We have initially evaluated both proposed extensions of GDL and we have obtained very promising results. Both the novel methodology and evaluation results will be described in this paper.

Alpena Community College Commercial Driver's License Program. Evaluation Summary.

ERIC Educational Resources Information Center

Alpena Community Coll., MI.

The Alpena Community College (ACC) Drivers Education Program was developed to deliver a basic skills program providing specific job-related basic skills instruction to approximately 300 workers throughout Michigan who desired to pass the Commercial Drivers License (CDL) examination. Other program goals were to establish greater partnerships…

The accuracy of noninvasive hemoglobin measurement by multiwavelength pulse oximetry after cardiac surgery.

PubMed

Nguyen, Ba-Vinh; Vincent, Jean-Louis; Nowak, Emmanuel; Coat, Michelle; Paleiron, Nicolas; Gouny, Pierre; Ould-Ahmed, Mehdi; Guillouet, Maité; Arvieux, Charles Christian; Gueret, Gildas

2011-11-01

In March 2008, a new multiwavelength pulse oximeter, the Radical 7 (Rad7; Masimo Corp., Irvine, CA), was developed that offers noninvasive measurement of hemoglobin concentration. Accuracy has been established in healthy adults and some surgical patients, but not in cardiac surgery intensive care patients, a group at high risk of postoperative bleeding events and anemia in whom early diagnosis could improve management. In this prospective, observational study conducted in a cardiovascular intensive care unit, we compared hemoglobin concentrations shown by the Rad7 with arterial hemoglobin concentrations determined by an automated hematology analyzer, XE-2100 (Roche, Neuilly sur Seine, France). Two software versions of Rad7 (V 7.3.0.1 [42 points of comparison in 14 patients] and the updated V 7.3.1.1 [61 points of comparison in 27 patients]) were studied during two 1-week periods. Bias, defined as the difference between the 2 methods (Masimo SpHb-XE-2100 laboratory hemoglobin), was calculated. A negative bias indicated that the Masimo underestimated hemoglobin compared with the laboratory analyzer. Correlation between the perfusion index given by Rad7 and the hemoglobin bias was also studied. Correlations between Rad7 and XE-2100 were weak for both software versions (R2=0.11 for V 7.3.0.1 and R2=0.27 for V 7.3.1.1). Mean bias was -1.3 g/dL for V 7.3.0.1 and -1.7 g/dL for V 7.3.1.1, with wide 95% prediction intervals for the bias (respectively, -4.6 to 2.1 g/dL and -5.7 to 2.3 g/dL). The absolute hemoglobin bias tended to increase when the perfusion index decreased. For the V 7.3.0.1 software, the average absolute bias was 1.9 g/dL for perfusion index<2 and 0.8 g/dL for perfusion index>2 (P=0.03). For V 7.3.1.1, the mean absolute bias was 2.1 g/dL when the perfusion index was <2, and 1.6 g/dL when the perfusion index was >2 (P=0.26). Our study demonstrates poor correlation between hemoglobin measured noninvasively by multiwavelength pulse oximetry and a laboratory hematology analyzer. The difference was greater when the pulse oximetry perfusion index was low, as may occur in shock, hypothermia, or vasoconstriction patients. The multiwavelength pulse oximetry is not sufficiently accurate for clinical use in a cardiovascular intensive care unit.

Modeling of the anode of a liquid-feed DMFC: Inhomogeneous compression effects and two-phase transport phenomena

NASA Astrophysics Data System (ADS)

García-Salaberri, Pablo A.; Vera, Marcos; Iglesias, Immaculada

2014-01-01

An isothermal two-phase 2D/1D across-the-channel model for the anode of a liquid-feed Direct Methanol Fuel Cell (DMFC) is presented. The model takes into account the effects of the inhomogeneous assembly compression of the Gas Diffusion Layer (GDL), including the spatial variations of porosity, diffusivity, permeability, capillary pressure, and electrical conductivity. The effective anisotropic properties of the GDL are evaluated from empirical data reported in the literature corresponding to Toray carbon paper TGP-H series. Multiphase transport is modeled according to the classical theory of porous media (two-fluid model), considering the effect of non-equilibrium evaporation and condensation of methanol and water. The numerical results evidence that the hydrophobic Leverett J-function approach is physically inconsistent to describe capillary transport in the anode of a DMFC when assembly compression effects are considered. In contrast, more realistic results are obtained when GDL-specific capillary pressure curves reflecting the mixed-wettability characteristics of GDLs are taken into account. The gas coverage factor at the GDL/channel interface also exhibits a strong influence on the gas-void fraction distribution in the GDL, which in turn depends on the relative importance between the capillary resistance induced by the inhomogeneous compression, Rc(∝ ∂pc / ∂ ε) , and the capillary diffusivity, Dbarc(∝ ∂pc / ∂ s) .

Additional BCAA-enriched nutrient mixture improves the nutritional condition in cirrhotic patients with hypoalbuminemia despite treatment with regular BCAA granules: A pilot study.

PubMed

Fukui, Aiko; Kawabe, Naoto; Hashimoto, Senju; Murao, Michihito; Nakano, Takuji; Shimazaki, Hiroaki; Kan, Toshiki; Nakaoka, Kazunori; Ohki, Masashi; Takagawa, Yuka; Kamei, Hiroyuki; Yoshioka, Kentaro

2015-07-01

To elucidate the effect of adding branched-chain amino acid (BCAA)-enriched nutrient mixtures in cirrhotic patients with hypoalbuminemia despite the use of BCAA granules. A BCAA-enriched nutrient mixture containing 5.6 g of BCAA and 210 kcal was additionally administered in 40 cirrhotic patients with hypoalbuminemia despite their treatment with BCAA granules containing 12 g of BCAA. Laboratory data were assessed at 6 months before beginning additional therapy, at baseline, and at 6 months after baseline. Serum albumin levels significantly decreased from 6 months before baseline (3.14±0.47 g/dL) to baseline (2.83±0.46 g/dL), despite the treatment with BCAA granules (p<0.001), and tended to increase from baseline to 6 months after baseline (2.95±0.42 g/dL) (p=0.084). In the subset of 23 patients without hepatocellular carcinoma treatments, upper gastrointestinal tract bleeding, or albumin infusion, serum albumin levels significantly increased from baseline (2.93±0.38 g/dL) to 6 months after baseline (3.15±0.34 g/dL) (p=0.014). Additional therapy with BCAA-enriched nutrient mixtures increased serum albumin levels of the cirrhotic patients with hypoalbuminemia despite the treatment with BCAA granules and without hepatocellular carcinoma treatment, upper gastrointestinal tract bleeding, or albumin infusion.

42 CFR 431.705 - Licensing authority.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Nursing Home Administrators § 431.705 Licensing authority. (a) The State licensing program must provide for licensing of nursing home administrators by— (1) The agency designated under the healing arts act... 42 Public Health 4 2010-10-01 2010-10-01 false Licensing authority. 431.705 Section 431.705 Public...

42 CFR 422.2272 - Licensing of marketing representatives and confirmation of marketing resources.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Medicare Advantage Marketing Requirements § 422.2272 Licensing of marketing representatives and...

Khoa Trinh Huan Luyen Giu Tre Ban Ngay Tai Gia (Family Day Care Training Curriculum--Vietnamese).

ERIC Educational Resources Information Center

Nakatsu, Gail

California's Family Day Care Training Program was designed to recruit and train, in 7 weeks, Lao, Vietnamese, and Chinese refugees to establish their own state-licensed, family day care homes. Topics in the program's curriculum include an introduction to family day care, state licenses and licensing requirements for family day care, licensing…

47 CFR 76.103 - Parties entitled to syndicated exclusivity.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (b) Distributors of syndicated programming shall be entitled to exercise exclusive rights pursuant to § 76.101 for a period of one year from the initial broadcast syndication licensing of such programming... rights in areas in which the programming has already been licensed. ...

45 CFR 1321.75 - Licenses and safety.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING Service Requirements § 1321.75 Licenses and safety. The State shall...

45 CFR 1321.75 - Licenses and safety.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING Service Requirements § 1321.75 Licenses and safety. The State shall...

45 CFR 1321.75 - Licenses and safety.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING Service Requirements § 1321.75 Licenses and safety. The State shall...

45 CFR 1321.75 - Licenses and safety.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING Service Requirements § 1321.75 Licenses and safety. The State shall...

Wage and Hour Administration, Alaska Department of Labor

Science.gov Websites

Preference Enforcement; Licensing Employment Agencies; Construction Contractor Licensing; and Alaska Family Contractor Licensing program protects the public from unlicensed, unbonded contractors, while protecting

Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers.

PubMed

Chen, Irene G; Durbin, Dennis R; Elliott, Michael R; Senserrick, Teresa; Winston, Flaura K

2006-01-01

To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.

7 CFR 1530.103 - License eligibility.

Code of Federal Regulations, 2011 CFR

2011-01-01

... OF AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE POLYHYDRIC ALCOHOL PROGRAM § 1530.103 License eligibility. (a) A raw cane sugar refiner, a manufacturer of sugar containing products, or a producer of certain polyhydric alcohols, that owns and operates...

7 CFR 1530.103 - License eligibility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... OF AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE POLYHYDRIC ALCOHOL PROGRAM § 1530.103 License eligibility. (a) A raw cane sugar refiner, a manufacturer of sugar containing products, or a producer of certain polyhydric alcohols, that owns and operates...

Glutathione and 2,3-diphosphoglycerate in the blood of hypoxic ruminants.

PubMed

O'Dea, J D; Agar, N S

1980-09-01

Two merino sheep and two angora goats were subjected to simulated altitudes of up to 5500 m for about 10 h per day for 38 days. Packed cell volume (PCV), haemoglobin (Hb) concentration and red blood cell (RBC) levels of reduced glutathione (GSH) and 2,3-diphosphoglycerate (2,3-DPG) were measured at regular intervals. Mean PCV increased from 33 per cent to 60 per cent in the sheep and from 33 per cent to 45 per cent in the goats. Mean Hb concentration rose from 11.7 g/dl to 23.1 g/dl in the sheep, and from 11.4 g/dl to 16.0 g/dl in the goats. The level of GSH began to rise in the sheep only after the animals were no longer being subjected to the hypoxic stress, increasing by about 20 mg/dl RBC. In the goats, the levels of GSH rose during, as well as after, the period of hypoxic stress, also by about 20 mg/dl RBC. No change in 2,3-DPG levels was found in either species.

Three-dimensional graphene as gas diffusion layer for micro direct methanol fuel cell

NASA Astrophysics Data System (ADS)

Zhu, Yingli; Zhang, Xiaojian; Li, Jianyu; Qi, Gary

2018-05-01

The gas diffusion layer (GDL), as an important structure of the membrane electrode assembly (MEA) of the direct methanol fuel cell (DMFC), provides a support layer for the catalyst and the fuel and the product channel. Traditionally, the material of GDL is generally carbon paper (CP). In this paper, a new material, namely three-dimensional graphene (3DG) is used as GDL for micro DMFC. The experimental results reveal that the performance of the DMFC has been improved significantly by application of 3DG. The peak powers increase from 25 mW to 31.2 mW and 32 mW by using 3DG as the anode and cathode GDL instead of CP, respectively. The reason may be the decrease of charge and mass transfer resistance of the cell. This means that the unique 3D porous architecture of the 3DG can provide lower contact resistance and sufficient fuel diffusion paths. The output performance of the cell will be further improved when porous metal current collectors is used.

Generational differences among newly licensed registered nurses.

PubMed

Keepnews, David M; Brewer, Carol S; Kovner, Christine T; Shin, Juh Hyun

2010-01-01

Responses of 2369 newly licensed registered nurses from 3 generational cohorts-Baby Boomers, Generation X, and Generation Y-were studied to identify differences in their characteristics, work-related experiences, and attitudes. These responses revealed significant differences among generations in: job satisfaction, organizational commitment, work motivation, work-to-family conflict, family-to-work conflict, distributive justice, promotional opportunities, supervisory support, mentor support, procedural justice, and perceptions of local job opportunities. Health organizations and their leaders need to anticipate intergenerational differences among newly licensed nurses and should provide for supportive working environments that recognize those differences. Orientation and residency programs for newly licensed nurses should be tailored to the varying needs of different generations. Future research should focus on evaluating the effectiveness of orientation and residency programs with regard to different generations so that these programs can be tailored to meet the varying needs of newly licensed nurses at the start of their careers. Copyright 2010 Mosby, Inc. All rights reserved.

The contractor`s role in low-level waste disposal facility application review and licensing

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

Serie, P.J.; Dressen, A.L.

1991-12-31

The California Department of Health Services will soon reach a licensing decision on the proposed Ward Valley low-level radioactive waste disposal facility. As the first regulatory agency in the country to address the 10 CFR Part 61 requirements for a new disposal facility, California`s program has broken new ground in its approach. Throughout the review process, the Department has relied on contractor support to augment its technical and administrative staff. A team consisting of Roy F. Weston, Inc., supported by ERM-Program Management Corp., Environmental Issues Management, Inc., and Rogers and Associates Engineering Corporation, has worked closely with the Department inmore » a staff extension role. The authors have been involved with the project in contractor project management roles since 1987, and continue to support the Department`s program as it proceeds to finalize its licensing process. This paper describes the selection process used to identify a contractor team with the needed skills and experience, and the makeup of team capabilities. It outlines the management, communication, and technical approaches used to assure a smooth agency-contractor function and relationship. It describes the techniques used to ensure that decisions and documents represented the Department credibly in its role as the regulatory and licensing agency under the Nuclear Regulatory Commission (NRC) Agreement State program. The paper outlines the license application review process and activities, through preparation of licensing documentation and responses to public comments. Lessons learned in coordination of an agency-contractor team effort to review and license a low-level waste disposal facility are reviewed and suggestions made for approaching a similar license application review and licensing situation.« less

Hemoglobin levels above anemia thresholds are maximally predictive for long-term survival in COPD with chronic respiratory failure.

PubMed

Kollert, Florian; Tippelt, Andrea; Müller, Carolin; Jörres, Rudolf A; Porzelius, Christine; Pfeifer, Michael; Budweiser, Stephan

2013-07-01

In patients with COPD, chronic anemia is known as an unfavorable prognostic factor. Whether the association between hemoglobin (Hb) levels and long-term survival is restricted to anemia or extends to higher Hb levels has not yet been systematically assessed. We determined Hb levels in 309 subjects with COPD and chronic respiratory failure prior to initiation of noninvasive ventilation, accounting for confounders that might affect Hb. Subjects were categorized as anemic (Hb < 12 g/dL in females, Hb < 13 g/dL in males), polycythemic (Hb ≥ 15 g/dL in females, Hb ≥ 17 g/dL in males), or normocythemic. In addition, percentiles of Hb values were analyzed with regard to mortality from any cause. Two-hundred seven subjects (67.0%) showed normal Hb levels, 46 (14.9%) had anemia, and 56 (18.1%) had polycythemia. Polycythemic subjects showed a higher survival rate than anemic (P = .01) and normocythemic subjects (P = .043). In a univariate Cox hazards model, Hb was associated with long-term survival (hazard ratio 0.855; 95% CI 0.783-0.934, P < .001). The 58th percentiles of Hb (14.3 g/dL in females, 15.1 g/dL in males) yielded the highest discriminative value for predicting survival (hazard ratio 0.463, 95% CI 0.324-0.660, P < .001). In the multivariate analysis this cutoff was an independent predictor for survival (hazard ratio 0.627, 95% CI 0.414-0.949, P = .03), in addition to age and body mass index. In subjects with COPD and chronic respiratory failure undergoing treatment with noninvasive ventilation and LTOT, high Hb levels are associated with better long-term survival. The optimal cutoff level for prediction was above the established threshold defining anemia. Thus, predicting survival only on the basis of anemia does not fully utilize the prognostic potential of Hb values in COPD.

Water Management In PEM Fuel Cell -“ A Lattice-Boltzmann Modeling Approach

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

Mukherjee, Shiladitya; Cole, James Vernon; Jain, Kunal

2009-06-01

In Proton Exchange Membrane Fuel Cells (PEMFCs), water management and the effective transport of water through the gas-diffusion-layer (GDL) are key issues for improved performance at high power density and for durability during freeze-thaw cycles. The diffusion layer is a thin (~150-350{micro}m), porous material typically composed of a web of carbon fibers and particles, and is usually coated with hydrophobic Teflon to remove the excess water through capillary action. In-situ diagnostics of water movement and gas-reactant transport through this thin opaque substrate is challenging. Numerical analyses are typically based on simplified assumptions, such as Darcy's Law and Leverett functions formore » the capillary pressure. The objective of this work is to develop a high fidelity CFD modeling and analysis tool to capture the details of multiphase transport through the porous GDL. The tool can be utilized to evaluate GDL material design concepts and optimize systems based on the interactions between cell design, materials, and operating conditions. The flow modeling is based on the Lattice Boltzmann Method (LBM). LBM is a powerful modeling tool to simulate multiphase flows. Its strength is in its kinetic theory based foundation, which provides a fundamental basis for incorporating intermolecular forces that lead to liquid-gas phase separation and capillary effects without resorting to expensive or ad-hoc interface reconstruction schemes. At the heart of the solution algorithm is a discrete form of the well-known Boltzmann Transport Equation (BTE) for molecular distribution, tailored to recover the continuum Navier-Stokes flow. The solution advances by a streaming and collision type algorithm, mimicking actual molecular physics, which makes it suitable for porous media involving complex boundaries. We developed a numerical scheme to reconstruct various porous GDL microstructures including Teflon loading. Single and multiphase LBM models are implemented to compute permeability. Predicted values are in good agreement with measured data. The present modeling approach resolves the GDL microstructures and captures the influence of fiber orientation on permeability and the influence of Teflon loading on the development of preferential flow paths through the GDL. These observations can potentially guide the development of novel GDL materials designed for efficient removal of water.« less

38 CFR 21.5230 - Programs of education.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Except for a program consisting of a licensing or certification test designed to help the veteran or...) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under 38 U.S.C... licensing or certification test, the program has an objective as described in § 21.5021(r) or (s); (3) Any...

38 CFR 21.5230 - Programs of education.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Except for a program consisting of a licensing or certification test designed to help the veteran or...) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under 38 U.S.C... licensing or certification test, the program has an objective as described in § 21.5021(r) or (s); (3) Any...

38 CFR 21.5230 - Programs of education.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) Except for a program consisting of a licensing or certification test designed to help the veteran or...) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under 38 U.S.C... licensing or certification test, the program has an objective as described in § 21.5021(r) or (s); (3) Any...

38 CFR 21.5230 - Programs of education.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Except for a program consisting of a licensing or certification test designed to help the veteran or...) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under 38 U.S.C... licensing or certification test, the program has an objective as described in § 21.5021(r) or (s); (3) Any...

38 CFR 21.5230 - Programs of education.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) Except for a program consisting of a licensing or certification test designed to help the veteran or...) VOCATIONAL REHABILITATION AND EDUCATION Post-Vietnam Era Veterans' Educational Assistance Under 38 U.S.C... licensing or certification test, the program has an objective as described in § 21.5021(r) or (s); (3) Any...

31 CFR 501.808 - License application and other procedures applicable to economic sanctions programs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... procedures applicable to economic sanctions programs. 501.808 Section 501.808 Money and Finance: Treasury... procedures applicable to economic sanctions programs. Upon submission to the Office of Management and Budget..., the license application and other procedures set forth in this subpart are applicable to economic...

Online driver's license renewal.

DOT National Transportation Integrated Search

2015-09-01

The Kentucky Department of Vehicle Regulation is exploring the possibility of developing and implementing online : drivers license renewal. The objective of this project was to: 1) evaluate online drivers license and REAL ID renewal : programs ...

42 CFR 431.709 - Issuance and revocation of license.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Programs for Licensing Nursing Home Administrators § 431.709 Issuance and revocation of license. Except as... 42 Public Health 4 2010-10-01 2010-10-01 false Issuance and revocation of license. 431.709 Section 431.709 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

76 FR 13973 - United States Warehouse Act; Processed Agricultural Products Licensing Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-15

... license for the processed agricultural products that are stored in climate controlled, cooler, and freezer..., and dry beans. Warehouse operators voluntarily agree to be licensed, observe the rules for licensing... program for processed agricultural products that are stored in climate controlled, cooler, and freezer...

A COMPARATIVE STUDY OF STATE LICENSING BOARDS FOR SCHOOL ADMINISTRATION AND OTHER SELECTED PROFESSIONS.

ERIC Educational Resources Information Center

MOLINARI, RALPH G.; AND OTHERS

COMPARISON OF THE COMPOSITION, CHARACTERISTICS, AND CURRENT LICENSING PRACTICES OF STATE LICENSING BOARDS FOR EDUCATIONAL ADMINISTRATION WITH LICENSING PROGRAMS FOR SEVEN OTHER PROFESSIONS, (ACCOUNTANCY, ARCHITECTURE, DENTISTRY, ENGINEERING, LAW, MEDICINE, AND NURSING) WAS THE PURPOSE OF THIS NATIONWIDE STUDY. THE RESEARCH PROCEDURES WERE DIVIDED…

Epoetin alfa improves survival after chemoradiation for Stage III esophageal cancer: Final results of a prospective observational study

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

Rades, Dirk; Tribius, Silke; Yekebas, Emre F.

Purpose: This prospective, nonrandomized study evaluates the effectiveness of epoetin alfa to maintain the hemoglobin levels at 12 to14 g/dL (optimal range for tumor oxygenation) during chemoradiation for Stage III esophageal cancer and its impact on overall survival (OS), metastatic-free survival (MFS), and locoregional control (LC). Methods and Materials: Ninety-six patients were included. Forty-two patients received epoetin alfa (150 IU/kg, 3 times a week) during radiotherapy, which was started at hemoglobin less than 13 g/dL and stopped at 14 g/dL or higher. Hemoglobin levels were measured weekly during RT. Results: Both groups were balanced for age, sex, performance status, tumormore » length/location, histology, grading, T-stage/N-stage, chemotherapy, treatment schedule, and hemoglobin before RT. Median change of hemoglobin was +0.3 g/dL/wk with epoetin alfa and -0.5 g/dL/wk without epoetin alfa. At least 60% of hemoglobin levels were 12 to 14 g/dL in 64% and 17% of the patients, respectively (p < 0.001). Patients who received epoetin alfa had better OS (32% vs. 8% at 2 years, p = 0.009) and LC (67% vs. 15% at 2 years, p = 0.001). MFS was not significantly different (42% vs. 18% at 2 years, p = 0.09). Conclusions: The findings suggest that epoetin alfa when used to maintain the hemoglobin levels at 12 to 14 g/dL can improve OS and LC of Stage III esophageal cancer patients.« less

Licensed Vocational Nurse Residency Program in Primary Care.

PubMed

Dannemeyer, Deborah; Jalandoni, Cecile; Vonderheide, Dawn

This article will explain one organization's experience in developing a licensed vocational nurse residency program in an ambulatory setting, the barriers and challenges, and program outcomes. It outlines results of the program in building competence and confidence for vocational nurses to perform as effective team members in the primary care office setting. Learnings from this experience may be applied to enhance new and transitioning employee orientation and education programs in ambulatory and inpatient settings.

Advanced control of liquid water region in diffusion media of polymer electrolyte fuel cells through a dimensionless number

NASA Astrophysics Data System (ADS)

Wang, Yun; Chen, Ken S.

2016-05-01

In the present work, a three-dimension (3-D) model of polymer electrolyte fuel cells (PEFCs) is employed to investigate the complex, non-isothermal, two-phase flow in the gas diffusion layer (GDL). Phase change in gas flow channels is explained, and a simplified approach accounting for phase change is incorporated into the fuel cell model. It is found that the liquid water contours in the GDL are similar along flow channels when the channels are subject to two-phase flow. Analysis is performed on a dimensionless parameter Da0 introduced in our previous paper [Y. Wang and K. S. Chen, Chemical Engineering Science 66 (2011) 3557-3567] and the parameter is further evaluated in a realistic fuel cell. We found that the GDL's liquid water (or liquid-free) region is determined by the Da0 number which lumps several parameters, including the thermal conductivity and operating temperature. By adjusting these factors, a liquid-free GDL zone can be created even though the channel stream is two-phase flow. Such a liquid-free zone is adjacent to the two-phase region, benefiting local water management, namely avoiding both severe flooding and dryness.

Investigation of GDL compression effects on the performance of a PEM fuel cell cathode by lattice Boltzmann method

NASA Astrophysics Data System (ADS)

Molaeimanesh, G. R.; Nazemian, M.

2017-08-01

Proton exchange membrane (PEM) fuel cells with a great potential for application in vehicle propulsion systems will have a promising future. However, to overcome the exiting challenges against their wider commercialization further fundamental research is inevitable. The effects of gas diffusion layer (GDL) compression on the performance of a PEM fuel cell is not well-recognized; especially, via pore-scale simulation technique capturing the fibrous microstructure of the GDL. In the current investigation, a stochastic microstructure reconstruction method is proposed which can capture GDL microstructure changes by compression. Afterwards, lattice Boltzmann pore-scale simulation technique is adopted to simulate the reactive gas flow through 10 different cathode electrodes with dissimilar carbon paper GDLs produced from five different compression levels and two different carbon fiber diameters. The distributions of oxygen mole fraction, water vapor mole fraction and current density for the simulated cases are presented and analyzed. The results of simulations demonstrate that when the fiber diameter is 9 μm adding compression leads to lower average current density while when the fiber diameter is 7 μm the compression effect is not monotonic.

[Effect of freezing on the "creamatocrit" measurement of the lipid content of human donor milk].

PubMed

Vázquez-Román, S; Alonso-Díaz, C; García-Lara, N R; Escuder-Vieco, D; Pallás-Alonso, C R

2014-09-01

To determine, by the creamatocrit measurement, the effect on the fat content of raw and pasteurized donor milk of freezing during 3 months at -20 °C. The evolution of the creamatocrit measurement (following Lucas technique) on frozen (-20 °C), raw and pasteurized human milk, was analyzed during 3 months. The fat content of raw milk (n=44) was 3.19 g/dl at the beginning and 2.86 g/dl after 3 months frozen (p=0.02). In pasteurized milk (n=36) fat content at the first determination was 2.59 g/dl and 2.20 g/dl after 1 month frozen (p=0.01). Afterwards there were no significant changes up to 3 months frozen. Variability was observed in the intermediate values. A reduction on the fat content measurement of raw and pasteurized donor human milk after freezing was observed. Freezing does not inactivate the milk lipase but does destroy the fat globule. Creamatocrit measurement may not be the best method to determine the fat content of processed human milk. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Advanced control of liquid water region in diffusion media of polymer electrolyte fuel cells through a dimensionless number

DOE PAGES

Wang, Yun; Chen, Ken S.

2016-03-21

In the present study, a three-dimension (3-D) model of polymer electrolyte fuel cells (PEFCs) is employed to investigate the complex, non-isothermal, two-phase flow in the gas diffusion layer (GDL). Phase change in gas flow channels is explained, and a simplified approach accounting for phase change is incorporated into the fuel cell model. It is found that the liquid water contours in the GDL are similar along flow channels when the channels are subject to two-phase flow. Here, analysis is performed on a dimensionless parameter Da 0 introduced in our previous paper and the parameter is further evaluated in a realisticmore » fuel cell. We found that the GDL's liquid water (or liquid-free) region is determined by the Da 0 number which lumps several parameters, including the thermal conductivity and operating temperature. By adjusting these factors, a liquid-free GDL zone can be created even though the channel stream is two-phase flow. Such a liquid-free zone is adjacent to the two-phase region, benefiting local water management, namely avoiding both severe flooding and dryness.« less

The adaptation of GDL motion recognition system to sport and rehabilitation techniques analysis.

PubMed

Hachaj, Tomasz; Ogiela, Marek R

2016-06-01

The main novelty of this paper is presenting the adaptation of Gesture Description Language (GDL) methodology to sport and rehabilitation data analysis and classification. In this paper we showed that Lua language can be successfully used for adaptation of the GDL classifier to those tasks. The newly applied scripting language allows easily extension and integration of classifier with other software technologies and applications. The obtained execution speed allows using the methodology in the real-time motion capture data processing where capturing frequency differs from 100 Hz to even 500 Hz depending on number of features or classes to be calculated and recognized. Due to this fact the proposed methodology can be used to the high-end motion capture system. We anticipate that using novel, efficient and effective method will highly help both sport trainers and physiotherapist in they practice. The proposed approach can be directly applied to motion capture data kinematics analysis (evaluation of motion without regard to the forces that cause that motion). The ability to apply pattern recognition methods for GDL description can be utilized in virtual reality environment and used for sport training or rehabilitation treatment.

Visual search and urban driving under the influence of marijuana and alcohol.

PubMed

Lamers, C. T. J.; Ramaekers, J. G.

2001-07-01

The purpose of the present study was to assess the effects of low doses of marijuana and alcohol, and their combination, on visual search at intersections and on general driving proficiency in the City Driving Test. Sixteen recreational users of alcohol and marijuana (eight males and eight females) were treated with these substances or placebo according to a balanced, 4-way, cross-over, observer- and subject-blind design. On separate evenings, subjects received weight-calibrated doses of THC, alcohol or placebo in each of the following treatment conditions: alcohol placebo + THC placebo, alcohol + THC placebo, THC 100 &mgr;g/kg + alcohol placebo, THC 100 &mgr;g/kg + alcohol. Alcohol doses administered were sufficient for achieving a blood alcohol concentration (BAC) of about 0.05 g/dl. Initial drinking preceded smoking by one hour. The City Driving Test commenced 15 minutes after smoking and lasted 45 minutes. The test was conducted over a fixed route within the city limits of Maastricht. An eye movement recording system was mounted on each subject's head for providing relative frequency measures of appropriate visual search at intersections. General driving quality was rated by a licensed driving instructor on a shortened version of the Royal Dutch Tourist Association's Driving Proficiency Test. After placebo treatment subjects searched for traffic approaching from side streets on the right in 84% of all cases. Visual search frequency in these subjects did not change when they were treated with alcohol or marijuana alone. However, when treated with the combination of alcohol and marijuana, the frequency of visual search dropped by 3%. Performance as rated on the Driving Proficiency Scale did not differ between treatments. It was concluded that the effects of low doses of THC (100 &mgr;g/kg) and alcohol (BAC < 0.05 g/dl) on higher-level driving skills as measured in the present study are minimal. Copyright 2001 John Wiley & Sons, Ltd.

Effectiveness of Nutrition Education vs. Non-Nutrition Education Intervention in Improving Awareness Pertaining Iron Deficiency among Anemic Adolescents.

PubMed

Yusoff, Hafzan; Wan Daud, Wan Nudri; Ahmad, Zulkifli

2013-01-01

This study was carried out to compare the effect between nutrition education intervention and non-nutrition education intervention on awareness regarding iron deficiency among schooling adolescents in Tanah Merah, one of rural district in Kelantan, Malaysia. This study which was started in year 2010 involved 280 respondents (223 girls, 57 boys, age: 16 yr) from schools in Tanah Merah. The selection criteria were based on hemoglobin level (Hb = 7 - 11.9 g/dL for girls; Hb = 7 - 12.9 g/dL for boys). They were divided into 2 groups. The first group received nutrition education package (Nutrition education, NE), whereas another group was entitled to receive non-nutrition education intervention (Non-Nutrition Education, NNE) (supplement only). Both interventions were implemented for 3 months. The changes in awareness among respondents of both groups were evaluated using multi-choices questionnaire. Nutrition education receiver group (NE) demonstrated improvement in awareness at post-intervention. No substantial improvement was demonstrated by the counterpart group (NNE). Multimedia nutrition education program conducted at school setting was in fact practical and effective in improving awareness on iron deficiency among anemic adolescents.

Upgrading Licensed Practical Nurse to Registered Nurse Program, September 1971 - June 1973. Report.

ERIC Educational Resources Information Center

Holloway, Sally

Twenty Licensed Practical Nurses (LPN) became Registered Nurses (RN) in a pilot program giving partial academic credit for their LPN training and building on their existing skills. The program revolved around three needs: (1) trained nurses; (2) eliminating the notion that jobs were dead-end; and (3) achieving upward mobility for hospital staff.…

76 FR 60937 - Draft License Renewal Interim Staff Guidance LR-ISG-2011-02; Aging Management Program for Steam...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

...-2011-02; Aging Management Program for Steam Generators AGENCY: Nuclear Regulatory Commission. ACTION... License Renewal Interim Staff Guidance (LR-ISG), LR-ISG-2011-02, ``Aging Management Program for Steam... using Revision 3 of NEI 97-06 to manage steam generator aging. The Draft LR-ISG revises the NRC staff's...

Liquid water breakthrough location distances on a gas diffusion layer of polymer electrolyte membrane fuel cells

NASA Astrophysics Data System (ADS)

Yu, Junliang; Froning, Dieter; Reimer, Uwe; Lehnert, Werner

2018-06-01

The lattice Boltzmann method is adopted to simulate the three dimensional dynamic process of liquid water breaking through the gas diffusion layer (GDL) in the polymer electrolyte membrane fuel cell. 22 micro-structures of Toray GDL are built based on a stochastic geometry model. It is found that more than one breakthrough locations are formed randomly on the GDL surface. Breakthrough location distance (BLD) are analyzed statistically in two ways. The distribution is evaluated statistically by the Lilliefors test. It is concluded that the BLD can be described by the normal distribution with certain statistic characteristics. Information of the shortest neighbor breakthrough location distance can be the input modeling setups on the cell-scale simulations in the field of fuel cell simulation.

[Macronutrients and energy in milk from mothers of premature infants].

PubMed

He, Bi-Zi; Sun, Xiu-Jing; Quan, Mei-Ying; Wang, Dan-Hua

2014-07-01

To study the dynamic changes in macronutrients and energy in human milk from mothers of premature infants. A total of 339 human milk samples were collected from 170 women who delivered preterm or full-term infants in the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital between November 2012 and January 2014. Macronutrients (proteins, fats and carbohydrates and energy were measured using a MIRIS human milk analyzer and compared between groups. In milk samples from premature infants' mothers, the protein levels were the highest in colostrum (2.22±0.49 g/dL), less in transitional milk (1.83±0.39 g/dL), and the least in mature milk (1.40±0.28 g/dL) (P<0.01), and the levels of fats (2.4±1.3 g/dL vs 3.1±1.1 g/dL; P<0.01), carbohydrates (6.4±0.9 g/dL vs 6.6±0.4 g/dL; P<0.05) and energy (55±9 kcal/dL vs 62±8 kcal/dL; P<0.01) were significantly lower in colostrum than in transitional milk. The protein levels in colostrum from premature infants' mothers were significantly higher than those in colostrum from term infants' mothers (2.22±0.49 g/dL vs 2.07±0.34 g/dL; P<0.05). The colostrum from mothers of premature infants with a gestational age of ≤30 weeks had significantly higher protein levels than those from mothers of premature infants with gestational ages of 30(+1)-33(+6) weeks and ≥34 weeks (2.48±0.68 g/dL vs 2.11±0.25 g/dL and 2.22±0.39 g/dL respectively, P<0.05); the energy levels in colostrum from mothers of premature infants with a gestational age of ≤30 weeks group (51±6 kcal/dL) were significantly lower than those in colostrum from mothers of premature infants with a gestational age of 30(+1)-33(+6) weeks (58±8 kcal/d; P<0.05). The carbohydrate levels in transitional milk from mothers of premature infants with a gestational age of ≤30 weeks were significantly higher than those in transitional milk from mothers of premature infants with gestational ages of 30(+1)-33(+6) weeks and ≥34 weeks (P<0.05). The protein levels in mature milk from mothers of premature infants with a gestational age of 30(+1)-33(+6) weeks were significantly higher than those in mature milk from mothers of premature infants with gestational ages of ≤30 weeks and ≥34 weeks (P<0.05). The levels of macronutrients and energy in milk from mothers of premature infants vary significantly between colostrum, transitional milk, and mature milk. Protein levels are significantly higher in colostrum from premature infants' mothers than in colostrum from term infants' mothers, but the significant difference is not seen for mature milk. Macronutrient and energy levels show significant differences between milk samples from mothers of premature infants with different gestational ages, so as to meet different needs of premature infants.

Systems planning for automated commercial vehicle licensing and permitting systems : national ITS/CVO program requirements

DOT National Transportation Integrated Search

1997-07-01

This report describes the work of the study, Systems Planning for Automated Commercial Vehicle Licensing and Permitting Systems. The objective of this study is to define the market, organization, and resource requirements for a national program...

42 CFR 431.707 - Standards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... be met by individuals in order to be licensed as a nursing home administrator. (b) The standards must be designed to insure that nursing home administrators are— (1) Of good character; (2) Otherwise... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home...

42 CFR 431.707 - Standards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home... be met by individuals in order to be licensed as a nursing home administrator. (b) The standards must be designed to insure that nursing home administrators are— (1) Of good character; (2) Otherwise...

Equilibrium and NMR studies on GdIII, YIII, CuII and ZnII complexes of various DTPA-N,N''-bis(amide) ligands. Kinetic stabilities of the gadolinium(III) complexes.

PubMed

Jászberényi, Zoltán; Bányai, István; Brücher, Ernö; Király, Róbert; Hideg, Kálmán; Kálai, Tamás

2006-02-28

Three DTPA-derivative ligands, the non-substituted DTPA-bis(amide) (L(0)), the mono-substituted DTPA-bis(n-butylamide) (L(1)) and the di-substituted DTPA-bis[bis(n-butylamide)] (L(2)) were synthesized. The stability constants of their Gd3+ complexes (GdL) have been determined by pH-potentiometry with the use of EDTA or DTPA as competing ligands. The endogenous Cu2+ and Zn2+ ions form ML, MHL and M(2)L species. For the complexes CuL(0) and CuL(1) the dissociation of the amide hydrogens (CuLH(-1)) has also been detected. The stability constants of complexes formed with Gd3+, Cu2+ and Zn2+ increase with an increase in the number of butyl substituents in the order ML(0) < ML(1) < ML(2). NMR studies of the diamagnetic YL(0) show the presence of four diastereomers formed by changing the chirality of the terminal nitrogens of their enantiomers. At 323 K, the enantiomerization process, involving the racemization of central nitrogen, falls into the fast exchange range. By the assignment and interpretation of 1H and 13C NMR spectra, the fractions of the diastereomers were found to be equal at pH = 5.8 for YL(0). The kinetic stabilities of GdL(0), GdL(1) and GdL(2) have been characterized by the rates of the exchange reactions occurring between the complexes and Eu3+, Cu2+ or Zn2+. The rates of reaction with Eu3+ are independent of the [Eu3+] and increase with increasing [H+], indicating the rate determining role of the proton assisted dissociation of complexes. The rates of reaction with Cu2+ and Zn2+ increase with rising metal ion concentration, which shows that the exchange can take place with direct attack of Cu2+ or Zn2+ on the complex, via the formation of a dinuclear intermediate. The rates of the proton, Cu2+ and Zn2+ assisted dissociation of Gd3+ complexes decrease with increasing number of the n-butyl substituents, which is presumably the result of steric hindrance hampering the formation or dissociation of the intermediates. The kinetic stabilities of GdL(0) and GdL(1) at pH = 7.4, [Cu2+] = 1 x 10(-6) M and [Zn(2+)] = 1 x 10(-5) M are similar to that of Gd(DTPA)2-, while the complex GdL2 possesses a much higher kinetic stability.

Accuracy of noninvasive and continuous hemoglobin measurement by pulse co-oximetry during preoperative phlebotomy.

PubMed

Dewhirst, Elisabeth; Naguib, Aymen; Winch, Peter; Rice, Julie; Galantowicz, Mark; McConnell, Patrick; Tobias, Joseph D

2014-01-01

In recent years, the continuous noninvasive hemoglobin measurement has been offered by devices using advanced pulse oximetry technology. Accuracy has been established in healthy adults as well as in surgical and intensive care unit patients but not in the setting of acute hemorrhage. In this study, we evaluated the accuracy of such a device in the clinical setting of preoperative phlebotomy thereby mimicking a scenario of acute blood loss. This prospective study included patients undergoing surgical repair of congenital heart disease (CHD) for whom preoperative phlebotomy was planned. Blood was removed after the induction of anesthesia and prior to the start of the surgical procedure. Replacement with crystalloid was guided by hemodynamic variables and cerebral oxygenation measured by near-infrared spectroscopy. Hemoglobin was measured by bedside whole blood analysis (total hemoglobin [tHb]) before and after phlebotomy, and concurrent measurements from the pulse co-oximeter (noninvasive, continuous, or spot-check testing of total hemoglobin [SpHb]) were recorded. The study cohort included 45 patients ranging in age from 3 months to 50 years. Preoperative phlebotomy removed an average of 9.2 mL/kg of blood that was replaced with an average of 7.2 mL/kg of crystalloid. The pre- and postphlebotomy tHb values were 13.0 ± 1.9 and 12.4 ± 1.8 g/dL, respectively. The absolute difference between the tHb and SpHb (▵Hb) was 1.2 ± 0.1 g/dL. Bland-Altman analysis revealed a bias of 0.1 g/dL, a precision of 1.5 g/dL, and 95% limits of agreement of -2.8 to 3.1 g/dL. In 52.2% of the sample sets, the SpHb was within 1 g/dL of the actual hemoglobin value (tHb), and in 80% of the sample sets, the SpHb was within 2 g/dL. No variation in the accuracy of the deviation was noted based on the patient's age, weight, or type of CHD (cyanotic versus acyanotic). The current study demonstrates that the accuracy of continuous, noninvasive hemoglobin measurement was not affected by acute blood loss simulated by preoperative phlebotomy. Although the device provided a clinically acceptable correlation with the actual hemoglobin value and offers the value of a continuous trend monitor, given the precision of the device, it does not appear that actual transfusion decisions can be based on the device alone. © The Author(s) 2013.

Leaf Concentrate Fortification of Antenatal Protein-Calorie Snacks Improves Pregnancy Outcomes

PubMed Central

Magon, Anjna; Joshi, Pallavi; Davys (Late), Glyn; Attlee, Amita; Mathur, Beena

2014-01-01

ABSTRACT Ready-to-eat (RTE) snacks are routinely distributed to pregnant women in India. These provide protein and calories but are low in micronutrients. We investigated whether RTE snacks fortified with leaf concentrate (LC) could improve pregnancy outcomes, including maternal haemoglobin (Hb) concentrations and infants’ birthweight. This randomized controlled two-arm trial was conducted over 18 months: control (sRTE) group received standard 120 g RTE snack (102 g wheat flour, 18 g soya flour); intervention (lcRTE) group received the same snack fortified with 7 g LC. The study was conducted in Jaipur, Rajasthan, India. One hundred and five pregnant women aged 18-35 years were studied. Among the 105 women randomized to the two arms of the trial, 2 (1.9%) were severely anaemic (Hb ≤6.0 g/dL); 55 (53.4%) were moderately anaemic (Hb 6.0-8.0 g/dL); 34 (33.0%) were mildly anaemic (Hb 8.6-10.9 g/dL); and 12 (11.7%) were not anaemic (Hb ≥11.0 g/dL). In the final month of pregnancy, 83.0% (39/47) of women in the sRTE group had Hb ≤8.5 g/dL compared to 37.8% (17/45) in the lcRTE group (p<0.001). After adjustment for age and baseline Hb concentration, the difference in Hb concentrations due to LC fortification was 0.94 g/dL (95% CI 6.8-12.0; p<0.001). Mean live birthweight in the lcRTE group was 2,695 g (SD 325 g) compared to 2,545 g (297 g) in the sRTE group (p=0.02). The lcRTE snacks increased infants’ birthweight by 133.7 g (95% CI 7.3-260.2; p=0.04) compared to sRTE snacks. Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants’ birthweight when compared with unfortified snacks. These findings require replication in a larger trial. PMID:25395906

The relation between platelet reactivity and glycemic control in diabetic patients with cardiovascular disease on maintenance aspirin and clopidogrel therapy.

PubMed

Singla, Anand; Antonino, Mark J; Bliden, Kevin P; Tantry, Udaya S; Gurbel, Paul A

2009-11-01

High platelet reactivity (HPR) during aspirin and clopidogrel therapy in patients with diabetes has been reported and may affect outcomes. However, the relation of platelet reactivity to glycemic control is less studied in patients on dual antiplatelet therapy. Platelet aggregation (PA) in response to 5 and 20 micromol/L adenosine diphosphate (ADP) was compared in type 2 diabetic (n = 36) and nondiabetic patients (n = 35) undergoing elective stenting on aspirin and clopidogrel maintenance therapy. The relation of glycosylated hemoglobin (HbA(1c)) <7 g/dL (n = 16) and HbA(1c) > or =7 g/dL (n = 20) on PA was examined. High platelet reactivity was defined as >46% for 5 micromol/L ADP-induced and >59% for 20 micromol/L ADP-induced PA. Diabetic patients had higher 5 and 20 micromol/L ADP-induced PA than nondiabetic patients (45 +/- 17 vs 33 +/- 12, P = .009 and 52 +/- 19 vs 40 +/- 12, P = .004, respectively). Diabetic patients with HbA(1c) > or =7.0 g/dL had significantly higher 5 and 20 micromol/L ADP-induced PA versus patients with diabetes with HbA(1c) <7.0 g/dL (54 +/- 15 vs 34 +/- 14, P < .001 and 62 +/- 14 vs 40 +/- 17, P < .001, respectively). Among diabetic patients with HbA(1c) > or =7 g/dL, the prevalence of HPR was 65% and 60%; and among diabetic patients with HbA(1c) <7 g/dL, the prevalence of HPR was 19% and 13% as measured by 5 and 20 micromol/L ADP-induced PA, respectively. A correlation was present between 5 and 20 micromol/L ADP-induced PA and HbA(1c) (r = 0.60 and 0.62, P = .0001, respectively). An important relation exists between glycemic control and platelet reactivity in patients with type 2 diabetes mellitus treated with dual antiplatelet therapy. Poorly controlled patients with diabetes have the greatest platelet reactivity and may require alternative antiplatelet strategies, and further clinical investigations are warranted.

Anaemia during pregnancy in Burkina Faso, west Africa, 1995-96: prevalence and associated factors. DITRAME Study Group.

PubMed Central

Meda, N.; Mandelbrot, L.; Cartoux, M.; Dao, B.; Ouangré, A.; Dabis, F.

1999-01-01

We report the results of a cross-sectional study carried out in 1995-96 on anaemia in pregnant women who were attending two antenatal clinics in Bobo-Dioulasso, Burkina Faso, as part of a research programme including a clinical trial of zidovudine (ZDV) in pregnancy (ANRS 049 Clinical Trial). For women infected with human immunodeficiency virus (HIV) in Africa, anaemia is of particular concern when considering the use of ZDV to decrease mother-to-child transmission of HIV. The objectives were to determine the prevalence of and risk factors for maternal anaemia in the study population, and the effect of HIV infection on the severity of maternal anaemia. HIV counselling and testing were offered to all women, and haemograms were determined for those women who consented to serological testing. Haemoglobin (Hb) levels were available for 2308 of the 2667 women who accepted HIV testing. The prevalence of HIV infection was 9.7% (95% confidence interval (CI): 8.6-10.8%). The overall prevalence of anaemia during pregnancy (Hb level < 11 g/dl) was 66% (95% CI: 64-68%). The prevalence of mild (10 g/dl < or = Hb < 11 g/dl), moderate (7 g/dl < or = Hb < 10 g/dl) and severe (Hb < 7 g/dl) anaemia was 30.8%, 33.5% and 1.7%, respectively. The prevalence of anaemia was 78.4% in HIV-infected women versus 64.7% in HIV-seronegative women (P < 0.001). Although the relative risk of HIV-seropositivity increased with the severity of anaemia, no significant association was found between degree of anaemia and HIV serostatus among the study women with anaemia. Logistic regression analysis showed that anaemia was significantly and independently related to HIV infection, advanced gestational age, and low socioeconomic status. This study confirms the high prevalence of anaemia during pregnancy in Burkina Faso. Antenatal care in this population must include iron supplementation. Although HIV-infected women had a higher prevalence of anaemia, severe anaemia was infrequent, possibly because few women were in the advanced stage of HIV disease. A short course regimen of ZDV should be well tolerated in this population. PMID:10612887

Leaf concentrate fortification of antenatal protein-calorie snacks improves pregnancy outcomes.

PubMed

Magon, Anjna; Collin, Simon M; Joshi, Pallavi; Davys Late, Glyn; Attlee, Amita; Mathur, Beena

2014-09-01

Ready-to-eat (RTE) snacks are routinely distributed to pregnant women in India. These provide protein and calories but are low in micronutrients. We investigated whether RTE snacks fortified with leaf concentrate (LC) could improve pregnancy outcomes, including maternal haemoglobin (Hb) concentrations and infants' birthweight. This randomized controlled two-arm trial was conducted over 18 months: control (sRTE) group received standard 120 g RTE snack (102 g wheat flour, 18 g soya flour); intervention (lcRTE) group received the same snack fortified with 7 g LC. The study was conducted in Jaipur, Rajasthan, India. One hundred and five pregnant women aged 18-35 years were studied. Among the 105 women randomized to the two arms of the trial, 2 (1.9%) were severely anaemic (Hb ≤ 6.0 g/dL); 55 (53.4%) were moderately anaemic (Hb 6.0-8.0 g/dL); 34 (33.0%) were mildly anaemic (Hb 8.6-10.9 g/dL); and 12 (11.7%) were not anaemic (Hb ≥ 11.0 g/dL). In the final month of pregnancy, 83.0% (39/47) of women in the sRTE group had Hb ≤ 8.5 g/dL compared to 37.8% (17/45) in the lcRTE group (p<0.001). After adjustment for age and baseline Hb concentration, the difference in Hb concentrations due to LC fortification was 0.94 g/dL (95% CI 6.8-12.0; p<0.001). Mean live birthweight in the lcRTE group was 2,695 g (SD 325 g) compared to 2,545 g (297 g) in the sRTE group (p=0.02). The lcRTE snacks increased infants' birthweight by 133.7 g (95% CI 7.3-260.2; p=0.04) compared to sRTE snacks. Leaf concentrate fortification of antenatal protein-calorie snacks in a low-income setting in India protected against declining maternal haemoglobin concentrations and increased infants' birthweight when compared with unfortified snacks. These findings require replication in a larger trial.

Markers of nutritional status and mortality in older adults: The role of anemia and hypoalbuminemia.

PubMed

Corona, Ligiana Pires; de Oliveira Duarte, Yeda Aparecida; Lebrão, Maria Lúcia

2018-01-01

The aim of the present study was to analyze the impact of anemia and hypoalbuminemia on mortality in a 5-year period. This was longitudinal population-based observational survey part of the Saúde, Bem-Estar e Envelhecimento study (Health, Well-being and Aging), carried out with 1256 older adults from the third wave of the cohort, followed for 5 years, when they were contacted for the fourth wave, in Sao Paulo, Brazil. Anemia was defined when hemoglobin was <12 g/dL for women and <13 g/dL for men, and hypoalbuminemia when serum albumin was <3.5 g/dL. Survival functions were estimated according to nutritional status in four groups: (i) without nutritional alteration; (ii) anemia only; (iii) hypoalbuminemia only; and (iv) anemia and hypoalbuminemia. Hazard ratios were calculated, following the Cox proportional hazards model, controlling for baseline covariates. All analyses considered sample weights, and were carried out using the Stata 12. After the 5-year period, 12.3% of the participants died, and 8.2% were lost to follow up. Those who died had lower hemoglobin and albumin concentrations (13.4 g/dL and 3.7 g/dL) compared with survivors (14.3d/dL and 3.9 g/dL; P < 0.001). The crude death rate was 27.6/1000 person-years for participants in group i, 124.3 in group ii, 116.0 in group iii and 222.8 in group iv (P < 0.001). In the final Cox models, group 2 and 3 had a similar effect (hazard ratio 2.23, P = 0.020; 2.53, P = 0.005; respectively) and group 4 had a higher risk (hazard ratio 3.36; P = 0.004). Anemia and hypoalbuminemia are important markers for death in older adults, and have an additive effect on mortality. Because they are common and cost-effective biomarkers, their use should be encouraged in geriatric evaluation for all health professionals and in population settings, such as primary care. Geriatr Gerontol Int 2018; 18: 177-182. © 2017 Japan Geriatrics Society.

Computers and Media Centers--A Winning Combination.

ERIC Educational Resources Information Center

Graf, Nancy

1984-01-01

Profile of the computer program offered by the library/media center at Chief Joseph Junior High School in Richland, Washington, highlights program background, operator's licensing procedure, the trainer license, assistance from high school students, need for more computers, handling of software, and helpful hints. (EJS)

Manipulating Water in High-Performance Hydroxide Exchange Membrane Fuel Cells through Asymmetric Humidification and Wetproofing

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

Kaspar, RB; Letterio, MP; Wittkopf, JA

Hydroxide exchange membrane fuel cells (HEMFCs) are an emerging low-cost alternative to conventional proton exchange membrane fuel cells. In addition to producing water at the anode, HEMFCs consume water at the cathode, leading to distinctive water transport behavior. We report that gas diffusion layer (GDL) wetproofing strictly lowers cell performance, but that the penalty is much higher when the anode side is wetproofed compared to the cathode side. We attribute this penalty primarily to mass transport losses from anode flooding, suggesting that cathode humidification may be more beneficial than anode humidification for this device. GDLs with little or no wetproofingmore » perform best, yielding a competitive peak power density of 737 mW cm(-2). (C) The Author(s) 2015. Published by ECS. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 License (CC BY, hup://creativecommons.orgilicenses/by/4.0/), which permits unrestricted reuse of the work in any medium, provided the original work is properly cited. All rights reserved.« less

Research notes : Oregon teen licensing changes have safety benefits.

DOT National Transportation Integrated Search

2007-08-01

Changes in Oregons teen licensing laws that went into effect in March 2000 significantly strengthened the provisional driver license program, which had been in place since October 1989. Nearly all states and Canadian provinces have some form of a ...

Collegiate Licensing in Canada and the Statutory Advantage.

ERIC Educational Resources Information Center

Burshtein, Sheldon

1985-01-01

Discusses a specific provision in a Canadian statute enabling universities and other educational institutions to obtain protection and financial gain in a collegiate licensing program, an advantage not held in other countries or by other trademark licensers in Canada. (MSE)

Association of hemoglobin values at booking with adverse maternal outcomes among Peruvian populations living at different altitudes.

PubMed

Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos E; Fort, Alfredo L

2012-05-01

To determine hemoglobin values associated with adverse maternal outcomes among Peruvian populations at different altitudes. A retrospective cohort study was conducted using data from the Perinatal Information System. Adverse maternal outcomes were assessed. Risk of pre-eclampsia increased at maternal hemoglobin levels above 14.5 g/dL (OR 1.27; 95% CI, 1.18-1.36) or below 7.0 g/dL (OR 1.52; CI 95%, 1.08-2.14). Altitude above 2000 m reduced risk (OR 0.65; 95% CI 0.62-0.68). Risk of postpartum hemorrhage (PPH) increased with moderate/severe anemia (OR 6.15; 95% CI, 3.86-9.78) and at moderate altitudes (OR 1.26; 95% CI, 1.12-1.43). Mild anemia at any altitude was associated with reduced risk of pre-eclampsia (OR 0.85, 95% CI, 0.81-0.89) and PPH (OR 1.01; 95% CI, 0.88-1.15). Risk of premature rupture of membranes was reduced at high hemoglobin values. Maternal mortality increased at hemoglobin levels below 9.0 g/dL (OR 5.68; 95% CI, 2.97-10.80) and above 14.5 g/dL (OR 2.18; 95% CI, 1.22-3.91). Maternal mortality increased at moderate altitudes (OR 29.2; 95% CI, 2.62-324.60) and high altitudes (OR 66.4; 95% CI, 6.65-780.30) when hemoglobin levels were below 9.0 g/dL. Elevated altitude and hemoglobin levels influence maternal outcomes. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

The effect of golimumab on haemoglobin levels in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis.

PubMed

Furst, Daniel E; Kay, Jonathan; Wasko, Mary Chester; Keystone, Edward; Kavanaugh, Arthur; Deodhar, Atul; Murphy, Frederick T; Magnus, Jeanette H; Hsia, Elizabeth C; Hsu, Benjamin; Xu, Stephen; Rahman, Mahboob U; Doyle, Mittie K

2013-10-01

To evaluate the effect of golimumab on haemoglobin levels in patients with RA, PsA or AS. Secondary analysis was performed on integrated data from five randomized controlled studies: three RA, one PsA and one AS (2303 patients total). Golimumab 50 or 100 mg was injected s.c. every 4 weeks with or without MTX. Control groups received placebo injections plus MTX or background therapy. Patients with haemoglobin levels below the age- and sex-specific normal ranges were considered to have anaemia. Ferritin levels were used to distinguish anaemia of mixed aetiology (≥ 15 and <60 ng/ml) and anaemia of inflammation (≥ 60 ng/ml). Changes from baseline to weeks 14 and 24 in haemoglobin level were compared between treatment groups using an analysis of variance on the van der Waerden normal scores. At baseline, 21% of RA patients, 9% of PsA patients and 15% of AS patients had anaemia. Of these, 24%, 57% and 25%, respectively, had anaemia of inflammation. The median increase from baseline to week 14 in the haemoglobin level of anaemic patients was 0.3 g/dl in the control group and 0.9 g/dl in the golimumab group (P < 0.001). Haemoglobin levels improved within the subgroups of patients with anaemia of mixed aetiology (control, 0.4 g/dl vs golimumab, 0.7 g/dl) (P = 0.305) and with anaemia of inflammation (0.2 vs 1.4 g/dl, respectively) (P < 0.001). Compared with the control group, patients receiving golimumab treatment had significantly improved haemoglobin levels, particularly among patients with anaemia of inflammation.

Effect of infusion of equine plasma or 6% hydroxyethyl starch (600/0.75) solution on plasma colloid osmotic pressure in healthy horses.

PubMed

McKenzie, Erica C; Esser, Melissa M; McNitt, Sarah E; Payton, Mark E

2016-07-01

OBJECTIVE To compare the effects of equivalent volumes of equine plasma and 6% hydroxyethyl starch (600/0.75) solution (hetastarch) administered IV on plasma colloid osmotic pressure (pCOP) and commonly monitored clinicopathologic variables in horses. ANIMALS 6 healthy mares. PROCEDURES In a randomized, crossover study, horses were administered hetastarch or plasma (both 10 mL/kg, IV) 18 months apart. The pCOP and variables of interest were measured before (baseline), immediately after, and at intervals up to 96 or 120 hours after infusion. Prothrombin and activated partial thromboplastin times were measured before and at 2 and 8 hours after each infusion. RESULTS Prior to hetastarch and plasma infusions, mean ± SEM pCOP was 19.4 ± 0.5 mm Hg and 19.4 ± 0.8 mm Hg, respectively. In general, hetastarch and plasma infusions comparably increased pCOP from baseline for 48 hours, with maximum increases of 2.0 and 2.3 mm Hg, respectively. Mean Hct and hemoglobin, total protein, and albumin concentrations were decreased for a period of 72, 96, or 120 hours after hetastarch infusion with maximum decrements of 8.8%, 3.2 g/dL, 1.2 g/dL, and 0.6 g/dL, respectively. Plasma infusion decreased (albeit not always significantly) hemoglobin concentration and Hct for 20 and 24 hours (maximum changes of 1.5 g/dL and 6.6%, respectively) and increased total solids concentration (maximum change of 0.6 g/dL) for 48 hours. Platelet count and coagulation times were minimally affected. CONCLUSIONS AND CLINICAL RELEVANCE Overall, the hetastarch and plasma infusions comparably increased pCOP in healthy horses for up to 48 hours. Hetastarch induced greater, more persistent perturbations in clinicopathologic variables.

Intravenous iron isomaltoside 1000 (Monofer®) reduces postoperative anaemia in preoperatively non-anaemic patients undergoing elective or subacute coronary artery bypass graft, valve replacement or a combination thereof: a randomized double-blind placebo-controlled clinical trial (the PROTECT trial).

PubMed

Johansson, P I; Rasmussen, A S; Thomsen, L L

2015-10-01

This trial explores whether intravenous iron isomaltoside 1000 (Monofer®) results in a better regeneration of haemoglobin levels and prevents anaemia compared to placebo in preoperative non-anaemic patients undergoing cardiac surgery. The trial is a prospective, double-blind, comparative, placebo-controlled trial of 60 non-anaemic patients undergoing cardiac surgery. The patients were randomized 1:1 to either 1000 mg intravenous iron isomaltoside 1000 administered perioperatively by infusion or placebo. Mean preoperative haemoglobin in the active treatment group was 14·3 g/dl vs. 14·0 g/dl in the placebo group. At discharge 5 days after surgery, haemoglobin levels were reduced to 10·7 and 10·5 g/dl, respectively. One month after surgery, haemoglobin concentration had increased to an average of 12·6 g/dl vs. 11·8 g/dl (p = 0·012) and significantly more patients were non-anaemic in the intravenous iron isomaltoside 1000-treated group compared to the placebo group (38·5% vs. 8·0%; p = 0·019). There were no differences in side-effects between the groups. A single perioperative 1000 mg dose of intravenous iron isomaltoside 1000 significantly increased the haemoglobin level and prevented anaemia 4 weeks after surgery, with a short-term safety profile similar to placebo. Future trials on potential clinical benefits of preoperative treatment with intravenous iron in non-anaemic patients are needed. © 2015 The Authors ISBT Science Series published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.

Japanese haemodialysis anaemia management practices and outcomes (1999–2006): results from the DOPPS

PubMed Central

Akizawa, Tadao; Pisoni, Ronald L.; Akiba, Takashi; Saito, Akira; Fukuhara, Shunichi; Asano, Yasushi; Hasegawa, Takeshi; Port, Friedrich K.; Kurokawa, Kiyoshi

2008-01-01

Background. Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients. Methods. Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Japanese dialysis units participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to describe anaemia management practices and outcomes for Japanese HD patients. Results. From 1999 to 2006, patient mean Hb increased from 9.7 g/dl to 10.4 g/dl, and the percentage of facilities with median Hb ≥10 g/dl increased from 27% to 75%. Hb was measured in the supine position for 90% of patients, resulting in substantially lower reported Hb values than those seen in other countries. As of 2006, erythropoietin (Epo) was prescribed to 83% of HD patients; mean Epo dose was 5231 units/week; intravenous (IV) iron use was 33% and median IV iron dose was 160 mg/month. Many patient- and facility-level factors were significantly related to higher Hb. A consistent overall pattern of lower mortality risk with higher baseline Hb levels was seen (RR = 0.89 per 1 g/dl higher Hb, P = 0.003). Facilities with median Hb ≥10.4 displayed a lower mortality risk (RR = 0.77, P = 0.03) versus facility median Hb <10.4 g/dl. Lower Hb levels were not significantly related to hospitalization risk, but were associated with lower QoL scores. Conclusions. These results provide detailed information on anaemia management practices in Japan and the relationships of anaemia control with outcomes, with implications of anaemia management worldwide. PMID:18577535

A new multi-wavelength optical-plethysmograph for quantitative determination of pulpal hemoglobin content and oxygen level using green and near-infrared LEDs

NASA Astrophysics Data System (ADS)

Kakino, S.; Miwa, Z.; Kirimoto, A.; Ohuchi, K.; Takatani, S.; Takagi, Y.

2007-02-01

A new multi-wavelength optical-plethysmograph has been designed to study the relation between the transmitted optical density (OD) of the tooth vs. hemoglobin (Hb) content and oxygen saturation (SO II) of the pulpal blood using the 467, 506, 522 and 810 nm light emitting diodes (LEDs). The experimental model utilized the extracted human upper incisor where the pulp cavity was filled with the blood having various values of Hb and SO II. A resin cap was made to fit the tooth crown and optical fibers for transmission measurement. The LEDs were pulsed sequentially at 520 Hz with the pulse duration of 240 μs. The OD as a function of Hb for the isosbestic wavelengths of 506 and 522 nm increased almost linearly from 8.0 to 11.0 for Hb changing from 0.0 (saline control) to 2.5 g/dL, but beyond 2.5 g/dL no change was observed. At 810 nm, the OD increased linearly till Hb of 13.4 g/dL, but its change was much smaller with 1.0 OD per 13.4 g/dL. As for SO II, the OD at 467 nm with Hb of 1.0 g/dL that simulated the mean pulpal Hb content in vivo varied by about 1.0 for SO II changing from 100 to 40%. The OD change with respect to Hb change at 506 and 522 nm showed better sensitivity than that at 810 nm. The combination of 467 and 506 or 522 nm wavelengths can provide a noninvasive measurement of both pulpal Hb content and SO II to diagnose pulp vitality of teeth in vivo.

Evaluating commercial driver's license program vulnerabilities : a study of the states of Illinois and Florida

DOT National Transportation Integrated Search

2000-10-01

This report represents the latest in a series of efforts by the U.S. Department of Transportation (DOT) and the Federal Motor Carrier Safety Administration (FMCSA) to enhance and improve the commercial driver's license (CDL) program. In September 199...

7 CFR 1530.109 - Reporting.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE... transaction; (2) The date of the entry, transfer (only a refiner shall report transfers to the Licensing... license number; (5) The country of origin (entry of raw sugar) or final destination (refined exports...

7 CFR 1530.109 - Reporting.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE... transaction; (2) The date of the entry, transfer (only a refiner shall report transfers to the Licensing... license number; (5) The country of origin (entry of raw sugar) or final destination (refined exports...

7 CFR 1530.109 - Reporting.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE... transaction; (2) The date of the entry, transfer (only a refiner shall report transfers to the Licensing... license number; (5) The country of origin (entry of raw sugar) or final destination (refined exports...

7 CFR 1530.109 - Reporting.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE... transaction; (2) The date of the entry, transfer (only a refiner shall report transfers to the Licensing... license number; (5) The country of origin (entry of raw sugar) or final destination (refined exports...

7 CFR 1530.109 - Reporting.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE THE REFINED SUGAR RE-EXPORT PROGRAM, THE SUGAR CONTAINING PRODUCTS RE-EXPORT PROGRAM, AND THE... transaction; (2) The date of the entry, transfer (only a refiner shall report transfers to the Licensing... license number; (5) The country of origin (entry of raw sugar) or final destination (refined exports...

Building a Snow Data Management System using Open Source Software (and IDL)

NASA Astrophysics Data System (ADS)

Goodale, C. E.; Mattmann, C. A.; Ramirez, P.; Hart, A. F.; Painter, T.; Zimdars, P. A.; Bryant, A.; Brodzik, M.; Skiles, M.; Seidel, F. C.; Rittger, K. E.

2012-12-01

At NASA's Jet Propulsion Laboratory free and open source software is used everyday to support a wide range of projects, from planetary to climate to research and development. In this abstract I will discuss the key role that open source software has played in building a robust science data processing pipeline for snow hydrology research, and how the system is also able to leverage programs written in IDL, making JPL's Snow Data System a hybrid of open source and proprietary software. Main Points: - The Design of the Snow Data System (illustrate how the collection of sub-systems are combined to create a complete data processing pipeline) - Discuss the Challenges of moving from a single algorithm on a laptop, to running 100's of parallel algorithms on a cluster of servers (lesson's learned) - Code changes - Software license related challenges - Storage Requirements - System Evolution (from data archiving, to data processing, to data on a map, to near-real-time products and maps) - Road map for the next 6 months (including how easily we re-used the snowDS code base to support the Airborne Snow Observatory Mission) Software in Use and their Software Licenses: IDL - Used for pre and post processing of data. Licensed under a proprietary software license held by Excelis. Apache OODT - Used for data management and workflow processing. Licensed under the Apache License Version 2. GDAL - Geospatial Data processing library used for data re-projection currently. Licensed under the X/MIT license. GeoServer - WMS Server. Licensed under the General Public License Version 2.0 Leaflet.js - Javascript web mapping library. Licensed under the Berkeley Software Distribution License. Python - Glue code and miscellaneous data processing support. Licensed under the Python Software Foundation License. Perl - Script wrapper for running the SCAG algorithm. Licensed under the General Public License Version 3. PHP - Front-end web application programming. Licensed under the PHP License Version 3.01

The value of routine haemoglobin concentration measurement before caesarean section.

PubMed

Vashisht, A; Yentis, S

2005-02-01

Women undergoing caesarean section routinely have a haemoglobin concentration check before delivery. We compared the haemoglobin concentration of 311 women taken at their 32-?34 week antenatal visit with their preoperative level. A significant rise from 11.04 g/dL to 11.51 g/dL was seen (mean (95% CI) 0.47 (0.37-0.57 g/dL)). This increase was most marked in the 201 women having emergency procedures, and there was a significant negative correlation between the 32 and 34 weeks level and the net change in haemoglobin concentration (r=-0.366 (P<0.001)). From our results we suggest that in women with an otherwise uncomplicated pregnancy, and a satisfactory haemoglobin concentration at 32-34 weeks, a repeat estimation of the blood count is unnecessary before operative delivery.

10 CFR 171.21 - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false [Reserved] 171.21 Section 171.21 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) ANNUAL FEES FOR REACTOR LICENSES AND FUEL CYCLE LICENSES AND MATERIALS LICENSES, INCLUDING HOLDERS OF CERTIFICATES OF COMPLIANCE, REGISTRATIONS, AND QUALITY ASSURANCE PROGRAM APPROVALS AND...

Recidivism Among Licensed-Released Prisoners Who Participated in the EM Program in Israel.

PubMed

Shoham, Efrat; Yehosha-Stern, Shirley; Efodi, Rotem

2015-08-01

Toward the end of 2006, a pilot program was launched in Israel wherein licensed-released prisoners were put under electronic monitoring (EM). In addition to EM, the pilot program, operated by the Prisoners' Rehabilitation Authority, provides programs of occupational supervision and personal therapy and is designed to allow for early release of those prisoners who, without increased supervision, would have been found unsuitable for early release. The aim of this study was to ascertain whether participation in the EM program among licensed-released prisoners in Israel might bring about lessened recidivism. For that matter, rates of arrests and incarceration were examined during a follow-up period of up to 4 years, among the entirety of licensed-released prisoners participating in the EM program between the years 2007 and 2009 (n = 155). To compare recidivism rates, a control group was assembled from among the entirety of released prisoners who were found unsuitable for early release in judicial conditions, and had therefore served the full term of their incarceration, to be released between the years 2005 and 2006 (a period of time during which an EM program was not yet operated among licensed-released prisoners in Israel). Study findings clearly show that while among the control group, 42% of released prisoners were re-incarcerated, at the end of a 4-year follow-up period, only 15% among the study group had returned to prison. These findings can be explained by combining the Social Control theory and the Self-Control theory which consider the period of time under EM program and the occupational and familial integration tools for reducing criminal connections and enhancing pro-social behavior. © The Author(s) 2014.

Microscale X-ray tomographic investigation of the interfacial morphology between the catalyst and micro porous layers in proton exchange membrane fuel cells

NASA Astrophysics Data System (ADS)

Prass, Sebastian; Hasanpour, Sadegh; Sow, Pradeep Kumar; Phillion, André B.; Mérida, Walter

2016-07-01

The interfacial morphology between the catalyst layer (CL) and micro porous layer (MPL) influences the performance of proton exchange membrane fuel cells (PEMFCs). Here we report a direct method to investigate the CL-MPL interfacial morphology of stacked and compressed gas diffusion layer (GDL with MPL)-catalyst coated membrane (CCM) assemblies. The area, origin and dimensions of interfacial gaps are studied with high-resolution X-ray micro computed tomography (X-μCT). The projected gap area (fraction of the CL-MPL interface separated by gaps) is higher for GDL-CCM assemblies with large differences in the surface roughness between CL and MPL but reduces with increasing compression and similarity in roughness. Relatively large continuous gaps are found in proximity to cracks in the MPL. These are hypothesized to form due to the presence of large pores on the surface of the GDL. Smaller gaps are induced by the surface roughness features throughout the CL-MPL interface. By modification of the pore sizes on the GDL surface serving as substrate for the MPL, the number and dimension of MPL crack induced gaps can be manipulated. Moreover, adjusting the CL and MPL surface roughness parameters to achieve similar orders of roughness can improve the surface mating characteristics of these two components.

Performance of gas diffusion layer from coconut waste for proton exchange membrane fuel cell

NASA Astrophysics Data System (ADS)

Widodo, H.; Destyorini, F.; Insiyanda, D. R.; Subhan, A.

2017-04-01

The performance of Gas Diffusion Layer (GDL) synthesized from coconut waste. Gas Diffusion Layer (GDL), produced from coconut waste, as a part of Proton Exchange Membrane Fuel Cell (PEMFC) component, has been characterized. In order to know the performance, the commercial products were used as the remaining parts of PEMFC. The proposed GDL possesses 69% porosity for diffusion of Hydrogen fuel and Oxygen, as well as for transporting electron. With the electrical conductivity of 500 mS.cm-1, it also has hydrophobic properties, which is important to avoid the reaction with water, with the contact angle of 139°. The 5 × 5 cm2 GDL paper was co-assembled with the catalyst, Nafion membrane, bipolar plate, current collector, end plate to obtain single Stack PEMFC. The performance was examined by flowing fuel and gas with the flow rate of 500 and 1000 ml.min-1, respectively, and analyse the I-V polarization curve. The measurements were carried out at 30, 35, and 40°C for 5 cycles to ensure the repeatability. The results shows that the current density and the maximum power density reaches 203 mA.cm-2 and 143 mW.cm-2, respectively, with a given voltage 0.6 V, at 40°C.

Ex-situ gas diffusion layer intrusion effect determination of polymer electrolyte membrane fuel cell flow fields

NASA Astrophysics Data System (ADS)

Haase, S.; Rauber, M.

2015-09-01

In automotive PEM fuel cell systems, one of the most important targets is to reduce the parasitic power of balance of plant components, e.g. the air supply. This can be achieved for example by decreasing air stoichiometry. However, this could lead to bad flow sharing in the fuel cell stack. Therefore the fluid distribution in the flow field has to be evaluated, understood and optimized. This work evaluates the effect of GDL intrusion on the pressure drop via ex-situ determination of GDL intrusion using CFD simulation. The intruded GDL geometries, evaluated by an optical microscope with 200 times enlargement, are transferred to pressure drop behaviors by a numerical CFD model. These results are compared to the results of the differential pressure method of mapping the pressure distribution, described in [43]. The intrusion of the GDL leads to homogeneous flow distribution up to clamping pressures of 2.5 MPa. The inhomogeneous intrusion, induced by cracked fibers that extend into the channel, dominates the flow at higher clamping pressures and leads to the exponential increase in pressure drop in the differential pressure method. For clamping pressures used in typical fuel cell applications, the results of both methods show homogeneous flow through the channels.

Groundwater discharge to lakes (GDL) - the disregarded component of lake nutrient budgets

NASA Astrophysics Data System (ADS)

Lewandowski, J.; Meinikmann, K.; Pöschke, F.; Nützmann, G.

2012-04-01

Eutrophication is a major threat to lakes in temperate climatic zones. It is necessary to determine the relevance of different nutrient sources to conduct effective management measures, to understand in-lake processes and to model future scenarios. A prerequisite for such nutrient budgets are water budgets. While most components of the water budget can be determined quite accurate the quantification of groundwater discharge to lakes (GDL) and surface water infiltration into the aquifer are much more difficult. For example, it is quite common to determine the groundwater component as residual in the water and nutrient budget which is extremely problematic since in that case all errors of the budget terms are summed up in the groundwater term. In total, we identified 10 different reasons for disregarding the groundwater path in nutrient budgets. We investigated the fate of the nutrients nitrogen and phosphorus on their pathway from the catchment through the reactive aquifer-lake interface into the lake. We reviewed the international literature and summarized numbers reported for GDL of nutrients. Since literature is quite sparse we also had a look at numbers reported for submarine groundwater discharge (SGD) of nutrients for which much more literature exists and which is despite some fundamental differences in principal comparable to GDL.

Using event-triggered naturalistic data to examine the prevalence of teen driver distractions in rear-end crashes.

PubMed

Carney, Cher; Harland, Karisa K; McGehee, Daniel V

2016-06-01

While teen driver distraction is cited as a leading cause of crashes, especially rear-end crashes, little information is available regarding its true prevalence. The majority of distraction studies rely on data derived from police reports, which provide limited information regarding driver distraction. This study examined over 400 teen driver rear-end crashes captured by in-vehicle event recorders. A secondary data analysis was conducted, paying specific attention to driver behaviors, eyes-off-road time, and response times to lead-vehicle braking. Among teens in moderate to severe rear-end crashes, over 75% of drivers were observed engaging in a potentially distracting behavior. The most frequently seen driver behaviors were cell phone use, attending to a location outside the vehicle, and attending to passengers. Drivers using a cell phone had a significantly longer response time than drivers not engaged in any behaviors, while those attending to passengers did not. Additionally, in about 50% of the rear-end crashes where the driver was operating/looking at a phone (e.g., texting), the driver showed no driver response (i.e., braking or steering input) before impact, compared to 10% of crashes where the driver was attending to a passenger. The high frequency of attending to passengers and use of a cell phone leading up to a crash, compounded with the associated risks, underlines the importance of continued investigation in these areas. Parents and teens must be educated regarding the frequency of and the potential effects of distractions. Additional enforcement may be necessary if Graduated Driver Licensing (GDL) programs are to be effective. Systems that alert distracted teens could also be especially helpful in reducing rear-end collisions. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

Technology and teen drivers.

PubMed

Lee, John D

2007-01-01

The rapid evolution of computing, communication, and sensor technology is likely to affect young drivers more than others. The distraction potential of infotainment technology stresses the same vulnerabilities that already lead young drivers to crash more frequently than other drivers. Cell phones, text messaging, MP3 players, and other nomadic devices all present a threat because young drivers may lack the spare attentional capacity for vehicle control and the ability to anticipate and manage hazards. Moreover, young drivers are likely to be the first and most aggressive users of new technology. Fortunately, emerging technology can also support safe driving. Electronic stability control, collision avoidance systems, intelligent speed adaptation, and vehicle tracking systems can all help mitigate the threats to young drivers. However, technology alone is unlikely to make young drivers safer. One promising approach to tailoring technology to teen drivers is to extend proven methods for enhancing young driver safety. The success of graduated drivers license programs (GDL) and the impressive safety benefit of supervised driving suggest ways of tailoring technology to the needs of young drivers. To anticipate the effects of technology on teen driving it may be useful to draw an analogy between the effects of passengers and the effects of technology. Technology can act as a teen passenger and undermine safety or it can act as an adult passenger and enhance safety. Rapidly developing technology may have particularly large effects on teen drivers. To maximize the positive effects and minimize the negative effects will require a broad range of industries to work together. Ideally, vehicle manufacturers would work with infotainment providers, insurance companies, and policy makers to craft new technologies so that they accommodate the needs of young drivers. Without such collaboration young drivers will face even greater challenges to their safety as new technologies emerge.

10 CFR 70.62 - Safety program and integrated safety analysis.

Code of Federal Regulations, 2011 CFR

2011-01-01

...) Radiological hazards related to possessing or processing licensed material at its facility; (ii) Chemical hazards of licensed material and hazardous chemicals produced from licensed material; (iii) Facility... performed by a team with expertise in engineering and process operations. The team shall include at least...

Creating Career Ladders in University Systems: The Accelerated Associate's Degree Program for Unemployed Licensed Nurses at the Inter-American University of Puerto Rico.

ERIC Educational Resources Information Center

Melendez, Edwin; Suarez, Carlos

This document describes the Accelerated Associate's Degree Program for Licensed Practical Nurses (LPN) at the Inter-American University of Puerto Rico. The program, targeting unemployed LPNs living in San Juan, Puerto Rico, allows students to complete an associate's degree in one year. Fifty-four students enrolled during the first year and 50% of…

Exploiting Temporal Constraints of Clinical Guidelines by Applying OpenEHR Archetypes.

PubMed

Cintho, Lilian Mie Mukai; Garcia, Diego; da Silva Santos, Bruno Henrique; Sacchi, Lucia; Quaglini, Silvana; Moro, Claudia Maria Cabral

2017-01-01

Studies describing Computer-Interpretable Clinical Guidelines (CIG) with temporal constrains (TC) generally have not addressed issues related to their integration into Electronic Health Record (EHR) systems. This study aimed to represent TCs contained in clinical guidelines by applying archetypes and Guideline Definition Language (GDL) to incorporate decision support into EHRs. An example of each TC class in the clinical guideline for management of Atrial Fibrillation was represented using archetypes and GDL.

Determination of the crystalline structure of scale solids from the 16H evaporator gravity drain line to tank 38H

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

Oji, L. N.

2015-10-01

August 2015, scale solids from the 16H Evaporator Gravity Drain Line (GDL) to the Tank 38H were delivered to SRNL for analysis. The desired analytical goal was to identify and confirm the crystalline structure of the scale material and determine if the form of the aluminosilicate mineral was consistent with previous analysis of the scale material from the GDL.

Clinical and hematological response to hydroxyurea in a patient with Hb Lepore/beta-thalassemia.

PubMed

Rigano, P; Manfré, L; La Galla, R; Renda, D; Renda, M C; Calabrese, A; Calzolari, R; Maggio, A

1997-05-01

The possibility of increasing Hb F in vivo using drugs like 5-azacytidine, hydroxyurea, and butyrate has been established. However, in many cases this does not entail an increase in total hemoglobin. We report on a patient with Hb Lepore/beta-thalassemia being treated with hydroxyurea (30 mg/Kg/day) because of the presence of erythroid extramedullary masses with severe neurological abnormalities. During therapy the patient showed a remarkable improvement in neurological signs due to the reduction in extra-medullary masses, a significant increase in both total hemoglobin (from 5.8 to 9.7 g/dl) and Hb F (from 4.9 g/dl to 9.1 g/dl). The marked improvement in hemoglobin level in our patient with Hb Lepore/beta-thalassemia suggests gamma-globin gene activation due to the DNA structure determined by the crossover event.

Haemoglobin concentrations and infection by Giardia intestinalis in children: effect of treatment with secnidazole.

PubMed

Jiménez, J C; Rodríguez, N; Di Prisco, M C; Lynch, N R; Costa, V

1999-12-01

The blood concentrations of haemoglobin were investigated in 82 children aged 2-9 years. Fifty-seven (31 boys and 26 girls) were stool-positive for Giardia intestinalis but the other 25, used as controls, were negative. The mean (S.D.) haemoglobin concentration among the infected children was significantly lower pre-treatment than that for the control group [11.6 (1.2) v. 12.6 (1.5) g/dl; P < 0.05]. Treatment of the infected children with a single oral dose of secnidazole (30 mg/kg) led to a significant increase in their mean haemoglobin level 15 days later, from 11.6 (1.2) g/dl pre-treatment to 12.4 (1.2) g/dl post-treatment (P < 0.05). The results indicate that the therapeutic control of giardiasis could be important in programmes to combat anaemia in children living in endemic areas.

Blood indicators of seasonal metabolic patterns in captive adult gray wolves

USGS Publications Warehouse

Seal, U.S.; Mech, L.D.

1983-01-01

Blood samples and physical data were collected weekly from a colony of gray wolves (Canis lupus) maintained under natural weather arid light conditions. Sampling over 33 continuous months indicated that hemoglobin, hematocrit, red blood cells, mean corpuscular hemoglobin concentration (MCHC), and thyroxine exhibited consistent circannual patterns of variation in both males and females. Hemoglobin levels peaked at 15-16 g/dl in January in females and at 16-17 g/dl in February in males, and were lowest in August at 10.5-11.5 g/dl (P < 0.00001). The cyclic patterns of hematocrit, red blood cells, and MCHC were similarly timed. Females also had a cyclic pattern of white blood cell counts and body weight; their weight peaked in early February and was lowest in August (P < 0.001). Body temperature, urea nitrogen, mean corpuscular volume (MCV), serum glucose, and cortisol did not follow a consistent seasonal pattern.

The use of NUREGs 1199 and 1200 in the Illinois LLW licensing program

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

Klinger, J.G.; Harmon, D.F.

1991-12-31

This paper will describe how the LLW licensing staff of the Illinois Department of Nuclear Safety used NRC`s NUREG 1199, NUREG 1200, NUREG 1300 and Regulatory Guide 4.18 in its licensing program for reviewing and evaluating a LLW disposal facility license application. The paper will discuss how Illinois guidance documents were prepared based on modifications made to these NRC documents which were necessary to take into account site and facility specific considerations, as well as changes required by Illinois statutes and regulatory codes. The paper will review the recent revisions (January 1991) to NUREG 1199 and 1200 and the importancemore » of these revisions. The paper will also discuss recommended modifications to these NRC documents and provide an update on the status of the Department`s review and evaluation of an application for a license to site, construct and operate a LLW disposal facility in Illinois.« less

77 FR 71822 - Notice of Invitation-Coal Exploration License Application MTM 103852, MT

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-04

...] Notice of Invitation--Coal Exploration License Application MTM 103852, MT AGENCY: Bureau of Land... Ambre Energy on a pro rata cost sharing basis in a program for the exploration of coal deposits owned by... program is to gain additional geologic knowledge of the coal underlying the exploration area for the...

75 FR 55360 - In the Matter of Mattingly Testing Services, Inc. Molt, MT; Order Revoking License (Effective...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-10

... radiation safety officer, and due to expire on February 28, 2016. The license authorizes Mattingly to... effectiveness of Mattingly's radiation safety and compliance programs by commencing an assessment of Mattingly's radiation safety program within 30 days of NRC's approval of the consultant; by reviewing Mattingly's...

47 CFR 73.3580 - Local public notice of filing of broadcast applications.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., other than a low power TV station license not locally originating programming as defined by § 74.701(h... originating programming as defined by § 74.701(h), an FM translator station or a TV translator station license... each calendar month. Stations broadcasting primarily in a foreign language should broadcast the...

47 CFR 73.3580 - Local public notice of filing of broadcast applications.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., other than a low power TV station license not locally originating programming as defined by § 74.701(h... originating programming as defined by § 74.701(h), an FM translator station or a TV translator station license... each calendar month. Stations broadcasting primarily in a foreign language should broadcast the...

Educational Progression of Licensed Practical Nurses to Registered Nursing Programs. Project Report.

ERIC Educational Resources Information Center

Hosch, India, Comp.

A project was conducted to develop a structural mechanism for articulation between colleges and vocational schools in West Virginia. Such articulation would permit licensed practical nurses (LPNs) desiring to become registered nurses to transfer credits for their licensed practical nursing courses and thereby eliminate unnecessary repetition of…

Measuring Critical Thinking in Newly Licensed Registered Nurses

ERIC Educational Resources Information Center

Rush, Carreen W.

2017-01-01

A national conversation is stirring in the United States about mandating residency programs of newly-licensed nurses as findings indicate that newly-licensed registered nurses are not prepared to make appropriate patient care decisions. Even with many commercial instruments available on the market for outcome measurements, accurately assessing the…

78 FR 21497 - Publication of General Licenses Related to the Burma Sanctions Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

... General License No. 19. FOR FURTHER INFORMATION CONTACT: Assistant Director for Sanctions Compliance & Evaluation, tel.: 202-622-2490, Assistant Director for Licensing, tel.: 202-622-2480, Assistant Director for Regulatory Affairs, tel.: 202-622-4855, Assistant Director for Policy, tel.: 202- 622-2746, Office of Foreign...

The Evolution and Effectiveness of Graduated Licensing.

ERIC Educational Resources Information Center

Simpson, Herb M.

2003-01-01

Traces the history and evolution of graduated driver licensing in the United States and elsewhere. Considers the extent to which graduated licensing achieves its objective of reducing collisions. Discusses a growing body of research that shows the effectiveness of the program. (Contains 2 tables and 47 references.) (AUTHOR/WFA)

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

PubMed

Leahy, Michael F; Hofmann, Axel; Towler, Simon; Trentino, Kevin M; Burrows, Sally A; Swain, Stuart G; Hamdorf, Jeffrey; Gallagher, Trudi; Koay, Audrey; Geelhoed, Gary C; Farmer, Shannon L

2017-06-01

Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001). Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

[Anemia in public school first graders in the city of Maceió, Alagoas, Brazil].

PubMed

Santos, Célia Dias dos; Santos, Leonor Maria Pacheco; Figueiroa, José Natal; Marroquim, Pajuçara Maria Guimarães; Oliveira, Maria Alice Araújo

2002-01-01

A cross-sectional study was conducted in a representative sample of 426 randomly selected first graders (ages 6 to 10 years) from public schools in Maceió, State of Alagoas, Brazil. The aim was to determine the prevalence of anemia, as well as its association with growth retardation. Data were collected from May to July 2000, and determination of hemoglobin (HGB) employed an STKS Coulter counter. Two cut-off points were used to classify anemia, both established by the World Health Organization: HGB < 11.5g/dl and HGB < 12.0g/dl. The indicators height/age (H/A), weight/age (W/A), and weight/height (W/H) below -2.0 standard deviations from the NCHS reference were diagnosed as growth retardation. Prevalence of anemia was 9.9% when HGB < 11.5g/dl was used, and 25.4% when the cut-off point was HGB < 12.0g/dl. Growth retardation was detected in 6.2% of children according to H/A, 4.0% for W/A, and 3.0% for W/H. There was no statistically significant association between the variables in the study. These findings confirm results of previous surveys where prevalence of anemia was much higher than that of growth retardation. The severe consequences of anemia in this age group justify the implementation of broad public policies to overcome this nutritional deficiency.

The effects of gas diffusion layers structure on water transportation using X-ray computed tomography based Lattice Boltzmann method

NASA Astrophysics Data System (ADS)

Jinuntuya, Fontip; Whiteley, Michael; Chen, Rui; Fly, Ashley

2018-02-01

The Gas Diffusion Layer (GDL) of a Polymer Electrolyte Membrane Fuel Cell (PEMFC) plays a crucial role in overall cell performance. It is responsible for the dissemination of reactant gasses from the gas supply channels to the reactant sites at the Catalyst Layer (CL), and the adequate removal of product water from reactant sites back to the gas channels. Existing research into water transport in GDLs has been simplified to 2D estimations of GDL structures or use virtual stochastic models. This work uses X-ray computed tomography (XCT) to reconstruct three types of GDL in a model. These models are then analysed via Lattice Boltzmann methods to understand the water transport behaviours under differing contact angles and pressure differences. In this study, the three GDL samples were tested over the contact angles of 60°, 80°, 90°, 100°, 120° and 140° under applied pressure differences of 5 kPa, 10 kPa and 15 kPa. By varying the contact angle and pressure difference, it was found that the transition between stable displacement and capillary fingering is not a gradual process. Hydrophilic contact angles in the region of 60°<θ < 90° showed stable displacement properties, whereas contact angles in the region of 100°<θ < 140° displayed capillary fingering characteristics.

Cycad Palm Toxicosis in 14 Dogs from Texas.

PubMed

Clarke, Carolyn; Burney, Derek

The goal of this study is to report clinical information, diagnostic findings, and treatment modalities; assess variables that may help distinguish survivors from nonsurvivors; and review the outcome of cycad palm toxicosis in dogs. Fourteen client-owned dogs with confirmed cycad palm ingestion were identified by reviewing the medical record database at Gulf Coast Veterinary Specialists. Information on signalment, time of ingestion to presentation, clinical signs, physical examination findings, initial and peak/nadir laboratory abnormalities, radiographic and ultrasonographic findings, treatment modalities, liver histopathology, and clinical outcome was retrieved. Of the 14 dogs, nine (64%) died as a direct result of cycad palm intoxication, and three survivors had persistently elevated liver enzymes, signifying residual liver damage. Despite decontamination, patients continued to display evidence of illness, indicating rapid absorption of toxins. When evaluating initial and peak/nadir laboratory values, nadir serum albumin levels and nadir platelet counts were significantly lower in nonsurvivors compared to survivors (1.25 g/dL [0.4-2.1 g/dL] versus 2.6 g/dL [1.7-3.4 g/dL] and 21 × 10 3 [0-64 × 10 3 ] versus 62 × 10 3 [6-144 × 10 3 ], respectively). In this cohort of dogs, the case fatality rate was higher than previously reported. Nadir serum albumin levels and nadir platelet counts may help distinguish potential survivors from nonsurvivors.

Perceptions of Polycom Programming for Delivery of Continuing Education to Florida's Licensed Pesticide Applicators

ERIC Educational Resources Information Center

Fishel, Fred; Ferrell, Jason; Vallad, Gary; Price, Jim; Cherry, Ron; Mizell, Russ; Duncan, Larry

2010-01-01

Polycom technology has potential for efficient use of program delivery by Extension educators. A survey of licensed pesticide applicators attending a 1-day event at one of 20 host polycom sites revealed that polycom distance learning is effective for presenting information and learning. Responses also indicated that most of this audience is…

76 FR 41450 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-14

... approved information collection procedure for Sugar Import Licensing Programs described in 7 CFR part 1530... INFORMATION: Title: Sugar Imported for Export as Refined Sugar or as a Sugar- Containing Product, or used in... primary objective of the Sugar Import Licensing Program is to permit entry of raw cane sugar, unrestricted...

A Measure of the Child Care Ecology: Day Care Program Compliance with State Regulations.

ERIC Educational Resources Information Center

Fiene, Richard

Between July 1978 and June 1980 a program evaluation was undertaken in Pennsylvania in order to measure compliance with state day care licensing regulations. The evaluation involved approximately 1000 licensed/approved child care centers and 50,000 children. Statistical data indicate that by the period April to June 1980 the statewide compliance…

North Carolina Star Rated License System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of North Carolina's Star Rated License System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Driving with Bioptic Telescopes: Organizing a Research Agenda

PubMed Central

Owsley, Cynthia

2012-01-01

Being a licensed driver in the U. S. and many other countries facilitates health and well-being. Based on the vision standards in most states, individuals with worse than 20/40 visual acuity who desire licensure are denied through the usual licensure application process. However, over 40 states have bioptic telescope licensing programs where applicants can gain licensure contingent on meeting specific requirements. In spite of the existence of the bioptic telescope and these licensing programs since the 1970s, there has been little rigorous scientific study of this topic. Here I offer an organizing perspective for a research agenda on driving with bioptic telescopes, with the long term practical goal being to provide an evidence basis for licensure policies and training programs. PMID:22863791

75 FR 80838 - Notice of Invitation to Participate In Coal Exploration License, Utah

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

...] Notice of Invitation to Participate In Coal Exploration License, Utah AGENCY: Bureau of Land Management, Interior. ACTION: Notice of Invitation to Participate in Coal Exploration License. SUMMARY: All interested... program for the exploration of coal deposits owned by the United States of America in Emery County, Utah...

10 CFR 72.218 - Termination of licenses.

Code of Federal Regulations, 2011 CFR

2011-01-01

... NUCLEAR FUEL, HIGH-LEVEL RADIOACTIVE WASTE, AND REACTOR-RELATED GREATER THAN CLASS C WASTE General License for Storage of Spent Fuel at Power Reactor Sites § 72.218 Termination of licenses. (a) The notification regarding the program for the management of spent fuel at the reactor required by § 50.54(bb) of...

10 CFR 72.218 - Termination of licenses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... NUCLEAR FUEL, HIGH-LEVEL RADIOACTIVE WASTE, AND REACTOR-RELATED GREATER THAN CLASS C WASTE General License for Storage of Spent Fuel at Power Reactor Sites § 72.218 Termination of licenses. (a) The notification regarding the program for the management of spent fuel at the reactor required by § 50.54(bb) of...

77 FR 60956 - State Graduated Driver Licensing Incentive Grant

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... multi-stage licensing systems that require novice drivers younger than 21 years of age to comply with... crashes involving 16-year-old drivers. A recent study by the Insurance Institute for Highway Safety ranked... associated with 30 percent lower fatal crash rates among 15-17 year- olds compared to weak licensing programs...

26 CFR 1.861-18 - Classification of transactions involving computer programs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... on a single disk for a one-time payment with restrictions on transfer and reverse engineering, which... license. The license is stated to be perpetual. Under the license no reverse engineering, decompilation... fee, on a World Wide Web home page on the Internet. P, the Country Z resident, in return for payment...

26 CFR 1.861-18 - Classification of transactions involving computer programs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... on a single disk for a one-time payment with restrictions on transfer and reverse engineering, which... license. The license is stated to be perpetual. Under the license no reverse engineering, decompilation... fee, on a World Wide Web home page on the Internet. P, the Country Z resident, in return for payment...

75 FR 43118 - Fisheries of the Exclusive Economic Zone Off Alaska; Gulf of Alaska License Limitation Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-23

.... 0912021424-0287-02] RIN 0648-AY42 Fisheries of the Exclusive Economic Zone Off Alaska; Gulf of Alaska License... the exclusive economic zone (EEZ) of the Bering Sea and Aleutian Islands Management Area (BSAI) and... license, including poor economic conditions in groundfish fisheries, [[Page 43120

High Oxygen Partial Pressure Decreases Anemia-Induced Heart Rate Increase Equivalent to Transfusion

PubMed Central

Feiner, John R.; Finlay-Morreale, Heather E.; Toy, Pearl; Lieberman, Jeremy A.; Viele, Maurene K.; Hopf, Harriet W.; Weiskopf, Richard B.

2011-01-01

Background Anemia is associated with morbidity and mortality and frequently leads to transfusion of erythrocytes. We sought to compare directly the effect of high inspired oxygen fraction vs. transfusion of erythrocytes on the anemia-induced increased heart rate (HR) in humans undergoing experimental acute isovolemic anemia. Methods We combined HR data from healthy subjects undergoing experimental isovolemic anemia in seven studies performed by our group. We examined HR changes associated with breathing 100% oxygen by non-rebreathing face mask vs. transfusion of erythrocytes at their nadir hemoglobin (Hb) concentration of 5 g/dL. Data were analyzed using a mixed-effects model. Results HR had an inverse linear relationship to hemoglobin concentration with a mean increase of 3.9 beats per minute per gram of Hb (beats/min/g Hb) decrease (95% confidence interval [CI], 3.7 – 4.1 beats/min/g Hb), P < 0.0001. Return of autologous erythrocytes significantly decreased HR by 5.3 beats/min/g Hb (95% CI, 3.8 – 6.8 beats/min/g Hb) increase, P < 0.0001. HR at nadir Hb of 5.6 g/dL (95% CI, 5.5 – 5.7 g/dL) when breathing air (91.4 beats/min; 95% CI, 87.6 – 95.2 beats/min) was reduced by breathing 100% oxygen (83.0 beats/min; 95% CI, 79.0 -87.0 beats/min), P < 0.0001. The HR at hemoglobin 5.6 g/dL when breathing oxygen was equivalent to the HR at Hb 8.9 g/dL when breathing air. Conclusions High arterial oxygen partial pressure reverses the heart rate response to anemia, probably owing to its usability, rather than its effect on total oxygen content. The benefit of high arterial oxygen partial pressure has significant potential clinical implications for the acute treatment of anemia and results of transfusion trials. PMID:21768873

A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial.

PubMed

Weltert, Luca; Rondinelli, Beatrice; Bello, Ricardo; Falco, Mauro; Bellisario, Alessandro; Maselli, Daniele; Turani, Franco; De Paulis, Ruggero; Pierelli, Luca

2015-07-01

We conducted a prospective single-blind randomized study to assess whether a single 80,000 IU dose of human recombinant erythropoietin (HRE), given just 2 days before cardiac surgery, could be effective in reducing perioperative allogeneic red blood cell transfusion (aRBCt). Six-hundred patients presenting with preoperative hemoglobin (Hb) level of not more than 14.5 g/dL were randomly assigned to either HRE or control. The primary endpoint was the incidence of perioperative aRBCt. The secondary endpoints were mortality and the incidence of adverse events in the first 45 days after surgery, Hb level on Postoperative Day 4, and number of units of RBC transfusions in the first 4 days after surgery. A total of 17% (HRE) versus 39% (control) required transfusion (relative risk, 0.436; p<0.0005). After baseline Hb was controlled for, there was no difference in the incidence of aRBCt between HRE (0%) and control (3.5%) among the patients with baseline Hb of 13.0 g/dL or more, which included the nonanemic fraction of the study population. The mean (range) Hb level on Postoperative Day 4 was 10.2 (9.9-10.6) g/dL (HRE) versus 8.7 (8.5-9.2) g/dL (control; p<0.0005). The distribution of number of units transfused was shifted toward fewer units in HRE (p<0.0005). The all-cause mortality at 45 days was 3.00% (HRE) versus 3.33% (control). The 45-day adverse event rate was 4.33% (HRE) versus 5.67% (control; both p=NS). In anemic patients (Hb<13 g/dL), a single high dose of HRE administered 2 days before cardiac surgery is effective in reducing the incidence of aRBCt without increasing adverse events. © 2015 AABB.

Macronutrient composition of human milk from Korean mothers of full term infants born at 37-42 gestational weeks

PubMed Central

Jung, Ji A; Kim, Hyesook; Jo, Ara; Kang, Sujeong; Lee, Si-Won; Yi, Hyunju; Kim, Jihee; Yim, Jong-Gap; Jung, Byung-Moon

2015-01-01

BACKGROUND/OBJECTIVES Breast milk is the best available food for optimum growth and development of infants and the breastfeeding rate is increasing in Korea. The purpose of this study is to measure the concentrations of macronutrients and to evaluate their changes according to lactation period in breast milk from lactating Korean women. SUBJECTS/METHODS Milk samples were obtained from 2,632 healthy lactating women (mean age; 32.0 ± 3.3 years), where the lactating period was up to a period of 8 months, who also volunteered to participate in the Human Milk Macronutrient Analysis Research. Lactose, protein, fat and water content in the breast milk samples were analyzed with infrared spectrometry using MilkoScan FT-2. RESULTS The mean macronutrient composition per 100 mL of mature breast milk was 7.1 g for lactose, 1.4 g for protein and 3.0 g for fat, and energy content was 61.1 kcal. The protein concentration was significantly lower in milk samples at 1-2 weeks (2.0 g/dL) to 2-3 months (1.4 g/dL) than those at 0-1 week (2.2 g/dL), but it was similar among samples from 3-4 months to 7-8 months (1.3 g/dL). Mean lipid levels varied among different lactational period groups (2.7-3.2 g/dL), but presented no significant difference. Lactose concentration in the milk samples did not differ with lactation period. Maternal body mass index was positively related to protein and lipid breast milk contents, but was negatively related to lactose content. General linear models examining the associations between maternal variables and milk macronutrient content revealed that lactation period had a major impact on protein and lipid, but not on lactose content in breast milk. CONCLUSIONS These results warrant future studies to explore factors that may be associated with changes in macronutrient content in human milk. PMID:26244084

Anti-Jk3 in a Filipino man.

PubMed

McCaskill, Shaina; Wise, Scott; Tinsley, Sheila

2015-01-01

A 62-year-old Filipino man with a history of chronic obstructive pulmonary disease, hypertension, and hyperlipidemia was admitted to the emergency department at Hospital A with recurrent fevers, weakness, and jaundice. The patient was evaluated and eventually discharged with a diagnosis of possible drug-induced hepatitis. One month later, the patient was admitted to Hospital B for recurrent fevers and weakness. The patient's hemoglobin was 3.8 g/dL. Six units of packed red blood cells (RBCs) were ordered for transfusion. The patient's sample typed as group B, D+, and the antibody screen was negative. All six units of packed RBCs appeared compatible (at immediate spin) and were transfused to the patient. His hemoglobin level 4 days post-transfusion was 9.3 g/dL, and the patient was discharged. The patient returned after a week for follow-up and his hemoglobin was found to have dropped to 8.5 g/dL, which continued to fall until it reached 7.0 g/dL. Additional packed RBCs were ordered for transfusion. during subsequent pre-transfusion compatibility testing, the antibody screen was found to be positive (all screening cells reactive at the antihuman globulin phase). An antibody identification panel was performed.The patient's serum was found to react with all panel cells tested, including the autocontrol tube. A direct antiglobulin test revealed the presence of both anti-IgG and anti-C3 coating the patient's RBCs. The specimen was then sent to a reference laboratory for further testing. Results from the reference lab testing revealed the presence of anti-Jk3 in the patient's serum. the patient was placed on steroids, and his reticulocyte count increased with no further signs of extravascular hemolysis. No additional transfusions were necessary. he was eventually discharged with a hemoglobin of 13.6 g/dL. the purpose of this case study is to report the findings of an extremely rare but clinically significant antibody, anti-Jk3.

National Accreditation and Its Role in Early Education: An Analysis of Florida's Gold Seal Quality Child-Care Program and Licensing Standards

ERIC Educational Resources Information Center

Winterbottom, Christian; Jones, Ithel

2014-01-01

This article reports on the first Florida statewide assessment of the Gold Seal Quality Care program, accreditation, and the relationship with licensing violations. This study analyzed the differences between the Department of Children and Families Gold Seal-Accredited facilities and nonaccredited facilities by comparing the facilities and the…

A Case Study of Factors Leading to Student Success in an Accelerated Licensed Practical Nurse to Associate Degree Nursing Program

ERIC Educational Resources Information Center

Taylor, Sherry T.

2012-01-01

This case study attempted to discover and comprehend the relationship of students and contributing factors of success, of one Licensed Practical Nurse (LPN) to Associate Degree in Nursing (ADN) program, to formulate an understanding of which contributing factors are most beneficial to enable students to persist to graduation and/or successfully…

76 FR 16808 - Notice of Invitation to Participate In Coal Exploration License, Utah

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

...] Notice of Invitation to Participate In Coal Exploration License, Utah AGENCY: Bureau of Land Management... Ark Land Company on a pro rata cost sharing basis in its program for the exploration of coal deposits... participate in this coal exploration license was published, once each week for 2 consecutive weeks, in the...

77 FR 25734 - Notice of Invitation To Participate in Coal Exploration License, Utah

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-01

...] Notice of Invitation To Participate in Coal Exploration License, Utah AGENCY: Bureau of Land Management... Ark Land Company on a pro rata cost-sharing basis in its program for the exploration of coal deposits... participate in this coal exploration license was published once each week for 2 consecutive weeks in The...

76 FR 15826 - Fisheries of the Exclusive Economic Zone Off Alaska; Gulf of Alaska License Limitation Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-22

... or non-trawl gear designations); and (4) designate the type of vessel operation permitted (i.e., LLP... catcher/processor). The endorsements for specific regulatory areas, gear designations, and vessel operational types are non-severable from the LLP license (i.e., once an LLP license is issued, the components...

78 FR 31958 - Privacy Act of 1974; Department of Homeland Security U.S. Customs and Border Protection-007...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

...; Secondary Examination Status, and License Plate number (or Vehicle Identification Number (VIN), if no plate... License Plate number of the conveyance (or VIN number when no plate exists). Under the Entry/Exist Program... Driver's License (EDL); (5) another Federal Agency that has issued a valid travel document, such as...

10 CFR 50.21 - Class 104 licenses; for medical therapy and research and development facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Class 104 licenses; for medical therapy and research and...; for medical therapy and research and development facilities. A class 104 license will be issued, to an... Administration entered into under the Cooperative Power Reactor Demonstration Program, except as otherwise...

Technology Licensing for the Benefit of the Developing World: UC Berkeley's Socially Responsible Licensing Program

ERIC Educational Resources Information Center

Mimura, Carol

2007-01-01

In the years since the passage of the Bayh-Dole Act of 1980, university technology transfer success has been measured primarily by traditional metrics such as numbers of patents filed, revenue obtained from licensed patents and numbers of start-up companies founded to commercialize university intellectual property. Intellectual property (IP)…

Your EHR license agreement: critical issues.

PubMed

Shay, Daniel F

2014-01-01

This article discusses several key provisions and concepts in software license agreements for electronic health records. It offers insight into what physician practices can expect to find in their license agreements, as well as practical advice on beneficial provisions. The article examines contractual language relating to term and termination, technical specifications and support, and compliance with governmental programs.

34 CFR Appendix B to Subpart B of... - Appendix I, Standards for Audit of Governmental Organizations, Programs, Activities, and...

Code of Federal Regulations, 2011 CFR

2011-07-01

... accountants should be employed. The type of qualifications, as stated by the Comptroller General, deemed... shall be conducted * * * by independent certified public accountants or by independent licensed public accountants, licensed on or before December 31, 1970, who are certified or licensed by a regulatory authority...

42 CFR 423.420 - Solvency standards for non-licensed entities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Organization Compliance with State Law and Preemption by Federal Law § 423.420 Solvency standards for non-licensed...

The decriminalization of prostitution is associated with better coverage of health promotion programs for sex workers.

PubMed

Harcourt, Christine; O'Connor, Jody; Egger, Sandra; Fairley, Christopher K; Wand, Handan; Chen, Marcus Y; Marshall, Lewis; Kaldor, John M; Donovan, Basil

2010-10-01

In order to assess whether the law has an impact on the delivery of health promotion services to sex workers, we compared health promotion programs in three Australian cities with different prostitution laws. The cities were Melbourne (brothels legalized if licensed, unlicensed brothels criminalized), Perth (criminalization of all forms of sex work) and Sydney (sex work largely decriminalized, without licensing). We interviewed key informants and gave questionnaires to representative samples of female sex workers in urban brothels. Despite the different laws, each city had a thriving and diverse sex industry and a government-funded sex worker health promotion program with shopfront, phone, online and outreach facilities. The Sydney program was the only one run by a community-based organisation and the only program employing multi-lingual staff with evening outreach to all brothels. The Melbourne program did not service the unlicensed sector, while the Perth program accessed the minority of brothels by invitation only. More Sydney workers reported a sexual health centre as a source of safer sex training and information (Sydney 52% v Melbourne 33% and Perth 35%; p<0.001). Sex workers in Melbourne's licensed brothels were the most likely to have access to free condoms (Melbourne 88%, Sydney 39%, Perth 12%; p<0.001). The legal context appeared to affect the conduct of health promotion programs targeting the sex industry. Brothel licensing and police-controlled illegal brothels can result in the unlicensed sector being isolated from peer-education and support. © 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.

Pore network modeling to explore the effects of compression on multiphase transport in polymer electrolyte membrane fuel cell gas diffusion layers

NASA Astrophysics Data System (ADS)

Fazeli, Mohammadreza; Hinebaugh, James; Fishman, Zachary; Tötzke, Christian; Lehnert, Werner; Manke, Ingo; Bazylak, Aimy

2016-12-01

Understanding how compression affects the distribution of liquid water and gaseous oxygen in the polymer electrolyte membrane fuel cell gas diffusion layer (GDL) is vital for informing the design of improved porous materials for effective water management strategies. Pore networks extracted from synchrotron-based micro-computed tomography images of compressed GDLs were employed to simulate liquid water transport in GDL materials over a range of compression pressures. The oxygen transport resistance was predicted for each sample under dry and partially saturated conditions. A favorable GDL compression value for a preferred liquid water distribution and oxygen diffusion was found for Toray TGP-H-090 (10%), yet an optimum compression value was not recognized for SGL Sigracet 25BC. SGL Sigracet 25BC exhibited lower transport resistance values compared to Toray TGP-H-090, and this is attributed to the additional diffusion pathways provided by the microporous layer (MPL), an effect that is particularly significant under partially saturated conditions.

Appraisal on the prevalence of malaria and anaemia in pregnancy and factors influencing uptake of intermittent preventive therapy with sulfadoxine-pyrimethamine in Kibaha district, Tanzania.

PubMed

Tarimo, S Donath

2007-10-01

To appraise the prevalence of malaria and anaemia in antenatal mothers; and explore the factors influencing coverage of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) under operational conditions in the national programme for malaria control in pregnancy. Descriptive cross-sectional survey. The reproductive and child health clinic in Kibaha district hospital, Tanzania SUBECTS: Pregnant mothers on routine antenatal visits Prevalence of malaria (peripheral parasitaemia) and anaemia, coverage of IPT with SP and the factors influencing coverage. A total of 395 mothers were recruited; 27.3% had malaria. Moderate anaemia i.e. haemoglobin (Hb) level 8. -10.9 g/dl was detected in 56.7% of mothers; 34.2% had severe anaemia (Hb < 8.0 g/dl). Hb > 8.0 g/dl was strongly associated with negative parasitaemia while Hb < 8.0 gidl was strongly associated with positive parasitaemia. About a third (40.0%) of the mothers did not receive SP for IPT

Maternal anaemia as an indicator for monitoring malaria control in pregnancy in sub-Saharan Africa.

PubMed

Savage, E J; Msyamboza, K; Gies, S; D'Alessandro, U; Brabin, B J

2007-10-01

Malarial anaemia is a major problem in many developing countries and often occurs more frequently in first pregnancies, as primigravidae are more susceptible to Plasmodium falciparum malaria and are at excess risk of malarial anaemia. To analyse the excess risk of anaemia in primigravidae as a potential indicator of malaria control and exposure in pregnant women living in sub-Saharan Africa. The sensitivity, specificity and predictive values for anaemia in first compared with later pregnancies are calculated for 27 studies from malarious and 7 studies from nonmalarious areas. Surveys of pregnancy anaemia reported for highly malarious and nonmalarious areas. In malarious areas, the weighted odds ratio for excess anaemia (haemoglobin [Hb] <11 g/dl) in primigravidae compared with multigravidae for all studies was 1.34 (95% CI 1.14-1.58). At an Hb cutoff below 8 g/dl, the weighted odds ratio was 1.79 (95% CI 1.52-2.10). In nonmalarious areas, there was no increased risk of anaemia in primigravidae with Hb below 11 g/dl (OR 0.80; 95% CI 0.63-1.90) or below 8 g/dl (OR 0.82, 95% CI 0.51-1.28). In view of the consistency of results across highly malarious areas compared with nonmalarious areas, maternal anaemia has the potential to be used for surveillance of malaria control in pregnancy. Based on the analysis, an anaemia nomogram is developed for use as a surveillance indicator in malarious areas in sub-Saharan Africa.

An Australasian model license reassessment procedure for identifying potentially unsafe drivers.

PubMed

Fildes, Brian N; Charlton, Judith; Pronk, Nicola; Langford, Jim; Oxley, Jennie; Koppel, Sjaanie

2008-08-01

Most licensing jurisdictions in Australia currently employ age-based assessment programs as a means to manage older driver safety, yet available evidence suggests that these programs have no safety benefits. This paper describes a community referral-based model license re assessment procedure for identifying and assessing potentially unsafe drivers. While the model was primarily developed for assessing older driver fitness to drive, it could be applicable to other forms of driver impairment associated with increased crash risk. It includes a three-tier process of assessment, involving the use of validated and relevant assessment instruments. A case is argued that this process is a more systematic, transparent and effective process for managing older driver safety and thus more likely to be widely acceptable to the target community and licensing authorities than age-based practices.

Report on Chiropractors Licensed in Washington; Information on Education and Training Programs.

ERIC Educational Resources Information Center

Senters, Jo; Cohen, Lynn

The purpose of this study was to determine profile characteristics of chiropractors licensed in the state of Washington. The results are based upon information gathered through a questionnaire which was sent to all chiropractors licensed in the state as of March 30, 1970. The response rate to the questionnaire was 83 0/0. The findings were that a…

Licensed Professional Counselor Interns' Level of Self-Efficacy Relating to Graduate Program of Study and Institution Type

ERIC Educational Resources Information Center

Webster, Matthew A.

2012-01-01

In the state of Texas, Licensed Professional Counselors (LPCs) work to provide mental- health services designed to meet the needs of those who are dealing with a variety of affective, cognitive, and behavioral issues. Multiple educational pathways are available for obtaining the LPC license, with primary distinctions being among the graduate…

Other High-Risk Factors for Young Drivers--How Graduated Licensing Does, Doesn't, or Could Address Them.

ERIC Educational Resources Information Center

Ferguson, Susan A.

2003-01-01

Examines the risk factors underlying the high crash rates of newly licensed drivers and assesses the extent to which existing graduated driver-licensing programs address these risks. Discusses such risks as driver fatigue, not using seat belts, high speeds, high-powered vehicles, and in-vehicle distractions. (Contains 66 references.) (AUTHOR/WFA)

Systematic Review and Meta-Analysis of Diagnostic Accuracy of Serum Refractometry and Brix Refractometry for the Diagnosis of Inadequate Transfer of Passive Immunity in Calves.

PubMed

Buczinski, S; Gicquel, E; Fecteau, G; Takwoingi, Y; Chigerwe, M; Vandeweerd, J M

2018-01-01

Transfer of passive immunity in calves can be assessed by direct measurement of immunoglobulin G (IgG) by methods such as radial immunodiffusion (RID) or turbidimetric immunoassay (TIA). IgG can also be measured indirectly by methods such as serum refractometry (REF) or Brix refractometry (BRIX). To determine the accuracy of REF and BRIX for assessment of inadequate transfer of passive immunity (ITPI) in calves. Systematic review and meta-analysis of diagnostic accuracy studies. Databases (PubMed and CAB Abstract, Searchable Proceedings of Animal Science) and Google Scholar were searched for relevant studies. Studies were eligible if the accuracy (sensitivity and specificity) of REF or BRIX was determined using direct measurement of IgG by RID or turbidimetry as the reference standard. The study population included calves <14 days old that were fed with natural colostrum (colostrum replacement products were excluded). Quality assessment was performed by the QUADAS-2 tool. Hierarchical models were used for meta-analysis. From 1,291 references identified, 13 studies of 3,788 calves were included. Of these, 11 studies evaluated REF and 5 studies evaluated BRIX. The median (range) prevalence of ITPI (defined as calves with IgG <10 g/L by RID or TIA) was 21% (1.3-56%). Risk of bias and applicability concerns were generally low or unclear. For REF, summary estimates were obtained for 2 different cutoffs: 5.2 g/dL (6 studies) and 5.5 g/dL (5 studies). For the 5.2 g/dL cutoff, the summary sensitivity (95% CI) and specificity (95% CI) were 76.1% (63.8-85.2%) and 89.3% (82.3-93.7%), and 88.2% (80.2-93.3%) and 77.9% (74.5-81.0%) for the 5.5 g/dL cutoff. Due to the low number of studies using the same cutoffs, summary estimates could not be obtained for BRIX. Despite their widespread use on dairy farms, evidence about the optimal strategy for using refractometry, including the optimal cutoff, are sparse (especially for BRIX). When using REF to rule out ITPI in herds, the 5.5 g/dL cutoff may be used whereas for ruling in ITPI, the 5.2 g/dL cutoff may be used. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

42 CFR 431.702 - State plan requirement.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Licensing Nursing Home Administrators § 431.702 State plan requirement. A State plan must provide that the State has a program for licensing administrators of nursing homes that meets the requirements of §§ 431...

42 CFR 431.702 - State plan requirement.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Licensing Nursing Home Administrators § 431.702 State plan requirement. A State plan must provide that the State has a program for licensing administrators of nursing homes that meets the requirements of §§ 431...

Gasdynamic lasers and photon machines.

NASA Technical Reports Server (NTRS)

Christiansen, W. H.; Hertzberg, A.

1973-01-01

The basic operational highlights of CO2-N2 gasdynamic lasers (GDL's) are described. Features common to powerful gas lasers are indicated. A simplified model of the vibrational kinetics of the system is presented, and the importance of rapid expansion nozzles is shown from analytic solutions of the equations. A high-power pulsed GDL is described, along with estimations of power extraction. A closed-cycle laser is suggested, leading to a description of a photon generator/engine. Thermodynamic analysis of the closed-cycle laser illustrates in principle the possibility of direct conversion of laser energy to work.

42 CFR 431.715 - Federal financial participation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Programs for Licensing Nursing Home Administrators § 431.715 Federal financial participation. No FFP is... licensing of nursing home administrators. ... 42 Public Health 4 2010-10-01 2010-10-01 false Federal financial participation. 431.715 Section...

Evaluating drivers licensed with medical conditions in Utah, 1992-1996

DOT National Transportation Integrated Search

1999-06-01

The Utah Driver License Division has implemented a program since 1979 that restricts drivers with medical conditions by functional ability category (medical condition) according to their functional ability level. This study compares the citation, all...

77 FR 58580 - Interview Room Recording System Standard and License Plate Reader Standard Workshops

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-21

... DEPARTMENT OF JUSTICE Office of Justice Programs [OJP (NIJ) Docket No. 1603] Interview Room Recording System Standard and License Plate Reader Standard Workshops AGENCY: National Institute of Justice, DOJ. [[Page 58581

Training program for driver licensing screening for medical impairment

DOT National Transportation Integrated Search

1977-08-01

The purpose of the contract was to create a complete curriculum package, for training motor vehicle license examiners to identify individuals with potentially unsafe physical or mental conditions. The present report describes the process followed in ...

Additive Manufacturing: An Analysis of Intellectual Property Rights on Navy Acquisition

DTIC Science & Technology

2015-12-01

Administration Office of Investment and Innovation . (2014, February 24). Small Business Innovative Research (SBIR) Program directive . Washington, DC... license agreements outside of standard licensing . • Small Business Innovative Research (SBIR) Rights: These rights prevent government users from...DFARS 227.227.7104(a) License Rights Principal Objective To identify the scope of data rights to be delivered under the Small Business Innovative

Chapter 5, "License Renewal and Aging Management for Continued Service

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

Naus, Dan J

As of August 2011, there were 104 commercial nuclear power reactors licensed to operate in 31 states in the United States. Initial operating licenses in the United States are granted for a period of 40 years. In order to help assure an adequate energy supply, the USNRC has established a timely license renewal process and clear requirements that are needed to ensure safe plant operation for an extended plant life. The principals of license renewal and the basic requirements that address license renewal are identified as well as additional sources of guidance that can be utilized as part of themore » license renewal process. Aging management program inspections and operating experience related to the concrete and steel containment structures are provided. Finally, several lessons learned are provided based on containment operating experience.« less

Considering Student Voices: Examining the Experiences of Underrepresented Students in Intervention Programs.

PubMed

Gibau, Gina Sanchez

2015-01-01

Qualitative studies that examine the experiences of underrepresented minority students in science, technology, engineering, and mathematics fields are comparatively few. This study explores the self-reported experiences of underrepresented graduate students in the biomedical sciences of a large, midwestern, urban university. Document analysis of interview transcripts from program evaluations capture firsthand accounts of student experiences and reveal the need for a critical examination of current intervention programs designed to reverse the trend of underrepresentation in the biomedical sciences. Findings point to themes aligned around the benefits and challenges of program components, issues of social adjustment, the utility of supportive relationships, and environmental impacts. © 2015 G. S. Gibau. CBE—Life Sciences Education © 2015 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Reference intervals for hemoglobin and hematocrit in a low-risk pregnancy cohort: implications of racial differences.

PubMed

Chiossi, Giuseppe; Palomba, Stefano; Costantine, Maged M; Falbo, Angela I; Harirah, Hassan M; Saade, George R; La Sala, Giovanni B

2018-03-23

As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number. We analyzed 23,657 hemograms from 7318 pregnancies and 6870 women. Multivariate analysis showed that when compared to Caucasians', African women's mean Hb and Ht were respectively 0.24 (95%CI 0.3-0.17) g/dl and 0.7 (95%CI 0.8-0.5) % lower, while Asian mothers' were 0.11 (95%CI 0.19-0.03) g/dl and 0.3 (95%CI 0.5-0.1) % inferior. Similarly, both African and Asian women had lower fifth Ht percentiles (-1, 95%CI -1.3 to -0.6, and -0.4, 95%CI -0.7 to -0.04) than Caucasians, while African mothers also had lower fifth Hb percentile (0.3, 95%CI 0.5-0.1). The fifth percentile for Hb and Ht were, respectively, 11.3 (95%CI 11-11.5) g/dl and 32.8 (95%CI 32.3-33.4) % in the first trimester, 10.4 (95%CI 10.1-10.6) g/dl and 30.2 (95%CI 29.6-30.8) % in the second trimester, 10.1 (95%CI 9.8-10.3) g/dl and 30.6 (95%CI 30-31.1) % in the third trimester. We provided contemporary references to define anemia in pregnancy, and we confirmed that even in pregnancy, African and Asian women have lower Hb and Ht than Caucasian. Racial and population-specific references may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment.

Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania.

PubMed

Liu, Enju; Duggan, Christopher; Manji, Karim P; Kupka, Roland; Aboud, Said; Bosch, Ronald J; Kisenge, Rodrick R; Okuma, James; Fawzi, Wafaie W

2013-08-13

Anaemia is prevalent among children born to HIV-positive women, and it is associated with adverse effects on cognitive and motor development, growth, and increased risks of morbidity and mortality. To examine the effect of daily multivitamin supplementation on haematologic status and mother-to-child transmission (MTCT) of HIV through breastfeeding. A total of 2387 infants born to HIV-positive women from Dar es Salaam, Tanzania were enrolled in a randomized, double-blind, placebo-controlled trial, and provided a daily oral supplement of multivitamins (vitamin B complex, C and E) or placebo at age 6 weeks for 24 months. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations <11 g/dL and severe anaemia <8.5 g/dL. Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p=0.03), 18 (9.76 vs. 9.57 g/dL, p=0.004), and 24 months (9.93 vs. 9.75 g/dL, p=0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.79-0.99; p=0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.56-0.92; p=0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.79-1.54; p=0.57; p for interaction=0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between multivitamin supplements and MTCT of HIV. Multivitamin supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy.

Further analysis of drivers licensed with medical conditions in Utah

DOT National Transportation Integrated Search

2001-03-01

The Utah Driver License Division has implemented a program since 1979 that restricts drivers with medical conditions by functional ability category (medical condition) by assigning them a functional ability level. This study compares the citation, al...

Does stapled anopexy for bleeding haemorrhoids cure associated anaemia?

PubMed

Hidalgo-Grau, L A; Llorca-Cardeñosa, S; Heredia-Budó, A; Estrada-Ferrer, Ò; Del Bas-Rubia, M; García-Torralbo, E M; Suñol-Sala, X

2014-10-01

The aim of this study was to evaluate the effectiveness of stapled anopexy (SA) in patients with chronic bleeding haemorrhoids and secondary anaemia. Our department performed 340 SA procedure per patient for haemorrhoids between January 1999 and December 2011. Fifty (14.7%) of these patients (25 male patients and 25 female patients) had anaemia (haemoglobin concentration < 13 g/dl in male patients and < 12 g/dl in female patients) secondary to chronic haemorrhoidal bleeding. Patients with colorectal bleeding and anaemia not caused by haemorrhoids were excluded. The mean (SD) age was 56.4 (13.9) years and the mean (SD) haemoglobin concentration was 9.2 (1.6) g/dl for male patients and 10.4 (1.2) g/dl for female patients. Five (10%) patients with anaemia had Grade II, 22 (44%) had Grade III and 23 (46%) had Grade IV haemorrhoids. The median (range) duration of postoperative follow-up was six (1-12) years. None of the patients required early postoperative admission or experienced early or late complications related to SA. The procedure was successful (normal haemoglobin concentration and no bleeding at 6 months postsurgery) in 45 (90%) patients. Of the five (10%) patients in whom SA was ineffective, one had Grade II, three had Grade III and one had Grade IV haemorrhoids. All these patients underwent Milligan-Morgan haemorrhoidectomy 3 months after SA. SA is an effective treatment for patients with bleeding haemorrhoids and subsequent anaemia. In our experience, the success rate was satisfactory and there were no serious complications. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

A review of blood transfusions in a trauma unit for young children.

PubMed

Salverda, M; Ketharanathan, N; Van Dijk, M; Beltchev, E; Buys, H; Numanoglu, A; Van As, A B

2017-02-27

Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2). A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients.

General deterrence effects of U.S. statutory DUI fine and jail penalties: long-term follow-up in 32 states.

PubMed

Wagenaar, Alexander C; Maldonado-Molina, Mildred M; Erickson, Darin J; Ma, Linan; Tobler, Amy L; Komro, Kelli A

2007-09-01

We examined effects of state statutory changes in DUI fine or jail penalties for firsttime offenders from 1976 to 2002. A quasi-experimental time-series design was used (n=324 monthly observations). Four outcome measures of drivers involved in alcohol-related fatal crashes are: single-vehicle nighttime, low BAC (0.01-0.07g/dl), medium BAC (0.08-0.14g/dl), high BAC (>/=0.15g/dl). All analyses of BAC outcomes included multiple imputation procedures for cases with missing data. Comparison series of non-alcohol-related crashes were included to efficiently control for effects of other factors. Statistical models include state-specific Box-Jenkins ARIMA models, and pooled general linear mixed models. Twenty-six states implemented mandatory minimum fine policies and 18 states implemented mandatory minimum jail penalties. Estimated effects varied widely from state to state. Using variance weighted meta-analysis methods to aggregate results across states, mandatory fine policies are associated with an average reduction in fatal crash involvement by drivers with BAC>/=0.08g/dl of 8% (averaging 13 per state per year). Mandatory minimum jail policies are associated with a decline in single-vehicle nighttime fatal crash involvement of 6% (averaging 5 per state per year), and a decline in low-BAC cases of 9% (averaging 3 per state per year). No significant effects were observed for the other outcome measures. The overall pattern of results suggests a possible effect of mandatory fine policies in some states, but little effect of mandatory jail policies.

The effect of a multidisciplinary care clinic on the outcomes in pediatric chronic kidney disease.

PubMed

Ajarmeh, Salma; Er, Lee; Brin, Genevieve; Djurdjev, Ognjenka; Dionne, Janis M

2012-10-01

Current best evidence-based practice for children with chronic kidney disease (CKD) attempts to achieve good clinical outcomes through careful management of comorbidities and is likely best achieved with a multidisciplinary care (MDC) CKD clinic. In this retrospective study of children with CKD in British Columbia, Canada, we analyzed clinical outcomes in a cohort of 73 CKD patients from 2003 under a standard care model and a second cohort of 125 CKD patients from 2009 under a MDC clinic model. Patient demographics were similar, but there was a decrease in the percentage of patients with CKD stage 3-5 in 2009 (59 vs. 75 %; p = 0.002), although the absolute number increased. After adjustment for severity of CKD, hemoglobin was significantly higher (13.0 g/dl vs. 12.2 g/dl, p < 0.03), calcium was significantly higher (9.6 mg/dl vs. 9.1 mg/dl, p < 0.001), and albumin was significantly higher (4.4 g/dl vs. 3.8 g/dl, p < 0.001) in the 2009 MDC cohort. The rate of disease progression, assessed by annualized estimated glomerular filtration rate (eGFR) slope, improved from -4.0 ml/min/1.73 m(2) in the 2003 cohort to 0.5 ml/min/1.73 m(2) in the 2009 cohort (p < 0.01). Blood pressure control was better in 2009 although not statistically significant. Multidisciplinary care improved the outcomes of children with CKD especially in anemia management, bone mineral metabolism, nutrition, and renal disease progression.

Triggers and appropriateness of red blood cell transfusions in the postpartum patient--a retrospective audit.

PubMed

So-Osman, C; Cicilia, J; Brand, A; Schipperus, M; Berning, B; Scherjon, S

2010-01-01

Despite published guidelines, a proportion of red blood cell (RBC) transfusions seem unnecessary. To evaluate the indications for and the appropriateness of RBC transfusions in the postpartum patient, we performed a retrospective audit over a 1-year period in two Dutch hospitals. Observational study of transfused obstetric patients, admitted in 2006 to the Departments of Obstetrics of a university and a general hospital, was carried out. Relevant clinical and laboratory data were recorded. The appropriateness of RBC transfusions was assessed using the national and age-based transfusion guidelines for the general population; for the studied group the transfusion threshold haemoglobin (Hb) value was 6.4 g/dl for non-massive and 8.1 g/dl for massive blood loss. From these we derived target Hb levels. Ninety patients received one or more RBC units within 48 h of delivery. Mean pretransfusion Hb level was 6.9 [SD 1.2] g/dl. Median number of transfusions was 2. Mean Hb level at discharge was 9.7 [SD 1.1] g/dl. Taking threshold Hb and the derived target Hb level into account, 68% (n = 61) of the patients may have received one or more RBC units inappropriately. Of 311 RBC units transfused, 143 units (46%) were possibly inappropriate, partly due to over-transfusion. A significant proportion of postpartum RBC transfusions are possibly inappropriate, partly due to over-transfusion. If current guidelines would be more specific, in particular, with respect to the target Hb levels, the total amount of RBC transfusions may be considerably decreased.

Incidence of anaemia among HIV-infected patients treated with highly active antiretroviral therapy.

PubMed

Curkendall, S M; Richardson, J T; Emons, M F; Fisher, A E; Everhard, F

2007-11-01

The aim of the study was to compare the incidence of anaemia in patients treated with zidovudine (ZDV) with that in patients treated with highly active antiretroviral therapy (HAART) not including ZDV. Using HIV Insight, a database of abstracted US HIV care centre medical charts, ZDV-naïve patients starting ZDV-containing HAART were compared with those starting non-ZDV, nucleoside reverse transcriptase inhibitor-containing HAART. Cohorts were divided as follows: group 1: without baseline anaemia [haemoglobin (Hb) >or=11 g/dL]; group 2: with baseline anaemia (Hb <11 g/dL). The incidence of anaemia (anaemia diagnosis, Hb <11 g/dL, erythropoietic therapy or blood transfusion) was computed for group 1. The anaemia hazard ratio (HR) was adjusted using Cox regression. The rate of worsening anaemia (Hb decrease >or=1.0 g/dL) was computed for group 2. In group 1, the incidence of anaemia was 24.3 and 8.1 per 100 person-years in the ZDV and non-ZDV cohorts, respectively, after 6 months of follow-up, and 12.5 and 5.3 per 100 person-years after 24 months. Significant predictors of anaemia were ZDV, low initial Hb, injecting drug use, CD4 count <200 cells/microL and AIDS. The adjusted HR for ZDV was 1.6 (P=0.005). In group 2, the ZDV/non-ZDV risk ratio for worsening anaemia was 2.2 (95% confidence interval 1.1-4.3). Patients initiating ZDV-containing HAART are at greater risk of developing new anaemia or worsening anaemia than patients initiating non-ZDV-containing HAART.

Delivery of iron-fortified yoghurt, through a dairy value chain program, increases hemoglobin concentration among children 24 to 59 months old in Northern Senegal: A cluster-randomized control trial.

PubMed

Le Port, Agnes; Bernard, Tanguy; Hidrobo, Melissa; Birba, Ousmane; Rawat, Rahul; Ruel, Marie T

2017-01-01

Innovative strategies are needed to enhance the nutritional impact of agriculture. Value chain approaches, which use supply chains to add value (usually economic) to products as they move from producers to consumers, can be used to increase access to nutritious foods and improve nutritional status. This study tested whether a dairy value chain could be used to distribute a micronutrient-fortified yoghurt (MNFY) (conditional upon the producer supplying a minimum amount of cow milk/day) to improve hemoglobin and reduce anemia among preschool children in a remote area in Northern Senegal. A cluster randomized control trial was used to compare 204 children (24 to 59 months of age at baseline) from households who received the MNFY coupled to a behavior change communication (BCC) campaign focusing on anemia prevention to 245 children from a control group (receiving BCC only) after one year. Randomization was done at the level of the family concession (households from the same family) (n = 321). Eligible households had a child of the target age and were willing to deliver milk to the dairy factory. Changes in anemia and hemoglobin between groups were assessed using mixed regression models. Anemia prevalence was very high at baseline (80%) and dropped to close to 60% at endline, with no differences between intervention groups. Hemoglobin increased by 0.55 g/dL, 95%CI (0.27; 0.84) more in the intervention compared to the control group after one year, in models that controlled for potentially confounding factors. The impact was greater (0.72 g/dL, 95%CI (0.34; 1.12)) for boys, compared to girls (0.38 g/dL, 95%CI (-0.03; 0.80)). The dairy value chain was a successful strategy to distribute MNFY among pastoralists in Northern Senegal, and increase Hb concentrations among their children. This study is one of the first proofs of concept showing that a nutrition-sensitive agriculture value chain approach can contribute to improved child nutrition in a remote pastoralist population. ClinicalTrials.gov NCT02079961.

Schistosoma, other helminth infections, and associated risk factors in preschool-aged children in urban Tanzania

PubMed Central

Hella, Jerry; Knopp, Stefanie; Nassoro, Tatu; Shija, Neema; Aziz, Fatma; Mhimbira, Francis; Schindler, Christian; Mwingira, Upendo; Mandalakas, Anna M.; Manji, Karim; Tanner, Marcel; Utzinger, Jürg; Fenner, Lukas

2017-01-01

Background Despite the high prevalence of helminth infections among preschool-aged children, control programs in sub-Saharan countries primarily focus on school-aged populations. We assessed the prevalence of helminth infections and determined risk factors for infection among preschool-aged children in the urban setting of Dar es Salaam, Tanzania. Methodology Starting in October 2015, we conducted a 12-month prospective study among tuberculosis (TB)-exposed children under the age of 5 years and unexposed controls from neighboring households. At the time of recruitment, we collected medical histories, assessed development and cognitive functions, and performed medical examinations. We performed full blood cell counts and screened for HIV and malaria. Point-of-care circulating cathodic antigen (POC-CCA), urine filtration, Kato-Katz, FLOTAC, and Baermann tests were employed to detect helminth infections in urine and stool. Helminth infections were stratified for Schistosoma and other helminths to identify risk factors, using logistic regression. Principal findings We included 310 children with a median age of 26 months (inter quartile range 17–42 months) in the study. Among these, 189 were TB-exposed and 121 TB-unexposed. Two thirds of the children were anemic (hemoglobin level <11 g/dl) and the HIV prevalence was 1.3%. Schistosoma spp. was the predominant helminth species (15.8%; 95% confidence interval [CI] 12.1–20.3%). Other helminth infections were less frequent (9.0%, 95% CI 6.3–12.8%). Poor hygiene, use of household water sources, and TB-exposure were not associated with helminth infection. Development and cognitive scores did not significantly differ in helminth-infected and uninfected peers, but hemoglobin levels were significantly lower in helminth-infected children (10.1 g/dl vs. 10.4 g/dl, p = 0.027). Conclusions/significance In Dar es Salaam, a city with more than 4 million inhabitants, the prevalence of Schistosoma spp. infection among preschool-aged children was unexpectedly high. Setting-specific interventions that target preschool-aged children and urban settlements should be considered to reduce the transmission of Schistosoma and other helminth infections and to improve children’s health. PMID:29108003

Delivery of iron-fortified yoghurt, through a dairy value chain program, increases hemoglobin concentration among children 24 to 59 months old in Northern Senegal: A cluster-randomized control trial

PubMed Central

Le Port, Agnes; Bernard, Tanguy; Hidrobo, Melissa; Birba, Ousmane; Rawat, Rahul; Ruel, Marie T.

2017-01-01

Background Innovative strategies are needed to enhance the nutritional impact of agriculture. Value chain approaches, which use supply chains to add value (usually economic) to products as they move from producers to consumers, can be used to increase access to nutritious foods and improve nutritional status. This study tested whether a dairy value chain could be used to distribute a micronutrient-fortified yoghurt (MNFY) (conditional upon the producer supplying a minimum amount of cow milk/day) to improve hemoglobin and reduce anemia among preschool children in a remote area in Northern Senegal. Methods A cluster randomized control trial was used to compare 204 children (24 to 59 months of age at baseline) from households who received the MNFY coupled to a behavior change communication (BCC) campaign focusing on anemia prevention to 245 children from a control group (receiving BCC only) after one year. Randomization was done at the level of the family concession (households from the same family) (n = 321). Eligible households had a child of the target age and were willing to deliver milk to the dairy factory. Changes in anemia and hemoglobin between groups were assessed using mixed regression models. Key findings Anemia prevalence was very high at baseline (80%) and dropped to close to 60% at endline, with no differences between intervention groups. Hemoglobin increased by 0.55 g/dL, 95%CI (0.27; 0.84) more in the intervention compared to the control group after one year, in models that controlled for potentially confounding factors. The impact was greater (0.72 g/dL, 95%CI (0.34; 1.12)) for boys, compared to girls (0.38 g/dL, 95%CI (-0.03; 0.80)). Conclusion The dairy value chain was a successful strategy to distribute MNFY among pastoralists in Northern Senegal, and increase Hb concentrations among their children. This study is one of the first proofs of concept showing that a nutrition-sensitive agriculture value chain approach can contribute to improved child nutrition in a remote pastoralist population. Trial registration ClinicalTrials.gov NCT02079961 PMID:28245227

Association of anemia, child and family characteristics with elevated blood lead concentrations in preschool children from Montevideo, Uruguay.

PubMed

Queirolo, Elena I; Ettinger, Adrienne S; Stoltzfus, Rebecca J; Kordas, Katarzyna

2010-01-01

Elevated blood lead levels (BPbs) have been identified in Uruguayan children in the La Teja neighborhood of Montevideo, but the extent of lead exposure in other city areas is unknown. Sources and predictors of exposure also remain understudied in this population. In 2007, the authors screened lead and hemoglobin levels in capillary blood of 222 preschool children from several areas of Montevideo, Uruguay, and identified predictors of elevated BPbs. Mean BPb was 9.0 +/- 6.0 microg/dL and 32.9% of children had levels >or= 10microg/dL. Mean hemoglobin level was 10.5 +/- 1.5 g/dL, with 44.1% having levels <10.5g/dL. Older child age, hemoglobin <10.5g/dL, and putting fingers/toys in the mouth were associated with higher BPbs. Young maternal age, less education, father's job with potential risk of lead exposure, and fewer family possessions were also associated with higher BPbs. Pediatric lead exposure is a public health problem in Uruguay, with children experiencing elevated BPbs at a young age.

Data-driven approach to human motion modeling with Lua and gesture description language

NASA Astrophysics Data System (ADS)

Hachaj, Tomasz; Koptyra, Katarzyna; Ogiela, Marek R.

2017-03-01

The aim of this paper is to present the novel proposition of the human motion modelling and recognition approach that enables real time MoCap signal evaluation. By motions (actions) recognition we mean classification. The role of this approach is to propose the syntactic description procedure that can be easily understood, learnt and used in various motion modelling and recognition tasks in all MoCap systems no matter if they are vision or wearable sensor based. To do so we have prepared extension of Gesture Description Language (GDL) methodology that enables movements description and real-time recognition so that it can use not only positional coordinates of body joints but virtually any type of discreetly measured output MoCap signals like accelerometer, magnetometer or gyroscope. We have also prepared and evaluated the cross-platform implementation of this approach using Lua scripting language and JAVA technology. This implementation is called Data Driven GDL (DD-GDL). In tested scenarios the average execution speed is above 100 frames per second which is an acquisition time of many popular MoCap solutions.

Applying openEHR's Guideline Definition Language to the SITS international stroke treatment registry: a European retrospective observational study.

PubMed

Anani, Nadim; Mazya, Michael V; Chen, Rong; Prazeres Moreira, Tiago; Bill, Olivier; Ahmed, Niaz; Wahlgren, Nils; Koch, Sabine

2017-01-10

Interoperability standards intend to standardise health information, clinical practice guidelines intend to standardise care procedures, and patient data registries are vital for monitoring quality of care and for clinical research. This study combines all three: it uses interoperability specifications to model guideline knowledge and applies the result to registry data. We applied the openEHR Guideline Definition Language (GDL) to data from 18,400 European patients in the Safe Implementation of Treatments in Stroke (SITS) registry to retrospectively check their compliance with European recommendations for acute stroke treatment. Comparing compliance rates obtained with GDL to those obtained by conventional statistical data analysis yielded a complete match, suggesting that GDL technology is reliable for guideline compliance checking. The successful application of a standard guideline formalism to a large patient registry dataset is an important step toward widespread implementation of computer-interpretable guidelines in clinical practice and registry-based research. Application of the methodology gave important results on the evolution of stroke care in Europe, important both for quality of care monitoring and clinical research.

Moderate alcohol intake and motor vehicle crashes: the conflict between health advantage and at-risk use.

PubMed

Heng, Kenneth; Hargarten, Stephen; Layde, Peter; Craven, Andy; Zhu, Shankuan

2006-01-01

To review the evidence on moderate alcohol intake and motor vehicle crash (MVC) risk, and discuss the possible public health tension in balancing risk reduction and increment with respect to moderate alcohol intake. A Medline review was conducted on moderate alcohol intake, MVC, and cardiovascular disease (CVD) risks. Moderate alcohol intake (24 g ethanol, two US standard drinks, or less a day) is associated with 20% reduction in risk of CVD. Public awareness of this may contribute to why rates of driving with blood alcohol content (BAC) <0.08 g/dl in the United States are static. Studies show 3- to 17-fold increased risk of a fatal MVC with BAC < 0.08 g/dl compared to sober drivers. The United States has 0.08 g/dl BAC laws, higher than that reached by a driver drinking two drinks per day or less. The public should be educated that although moderate alcohol drinking may not violate BAC laws, it still carries significant risk of MVC. Current BAC laws in some countries needs re-evaluation.

How Would Programs Rate under California's Proposed Quality Rating and Improvement System? Evidence from Statewide and County Data on Early Care and Education Program Quality. Documented Briefing

ERIC Educational Resources Information Center

Karoly, Lynn A.; Zellman, Gail L.

2012-01-01

In 2010, the California Early Learning Quality Improvement System (CAEL QIS) Advisory Committee recommended a structure for a voluntary quality rating and improvement system (QRIS) that could apply to the state's 11,000 licensed centers and 36,600 licensed family child care homes (FCCHs). The proposed design consisted of an unweighted block system…

The Role of Supervised Driving Requirements in Graduated Driver Licensing Programs

DOT National Transportation Integrated Search

2012-03-01

Many States require parents to certify that their teens have completed a certain amount of supervised driving practice, usually 40 to 50 hours, : before they are permitted to obtain an intermediate license. Although strongly supported by numerous gro...

50 CFR 80.33 - How does an agency decide who to count as paid license holders in the annual certification?

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND SPORT FISH RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Certification of License Holders § 80.33 How does an...

50 CFR 80.37 - What must an agency do if it becomes aware of errors in its certified license data?

Code of Federal Regulations, 2013 CFR

2013-10-01

... SPORT FISH RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS Certification of License Holders § 80.37 What must an agency...

75 FR 438 - Notice of Invitation-Coal Exploration License Application MTM 99242

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-05

...] Notice of Invitation--Coal Exploration License Application MTM 99242 AGENCY: Bureau of Land Management... Energy Company in a program for the exploration of coal deposits owned by the United States of America in... section [[Page 439

10 CFR 170.31 - Schedule of fees for materials licenses and other regulatory services, including inspections, and...

Code of Federal Regulations, 2011 CFR

2011-01-01

..., including x-ray fluorescence analyzers.4 Application [Program Code(s): 22140] $1,200 D. All other special... extraction of metals other than uranium or thorium, including licenses authorizing the possession of...

Evaluation of a responsible beverage service and enforcement program: Effects on bar patron intoxication and potential impaired driving by young adults.

PubMed

Fell, James C; Fisher, Deborah A; Yao, Jie; McKnight, A Scott

2017-08-18

Studies of alcohol-related harm (violence, injury, illness) suggest that the most significant risk factors are the amount of alcohol consumed and whether obviously intoxicated patrons continue to be served. This study's objective was to investigate the effects of a responsible beverage service (RBS)/enhanced alcohol enforcement intervention on bars, bar patrons, and impaired driving. Two communities-Monroe County, New York, and Cleveland, Ohio-participated in a demonstration program and evaluation. The intervention applied RBS training, targeted enforcement, and corrective actions by law enforcement to a random sample of 10 identified problem bars in each community compared to 10 matched nonintervention problem bars. Data were collected over 3 waves on bar serving practices, bar patron intoxication, drinking and driving, and other alcohol-related harm from intervention and control bars and treatment and comparison communities. In Monroe County, New York, of the 14 outcome measures analyzed, 7 measures showed statistically significant differences from pre- to postintervention. Six of those measures indicated changes in the desired or positive direction and 2 measures were in the undesired or negative direction. Of note in the positive direction, the percentage of intervention bar patrons who were intoxicated decreased from 44 to 27% and the average blood alcohol concentration of patrons decreased from 0.097 to 0.059 g/dL pre- to postintervention. In Cleveland, Ohio, 6 of the 14 measures showed statistically significant changes pre- to postintervention with 6 in the positive direction and 4 in the negative direction. Of note, the percentage of pseudo-intoxicated patrons denied service in intervention bars increased from 6 to 29%. Of the 14 outcome measures that were analyzed in each community, most indicated positive changes associated with the intervention, but others showed negative associations. About half of the measures showed no significance, the sample sizes were too small, or the data were unavailable. Therefore, at best, the results of these demonstration programs were mixed. There were, however, some positive indications from the intervention. It appears that when bar managers and owners are aware of the program and its enforcement and when servers are properly trained in RBS, fewer patrons may become intoxicated and greater efforts may be made to deny service to obviously intoxicated patrons. Given that about half of arrested impaired drivers had their last drink at a licensed establishment, widespread implementation of this strategy has the potential to help reduce impaired driving.

Formulation, Implementation and Validation of a Two-Fluid model in a Fuel Cell CFD Code

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

Jain, Kunal; Cole, J. Vernon; Kumar, Sanjiv

2008-12-01

Water management is one of the main challenges in PEM Fuel Cells. While water is essential for membrane electrical conductivity, excess liquid water leads to flooding of catalyst layers. Despite the fact that accurate prediction of two-phase transport is key for optimal water management, understanding of the two-phase transport in fuel cells is relatively poor. Wang et. al. have studied the two-phase transport in the channel and diffusion layer separately using a multiphase mixture model. The model fails to accurately predict saturation values for high humidity inlet streams. Nguyen et. al. developed a two-dimensional, two-phase, isothermal, isobaric, steady state modelmore » of the catalyst and gas diffusion layers. The model neglects any liquid in the channel. Djilali et. al. developed a three-dimensional two-phase multicomponent model. The model is an improvement over previous models, but neglects drag between the liquid and the gas phases in the channel. In this work, we present a comprehensive two-fluid model relevant to fuel cells. Models for two-phase transport through Channel, Gas Diffusion Layer (GDL) and Channel-GDL interface, are discussed. In the channel, the gas and liquid pressures are assumed to be same. The surface tension effects in the channel are incorporated using the continuum surface force (CSF) model. The force at the surface is expressed as a volumetric body force and added as a source to the momentum equation. In the GDL, the gas and liquid are assumed to be at different pressures. The difference in the pressures (capillary pressure) is calculated using an empirical correlations. At the Channel-GDL interface, the wall adhesion affects need to be taken into account. SIMPLE-type methods recast the continuity equation into a pressure-correction equation, the solution of which then provides corrections for velocities and pressures. However, in the two-fluid model, the presence of two phasic continuity equations gives more freedom and more complications. A general approach would be to form a mixture continuity equation by linearly combining the phasic continuity equations using appropriate weighting factors. Analogous to mixture equation for pressure correction, a difference equation is used for the volume/phase fraction by taking the difference between the phasic continuity equations. The relative advantages of the above mentioned algorithmic variants for computing pressure correction and volume fractions are discussed and quantitatively assessed. Preliminary model validation is done for each component of the fuel cell. The two-phase transport in the channel is validated using empirical correlations. Transport in the GDL is validated against results obtained from LBM and VOF simulation techniques. The Channel-GDL interface transport will be validated against experiment and empirical correlation of droplet detachment at the interface.« less

Functional analysis of the Glucan Degradation Locus (GDL) in Caldicellulosiruptor bescii reveals essential roles of component glycoside hydrolases in plant biomass deconstruction.

PubMed

Conway, Jonathan M; McKinley, Bennett S; Seals, Nathaniel L; Hernandez, Diana; Khatibi, Piyum A; Poudel, Suresh; Giannone, Richard J; Hettich, Robert L; Williams-Rhaesa, Amanda M; Lipscomb, Gina L; Adams, Michael W W; Kelly, Robert M

2017-10-06

The ability to hydrolyze microcrystalline cellulose is an uncommon feature in the microbial world, but one that can be exploited for conversion of lignocellulosic feedstocks into bio-based fuels and chemicals. Understanding the physiological and biochemical mechanisms by which microorganisms deconstruct cellulosic material is key to achieving this objective. The Glucan Degradation Locus (GDL) in the genomes of extremely thermophilic Caldicellulosiruptor species encodes polysaccharide lyases (PLs), unique cellulose binding proteins (tāpirins), and putative post-translational modifying enzymes, in addition to multi-domain, multi-functional glycoside hydrolases (GHs), thereby representing an alternative paradigm for plant biomass degradation, as compared to fungal or cellulosomal systems. To examine the individual and collective in vivo roles of the glycolytic enzymes, the six GHs in the GDL of Caldicellulosiruptor bescii were systematically deleted, and the extent to which the resulting mutant strains could solubilize microcrystalline cellulose (Avicel) and plant biomasses (switchgrass or poplar) was examined. Three of the GDL enzymes, Athe_1867 (CelA) (GH9-CBM3-CBM3-CBM3-GH48), Athe_1859 (GH5-CBM3-CBM3-GH44), and Athe_1857 (GH10-CBM3-CBM3-GH48), acted synergistically in vivo and accounted for 92% of naked microcellulose (Avicel) degradation. However, the relative importance of the GDL GHs varied for the plant biomass substrates tested. Furthermore, mixed cultures of mutant strains showed switchgrass solubilization depended on the secretome-bound enzymes collectively produced by the culture and not on the specific strain from which they came. These results demonstrate that certain GDL GHs are primarily responsible for the degradation of microcrystalline-containing substrates by C. bescii and provide new insights into the workings of a novel microbial mechanism for lignocellulose utilization. Importance The efficient and extensive degradation of complex polysaccharides in lignocellulosic biomass, particularly microcrystalline cellulose, remains a major barrier to its use as a renewable feedstock for the production of fuels and chemicals. Extremely thermophilic bacteria from the genus Caldicellulosiruptor rapidly degrade plant biomass to fermentable sugars at temperatures between 70-78°C, although the specific mechanism by which this occurs is not clear. Previous comparative genomic studies identified a genomic locus found only in certain Caldicellulosiruptor species that was hypothesized to be mainly responsible for microcrystalline cellulose degradation. By systematically deleting genes in this locus in Caldicellulosiruptor bescii , the nuanced, substrate-specific, in vivo roles of glycolytic enzymes in deconstructing crystalline cellulose and plant biomasses could be discerned. The results here point to synergism of three multi-domain cellulases in C. bescii , working in conjunction with the aggregate, secreted enzyme inventory, as the key to the plant biomass degradation ability by this extreme thermophile. Copyright © 2017 American Society for Microbiology.

Building Better Bridges into STEM: A Synthesis of 25 Years of Literature on STEM Summer Bridge Programs.

PubMed

Ashley, Michael; Cooper, Katelyn M; Cala, Jacqueline M; Brownell, Sara E

2017-01-01

Summer bridge programs are designed to help transition students into the college learning environment. Increasingly, bridge programs are being developed in science, technology, engineering, and mathematics (STEM) disciplines because of the rigorous content and lower student persistence in college STEM compared with other disciplines. However, to our knowledge, a comprehensive review of STEM summer bridge programs does not exist. To provide a resource for bridge program developers, we conducted a systematic review of the literature on STEM summer bridge programs. We identified 46 published reports on 30 unique STEM bridge programs that have been published over the past 25 years. In this review, we report the goals of each bridge program and whether the program was successful in meeting these goals. We identify 14 distinct bridge program goals that can be organized into three categories: academic success goals, psychosocial goals, and department-level goals. Building on the findings of published bridge reports, we present a set of recommendations for STEM bridge programs in hopes of developing better bridges into college. © 2017 M. Ashley, K. M. Cooper, et al. CBE—Life Sciences Education © 2017 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

The effectiveness of written driver knowledge tests.

DOT National Transportation Integrated Search

1979-01-01

Highway Safety Program Standard 5, Driver Licensing, issued by the U. S. Department of Transportation requires, in part, that the states test applicants for a renewal of their operator's license on rules of the road at least once every 4 years. The s...

47 CFR 27.1201 - EBS eligibility.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... will serve on the local program committee and demonstrate a recognition of the composition and power of... existing licenses, and their licenses may be renewed, assigned, or transferred, so long as the licensee is...

47 CFR 27.1201 - EBS eligibility.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... will serve on the local program committee and demonstrate a recognition of the composition and power of... existing licenses, and their licenses may be renewed, assigned, or transferred, so long as the licensee is...

47 CFR 27.1201 - EBS eligibility.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... will serve on the local program committee and demonstrate a recognition of the composition and power of... existing licenses, and their licenses may be renewed, assigned, or transferred, so long as the licensee is...

47 CFR 27.1201 - EBS eligibility.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... will serve on the local program committee and demonstrate a recognition of the composition and power of... existing licenses, and their licenses may be renewed, assigned, or transferred, so long as the licensee is...

47 CFR 27.1201 - EBS eligibility.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES MISCELLANEOUS WIRELESS... will serve on the local program committee and demonstrate a recognition of the composition and power of... existing licenses, and their licenses may be renewed, assigned, or transferred, so long as the licensee is...

38 CFR 21.9600 - Overcharges.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) VOCATIONAL REHABILITATION AND EDUCATION Post-9/11 GI Bill Approved Programs of Education and Courses § 21...) Overcharges by organizations or entities offering licensing or certification tests may result in disapproval of tests. VA may disapprove an organization or entity offering a licensing or certification test when...

The short-term effectiveness of written driver knowledge tests.

DOT National Transportation Integrated Search

1978-01-01

Highway Safety Program Standard 5, Driver Licensing, issued by the U. S. Department of Transportation requires the states to test applicants for a renewal of their operator's license on rules of the road at least once every four years. The cost of ad...

Assuring the Quality of Licensing and Certification Programs.

ERIC Educational Resources Information Center

Shimberg, Benjamin

When one considers the importance and social significance of licensing and certification examinations, it is amazing that the enterprise operates with virtually no societal oversight. The "Standards for Educational and Psychological Testing" and the "Code of Fair Testing Practices in Education" of the American Psychological…

Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with a Preoperative Albumin Level of Less Than 4.0 g/dl.

PubMed

Lee, Eun-Ho; Kim, Wook-Jong; Kim, Ji-Yeon; Chin, Ji-Hyun; Choi, Dae-Kee; Sim, Ji-Yeon; Choo, Suk-Jung; Chung, Cheol-Hyun; Lee, Jae-Won; Choi, In-Cheol

2016-05-01

Hypoalbuminemia may increase the risk of acute kidney injury (AKI). The authors investigated whether the immediate preoperative administration of 20% albumin solution affects the incidence of AKI after off-pump coronary artery bypass surgery. In this prospective, single-center, randomized, parallel-arm double-blind trial, 220 patients with preoperative serum albumin levels less than 4.0 g/dl were administered 100, 200, or 300 ml of 20% human albumin according to the preoperative serum albumin level (3.5 to 3.9, 3.0 to 3.4, or less than 3.0 g/dl, respectively) or with an equal volume of saline before surgery. The primary outcome measure was AKI incidence after surgery. Postoperative AKI was defined by maximal AKI Network criteria based on creatinine changes. Patient characteristics and perioperative data except urine output during surgery were similar between the two groups studied, the albumin group and the control group. Urine output (median [interquartile range]) during surgery was higher in the albumin group (550 ml [315 to 980]) than in the control group (370 ml [230 to 670]; P = 0.006). The incidence of postoperative AKI in the albumin group was lower than that in the control group (14 [13.7%] vs. 26 [25.7%]; P = 0.048). There were no significant between-group differences in severe AKI, including renal replacement therapy, 30-day mortality, and other clinical outcomes. There were no significant adverse events. Administration of 20% exogenous albumin immediately before surgery increases urine output during surgery and reduces the risk of AKI after off-pump coronary artery bypass surgery in patients with a preoperative serum albumin level of less than 4.0 g/dl.

Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients

PubMed Central

Hanafusa, Norio; Nomura, Takanobu; Hasegawa, Takeshi; Nangaku, Masaomi

2014-01-01

Background The elderly hemodialyzed population is growing. However, little is known about the relationship between hemoglobin level and survival according to age. We investigated the effect of age on the relationship between hemoglobin and survival within the Japan Dialysis Outcomes and Practice Patterns Study (DOPPS) cohort. Methods We enrolled the entire Japan DOPPS phases 3 and 4 population. Patients were divided by the age of 75 years into two groups. Cox's proportional hazard model was used with hemoglobin at every 4 months treated as a time-dependent variable. The interaction of age and hemoglobin was analyzed. Results We included 3341 patients in the analyses. The primary outcome occurred in 567 patients during the median follow-up of 2.64 years. Hemoglobin of entire population was 10.3 ± 1.3 g/dL. The median of epoetin dose was 3000 IU/week. Interaction was found between ages stratified by the age of 75 years and hemoglobin values (P = 0.045) with use of Cox's proportional hazard model. The nonelderly population had poorer prognosis with hemoglobin <10 g/dL, while elderly population only with hemoglobin <9 g/dL. For both hemoglobin strata <9, ≥9 and <10 g/dL, interactions between age and hemoglobin were significant. Subgroup analysis indicated that interaction between age and Hb levels was observed only in the nondiabetic nephropathy group. Several sensitivity analyses demonstrated a similar trend with the original analyses and reinforced the robustness. Conclusions The elderly population might tolerate low hemoglobin levels. Our findings open the way for further investigation of individualized anemia management. PMID:25150218

Randomized controlled open-label trial of vitamin E-bonded polysulfone dialyzer and erythropoiesis-stimulating agent response.

PubMed

Sanaka, Tsutomu; Mochizuki, Takahiro; Kinugasa, Eriko; Kusano, Eiji; Ohwada, Shigeru; Kuno, Tsutomu; Kojima, Kenichiro; Kobayashi, Shuzo; Satoh, Minoru; Shimada, Noriaki; Nakao, Kazushi; Nakazawa, Ryoichi; Nishimura, Hideki; Noiri, Eisei; Shigematsu, Takashi; Tomo, Tadashi; Maeda, Teiryo

2013-06-01

A 1-year multicenter prospective randomized controlled study was conducted on the effects of vitamin E-bonded polysulfone dialyzers on erythropoiesis-stimulating agent response in hemodialysis patients. Major inclusion criteria were use of high-flux polysulfone dialyzers with 50-70 ml/min β2-microglobulin clearance over 3 months, transferrin saturation over 20%, same erythropoiesis-stimulating agent for over 3 months, and hemoglobin at 10-12 g/dl. Hemodialysis patients were placed in four interventional groups: two hemoglobin ranges (10.0-10.9 or 11.0-11.9 g/dl) and two dialyzers. Patients were randomly assigned by central registration to a vitamin E-bonded polysulfone dialyzers or polysulfone control group. Primary end point was relative erythropoiesis resistance index at baseline between groups at 12 months. Erythropoiesis resistance index was defined as total weekly erythropoiesis-stimulating agent dose divided by hemoglobin. There were no statistically significant differences in age or sex. There was no significant difference in relative erythropoiesis resistance index between vitamin E-bonded polysulfone dialyzers and control groups at 12 months (vitamin E-bonded polysulfone dialyzers: 1.1, control: 1.3). The vitamin E-bonded polysulfone dialyzers group showed better relative erythropoiesis resistance index than the control group at 11.0-11.9 g/dl hemoglobin (vitamin E-bonded polysulfone dialyzers: 1.0, control: 1.4 at 12 months, significant difference) but no difference at 10.0-10.9 g/dl hemoglobin. The overall relative erythropoiesis resistance index showed no difference between the vitamin E-bonded polysulfone dialyzers and control groups, although the change in relative erythropoiesis resistance index differed according to hemoglobin level.

Randomized Controlled Open-Label Trial of Vitamin E-Bonded Polysulfone Dialyzer and Erythropoiesis-Stimulating Agent Response

PubMed Central

Mochizuki, Takahiro; Kinugasa, Eriko; Kusano, Eiji; Ohwada, Shigeru; Kuno, Tsutomu; Kojima, Kenichiro; Kobayashi, Shuzo; Satoh, Minoru; Shimada, Noriaki; Nakao, Kazushi; Nakazawa, Ryoichi; Nishimura, Hideki; Noiri, Eisei; Shigematsu, Takashi; Tomo, Tadashi; Maeda, Teiryo

2013-01-01

Summary Background and objectives A 1-year multicenter prospective randomized controlled study was conducted on the effects of vitamin E-bonded polysulfone dialyzers on erythropoiesis-stimulating agent response in hemodialysis patients. Design, setting, participants, & measurements Major inclusion criteria were use of high-flux polysulfone dialyzers with 50–70 ml/min β2-microglobulin clearance over 3 months, transferrin saturation over 20%, same erythropoiesis-stimulating agent for over 3 months, and hemoglobin at 10–12 g/dl. Hemodialysis patients were placed in four interventional groups: two hemoglobin ranges (10.0–10.9 or 11.0–11.9 g/dl) and two dialyzers. Patients were randomly assigned by central registration to a vitamin E-bonded polysulfone dialyzers or polysulfone control group. Primary end point was relative erythropoiesis resistance index at baseline between groups at 12 months. Erythropoiesis resistance index was defined as total weekly erythropoiesis-stimulating agent dose divided by hemoglobin. Results There were no statistically significant differences in age or sex. There was no significant difference in relative erythropoiesis resistance index between vitamin E-bonded polysulfone dialyzers and control groups at 12 months (vitamin E-bonded polysulfone dialyzers: 1.1, control: 1.3). The vitamin E-bonded polysulfone dialyzers group showed better relative erythropoiesis resistance index than the control group at 11.0–11.9 g/dl hemoglobin (vitamin E-bonded polysulfone dialyzers: 1.0, control: 1.4 at 12 months, significant difference) but no difference at 10.0–10.9 g/dl hemoglobin. Conclusions The overall relative erythropoiesis resistance index showed no difference between the vitamin E-bonded polysulfone dialyzers and control groups, although the change in relative erythropoiesis resistance index differed according to hemoglobin level. PMID:23599410

Phase III randomized trial comparing intravenous to oral iron in patients with cancer-related iron deficiency anemia not on erythropoiesis stimulating agents.

PubMed

Noronha, Vanita; Joshi, Amit; Patil, Vijay Maruti; Banavali, Shripad D; Gupta, Sudeep; Parikh, Purvish M; Marfatia, Shalaka; Punatar, Sachin; More, Sucheta; Goud, Supriya; Nakti, Dipti; Prabhash, Kumar

2018-04-01

We aimed to find the optimal route of iron supplementation in patients with malignancy and iron deficiency (true or functional) anemia not receiving erythropoiesis stimulating agents (ESA). Adult patients with malignancy requiring chemotherapy, hemoglobin (Hb) <12 g/dL and serum ferritin <100 mcg/mL, transferrin saturation <20% or hypochromic red blood cells >10% were randomized to intravenous (IV) iron sucrose or oral ferrous sulfate. The primary endpoint was change in Hb from baseline to 6 weeks. Secondary endpoints included blood transfusion, quality of life (QoL), toxicity, response and overall survival. A total of 192 patients were enrolled over 5 years: 98 on IV arm and 94 on oral arm. Median age was 51 years; over 95% patients had solid tumors. The mean absolute increase in Hb at 6 weeks was 0.11 g/dL (standard deviation [SD]: 1.48) in IV arm and -0.16 g/dL (SD: 1.36) in oral arm, P = 0.23. Twenty-three percent patients on IV iron and 18% patients on oral iron had a rise in Hb of ≥1 g/dL at 6 weeks, P = 0.45. Thirteen patients (13.3%) on the IV iron arm and 14 patients (14.9%) on the oral arm required blood transfusion, P = 1.0. Gastrointestinal toxicity (any grade) developed in 41% patients on IV iron and 44% patients on oral iron, P = 1.0. 5 patients on IV iron and none on oral iron had hypersensitivity, P = 0.06. QoL was not significantly different between the two arms. IV iron was not superior to oral iron in patients with malignancy on chemotherapy and iron deficiency anemia. © 2017 John Wiley & Sons Australia, Ltd.

Nutritional status, fertility and factors associated with anaemia: a cross sectional study among a rural population of Muslim women in Assam, India.

PubMed

Haloi, Anjali; Limbu, Dhruba Kumar

2013-01-01

In the present study an attempt has been made to report on the nutritional status of the Assamese Muslim women of Dadara and Agyathuri villages of the Kamrup district in Assam, India on their basis of body mass index (BMI) and haemoglobin (hb) content. Cross sectional data on 1034 women belonging to the age group of 19 years and above were collected following internationally accepted standards. The fertility of mothers by BMI range was found to be highest (6.50 (mean) +/- 0.14 (SE) and range being 1-11) amongst underweight mothers. The one-way analysis of variance (ANOVA) test of BMI and fertility shows significant relation between different BMI groups withp < 0.01. Highest haemoglobin levels were recorded in the age group of < or = 23 years with a mean of 11.61 +/- 0.06 g/dl, the range being 9.8-13.9 g/dl. Whereas lowest levels of haemoglobin were found in the age groups of 44+ years having a mean value of 10.26 +/- 0.04 g/dl and a range of 9.2-11.8 g/dl. The ANOVA analysis for haemoglobin content and corresponding fertility rates show significant difference between different hemoglobin levels with their live births at p < 0.01. The summary of ANOVA analysis for haemoglobin and BMI range shows the significant difference between groups i.e., normal, overweight and underweight. The t-value and F-ratio is 118.61 and 14068.42, respectively, which is significant at 1% probability. The authors conclude a general trend in the study population of women with high fertility having poor nutritional status. These findings might be important in formulating responsive health policies in an underdeveloped region.

Hair Mercury Level is Associated with Anemia and Micronutrient Status in Children Living Near Artisanal and Small-Scale Gold Mining in the Peruvian Amazon.

PubMed

Weinhouse, Caren; Ortiz, Ernesto J; Berky, Axel J; Bullins, Paige; Hare-Grogg, John; Rogers, Laura; Morales, Ana-Maria; Hsu-Kim, Heileen; Pan, William K

2017-12-01

Anemia has been widely studied in global health contexts because of severe nutritional deficiency, and more recently, inflammatory status, but chemical exposures are rarely considered. Until recently, "anemia" was used synonymously with "iron deficiency anemia (IDA)" in global health settings. However, only 50% of anemia cases worldwide are IDA. Environmental toxicology studies of anemia risk have generally focused on populations in developed countries, albeit with high exposure to environmental toxicants, such as lead or cadmium. In the developing world, toxicant exposures commonly coexist with other risk factors for anemia. In particular, artisanal and small-scale gold mining (ASGM) communities are at risk for dietary methylmercury exposure through contaminated fish consumption, and for anemia due to food insecurity and infectious and chronic diseases. Here, we report analysis of total hair mercury content, hemoglobin, and serum micronutrient levels in children < 12 years of age ( N = 83) near ASGM in the Peruvian Amazon. Forty-nine percent ( N = 29/59) of those aged < 5 years were anemic (< 11 g/dL) and 52% ( N = 12/23) of those aged 5-11 years (< 11.5 g/dL). Few children were stunted, wasted, or micronutrient deficient. Median total hair mercury was 1.18 μg/g (range: 0.06-9.70 μg/g). We found an inverse association between total mercury and hemoglobin (β = -0.12 g/dL, P = 0.06) that persisted (β = -0.14 g/dL, P = 0.04) after adjusting for age, sex, anthropometrics, and vitamin B 12 in multivariate regression. This study provides preliminary evidence that methylmercury exposure is associated with anemia, which is especially relevant to children living near ASGM.

Anaemia in patients with aortic stenosis: influence on long-term prognosis.

PubMed

Ng, Arnold C T; Kong, William K F; Kamperidis, Vasileios; Bertini, Matteo; Antoni, M Louisa; Leung, Dominic Y; Marsan, Nina Ajmone; Delgado, Victoria; Bax, Jeroen J

2015-10-01

The prognostic implications of anaemia in patients with aortic stenosis (AS) remain unclear. Accordingly, the present study aimed to evaluate the prognostic implications of anaemia in AS patients before and after aortic valve replacement (AVR). A total of 856 AS patients (age 71 ± 12 years, 60.2% male, 47.4% severe AS) were included. The mean haemoglobin (Hb) level was 13.2 ± 1.8 g/dL, and the prevalence of anaemia (Hb <13.0 g/dL for men, <12.0 g/dL for women) was 32.0%. The prevalence of anaemia rose with increasing severity of AS (28.9% and 35.6% in moderate and severe AS, respectively, P = 0.048) and was independently associated with increased all-cause mortality in severe AS patients whilst under medical therapy [hazard ratio (HR) 2.26, 95% confidence interval (CI) 1.29-3.97, P = 0.005). Similarly, each 1.0 g/dL decrease in Hb was independently associated with increased mortality risk at follow-up (HR 1.35, 95% CI 1.07-1.47, P = 0.006). However, after AVR surgery, severe AS patients who had anaemia had similar long-term survival as patients with normal Hb (log rank P = 0.19). When all AS patients were included and AVR surgery entered as a covariate, anaemia was still independently associated with increased all-cause mortality irrespective of the severity of AS. A high prevalence of anaemia in moderate and severe AS patients was observed, and its presence was independently associated with increased all-cause mortality. However, after AVR surgery, anaemic patients had similar survival rates as patients with normal Hb. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study.

PubMed

Fox, Kathleen M; Yee, Jerry; Cong, Ze; Brooks, John M; Petersen, Jeffrey; Lamerato, Lois; Gandra, Shravanthi R

2012-01-24

Transfusion patterns are not well characterized in non-dialysis (ND) chronic kidney disease (CKD) patients. This study describes the proportion of patients transfused, units of blood transfused and trigger-hemoglobin (Hb) levels for transfusions in severe anemic, ND-CKD patients in routine practice. A retrospective cohort study of electronic medical record data from the Henry Ford Health System identified 374 adult, ND-CKD patients with severe anemia (Hb < 10 g/dL and subsequent use of erythropoiesis-stimulating agents [ESA] therapy, blood transfusions, or a second Hb < 10 g/dL) between January 2004 and June 2008. Exclusions included those with prior diagnoses of cancer, renal or liver transplant, end-stage renal disease, acute bleeding, trauma, sickle cell disease, or aplastic anemia. A gap of ≥ 1 days between units of blood transfused was counted as a separate transfusion. At least 1 transfusion (mean of 2 units; range, 1-4) was administered to 20% (75/374) of ND-CKD patients with mean (± SD) follow-up of 459 (± 427) days. The mean (± SD) Hb level closest and prior to a transfusion was 8.8 (± 1.5) g/dL. Patients who were hospitalized in the 6 months prior to their first anemia diagnosis were 6.3 times more likely to receive a blood transfusion than patients who were not hospitalized (p < 0.0001). Patients with peripheral vascular disease (PVD) were twice as likely to have a transfusion as patients without PVD (p = 0.04). Transfusions were prevalent and the trigger hemoglobin concentration was approximately 9 g/dL among ND-CKD patients with anemia. To reduce the transfusion burden, clinicians should consider other anemia treatments including ESA therapy.

Autoimmune acute liver failure: proposed clinical and histological criteria.

PubMed

Stravitz, R Todd; Lefkowitch, Jay H; Fontana, Robert J; Gershwin, M Eric; Leung, Patrick S C; Sterling, Richard K; Manns, Michael P; Norman, Gary L; Lee, William M

2011-02-01

Identifying autoimmune hepatitis as the etiology of acute liver failure (ALF) is potentially important, because administering corticosteroids might avoid the need for liver transplantation. However, clinical and histological criteria of autoimmune ALF (AI-ALF) have not been defined. Liver sections (biopsies and explants) from a 72-patient subset of the ALF Study Group Registry with indeterminate ALF were reviewed by a pathologist blinded to all clinical data and were diagnosed with probable AI-ALF based on four features suggestive of an autoimmune pathogenesis: distinctive patterns of massive hepatic necrosis (present in 42% of sections), presence of lymphoid follicles (32%), a plasma cell-enriched inflammatory infiltrate (63%), and central perivenulitis (65%). Forty-two sections (58%) were considered probable for AI-ALF; this group demonstrated higher serum globulins (3.7 ± 0.2 g/dL versus 3.0 ± 0.2 g/dL; P = 0.037) and a higher prevalence of antinuclear and/or anti-smooth muscle antibodies (73% versus 48%; P = 0.034) compared to those without histology suggestive of probable AI-ALF. Thirty patients concordant for autoantibodies and probable AI-ALF upon histological analysis were more likely to have the classical autoimmune hepatitis phenotype (female predominance [72% versus 48%; P < 0.05], higher globulins [3.9 ± 0.2 g/dL versus 3.0 ± 0.2 g/dL; P < 0.005], and higher incidence of chronic hepatitis in long-term follow-up [67% versus 17%, P = 0.019]) compared to the population without concordant AI-ALF histology and autoantibodies. Patients with indeterminate ALF often have features of autoimmune disease by histological analysis, serological testing, and clinical recurrence during follow-up. In contrast to classical autoimmune hepatitis, histological features of AI-ALF predominate in the centrilobular zone. Copyright © 2010 American Association for the Study of Liver Diseases.

Peclet number analysis of cross-flow in porous gas diffusion layer of polymer electrolyte membrane fuel cell (PEMFC).

PubMed

Suresh, P V; Jayanti, Sreenivas

2016-10-01

Adoption of hydrogen economy by means of using hydrogen fuel cells is one possible solution for energy crisis and climate change issues. Polymer electrolyte membrane (PEM) fuel cell, which is an important type of fuel cells, suffers from the problem of water management. Cross-flow is induced in some flow field designs to enhance the water removal. The presence of cross-flow in the serpentine and interdigitated flow fields makes them more effective in proper distribution of the reactants on the reaction layer and evacuation of water from the reaction layer than diffusion-based conventional parallel flow fields. However, too much of cross-flow leads to flow maldistribution in the channels, higher pressure drop, and membrane dehydration. In this study, an attempt has been made to quantify the amount of cross-flow required for effective distribution of reactants and removal of water in the gas diffusion layer. Unit cells containing two adjacent channels with gas diffusion layer (GDL) and catalyst layer at the bottom have been considered for the parallel, interdigitated, and serpentine flow patterns. Computational fluid dynamics-based simulations are carried out to study the reactant transport in under-the-rib area with cross-flow in the GDL. A new criterion based on the Peclet number is presented as a quantitative measure of cross-flow in the GDL. The study shows that a cross-flow Peclet number of the order of 2 is required for effective removal of water from the GDL. Estimates show that this much of cross-flow is not usually produced in the U-bends of Serpentine flow fields, making these areas prone to flooding.

Severe anemia in pregnancy in rural Ghana: a case-control study of causes and management.

PubMed

Geelhoed, Diederike; Agadzi, Florence; Visser, Lucia; Ablordeppey, Emelia; Asare, Kofi; O'Rourke, Peter; van Leeuwen, Jules Schagen; van Roosmalen, Jos

2006-01-01

Various factors contribute to severe anemia in pregnancy in low-income countries. This study assesses which of these are of importance in rural Ghana, and evaluates management. Prospective case-control study in two (sub)district hospitals in rural Ghana among 175 severely anemic pregnant women (Hb < 8.0 g/dl), receiving a comprehensive treatment package; and 152 non-anemic pregnant women (Hb > or = 10.9 g/dl), giving birth at the study hospitals, matched for age and parity. Evaluated characteristics were need for treatment for urinary tract infection and schistosomiasis; sickle cell and HIV status; antenatal care characteristics; and Hb increase after treatment. Statistical analysis included Chi square test and general linear modeling. Associated with severe anemia were multiple pregnancy (OR 8.9; 95%CI 1.1-71.0), urinary tract infection (OR 6.2; 95%CI 3.5-11.0), residence outside study (sub)district (OR 2.7; 95%CI 1.7-4.3), body mass index < 20.0 (OR 2.0; 95%CI 1.2-3.4), and less than 4 antenatal clinic visits (OR 1.9; 95%CI 1.2-3.0). No association was found with sickle cell or HIV status, schistosomiasis treatment, blood loss in pregnancy, or gestational age at antenatal care registration. After treatment, mean Hb in the severe anemia group increased by 3.2 g/dl, significantly more than in the control group (0.2 g/dl; p<0.001). Modeling showed that the number of antenatal visits and the lowest Hb together explained approximately 25% of the variability in Hb prior to childbirth among women with severe anemia. Treatable causes contribute considerably to severe anemia in pregnancy in low-income countries. Even with limited resources, a substantial increase of Hb can be achieved.

Anaemia in pregnancy in the district of Anuradhapura, Sri Lanka--need for updating prevalence data and screening strategies.

PubMed

Chathurani, U; Dharshika, I; Galgamuwa, D; Wickramasinghe, N D; Agampodi, T C; Agampodi, S B

2012-09-01

To determine the prevalence of anaemia during pregnancy in Anuradhapura district and evaluate present screening methods for anaemia. Modified WHO 30 cluster sampling method with increased precision was used to estimate the prevalence of anaemia in the Anuradhapura district, Sri Lanka. Serum haemoglobin was measured using methemoglobin method. Clinical examination was carried out to evaluate the conjunctival method in anaemia screening. Values recorded from haemoglobin colour scale method used in the field antenatal clinics were collected. A total of 990 pregnant women participated in the study. In the first, second and third trimesters, prevalence of anaemia was 7.6%, 19.7% and 19.3% respectively. Gestational age adjusted anaemia prevalence among pregnant women in this study population was 14.1% (95% CI 12.0-16.4%). Mean and median haemoglobin concentration of the study sample was 11.8g/dL (SD 1.02g/dl and IQR 11.2-12.5g/dl). Among anaemic pregnant women, average values for Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were, 82.9 fl (SD 11.5), 27.6 (SD-3.6) pg/cell and 32.9g/dl (SD 1.8) respectively. Sensitivity and specificity of haemoglobin colour scale method was 50% (95% CI 29.0-71.0%) and 76.3% (95% CI 66.9-83.7%) respectively. Sensitivity and specificity of conjunctival method in detecting anaemia during pregnancy was 18.8% (95% CI 11.9-28.4) and 69.3% (95% CI 58.2- 78.6%). Prevalence of anaemia in the district of Anuradhapura was less than 50% of the estimated prevalence for Sri Lanka. Both haemoglobin colour scale and conjunctival method were having low validity in detecting anaemia in pregnancy.

Hemolytic Potential of Tafenoquine in Female Volunteers Heterozygous for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency (G6PD Mahidol Variant) versus G6PD-Normal Volunteers.

PubMed

Rueangweerayut, Ronnatrai; Bancone, Germana; Harrell, Emma J; Beelen, Andrew P; Kongpatanakul, Supornchai; Möhrle, Jörg J; Rousell, Vicki; Mohamed, Khadeeja; Qureshi, Ammar; Narayan, Sushma; Yubon, Nushara; Miller, Ann; Nosten, François H; Luzzatto, Lucio; Duparc, Stephan; Kleim, Jörg-Peter; Green, Justin A

2017-09-01

Tafenoquine is an 8-aminoquinoline under investigation for the prevention of relapse in Plasmodium vivax malaria. This open-label, dose-escalation study assessed quantitatively the hemolytic risk with tafenoquine in female healthy volunteers heterozygous for the Mahidol 487A glucose-6-phosphate dehydrogenase (G6PD)-deficient variant versus G6PD-normal females, and with reference to primaquine. Six G6PD-heterozygous subjects (G6PD enzyme activity 40-60% of normal) and six G6PD-normal subjects per treatment group received single-dose tafenoquine (100, 200, or 300 mg) or primaquine (15 mg × 14 days). All participants had pretreatment hemoglobin levels ≥ 12.0 g/dL. Tafenoquine dose escalation stopped when hemoglobin decreased by ≥ 2.5 g/dL (or hematocrit decline ≥ 7.5%) versus pretreatment values in ≥ 3/6 subjects. A dose-response was evident in G6PD-heterozygous subjects ( N = 15) receiving tafenoquine for the maximum decrease in hemoglobin versus pretreatment values. Hemoglobin declines were similar for tafenoquine 300 mg (-2.65 to -2.95 g/dL [ N = 3]) and primaquine (-1.25 to -3.0 g/dL [ N = 5]). Two further cohorts of G6PD-heterozygous subjects with G6PD enzyme levels 61-80% ( N = 2) and > 80% ( N = 5) of the site median normal received tafenoquine 200 mg; hemolysis was less pronounced at higher G6PD enzyme activities. Tafenoquine hemolytic potential was dose dependent, and hemolysis was greater in G6PD-heterozygous females with lower G6PD enzyme activity levels. Single-dose tafenoquine 300 mg did not appear to increase the severity of hemolysis versus primaquine 15 mg × 14 days.

[Can venous iron and tranexamic acid reduce the transfusion need? Report on a non randomized, case control study].

PubMed

Essola, L; Kouégnigan Rérambiah, L; Obame, R; Issembè, H; Sima Zué, A

2017-06-01

To evaluate if the association of injectable iron and tranexamic acid allows a significant saving in transfusion, in cases of myomectomies and hysterectomies. This is a prospective, non randomized study done over 8 months (from January 2013 to August 2013). Were included, patients undergoing hysterectomy or myomectomy who had a hemoglobin level greater than or equal to 8g/dl and less than 12g/dl. Two groups were compared: group A consisting of patients for whom a pack red cells was ordered and the group B which patients received intravenous iron preoperatively and tranexamic acid perioperatively. The level of hemoglobin, pre- and postoperative, the average number of blood units per patient and estimated blood loss was compared. The transfusion economy was evaluated. During this period, 87 patients with a mean age of 40±9 years (range: 23 and 70years) were included according to our criteria: 44 patients in group A and 43 patients in group B. Initial mean hemoglobin in both groups was 9.1±0.7g/dl. In group B, after iron administration, the mean hemoglobin was 11.3±0.7g/dl. The average number of red blood cells received intraoperative patient in group A was 1.54±0.51. The estimated blood loss was significant greater (P=0.0002) in group A (571.6±237.1ml) than in group B (213.7±131.7ml). No transfusion was performed in group B. The association intravenous iron and tranexamic acid resulted in the reduction of transfusion requirements in our setting. It could be integrated in the strategy for sparing blood transfusion in scheduled surgery with hemorrhagic risks. Copyright © 2017. Published by Elsevier SAS.

Effect of Holder pasteurization and frozen storage on macronutrients and energy content of breast milk.

PubMed

García-Lara, Nadia Raquel; Vieco, Diana Escuder; De la Cruz-Bértolo, Javier; Lora-Pablos, David; Velasco, Noelia Ureta; Pallás-Alonso, Carmen Rosa

2013-09-01

The aim of this study was to explore the effect of Holder pasteurization and frozen storage at -20°C after pasteurization on fat, total nitrogen, lactose, and energy content of breast milk. Both procedures are routinely practiced in human milk banks. A total of 34 samples of frozen breast milk, donated by 28 women, were collected. Once thawed, an aliquot of each sample was analyzed before pasteurization; the remaining milk was pasteurized (Holder method) and split into 8 aliquots. One aliquot was analyzed after pasteurization and the remainder frozen at -20°C and analyzed 30, 60, 90, 120, and 180 days later. For every aliquot, fat, total nitrogen, lactose, and energy content were determined using the device human Milk Analyzer. We observed a significant reduction in fat (3.5%; -0.17 (-0.29; -0.04) g/dL) and energy content (2.8%; -2.03 (-3.60; -0.46) g/dL) after pasteurization. A significant decrease over time was observed for fat, lactose and energy content. No significant changes were observed for nitrogen content. Mean differences between day 0 postpasteurization and day 180 were -0.13 (-0.21; -0.06) g/dL for fat, -0.08 (-0.13; -0.03) g/dL for lactose, and -1.55 (-2.38; -0.71) kcal/dL for energy content. The relative decreases were 2.8%, 1.7%, and 2.2%, respectively. Overall (postpasteurization + frozen storage), a 6.2% and 5% decrease were observed for fat and energy, respectively. Holder pasteurization decreased fat and energy content of human milk. Frozen storage at -20°C of pasteurized milk significantly reduced fat, lactose, and energy content of human milk.

Effects of hypotensive anesthesia on blood transfusion rates in craniosynostosis corrections.

PubMed

Fearon, Jeffrey A; Cook, T Kevin; Herbert, Morley

2014-05-01

Hypotensive anesthesia is routinely used during craniosynostosis corrections to reduce blood loss. Noting that cerebral oxygenation levels often fell below recommended levels, the authors sought to measure the effects of hypotensive versus standard anesthesia on blood transfusion rates. One hundred children undergoing craniosynostosis corrections were randomized prospectively into two groups: a target mean arterial pressure of either 50 mm Hg or 60 mm Hg. Aside from anesthesiologists, caregivers were blinded and strict transfusion criteria were followed. Multiple variables were analyzed, and appropriate statistical testing was performed. The hypotensive and standard groups appeared similar, with no statistically significant differences in mean age (46.5 months versus 46.5 months), weight (19.25 kg versus 19.49 kg), procedure [anterior remodeling (34 versus 31) versus posterior (19 versus 16)], or preoperative hemoglobin level (13 g/dl versus 12.9 g/dl). Intraoperative mean arterial pressures differed significantly (56 mm Hg versus 66 mm Hg; p < 0.001). The captured cell saver amount was lower in the hypotensive group (163 cc versus 204 cc; p = 0.02), yet no significant differences were noted in postoperative hemoglobin levels (8.8 g/dl versus 9.3 g/dl). Fifteen of 100 patients (15 percent) received allogenic transfusions, but no statistically significant differences were noted in transfusion rates between the hypotensive [nine of 53 (17.0 percent)] and standard anesthesia [six of 47 (13 percent)] group (p = 0.056). No significant difference in transfusion requirements was found between hypotensive and standard anesthesia during craniosynostosis corrections. Considering potential benefits of improved cerebral blood flow and total body perfusion, surgeons might consider performing craniosynostosis corrections without hypotension. Therapeutic, II.

Increasing Severity of Malnutrition Is Associated With Poorer 30-Day Outcomes in Patients Undergoing Hip Fracture Surgery.

PubMed

Chung, Andrew S; Hustedt, Joshua W; Walker, Robert; Jones, Clifford; Lowe, Jason; Russell, George V

2018-04-01

Low serum albumin levels (hypoalbuminemia) have classically been used to identify malnutrition. The effect of increasing severity of malnutrition on postoperative outcomes in patients undergoing hip fracture surgery has not been well delineated on a large scale. Retrospective. Multicenter. A total of 12,373 patients undergoing hip fracture surgery from 2006 to 2013 National Surgery Quality Improvement Project data were identified. Patient demographic, comorbidity, and preoperative laboratory data and complication, reoperation, and readmission data were collected. Multivariate logistic regression was used to determine the effect of increasing severity of malnutrition on rates of 30-day postoperative complications, readmissions, and reoperations. A total of 12,373 hip fractures met inclusion criteria. A total of 6506 (52.6%) patients had normal albumin levels (albumin ≥3.5 g/dL), 3205 (25.9%) patients were mildly malnourished (albumin 3.1-3.49 g/dL), 2265 (18.3%) were moderately malnourished (albumin 2.4-3.1 g/dL), and 397 (3.2%) patients were severely malnourished (albumin <2.4 g/dL). Mean age was similar between the 4 cohorts (P < 0.001). Severe malnutrition was associated with a 2-fold increase in the odds of postoperative complications and mortality when compared with mild malnutrition (P < 0.001). Increasing severity of malnutrition was associated with significantly longer lengths of stay and higher odds of experiencing a related readmission (P < 0.001). Increasing severity of hypoalbuminemia is independently associated with poorer outcomes in the 30 days after hip fracture surgery. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Hematinic deficiencies and pernicious anemia in oral mucosal disease patients with macrocytosis.

PubMed

Chang, Julia Yu-Fong; Wang, Yi-Ping; Wu, Yang-Che; Cheng, Shih-Jung; Chen, Hsin-Ming; Sun, Andy

2015-08-01

Macrocytosis is defined as having the mean corpuscular volume (MCV) ≥ 100 fL. This study assessed hematinic deficiencies and pernicious anemia (PA) in oral mucosal disease patients with macrocytosis. The blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine concentrations and MCV in 60 oral mucosal disease patients with macrocytosis were measured and compared with the corresponding data in 120 age- and sex-matched healthy control participants. PA was defined by the World Health Organization (WHO) as having an Hb concentration < 13 g/dL for men and < 12 g/dL for women, an MCV ≥ 100 fL, a serum vitamin B12 level < 200 pg/mL, and serum gastric parietal cell antibody (GPCA) positivity. We found that 30 (50.0%), 7 (11.7%), 24 (40.0%), and three (5.0%) oral mucosal disease patients with macrocytosis had deficiencies of Hb (men < 13 g/dL, women < 12 g/dL), iron (< 60 μg/dL), vitamin B12 (< 200 pg/mL), and folic acid (< 4 mg/mL), respectively. Moreover, 38 (63.3%) and 16 (26.7%) macrocytosis patients had abnormally high blood homocysteine level (> 12.3 μM) and serum GPCA positivity, respectively. Macrocytosis patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, and of GPCA positivity than healthy control participants (p < 0.001). However, only 16.7% of 60 macrocytosis patients were diagnosed as having PA by the WHO definition. Only 16.7% of oral mucosal disease patients with macrocytosis are discovered to have PA by the WHO definition. Copyright © 2015. Published by Elsevier B.V.

Beyond Academic and Social Integration: Understanding the Impact of a STEM Enrichment Program on the Retention and Degree Attainment of Underrepresented Students.

PubMed

Lane, Tonisha B

2016-01-01

The current study used a case study methodological approach, including document analysis, semistructured interviews, and participant observations, to investigate how a science, technology, engineering, and mathematics (STEM) enrichment program supported retention and degree attainment of underrepresented students at a large, public, predominantly white institution. From this study, a model emerged that encompassed four components: proactive care, holistic support, community building, and catalysts for STEM identity development. These components encompassed a number of strategies and practices that were instrumental in the outcomes of program participants. This paper concludes with implications for practice, such as using models to inform program planning, assessment, and evaluation. © 2016 T. B. Lane. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Closed-cycle gas dynamic laser design investigation

NASA Technical Reports Server (NTRS)

Ketch, G. W.; Young, W. E.

1977-01-01

A conceptual design study was made of a closed cycle gas-dynamic laser to provide definition of the major components in the laser loop. The system potential application is for long range power transmission by way of high power laser beams to provide satellite propulsion energy for orbit changing or station keeping. A parametric cycle optimization was conducted to establish the thermodynamic requirements for the system components. A conceptual design was conducted of the closed cycle system and the individual components to define physical characteristics and establish the system size and weight. Technology confirmation experimental demonstration programs were outlined to develop, evaluate, and demonstrate the technology base needed for this closed cycle GDL system.

31 CFR 515.565 - Educational activities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Educational activities. 515.565..., Authorizations, and Statements of Licensing Policy § 515.565 Educational activities. (a) Specific institutional... structured educational program in Cuba as part of a course offered at the licensed institution, provided the...

78 FR 37806 - Information Collection Request Submitted to OMB for Review and Approval; Comment Request; EPA's...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-24

... profanity, threats, information claimed to be Confidential Business Information (CBI) or other information... strategic planning efforts, EPA encourages programs to develop meaningful performance measures, set...), Licensed Certification Providers (6100-20), Licensed Certifying Body (6100-13) Annual Reporting Form...

34 CFR 395.37 - Arbitration of State licensing agency complaints.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Arbitration of State licensing agency complaints. 395.37 Section 395.37 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION VENDING FACILITY PROGRAM...

50 CFR 80.4 - Diversion of license fees.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) FINANCIAL ASSISTANCE-WILDLIFE SPORT FISH RESTORATION PROGRAM ADMINISTRATIVE REQUIREMENTS, PITTMAN-ROBERTSON WILDLIFE RESTORATION AND DINGELL-JOHNSON SPORT FISH RESTORATION ACTS § 80.4 Diversion of license... charges imposed by the State to hunt or fish for sport or recreation. (2) Sale, lease, rental, or other...

45 CFR 1321.75 - Licenses and safety.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Licenses and safety. 1321.75 Section 1321.75 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON AGING, OLDER AMERICANS PROGRAMS GRANTS TO STATE...

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

Meurer, Aaron; Smith, Christopher P.; Paprocki, Mateusz

Here, SymPy is a full featured computer algebra system (CAS) written in the Python programming language. It is open source, being licensed under the extremely permissive 3-clause BSD license. SymPy was started by Ondrej Certik in 2005, and it has since grown into a large open source project, with over 500 contributors.

47 CFR 74.1281 - Station records.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., AUXILIARY, SPECIAL BROADCAST AND OTHER PROGRAM DISTRIBUTIONAL SERVICES FM Broadcast Translator Stations and..., place of business, or other suitable place, in one of the communities of license of the translator or booster, except that the station records of a booster or translator licensed to the licensee of the...

Magnitude and Correlates of Anemia in Elderly Women of a Resettlement Colony of Delhi.

PubMed

Singh, Tulika; Nagesh, S; Ray, T K

2018-01-01

Anemia of any degree contributes significantly to morbidity and mortality and has a significant effect on the quality of life of elderly women. Despite its clinical importance, anemia in the elderly women is underrecognized. The objective of this study was to assess the magnitude and correlates of anemia in elderly women of a resettlement colony of Delhi. A community-based, cross-sectional study for the duration of 1 year was conducted among 512 geriatric women (≥60 years). Demographic characteristics, dietary assessment, and behavioral risk factors were determined by interview, and the participants underwent physical examination followed by hemoglobin estimation by HemoCue. Anemia was defined using the WHO criteria of hemoglobin <12 g/dl. Chi-square test was employed to study the association between sociodemographic factors and anemia followed by multivariate regression analysis. The prevalence of anemia was 79.9% according to the WHO criteria of hemoglobin <12 g/dl in females. Age, education, marital status, financial dependence, diagnosed chronic disease, diet, calorie intake, history of worm infestation, and body mass index (BMI) were significantly associated with anemia on univariate analysis. In multivariate analysis, age, marital status, financial dependence, diagnosed chronic disease, diet, calorie intake, and BMI were significant explanatory variables for anemia. Our study points out high prevalence of and some of the major factors associated with anemia in elderly women. The need of the hour is to include our elderly women under the gamut of National Anemia Prophylaxis Program.

Hematologic reference values for clinically healthy captive golden conures (Guaruba guarouba).

PubMed

Prioste, Fabíola Eloisa Setim; Zwarg, Ticiana; Teixeira, Rodrigo Hidalgo; Vanstreels, Ralph Eric Thijl; Rocha, Arnaldo; Matushima, Eliana Reiko

2012-12-01

Golden conures or ararajubas (Guaruba guarouba) are endangered parrots endemic to the Brazilian Amazon forest. Body mass, blood cell counts, and total plasma protein were determined for 70 clinically healthy golden conures captive at zoologic parks and private breeder facilities in Brazil. Hematologic results (mean +/- SD) were: Erythrocytes 3.6 +/- 0.5 x 10(6) cells/mm3, hemoglobin 12.8 +/- 1.4 g/dl, packed cell volume 46 +/- 3.8%, mean corpuscular volume 132 +/- 20 fl, mean corpuscular hemoglobin (MCH) 36 +/- 5.7 pg, mean corpuscular hemoglobin concentration (MCHC) 28 +/- 3.5%, thrombocytes 26.3 +/- 9.3 x 10(3) cells/mm3, leukocytes 11.9 +/- 4.5 x 10(3) cells/mm3, heterophils 6284 +/- 2715 cells/mm3, lymphocytes 5473 +/- 2408 cells/ mm3, monocytes 113 +/- 162 cells/mm3, eosinophils 10 +/- 42 cells/mm3, basophils 27 +/- 64 cells/mm3. Body mass was 254 +/- 24.9 g and total plasma protein (TPP) was 3.54 +/- 0.58 g/dl. No statistical differences were observed between genders within age groups. Differences between juveniles (J) and adults (A) were identified for TPP (J < A), MCH (J > A), and MCHC (J > A). These results provide reliable reference values for the clinical interpretation of hematologic results for the species. Hematology may be an important tool for population health investigations on free-ranging golden conure populations and will also be essential to survey the health of release candidates in future reintroduction programs.

Hypoalbuminaemia-a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures.

PubMed

Aldebeyan, Sultan; Nooh, Anas; Aoude, Ahmed; Weber, Michael H; Harvey, Edward J

2017-02-01

Our aim was to determine the effect of hypoalbuminaemia as a marker of malnutrition on the 30-day postoperative complication rate and mortality in patients receiving surgical treatment for hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. We analyzed all patients admitted with hip fractures receiving surgical treatment from 2011 to 2013. Patients were dichotomized based on their albumin levels; hypoalbuminaemia (albumin <3.5g/dL), and nonhypoalbuminaemia (albumin >3.5g/dL). Patient demographics, postoperative complications, and length of stay were analysed. Logistic regression analysis was conducted to assess the ability of albumin level for predicting postoperative complications, length of stay, and mortality. A total of 10,117 patients with hip fractures were identified with 5414 patients with normal albumin levels, and 4703 with low albumin. Multivariate analysis showed that when controlling for comorbidities; hypoalbuminaemia alone was a predictor of postoperative complications (death, unplanned intubation, being on a ventilator >48h, sepsis, and blood transfusion), and increased length of stay (6.90±7.23 versus 8.44±8.70, CI 0.64-1.20, P<0.001). Hypoalbuminaemia alone can predict postoperative outcomes in patients with hip fractures. Furthermore, patients with hypoalbuminaemia had a longer hospital length of stay. Further studies are needed to assess whether nutritional support can improve postoperative complications in patients with hypoalbuminaemia. Copyright © 2016 Elsevier Ltd. All rights reserved.

- XSUMMER- Transcendental functions and symbolic summation in FORM

NASA Astrophysics Data System (ADS)

Moch, S.; Uwer, P.

2006-05-01

Harmonic sums and their generalizations are extremely useful in the evaluation of higher-order perturbative corrections in quantum field theory. Of particular interest have been the so-called nested sums, where the harmonic sums and their generalizations appear as building blocks, originating for example, from the expansion of generalized hypergeometric functions around integer values of the parameters. In this paper we discuss the implementation of several algorithms to solve these sums by algebraic means, using the computer algebra system FORM. Program summaryTitle of program:XSUMMER Catalogue identifier:ADXQ_v1_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/ADXQ_v1_0 Program obtainable from:CPC Program Library, Queen's University of Belfast, N. Ireland License:GNU Public License and FORM License Computers:all Operating system:all Program language:FORM Memory required to execute:Depending on the complexity of the problem, recommended at least 64 MB RAM No. of lines in distributed program, including test data, etc.:9854 No. of bytes in distributed program, including test data, etc.:126 551 Distribution format:tar.gz Other programs called:none External files needed:none Nature of the physical problem:Systematic expansion of higher transcendental functions in a small parameter. The expansions arise in the calculation of loop integrals in perturbative quantum field theory. Method of solution:Algebraic manipulations of nested sums. Restrictions on complexity of the problem:Usually limited only by the available disk space. Typical running time:Dependent on the complexity of the problem.

Evaluation of a program to enhance young drivers' safety in Israel.

PubMed

Toledo, Tomer; Lotan, Tsippy; Taubman-Ben-Ari, Orit; Grimberg, Einat

2012-03-01

Young drivers in Israel, as in other parts of the world, are involved in car crashes more than any other age group. The graduated driver licensing system in Israel requires that all new drivers be accompanied by an experienced driver whenever they drive for the first 3 months after obtaining a driving license. In an effort to make the accompanied driving phase more effective, a novel program which targets both young drivers and their parents was initiated in 2005. The program administers a personal meeting with the young driver and the accompanying parent scheduled for the beginning of the accompanied driving phase. In this meeting guidance is given regarding best practices for undertaking the accompanied driving, as well as tips for dealing with in-vehicle parent-teen dynamics. Through 2008, almost 130,000 families of young drivers have participated in the program. In order to evaluate the effectiveness of the program, injury crash records of the young drivers who participated in the program were compared with those of all other young drivers that were licensed at the same time period. The results obtained indicate statistically significant lower crash records for young drivers that participated in the program. Limitations of the evaluation related to self-selection biases are discussed, and practical implications are suggested. Copyright © 2011 Elsevier Ltd. All rights reserved.

Dynamic behaviors of liquid droplets on a gas diffusion layer surface: Hybrid lattice Boltzmann investigation

NASA Astrophysics Data System (ADS)

Wu, Jie; Huang, Jun-Jie

2015-07-01

Water management is one of the key issues in proton exchange membrane fuel cells. Fundamentally, it is related to dynamic behaviors of droplets on a gas diffusion layer (GDL) surface, and consequently they are investigated in this work. A two-dimensional hybrid method is employed to implement numerical simulations, in which the flow field is solved by using the lattice Boltzmann method and the interface between droplet and gas is captured by solving the Cahn-Hilliard equation directly. One or two liquid droplets are initially placed on the GDL surface of a gas channel, which is driven by the fully developed Poiseuille flow. At a fixed channel size, the effects of viscosity ratio of droplet to gas ( μ ∗ ), Capillary number (Ca, ratio of gas viscosity to surface tension), and droplet interaction on the dynamic behaviors of droplets are systematically studied. By decreasing viscosity ratio or increasing Capillary number, the single droplet can detach from the GDL surface easily. On the other hand, when two identical droplets stay close to each other or a larger droplet is placed in front of a smaller droplet, the removal of two droplets is promoted.

Ethanol analysis by headspace gas chromatography with simultaneous flame-ionization and mass spectrometry detection.

PubMed

Tiscione, Nicholas B; Alford, Ilene; Yeatman, Dustin Tate; Shan, Xiaoqin

2011-09-01

Ethanol is the most frequently identified compound in forensic toxicology. Although confirmation involving mass spectrometry is desirable, relatively few methods have been published to date. A novel technique utilizing a Dean's Switch to simultaneously quantitate and confirm ethyl alcohol by flame-ionization (FID) and mass spectrometric (MS) detection after headspace sampling and gas chromatographic separation is presented. Using 100 μL of sample, the limits of detection and quantitation were 0.005 and 0.010 g/dL, respectively. The zero-order linear range (r(2) > 0.990) was determined to span the concentrations of 0.010 to 1.000 g/dL. The coefficient of variation of replicate analyses was less than 3.1%. Quantitative accuracy was within ±8%, ±6%, ±3%, and ±1.5% at concentrations of 0.010, 0.025, 0.080, and 0.300 g/dL, respectively. In addition, 1,1-difluoroethane was validated for qualitative identification by this method. The validated FID-MS method provides a procedure for the quantitation of ethyl alcohol in blood by FID with simultaneous confirmation by MS and can also be utilized as an identification method for inhalants such as 1,1-difluoroethane.

Microstructural analysis of mass transport phenomena in gas diffusion media for high current density operation in PEM fuel cells

NASA Astrophysics Data System (ADS)

Kotaka, Toshikazu; Tabuchi, Yuichiro; Mukherjee, Partha P.

2015-04-01

Cost reduction is a key issue for commercialization of fuel cell electric vehicles (FCEV). High current density operation is a solution pathway. In order to realize high current density operation, it is necessary to reduce mass transport resistance in the gas diffusion media commonly consisted of gas diffusion layer (GDL) and micro porous layer (MPL). However, fundamental understanding of the underlying mass transport phenomena in the porous components is not only critical but also not fully understood yet due to the inherent microstructural complexity. In this study, a comprehensive analysis of electron and oxygen transport in the GDL and MPL is conducted experimentally and numerically with three-dimensional (3D) microstructural data to reveal the structure-transport relationship. The results reveal that the mass transport in the GDL is strongly dependent on the local microstructural variations, such as local pore/solid volume fractions and connectivity. However, especially in the case of the electrical conductivity of MPL, the contact resistance between carbon particles is the dominant factor. This suggests that reducing the contact resistance between carbon particles and/or the number of contact points along the transport pathway can improve the electrical conductivity of MPL.

Multi-scale structural analysis of gas diffusion layers

NASA Astrophysics Data System (ADS)

Göbel, Martin; Godehardt, Michael; Schladitz, Katja

2017-07-01

The macroscopic properties of materials are strongly determined by their micro structure. Here, transport properties of gas diffusion layers (GDL) for fuel cells are considered. In order to simulate flow and thermal properties, detailed micro structural information is essential. 3D images obtained by high-resolution computed tomography using synchrotron radiation and scanning electron microscopy (SEM) combined with focused ion beam (FIB) serial slicing were used. A recent method for reconstruction of porous structures from FIB-SEM images and sophisticated morphological image transformations were applied to segment the solid structural components. The essential algorithmic steps for segmenting the different components in the tomographic data-sets are described and discussed. In this paper, two types of GDL, based on a non-woven substrate layer and a paper substrate layer were considered, respectively. More than three components are separated within the synchrotron radiation computed tomography data. That is, fiber system, polytetrafluoroethylene (PTFE) binder/impregnation, micro porous layer (MPL), inclusions within the latter, and pore space are segmented. The usage of the thus derived 3D structure data in different simulation applications can be demonstrated. Simulations of macroscopic properties such as thermal conductivity, depending on the flooding state of the GDL are possible.

Novel electrospun gas diffusion layers for polymer electrolyte membrane fuel cells: Part II. In operando synchrotron imaging for microscale liquid water transport characterization

NASA Astrophysics Data System (ADS)

Chevalier, S.; Ge, N.; Lee, J.; George, M. G.; Liu, H.; Shrestha, P.; Muirhead, D.; Lavielle, N.; Hatton, B. D.; Bazylak, A.

2017-06-01

This is the second paper in a two-part series in which we investigate the impact of the gas diffusion layer structure on the liquid water distribution in an operating polymer electrolyte membrane (PEM) fuel cell through the procedures of design, fabrication, and testing of novel hydrophobic electrospun gas diffusion layers (eGDLs). In this work, fibre diameters and alignment in eGDLs are precisely controlled, and concurrent synchrotron X-ray radiography and electrochemical impedance spectroscopy (EIS) are used to evaluate the influence of the controlled eGDL parameters on the liquid water distribution and on membrane liquid water content. For eGDLs with small fibre diameters (150-200 nm) and correspondingly smaller pore sizes, reduced liquid water accumulation under the flow field ribs is observed. However, more liquid water is pinned onto the eGDL - at the interface with flow field channels. Orienting fibre alignment perpendicular to the flow field channel direction leads to improved eGDL-catalyst layer contact and prevents rib-channel membrane deformation. On the other hand, eGDLs facilitate significant membrane dry-out, even under highly humidified operating conditions at high current densities.

Real-time MR imaging of adeno-associated viral vector delivery to the primate brain

PubMed Central

Fiandaca, Massimo S.; Varenika, Vanja; Eberling, Jamie; McKnight, Tracy; Bringas, John; Pivirotto, Phillip; Beyer, Janine; Hadaczek, Piotr; Bowers, William; Park, John; Federoff, Howard; Forsayeth, John; Bankiewicz, Krystof S.

2009-01-01

We are developing a method for real-time magnetic resonance imaging (MRI) visualization of convection-enhanced delivery (CED) of adeno-associated viral vectors (AAV) to the primate brain. By including gadolinium-loaded liposomes (GDL) with AAV, we can track the convective movement of viral particles by continuous monitoring of distribution of surrogate GDL. In order to validate this approach, we infused two AAV (AAV1-GFP and AAV2-hAADC) into three different regions of non-human primate brain (corona radiata, putamen, and thalamus). The procedure was tolerated well by all three animals in the study. The distribution of GFP determined by immunohistochemistry in both brain regions correlated closely with distribution of GDL determined by MRI. Co-distribution was weaker with AAV2-hAADC, although in vivo PET scanning with FMT for AADC activity correlated well with immunohistochemistry of AADC. Although this is a relatively small study, it appears that AAV1 correlates better with MRI-monitored delivery than does AAV2. It seems likely that the difference in distribution may be due to differences in tissue specificity of the two serotypes. PMID:19095069

Evaluation of passive transfer in captive greater kudu (Tragelaphus strepsiceros).

PubMed

Hammond, Elizabeth E; Fiorello, Christine V

2011-12-01

Failure of passive transfer (FPT) in captive greater kudu (Tragelaphus strepsiceros) calves can lead to increased morbidity and mortality. In this retrospective study, serum samples from neonatal kudu calves were tested for immunoglobulin using different tests validated for domestic ruminants, including measurement of gamma globulin (GG) measured by protein electrophoresis, total solids (TS) measured by calibrated refractometry, total protein (TP) and globulins measured by colorimetry, gamma glutamyltransferase (GGT), and the zinc sulfate turbidity test (ZSTT). In a logistic regression model, TP, TS, globulins, and the natural log transform of GGT were the only significant parameters associated with FPT. Various historic parameters related to the dam, as well as calf weight, sex, glucose, and packed cell volume, were not significant. Based on the results, FPT in greater kudu is defined as GG of < 0.5 g/dl, a value lower than that in domestic cattle. TS measured by refractometry has an 80% sensitivity and a 100% specificity for FPT in greater kudu. With FPT defined as GG < 0.5 g/dl, kudu calves with a TS < 4.8 g/dl and a negative ZSTT have an increased probability of requiring medical intervention and additional diagnostics may be warranted.

An integrated simulator of structure and anisotropic flow in gas diffusion layers with hydrophobic additives

NASA Astrophysics Data System (ADS)

Burganos, Vasilis N.; Skouras, Eugene D.; Kalarakis, Alexandros N.

2017-10-01

The lattice-Boltzmann (LB) method is used in this work to reproduce the controlled addition of binder and hydrophobicity-promoting agents, like polytetrafluoroethylene (PTFE), into gas diffusion layers (GDLs) and to predict flow permeabilities in the through- and in-plane directions. The present simulator manages to reproduce spreading of binder and hydrophobic additives, sequentially, into the neat fibrous layer using a two-phase flow model. Gas flow simulation is achieved by the same code, sidestepping the need for a post-processing flow code and avoiding the usual input/output and data interface problems that arise in other techniques. Compression effects on flow anisotropy of the impregnated GDL are also studied. The permeability predictions for different compression levels and for different binder or PTFE loadings are found to compare well with experimental data for commercial GDL products and with computational fluid dynamics (CFD) predictions. Alternatively, the PTFE-impregnated structure is reproduced from Scanning Electron Microscopy (SEM) images using an independent, purely geometrical approach. A comparison of the two approaches is made regarding their adequacy to reproduce correctly the main structural features of the GDL and to predict anisotropic flow permeabilities at different volume fractions of binder and hydrophobic additives.

Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania

PubMed Central

Liu, Enju; Duggan, Christopher; Manji, Karim P; Kupka, Roland; Aboud, Said; Bosch, Ronald J; Kisenge, Rodrick R; Okuma, James; Fawzi, Wafaie W

2013-01-01

Introduction Anaemia is prevalent among children born to HIV-positive women, and it is associated with adverse effects on cognitive and motor development, growth, and increased risks of morbidity and mortality. Objective To examine the effect of daily multivitamin supplementation on haematologic status and mother-to-child transmission (MTCT) of HIV through breastfeeding. Methods A total of 2387 infants born to HIV-positive women from Dar es Salaam, Tanzania were enrolled in a randomized, double-blind, placebo-controlled trial, and provided a daily oral supplement of multivitamins (vitamin B complex, C and E) or placebo at age 6 weeks for 24 months. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations<11 g/dL and severe anaemia<8.5 g/dL. Results Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p=0.03), 18 (9.76 vs. 9.57 g/dL, p=0.004), and 24 months (9.93 vs. 9.75 g/dL, p=0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.79–0.99; p=0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.56–0.92; p=0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.79–1.54; p=0.57; p for interaction=0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between multivitamin supplements and MTCT of HIV. Conclusions Multivitamin supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy. PMID:23948440

Hematology and plasma chemistry reference intervals for cultured shortnose sturgeon (Acipenser brevirostrum).

PubMed

Knowles, Susan; Hrubec, Terry C; Smith, Stephen A; Bakal, Robert S

2006-12-01

The shortnose sturgeon, Acipenser brevirostrum, is an imperiled species distributed along the Atlantic coast of North America. Interest in replenishing wild stocks with hatchery-reared fish has created a need for accurate hematologic and biochemical reference intervals to evaluate the health of both fish raised in aquaculture systems and fish in the wild. The objective of this study was to generate hematologic and biochemistry reference intervals for healthy shortnose sturgeon. Blood samples were collected in heparinized tubes from 77 shortnose sturgeon raised in flow-through aquaculture systems. Whole blood and plasma samples were analyzed for hematologic and biochemical variables using standard techniques. Reference intervals were calculated as the central 95% (percentile) of data. Hematologic reference intervals (n = 46) were as follows: PCV 26-46%, hemoglobin 5.7-8.7 g/dL, MCV 307-520 fL, MCH 65.9-107.1 pg, MCHC 15-30 g/dL, plasma proteins (refractometry) 2.8-6.0 g/dL, RBC count 0.65-1.09 x 10(6)/microL, total WBC count 28,376-90,789/microL, small lymphocytes 9063-56,656/microL, large lymphocytes 2122-10,435/microL, neutrophils 3758-33,592/microL, monocytes 0-7137/microL, eosinophils 0-1544/microL, thrombocyte-like cells 6863-23,046/microL, thrombocytes 32,205-122,179/microL, and neutrophil:lymphocyte ratio 0.068-1.026. Plasma chemistry reference intervals (n = 77) were as follows: total protein 2.7-5.3 g/dL, albumin 0.8-1.7 g/dL, globulins 1.8-3.7 mg/dL, creatinine 0-1.4 mg/dL, total bilirubin 0-0.1 mg/dL, alkaline phosphatase 47-497 U/L, aspartate aminotransferase 90-311 U/L, sodium 124-141 mmol/L, potassium 2.9-3.7 mmol/L, chloride 106-121 mmol/L, calcium 6.6-12.1 mg/dL, magnesium 1.6-2.3 mg/dL, phosphorus 5.1-8.1 mg/dL, glucose 37-74 mg/dL, cholesterol 42-133 mg/dL, and osmolality 232-289 mOsm/kg. Reference values reported here will be useful for the early detection, identification, and monitoring of disease and sublethal conditions in cultured shortnose sturgeon.

Glucose-6-Phosphate Dehydrogenase Deficiency and Haemoglobin Drop after Sulphadoxine-Pyrimethamine Use for Intermittent Preventive Treatment of Malaria during Pregnancy in Ghana – A Cohort Study

PubMed Central

Owusu, Ruth; Asante, Kwaku Poku; Mahama, Emmanuel; Awini, Elizabeth; Anyorigiya, Thomas; Dosoo, David; Amu, Alberta; Jakpa, Gabriel; Ofei, Emmanuel; Segbaya, Sylvester; Oduro, Abraham Rexford; Gyapong, Margaret; Hodgson, Abraham; Bart-Plange, Constance; Owusu-Agyei, Seth

2015-01-01

Background Sulphadoxine-Pyrimethamine (SP) is still the only recommended antimalarial for use in intermittent preventive treatment of malaria during pregnancy (IPTp) in some malaria endemic countries including Ghana. SP has the potential to cause acute haemolysis in G6PD deficient people resulting in significant haemoglobin (Hb) drop but there is limited data on post SP-IPTp Hb drop. This study determined the difference, if any in proportions of women with significant acute haemoglobin drop between G6PD normal, partial deficient and full deficient women after SP-IPTp. Methods and Findings Prospectively, 1518 pregnant women who received SP for IPTp as part of their normal antenatal care were enrolled. Their G6PD status were determined at enrollment followed by assessments on days 3, 7,14 and 28 to document any adverse effects and changes in post-IPTp haemoglobin (Hb) levels. The three groups were comparable at baseline except for their mean Hb (10.3 g/dL for G6PD normal, 10.8 g/dL for G6PD partial deficient and 10.8 g/dL for G6PD full defect women).The prevalence of G6PD full defect was 2.3% and 17.0% for G6PD partial defect. There was no difference in the proportions with fractional Hb drop ≥ 20% as compared to their baseline value post SP-IPTp among the 3 groups on days 3, 7, 14. The G6PD full defect group had the highest median fractional drop at day 7. There was a weak negative correlation between G6PD activity and fractional Hb drop. There was no statistical difference between the three groups in the proportions of those who started the study with Hb ≥ 8g/dl whose Hb level subsequently fell below 8g/dl post-SP IPTp. No study participant required transfusion or hospitalization for severe anaemia. Conclusions There was no significant difference between G6PD normal and deficient women in proportions with significant acute haemoglobin drop post SP-IPTp and lower G6PD enzyme activity was not strongly associated with significant acute drug-induced haemoglobin drop post SP-IPTp but a larger study is required to confirm consistency of findings. PMID:26327623

Risks of Hemolysis in Glucose-6-Phosphate Dehydrogenase Deficient Infants Exposed to Chlorproguanil-Dapsone, Mefloquine and Sulfadoxine-Pyrimethamine as Part of Intermittent Presumptive Treatment of Malaria in Infants.

PubMed

Poirot, Eugenie; Vittinghoff, Eric; Ishengoma, Deus; Alifrangis, Michael; Carneiro, Ilona; Hashim, Ramadhan; Baraka, Vito; Mosha, Jacklin; Gesase, Samwel; Chandramohan, Daniel; Gosling, Roland

2015-01-01

Chlorproguanil-dapsone (CD) has been linked to hemolysis in symptomatic glucose-6-phosphate dehydrogenase deficient (G6PDd) children. Few studies have explored the effects of G6PD status on hemolysis in children treated with Intermittent Preventive Treatment in infants (IPTi) antimalarial regimens. We sought to examine the joint effects of G6PD status and IPTi antimalarial treatment on incidence of hemolysis in asymptomatic children treated with CD, sulfadoxine-pyrimethamine (SP), and mefloquine (MQ). A secondary analysis of data from a double-blind, placebo-controlled trial of IPTi was conducted. Hemoglobin (Hb) measurements were made at IPTi doses, regular follow-up and emergency visits. G6PD genotype was determined at 9 months looking for SNPs for the A- genotype at coding position 202. Multivariable linear and logistic regression models were used to examine hemolysis among children with valid G6PD genotyping results. Hemolysis was defined as the absolute change in Hb or as any post-dose Hb <8 g/dL. These outcomes were assessed using either a single follow-up Hb on day 7 after an IPTi dose or Hb obtained 1 to 14 or 28 days after each IPTi dose. Relative to placebo, CD reduced Hb by approximately 0.5 g/dL at day 7 and within 14 days of an IPTi dose, and by 0.2 g/dL within 28 days. Adjusted declines in the CD group were larger than in the MQ and SP groups. At day 7, homo-/hemizygous genotype was associated with higher odds of Hb <8 g/dL (adjusted odds ratio = 6.7, 95% CI 1.7 to 27.0) and greater absolute reductions in Hb (-0.6 g/dL, 95% CI -1.1 to 0.003). There was no evidence to suggest increased reductions in Hb among homo-/hemizygous children treated with CD compared to placebo, SP or MQ. While treatment with CD demonstrated greater reductions in Hb at 7 and 14 days after an IPTi dose compared to both SP and MQ, there was no evidence that G6PD deficiency exacerbated the adverse effects of CD, despite evidence for higher hemolysis risk among G6PDd infants.

Glucose-6-Phosphate Dehydrogenase Deficiency and Haemoglobin Drop after Sulphadoxine-Pyrimethamine Use for Intermittent Preventive Treatment of Malaria during Pregnancy in Ghana - A Cohort Study.

PubMed

Owusu, Ruth; Asante, Kwaku Poku; Mahama, Emmanuel; Awini, Elizabeth; Anyorigiya, Thomas; Dosoo, David; Amu, Alberta; Jakpa, Gabriel; Ofei, Emmanuel; Segbaya, Sylvester; Oduro, Abraham Rexford; Gyapong, Margaret; Hodgson, Abraham; Bart-Plange, Constance; Owusu-Agyei, Seth

2015-01-01

Sulphadoxine-Pyrimethamine (SP) is still the only recommended antimalarial for use in intermittent preventive treatment of malaria during pregnancy (IPTp) in some malaria endemic countries including Ghana. SP has the potential to cause acute haemolysis in G6PD deficient people resulting in significant haemoglobin (Hb) drop but there is limited data on post SP-IPTp Hb drop. This study determined the difference, if any in proportions of women with significant acute haemoglobin drop between G6PD normal, partial deficient and full deficient women after SP-IPTp. Prospectively, 1518 pregnant women who received SP for IPTp as part of their normal antenatal care were enrolled. Their G6PD status were determined at enrollment followed by assessments on days 3, 7,14 and 28 to document any adverse effects and changes in post-IPTp haemoglobin (Hb) levels. The three groups were comparable at baseline except for their mean Hb (10.3 g/dL for G6PD normal, 10.8 g/dL for G6PD partial deficient and 10.8 g/dL for G6PD full defect women).The prevalence of G6PD full defect was 2.3% and 17.0% for G6PD partial defect. There was no difference in the proportions with fractional Hb drop ≥ 20% as compared to their baseline value post SP-IPTp among the 3 groups on days 3, 7, 14. The G6PD full defect group had the highest median fractional drop at day 7. There was a weak negative correlation between G6PD activity and fractional Hb drop. There was no statistical difference between the three groups in the proportions of those who started the study with Hb ≥ 8g/dl whose Hb level subsequently fell below 8g/dl post-SP IPTp. No study participant required transfusion or hospitalization for severe anaemia. There was no significant difference between G6PD normal and deficient women in proportions with significant acute haemoglobin drop post SP-IPTp and lower G6PD enzyme activity was not strongly associated with significant acute drug-induced haemoglobin drop post SP-IPTp but a larger study is required to confirm consistency of findings.

Erythropoietin, Iron Depletion and Relative Thrombocytosis: A Possible Explanation for Hemoglobin-Survival Paradox in Chronic Kidney Disease

PubMed Central

Streja, Elani; Kovesdy, Csaba P; Greenland, Sander; Kopple, Joel D.; McAllister, Charles J; Nissenson, Allen R; Kalantar-Zadeh, Kamyar

2017-01-01

Background High doses of human recombinant erythropoietin (rHuEPO) to achieve hemoglobin levels above 13 g/dL in chronic kidney disease appear associated with elevated mortality. Study Design We conducted logistic regression and survival analyses in a retrospective cohort of maintenance hemodialysis (MHD) patients to examine the hypothesis that the induced iron depletion with resultant relative thrombocytosis may be a possible contributor to the link between the high rHuEPO dose associated hemoglobin ≥13 g/dL and mortality. Setting & Participants The national database of a large dialysis organization (DaVita) with 40,787 MHD patients during July to December 2001 and their survival up to July 2004 were examined. Predictors Hemoglobin level, platelet count and administered rHuEPO dose during each calendar quarter. Outcomes & other Measurements Case-mix adjusted 3-year all-cause mortality; and measures of iron stores including serum ferritin and iron saturation ratio (ISAT). Results Higher platelet count was associated with lower iron stores and higher prescribed rHuEPO dose. Compared to hemoglobin of 12-13 g/dL, hemoglobin ≥13 g/dL was associated with increased mortality in the presence of relative thrombocytosis, i.e., platelet count ≥300,000/μl, (case-mix adjusted death-rate ratio [RR]: 1.21, 95% confidence limits [CL]: 1.02–1.44, P=0.03) as opposed to the absence of relative thrombocytosis (RR: 1.04, 95% CL: 0.98–1.08, P=0.13). Prescribed rHuEPO dose >20,000 units/week was associated with higher likelihood of iron depletion (ISAT<20%) and relative thrombocytosis (case-mix adjusted odds ratio: 2.53 [CL: 2.37–2.69] and 1.36 [CL: 1.30–1.42], respectively, p<0.001) and increased mortality over 3 years (death-rate ratio of 1.59, CL: 1.54, 1.65, p<0.001). Limitations Our results may incorporate uncontrolled confounding. Achieved hemoglobin may have different mortality-predictability than targeted hemoglobin. Conclusions Iron depletion and associated relative thrombocytosis might contribute to increased mortality when administering high rHuEPO doses to achieve hemoglobin ≥13 g/dL in MHD patients. Randomized trials are needed to test these observational associations. PMID:18760517

Impact of healthy work environments and multistage nurse residency programs on retention of newly licensed RNs.

PubMed

Kramer, Marlene; Halfer, Diana; Maguire, Pat; Schmalenberg, Claudia

2012-03-01

The objective of the study was to examine effects of nurse-confirmed healthy unit work environments and multistage nurse residency programs (NRPs) on retention rates of newly licensed RNs (NLRNs). Establishing a culture of retention and healthy clinical nurse practice environments are two major challenges confronting nurse leaders today. Nurse residency programs are a major component of NLRN work environments and have been shown to be effective in abating nurse turnover. Sample for this study consisted of 5,316 new graduates in initial RN roles in 28 Magnet® hospitals. There were no differences in retention rates by education or patient population on clinical unit. NLRN retention rate was higher in community than in academic hospitals. More than half of NLRNs were placed on units with very healthy work environments. Newly licensed RNs on units with work environments needing improvement resigned at a significantly higher rate than did other NLRNs. The quality of clinical unit work environments is the most important factor in NLRN retention.

Open source clustering software.

PubMed

de Hoon, M J L; Imoto, S; Nolan, J; Miyano, S

2004-06-12

We have implemented k-means clustering, hierarchical clustering and self-organizing maps in a single multipurpose open-source library of C routines, callable from other C and C++ programs. Using this library, we have created an improved version of Michael Eisen's well-known Cluster program for Windows, Mac OS X and Linux/Unix. In addition, we generated a Python and a Perl interface to the C Clustering Library, thereby combining the flexibility of a scripting language with the speed of C. The C Clustering Library and the corresponding Python C extension module Pycluster were released under the Python License, while the Perl module Algorithm::Cluster was released under the Artistic License. The GUI code Cluster 3.0 for Windows, Macintosh and Linux/Unix, as well as the corresponding command-line program, were released under the same license as the original Cluster code. The complete source code is available at http://bonsai.ims.u-tokyo.ac.jp/mdehoon/software/cluster. Alternatively, Algorithm::Cluster can be downloaded from CPAN, while Pycluster is also available as part of the Biopython distribution.

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2010 CFR

2010-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2013 CFR

2013-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2014 CFR

2014-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

45 CFR 265.9 - What information must the State file annually?

Code of Federal Regulations, 2011 CFR

2011-10-01

... (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES DATA... child care services made by the State through the use of disregards, by the following types of child care providers: (i) Licensed/regulated in-home child care; (ii) Licensed/regulated family child care...

76 FR 45545 - Foreign Institutions-Federal Student Aid Programs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-29

... U.S. Medical Licensing Examination (USMLE) and citizenship data by foreign graduate medical schools...' scores on the U.S. Medical Licensing Examination (USMLE), and the school's citizenship rate (i.e., the... medical schools must submit a statement of the foreign graduate medical school's citizenship rate for 2010...

77 FR 37093 - Amendments to Highway Safety Program Guidelines

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-20

...: Make. Model year. Vehicle Identification Number. Type of body. License plate number. Name of current.... Privacy Act: Anyone is able to search the electronic form of all comments received into any of our dockets... Driver Education, Guideline No. 5 Non-Commercial Driver Licenses, Guideline No. 7, Judicial and Court...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

38 CFR 53.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... STATES FOR PROGRAMS TO PROMOTE THE HIRING AND RETENTION OF NURSES AT STATE VETERANS HOMES § 53.2 Definitions. For the purpose of this part: Nurse means an individual who is a registered nurse, a licensed practical nurse, a licensed vocational nurse, or a nursing assistant certified in the State in which payment...

42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Medical or other remedial care provided by licensed practitioners. 440.60 Section 440.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS...

42 CFR 440.60 - Medical or other remedial care provided by licensed practitioners.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Medical or other remedial care provided by licensed practitioners. 440.60 Section 440.60 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS...

Licensing and Other Controls of the Drinking Driver.

ERIC Educational Resources Information Center

Waller, Patricia F.

Driver licensing, the only state program with the opportunity for routine personal contact with every driver, has unmatched potential for both general and specific countermeasures to the problem of drunk driving. General countermeasures apply to large groups of drivers prior to the occurrence of any infraction. They may be considered basically…

The Teaching Internship. Practical Preparation for a Licensed Profession.

ERIC Educational Resources Information Center

Darling-Hammond, Linda; And Others

This report presents proposed standards for teaching internship programs. The internship standards are intended to be embedded in a state's teacher licensing system. The year-long (paid) internship is simultaneously the last year of formal teacher preparation, the first year of (supervised) teaching, and one requirement for the unrestricted…

49 CFR 40.281 - Who is qualified to act as a SAP?

Code of Federal Regulations, 2013 CFR

2013-10-01

...); (2) You are a licensed or certified social worker; (3) You are a licensed or certified psychologist..., including the initial employee evaluation, referrals for education and/or treatment, the follow-up...; (ix) Issues that SAPs confront in carrying out their duties under the program. (2) Following your...

49 CFR 40.281 - Who is qualified to act as a SAP?

Code of Federal Regulations, 2014 CFR

2014-10-01

...); (2) You are a licensed or certified social worker; (3) You are a licensed or certified psychologist..., including the initial employee evaluation, referrals for education and/or treatment, the follow-up...; (ix) Issues that SAPs confront in carrying out their duties under the program. (2) Following your...

49 CFR 40.281 - Who is qualified to act as a SAP?

Code of Federal Regulations, 2012 CFR

2012-10-01

...); (2) You are a licensed or certified social worker; (3) You are a licensed or certified psychologist..., including the initial employee evaluation, referrals for education and/or treatment, the follow-up...; (ix) Issues that SAPs confront in carrying out their duties under the program. (2) Following your...

38 CFR 21.4250 - Course and licensing and certification test approval; jurisdiction and notices.

Code of Federal Regulations, 2011 CFR

2011-07-01

...' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VOCATIONAL REHABILITATION AND EDUCATION Administration of Educational Assistance Programs Courses § 21.4250 Course and licensing and certification test... exceptions found in paragraph (c) of this section. (1) If an educational institution offers a resident course...

34 CFR 395.37 - Arbitration of State licensing agency complaints.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Arbitration of State licensing agency complaints. 395.37 Section 395.37 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION VENDING FACILITY PROGRAM FOR THE...

77 FR 40586 - Coastal Programs Division

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-10

... approval of extension of deep sea hard mineral exploration licenses and amended exploration plan. SUMMARY... FR 12245 on the request of Lockheed Martin Corp. to extend the deep seabed hard mineral exploration licenses USA-1 and USA-4 issued under the Deep Seabed Hard Mineral Resources Act (DSHMRA; 30 U.S.C. 1401...

77 FR 63343 - Biweekly Notice: Applications and Amendments to Facility Operating Licenses and Combined Licenses...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... PWR [Pressurized-Water Reactor] Steam Generator Tubes'' (Reference 32) and [Nuclear Energy Institute... maintains the required structural margins of the SG tubes for both normal and accident conditions. Nuclear Energy Institute 97-06, ``Steam Generator Program Guidelines'' (Reference 8), and NRC Regulatory Guide 1...

Efficacy and Safety of Ibrutinib in Indian Patients with Relapsed or Refractory Chronic Lymphocytic Leukemia and Mantle Cell Lymphoma: Cases from a Named Patient Program.

PubMed

Agarwal, Mohan B; Bhurani, Dinesh; Shah, Chirag; Sood, Nitin; Singhal, Manish; Kamat, Anil; Chezhian, Subash; Mishra, Suryaprakash; Nagrale, Dinesh

2017-01-01

This named patient program evaluated the safety and efficacy of ibrutinib, a selective inhibitor of Bruton's tyrosine kinase in Indian patients with relapsed/refractory chronic lymphocytic leukemia (CLL, with/without chromosome 17 deletion [del17p]) and mantle cell lymphoma (MCL). The eight enrolled patients (relapsed/refractory CLL: n = 6 [4/6 patients with del17p] and relapsed/refractory MCL: n = 2) had median age of 55 years (range, 52-60) and had received a median of 3 (CLL patients) and 4 (MCL patients) prior therapies. Patients received once-daily dose of ibrutinib (420 mg: CLL, 560 mg: MCL). In CLL patients, the median time to response was 3 months (range, 0.5-7) and five of six patients had partial response (PR) whereas one achieved complete response (CR). Median time on treatment was 11.5 months (range, 8-14); five patients continued treatment and one was recommended stem cell transplantation (SCT). Of the two MCL patients, one achieved PR and one showed CR and advanced to SCT. In CLL patients, the median (range) hemoglobin level improved from 9.8 g/dL (7.2-11) at baseline to 12.0 g/dL (9.5-13.2) and median (range) platelet count improved from 150,000 cells/μL (21,000-195,000) at baseline to 190,350 cells/μL (130,000-394,000) at the time of analysis (July 2016). Most adverse events (AEs) reported were infections ( n = 2). No Grade 3-4 or serious AEs, dose reductions, or treatment discontinuation due to AEs were reported. In this first real-world experience in Indian patients, ibrutinib demonstrated therapeutic efficacy in relapsed/refractory CLL (with/without del17p) and MCL. Safety results were consistent with the current known profile of ibrutinib.

Current state of continuous ambulatory peritoneal dialysis in Egypt.

PubMed

Elzorkany, Khaled Mohamed Amin

2017-01-01

Patients with end-stage renal disease (ESRD) continue to increase in number worldwide, especially in developing countries. Although continuous ambulatory peritoneal dialysis (CAPD) has comparable survival advantages as hemodialysis (HD), it is greatly underutilized in many regions worldwide. The prevalence of use of CAPD in Egypt is 0.29/million population in 2017. The aim of this study is to describe the current state and practice of CAPD in Egypt and included 22 adult patients who were treated by CAPD. All the study patients were switched to CAPD after treatment with HD failed due to vascular access problems. Patients were mainly female (68.2 %) with the mean age of 49.77 ± 11.41 years. The average duration on CAPD was 1.76 ± 1.30 years. Hypertension was the main cause of end-stage renal disease (ESRD) constituting 36.4%, followed by diabetes (27.3 %), and toxic nephropathy (4.5%). Of importance is that about 31.8% of patients had ESRD of unknown etiology. The mean weekly Kt/V urea of patients on PD was 1.92 ± 0.18. The mean hemoglobin, serum calcium, phosphorus, parathormone, and albumin levels were 10.27 ± 1.98 g/dL, 8.36 ± 1.19 mg/dL, 5.70 ± 1.35 mg/dL, 541.18 ± 230.12 pg/mL, and 2.98 ± 0.73 g/dL, respectively. There was no significant difference between diabetic and nondiabetic CAPD patients regarding demographic and laboratory data. Our data indicate that there is continuing underutilization of CAPD in Egypt which may be related to nonavailability of CAPD fluid, patient factors (education and motivation), gradual decline of the efficiency of health-care professionals, and lack of a national program to start PD as the first modality for renal replacement therapy. It is advised to start an organized program to make CAPD widespread and encourage local production of PD fluids to reduce the cost of CAPD.

From the USDA: Educating the Next Generation: Funding Opportunities in Food, Agricultural, Natural Resources, and Social Sciences Education.

PubMed

Parker, Joyce E; Wagner, David J

The National Institute of Food and Agriculture within the U.S. Department of Agriculture provides leadership, capacity, and funds to support the continuing development of a safe and competitive agricultural system. Many of the agency's educational programs are led by the Division of Community and Education (DOCE). These programs span agricultural education, enhancing agricultural literacy through both formal and nonformal education. Here, we have highlighted funding opportunities within DOCE that enhance agricultural education and literacy by supporting the improvement of students' critical communication, leadership skills, and experiential learning opportunities. Some of these programs include opportunities for which students can apply, while others focus on faculty applications. Opportunities faculty can apply for may support student-recruitment and student-retention techniques, curriculum development, innovative teaching methods, and institutional capacity-building programs. Overall, these programs foster a diverse workforce in agricultural science that matches the increasing diversity of the country. © 2016 J. E. Parker and D. J. Wagner. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

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

Klise, Katherine A.; Siirola, John Daniel; Hart, David

The Water Security Toolkit (WST) is a suite of open source software tools that can be used by water utilities to create response strategies to reduce the impact of contamination in a water distribution network . WST includes hydraulic and water quality modeling software , optimizati on methodologies , and visualization tools to identify: (1) sensor locations to detect contamination, (2) locations in the network in which the contamination was introduced, (3) hydrants to remove contaminated water from the distribution system, (4) locations in the network to inject decontamination agents to inactivate, remove, or destroy contaminants, (5) locations in themore » network to take grab sample s to help identify the source of contamination and (6) valves to close in order to isolate contaminate d areas of the network. This user manual describes the different components of WST , along w ith examples and case studies. License Notice The Water Security Toolkit (WST) v.1.2 Copyright c 2012 Sandia Corporation. Under the terms of Contract DE-AC04-94AL85000, there is a non-exclusive license for use of this work by or on behalf of the U.S. government. This software is distributed under the Revised BSD License (see below). In addition, WST leverages a variety of third-party software packages, which have separate licensing policies: Acro Revised BSD License argparse Python Software Foundation License Boost Boost Software License Coopr Revised BSD License Coverage BSD License Distribute Python Software Foundation License / Zope Public License EPANET Public Domain EPANET-ERD Revised BSD License EPANET-MSX GNU Lesser General Public License (LGPL) v.3 gcovr Revised BSD License GRASP AT&T Commercial License for noncommercial use; includes randomsample and sideconstraints executable files LZMA SDK Public Domain nose GNU Lesser General Public License (LGPL) v.2.1 ordereddict MIT License pip MIT License PLY BSD License PyEPANET Revised BSD License Pyro MIT License PyUtilib Revised BSD License PyYAML MIT License runpy2 Python Software Foundation License setuptools Python Software Foundation License / Zope Public License six MIT License TinyXML zlib License unittest2 BSD License Utilib Revised BSD License virtualenv MIT License Vol Common Public License vpykit Revised BSD License Additionally, some precompiled WST binary distributions might bundle other third-party executables files: Coliny Revised BSD License (part of Acro project) Dakota GNU Lesser General Public License (LGPL) v.2.1 PICO Revised BSD License (part of Acro project) i Revised BSD License Redistribution and use in source and binary forms, with or without modification, are permitted provided that the following conditions are met: * Redistributions of source code must retain the above copyright notice, this list of conditions and the following disclaimer. * Redistributions in binary form must reproduce the above copyright notice, this list of conditions and the following disclaimer in the documentation and/or other materials provided with the distribution. * Neither the name of Sandia National Laboratories nor Sandia Corporation nor the names of its con- tributors may be used to endorse or promote products derived from this software without specific prior written permission. THIS SOFTWARE IS PROVIDED BY THE COPYRIGHT HOLDERS AND CONTRIBUTORS "AS IS" AND ANY EXPRESS OR IMPLIED WARRANTIES, INCLUDING, BUT NOT LIMITED TO, THE IM- PLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ARE DISCLAIMED. IN NO EVENT SHALL SANDIA CORPORATION BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUD- ING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATA, OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER CAUSED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THIS SOFTWARE, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGE. ii Acknowledgements This work was supported by the U.S. Environmental Protection Agency through its Office of Research and Development (Interagency Agreement # DW8992192801). The material in this document has been subject to technical and policy review by the U.S. EPA, and approved for publication. The views expressed by individual authors, however, are their own, and do not necessarily reflect those of the U.S. Environmental Protection Agency. Mention of trade names, products, or services does not convey official U.S. EPA approval, endorsement, or recommendation. The Water Security Toolkit is an extension of the Threat Ensemble Vulnerability Assessment-Sensor Place- ment Optimization Tool (TEVA-SPOT), which was also developed with funding from the U.S. Environ- mental Protection Agency through its Office of Research and Development (Interagency Agreement # DW8992192801). The authors acknowledge the following individuals for their contributions to the devel- opment of TEVA-SPOT: Jonathan Berry (Sandia National Laboratories), Erik Boman (Sandia National Laboratories), Lee Ann Riesen (Sandia National Laboratories), James Uber (University of Cincinnati), and Jean-Paul Watson (Sandia National Laboratories). iii Acronyms ATUS American Time-Use Survey BLAS Basic linear algebra sub-routines CFU Colony-forming unit CVAR Conditional value at risk CWS Contamination warning system EA Evolutionary algorithm EDS Event detection system EPA U.S. Environmental Protection Agency EC Extent of Contamination ERD EPANET results database file GLPK GNU Linear Programming Kit GRASP Greedy randomized adaptive sampling process HEX Hexadecimal HTML HyperText markup language INP EPANET input file LP Linear program MC Mass consumed MILP Mixed integer linear program MIP Mixed integer program MSX Multi-species extension for EPANET NFD Number of failed detections NS Number of sensors NZD Non-zero demand PD Population dosed PE Population exposed PK Population killed TAI Threat assessment input file TCE Tailed-conditioned expectation TD Time to detection TEC Timed extent of contamination TEVA Threat ensemble vulnerability assessment TSB Tryptic soy broth TSG Threat scenario generation file TSI Threat simulation input file VAR Value at risk VC Volume consumed WST Water Security Toolkit YML YAML configuration file format for WST iv Symbols Notation Definition Example { , } set brackets { 1,2,3 } means a set containing the values 1,2, and 3. [?] is an element of s [?] S means that s is an element of the set S . [?] for all s = 1 [?] s [?] S means that the statement s = 1 is true for all s in set S . P summation P n i =1 s i means s 1 + s 2 + * * * + s n . \\ set minus S \\ T means the set that contains all those elements of S that are not in set T . %7C given %7C is used to define conditional probability. P ( s %7C t ) means the prob- ability of s occurring given that t occurs. %7C ... %7C cardinality Cardinality of a set is the number of elements of the set. If set S = { 2,4,6 } , then %7C S %7C = 3. v« less

Stop waiting and start creating: service learning with an outpatient bone marrow transplant unit art cart program.

PubMed

Fletcher, Tina; Bayer, Christina; Beyer, Emily; Gonzales, Jessica; Ralston, Ashley; Yount, Phyllis

2013-01-01

This paper examines how master of occupational therapy students, their occupational therapy instructor, and a community-based licensed clinical social worker collaborated in a service learning art cart program on an outpatient bone marrow transplant unit. As they progressed through the phases of Kolb's model of service learning, occupational therapy students, their occupational therapy instructor, and the licensed clinical social worker were all able to meet mutual goals of serving a unique patient population, increasing knowledge of best practices, and building and fostering university/community relationships.

Use of a hand-held computer observational tool to improve communication for care planning and psychosocial well-being

PubMed Central

Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.

2013-01-01

Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behaviors may worsen nursing staff relationships. PMID:19182546

78 FR 37234 - Notice of Invitation; Coal Exploration License Application NDM 105349, ND

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-20

...] Notice of Invitation; Coal Exploration License Application NDM 105349, ND AGENCY: Bureau of Land Management, Interior. ACTION: Notice. SUMMARY: Members of the public are invited to participate with BNI Coal Ltd. on a pro rata cost sharing basis in a program for the exploration of coal deposits owned by the...

76 FR 38680 - Notice of Invitation-Coal Exploration License Application COC-74817

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

...] Notice of Invitation--Coal Exploration License Application COC- 74817 AGENCY: Bureau of Land Management... Mountain Energy, Inc. on a pro rata cost-sharing basis in a program for the exploration of coal deposits... is to gain additional geologic knowledge of the coal underlying the exploration area for the purpose...

34 CFR Appendix B to Subpart B of... - Appendix I, Standards for Audit of Governmental Organizations, Programs, Activities, and...

Code of Federal Regulations, 2010 CFR

2010-07-01

... shall be conducted * * * by independent certified public accountants or by independent licensed public... provide for the continuing licensing of public accountants and which are prescribed by the Secretary in... expression of an opinion on financial reports of governmental organizations, only fully qualified public...

Alternative Fuels Data Center

Science.gov Websites

AFV special license plate, which are available from the Arizona Department of Transportation (ADOT license plate. ADOT has reached its maximum limit of 10,000 vehicles and the issuance of Energy Efficient Alternative Fuel Vehicle (AFV) and Energy Efficient Plate Programs Dedicated AFVs qualify for an

SymPy: Symbolic computing in python

DOE PAGES

Meurer, Aaron; Smith, Christopher P.; Paprocki, Mateusz; ...

2017-01-02

Here, SymPy is a full featured computer algebra system (CAS) written in the Python programming language. It is open source, being licensed under the extremely permissive 3-clause BSD license. SymPy was started by Ondrej Certik in 2005, and it has since grown into a large open source project, with over 500 contributors.

75 FR 55366 - In the Matter of Mark M. Ficek; Order Prohibiting Involvement in NRC-Licensed Activities...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-10

... (Effective Immediately) Mr. Mark M. Ficek is the President, owner, and former radiation safety officer (RSO... new radiation safety officer, and due to expire on February 28, 2016. The license authorizes Mattingly... assessing Mattingly's entire radiation safety program, providing radiation safety training to the Mattingly...

10 CFR 171.16 - Annual fees: Materials licensees, holders of certificates of compliance, holders of sealed source...

Code of Federal Regulations, 2010 CFR

2010-01-01

... contained in devices used in industrial measuring systems, including x-ray fluorescence analyzers [Program... ores containing source material for extraction of metals other than uranium or thorium, including.... 4 Another license includes licenses for extraction of metals, heavy metals, and rare earths. 5 There...

A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

ERIC Educational Resources Information Center

West, Paul L.; Hamm, Terri

2012-01-01

Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors. (Contains 3…

Residency Applicants Misinterpret Their United States Medical Licensing Exam Scores

ERIC Educational Resources Information Center

Jones, Roger C.; Desbiens, Norman A.

2009-01-01

Proper interpretation of the results of the United States Medical Licensing Exam (USMLE) is important for program directors, residents, and faculty who advise applicants about applying for residency positions. We suspected that applicants often misinterpreted their performance in relationship to others who took the same examination. In 2005, 54…

Preparing MSW Students for Social Work Licensure: A Curricular Case Example

ERIC Educational Resources Information Center

Miller, J. Jay; Grise-Owens, Erlene; Escobar-Ratliff, Laura

2015-01-01

Licensing has been a dynamic tension for the social work profession for many years, specifically in social work education. Increasingly, social work programs are using factors related to social work licensing (pass rates, number of test takers, etc.) as an indicator of programmatic success. Yet few, if any, published papers examine curricular…

42 CFR 423.2272 - Licensing of marketing representatives and confirmation of marketing resources.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Licensing of marketing representatives and confirmation of marketing resources. 423.2272 Section 423.2272 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Part D Marketing...

42 CFR 1001.501 - License revocation or suspension.

Code of Federal Regulations, 2011 CFR

2011-10-01

... result of, or in connection with, a State licensing agency action. (2) Any of the following factors may... care had or could have had a significant adverse physical, emotional or financial impact on one or more... had a significant adverse impact on the financial integrity of the programs; or (iv) The individual or...

42 CFR 1001.501 - License revocation or suspension.

Code of Federal Regulations, 2014 CFR

2014-10-01

... result of, or in connection with, a State licensing agency action. (2) Any of the following factors may... care had or could have had a significant adverse physical, emotional or financial impact on one or more... had a significant adverse impact on the financial integrity of the programs; or (iv) The individual or...

CACREP Accreditation: A Solution to License Portability and Counselor Identity Problems

ERIC Educational Resources Information Center

Mascari, J. Barry; Webber, Jane

2013-01-01

A confluence of forces addressing counselor identity occurred with the 20/20: A Vision for the Future of Counseling initiative, the 2009 Standards of the Council for Accreditation of Counseling and Related Education Programs (CACREP), and the quest by the American Association of State Counseling Boards to establish license portability. This…

Neoliberal Governance and the "New Professionalism" of Israeli Principals

ERIC Educational Resources Information Center

Berkovich, Izhak

2014-01-01

The Israeli Ministry of Education has recently initiated a program of reform in the training of public school principals that aims to expand state licensing regulations for educational leaders. This article suggests that the principals' training and licensing (PTL) reform should be linked to the attempt by Israeli policy makers to institutionalize…

75 FR 62592 - Applications and Amendments to Facility Operating Licenses Involving Proposed No Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-12

... Operating Licenses include: (1) The proposed Cyber Security Plan for CCNPP, Ginna, and NMPNS, (2) an... provisions of the Nuclear Regulatory Commission-approved Cyber Security Plan for CCNPP, Ginna, and NMPNS as... Communication Systems and Networks,'' establish the requirements for a cyber security program. This regulation...

22 CFR 123.4 - Temporary import license exemptions.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Foreign Military Sales (FMS) program pursuant to an executed U.S. Department of Defense Letter of Offer... THE EXPORT OF DEFENSE ARTICLES § 123.4 Temporary import license exemptions. (a) Port Directors of U.S..., for a period of up to 4 years, of unclassified U.S.-origin defense items (including any items...

77 FR 15818 - License Renewal Interim Staff Guidance LR-ISG-2011-05: Ongoing Review of Operating Experience

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

...-05: Ongoing Review of Operating Experience AGENCY: Nuclear Regulatory Commission. ACTION: Interim... License Renewal Interim Staff Guidance (LR-ISG), LR-ISG-2011-05, ``Ongoing Review of Operating Experience... industry-wide operating experience as an attribute of aging management programs used at nuclear power...

34 CFR 395.3 - Application for designation as State licensing agency; content.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROGRAM FOR THE BLIND ON FEDERAL AND OTHER PROPERTY The State Licensing Agency § 395.3 Application for... vocational potential of each blind vendor is achieved; (3) The policies and standards to be employed in the... and active participation of the State Committee of Blind Vendors in matters affecting policy and...

34 CFR 395.3 - Application for designation as State licensing agency; content.

Code of Federal Regulations, 2011 CFR

2011-07-01

... PROGRAM FOR THE BLIND ON FEDERAL AND OTHER PROPERTY The State Licensing Agency § 395.3 Application for... vocational potential of each blind vendor is achieved; (3) The policies and standards to be employed in the... and active participation of the State Committee of Blind Vendors in matters affecting policy and...

34 CFR 395.3 - Application for designation as State licensing agency; content.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROGRAM FOR THE BLIND ON FEDERAL AND OTHER PROPERTY The State Licensing Agency § 395.3 Application for... vocational potential of each blind vendor is achieved; (3) The policies and standards to be employed in the... and active participation of the State Committee of Blind Vendors in matters affecting policy and...

34 CFR 395.3 - Application for designation as State licensing agency; content.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROGRAM FOR THE BLIND ON FEDERAL AND OTHER PROPERTY The State Licensing Agency § 395.3 Application for... vocational potential of each blind vendor is achieved; (3) The policies and standards to be employed in the... and active participation of the State Committee of Blind Vendors in matters affecting policy and...

7 CFR 4290.390 - Licensing as a RBIC.

Code of Federal Regulations, 2010 CFR

2010-01-01

... financial information concerning the RBIC in order to qualify for a Leverage commitment; and (4) Enter into... a participant or potential participant in the RBIC program. (d) Effect of a RBIC license. The... following: (1) Approval to operate as a RBIC under the Act; (2) A commitment of Leverage; and (3) An...

An economic analysis of unilateral refusals to license intellectual  property

PubMed Central

Gilbert, Richard J.; Shapiro, Carl

1996-01-01

The intellectual property laws in the United States provide the owners of intellectual property with discretion to license the right to use that property or to make or sell products that embody the intellectual property. However, the antitrust laws constrain the use of property, including intellectual property, by a firm with market power and may place limitations on the licensing of intellectual property. This paper focuses on one aspect of antitrust law, the so-called “essential facilities doctrine,” which may impose a duty upon firms controlling an “essential facility” to make that facility available to their rivals. In the intellectual property context, an obligation to make property available is equivalent to a requirement for compulsory licensing. Compulsory licensing may embrace the requirement that the owner of software permit access to the underlying code so that others can develop compatible application programs. Compulsory licensing may undermine incentives for research and development by reducing the value of an innovation to the inventor. This paper shows that compulsory licensing also may reduce economic efficiency in the short run by facilitating the entry of inefficient producers and by promoting licensing arrangements that result in higher prices. PMID:8917489

When to transfuse blood in sickle cell disease? Lessons from Jehovah's Witnesses.

PubMed

Pearlman, E S; Ballas, S K

1994-01-01

Hemoglobin concentration of 7 to 8 g/dl has been considered an indication for transfusion in the general adult population and has also been frequently applied to patients with sickle cell disease (SCD). Through a review of the case histories of two patients with SCD who were also Jehovah's Witnesses and developed severe anemia, and considering as well the clinical characteristics of this population and the basic physiology of oxygen transport, the appropriateness is questioned of this transfusion "trigger" in patients with SCD. It is suggested for the latter that a Hb of 5.5 g/dl be used as an indication for transfusion except in very specific clinical circumstances.

Outcomes associated with intradialytic oral nutritional supplements in patients undergoing maintenance hemodialysis: a quality improvement report.

PubMed

Lacson, Eduardo; Wang, Weiling; Zebrowski, Barbara; Wingard, Rebecca; Hakim, Raymond M

2012-10-01

Insufficient clinical data exist to determine whether provision of oral nutritional supplements during dialysis can improve survival in hypoalbuminemic maintenance hemodialysis patients. Retrospective matched-cohort study. All oral nutritional supplement program-eligible in-center maintenance hemodialysis patients with albumin level ≤3.5 g/dL in quarter 4 of 2009 without oral nutritional supplements in the prior 90 days at Fresenius Medical Care, North America facilities. Monitored intradialytic oral nutritional supplements were provided to eligible maintenance hemodialysis patients upon physician order, to continue for a year or until serum albumin level was ≥4.0 g/dL. Mortality (including deaths and withdrawals), followed up until December 31, 2010. Both an intention-to-treat (ITT) and an as-treated analysis was performed using a 1:1 geographic region and propensity score-matched study population (using case-mix, laboratory test, access type, 30-day prior hospitalization, and incident patient status) comparing patients treated with intradialytic oral nutritional supplements with usual-care patients. Cox models were constructed, unadjusted and adjusted for facility standardized mortality ratio and case-mix and laboratory variables. The ITT and as-treated analyses both showed lower mortality in the oral nutritional supplement group. The conservative ITT models with 5,227 matched pairs had 40% of controls subsequently receiving oral nutritional supplements after January 1, 2010 (because many physicians delayed participation), with comparative death rates of 30.1% versus 30.4%. The corresponding as-treated (excluding crossovers) death rates for 4,289 matched pairs were 30.9% versus 37.3%. The unadjusted ITT mortality HR for oral nutritional supplement use was 0.95 (95% CI, 0.88-1.01), and the adjusted HR was 0.91 (95% CI, 0.85-0.98); the corresponding as-treated HRs were 0.71 (95% CI, 0.66-0.76) and 0.66 (95% CI, 0.61-0.71) before and after adjustment, respectively. Limited capture of oral nutritional supplement intake outside the facility and potential residual confounding from unmeasured variables, such as dietary intake. Maintenance hemodialysis patients with albumin levels ≤3.5 g/dL who received monitored intradialytic oral nutritional supplements showed survival significantly better than similar matched patient controls, with the as-treated analysis highlighting the potentially large effect of this strategy in clinical practice. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Endocrine Disruptor Screening Program Reports to Congress

EPA Pesticide Factsheets

This page includes EPA reports to congress on pesticide licensing and endocrine disruptor screening activities, Endocrine Disruptor Methods Validation Subcomittee (EDMVS) progress, and Endocrine Disruptor Screening Program (EDSP) implementation progress.

Iron status in Norwegian blood donors: comparison of iron status in new blood donors registered in 1993-1997 and in 2005-2006.

PubMed

Røsvik, A S; Hervig, T; Wentzel-Larsen, T; Ulvik, R J

2009-01-01

The impact of a poor iron status on the difficulties to keep recruitment of new donors at pace with the ongoing increased demand for blood transfusions was studied by comparing the iron status of new donors recruited in 1993-1997 and in 2005-2006. Iron status was defined by haemoglobin and serum ferritin. Inclusion criteria for approving new donors were haemoglobin >/= 12.5 g/dl for women and >/= 13.5 g/dl for men, and serum ferritin > 15 microg/l for both genders. Data were gathered retrospectively from 943 subjects (55% women) in the 1990 ties and prospectively from 1013 subjects (63% women) 10 years later. In women, there was a significant fall in haemoglobin and serum ferritin mean values from 13.2 to 13.1 g/dl and from 30.9 to 26.9 microg/l, respectively. Rejection due to low haemoglobin was significantly increased from 14% to 24%. In men, there were minor changes that did not affect rejection rates. Iron status of women who want to serve as blood donors has deteriorated in the last 10 years, leading to an increased rejection due to haemoglobin below the inclusion criterion for blood donors.

Empowering a tea-plantation community to improve its micronutrient health.

PubMed

Gopaldas, Tara; Gujral, Sunder

2002-06-01

This project was designed to convince and empower management and plantation workers to improve their own nutritional health status and productivity. Plantations are generally bypassed by the government's primary health-care system. A nine-month intervention with iron (60 mg of elemental iron) and vitamin A supplementation and iodized salt was performed on the Balanoor Plantations in India. Of the women tea pickers, 99% (n = 334) received the supplements and bought the iodized salt from the plantation ration shop. Their mean hemoglobin level rose significantly from 11.0 to 11.9 g/dl. The women pickers gave the supplements to their families as well as themselves. The results were the same whether iron was given once or twice a week. The mean hemoglobin level of the women pickers rose significantly from 11.1 to 12.0 g/dl with the twice-weekly dose and from 10.9 to 11.8 g/dl with the weekly dose. The prevalence of clinical signs of vitamin A deficiency in the entire plantation population (about 2,500) was reduced significantly (from 19% to 4%), as was iodine deficiency (from 17% to 7%). Common health problems decreased from 88% to 54%. The number of patients referred to larger hospitals decreased significantly from 116 to 86. Absenteeism was not affected.

Supportive therapy in medical therapy of head and neck tumors

PubMed Central

Link, Hartmut

2012-01-01

Fever during neutropenia may be a symptom of severe life threatening infection, which must be treated immediately with antibiotics. If signs of infection persist, therapy must be modified. Diagnostic measures should not delay treatment. If the risk of febrile neutropenia after chemotherapy is ≥20%, then prophylactic therapy with G-CSF is standard of care. After protocols with a risk of febrile neutropenia of 10–20%, G-CSF is necessary, in patients older than 65 years or with severe comorbidity, open wounds, reduced general condition. Anemia in cancer patients must be diagnosed carefully, even preoperatively. Transfusions of red blood cells are indicated in Hb levels below 7–8 g/dl. Erythropoiesis stimulating agents (ESA) are recommended after chemotherapy only when hemoglobin levels are below 11 g/dl. The Hb-level must not be increased above 12 g/dl. Anemia with functional iron deficiency (transferrin saturation <20%) should be treated with intravenous iron, as oral iron is ineffective being not absorbed. Nausea or emesis following chemotherapy can be classified as minimal, low, moderate and high. The antiemetic prophylaxis should be escalated accordingly. In chemotherapy with low emetogenic potential steroids are sufficient, in the moderate level 5-HT3 receptor antagonists (setrons) are added, and in the highest level Aprepitant as third drug. PMID:23320053

Ethanol elimination rates in men and women in consideration of the calculated liver weight.

PubMed

Dettling, Andrea; Fischer, Florian; Böhler, Svenja; Ulrichs, Fee; Skopp, Gisela; Graw, Matthias; Haffner, Hans-Thomas

2007-09-01

The purpose of the study was to examine gender differences on the pharmacokinetics of ethanol. Sixty-eight healthy men and 64 healthy women with normal body mass indexes received between 0.79 and 0.95 g ethanol/kg body weight in the form of their choice after they had eaten a "typical" breakfast. The aimed concentration for both genders was a blood alcohol concentration C(0) of 0.104 g/dl. Blood samples in the elimination phase were taken in 10- to 20-min intervals beginning after completion of absorption. The maximum blood ethanol concentration was 0.0819+/-0.0184 g/dl for women and 0.0841+/-0.0155 g/dl for men. The hourly ethanol elimination rate, calculated over a linear function, in blood of 0.0179+/-0.0030 g/dl/h in women was significantly higher than the 0.0159+/-0.0029 g/dl/h for men (P<.0001). In relation to the liver weight, the hourly elimination rates were 5.008+/-0.678 g/kg liver/h for women and 4.854+/-0.659 g/kg liver/h for men, and were not statistically significant. The different liver masses as calculated in relation to the distribution volume account for the differing ethanol elimination rates between men and women.

Contact behavior modelling and its size effect on proton exchange membrane fuel cell

NASA Astrophysics Data System (ADS)

Qiu, Diankai; Peng, Linfa; Yi, Peiyun; Lai, Xinmin; Janßen, Holger; Lehnert, Werner

2017-10-01

Contact behavior between the gas diffusion layer (GDL) and bipolar plate (BPP) is of significant importance for proton exchange membrane fuel cells. Most current studies on contact behavior utilize experiments and finite element modelling and focus on fuel cells with graphite BPPs, which lead to high costs and huge computational requirements. The objective of this work is to build a more effective analytical method for contact behavior in fuel cells and investigate the size effect resulting from configuration alteration of channel and rib (channel/rib). Firstly, a mathematical description of channel/rib geometry is outlined in accordance with the fabrication of metallic BPP. Based on the interface deformation characteristic and Winkler surface model, contact pressure between BPP and GDL is then calculated to predict contact resistance and GDL porosity as evaluative parameters of contact behavior. Then, experiments on BPP fabrication and contact resistance measurement are conducted to validate the model. The measured results demonstrate an obvious dependence on channel/rib size. Feasibility of the model used in graphite fuel cells is also discussed. Finally, size factor is proposed for evaluating the rule of size effect. Significant increase occurs in contact resistance and porosity for higher size factor, in which channel/rib width decrease.

Tractor Trailer Driver's Training Programs. Performance Report.

ERIC Educational Resources Information Center

New Hampshire Vocational Technical Coll., Nashua.

This document describes a project to develop a 320-hour tractor trailer driver training program and a 20-hour commercial driver licensing upgrade training program. Of 34 graduates from the training program, 28 secured employment in the trucking industry. From August 1989 to June 1990, 725 students were trained in the upgrade training program with…

10 CFR 35.24 - Authority and responsibilities for the radiation protection program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... protection program. (a) In addition to the radiation protection program requirements of § 20.1101 of this...) Radiation protection program changes that do not require a license amendment and are permitted under § 35.26... responsible for implementing the radiation protection program. The licensee, through the Radiation Safety...

10 CFR 35.24 - Authority and responsibilities for the radiation protection program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... protection program. (a) In addition to the radiation protection program requirements of § 20.1101 of this...) Radiation protection program changes that do not require a license amendment and are permitted under § 35.26... responsible for implementing the radiation protection program. The licensee, through the Radiation Safety...

10 CFR 35.24 - Authority and responsibilities for the radiation protection program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... protection program. (a) In addition to the radiation protection program requirements of § 20.1101 of this...) Radiation protection program changes that do not require a license amendment and are permitted under § 35.26... responsible for implementing the radiation protection program. The licensee, through the Radiation Safety...

10 CFR 35.24 - Authority and responsibilities for the radiation protection program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... protection program. (a) In addition to the radiation protection program requirements of § 20.1101 of this...) Radiation protection program changes that do not require a license amendment and are permitted under § 35.26... responsible for implementing the radiation protection program. The licensee, through the Radiation Safety...

10 CFR 35.24 - Authority and responsibilities for the radiation protection program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... protection program. (a) In addition to the radiation protection program requirements of § 20.1101 of this...) Radiation protection program changes that do not require a license amendment and are permitted under § 35.26... responsible for implementing the radiation protection program. The licensee, through the Radiation Safety...

Alumni perspectives on career preparation during a postdoctoral training program: a qualitative study.

PubMed

Faupel-Badger, Jessica M; Raue, Kimberley; Nelson, David E; Tsakraklides, Sophia

2015-03-02

Published evaluations of career preparation of alumni from long-standing postdoctoral fellowship programs in the biomedical sciences are limited and often focus on quantitative analysis of data from extant publicly available sources. Qualitative methods provide the opportunity to gather robust information about specific program elements from structured postdoctoral training programs and the influence of this training on subsequent career paths of alumni. In-depth interviews with a subset of the National Cancer Institute's Cancer Prevention Fellowship Program (CPFP) alumni (n=27), representing more than 25 years of the program's history and multiple career sectors, were conducted to assess alumni reflections on the training environment and career preparation during their time in the CPFP. NVivo software was used to analyze data and identify major themes. Four main themes emerged from these interviews, including: the value of structured training curriculum, mentorship, transdisciplinary environment, and professional identity. Even when reflecting on training that occurred one to two decades earlier, alumni were able to highlight specific components of a structured postdoctoral training program as influencing their research and career trajectories. These results may have relevance for those interested in assessing how postdoctoral training can influence fellows throughout their careers and understanding salient features of structured programs. © 2015 J. M. Faupel-Badger et al. CBE—Life Sciences Education © 2015 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

78 FR 76319 - Notice of Invitation-Coal Exploration License Application MTM 106757, Montana

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-17

...] Notice of Invitation--Coal Exploration License Application MTM 106757, Montana AGENCY: Bureau of Land... Signal Peak Energy, LLC on a pro rata cost sharing basis in a program for the exploration of coal... Office coal Web site at http://www.blm.gov/mt/st/en/prog/energy/coal.html . A written notice to...

76 FR 31976 - Notice of Invitation-Coal Exploration License Application MTM 101688

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

...] Notice of Invitation--Coal Exploration License Application MTM 101688 AGENCY: Bureau of Land Management... Creek Coal Company on a pro rata cost sharing basis in a program for the exploration of coal deposits... notice to both the Bureau of Land Management (BLM) and the Spring Creek Coal Company as provided in the...

77 FR 40629 - Notice of Invitation To Participate; Coal Exploration License Application WYW180996, Wyoming

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-10

...] Notice of Invitation To Participate; Coal Exploration License Application WYW180996, Wyoming AGENCY..., as amended by the Federal Coal Leasing Amendments Act of 1976, and to Bureau of Land Management (BLM... a pro rata cost- sharing basis, in its program for the exploration of coal deposits owned by the...

76 FR 53693 - Notice of Invitation To Participate; Coal Exploration License Application COC-74911, Colorado

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-29

...] Notice of Invitation To Participate; Coal Exploration License Application COC-74911, Colorado AGENCY..., as amended by the Federal Coal Leasing Amendments Act of 1976, and to Bureau of Land Management (BLM... cost-sharing basis, in a program for the exploration of coal deposits owned by the United States of...

Getting Your Driver's License. An Adult Competency Education Learning Module.

ERIC Educational Resources Information Center

Wallace, Virginia

This instructional unit on getting one's driver's license is one of six Adult Competency Education Learning Modules designed for use in a program of competency-based instruction for students with intermediate reading level ability. It is self-contained and designed for immediate classroom use. The module is comprised of 4 parts and 10 lessons: The…

22 CFR 125.9 - Filing of licenses and other authorizations for exports of classified technical data and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... Defense Trade Controls to the Defense Security Service of the Department of Defense in accordance with the provisions of the Department of Defense National Industrial Security Program Operating Manual (unless such... a copy of the license to the applicant for the applicant's information. The Defense Security Service...

76 FR 47217 - Government-Owned Inventions; Availability for Licensing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

.... 2009;7:1-32. [PMID: 19381306]. 2. Yang XO, et al. T helper 17 lineage differentiation is programmed by.... SUMMARY: The inventions listed below are owned by an agency of the U.S. Government and are available for...: Licensing information and copies of the U.S. patent applications listed below may be obtained by writing to...

77 FR 31655 - Biweekly Notice; Applications and Amendments to Facility Operating Licenses and Combined Licenses...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... controverted. In addition, the requestor/petitioner shall provide a brief explanation of the bases for the... against burst, as discussed in Regulatory Guide (RG) 1.121, ``Bases for Plugging Degraded PWR [Pressurized... Institute] 97-06, Revision 3, ``Steam Generator Program Guidelines'' (Reference 1) and RG 1.121, ``Bases for...

75 FR 66786 - Notice of Invitation To Participate; Exploration for Coal in Colorado License Application COC-74447

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-29

...] Notice of Invitation To Participate; Exploration for Coal in Colorado License Application COC-74447... Routt Counties, Colorado. DATES: Any party electing to participate in this exploration program must send... notice will be published once a week for 2 consecutive weeks in the Craig Daily Press, Craig, Colorado...

78 FR 25487 - Final License Renewal Interim Staff Guidance LR-ISG-2012-01: Wall Thinning Due to Erosion Mechanisms

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

....'' This LR-ISG revises an NRC staff-recommended aging management program (AMP) in NUREG-1801, Revision 2, ``Generic Aging Lessons Learned (GALL) Report,'' and the NRC staff's aging management review procedure and... for piping and components within the scope of the Requirements for Renewal of Operating Licenses for...

42 CFR 431.704 - Nursing homes designated by other terms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the term...

42 CFR 431.704 - Nursing homes designated by other terms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the term...

42 CFR 431.704 - Nursing homes designated by other terms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the term...

42 CFR 431.704 - Nursing homes designated by other terms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the term...

42 CFR 431.704 - Nursing homes designated by other terms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Nursing homes designated by other terms. 431.704... Programs for Licensing Nursing Home Administrators § 431.704 Nursing homes designated by other terms. If a State licensing law does not use the term “nursing home,” the CMS Administrator will determine the term...

42 CFR 431.714 - Waivers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION State Programs for Licensing Nursing Home... subpart for any person who has served in the capacity of a nursing home administrator during all of the 3...

Defining Dogma: Quantifying Crystalloid Hemodilution in a Prospective Randomized Control Trial with Blood Donation as a Model for Hemorrhage.

PubMed

Ross, Samuel Wade; Christmas, A Britton; Fischer, Peter E; Holway, Haley; Seymour, Rachel; Huntington, Ciara R; Heniford, B Todd; Sing, Ronald F

2018-06-04

The concept of hemodilution after blood loss and crystalloid infusion is a surgical maxim that remains unproven in humans. We sought to quantify the effect of hemodilution after crystalloid administration in voluntary blood donors as a model for acute hemorrhage. A prospective, randomized control trial was conducted in conjunction with community blood drives. Donors were randomized to receive no IV fluid(noIVF), two liters normal saline(NS), or two liters lactated ringers(LR) after blood donation. Blood samples were taken before donation of 500 mL of blood, immediately after donation, and following IV fluid administration. Hemoglobin(Hgb) was measured at each time point. Hgb between time points were compared between groups using standard statistical tests and the Bonferroni correction for multiple comparisons. Statistical significance was set at p≤0.0167. Of 165 patients consented, 157 patients completed the study. Average pre-donation Hgb was 14.3 g/dL. There was no difference in the mean Hgb levels after blood donation between the three groups(p>0.05). Compared to the control group, there was a significant drop in Hgb in the crystalloid infused groups from the post-donation level to post-resuscitation(13.2 vs 12.1 vs 12.2 g/dL, p<0.0001). A formula was created to predict hemoglobin levels from a given estimated blood loss(EBL) and volume replacement(VR): Hemodilution Hgb=(MeanPre-donation Hgb - hemorrhage Hgb drop - equilibration hemoglobin drop - resuscitation Hgb drop)=MeanPre-donation Hgb - [(EBL/TBV)*l] - [(EBL/TBV)*h] - [(VR/TBV)*r], l = 5.111g/dL = blood loss coefficient, h=6.722 g/dL=equilibration coefficient, r= 2.617g/dL= resuscitation coefficient. This study proves the concept of hemodilution and derived a mathematical relationship between blood loss and resuscitation. This data may help to estimate response of hemoglobin levels to blood loss and fluid resuscitation in clinical practice. Copyright © 2018. Published by Elsevier Inc.

Effects of peridialytic oral supplements on nutritional status and quality of life in chronic hemodialysis patients.

PubMed

Scott, Meri Kay; Shah, Niyati A; Vilay, A Mary; Thomas, Joseph; Kraus, Michael A; Mueller, Bruce A

2009-03-01

Our objective was to determine the effects of peridialytic oral supplements on nutritional markers and quality of life (QOL) in patients receiving maintenance hemodialysis. This trial was open, prospective, nonrandomized, and comparative. This study was performed at an outpatient hemodialysis unit in a teaching hospital. This study included 88 adults with chronic kidney disease at stage 5. This study involved directly observed nutrition therapy with >or=1 can of enteral nutrition (Nepro) with each hemodialysis session thrice weekly for 3 months, or standard care. Changes in biochemical markers of nutritional status and QOL, as measured by the Kidney Disease Quality of Life-Short Form, were determined. Peridialytic oral nutrition resulted in a significant difference between the nutrition and comparison groups in serum albumin change over time (P = .03; repeated-measures analysis of variance with covariates). Mean (+/-SD) serum albumin concentration did not differ between baseline and month 3 in the nutrition group (3.68 +/- 0.33 g/dL vs. 3.75 +/- 0.40 g/dL; P = .12), but in the comparison group, serum albumin levels declined significantly (3.93 +/- 0.34 g/dL at baseline versus 3.81 +/- 0.37 g/dL at month 3; P = .04). The "role-physical" domain score of the Kidney Disease Quality of Life-Short Form significantly changed over time in the nutrition group versus the comparison group (P = .02; repeated-measures analysis of variance with covariates). Nepro was well-tolerated, and greater than 80% of the prescribed therapy was consumed. Oral nutrition, as part of structured, directly observed peridialytic therapy in chronic hemodialysis patients, was well-accepted, and resulted in the maintenance of serum albumin levels and QOL with respect to impact of physical health on daily activities. These findings need to be confirmed in a randomized, controlled trial.

Monitoring compliance with transfusion guidelines in hospital departments by electronic data capture

PubMed Central

Norgaard, Astrid; de Lichtenberg, Trine Honnens; Nielsen, Jens; Johansson, Pär I.

2014-01-01

Background The practice of transfusing red blood cells is still liberal in some centres suggesting a lack of compliance with guidelines recommending transfusion of red blood cells at haemoglobin levels of 6–8 g/dL in the non-bleeding patient. Few databases provide ongoing feedback of data on pre-transfusion haemoglobin levels at the departmental level. In a tertiary care hospital, no such data were produced before this study. Our aim was to establish a Patient Blood Management database based on electronic data capture in order to monitor compliance with transfusion guidelines at departmental and hospital levels. Materials and methods Hospital data on admissions, diagnoses and surgical procedures were used to define the populations of patients. Data on haemoglobin measurements and red blood cell transfusions were used to calculate pre-transfusion haemoglobin, percentage of transfused patients and transfusion volumes. Results The model dataset include 33,587 admissions, of which 10% had received at least one unit of red blood cells. Haemoglobin measurements preceded 96.7% of the units transfused. The median pre-transfusion haemoglobin was 8.9 g/dL (interquartile range 8.2–9.7) at the hospital level. In only 6.5% of the cases, transfusion was initiated at 7.3 g/dL or lower as recommended by the Danish national transfusion guideline. In 27% of the cases, transfusion was initiated when the haemoglobin level was 9.3 g/dL or higher, which is not recommended. A median of two units was transfused per transfusion episode and per hospital admission. Transfusion practice was more liberal in surgical and intensive care units than in medical departments. Discussion We described pre-transfusion haemoglobin levels, transfusion rates and volumes at hospital and departmental levels, and in surgical subpopulations. Initial data revealed an extensive liberal practice and low compliance with national transfusion guidelines, and identified wards in need of intervention. PMID:24960656

Magnitude of Anemia at Discharge Increases 30-Day Hospital Readmissions.

PubMed

Koch, Colleen G; Li, Liang; Sun, Zhiyuan; Hixson, Eric D; Tang, Anne; Chagin, Kevin; Kattan, Michael; Phillips, Shannon C; Blackstone, Eugene H; Henderson, J Michael

2017-12-01

Anemia during hospitalization is associated with poor health outcomes. Does anemia at discharge place patients at risk for hospital readmission within 30 days of discharge? Our objectives were to examine the prevalence and magnitude of anemia at hospital discharge and determine whether anemia at discharge was associated with 30-day readmissions among a cohort of hospitalizations in a single health care system. From January 1, 2009, to August 31, 2011, there were 152,757 eligible hospitalizations within a single health care system. The endpoint was any hospitalization within 30 days of discharge. The University HealthSystem Consortium's clinical database was used for demographics and comorbidities; hemoglobin values are from the hospitals' electronic medical records, and readmission status was obtained from the University HealthSystem Consortium administrative data systems. Mild anemia was defined as hemoglobin of greater than 11 to less than 12 g/dl in women and greater than 11 to less than 13 g/dl in men; moderate, greater than 9 to less than or equal to 11 g/dl; and severe, less than or equal to 9 g/dl. Logistic regression was used to assess the association of anemia and 30-day readmissions adjusted for demographics, comorbidity, and hospitalization type. Among 152,757 hospitalizations, 72% of patients were discharged with anemia: 31,903 (21%), mild; 52,971 (35%), moderate; and 25,522 (17%), severe. Discharge anemia was associated with severity-dependent increased odds for 30-day hospital readmission compared with those without anemia: for mild anemia, 1.74 (1.65-1.82); moderate anemia, 2.76 (2.64-2.89); and severe anemia, 3.47 (3.30-3.65), P < 0.001. Anemia at discharge is associated with a severity-dependent increased risk for 30-day readmission. A strategy focusing on anemia treatment care paths during index hospitalization offers an opportunity to influence subsequent readmissions.

A fast-track anaemia clinic in the Emergency Department: feasibility and efficacy of intravenous iron administration for treating sub-acute iron deficiency anaemia.

PubMed

Quintana-Díaz, Manuel; Fabra-Cadenas, Sara; Gómez-Ramírez, Susana; Martínez-Virto, Ana; García-Erce, José A; Muñoz, Manuel

2016-03-01

Clinically significant anaemia, requiring red blood cell transfusions, is frequently observed in Emergency Departments (ED). To optimise blood product use, we developed a clinical protocol for the management of iron-deficiency anaemia in a fast-track anaemia clinic within the ED. From November 2010 to January 2014, patients presenting with sub-acute, moderate-to-severe anaemia (haemoglobin [Hb] <11 g/dL) and confirmed or suspected iron deficiency were referred to the fast-track anaemia clinic. Those with absolute or functional iron deficiency were given intravenous (IV) ferric carboxymaltose 500-1,000 mg/week and were reassessed 4 weeks after receiving the total iron dose. The primary study outcome was the haematological response (Hb≥12 g/dL and/or Hb increment ≥2 g/dL). Changes in blood and iron parameters, transfusion rates and IV iron-related adverse drug effects were secondary outcomes. Two hundred and two anaemic patients with iron deficiency (150 women/52 men; mean age, 64 years) were managed in the fast-track anaemia clinic, and received a median IV iron dose of 1,500 mg (1,000-2,000 mg). Gastro-intestinal (44%) or gynaecological (26%) bleeding was the most frequent cause of the anaemia. At follow-up (183 patients), the mean Hb increment was 3.9±2.2 g/dL; 84% of patients were classified as responders and blood and iron parameters normalised in 90%. During follow-up, 35 (17%) patients needed transfusions (2 [range: 1-3] units per patient) because they had low Hb levels, symptoms of anaemia and/or were at risk. Eight mild and one moderate, self-limited adverse drug effects were witnessed. Our data support the feasibility of a clinical protocol for management of sub-acute anaemia with IV iron in the ED. IV iron was efficacious, safe and well tolerated. Early management of anaemia will improve the use of blood products in the ED.

Serum Hepcidin and Iron Indices Affect Anemia Status Differently According to the Kidney Function of Non-Dialysis Chronic Kidney Disease Patients: Korean Cohort Study For Outcome in Patients with Chronic Kidney Disease (KNOW-CKD).

PubMed

Lee, Sung Woo; Kim, Yeong Hoon; Chung, Wookyung; Park, Sue K; Chae, Dong Wan; Ahn, Curie; Kim, Yong-Soo; Sung, Su Ah

2017-01-01

No studies have examined the association among serum hepcidin, iron indices, or anemia status based on the kidney function of non-dialysis chronic kidney disease (CKD) patients. We reviewed data of 2238 patients from a large-scale multicenter prospective Korean study (2011-2016) and excluded 198 patients with missing data regarding serum hepcidin, hemoglobin, transferrin saturation (TSAT), ferritin, and usage of erythropoiesis-stimulating agents (ESA) or supplemental iron and 363 patients using ESA or supplemental iron. Finally, 1677 patients were included. The mean patient age was 53.5 years, and 65.4% were men. TSAT and serum hepcidin were significantly associated with anemia status, whereas serum ferritin was not, regardless of anemia severity. For patients with an estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2, a 10% increase of TSAT was associated with hemoglobin <13 g/dL (odds ratio [OR], 0.628; 95% confidence interval [CI], 0.515-0.765; P<0.001) and hemoglobin <11.5 g/dL (OR, 0.672; 95% CI, 0.476-0.950; P=0.024), whereas a 10-ng/mL increase of serum hepcidin was associated with hemoglobin <11.5 g/dL (OR, 1.379; 95% CI, 1.173-1.620; P<0.001) and hemoglobin <10.0 g/dL (OR, 1.360; 95% CI, 1.115-1.659; P=0.002) for patients with eGFR <45 mL/min/1.73 m2 according to multivariate logistic analysis. TSAT was associated with less severe anemia in early CKD patients. Serum hepcidin was associated with more severe anemia in advanced CKD patients. © 2017 The Author(s). Published by S. Karger AG, Basel.

Concurrence of Serum Creatinine and Albumin with Lower Risk for Death in Twice-Weekly Hemodialysis Patients

PubMed Central

Wang, Jialin; Streja, Elani; Soohoo, Melissa; Chen, Joline L.T.; Rhee, Connie M.; Kim, Taehee; Molnar, Miklos Z.; Kovesdy, Csaba P.; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

2016-01-01

Objective Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice-weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. Design, Settings and Subjects We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (<6 mg/dl vs. ≥6 mg/dl) and albumin (<3.5 g/dl vs. ≥3.5 g/dl) for each treatment frequency yielding a total of eight groups. Results Patients were 70±14 years old and included 48% women, and 55% diabetics. Using the thrice-weekly hemodialysis patients with creatinine≥6mg/dl and albumin≥3.5g/dl as reference, patients with creatinine<6mg/dl and albumin<3.5g/dl had a 1.8-fold higher risk of mortality (HR: 1.75, 95%CI: 1.33-2.30) in twice-weekly and 2.2-fold increased risk of mortality (HR: 2.21, 95%CI: 1.81-2.70) in thrice-weekly hemodialysis patients, respectively in fully adjusted models adjusted for demographics, comorbidities and markers of malnutrition and inflammation. A test for interaction showed there was no significant difference in albumin creatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (p-for-interaction 0.7667). Conclusions Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients. PMID:27528412

Anaemia among pregnant women in northern Tanzania: prevalence, risk factors and effect on perinatal outcomes.

PubMed

Msuya, Sia E; Hussein, Tamara H; Uriyo, Jacqueline; Sam, Noel E; Stray-Pedersen, Babill

2011-01-01

Anaemia during pregnancy is associated with negative maternal and neonatal outcomes. However, there is limited data regarding prevalence and effects of anaemia during pregnancy in northern Tanzania. The objective of this study was to determine the prevalence and possible risk factors for anaemia and its effect on perinatal outcomes among pregnant women attending antenatal care in Moshi Municipality in northern Tanzania. A cohort of pregnant women aged 14-43 years and in their 3rd trimester, was recruited from two primary health care clinics between June 2002 and March 2004. Interviews, anthropometric measurements and haematological examinations were conducted on 2654 consenting women. Perinatal outcomes were recorded during delivery and at 1 week after delivery. Of the 2654 participants, 47.4% had anaemia (haemoglobin [Hb] <11g/dl), 35.3% had mild anaemia (Hb= 9-10.9g/dl), 9.9% had moderate anaemia (Hb =7- 8.9g/dl), and 2.1% had severe anaemia (Hb < 7 g/dl). Anaemia was significantly more prevalent in HIV-positive (56.4%) than in HIV-negative women (46.7%), (P = 0.01). In logistic regression anaemia was independently associated with maternal HIV (OR= 1.5), malaria (OR= 5.2), clinic of recruitment (OR= 1.5) and low income (OR= 1.9). Pregnant women with anaemia were more likely to have low birth weight (LBW) infants. Compared with non-anaemic women, the risk of LBW was 1.6 times and 4.8 times higher for children born to women with moderate and severe anaemia, respectively. In conclusion, anaemia in pregnancy is a severe public health problem in northern Tanzania. Control of maternal anaemia may be one important strategy to prevent LBW in this setting. Measures to prevent malaria and to control anaemia among all pregnant women irrespective of HIV status, should be strengthened. Outside of the health sector broader approaches for anaemia prevention targeting women of lower income, are required.

Realizing effectiveness across continents with hydroxyurea: Enrollment and baseline characteristics of the multicenter REACH study in Sub-Saharan Africa.

PubMed

McGann, Patrick T; Williams, Thomas N; Olupot-Olupot, Peter; Tomlinson, George A; Lane, Adam; Luís Reis da Fonseca, José; Kitenge, Robert; Mochamah, George; Wabwire, Ham; Stuber, Susan; Howard, Thad A; McElhinney, Kathryn; Aygun, Banu; Latham, Teresa; Santos, Brígida; Tshilolo, Léon; Ware, Russell E

2018-08-01

Despite its well-described safety and efficacy in the treatment of sickle cell anemia (SCA) in high-income settings, hydroxyurea remains largely unavailable in sub-Saharan Africa, where more than 75% of annual SCA births occur and many comorbidities exist. Realizing Effectiveness Across Continents with Hydroxyurea (REACH, ClinicalTrials.gov NCT01966731) is a prospective, Phase I/II open-label trial of hydroxyurea designed to evaluate the feasibility, safety, and benefits of hydroxyurea treatment for children with SCA in four sub-Saharan African countries. Following comprehensive training of local research teams, REACH was approved by local Ethics Committees and achieved full enrollment ahead of projections with 635 participants enrolled over a 30-month period, despite half of families living >12 km from their clinical site. At enrollment, study participants (age 5.4 ± 2.4 years) had substantial morbidity, including a history of vaso-occlusive pain (98%), transfusion (68%), malaria (85%), and stroke (6%). Significant differences in laboratory characteristics were noted across sites, with lower hemoglobin concentrations (P < .01) in Angola (7.2 ± 1.0 g/dL) and the DRC (7.0 ± 0.9 g/dL) compared to Kenya (7.4 ± 1.1 g/dL) and Uganda (7.5 ± 1.1 g/dL). Analysis of known genetic modifiers of SCA demonstrated a high frequency of α-thalassemia (58.4% with at least a single α-globin gene deletion) and G6PD deficiency (19.7% of males and 2.4% of females) across sites. The CAR β-globin haplotype was present in 99% of participants. The full enrollment to REACH confirms the feasibility of conducting high-quality SCA research in Africa; this study will provide vital information to guide safe and effective dosing of hydroxyurea for children with SCA living in Africa. © 2018 Wiley Periodicals, Inc.

Hemolytic Potential of Tafenoquine in Female Volunteers Heterozygous for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency (G6PD Mahidol Variant) versus G6PD-Normal Volunteers

PubMed Central

Rueangweerayut, Ronnatrai; Bancone, Germana; Harrell, Emma J.; Beelen, Andrew P.; Kongpatanakul, Supornchai; Möhrle, Jörg J.; Rousell, Vicki; Mohamed, Khadeeja; Qureshi, Ammar; Narayan, Sushma; Yubon, Nushara; Miller, Ann; Nosten, François H.; Luzzatto, Lucio; Duparc, Stephan; Kleim, Jörg-Peter; Green, Justin A.

2017-01-01

Abstract. Tafenoquine is an 8-aminoquinoline under investigation for the prevention of relapse in Plasmodium vivax malaria. This open-label, dose-escalation study assessed quantitatively the hemolytic risk with tafenoquine in female healthy volunteers heterozygous for the Mahidol487A glucose-6-phosphate dehydrogenase (G6PD)-deficient variant versus G6PD-normal females, and with reference to primaquine. Six G6PD-heterozygous subjects (G6PD enzyme activity 40–60% of normal) and six G6PD-normal subjects per treatment group received single-dose tafenoquine (100, 200, or 300 mg) or primaquine (15 mg × 14 days). All participants had pretreatment hemoglobin levels ≥ 12.0 g/dL. Tafenoquine dose escalation stopped when hemoglobin decreased by ≥ 2.5 g/dL (or hematocrit decline ≥ 7.5%) versus pretreatment values in ≥ 3/6 subjects. A dose–response was evident in G6PD-heterozygous subjects (N = 15) receiving tafenoquine for the maximum decrease in hemoglobin versus pretreatment values. Hemoglobin declines were similar for tafenoquine 300 mg (−2.65 to −2.95 g/dL [N = 3]) and primaquine (−1.25 to −3.0 g/dL [N = 5]). Two further cohorts of G6PD-heterozygous subjects with G6PD enzyme levels 61–80% (N = 2) and > 80% (N = 5) of the site median normal received tafenoquine 200 mg; hemolysis was less pronounced at higher G6PD enzyme activities. Tafenoquine hemolytic potential was dose dependent, and hemolysis was greater in G6PD-heterozygous females with lower G6PD enzyme activity levels. Single-dose tafenoquine 300 mg did not appear to increase the severity of hemolysis versus primaquine 15 mg × 14 days. PMID:28749773

Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to reduce cardiovascular events with Aranesp therapy (TREAT) study.

PubMed

Locatelli, Francesco; Aljama, Pedro; Canaud, Bernard; Covic, Adrian; De Francisco, Angel; Macdougall, Iain C; Wiecek, Andrzej; Vanholder, Raymond

2010-09-01

The European Renal Best Practice (ERBP), which are issued by ERA-EDTA, are suggestions for clinical practice in areas in which evidence is lacking or weak, together with position statements on recently published randomized controlled trials, or on existing guidelines and recommendations. In 2009, the Anaemia Working Group of ERBP published its first position statement about the haemoglobin target to aim for with erythropoietin-stimulating agents (ESA) and on issues that were not covered by K-DOQI in 2006-07. This second position paper of the group follows the publication of the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) Study. This multi-centre, placebo-controlled trial compared cardiovascular and renal outcomes in 4038 patients with type 2 diabetes, chronic kidney disease not on dialysis, and anaemia who were randomized to complete anaemia correction (haemoglobin target of 13 g/dL using darbepoetin alpha) or placebo (with a haemoglobin rescue value of 9 g/dL). Following the findings of the TREAT study, the Anaemia Working Group of ERBP maintains its view that 'Hb values of 11-12 g/dL should be generally sought in the CKD population without intentionally exceeding 13 g/dL' and that the doses of ESA therapy to achieve the target haemoglobin should also be considered. More caution is suggested when treating anaemia with ESA therapy in patients with type 2 diabetes not undergoing dialysis (and probably in diabetics at all CKD stages). In those with ischaemic heart disease or with a previous history of stroke, possible benefits should be weighed up against an increased risk of stroke recurrence, when deciding which Hb level to aim for. These recommendations are not intended to represent a new guideline as they are not the result of a systematic review of the evidence.

Accuracy of non-invasive hemoglobin monitoring by pulse CO-oximeter during liver transplantation.

PubMed

Erdogan Kayhan, Gulay; Colak, Yusuf Z; Sanli, Mukadder; Ucar, Muharrem; Toprak, Huseyin I

2017-05-01

Hemoglobin level monitoring is essential during liver transplantation (LT) due to substantial blood loss. We evaluated the accuracy of non-invasive and continuous hemoglobin monitoring (SpHb) obtained by a transcutaneous spectrophotometry-based technology (Masimo Corporation, Irvine, CA) compared with conventional laboratory Hb measurement (HbL) during LT. Additionally, we made subgroup analyses for distinct surgical phases that have special features and hemodynamic problems and thus may affect the accuracy of SpHb. During LT, blood samples were obtained twice for each of the three phases of LT (pre-anhepatic, anhepatic, and neohepatic) and were analyzed by the central laboratory. The HbL measurements were compared with SpHb obtained at the time of the blood draws. A total of 282 data pairs obtained from 53 patients were analyzed. The SpHb values ranged from 6.9 to 17.7 g/dL, and the HbL values ranged from 5.4 to 17.1 g/dL. The correlation coefficient between SpHb and HbL was 0.73 (P<0.001), and change in SpHb versus change in HbL was 0.76 (P<0.001). The sensitivity value determined using a 4-quadrant plot was 79%. The bias and precision of SpHb to HbL were 0.86±1.58 g/dL; the limits of agreement were -2.25 to 3.96 g/dL. The overall correlation between SpHb and HbL remained stable in different phases of surgical procedure. SpHb was demonstrated to have a clinically acceptable accuracy of hemoglobin measurement in comparison with a standard laboratory device when used during LT. This technology can be useful as a trend monitor during all surgical phases of LT and can supplement HbL to optimize transfusion decisions or to detect occult bleeding.

A novel amino acids oral supplementation in hemodialysis patients: a pilot study.

PubMed

Bolasco, Piergiorgio; Caria, Stefania; Cupisti, Adamasco; Secci, Romina; Saverio Dioguardi, Francesco

2011-01-01

Protein malnutrition and lowering serum albumin is frequent in hemodialysis patients. A special amino acid formulation has recently been used with favorable effects in elderly people but no data exist in renal patients. To assess the effects of this novel amino acid formulation in stable hemodialysis patients with reduced albumin levels. Thirty stable hemodialysis patients with serum albumin levels <3.5 g/dL, normalized protein nitrogen appearance (nPNA) <1.1 g/kg/d, and body mass index (BMI) >20 kg/m(2) were selected: 15 patients were randomized to oral amino acid supplementation (4 g thrice a day) for 3 months and 15 patients comparable for age, gender, and dialysis durations formed the control group. Biochemistry and bioimpedentiometry parameters were measured at baseline and at the end of treatment. No difference was observed between study group and control group at baseline. At the end of the study period, no change occurred in the studied parameters in the control group, whereas increase in serum albumin (3.1 ± 0.3 vs. 3.6 ± 0.2 g/dL, p < 0.001) and in total proteins (5.7 ± 0.4 vs. 6.4 ± 0.7 g/dL, p < 0.001) occurred in the study group. Hemoglobin rose from 10.7 ± 0.9 to 11.7 ± 0.8 g/dL (p < 0.05) at the same erythropoiesis-stimulating agent (ESA) dosage. C-Reactive protein (CRP) levels decreased in the study group (8.7 ± 7.3 vs. 3.8 ± 3.1 mg/L, p < 0.01). Increase of body weight and of equilibrated protein catabolic rate (ePCR) was observed in the study group. Oral amino acids supplementation was able to improve albumin and total protein in hypoalbuminemia hemodialysis patients. This effect was associated with reduction of CRP levels that is with lowering of pro-inflammatory status and anemia improvement.

Iron-deficiency anemia in young working women can be reduced by increasing the consumption of cereal-based fermented foods or gooseberry juice at the workplace.

PubMed

Gopaldas, Tara

2002-03-01

This efficacy for both employers and employees (young working women 18 to 23 years of age) was undertaken to determine whether culturally acceptable dietary changes in lunches in the workplace and at home could bring about a behavioral change and improvement in their iron-deficiency anemia status. Maximum weight was given to increasing consumption of iddli, a popular cereal-based-fermented food, or of gooseberry juice. Four small factories were selected in periurban Bangalore, with a sample of 302 women. The 180-day interventions were supervised at the workplace. In unit 1 (72 women), the intervention consisted of iddli four times a week plus information, education, and communication (IEC) related to iron-deficiency anemia. Unit 2 (80 women) received 20 ml of gooseberry juice (containing 40 mg of vitamin C) three times a week plus IEC once a month. Women in unit 3 (70 women), the positive control, received 400 mg albendazole once plus ferrous sulfate tablets (60 mg elemental iron) two times a week. No IEC was given. Unit 4 (70 women) served as the negative control and received no intervention. The pre-post impact measures were dietary and nutrient intake, knowledge and practice, and hemoglobin status. In units 1, 2, and 3, the hemoglobin status of the women improved significantly from 11.10 to 12.30 g/dl, 11.20 to 12.70 g/dl, and 11.50 to 13.00 g/dl, respectively. In unit 4 there was no change: the values were 10.90 g/dl before and after intervention. The results show that the type of workplace lunch was of greater significance than IEC. Knowledge gains were impressive, but behavioral change was not sustained. It was concluded that the hemoglobin levels of the workers can easily be improved by cost-effective workplace lunches that also lead to better employer-employee relations.

Is Your LPN Program Keeping P.A.C.E.?

ERIC Educational Resources Information Center

Miller, George; Schill, William John

High demand for admission to Licensed Practical Nursing (LPN) programs and limited state resource allocations for LPN training programs in Washington, have forced North Seattle Community College (NSCC) to utilize a selective admissions policy for its LPN program. Currently, prospective LPN students are required to obtain satisfactory scores on…

ReactorHealth Physics operations at the NIST center for neutron research.

PubMed

Johnston, Thomas P

2015-02-01

Performing health physics and radiation safety functions under a special nuclear material license and a research and test reactor license at a major government research and development laboratory encompasses many elements not encountered by industrial, general, or broad scope licenses. This article reviews elements of the health physics and radiation safety program at the NIST Center for Neutron Research, including the early history and discovery of the neutron, applications of neutron research, reactor overview, safety and security of radiation sources and radioactive material, and general health physics procedures. These comprise precautions and control of tritium, training program, neutron beam sample processing, laboratory audits, inventory and leak tests, meter calibration, repair and evaluation, radioactive waste management, and emergency response. In addition, the radiation monitoring systems will be reviewed including confinement building monitoring, ventilation filter radiation monitors, secondary coolant monitors, gaseous fission product monitors, gas monitors, ventilation tritium monitor, and the plant effluent monitor systems.