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Sample records for reducing ed utilisation

  1. New Zealand's emergency department target - did it reduce ED length of stay, and if so, how and when?

    PubMed

    Tenbensel, Tim; Chalmers, Linda; Jones, Peter; Appleton-Dyer, Sarah; Walton, Lisa; Ameratunga, Shanthi

    2017-09-26

    In 2009, the New Zealand government introduced a hospital emergency department (ED) target - 95% of patients seen, treated or discharged within 6 h - in order to alleviate crowding in public hospital EDs. While these targets were largely met by 2012, research suggests that such targets can be met without corresponding overall reductions in ED length-of-stay (LOS). Our research explores whether the NZ ED time target actually reduced ED LOS, and if so, how and when. We adopted a mixed-methods approach with integration of data sources. After selecting four hospitals as case study sites, we collected all ED utilisation data for the period 2006 to 2012. ED LOS data was derived in two forms-reported ED LOS, and total ED LOS - which included time spent in short-stay units. This data was used to identify changes in the length of ED stay, and describe the timing of these changes to these indicators. Sixty-eight semi-structured interviews and two surveys of hospital clinicians and managers were conducted between 2011 and 2013. This data was then explored to identify factors that could account for ED LOS changes and their timing. Reported ED LOS reduced in all sites after the introduction of the target, and continued to reduce in 2011 and 2012. However, total ED LOS only decreased from 2008 to 2010, and did not reduce further in any hospital. Increased use of short-stay units largely accounted for these differences. Interview and survey data showed changes to improve patient flow were introduced in the early implementation period, whereas increased ED resources, better information systems to monitor target performance, and leadership and social marketing strategies mainly took throughout 2011 and 2012 when total ED LOS was not reducing. While the ED target clearly stimulated improvements in patient flow, our analysis also questions the value of ED targets as a long term approach. Increased use of short-stay units suggests that the target became less effective in 'standing

  2. Applying Lean methodologies reduces ED laboratory turnaround times.

    PubMed

    White, Benjamin A; Baron, Jason M; Dighe, Anand S; Camargo, Carlos A; Brown, David F M

    2015-11-01

    Increasing the value of health care delivery is a national priority, and providers face growing pressure to reduce cost while improving quality. Ample opportunity exists to increase efficiency and quality simultaneously through the application of systems engineering science. We examined the hypothesis that Lean-based reorganization of laboratory process flow would improve laboratory turnaround times (TAT) and reduce waste in the system. This study was a prospective, before-after analysis of laboratory process improvement in a teaching hospital emergency department (ED). The intervention included a reorganization of laboratory sample flow based in systems engineering science and Lean methodologies, with no additional resources. The primary outcome was the median TAT from sample collection to result for 6 tests previously performed in an ED kiosk. After the intervention, median laboratory TAT decreased across most tests. The greatest decreases were found in "reflex tests" performed after an initial screening test: troponin T TAT was reduced by 33 minutes (86 to 53 minutes; 99% confidence interval, 30-35 minutes) and urine sedimentation TAT by 88 minutes (117 to 29 minutes; 99% confidence interval, 87-90 minutes). In addition, troponin I TAT was reduced by 12 minutes, urinalysis by 9 minutes, and urine human chorionic gonadotropin by 10 minutes. Microbiology rapid testing TAT, a "control," did not change. In this study, Lean-based reorganization of laboratory process flow significantly increased process efficiency. Broader application of systems engineering science might further improve health care quality and capacity while reducing waste and cost. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. The impact of reducing financial barriers on utilisation of a primary health care facility in Rwanda.

    PubMed

    Dhillon, Ranu S; Bonds, Matthew H; Fraden, Max; Ndahiro, Donald; Ruxin, Josh

    2012-01-01

    This study investigates the impact of subsidising community-based health insurance (mutuelle) enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a sector of rural Rwanda of approximately 25,000 people divided among five 'imidugudu' or small villages. While comprehensive service upgrades were introduced in the Mayange Health Centre between April 2006 and February 2007, utilisation rates remained similar to comparison sites. Between February 2007 and April 2007, subsidies for mutuelle enrolment established virtually 100% coverage. Immediately after co-payments were eliminated in February 2007, patient visits levelled at a rate triple the previous value. Regression analyses using data from Mayange and two comparison sites indicate that removing financial barriers resulted in about 0.6 additional annual visits for curative care per capita. Although based on a single local pilot, these findings suggest that in order to achieve improved health outcomes, key short-term objectives include improved service delivery and reduced financial barriers. Based on this pilot, higher utilisation rates may be affected if broader swaths of the population are enrolled in mutuelle and co-payments are eliminated. Health leaders in Rwanda should consider further studies to determine if the impact of eliminating co-payments and increasing subsidies for mutuelle enrolment as seen in Mayange holds at greater levels of scale. Broader studies to better elucidate the impact of enrolment subsidies and co-payment subsidies on utilisation, health outcomes, and costs would also provide policy insights.

  4. Persisting stigma reduces the utilisation of HIV-related care and support services in Viet Nam.

    PubMed

    Thanh, Duong Cong; Moland, Karen Marie; Fylkesnes, Knut

    2012-11-25

    Seeking and utilisation of HIV prevention, treatment, care, and support services for people living with HIV is often hampered by HIV-related stigma. The study aimed to explore the perceptions and experiences regarding treatment, care, and support amongst people living with HIV in Viet Nam, where the HIV epidemic is concentrated among injecting drug users, sex workers, and men who have sex with men. In-depth interviews and focus group discussions were conducted during September 2007 in 6 districts in Hai Phong with a very high HIV prevalence among injecting drug users. The information obtained was analysed and merged within topic areas. Illustrative quotes were selected. Stigma and discrimination against people living with HIV in the community and healthcare settings was commonly reported, and substantially hampered the seeking and the utilisation of HIV-related services. The informants related the high level of stigma to the way the national HIV preventive campaigns played on fear, by employing a "scare tactic" mainly focusing on drug users and sex workers, who were defined as "social evils" in the anti-drug and anti-prostitution policy. There was a strong exclusion effect caused by the stigma, with serious implications, such as loss of job opportunities and isolation. The support and care provided by family members was experienced as vital for the spirit and hope for the future among people living with HIV. A comprehensive care and support programme is needed. The very high levels of stigma experienced seem largely to have been created by an HIV preventive scare tactic closely linked to the "social evil" approach in the national policy on drug and prostitution. In order to reduce the stigma and create more effective interventions, this tactic will have to be replaced with approaches that create better legal and policy environments for drug users and sex workers.

  5. Increased iron level in phytase-supplemented diets reduce performance and nutrient utilisation in broiler chickens.

    PubMed

    Akter, M; Iji, P A; Graham, H

    2017-04-11

    1. The effect of different levels of dietary iron on phytase activity and its subsequent effect on broiler performance was investigated in a 3 x 2 factorial arrangement. A total of 360 day-old Ross 308 male broiler chicks were distributed to 6 experimental diets, formulated with three levels of Fe (60, 80 and 100 mg/kg) and two levels of phytase (0, 500 FTU/kg). 2. Phytase supplemented to mid-Fe diets increased feed consumption more than the non-supplemented diet at d 24. From hatch to d 35, Fe x phytase interaction significantly influenced the FI, BWG and FCR. The high-Fe diet supplemented with phytase significantly reduced FI and BWG of broilers than those supplemented with low or mid-Fe diets. The overall FCR was significantly better in birds fed on the mid-Fe diets with phytase supplementation. 3. A significant improvement in ileal digestibility of N, P, Mg and Fe was observed in birds feed diets containing 60 mg Fe/kg, with significant interaction between Fe and phytase. 4. Phytase improved the bone breaking strength when supplemented to low or mid-Fe diets, compared to the non-supplemented diets. There was a significant Fe x phytase interaction effect. Tibia Fe content was higher in birds fed on phytase-free diets with high Fe but the reverse was the case when phytase was added and their interaction was significant. High dietary Fe significantly increased the accumulation of Fe in liver. 5. Phytase improved Ca-Mg-ATPase, Ca-ATPase and Mg-ATPase activities in jejunum when supplemented to the diet containing 80 mg Fe/kg. 6. This study indicates that high (100 mg/kg) dietary Fe inhibited phytase efficacy and subsequently reduced the overall performance and nutrient utilisation of broilers.

  6. Reduced Radiation in Children Presenting to the ED With Suspected Ventricular Shunt Complication.

    PubMed

    Marchese, Ronald F; Schwartz, Erin S; Heuer, Gregory G; Lavelle, Jane; Huh, Jimmy W; Bell, Louis M; Luan, Xianqun; Zorc, Joseph J

    2017-05-01

    Ventricular shunt complications in children can be severe and life-threatening if not identified and treated in a timely manner. Evaluation for shunt obstruction is not without risk, including lifetime cumulative radiation as patients routinely receive computed tomography (CT) scans of the brain and shunt series (multiple radiographs of the skull, neck, chest, and abdomen). A multidisciplinary team collaborated to develop a clinical pathway with the goal of standardizing the evaluation and management of patients with suspected shunt complication. The team implemented a low-dose CT scan, specifically tailored for the detection of hydrocephalus and discouraged routine use of shunt series with single-view radiographs used only when specifically indicated. There was a reduction in the average CT effective dose (millisievert) per emergency department (ED) encounter of 50.6% (confidence interval, 46.0-54.9; P ≤ .001) during the intervention period. There was a significant reduction in the number of shunt surveys obtained per ED encounter, from 62.4% to 5.32% (P < .01). There was no significant change in the 72-hour ED revisit rate or CT scan utilization rate after hospital admission. There were no reports of inadequate patient evaluations or serious medical events. A new clinical pathway has rapidly reduced radiation exposure, both by reducing the radiation dose of CT scans and eliminating or reducing the number of radiographs obtained in the evaluation of patients with ventricular shunts without compromising clinical care. Copyright © 2017 by the American Academy of Pediatrics.

  7. ED triage pain protocol reduces time to receiving analgesics in patients with painful conditions.

    PubMed

    Barksdale, Aaron Nathan; Hackman, Jeff Lee; Williams, Karen; Gratton, Matt Christopher

    2016-12-01

    Studies suggest that collaborative nursing protocols initiated in triage improve emergency department (ED) throughput and decrease time to treatment. The objective of the study is to determine if an ED triage pain protocol improves time to provision of analgesics. Retrospective data abstracted via electronic medical record of patients at a safety net facility with 67 000 annual adult visits. Patients older than 18 years who presented to the ED between March 1, 2011, and May 31, 2013, with 1 of 6 conditions were included: back pain, dental pain, extremity trauma, sore throat, ear pain, or pain from an abscess. A 3-month orientation to an ED nurse-initiated pain protocol began on March 1, 2012. Nurses administered oral analgesics per protocol, beginning with acetaminophen or ibuprofen and progressing to oxycodone. Preimplementation and postimplementation analyses examined differences in time to analgesics. Multivariable analysis modeled time to analgesics as a function of patient factors. Over a 27-month period, 23 409 patients were included: 13 112 received pain medications and 10 297 did not. A total of 12 240 (52%) were male, 12 578 (54%) were African American, and 7953 (34%) were white, with a mean (SD) age of 39 years (13 years). The pain protocol was used in 1002 patients. There was a significant change in mean time (minutes) to provision of analgesics between preimplementation (238) and postimplementation (168) (P < .0001). Linear regression showed the protocol-delivered medications to younger patients and of lower acuity in a reduced time. Variables not related to time to provision of medication included sex, payer, and race. Emergency department triage pain protocol decreased time to provision of pain medications and did so without respect to payer category, sex, or race. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Right to know: reducing risks of fecal pathogen exposure for ED patients and staff.

    PubMed

    Delaney, Molly Bridget

    2014-07-01

    The purpose of this article is to review the literature regarding the multiple challenges that contribute to ED bedside toileting and examine best practices that will reduce fecal exposure, cross-contamination among patients, and employee splash injuries. We searched the Cumulative Index to Nursing and Allied Health Literature, MEDLINE, and Cochrane database for information about the multiple challenges involved in bedside toileting, using the following search terms: bedside toileting, gastroenteritis, macerator, sluice machine, fecal pathogen exposure, and splash injury. In addition, costs and benefits of reusable versus disposable bedside toileting equipment were compared and contrasted. Emergency departments have a higher exposure rate to fecal pathogens with current methods of bedside toileting. Short incubation periods may not allow the proper lead time needed for patients to access primary care providers. As a result, emergency departments and urgent care centers become a likely point of entry into the health care system. Although most inpatient rooms have built-in bathrooms, most emergency departments and outpatient examination rooms do not. Although many patients are ambulatory, restrictive monitoring equipment is required. For safety reasons, staff must bring toileting equipment to the bedsides of both ambulatory and non-ambulatory patients. Hopper dependence creates longer walking distances and delays. These delays may lead to incontinence events, skin breakdown, more frequent bed changes, and higher linen and labor costs. Reusable bedside toileting equipment is associated with at-risk behaviors. Examples are procrastination and sanitization shortcuts. These behaviors risk cross-contamination of patients especially when urgent situations require equipment to be reused in the interim. ED patients and staff are 5 times more likely to undergo fecal exposure. The 5 phases of ED bedside toileting at which risks occur are as follows: equipment setup, transport

  9. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis.

    PubMed

    Panagioti, Maria; Richardson, Gerry; Small, Nicola; Murray, Elizabeth; Rogers, Anne; Kennedy, Anne; Newman, Stanton; Bower, Peter

    2014-08-27

    There is increasing interest in the role of 'self-management' interventions to support the management of long-term conditions in health service settings. Self-management may include patient education, support for decision-making, self-monitoring and psychological and social support. Self-management support has potential to improve the efficiency of health services by reducing other forms of utilisation (such as primary care or hospital use), but a shift to self-management may lead to negative outcomes, such as patients who feel more anxious about their health, are less able to cope, or who receive worse quality of care, all of which may impact on their health and quality of life. We sought to determine which models of self-management support are associated with significant reductions in health services utilisation without compromising outcomes among patients with long-term conditions. We used systematic review with meta-analysis. We included randomised controlled trials in patients with long-term conditions which included self-management support interventions and reported measures of service utilisation or costs, as well as measures of health outcomes (standardized disease specific quality of life, generic quality of life, or depression/anxiety).We searched multiple databases (CENTRAL, CINAHL, Econlit, EMBASE, HEED, MEDLINE, NHS EED and PsycINFO) and the reference lists of published reviews. We calculated effects sizes for both outcomes and costs, and presented the results in permutation plots, as well as conventional meta-analyses. We included 184 studies. Self-management support was associated with small but significant improvements in health outcomes, with the best evidence of effectiveness in patients with diabetic, respiratory, cardiovascular and mental health conditions. Only a minority of self-management support interventions reported reductions in health care utilisation in association with decrements in health. Evidence for reductions in utilisation

  10. Comprehensive pain management protocol reduces children's memory of pain at discharge from the pediatric ED.

    PubMed

    Crocker, Patrick J; Higginbotham, Eric; King, Benjamin T; Taylor, Diane; Milling, Truman J

    2012-07-01

    Historically, pain has been poorly managed in the pediatric emergency department (ED) (PED), resulting in measurable psychosocial issues both acute and delayed. The aim of the study was to measure the impact of protocolized pain management on patients with painful conditions or undergoing painful procedures in the PED. We performed an analysis before and after the implementation of the protocol, dubbed the "Comfort Zone." Validated, age-appropriate pain scales were performed. Validation (using Cronbach α, confirmatory factor analysis) was followed by comparison of responses between the pre- and posttests collected (χ(2) and Wilcoxon rank sum tests). Pain scores were collected at triage and at discharge. At triage, patients were asked to report pain levels. At discharge, they were asked to report their current pain and recall the level of pain during their stay. At triage, parents were asked to report about their perception of the child's pain. At discharge, they were asked to report about their perception of the child's current pain and recall the level of pain during the stay and during procedures, if done. Five hundred thirty-one patients were enrolled in the preprotocol group; 47% were women with a median age of 5 years (range, 30 days-18 years). Two hundred sixty-three patients were enrolled in the protocol group; 39% were women with a median age of 6 years (range, 30 days-18 years). Patient-recalled pain scores of the ED visit in the protocol group were significantly lower than those of the preprotocol group (Wong-Baker Faces Pain Scale, 5.07-4.01; P < .001); yet parent estimates of pain did not show a significant change at any point. Patient assessment of pain at ED discharge did not show a significant change either (Wong-Baker Faces Pain Scale, 1.99-1.56; P = .09). The Faces scale is not well validated for patients younger than 4, so that group had only parental assessment of pain and, consistent with the larger data set, showed no significant pain scale

  11. Rapid Primary Care Follow-up from the ED to Reduce Avoidable Hospital Admissions.

    PubMed

    Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy

    2017-08-01

    Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option

  12. Using PAs in prehospital environments to reduce ED and EMS overuse.

    PubMed

    Thompson, Katherine M; Tozier, William L

    2017-04-01

    Emergency medical services (EMS) and EDs in large cities are burdened with a significant number of patients with chronic disease who have limited options for receiving proper care. Despite their relatively small numbers, these "superusers" can have a significant effect on EMS, particularly in large cities. Additionally, EDs are not designed to provide chronic and continuous healthcare. This article describes how several organizations use physician assistants to manage these patients.

  13. Take advantage of opportunities to reduce ED violence, recidivism among children and young adults.

    PubMed

    2013-05-01

    There is evidence that ED-based interventions can make a difference in short-circuiting the cycle of violence that often impacts children and young adults. Since the Violence Intervention Advocacy Program was launched at Boston Medical Center in 2006, recidivism to the ED among gunshot victims is down by 30% and recidivism among stabbing victims is down by about one-half. At Denver Health Medical Center, the At Risk Intervention and Monitoring (AIM) project just launched in June, but thus far, none of the patients being followed in the program have reappeared in the ED with a violent injury. The U.S. Centers for Disease Control and Prevention reports that 700,000 people between the ages of 10 and 24 were treated in EDs for injuries caused by violence in 2009. To effectively intervene with victims of violence, experts recommend that EDs partner with community groups that have deep ties to the neighborhoods most impacted by violence. To avoid re-traumatizing victims of violence, health care personnel need to be trained in how to provide"trauma-informed care," a method of speaking to patients so that they feel empowered and safe. With young victims of violence, the biggest issues requiring attention are mental health, safety, and housing.

  14. Testing the effects of educational toilet posters: a novel way of reducing haemolysis of blood samples within ED.

    PubMed

    Corkill, David

    2012-02-01

    Haemolysed blood samples are an unnecessary burden on Emergency Departments (ED) as they increase workloads and drive down efficiencies. Little empirical data exists that demonstrates the effectiveness of educational posters displayed in staff toilet cubicles. This study explored the impact educational toilet posters have on reducing haemolysis rates within the ED. A time series study of the clinical effect of educational toilet posters on reducing haemolysis rates throughout a 12 month period at the Gold Coast Hospital ED was undertaken. The GCH ED is a tertiary emergency service that has approximately 66,000 patient presentations per year. Data was collected prospectively. Analysis was undertaken to investigate the effects on total number of haemolysed samples and those clinically significant samples with a haemolytic index >3. Further investigation explored the specific effects on medical and nursing staff. Analysis undertaken using an independent t-test found that the pre-intervention data demonstrates a medium haemolysis rate of 4.92% (SD=1.04). This is a statistically significantly different (t=3.56, df=50, p=0.001) from the median post intervention data of 3.95% (SD=0.84). The difference of 0.97% (95%CI=0.42, 1.52) represents a 19.72% reduction in clinically significant haemolysed samples over the study period. This study reveals that the use of educational toilet posters had a positive impact on reducing the rates of haemolysed samples collected within the ED. This simple and cost effective educational initiative changed the behaviour of clinical staff. Further investigation is warranted to examine the impact of educational toilet posters on additional clinical scenarios. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  15. Targeting services to reduce social inequalities in utilisation: an analysis of breast cancer screening in New South Wales

    PubMed Central

    Birch, Stephen; Haas, Marion; Savage, Elizabeth; Van Gool, Kees

    2007-01-01

    Background Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia. Methods Using the 1997 and 1998 NSW Health Surveys we estimated probit models on the probability of having had a screening mammogram in the last two years for all women aged 40–79. The models examined the relative importance of socio-economic and geographic factors in predicting screening behaviour in three different needs groups – where needs were defined on the basis of a woman's age. Results We find that women in higher socio-economic groups are more likely to have been screened than those in lower groups for all age groups. However, the socio-economic effect is significantly less among women who were in the actively targeted age group. Conclusion This indicates that recruitment and follow-up was associated with a modest reduction in social inequalities in utilisation although significant income differences remain. PMID:17550622

  16. Cost of an Integrated Care Program to Reduce ED Visits During Diabetic Prisoner Court Hearings.

    PubMed

    Pauley, Tim; Matienzo, Joy; Ventura, Joseph; Barbita, Josie

    2017-07-01

    Diabetic events occurring during court hearings previously required emergency medical services (EMS) transport to the emergency department (ED). A new process was implemented whereby the provincial court (PC) was notified by the detention center of diabetes status of prisoners scheduled for court later that day, enabling a community nursing services provider to provide on-site diabetes assessment and treatment at the PC. During the 13-month pre-implementation phase, there were 10 incidents of diabetic distress resulting in an ED visit at a total cost of $797.58/prisoner, including police service personnel, EMS, and ED staff/physician. During the 12.5-month postimplementation phase, insulin was administered on-site during 72 court dates at a cost of $161.93/prisoner. The new process for managing diabetic needs of prisoners during court dates resulted in a substantial cost savings in terms of police services and health care personnel and improved the immediacy and quality of care for prisoners.

  17. Free and Reduced-Price Lunch Eligibility Data in Ed"Facts": A White Paper on Current Status and Potential Changes

    ERIC Educational Resources Information Center

    Hoffman, Lee

    2012-01-01

    ED"Facts" is an initiative of the U. S. Department of Education to base education policy on reliable performance data provided by state education agencies. Among its many data items, ED"Facts" houses school-level counts of students disaggregated by state-defined student economic status, typically free and reduced-price lunch…

  18. Effects of reduced dietary calcium and phytase supplementation on calcium and phosphorus utilisation in broilers with modified mineral status.

    PubMed

    Letourneau-Montminy, M P; Lescoat, P; Narcy, A; Sauvant, D; Bernier, J F; Magnin, M; Pomar, C; Nys, Y; Jondreville, C

    2008-11-01

    1. The impact of modified mineral status and dietary Ca:P ratio on Ca and P utilisation was measured in chicks with or without phytase supplementation. 2. In a preliminary study, 4 diets were given to chicks from 3 to 15 d of age: D1 (6.5 g P/kg and Ca:P = 1.5) and D2, D3 and D4 (6.0, 5.4 and 5.0 g P/kg, respectively, and Ca:P = 1.2). Growth performance was similar across diets. Tibia ash was similar in chicks given D1 and D2, but was gradually depressed from D2 to D4 (-22%). 3. In the depletion period, two groups of chicks, with similar performance, but with different mineral status were achieved by feeding them, from 5 to 15 d of age, diets with a similar Ca:P ratio of 1.2, but containing 6.3 or 5.2 g P/kg. 4. During the subsequent 11 d of the repletion period, chicks from each of the two previous groups were given one of the 4 diets containing 5.7 g P/kg, but differing in their Ca (8.3 and 5.3 g Ca/kg) and microbial phytase (0 or 1000 FTU, Natuphos levels in a 2 x 2 x 2 factorial arrangement. 5. At the end of the repletion period, the initially depleted chicks could not be differentiated from the non-depleted chicks, indicating the capacity of chicks to compensate for their initial depleted mineral status. 6. Interaction between dietary Ca and phytase levels was not significant. Phytase improved growth performance and bone characteristics. Reduced dietary Ca enhanced feed intake and growth rate, but depressed bone dry matter and ash weight. 7. At the end, diets supplemented with phytase maximised bone ash weight when chicks were fed with a Ca:P ratio of 1.5 but elicited the highest growth rate when chicks were fed with a Ca:P ratio of 0.9.

  19. COPD: Health Care Utilisation Patterns with Different Disease Management Interventions.

    PubMed

    Luk, Edwin K; Hutchinson, Anastasia F; Tacey, Mark; Irving, Louis; Khan, Fary

    2017-08-01

    The management of COPD is a significant and costly issue worldwide, with acute healthcare utilisation consisting of admissions and outpatient attendances being a major contributor to the cost. Pulmonary rehabilitation (PR) and integrated disease management (IDM) are often offered. Whilst there is strong evidence of physical and quality of life outcomes following IDM and PR, few studies have looked into healthcare utilisation. The aims of this study were to confirm whether IDM and PR reduce acute healthcare utilisation and to identify factors which contribute to acute health care utilisation or increased mortality. This was a retrospective cohort study of patients with COPD who were referred to IDM over a 10-year period. Patients were also offered an 8-week PR program. Data collected were matched with the hospital dataset to obtain information on inpatient, ED and outpatient attendances. 517 patients were enrolled to IDM. 315 (61%) also commenced PR and 220 (43%) completed PR. Patients who were referred to PR were younger and had less comorbidities (p < 0.001). Both groups (IDM only and IDM + PR referred) had reductions in healthcare utilisation but the IDM-only group had greater reductions. A survival benefit (HR 0.68, 95% CI 0.50-0.92) was seen in those who were PR completers compared to patients who received IDM only. Patients with COPD who successfully complete PR in addition to participating in IDM have improved survival. IDM alone was effective in the reduction of healthcare utilisation; however, the addition of PR did not reduce healthcare usage further.

  20. Reducing cyclic testing time for components of automotive suspension system utilising the wavelet transform and the Fuzzy C-Means

    NASA Astrophysics Data System (ADS)

    Putra, T. E.; Abdullah, S.; Schramm, D.; Nuawi, M. Z.; Bruckmann, T.

    2017-06-01

    This study aims to introduce a novel method for accelerating fatigue tests. Strain signals measured at automotive suspension components were extracted based on the Morlet wavelet producing damaging segments. Furthermore, the segments were clustered using the Fuzzy C-Means to remove the segments having lower energy. The process was able to shorten the strain signals up to 41.4% and it was able to retain at least 90% of the fatigue damage. It reduced the testing time by more than 33%, with equivalent fatigue life. Indirectly, the use of modified strain signals could reduce device operating costs.

  1. Do new workforce roles reduce waiting times in ED? A difference-in-difference evaluation using hospital administrative data.

    PubMed

    Scott, Anthony; Yong, Jongsay

    2015-04-01

    This paper evaluates the effect of introducing two new workforce roles under a pilot program conducted in Victoria, Australia. The trial took place at a regional hospital's emergency department (ED) between 1 July 2008 and 30 June 2009. The evaluation is based on three outcome measures: waiting time (in minutes) at ED before treatment; proportion of presentations with waiting time on target; and length of stay (in days), for ED presentations that led to in-patient admissions. The technique of difference-in-differences analysis is used. A total of 142,980 patient records from the pilot hospital and three comparison hospitals were extracted from the Victorian Emergency Minimum Dataset (VEMD). Further, 21,925 records of patients whose ED presentations led to in-patient admissions were extracted from the Victorian Admitted Episodes Dataset (VAED). The evaluation finds the piloted roles have lowered waiting time and raised the proportion of on-target presentations. These effects were found to be the strongest for less urgent triage categories. However, the evidence on in-patient length of stay was mixed. The results provide positive evidence that new workforce roles can be effective in improving the efficiency of emergency care delivery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Optimising yield and resource utilisation of summer maize under the conditions of increasing density and reducing nitrogen fertilization.

    PubMed

    Wei, Shanshan; Wang, Xiangyu; Zhu, Qicen; Jiang, Dong; Dong, Shuting

    2017-10-05

    The inefficient use of resources always poses risks of maize (Zea mays L.) yield reduction in China. We performed this research to monitor the effects of increasing plant density and reducing nitrogen (N) rate on radiation-use efficiency (RUE), N efficiency traits, grain yield (GY) and their inter-relationships. Besides, whether GY and resource-use efficiency can both be maximized was examined. Hence, a 2-year field experiment was conducted using a widely grown variety "Denghai 618" in Shandong, China. Treatments contained two different plant densities [67,500 (D1) and 97,500 (D2) plant ha(-1)] and three N levels [0 (N-2), 180 (N-1), 360 (Nck) kg ha(-1)], set D1Nck as control. Significant increases in grain yield, biomass, RUE, above-ground N uptake (AGN) and N efficiency were observed when density increased from D1 to D2. Declining N application was accompanied by reductions in yield, RUE and AGN especially under high density, yet an obvious improvement in N recovery efficiency (NRE), agronomic N efficiency and N partial factor productivity. The increased GY was positive related with population biomass (r = 0.895**), RUE (r = 0.769**) and AGN (r = 0.923**), whereas it has no significant correlation with N efficiency. In this study, D2Nck obtained 18.8, 17.9, 24.8 and 29.7% higher grain yield, RUE, AGN and NRE respectively, compared to control, optimizing both yield and the efficiencies of radiation and N use. Furthermore, higher yield and RUE with more desirable N efficiency may be possible via optimizing density and N rate combination.

  3. Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis.

    PubMed

    Heyer, Nicholas J; Derzon, James H; Winges, Linda; Shaw, Colleen; Mass, Diana; Snyder, Susan R; Epner, Paul; Nichols, James H; Gayken, Julie A; Ernst, Dennis; Liebow, Edward B

    2012-09-01

    To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35-0.57]. Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site. © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  4. Effectiveness of practices to reduce blood sample hemolysis in EDs: A laboratory medicine best practices systematic review and meta-analysis

    PubMed Central

    Heyer, Nicholas J.; Derzon, James H.; Winges, Linda; Shaw, Colleen; Mass, Diana; Snyder, Susan R.; Epner, Paul; Nichols, James H.; Gayken, Julie A.; Ernst, Dennis; Liebow, Edward B.

    2015-01-01

    Objective To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. Results A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11–0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35–0.57]. Conclusions Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site. Disclaimer The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC. PMID:22968086

  5. Does receiving care in a medical home reduce racial/ethnic disparities in ED visits among children with asthma in the United States?

    PubMed

    Lin, Susan X; Younge, Richard G; Kleinman, Lawrence C

    2016-07-14

    Evidence has shown the implementation of medical home model improves care quality and outcomes. However, it is not clear whether receiving care from a medical home has any impact on racial/ethnic disparities in emergency department (ED) use by children with asthma. This study using the US National Survey of Children with Special Health Care Needs, 2009-2010, estimated racial/ethnic disparities in ED use. Generalized liner models were used to examine factors associated with ED use. Racial/ethnic differences in ED use were attenuated after adjusting for socio-economic variables. Ratios of prevalence ratios were calculated to examine the effect modification of medical home on ED use associated with race/ethnicity. The adjusted prevalence ratio of ED use of the Black to non-Hispanic White was 1.51 (95% confidence interval (CI): 1.36-1.67) with medical home and 1.35 (95% CI: 1.24-1.47) without medical home. Among those with care from a medical home Latino children had higher ED use compared with White children. There is no evidence that the self-reported care from a medical home narrows the gaps in ED use between non-Hispanic White and Black or Latino children with asthma.

  6. Spent potlining utilisation possibilities.

    PubMed

    Miksa, Dragan; Homsak, Marko; Samec, Niko

    2003-10-01

    As the world's capacity for aluminium production increases, the amount of waste connected with this industry is also increasing. Spent potlining (SPL) from aluminium reduction cell cathodes presents a major environmental concern in the primary aluminium industry. It is concluded, after laboratory tests, that leachable cyanide and fluoride compounds present the major problem in SPL disposal. The behaviour of cyanide and fluoride under high temperature treatment has been investigated. On the basis of this laboratory investigation, the possibilities for SPL utilisation in red brick manufacturing, cement industry and thermal power stations were evaluated. SPL refractory material is already re-used in red brick manufacturing. In the cement industry, a pilot test on the utilisation of 25 t SPL carbon waste mixed with green petrol coke gave positive results. Additionally a fluoride emission forecast for a thermal power station utilising carbon waste SPL mixed with coal was elaborated.

  7. Imitation and utilisation behaviour.

    PubMed Central

    De Renzi, E; Cavalleri, F; Facchini, S

    1996-01-01

    OBJECTIVE: To investigate the incidence, anatomical correlates, and clinical features of imitation and utilisation behaviour, which are thought by Lhermitte and coworkers to represent a reliable and frequent index of frontal lobe disease. METHODS: 78 patients with hemispheric local lesions were tested in two separate sessions, in which their reactions to a series of gestures performed by the examiner and to the presentation of a set of objects were recorded. The patients were stratified into a frontal (n = 52) and a non-frontal group (n = 26) on the basis of their CT data. RESULTS AND CONCLUSIONS: Imitation behaviour was present in 39% of the frontal patients and was mainly associated with medial and lateral lesions, at odds with the claim of Lhermitte et al that it is a constant accompaniment of lower, mediobasal lesions. In the non-frontal group it was found in three patients, all with damage to the deep nuclei region. Utilisation behaviour was a much rarer phenomenon, present in only two patients, both of whom had frontal damage. Neither imitation behaviour nor utilisation behaviour were found in patients with retrorolandic cortical lesions. PMID:8890779

  8. Demographic and clinical predictors of unplanned hospital utilisation among chronically ill patients: a prospective cohort study.

    PubMed

    Mallitt, Kylie-Ann; Kelly, Patrick; Plant, Natalie; Usherwood, Tim; Gillespie, James; Boyages, Steven; Jan, Stephen; Leeder, Stephen

    2015-04-03

    In urban Australia, patients with serious and continuing illnesses make frequent use of hospital emergency department (ED) services. However, the risk factors for hospital utilisation among the broad population of people with chronic illness are not well known. The aim of this study was to assess the predictors of hospital utilisation (either inpatient admissions or ED visits) in a cohort of 308 patients with chronic illness. We studied patients with serious and continuing chronic illnesses presenting to an ED in a large periurban hospital in western Sydney, Australia, between 2010 and 2013. ED presentations and hospital admissions were observed over two years. Multivariate negative-binomial regression analyses were used to identify risk factors for the number of presentations to hospital. The main risk factors for hospital utilisation were having a live-in carer, and a history of hospital utilisation. Having a live-in carer was associated with an increase in number of ED presentations by 88% (RR 1.88; 95% CI 1.41-2.51), and of admissions by 116% (RR 2.16; 95% CI 1.61-2.92). Seventy-seven percent of hospital utilisation in the cohort was attributable to carer status. Each additional ED presentation that a person had in the 12 months prior to the study led to an increased risk of an ED presentation in the follow-up period by 6% (RR = 1.06, 95% CI = 1.03-1.08). Between 20% and 25% of variability in hospital utilisation in the cohort was attributable to the number of hospital admissions or ED presentations in the previous 12 months. Patients with a live-in carer and with a history of hospital utilisation are at high risk for future hospital use.

  9. Nutritional values and bioactive components of under-utilised vegetables consumed by indigenous people in Malaysia.

    PubMed

    Abdul Wahab, Norsuhaila; Ahdan, Rohaina; Ahmad Aufa, Zabidah; Kong, Kin Weng; Johar, Mohd Hafizan; Shariff Mohd, Zalilah; Ismail, Amin

    2015-10-01

    Diverse plants species in the forest remain under-utilised and they are mainly consumed only by local people. However, increasing issues in food security prompted the present study, which explores the nutritional and antioxidant aspects of Malaysian under-utilised vegetables. The studied vegetables were Paku Nyai (Stenochlaena palustris), Cemperai (Champereia manillana), Maman Pasir (Cleome viscose), Dudung (Erechtites valerianifolia) and Semambuk (Ardisia pendula). Overall, these vegetables exhibited a low proximal content but they were high in vitamin C [7.07-1263 mg kg(-1) edible fresh sample (EFS)] and β-carotene content (18.4-43.9 mg kg(-1) kg(-1) EFS). Cemperai had the highest calcium content (565 mg kg(-1) EFS), whereas Semambuk had the highest total phenolic content [28.21 g gallic acid equivalents kg(-1) edible dried sample (EDS)] and antioxidant activity (86.1%) measured using β-carotene bleaching assay. Maman Pasir contained the highest total flavonoid content (39.99 g CE kg(-1) EDS) and 1,1-diphenyl-2-picryl hydrazyl radical scavenging activity (82.2%). The extracts of these vegetables had significantly prevented the oxidation of haemoglobin and low-density lipoprotein, which yielded a reduced production of malondialdehyde. Semambuk and Maman Pasir are potent to be used as new food and functional food sources as they are rich in nutrients and antioxidants. © 2014 Society of Chemical Industry.

  10. Reduced dental calcium expression and dental mass in chronic sleep deprived rats: Combined EDS, TOF-SIMS, and micro-CT analysis

    NASA Astrophysics Data System (ADS)

    Kuo, Yi-Jie; Huang, Yung-Kai; Chou, Hsiu-Chu; Pai, Man-Hui; Lee, Ai-Wei; Mai, Fu-Der; Chang, Hung-Ming

    2015-08-01

    Teeth are the hardest tissue in the body. The growth of teeth is closely regulated by circadian rhythmicity. Considering that sleep deprivation (SD) is a severe condition that disrupts normal circadian rhythmicity, this study was conducted to determine whether calcium expression (the major element participating in teeth constitution), and dental mass would be significantly impaired following SD. Adolescent rats subjected to 3 weeks of SD were processed for energy dispersive spectrum (EDS), time-of-flight secondary ion mass spectrometry (TOF-SIMS), and micro-computed tomography (micro-CT) analyses. The EDS and TOF-SIMS results indicated that high calcium intensity was detected in both the upper and lower incisors of untreated rats. Micro-CT analysis corresponded closely with spectral data in which an enhanced dental mass was calculated in intact animals. However, following SD, both calcium expression and the dental mass were remarkably decreased to nearly half those of the untreated values. Because SD plays a detrimental role in impairing dental structure, establishing satisfactory sleep behavior would therefore serve as a crucial strategy for preventing or improving prevalent dental dysfunctions.

  11. PREFACE: EDS2010 Preface

    NASA Astrophysics Data System (ADS)

    Heggie, Malcolm I.

    2011-03-01

    The biennial international conference on Extended Defects in Semiconductors started in 1978 with a meeting in Hünfeld, Germany. Subsequent meetings rotated between Poland, France, Great Britain, Germany, Russia and Italy, culminating in EDS2004 in Chernogolovka, EDS2006 in Halle and EDS2008 in Poitiers. EDS2010 was held at the University of Sussex at Brighton, UK from September 19th to 24th. An extension of the tabulation of this history, which first appeared on the EDS2006 website, is given in the attached PDF. It is with sadness that we note one of the founders of the series, Prof. Dr Helmut Alexander, passed away on 3 December 2009 and we were proud to dedicate EDS2010 to his memory. It has become a tradition to make an award in his name, and this year it was made to Ivan Isacov for his poster "Electrical levels of dislocation networks in p- and n-type silicon". A short and warm celebration of Prof. Dr Alexander's life by his friends and colleagues, Prof. Drs Helmut Gottschalk, Eicke Weber and Wolfgang Schröter, is included in this volume. The conference was a forum for the state-of-the-art of investigation and modelling of extended defects in semiconductors. Scientists from universities, research institutes and industry made contributions to a deeper understanding of extended defects, their interaction with point defects and their role in the development of semiconductor technology. The remit of the conference included extended defects, nanostructures, nanoparticles, quantum dots and interfaces within semiconducting materials ranging from narrow to wide band gaps, including graphene-derived materials and diamond. Scientific interests range from defect geometry, electronic structure, dynamics, spectroscopy, microscopy, reactions and chemistry to introduction mechanisms, such as implantation and strained layers and the operation of devices such as integrated circuits, heterostructures, and solar cells. The organisers were confronted with a long period between

  12. Intrathecal magnesium sulfate does not reduce the ED50 of intrathecal hyperbaric bupivacaine for cesarean delivery in healthy parturients: a prospective, double blinded, randomized dose-response trial using the sequential allocation method.

    PubMed

    Xiao, Fei; Xu, Wenping; Feng, Ying; Fu, Feng; Zhang, Xiaomin; Zhang, Yinfa; Wang, Lizhong; Chen, Xinzhong

    2017-01-17

    Addition of intrathecal magnesium sulfate to local anesthetics has been reported to potentiate spinal anesthesia and prolong analgesia in parturients. The current study was to determine whether intrathecal magnesium sulfate would reduce the dose of hyperbaric bupivacaine in spinal anesthesia with bupivacaine and sufentanil for cesarean delivery. Sixty healthy parturients undergoing scheduled cesarean delivery were randomly assigned to receive spinal anesthesia with 0.5% hyperbaric bupivacaine and 5 μg sufentanil with either 0.9% sodium chloride (Control group) or 50% magnesium sulfate (50 mg) (Magnesium group). Effective anesthesia was defined as a bilateral T5 sensory block level achieved within 10 min of intrathecal drug administration and no additional epidural anesthetic was required during surgery. Characteristic of spinal anesthesia and the incidence of side effects were observed. The ED50 for both groups was calculated using the Dixon and Massey formula. There was no significant difference in the ED50 of bupivacaine between the Magnesium group and the Control group (4.9 mg vs 4.7 mg) (P = 0.53). The duration of spinal anesthesia (183 min vs 148 min, P < 0.001) was longer, the consumption of fentanyl during the first 24 h postoperatively (343 μg vs 550 μg, P < 0.001) was lower in the Magnesium group than that in the Control group. Intrathecal magnesium sulfate (50 mg) did not reduce the dose requirement of intrathecal bupivacaine, but can extend the duration of spinal anesthesia with no obvious additional side effects. This study was registered with Chinese Clinical Trial Registry (ChiCTR) on 15 Jul. 2014 and was given a trial ID number ChiCTR-TRC- 14004954 .

  13. An analysis of partial efficiencies of energy utilisation of different macronutrients by barramundi (Lates calcarifer) shows that starch restricts protein utilisation in carnivorous fish.

    PubMed

    Glencross, Brett D; Blyth, David; Bourne, Nicholas; Cheers, Susan; Irvin, Simon; Wade, Nicholas M

    2017-02-01

    This study examined the effect of including different dietary proportions of starch, protein and lipid, in diets balanced for digestible energy, on the utilisation efficiencies of dietary energy by barramundi (Lates calcarifer). Each diet was fed at one of three ration levels (satiety, 80 % of initial satiety and 60 % of initial satiety) for a 42-d period. Fish performance measures (weight gain, feed intake and feed conversion ratio) were all affected by dietary energy source. The efficiency of energy utilisation was significantly reduced in fish fed the starch diet relative to the other diets, but there were no significant effects between the other macronutrients. This reduction in efficiency of utilisation was derived from a multifactorial change in both protein and lipid utilisation. The rate of protein utilisation deteriorated as the amount of starch included in the diet increased. Lipid utilisation was most dramatically affected by inclusion levels of lipid in the diet, with diets low in lipid producing component lipid utilisation rates well above 1·3, which indicates substantial lipid synthesis from other energy sources. However, the energetic cost of lipid gain was as low as 0·65 kJ per kJ of lipid deposited, indicating that barramundi very efficiently store energy in the form of lipid, particularly from dietary starch energy. This study defines how the utilisation efficiency of dietary digestible energy by barramundi is influenced by the macronutrient source providing that energy, and that the inclusion of starch causes problems with protein utilisation in this species.

  14. Edward (Ed) T. Schneider

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Research Pilot Edward T. Schneider is shown sitting in the cockpit of a McDonnell Douglas F/A-18 Hornet that was used in the High Angle-of-Attack Research Vehicle (HARV) program at the National Aeronautics and Space Administration's Ames - Dryden Flight Research Facility. When the aircraft arrived at the Dryden Facility in 1987, from the US Naval Air Test Center, Patuxent River, Maryland, it consisted of parts in crates. The aircraft crew made an airplane from those parts, and in doing so they took a 'sow's ear' and created a 'silk purse', thus the name on the side of the aircraft. Ed's helmet is from his time in the Navy. The design was taken from the Flag that is flown on the bow of a Navy ship, referred to as the Jack, and is navy blue with the 50 States being represented by the white stars. Ed arrived at the NASA Ames-Dryden Flight Research Facility (later renamed the Dryden Flight Research Center) on July 5, 1982, as a Navy Liaison Officer, becoming a NASA research pilot one year later. Ed was the project pilot for the F-18 High Angle-of-Attack program and later served as a project pilot for the F-15 aeronautical research aircraft, the NASA B-52 launch aircraft, and the SR-71 'Blackbird' aircraft. He served on active duty with the U.S. Navy from 1968 to 1983. Following squadron service he graduated from the U.S. Naval Test Pilot School, Patuxent River, Maryland, in 1973, and then served as an engineering test pilot, and test pilot school instructor at the Naval Air Test Center. Ed has been an active member of the Society of Experimental Test Pilots since 1974. He was made a Fellow of the Society in 1993 and served as its President in 1993/94. In 1996 he was awarded the NASA Exceptional Service Medal and the American Institute of Aeronautics and Astronautics' Chanute Flight Award. He retired as a NASA research pilot in September 2000.

  15. Edward (Ed) T. Schneider

    NASA Technical Reports Server (NTRS)

    1989-01-01

    Research Pilot Edward T. Schneider is shown sitting in the cockpit of a McDonnell Douglas F/A-18 Hornet that was used in the High Angle-of-Attack Research Vehicle (HARV) program at the National Aeronautics and Space Administration's Ames - Dryden Flight Research Facility. When the aircraft arrived at the Dryden Facility in 1987, from the US Naval Air Test Center, Patuxent River, Maryland, it consisted of parts in crates. The aircraft crew made an airplane from those parts, and in doing so they took a 'sow's ear' and created a 'silk purse', thus the name on the side of the aircraft. Ed's helmet is from his time in the Navy. The design was taken from the Flag that is flown on the bow of a Navy ship, referred to as the Jack, and is navy blue with the 50 States being represented by the white stars. Ed arrived at the NASA Ames-Dryden Flight Research Facility (later renamed the Dryden Flight Research Center) on July 5, 1982, as a Navy Liaison Officer, becoming a NASA research pilot one year later. Ed was the project pilot for the F-18 High Angle-of-Attack program and later served as a project pilot for the F-15 aeronautical research aircraft, the NASA B-52 launch aircraft, and the SR-71 'Blackbird' aircraft. He served on active duty with the U.S. Navy from 1968 to 1983. Following squadron service he graduated from the U.S. Naval Test Pilot School, Patuxent River, Maryland, in 1973, and then served as an engineering test pilot, and test pilot school instructor at the Naval Air Test Center. Ed has been an active member of the Society of Experimental Test Pilots since 1974. He was made a Fellow of the Society in 1993 and served as its President in 1993/94. In 1996 he was awarded the NASA Exceptional Service Medal and the American Institute of Aeronautics and Astronautics' Chanute Flight Award. He retired as a NASA research pilot in September 2000.

  16. Folic acid utilisation related to sulfa drug resistance in Saccharomyces cerevisiae.

    PubMed

    Bayly, A M; Berglez, J M; Patel, O; Castelli, L A; Hankins, E G; Coloe, P; Hopkins Sibley, C; Macreadie, I G

    2001-11-13

    Saccharomyces cerevisiae mutants deficient in folate synthesis have been constructed and employed to study the utilisation of exogenous folates in yeast. One mutant specifically lacked dihydropteroate synthase while the second lacked dihydrofolate synthase. Exogenous folinic acid restored optimal growth to both strains. Folic acid did not generally rescue growth but spontaneous isolates capable of utilising folic acid were selected. The folic acid synthesis pathway in the folate utilising isolates was restored via transformation with FOL1 or FOL3 expression plasmids and transformants were tested for resistance to sulfamethoxazole (SMX). The presence of elevated levels of folic acid led to greatly reduced SMX sensitivity regardless of whether strains were folate utilisers or not.

  17. Modular operation of membrane bioreactors for higher hydraulic capacity utilisation.

    PubMed

    Veltmann, K; Palmowski, L M; Pinnekamp, J

    2011-01-01

    Using data from 6 full-scale municipal membrane bioreactors (MBR) in Germany the hydraulic capacity utilisation and specific energy consumption were studied and their connexion shown. The average hydraulic capacity utilisation lies between 14% and 45%. These low values are justified by the necessity to deal with intense rain events and cater for future flow increases. However, this low hydraulic capacity utilisation leads to high specific energy consumption. The optimisation of MBR operation requires a better utilisation of MBR hydraulic capacity, particularly under consideration of the energy-intensive membrane aeration. A first approach to respond to large influent flow fluctuations consists in adjusting the number of operating modules. This is practised by most MBR operators but so far mostly with variable flux and constant membrane aeration. A second approach is the real-time adjustment of membrane aeration in line with flux variations. This adjustment is not permitted under current manufacturers' warranty conditions. A further opportunity is a discontinuous operation, in which filtration takes place over short periods at high flux and energy for membrane aeration is saved during filtration pauses. The integration of a buffer volume is thereby indispensable. Overall a modular design with small units, which can be activated/ inactivated according to the influent flow and always operate under optimum conditions, enables a better utilisation of MBR hydraulic capacity and forms a solid base to reduce MBR energy demand.

  18. Characteristics of Medicaid enrollees with frequent ED use.

    PubMed

    Capp, Roberta; Rosenthal, Marjorie S; Desai, Mayur M; Kelley, Lauren; Borgstrom, Christopher; Cobbs-Lomax, Darcey L; Simonette, Peggy; Spatz, Erica S

    2013-09-01

    Medicaid enrollees are disproportionately represented among patients with frequent Emergency Department (ED) visits, yet prior studies investigating frequent ED users have focused on patients with all insurance types. This was a single center, retrospective study of Medicaid-insured frequent ED users (defined as ≥4 ED visits/year not resulting in hospital admission) to assess patients' sociodemographic and clinical characteristics and evaluate differences in these characteristics by frequency of use (4-6, 7-17, and ≥18 ED visits). Twelve percent (n = 1619) of Medicaid enrollees who visited the ED during the 1-year study period were frequent ED users, accounting for 38% of all ED visits (n = 10,337). Most frequent ED users (n = 1165, 72%) had 4-6 visits; 416 (26%) had 7-17 visits, and 38 (2%) had ≥18 visits. Overall, 67% had a primary care provider and 56% had at least one chronic medical condition. The most common ED diagnosis among patients with 4-6 visits was abdominal pain (7%); among patients with 7-17 and ≥18 ED visits, the most common diagnosis was alcohol-related disorders (11% and 36%, respectively). Compared with those who had 4-6 visits, patients with ≥18 visits were more likely to be homeless (7% vs 42%, P < .05) and suffer from alcohol abuse (15% vs 42%, P < .05). One out of 8 Medicaid enrollees who visited the ED had ≥4 visits in a year. Efforts to reduce frequent ED use should focus on reducing barriers to accessing primary care. More tailored interventions are needed to meet the complex needs of adults with ≥18 visits per year. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Mobile unit helps ED cut LWBS in half.

    PubMed

    2008-03-01

    One viable option for reducing the stress on an overburdened ED is the leasing of a mobile unit. For a relatively modest cost, it can be used as a fast-track department, as the ED at Jefferson Memorial Hospital in Ranson, WV, is doing. The unit at Jefferson is staffed by a registered nurse, a nurse practitioner, and a technician who floats between the mobile unit and the main ED. The mobile care unit has four beds and also is equipped with computers, a medication dispensing system, and monitors to view digital X-rays. The triage nurse determines whether a patient goes to the mobile unit or the main ED.

  20. What Is Ag-Ed?

    ERIC Educational Resources Information Center

    Lindley, Judy

    Ag-Ed is an agricultural education project aimed at upper primary students, held in conjunction with the Toowoomba Show (similar to a county fair) in Queensland, Australia. The program achieves its purpose of helping children understand the impact and relevance that agriculture has on their everyday lives through two components, an Ag-Ed day and a…

  1. Rebooting the EdD

    ERIC Educational Resources Information Center

    Wergin, Jon F.

    2011-01-01

    In this essay, Jon Wergin reminds readers of the philosophical and historical foundations of the doctor of education (EdD) degree. He argues that the EdD should be based, in large part, on John Dewey's progressive ideals of democratization and Paulo Freire's concepts of emancipatory education. Drawing on theories of reflective practice,…

  2. Rebooting the EdD

    ERIC Educational Resources Information Center

    Wergin, Jon F.

    2011-01-01

    In this essay, Jon Wergin reminds readers of the philosophical and historical foundations of the doctor of education (EdD) degree. He argues that the EdD should be based, in large part, on John Dewey's progressive ideals of democratization and Paulo Freire's concepts of emancipatory education. Drawing on theories of reflective practice,…

  3. Sago starch and its utilisation.

    PubMed

    Abd-Aziz, Suraini

    2002-01-01

    The importance and development of industrial biotechnology processing has led to the utilisation of microbial enzymes in various applications. One of the important enzymes is amylase, which hydrolyses starch to glucose. In Malaysia, the use of sago starch has been increasing, and it is presently being used for the production of glucose. Sago starch represents an alternative cheap carbon source for fermentation processes that is attractive out of both economic and geographical considerations. Production of fermentable sugars from the hydrolysis of starches is normally carried out by an enzymatic processes that involves two reaction steps, liquefaction and saccharification, each of which has different temperature and pH optima with respect to the maximum reaction rate. This method of starch hydrolysis requires the use of an expensive temperature control system and a complex mixing device. Our laboratory has investigated the possibility of using amylolytic enzyme-producing microorganisms in the continuous single-step biological hydrolysis of sago flour for the production of a generic fermentation medium. The ability of a novel DNA-recombinated yeast, Saccharomyces cerevisiae strain YKU 107 (expressing alpha-amylase production) to hydrolyse gelatinised sago starch production has been studied with the aim of further utilizing sago starch to obtain value-added products.

  4. Rural ED transfers due to lack of radiology services.

    PubMed

    Lyon, Matthew; Sturgis, LaShon; Lendermon, Darren; Kuchinski, Ann Marie; Mueller, Taylor; Loeffler, Patrick; Xu, Hongyan; Gibson, Robert

    2015-11-01

    Our objectives were to determine the frequency of patient transfers to a tertiary care emergency department (Tertiary ED) due to a lack of radiology services in rural hospital EDs (Rural EDs), and examine the community and patient attributes that are associated with these transfers. This was a retrospective chart review of patients transferred to a Tertiary ED from Rural EDs. Transfers excluded from the study included pediatric patients (age <18 years old) and patients transferred for trauma surgeon evaluation. Only those patients who were transferred for radiology services were included in the final analysis. Over a 12-month period, 1445 patients were transferred to the Tertiary ED with 73.8% (n = 1066) of this population being transferred from a Rural ED. Excluding 381 trauma and pediatric patients, 64.3% (n = 685) of patients were transferred from a Rural ED and were included in the study. Of these 685 transfers, 24.5% (n = 168) were determined to be due primarily to a lack of a radiology service. Lack of radiology services in Rural EDs leads to numerous patient transfers to the Tertiary ED each year. A disproportionate number of these transfer patients are African American. These transfers place additional financial and social burdens on patients and their families. This study discusses these findings and alternative diagnostic options (ie, telemedicine and ultrasound video transfer) to address the lack of radiology services available in Rural EDs. The use of these alternate diagnostic options will likely reduce the number of patient transfers to Tertiary EDs. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. EDS operator and control software

    SciTech Connect

    Ott, L.L.

    1985-04-01

    The Enrichment Diagnostic System (EDS) was developed at Lawrence Livermore National Laboratory (LLNL) to acquire, display and analyze large quantities of transient data for a real-time Advanced Vapor Laser Isotope Separation (AVLIS) experiment. Major topics discussed in this paper are the EDS operator interface (SHELL) program, the data acquisition and analysis scheduling software, and the graphics software. The workstation concept used in EDS, the software used to configure a user's workstation, and the ownership and management of a diagnostic are described. An EDS diagnostic is a combination of hardware and software designed to study specific aspects of the process. Overall system performance is discussed from the standpoint of scheduling techniques, evaluation tools, optimization techniques, and program-to-program communication methods. EDS is based on a data driven design which keeps the need to modify software to a minimum. This design requires a fast and reliable data base management system. A third party data base management product, Berkeley Software System Database, written explicitly for HP1000's, is used for all EDS data bases. All graphics is done with an in-house graphics product, Device Independent Graphics Library (DIGLIB). Examples of devices supported by DIGLIB are: Versatec printer/plotters, Raster Technologies Graphic Display Controllers, and HP terminals (HP264x and HP262x). The benefits derived by using HP hardware and software as well as obstacles imposed by the HP environment are presented in relation to EDS development and implementation.

  6. A Successful ED Fall Risk Program Using the KINDER 1 Fall RiskAssessment Tool.

    PubMed

    Townsend, Ann B; Valle-Ortiz, Marisol; Sansweet, Tracy

    2016-11-01

    Emergency nurses did not perform falls risk assessments routinely on our ED patients; the instrument used was aimed at inpatients. We identified a need to revise fall assessment practices specific to our emergency department. The purpose of the performance improvement project was to reduce ED falls and evaluate the use of an ED-specific fall risk tool, the KINDER 1 Fall Risk Assessment. The plan was to establish fall risk assessment practices at point of ED entry and to decrease total falls.

  7. Effects of Using a Neuroeducational Intervention to Enhance Perseverance for Online EdD and EdS Students

    ERIC Educational Resources Information Center

    Cadle, Charles R.

    2013-01-01

    Developing and maintaining a "completion mindset" is a necessary mental condition for online educational doctorate (EdD) and educational specialist (EdS) students to obtain their advanced degrees. The purpose of this research study was to examine the effect of a neuroeducational intervention on a volunteer convenience sample of EdD and…

  8. Effects of Using a Neuroeducational Intervention to Enhance Perseverance for Online EdD and EdS Students

    ERIC Educational Resources Information Center

    Cadle, Charles R.

    2013-01-01

    Developing and maintaining a "completion mindset" is a necessary mental condition for online educational doctorate (EdD) and educational specialist (EdS) students to obtain their advanced degrees. The purpose of this research study was to examine the effect of a neuroeducational intervention on a volunteer convenience sample of EdD and…

  9. Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales

    NASA Astrophysics Data System (ADS)

    Jegasothy, Edward; McGuire, Rhydwyn; Nairn, John; Fawcett, Robert; Scalley, Benjamin

    2017-03-01

    Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005-2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0-10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1-15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.

  10. Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales.

    PubMed

    Jegasothy, Edward; McGuire, Rhydwyn; Nairn, John; Fawcett, Robert; Scalley, Benjamin

    2017-03-20

    Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005-2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0-10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1-15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.

  11. Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales

    NASA Astrophysics Data System (ADS)

    Jegasothy, Edward; McGuire, Rhydwyn; Nairn, John; Fawcett, Robert; Scalley, Benjamin

    2017-08-01

    Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005-2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0-10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1-15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.

  12. Prospective study of violence against ED workers.

    PubMed

    Kowalenko, Terry; Gates, Donna; Gillespie, Gordon Lee; Succop, Paul; Mentzel, Tammy K

    2013-01-01

    Health care support occupations have an assault-injury rate nearly 10 times the general sector. Emergency departments (EDs) are at greatest risk of such events. The objective was to describe the incidence of violence in ED health care workers (HCWs) over 9 months. Specific aims were to (1) identify demographic, occupational, and perpetrator factors related to violent events (VEs) and (2) identify predictors of acute stress in victims and predictors of loss of productivity. A longitudinal, repeated-methods design was used to collect monthly survey data from ED HCWs at 6 hospitals. Surveys assessed number and type of VEs, and feelings of safety and confidence. Victims also completed specific VE surveys. Descriptive statistics and a repeated-measure linear regression model were used. Two hundred thirteen ED HCWs completed 1795 monthly surveys and 827 VEs were reported. Average VE rate per person per 9 months was 4.15. Six hundred one events were physical threats (PTs) (3.01 per person). Two hundred twenty six events were assaults (1.13 per person). Five hundred one VE surveys were completed, describing 341 PTs and 160 assaults. Men perpetrated 63% of PTs and 52% of assaults. Significant differences in VEs were reported between registered nurses (RNs) and medical doctors (MDs) (P = .0017) and patient care assistants (P < .05). The RNs felt less safe than the MDs (P = .0041). The MDs felt more confident than the RNs in dealing with violent patients (P = .013). The RNs were more likely to experience acute stress than the MDs (P < .001). Acute stress reduced productivity (P < .001). Emergency department HCWs are frequent victims of violence perpetrated by visitors and patients. This results in injuries, acute stress, and lost productivity. Acute stress has negative consequences on workers' ability to perform their duties. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Mitigating Higher Ed Cyber Attacks

    ERIC Educational Resources Information Center

    Rogers, Gary; Ashford, Tina

    2015-01-01

    In this presentation we will discuss the many and varied cyber attacks that have recently occurred in the higher ed community. We will discuss the perpetrators, the victims, the impact and how these institutions have evolved to meet this threat. Mitigation techniques and defense strategies will be covered as will a discussion of effective security…

  14. Energy and nutrient utilisation by embryonic reptiles.

    PubMed

    Thompson, Michael B; Speake, Brian K

    2002-11-01

    Most reptiles are oviparous, with the developing embryos relying on the contents of the yolk to sustain development until hatching (lecithotrophy). The yolk is composed primarily of lipid and protein, which act as an energy source and the essential components to build embryonic tissue. Nevertheless, yolk and the resulting embryos contain many other nutrients, including inorganic ions, vitamins, carotenoids, water and hormones. Apart from water and oxygen, which may be taken up by eggs, and some inorganic ions that can come from the eggshell or even from outside the egg, everything required by the embryo must be in the egg when it is laid. Approximately 20% of squamate reptiles are viviparous, exhibiting a variety of placental complexities. Species with complex placentae have reduced yolk volumes, with the mother augmenting embryonic nutrition by provision across the placenta (placentotrophy). Despite assumed advantages of placentotrophy, only 5 out of approximately 100 lineages of viviparous squamates exhibit substantial placentotrophy. This paper reviews available and recent information on the yolk contents of a variety of squamate reptiles to ask the question, how are nutrients transported from the yolk to the embryo or across the placenta? Although, current available data suggest that, in broad terms, yolk is taken up by embryos without discrimination of the nutrients, there are some apparent exceptions, including the very long chain polyunsaturated fatty acids. In addition, fundamental differences in the patterns of energy utilisation in lizards and snakes suggest fundamental differences in lipid profiles in these taxa, which appear to reflect the differences between placentotrophic and lecithotrophic viviparous lizards.

  15. Overview of Deployed EDS Technologies

    SciTech Connect

    Martz, H E; Crawford, C

    2009-09-24

    The term explosive detection system (EDS) is used by the TSA to describe equipment that is certified to detect explosives in checked bags. The EDS, as certified, by the TSL must consist of device for interrogating a bag and an automated detection algorithm (ATD) for evaluating the results of the interrogation. We only consider CT as the interrogation device in this report. A schematic drawing of a CT-based EDS is shown in Figure 2. The output of the ATD is the binary decision of alarm or non-alarm. Alarms may true- or false-positives. Non-alarms may be true- or false-negatives. False positives are also denoted false alarms. The true detection means that the ATD reports an alarm when a threat is present in the scanned bag. The probability of detecting a threat given that a threat is present is denoted the probability of detection (PD). The probability of false alarm (PFA) is the case when an alarm is reported when a threat is not present in a bag. Certification in this context means passing tests for PD and PFA at the TSL. The results of the EDS include CT cross-sectional images of the bag and specifics about the alarmed objects generated by ATD. These results are presented on a display so that a person may override the decision of ATD and declare the alarm to be a non-alarm. This process is denoted clearing. Bags that are not cleared by the person are sent to a secondary inspection process. Here the bags may be opened or assessed with explosive trace detection (ETD) in order to clear the bags. Bags that are not cleared at this point are evaluated by an ordinance disposal team. The CT scanner along with ATD is denoted Level 1 screening. The process of clearing on a display is denoted Level 2 screening. Secondary inspection is denoted Level 3 screening. Vendors of the deployed EDSs supply the TSA with equipment for all three levels. Therefore, the term EDS may include the equipment provided for Levels 1, 2 and 3. A schematic diagram of an EDS and the levels of

  16. Effectiveness of a five-level Paediatric Triage System: an analysis of resource utilisation in the emergency department in Taiwan

    PubMed Central

    Chang, Yu-Che; Ng, Chip-Jin; Wu, Chang-Teng; Chen, Li-Chin; Chen, Jih-Chang; Hsu, Kuang-Hung

    2013-01-01

    Objectives To examine the effectiveness of a five-level Paediatric Triage and Acuity System (Ped-TTAS) by comparing the reliability of patient prioritisation and resource utilisation with the four-level Paediatric Taiwan Triage System (Ped-TTS) among non-trauma paediatric patients in the emergency department (ED). Methods The study design used was a retrospective longitudinal analysis based on medical chart review and a computer database. Except for a shorter list of complaints and some abnormal vital sign criteria modifications, the structure and triage process for applying Ped-TTAS was similar to that of the Paediatric Canadian Emergency Triage and Acuity Scale. Non-trauma paediatric patients presenting to the ED were triaged by well-trained triage nurses using the four-level Ped-TTS in 2008 and five-level Ped-TTAS in 2010. Hospitalisation rates and medical resource utilisation were analysed by acuity levels between the contrasting study groups. Results There was a significant difference in patient prioritisation between the four-level Ped-TTS and five-level Ped-TTAS. Improved differentiation was observed with the five-level Ped-TTAS in predicting hospitalisation rates and medical costs. Conclusions The five-level Ped-TTAS is better able to discriminate paediatric patients by triage acuity in the ED and is also more precise in predicting resource utilisation. The introduction of a more accurate acuity and triage system for use in paediatric emergency care should provide greater patient safety and more timely utilisation of appropriate ED resources. PMID:22983978

  17. Molecular cloning and characterization of enhanced disease susceptibility 1 (EDS1) from Gossypium barbadense.

    PubMed

    Su, Xiaofeng; Qi, Xiliang; Cheng, Hongmei

    2014-06-01

    Arabidopsis enhanced disease susceptibility 1 (EDS1) plays an important role in plant defense against biotrophic and necrotrophic pathogens. The necrotrophic pathogen Verticillium dahliae infection of Gossypium barbadense could lead to Verticillium wilt which seriously reduces the cotton production. Here, we cloned and characterized a G. barbadense homolog of EDS1, designated as GbEDS1. The full-length cDNA of the GbEDS1 gene was obtained by the technique of rapid-amplification of cDNA ends. The open reading frame of the GbEDS1 gene was 1,647 bp long and encoded a protein of 548 amino acids residues. Comparison of the cDNA and genomic DNA sequence of GbEDS1 indicated that this gene contained a single intron and two exons. Like other EDS1s, GbEDS1 contained a conserved N-terminal lipase domain and an EDS1-specific KNEDT motif. Subcellular localization assay revealed that GbEDS1-green fluorescence protein fusion protein was localized in both cytosol and nucleus. Interestingly, the transcript levels of GbEDS1 were dramatically increased in response to pathogen V. dahliae infection. To investigate the role of GbEDS1 in plant resistance against V. dahliae, a conserved fragment derived from GbEDS1 was used to knockdown the endogenous EDS1 in Nicotiana benthamiana by heterologous virus-induced gene silencing. Our data showed that silencing of NbEDS1 resulted in increased susceptibility to V. dahliae infection in N. benthamiana, suggesting a possible involvement of the novelly isolated GbEDS1 in the regulation of plant defense against V. dahliae.

  18. Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

    PubMed Central

    Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

    2016-01-01

    Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

  19. In review of ED utilization reduction strategies, data regarding impact on safety, outcomes in short supply.

    PubMed

    2014-01-01

    To gather insight on an array strategies used to curb ED utilization, investigators conducted a systematic review of five types of interventions that are based outside of the ED: patient education, patient financial incentives, the creation of additional non-ED capacity, pre-hospital diversion, and managed care. While the available evidence showed that all of the interventions had some impact on reducing ED utilization, researchers caution that there was scant data showing what impact these interventions had on outcomes or safety. Investigators found that patient education interventions were associated with the greatest magnitude of reductions in ED use, but they stress that the interventions reviewed were very heterogeneous. Interventions involving patient financial incentives primarily focused on putting financial barriers in place between patients and the ED. They were effective at reducing ED utilization, but investigators caution that policy makers need to consider the potential impact on outcomes. There was some evidence that creating additional non-ED capacity fueled demand for care, but had a small impact on ED utilization. Going forward, emergency providers need to fully engage in any discussions about ED utilization and demonstrate the value that EDs bring to the health care system, say experts.

  20. Associated gas utilisation in Sabah, Malaysia

    SciTech Connect

    Kia, T.E.; Sikchi, K.G.

    1984-02-01

    Based on extensive studies and planning, the State Government of Sabah are now investing the equivalent of 1 billion US Dollars in a gas utilisation project which will stop the venting of associated gas produced offshore Sabah and broaden the state's economy base. The project involves the installation of new platform facilities adjacent to existing oil production platforms in the Samarang and Erb West fields for collection, processing and transmission of up to 90 mmscfd of gas to the island of Labuan where gas will be utilised by a 47MW combined cycle power plant, a 2000 ton/day hot briquetted iron plant and a 2000 ton/day methanol plant, presently under construction. The project is targetted to come on stream second quarter of 1984.

  1. Real time analysis under EDS

    NASA Astrophysics Data System (ADS)

    Schneberk, D.

    1985-07-01

    The analysis component of the Enrichment Diagnostic System (EDS) developed for the Atomic Vapor Laser Isotope Separation Program (AVLIS) at Lawrence Livermore National Laboratory (LLNL) is described. Four different types of analysis are performed on data acquired through EDS: (1) absorption spectroscopy on laser-generated spectral lines, (2) mass spectrometer analysis, (3) general purpose waveform analysis, and (4) separation performance calculations. The information produced from this data includes: measures of particle density and velocity, partial pressures of residual gases, and overall measures of isotope enrichment. The analysis component supports a variety of real-time modeling tasks, a means for broadcasting data to other nodes, and a great degree of flexibility for tailoring computations to the exact needs of the process. A particular data base structure and program flow is common to all types of analysis. Key elements of the analysis component are: (1) a fast access data base which can configure all types of analysis, (2) a selected set of analysis routines, (3) a general purpose data manipulation and graphics package for the results of real time analysis.

  2. Real time analysis under EDS

    SciTech Connect

    Schneberk, D.

    1985-07-01

    This paper describes the analysis component of the Enrichment Diagnostic System (EDS) developed for the Atomic Vapor Laser Isotope Separation Program (AVLIS) at Lawrence Livermore National Laboratory (LLNL). Four different types of analysis are performed on data acquired through EDS: (1) absorption spectroscopy on laser-generated spectral lines, (2) mass spectrometer analysis, (3) general purpose waveform analysis, and (4) separation performance calculations. The information produced from this data includes: measures of particle density and velocity, partial pressures of residual gases, and overall measures of isotope enrichment. The analysis component supports a variety of real-time modeling tasks, a means for broadcasting data to other nodes, and a great degree of flexibility for tailoring computations to the exact needs of the process. A particular data base structure and program flow is common to all types of analysis. Key elements of the analysis component are: (1) a fast access data base which can configure all types of analysis, (2) a selected set of analysis routines, (3) a general purpose data manipulation and graphics package for the results of real time analysis. Each of these components are described with an emphasis upon how each contributes to overall system capability. 3 figs.

  3. Communication and Influencing for ED Professionals: A training programme developed in the emergency department for the emergency department.

    PubMed

    Rixon, Andrew; Rixon, Sascha; Addae-Bosomprah, Hansel; Ding, Mingshuang; Bell, Anthony

    2016-08-01

    The objective of the present study is to develop and pilot a communication and influencing skills training programme that meets ED health professionals' needs at an urban district hospital. Qualitative methods within a participatory action research framework were utilised. An interdisciplinary team guided the programme's design and development. A training needs analysis saw team meetings, interviews, focus groups and observations conducted across the ED. Thematic analysis of the data identified health professionals' communication and influencing challenges. The training needs analysis informed the training programme curriculum's development. The pilot programme involved an interdisciplinary group of seven health professionals across 5 × 2 h sessions over 3 months, followed by a post-training survey. Five themes of communication and influencing challenges were identified: participating in effective handovers, involving patients in bedside handovers, effectively communicating with interdepartmental colleagues, asking ED colleagues to do tasks and understanding ED colleagues' roles, expectations and assumptions. Based on these challenges, the formulated RESPECT model (which stands for Relationships, Expectations, Styles, Partnerships, Enquiry, Coaching and Teamwork) informed the training curriculum. The peer coaching model used in the training programme was highly regarded by participants. Communication and Influencing for ED Professionals™ (Babel Fish Group Pty Ltd, Melbourne, Victoria, Australia) addresses a gap for communication programmes developed in the ED for the ED. Future research will evaluate the programme's impact in this ED. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. Instability of EDS maglev systems

    SciTech Connect

    Cai, Y.; Chen, S.S.

    1993-09-01

    Instabilities of an EDS maglev suspension system with 3 D.O.F. and 5 D.O.F. vehicles traveling on a double L-shaped set of guideway conductors have been investigated with various experimentally measured magnetical force data incorporated into the theoretical models. Divergence and flutter are obtained from both analytical and numerical solutions for coupled vibration of the 3 D.O.F. maglev vehicle model. Instabilities of five direction motions (heave, slip, rill, pitch and yaw) are observed for the 4 D.O.F. vehicle model. It demonstrates that system parameters, such as, system damping, vehicle geometry and coupling effects among five different motions play very important roles in the occurrence of dynamic instabilities of maglev vehicles.

  5. ED becomes 'lean' and cuts LBTC, LOS times.

    PubMed

    2008-04-01

    Lean manufacturing techniques, first developed by Toyota, can be successfully adapted to help improve processes in your ED. St. Luke's Episcopal Hospital in Houston, has used Lean to reduce median length of stay, frequency of diversions, and the percentage of patients who left before treatment was complete (LBTC). Here's why "Lean" can help improve the performance of your ED: It enables you and your staff to see things from the patient's point of view. Lean tools enable you to view the status of your department in real-time and to compare that status with your performance goals. Exercises help identify areas where your processes break down and determine the most likely solutions.

  6. Reduction of electron channeling in EDS using precession.

    PubMed

    Liao, Yifeng; Marks, Laurence D

    2013-03-01

    We demonstrated that EDS measurement can be significantly improved by precessing the electron beam, thereby reducing electron channeling effects. For a SrTiO3 specimen orientated along the [001] zone axis, the measured strontium to titanium atomic ratio was 0.74-0.80 using conventional EDS methods, and the ratio was improved to ~0.99 by precessing the electron beam for angles greater than 22.54 mRad. In ALCHEMI-like experiments in which the specimen was tilted to near two-beam condition, the strontium to titanium ratio was insensitive to the deviation from the Bragg condition using a precessed electron beam. Similar reduction of electron channeling effects was also observed in precession-assisted EDS measurements for an L21-ordered Fe2MnAl intermetallic alloy tilted to the [011] zone axis as well as near two-beam conditions.

  7. Motivations for seeking treatment for ED: the woman's perspective.

    PubMed

    McCabe, M P; Conaglen, H; Conaglen, J; O'Connor, E

    2010-01-01

    There is increasing evidence that partners have a major role in treatment-seeking behavior for men with ED. This study investigated the motivations of 100 females for seeking medical treatment for their partner's ED. Semi-structured interviews focused on reasons for seeking treatment from the female's perspective. The themes that emerged from the data centered on the importance of sex in the relationship, with closeness and intimacy frequently being seen as more important than sex. The second major theme related to hopes that females had in relation to the medication, particularly in relation to increasing their partner's confidence and reducing his sexual frustration. Enhancement of the relationship as well as improving the female's own feelings of self-doubt and sexual frustration were also mentioned. The results of this study show the multi-faceted nature of the motivations that females express in terms of seeking help for their partner's ED.

  8. Utilisation of magnets to enhance gastrointestinal endoscopy

    PubMed Central

    Rahman, Imdadur; Patel, Praful; Boger, Philip; Thomson, Mike; Afzal, Nadeem Ahmad

    2015-01-01

    Methods to assess, access and treat pathology within the gastrointestinal tract continue to evolve with video endoscopy replacing radiology as the gold standard. Whilst endoscope technology develops further with the advent of newer higher resolution chips, an array of adjuncts has been developed to enhance endoscopy in other ways; most notable is the use of magnets. Magnets are utilised in many areas, ranging from endoscopic training, lesion resection, aiding manoeuvrability of capsule endoscopes, to assisting in easy placement of tubes for nutritional feeding. Some of these are still at an experimental stage, whilst others are being increasingly incorporated in our everyday practice. PMID:26722611

  9. Utilisation of Thermal Radiation for Process Monitoring

    NASA Astrophysics Data System (ADS)

    Weberpals, Jan; Hermann, Tobias; Berger, Peter; Singpiel, Holger

    Particularly the automation of thermal material processing makes high demands on monitoring and controlling the resulting quality. A new promising approach is the utilisation of the emitted thermal radiation to get detailed information about temperature distributions and geometrical structures. Indeed, current laser systems with strong focusability exhibit a high innovation potential in many application ranges, for example the possibility of adjusting the welding depth to even small material thicknesses. However, the usability of these advantages is limited because the suitable process windows are considerably constricted at increased welding speed. Therefore, a reliable monitoring of thermal material processing is of vital importance.

  10. Trends in metformin utilisation and dose appropriateness in Australia.

    PubMed

    Moon, J; Kumar, S S; Graham, G G; Baysari, M T; Williams, K M; Chen, W; Viardot, A; Greenfield, J R; Day, R O

    2016-12-01

    The study aimed to (1) determine the trends in the utilisation of metformin in Australia, (2) determine the appropriateness of metformin dosing in an Australian teaching hospital and (3) gather the opinions of prescribers on the relationship between metformin dose and renal function. National prescription data between 1990 and 2012 were accessed. A retrospective audit (2008-2012) of metformin doses and patient renal function (20 % random sample of all in-patients prescribed metformin) was conducted at St Vincent's Hospital (SVH), Sydney. Prescribers of metformin were interviewed (semi-structured; consultants at SVH) or surveyed (Australian endocrinologists) to gather their understanding of metformin dosing in relation to renal function. Metformin utilisation increased fivefold nationally between 1995 and 2012. Metformin tended to be under-dosed in SVH patients with normal renal function (83.5 %) and over-dosed in patients with impaired renal function (estimated glomerular filtration rate (eGFR) <30 mL/min, 50 %). Consultants indicated that metformin doses needed to be reduced in renal impairment. Most endocrinologists (61 %) were comfortable prescribing metformin down to eGFRs around 30 mL/min. The use of metformin increased greatly over the period of the study. Metformin is prescribed frequently for patients with eGFR values below the minimal level approved in the product label (60 mL/min). While prescribers expressed their understanding of the need to reduce metformin doses in patients with renal impairment, we found that metformin doses were higher than appropriate in patients with impaired renal function. Metformin may be used safely when renal function is poor provided dosage is appropriately reduced.

  11. A primary-school-based study to reduce the prevalence of childhood obesity – the EdAl (Educació en Alimentació) study: a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Obesity is one of the main determinants of avoidable disease burden. To implement a program by university students acting as “health promoting agents” (HPAs) and to evaluate the effects on obesity prevalence of the primary-school-based program that promotes healthy lifestyle, including dietary and physical activity recommendations over 28 months. Methods Two school clusters were randomly assigned to intervention (24 schools, 1,222 pupils) or control (14 schools, 717 pupils); 78% of pupils were Western European. Mean age (±SD) was 8.4 ± 0.6 years (49.9% females) at baseline. Generalized linear mixed models were used to analyze differences in primary outcome between both groups. Data collected included body mass index (BMI) every year. Dietary habits and lifestyle questionnaires were filled in by the parents at baseline and at the end of the study. The interventions focused on eight lifestyle topics covered in 12 activities (1 hour/activity/session) implemented by HPAs over 3 school academic years. Results At 28 months, obesity prevalence in boys was decreased −2.36% in the intervention group (from 9.59% to 7.23%) and increased 2.03% (from 7.40% to 9.43%) in the control group; the difference was 4.39% (95% CI 3.48 to 5.30; P = 0.01). The boys in the intervention group had an effective reduction of −0.24 units in the change of BMI z-score (from 0.01 to −0.04), compared to control (from −0.10 to 0.09); 5.1% more intervention pupils undertook physical activity >5 hours/week than control pupils (P = 0.02). Fish consumption was a protector (odds ratio 0.39; 95% CI 0.23 to 0.67) while “fast-food” consumption was a risk factor for childhood obesity (odds ratio: 2.27; 95% CI 1.08 to 4.77). Conclusions Our school-based program, conducted by HPA students, successfully reduced childhood obesity prevalence in boys. Trial registration International Standard Randomized Controlled Trial Number: ISRCTN29247645. PMID:24529258

  12. Utilising shade to optimize UV exposure for vitamin D

    NASA Astrophysics Data System (ADS)

    Turnbull, D. J.; Parisi, A. V.

    2008-06-01

    Numerous studies have stated that humans need to utilise full sun radiation, at certain times of the day, to assist the body in synthesising the required levels of vitamin D3. The time needed to be spent in the full sun depends on a number of factors, for example, age, skin type, latitude, solar zenith angle. Current Australian guidelines suggest exposure to approximately 1/6 to 1/3 of a minimum erythemal dose (MED), depending on age, would be appropriate to provide adequate vitamin D3 levels. The aim of the study was to determine the exposure times to diffuse solar UV to receive exposures of 1/6 and 1/3 MED for a changing solar zenith angle in order to assess the possible role that diffuse UV (scattered radiation) may play in vitamin D3 effective UV exposures (UVD3). Diffuse and global erythemal UV measurements were conducted at five minute intervals over a twelve month period for a solar zenith angle range of 4° to 80° at a latitude of 27.6° S. For a diffuse UV exposure of 1/3 MED, solar zenith angles smaller than approximately 50° can be utilised for exposure times of less than 10 min. Spectral measurements showed that, for a solar zenith angle of 40°, the UVA (315-400 nm) in the diffuse component of the solar UV is reduced by approximately 62% compared to the UVA in the global UV, whereas UVD3 wavelengths are only reduced by approximately 43%. At certain latitudes, diffuse UV under shade may play an important role in providing the human body with adequate levels of UVD3 (290-315 nm) radiation without experiencing the high levels of UVA observed in full sun.

  13. Utilising shade to optimize UV exposure for vitamin D

    NASA Astrophysics Data System (ADS)

    Turnbull, D. J.; Parisi, A. V.

    2008-01-01

    Numerous studies have stated that humans need to utilise full sun radiation, at certain times of the day, to assist the body in synthesising the required levels of vitamin D3. The time needed to be spent in the full sun depends on a number of factors, for example, age, skin type, latitude, solar zenith angle. Current Australian guidelines suggest exposure to approximately 1/6 to 1/3 of a minimum erythemal dose (MED), depending on age, would be appropriate to provide adequate vitamin D3 levels. The aim of the study was to determine the exposure times to diffuse solar UV to receive exposures of 1/6 and 1/3 MED for a changing solar zenith angle in order to assess the possible role that diffuse UV (scattered radiation) may play in vitamin D3 effective UV exposures (UVD3). Diffuse and global erythemal UV measurements were conducted at five minute intervals over a twelve month period for a solar zenith angle range of 4° to 80° at a latitude of 27.6° S. For diffuse UV exposures of 1/6 and 1/3 MED, solar zenith angles smaller than 60° and 50° respectively can be utilised for exposure times of less than 10 min. Spectral measurements showed that, for a solar zenith angle of 40°, the UVA (315-400 nm) in the diffuse component of the solar UV is reduced by approximately 62% compared to the UVA in the global UV, whereas UVD3 wavelengths are only reduced by approximately 43%. At certain latitudes, diffuse UV under shade may play an important role in providing the human body with adequate levels of UVD3 (290-330 nm) radiation without experiencing the high levels of damaging UVA observed in full sun.

  14. The Impact of "ED" on Educational Research.

    ERIC Educational Resources Information Center

    Florio, David H.

    1980-01-01

    The purposes, structure, and component parts of the newly formed Department of Education (ED) organizations from which educational research programs will be administered are discussed. As the climate surrounding ED changes, opportunities to take advantage of the elevated status of research will be presented. (Author/RL)

  15. Environmental assessment of incinerator residue utilisation.

    PubMed

    Toller, S; Kärrman, E; Gustafsson, J P; Magnusson, Y

    2009-07-01

    Incineration ashes may be treated either as a waste to be dumped in landfill, or as a resource that is suitable for re-use. In order to choose the best management scenario, knowledge is needed on the potential environmental impact that may be expected, including not only local, but also regional and global impact. In this study, A life cycle assessment (LCA) based approach was outlined for environmental assessment of incinerator residue utilisation, in which leaching of trace elements as well as other emissions to air and water and the use of resources were regarded as constituting the potential environmental impact from the system studied. Case studies were performed for two selected ash types, bottom ash from municipal solid waste incineration (MSWI) and wood fly ash. The MSWI bottom ash was assumed to be suitable for road construction or as drainage material in landfill, whereas the wood fly ash was assumed to be suitable for road construction or as a nutrient resource to be recycled on forest land after biofuel harvesting. Different types of potential environmental impact predominated in the activities of the system and the use of natural resources and the trace element leaching were identified as being relatively important for the scenarios compared. The scenarios differed in use of resources and energy, whereas there is a potential for trace element leaching regardless of how the material is managed. Utilising MSWI bottom ash in road construction and recycling of wood ash on forest land saved more natural resources and energy than when these materials were managed according to the other scenarios investigated, including dumping in landfill.

  16. Stoichiometric modelling of assimilatory and dissimilatory biomass utilisation in a microbial community

    PubMed Central

    Hunt, Kristopher A.; Jennings, Ryan deM.; Inskeep, William P.; Carlson, Ross P.

    2017-01-01

    Summary Assimilatory and dissimilatory utilisation of autotroph biomass by heterotrophs is a fundamental mechanism for the transfer of nutrients and energy across trophic levels. Metagenome data from a tractable, thermoacidophilic microbial community in Yellowstone National Park was used to build an in silico model to study heterotrophic utilisation of autotroph biomass using elementary flux mode analysis and flux balance analysis. Assimilatory and dissimilatory biomass utilisation was investigated using 29 forms of biomass-derived dissolved organic carbon (DOC) including individual monomer pools, individual macromolecular pools and aggregate biomass. The simulations identified ecologically competitive strategies for utilizing DOC under conditions of varying electron donor, electron acceptor or enzyme limitation. The simulated growth environment affected which form of DOC was the most competitive use of nutrients; for instance, oxygen limitation favoured utilisation of less reduced and fermentable DOC while carbon-limited environments favoured more reduced DOC. Additionally, metabolism was studied considering two encompassing metabolic strategies: simultaneous versus sequential use of DOC. Results of this study bound the transfer of nutrients and energy through microbial food webs, providing a quantitative foundation relevant to most microbial ecosystems. PMID:27387069

  17. Stoichiometric modelling of assimilatory and dissimilatory biomass utilisation in a microbial community.

    PubMed

    Hunt, Kristopher A; Jennings, Ryan deM; Inskeep, William P; Carlson, Ross P

    2016-12-01

    Assimilatory and dissimilatory utilisation of autotroph biomass by heterotrophs is a fundamental mechanism for the transfer of nutrients and energy across trophic levels. Metagenome data from a tractable, thermoacidophilic microbial community in Yellowstone National Park was used to build an in silico model to study heterotrophic utilisation of autotroph biomass using elementary flux mode analysis and flux balance analysis. Assimilatory and dissimilatory biomass utilisation was investigated using 29 forms of biomass-derived dissolved organic carbon (DOC) including individual monomer pools, individual macromolecular pools and aggregate biomass. The simulations identified ecologically competitive strategies for utilizing DOC under conditions of varying electron donor, electron acceptor or enzyme limitation. The simulated growth environment affected which form of DOC was the most competitive use of nutrients; for instance, oxygen limitation favoured utilisation of less reduced and fermentable DOC while carbon-limited environments favoured more reduced DOC. Additionally, metabolism was studied considering two encompassing metabolic strategies: simultaneous versus sequential use of DOC. Results of this study bound the transfer of nutrients and energy through microbial food webs, providing a quantitative foundation relevant to most microbial ecosystems. © 2016 Society for Applied Microbiology and John Wiley & Sons Ltd.

  18. The consequences of introducing stochasticity in nutrient utilisation models: the case of phosphorus utilisation by pigs.

    PubMed

    Symeou, V; Leinonen, I; Kyriazakis, I

    2016-02-14

    Simulation models of nutrient utilisation ignore that variation in pig system components can influence the predicted mean and variance of the performance of a group of pigs. The objective of this study was to develop a methodology to investigate how variation in feed composition would (a) affect the outputs of a nutrient utilisation model and (b) interact with variation that arises from the traits of individual pigs. We used a P intake and utilisation model to address these characteristics. Introduction of stochasticity gave rise to a number of methodological challenges--for example, how to generate variation in both feed composition and pigs and account for correlations between ingredients when modelling variation associated with feed mixing efficiency. Introducing variation in feed composition and pig phenotype resulted in moderate decreases in mean digested, retained and excreted P predicted for a population of pigs and an increase in their associated CV. A lower percentage of pigs in the population were predicted to meet their requirements during the feeding period considered, by comparison with the no-variation scenario. Variation in feed ingredient composition contributed more to performance variation than variation due to mixing efficiency. When variations in both feed composition and pig traits were considered, it was the former rather than the latter that had the dominant influence on variability in pig performance. The developed framework emphasises the consequences of random variability on the predictions of nutrient utilisation models. Such consequences will have a significant impact on decisions about management strategies such as feeding that are subject to variation.

  19. Chronic hypothyroidism only marginally affects adult-type Leydig cell regeneration after EDS administration.

    PubMed

    Rijntjes, Eddy; van Kesteren-Buiting, Anita; Keijer, Jaap; Teerds, Katja J

    2010-02-01

    Chronic prenatally induced dietary hypothyroidism delays adult-type Leydig cell development, but does not block this process. Using a chemical model to induce hypothyroidism, it was suggested that development of a new population of Leydig cells was completely inhibited following the addition of the cytotoxic compound ethane-1,2-dimethyl sulphonate (EDS). In this study, we used a dietary approach to induce hypothyroidism and reinvestigated the regeneration of the Leydig cell population following EDS administration. Eighty-four day old euthyroid and chronically hypothyroid rats received an injection of EDS and were killed directly before or at regular intervals up to 77 days after EDS. In some control and hypothyroid animals, the first progenitor-type Leydig cells were observed at day 12 after EDS. At day 16, Leydig cell progenitors were present in all rats. The percentage of proliferating Leydig cells peaked in the euthyroid animals at day 21 after EDS. In the hypothyroid testis such a peak was not observed, although the percentage of proliferating regenerating Leydig cells was significantly higher from days 35 to 56 compared with the controls. This suggested that the wave of Leydig cell proliferation was delayed in the hypothyroid animals as compared with the euthyroid controls. On the day of EDS injection, the Leydig/Sertoli cell ratio was 37% lower in the hypothyroid rats compared with the controls. The Leydig/Sertoli cell ratio remained lower in the EDS-treated hypothyroid animals compared with the controls at all time points investigated. At day 77 after EDS, the Leydig cell population had returned to its pre-treatment size in both groups. Plasma testosterone production was reduced to below detectable levels immediately after EDS injection, and started to increase again on day 16, reaching pre-treatment values on day 21 in both groups. Taken together, severely reduced thyroid hormone levels did not block the regeneration of the adult-type Leydig cell population

  20. An ED pilot intervention to facilitate outpatient acute care for cancer patients.

    PubMed

    Brooks, Gabriel A; Chen, Eddy J; Murakami, Mark A; Giannakis, Marios; Baugh, Christopher W; Schrag, Deb

    2016-10-01

    Unplanned hospitalizations are common in patients with cancer, and most hospitalizations originate in the emergency department (ED). We implemented an ED-based pilot intervention designed to reduce hospitalizations among patients with solid tumors. The intervention, piloted at a single academic medical center, involved a medical oncologist embedded in the ED during evening hours. We used a quasiexperimental preimplementation/postimplementation study design to evaluate the proportion of ED visits that resulted in inpatient hospital admission, before and after pilot implementation. General estimating equations were used to evaluate the association between the intervention and hospital admission. There were 390 ED visits by eligible cancer patients in the preintervention period and 418 visits in the intervention period. During the intervention period, 158 (38%) of 418 ED visits were identified by the embedded oncologist during the evening intervention shift. The proportion of ED visits leading to hospitalization was 70% vs 69% in the preintervention and intervention periods (odds ratio, 0.93 [95% confidence interval, 0.69-1.24]; P= .62). There were no differences between periods in ED length of stay or subsequent use of acute care. Among patients with initial ED presentation during the operating hours of the intervention, the proportion of ED visits leading to hospitalization was 77% vs 67% in the preintervention and intervention periods (odds ratio, 0.62 [0.36-1.08]; P= .08). Embedding an oncologist in the ED of an academic medical center did not significantly reduce hospital admissions. Novel approaches are needed to strengthen outpatient acute care for patients with cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Mechanical Ventilation and ARDS in the ED

    PubMed Central

    Mohr, Nicholas M.; Miller, Christopher N.; Deitchman, Andrew R.; Castagno, Nicole; Hassebroek, Elizabeth C.; Dhedhi, Adam; Scott-Wittenborn, Nicholas; Grace, Edward; Lehew, Courtney; Kollef, Marin H.

    2015-01-01

    BACKGROUND: There are few data regarding mechanical ventilation and ARDS in the ED. This could be a vital arena for prevention and treatment. METHODS: This study was a multicenter, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS after admission. Multivariable logistic regression was used to determine the predictors of ARDS. RESULTS: We analyzed 219 patients receiving mechanical ventilation to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight (PBW) (interquartile range, 6.9-8.9), with a range of 4.3 to 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 patients (55.7%). The incidence of ARDS after admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the 15 patients with ARDS in the ED (6.8%), lung-protective ventilation was used in seven (46.7%). Patients who progressed to ARDS experienced greater duration in organ failure and ICU length of stay and higher mortality. CONCLUSIONS: Lung-protective ventilation is infrequent in patients receiving mechanical ventilation in the ED, regardless of ARDS status. Progression to ARDS is common after admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset after admission from the ED, measures to prevent onset and to mitigate severity should be instituted in the ED. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01628523; URL: www.clinicaltrials.gov PMID:25742126

  2. Remotely operated welding systems for EdF plant maintenance

    SciTech Connect

    Thapon, G. ); Blight, J.; Durand, B. )

    1992-01-01

    With the objective of improving weld quality, reducing outage times, and minimizing integrated dose, Electricite de France (EdF) and Comex Nucleaire (CxN) have developed a number of advanced remotely controlled welding systems. Three such developments are described, two having been used operationally and the third being qualified for use in the coming months. The three developments involve replacing pressurizes heaters, replacing fuel charge head sleeves, and real-time interactive welding.

  3. Perspectives and visions on CO2 capture and utilisation.

    PubMed

    North, M; Styring, P

    2015-01-01

    This article summarises and contextualises the debates which occurred during the Carbon Dioxide Utilisation Faraday Discussion meeting. The utilisation of carbon dioxide is discussed in terms of both conversion to fuel, with a potential impact on atmospheric carbon dioxide levels, and conversion to chemicals with a potential impact on sustainability.

  4. Trends in hospital bed utilisation in New Zealand 1989 to 2006: more or less beds in the future?

    PubMed

    Malcolm, Laurence

    2007-10-26

    Reduction in hospital bed utilisation has been a key factor in controlling costs in recent decades in many health systems, including New Zealand's. This paper has the following aims: to analyse trends in hospital bed utilisation from 1988 to 2006; to examine variation between district health boards (DHBs); to consider factors which may explain the trends observed; to compare the results with international trends; and to discuss future need for beds and factors affecting this need, including the integrated DHB system. Ministry of Health Hospital Throughput reports for 1988/89 to 2005/06 were accessed and present standardised, filtered, and truncated data on discharges, average length of stay (ALOS), bed days, and DHB comparisons. Data on beds were also obtained from the Private Surgical Hospitals Association. Rates of utilisation were calculated using Statistics New Zealand and the Ministry of Health population data. Australian, UK, and US comparisons were obtained. The New Zealand data showed a continuing rise in discharge rates, especially case weighted. This was almost entirely due to the increase in day patients. There was a marked downward trend in bed day rates due to a more than 50% decline in the ALOS and a corresponding decline in bed availability. There was a marked variation between DHBs in standardised discharge ratios in 2005/06, with low rates indicating potential benchmarks to which higher utilisation DHBs might aspire. New Zealand was well ahead of both Australia and the UK National Health System (NHS) in reducing bed utilisation but comparisons with Kaiser Permanente indicated that DHBs could potentially, even dramatically, reduce bed utilisation through reducing admissions. The findings point to important progress in New Zealand in containing costs associated with hospital bed utilisation. Future strategies need to focus strongly on reducing hospital admissions through PHO action to provide community alternatives and chronic disease management.

  5. Utilisation of chip thickness models in grinding

    NASA Astrophysics Data System (ADS)

    Singleton, Roger

    Grinding is now a well established process utilised for both stock removal and finish applications. Although significant research is performed in this field, grinding still experiences problems with burn and high forces which can lead to poor quality components and damage to equipment. This generally occurs in grinding when the process deviates from its safe working conditions. In milling, chip thickness parameters are utilised to predict and maintain process outputs leading to improved control of the process. This thesis looks to further the knowledge of the relationship between chip thickness and the grinding process outputs to provide an increased predictive and maintenance modelling capability. Machining trials were undertaken using different chip thickness parameters to understand how these affect the process outputs. The chip thickness parameters were maintained at different grinding wheel diameters for a constant productivity process to determine the impact of chip thickness at a constant material removal rate.. Additional testing using a modified pin on disc test rig was performed to provide further information on process variables. The different chip thickness parameters provide control of different process outputs in the grinding process. These relationships can be described using contact layer theory and heat flux partitioning. The contact layer is defined as the immediate layer beneath the contact arc at the wheel workpiece interface. The size of the layer governs the force experienced during the process. The rate of contact layer removal directly impacts the net power required from the system. It was also found that the specific grinding energy of a process is more dependent on the productivity of a grinding process

  6. Integrated nuclear data utilisation system for innovative reactors.

    PubMed

    Yamano, N; Hasegawa, A; Kato, K; Igashira, M

    2005-01-01

    A five-year research and development project on an integrated nuclear data utilisation system was initiated in 2002, for developing innovative nuclear energy systems such as accelerator-driven systems. The integrated nuclear data utilisation system will be constructed as a modular code system, which consists of two sub-systems: the nuclear data search and plotting sub-system, and the nuclear data processing and utilisation sub-system. The system will be operated with a graphical user interface in order to enable easy utilisation through the Internet by both nuclear design engineers and nuclear data evaluators. This paper presents an overview of the integrated nuclear data utilisation system, describes the development of a prototype system to examine the operability of the user interface and discusses specifications of the two sub-systems.

  7. ED09-0070-01

    NASA Image and Video Library

    2009-03-29

    The U.S. Air Force's F-16D Automatic Collision Avoidance Technology (ACAT) aircraft cruises during a flight originating from NASA's Dryden Flight Research Center. NASA Dryden worked with the Air Force Research Laboratory in the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for fighter/attack aircraft that would reduce the risk of ground and mid-air collisions.

  8. ED10-0236-35

    NASA Image and Video Library

    2010-08-17

    The Air Force F-16D Automatic Collision Avoidance Technology aircraft flew at low levels above the Sierra Nevada Mountains to test the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for aircraft, to reduce the risk of ground collisions.

  9. MicroED data collection and processing

    SciTech Connect

    Hattne, Johan; Reyes, Francis E.; Nannenga, Brent L.; Shi, Dan; Cruz, M. Jason de la; Leslie, Andrew G. W.; Gonen, Tamir

    2015-07-01

    The collection and processing of MicroED data are presented. MicroED, a method at the intersection of X-ray crystallography and electron cryo-microscopy, has rapidly progressed by exploiting advances in both fields and has already been successfully employed to determine the atomic structures of several proteins from sub-micron-sized, three-dimensional crystals. A major limiting factor in X-ray crystallography is the requirement for large and well ordered crystals. By permitting electron diffraction patterns to be collected from much smaller crystals, or even single well ordered domains of large crystals composed of several small mosaic blocks, MicroED has the potential to overcome the limiting size requirement and enable structural studies on difficult-to-crystallize samples. This communication details the steps for sample preparation, data collection and reduction necessary to obtain refined, high-resolution, three-dimensional models by MicroED, and presents some of its unique challenges.

  10. Expedition 7 Crew Interview: Ed Lu

    NASA Technical Reports Server (NTRS)

    2003-01-01

    Ed Lu of Expedition Seven is seen during a pre-launch interview. He explains why he became interested in space flight. He states that this is a different type of mission and gives his reaction to the Columbia Space Shuttle tragedy. The handover of Expedition six is explained by Ed Lu. The challenges of this mission are also described by Lu. These challenges include working with a crew member reduction from three to two, and the conservation of clothing and consumables. Ed Lu talks about what it is like to work with commander Yuri Malenchenko in space. Finally, Ed Lu states that he will continue scientific experiments in space on calcium loss in bones.

  11. Expedition 7 Crew Interview: Ed Lu

    NASA Technical Reports Server (NTRS)

    2003-01-01

    Ed Lu of Expedition Seven is seen during a pre-launch interview. He explains why he became interested in space flight. He states that this is a different type of mission and gives his reaction to the Columbia Space Shuttle tragedy. The handover of Expedition six is explained by Ed Lu. The challenges of this mission are also described by Lu. These challenges include working with a crew member reduction from three to two, and the conservation of clothing and consumables. Ed Lu talks about what it is like to work with commander Yuri Malenchenko in space. Finally, Ed Lu states that he will continue scientific experiments in space on calcium loss in bones.

  12. 78 FR 55684 - ConnectED Workshop

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... ConnectED Workshop will discuss the growing bandwidth needs of K-12 schools as more schools use mobile devices to enrich the learning experience; as teachers increasingly integrate Web video and other digital...

  13. Utilisation of cancer screening services by disabled women in Chile.

    PubMed

    Sakellariou, Dikaios; Rotarou, Elena S

    2017-01-01

    Research has shown that women with disabilities face additional challenges in accessing and using healthcare services compared to non-disabled women. However, relatively little is known about the utilisation of cancer screening services for women with disabilities. This study addresses this gap by examining the utilisation of the Papanicolaou test and mammography for disabled women in Chile. We used cross-sectional data, taken from a 2015 nationally-representative survey. Initially, we employed logistic regressions to test for differences in utilisation rates for the Papanicolaou test (66,281 observations) and the mammogram (35,294 observations) between disabled and non-disabled women. Next, logistic regressions were used to investigate the demographic, socioeconomic, and health-related factors affecting utilisation rates for cancer screening services for disabled women (sample sizes: 5,823 observations for the Papanicolaou test and 5,731 observations for the mammogram). Disabled women were less likely to undergo screening tests than non-disabled women. For the Papanicolaou test and mammography, the multivariable regression models showed that living in rural areas, having higher education, being affiliated with a private health insurance company, giving a good health self-assessment score, and being under medical treatment for other illnesses were associated with higher utilisation rates. On the other hand, being single, inactive with regard to employment, and having a better income were linked with lower utilisation. While utilisation rates for both disabled and non-disabled women have increased since 2006, the utilisation disparity has slightly increased. This study shows the influence of various factors in the utilisation rates of preventive cancer screening services for disabled women. To develop effective initiatives targeting inequalities in the utilisation of cancer screening tests, it is important to move beyond an exclusively single-disease approach and

  14. Dietary sugar utilisation by putative oral probiotics.

    PubMed

    Stamatova, I; Kari, K; Hervonen, L; Meurman, J H

    2012-09-01

    Probiotic consumption and repeated probiotic intake have shown promising results as adjunct therapies in prevention and alleviation of some chronic disease conditions in the gastrointestinal tract. Recent evidence suggests that probiotics may also be beneficial in preventing oral diseases. An efficient probiotic candidate in the mouth, however, should not impose any risk to oral tissues, such as acid demineralisation of tooth enamel because of sugar fermentation. The aim of the present in vitro study was to evaluate the utilisation of some sugars and sugar alcohols by yogurt starter Lactobacillus delbrueckii subsp. bulgaricus strains and to assess the influence of these carbohydrate sources on cell surface properties. For comparsion, a commercially available probiotic, Lactobacillus rhamnosus GG, was used. The results showed that lactose, glucose and fructose were readily metabolised by all strains tested. However, strain-specific metabolic patterns were observed when other sugars and sugar alcohols were used as sole carbohydrate source in the growth medium. Surface properties of the bacteria such as hydrophobicity and surface-associated proteins appeared to vary with the carbohydrate content of the growth medium. Based on these results it can be concluded that among the L. delbrueckii subsp. bulgaricus strains probiotic candidate strains are available that warrant further studies due to their inability to ferment sugars with pronounced cariogenic properties.

  15. The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder.

    PubMed

    Robinson, Paul; Hellier, Jennifer; Barrett, Barbara; Barzdaitiene, Daiva; Bateman, Anthony; Bogaardt, Alexandra; Clare, Ajay; Somers, Nadia; O'Callaghan, Aine; Goldsmith, Kimberley; Kern, Nikola; Schmidt, Ulrike; Morando, Sara; Ouellet-Courtois, Catherine; Roberts, Alice; Skårderud, Finn; Fonagy, Peter

    2016-11-17

    In this multi-centre randomized controlled trial (RCT) we compared modified mentalisation-based treatment (MBT-ED) to specialist supportive clinical management (SSCM-ED) in patients with eating disorders (EDs) and borderline personality disorder symptoms (BPD). This group of patients presents complex challenges to clinical services, and a treatment which addresses their multiple problems has the potential to improve outcome. MBT has been shown to be effective in improving outcome in patients with BPD, but its use has not been reported in ED. Sixty-eight eligible participants were randomised to MBT-ED or SSCM-ED. The primary outcome measure was the global score on the Eating Disorder Examination. Secondary outcomes included measures of BPD symptoms (the Zanarini Rating Scale for Borderline Personality Disorder), general psychiatric state, quality of life and service utilisation. Participants were assessed at baseline and at 6, 12 and 18 months after randomisation. Analysis was performed using linear mixed models. Only 15 participants (22 %) completed the 18 month follow-up. Early drop-out occurred significantly more in the SSCM-ED group. Drop-out did not vary with treatment model later in therapy and was sometimes attributed to participants moving away. There was higher drop--out amongst smokers and those with higher neuroticism scores. 47.1 % of participants in the MBT-ED arm and 37.1 % in the SSCM-ED arm attended at least 50 % of therapy sessions offered. Amongst those remaining in the trial, at 12 and 18 months MBT-ED was associated with a greater reduction in Shape Concern and Weight Concern in the Eating Disorder Examination compared to SSCM-ED. At 6, 12 and 18 months there was a decline of ED and BPD symptoms in both groups combined. Ten participants were reported as having had adverse events during the trial, mostly self-harm, and there was one death, attributed as 'unexplained' by the coroner. The high drop-out rate made interpretation of the results

  16. Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort.

    PubMed

    Linard, M; Blondel, B; Estellat, C; Deneux-Tharaux, C; Luton, D; Oury, J F; Schmitz, T; Mandelbrot, L; Azria, E

    2017-06-20

    Because the effectiveness of antenatal care in reducing pregnancy complications is still discussed despite widespread recommendations of its use, we sought to assess the association between utilisation of recommended antenatal care and severe maternal (SMM) and perinatal morbidity (SPM). Prospective cohort study. Four maternity units around Paris in 2010-2012. 9117 women with singleton pregnancies. Logistic regression models adjusted for maternal social, demographic and medical characteristics. Antenatal care utilisation was assessed by: (1) initiation of care after 14 weeks, (2) < 50% of recommended visits made, according to gestational age, (3) absence of the first, second or third trimester ultrasounds, (4) two modified Adequacy of Prenatal Care Utilisation indexes, combining these components. The two main outcomes were composite variables of SMM and SPM. According to the modified Adequacy of Prenatal Care Utilisation index, 34.6% of women had inadequate antenatal care utilisation; the incidence of severe maternal morbidity (SMM) was 2.9% and severe perinatal morbidity (SPM) 5.5%. A percentage of recommended visits below 50% (2.6% of women) was associated with SMM [adjusted odds ratio (OR) 2.40 (1.38-4.17)] and SPM [aOR 2.27 (1.43-3.59)]. Late initiation of care (17.0% of women) was not associated with SMM or SPM. Failure to undergo the recommended ultrasounds (16, 17 and 22% of women) was associated with SPM. Inadequate antenatal care utilisation according to the index was associated with SPM [aOR 1.37 (1.05-1.80)]. Inadequate antenatal care utilisation is associated with SMM and SPM, to degrees that vary with the component of care and the outcome considered. Inadequate antenatal care utilisation is associated with severe maternal and perinatal morbidity. © 2017 Royal College of Obstetricians and Gynaecologists.

  17. ED visits by males with hemophilia.

    PubMed

    Nuss, Rachelle; Hoffman, Richard; Hammond, Lucinda

    2002-03-01

    Hemophilia is a rare disorder affecting 1 in 5,000 males. Because hemophilia-associated hemorrhage may occur at anytime, affected males frequently seek care in the ED. We studied the epidemiology of ED visits by males with hemophilia. The medical records of all identified Coloradan males with hemophilia who sought care in Colorado EDs in 1998 were reviewed. Fifty-one males with hemophilia had a total of 125 ED visits; hemorrhage accounted for 64.8% of visits (95% CI=55.6, 73.1). On 13.0% (95% CI=6.4, 22.6) of visits for hemorrhage, treatment was warranted, but not given. On 12.3% (95% CI=5.5, 22.8) of visits when treatment was given, there were errors in product choice or dose. Documentation of factor concentrate brand and lot number was present for just 13.9% (95% CI=6.5, 24.7) and 24.6% (95% CI=14.8, 36.9) of visits, respectively. There is substantial room for improvement in the prescribing practices and documentation related to hemophilia care in the ED. Available resources should be utilized by ED physicians. Copyright 2002, Elsevier Science (USA). All rights reserved.)

  18. ED09-0070-02

    NASA Image and Video Library

    2009-03-29

    The U.S. Air Force's F-16D Automatic Collision Avoidance Technology (ACAT) aircraft eclipsed the sun during a flight in March 2009. NASA's Dryden Flight Research Center worked with the Air Force Research Laboratory in the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for fighter/attack aircraft that would reduce the risk of ground and mid-air collisions.

  19. ED09-0070-27

    NASA Image and Video Library

    2009-03-29

    The U.S. Air Force's F-16D Automatic Collision Avoidance Technology (ACAT) aircraft banks over NASA's Dryden Flight Research Center during a March 2009 flight. NASA Dryden worked with the Air Force Research Laboratory in the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for fighter/attack aircraft that would reduce the risk of ground and mid-air collisions.

  20. ED09-0070-21

    NASA Image and Video Library

    2009-03-29

    The U.S. Air Force's F-16D Automatic Collision Avoidance Technology (ACAT) aircraft flies over Rogers Dry Lake at Edwards Air Force Base, CA. NASA's Dryden Flight Research Center worked with the Air Force Research Laboratory in the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for fighter/attack aircraft that would reduce the risk of ground and mid-air collisions.

  1. ED09-0070-39

    NASA Image and Video Library

    2009-03-29

    The U.S. Air Force's F-16D Automatic Collision Avoidance Technology (ACAT) aircraft crew takes a close look at a Mojave Desert hill during a March 2009 flight. NASA's Dryden Flight Research Center worked with the Air Force Research Laboratory in the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for fighter/attack aircraft that would reduce the risk of ground and mid-air collisions.

  2. ED09-0070-29

    NASA Image and Video Library

    2009-03-29

    The U.S. Air Force's F-16D Automatic Collision Avoidance Technology (ACAT) aircraft banks over NASA's Dryden Flight Research Center during a flight in March 2009. NASA Dryden worked with the Air Force Research Laboratory in the ACAT Fighter Risk Reduction Project to develop collision avoidance technologies for fighter/attack aircraft that would reduce the risk of ground and mid-air collisions.

  3. Prevalence and correlates of erectile dysfunction (ED) and treatment seeking for ED in Asian Men: the Asian Men's Attitudes to Life Events and Sexuality (MALES) study.

    PubMed

    Tan, Hui-Meng; Low, Wah Yun; Ng, Chirk Jenn; Chen, Kuang-Kuo; Sugita, Minoru; Ishii, Nobuhisa; Marumo, Ken; Lee, Sung Won; Fisher, William; Sand, Michael

    2007-11-01

    There have been limited multiregional studies in Asia examining the parameters of men's general and sexual health and quality of life in the general population vs. those in clinical cohorts of patients with erectile dysfunction (ED). The aims of the Asian Men's Attitudes to Life Events and Sexuality (Asian MALES) study were to investigate the prevalence of ED, associated health conditions, and ED treatment-seeking patterns in the general male population in five regions of Asia (China, Japan, Korea, Malaysia, and Taiwan). Standardized questionnaire previously used in a similar multiregional study and modified to ensure culturally appropriate content for Asia. Phase I of the study involved 10,934 adult men, aged 20-75 years, who were interviewed using the standardized questionnaire. Phase II of the study involved men with self-reported ED recruited from Phase I and via physician referral, invitations in general practitioner offices, and street interception (total Phase II sample, N = 1,209). The overall prevalence of self-reported ED in the Phase I study population was 6.4%. ED prevalence varied by region and significantly increased with age (P < 0.01). Men with ED reported significantly greater rates of comorbid illness (P < 0.0001) and a reduced quality of life (P = 0.0001), compared with men without ED. Phase II of the study revealed that fewer than half of men with self-reported ED had sought treatment for their problem. Men were more likely to seek help for erection difficulties from Western doctors than from traditional medicine practitioners (P = 0.0001). A man's partner/spouse was the most common influencer of treatment seeking in all regions except Malaysia. The findings confirm those of existing research on ED in both Asian and non-Asian males: ED is a prevalent condition; the prevalence of ED increases with age and is strongly associated with comorbid conditions; and the majority of men have never sought treatment for their condition. This study highlights

  4. Patient non-attendance: utilising clinical time.

    PubMed

    Bateman, Heidi; Thomason, J Mark; Ellis, Janice

    2016-06-01

    In undergraduate dental or medical programmes clinical time with exposure to patients is limited. A priority for all those involved in the delivery of a clinical programme is to ensure that this time is used effectively and to maximum potential. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important. We have developed a range of close-contact teaching and learning activities (CCTLs) for dental students to productively use patient non-attendance time. CCTLs are short, skills-based tasks that are directly observed and have structured assessment criteria. Used formatively, they are performed in the clinical environment utilising the materials, equipment and clinical staff usually available during the clinical session. The CCTLs have proved particularly useful for early-stage clinical students, by developing understanding and skills, reinforcing protocols and promoting the role of the wider dental team in teaching. Students have welcomed these activities and engagement has been high. In addition to improving skills, they have proved helpful in familiarising students with direct observation, and have inspired peer collaboration and feedback. The CCTLs have promoted opportunities for students to receive direct feedback, which may be difficult to deliver if a patient were present. Empowering students to lead on their own learning requirements also promotes the ethos of lifelong learning that will be fundamental to future professional development. Investment of resources to develop these activities has proved worthwhile, as we have found that CCTLs can complement and maximise the potential of clinical attachments. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important. © 2015 John Wiley & Sons Ltd.

  5. Plutonium utilisation in future UK PWRs

    SciTech Connect

    Thomas, G. M.; Worrall, A.

    2006-07-01

    Plutonium recycling in the form of Mixed Oxide (MOX) fuels is already a reality in over 30 reactors in Europe (in Belgium, Switzerland, Germany and France). Japan also plans to use MOX in approximately 30% of its reactors in the near future[1]. This paper describes potential near to mid-term disposition strategies for the United Kingdom's stockpile of plutonium. In order to be confident that MOX fuel can be utilised effectively in Pressurised Water Reactors (PWRs) in the UK, details are given of studies carried out recently at Nexia Solutions on PWR cores loaded with MOX containing typical UK plutonium isotopic compositions. Three dimensional steady state neutronic models of a standard Westinghouse four loop PWR design are constructed using state of the art tools (Studsvik of America's Core Management System[2, 3, 4]). Initially, a standard 18-month equilibrium UO{sub 2} fuel cycle is generated, followed by safety analyses and fuel performance calculations to demonstrate its feasibility. This equilibrium UO{sub 2} core is then gradually transitioned through loading patterns containing increasing MOX core loading fractions. Finally, an equilibrium MOX core loading pattern is determined. Technical safety analyses are also carried out on the transition cores and the final equilibrium scenario to ensure that all of the MOX cores are robust from a technical and safety viewpoint. Once these studies are completed the annual fuel throughputs for each scenario can be determined and used to produce options for managing the UK's plutonium stockpile. This work is part of a wider exercise currently being carried out by Nexia Solutions to explore the options for the safe disposition of the UK civil stockpile of separated PUO{sub 2}. (authors)

  6. Safe Handling of Snakes in an ED Setting.

    PubMed

    Cockrell, Melanie; Swanson, Kristofer; Sanders, April; Prater, Samuel; von Wenckstern, Toni; Mick, JoAnn

    2017-01-01

    Efforts to improve consistency in management of snakes and venomous snake bites in the emergency department (ED) can improve patient and staff safety and outcomes, as well as improve surveillance data accuracy. The emergency department at a large academic medical center identified an opportunity to implement a standardized process for snake disposal and identification to reduce staff risk exposure to snake venom from snakes patients brought with them to the ED. A local snake consultation vendor and zoo Herpetologist assisted with development of a process for snake identification and disposal. All snakes have been identified and securely disposed of using the newly implemented process and no safety incidents have been reported. Other emergency department settings may consider developing a standardized process for snake disposal using listed specialized consultants combined with local resources and suppliers to promote employee and patient safety. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  7. Impact of continuous Medical Aid utilisation on healthcare utilisation: unique insight using the 2008–2012 Korean Welfare Panel Study (KOWEPS)

    PubMed Central

    Kim, Jae-Hyun; Kim, Na Rae; Park, Eun-Cheol; Han, Kyu-Tae; Choi, Young; Lee, Sang Gyu

    2016-01-01

    Objectives Although there has been considerable discussion about the social safety net, few studies related to effect of duration of continuous receipt of Medical Aid on healthcare utilisation have been conducted. Therefore, we investigate whether the duration of receiving Medical Aid affected medical care utilisation. Setting Data were collected from the Korean Welfare Panel Study conducted from 2008 to 2012. Participants We included 11 783 samples. Interventions Estimating changes in their healthcare utilisation during specific time intervals (1, 2 and ≥3 years) after they switched from National Health Insurance to Medical Aid. Primary and secondary outcome measures Number of outpatient visits. Results The number of outpatient visits per year was 0.0.051-fold higher (p value: 0.434) among those who were Medical Aid beneficiaries for a continuous period of 1 year, 0.0.267-fold higher (p value: 0.000) among those who were beneficiaries for a continuous period of 2 years, and 0.0.562-fold higher (p value:<0.0001) among those who were beneficiaries for a continuous period of 3 years than it was among those who were beneficiaries of National Health Insurance. Conclusions Our results reflect an association between the number of consecutive years of receiving Medical Aid and number of outpatient visits. Since duration of dependence is correlated with reduced exit rates, limits on length of benefits should be considered to strengthen the incentive to return to work. PMID:27053265

  8. Natural gas development and utilisation pattern in India

    SciTech Connect

    Mulchandani, H.K.; Balakrishnan, M.

    1984-02-01

    In this era of energy consciousness, Natural Gas is destined to play an important role in the economic life of India. The luxury of flaring into atmosphere is over. Rather stocks are being assessed and capital investments are planned for the optimum development and utilisation of gas. In this paper, authors have attempted to tie up various data on different aspects of gas business such as supply, source, production, utilisation pattern and its share in energy and economy. The optimal utilisation plan as discussed here could be of some value to the planners.

  9. Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study

    PubMed Central

    2013-01-01

    Background Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6–12 months post-event, in central Australia. Methods This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients’ “typical” journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels. Results Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. Conclusion Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented

  10. Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions.

    PubMed

    Johnson, Pamela Jo; Ghildayal, Neha; Ward, Andrew C; Westgard, Bjorn C; Boland, Lori L; Hokanson, Jon S

    2012-12-01

    Hospital care for ambulatory care sensitive conditions (ACSC) is potentially avoidable and often viewed as an indicator of suboptimal primary care. However, potentially preventable encounters with the health care system also occur in emergency department (ED) settings. We examined ED visits to identify subpopulations with disproportionate use of EDs for ACSC care. We analyzed data from the 2007-2009 National Hospital Ambulatory Medical Care Survey for 78,114 ED visits by adults aged 18 and older. Outcomes were ACSC visits determined from the primary ED diagnosis. We constructed analytic groups aligned with Agency for Healthcare Research and Quality's priority populations. Multivariate logistic regression was used to estimate the odds of all-cause, acute, and chronic ACSC visits. We used Stata SE survey techniques to account for the complex survey design. Overall, 8.4% of ED visits were for ACSC, representing over 8 million potentially avoidable ED visits annually. ACSC visits were more likely to result in hospitalization than non-ACSC visits (34.4% vs. 14.0%, P<0.001). Multivariate models revealed significant disparities in ACSC visits to the ED by race/ethnicity, insurance status, age group, and socioeconomic status, although patterns differed for acute and chronic ACSC. Disproportionately higher use of EDs for ACSC care exists for many priority populations and across a broader range of priority populations than previously documented. These differences constitute disparities in potentially avoidable ED visits for ACSC. To avoid exacerbating disparities, health policy efforts to minimize economic inefficiencies in health care delivery by limiting ED visits for ACSC should first address their determinants.

  11. Study: wait times continue to lengthen--visits increase as EDS disappear.

    PubMed

    2008-03-01

    Despite seemingly insurmountable odds, several ED managers have been able to reduce wait times--in many cases, quite dramatically. Here are some of the strategies they say will help you decrease those waiting times: Create a chest pain policy that focuses not only on getting patients back as quickly as possible, but also frontloads your work force. Encourage staff to bring EKG results to the ED doc as soon as they are obtained. When seeking important hospitalwide changes, remind your board of the political consequences of a poor ED image.

  12. Increased biohydrogen yields, volatile fatty acid production and substrate utilisation rates via the electrodialysis of a continually fed sucrose fermenter.

    PubMed

    Jones, Rhys Jon; Massanet-Nicolau, Jaime; Mulder, Martijn J J; Premier, Giuliano; Dinsdale, Richard; Guwy, Alan

    2017-04-01

    Electrodialysis (ED) removed volatile fatty acids (VFAs) from a continually-fed, hydrogen-producing fermenter. Simultaneously, electrochemical removal and adsorption removed gaseous H2 and CO2, respectively. Removing VFAs via ED in this novel process increased H2 yields by a factor of 3.75 from 0.24molH2mol(-1)hexose to 0.90molH2mol(-1)hexose. VFA production and substrate utilisation rates were consistent with the hypothesis that end product inhibition arrests H2 production. The methodology facilitated the recovery of 37g of VFAs, and 30L H2 that was more than 99% pure, both of which are valuable, energy dense chemicals. Typically, short hydraulic and solid retention times, and depressed pH levels are used to suppress methanogenesis, but this limits H2 production. To produce H2 from real world, low grade biomass containing complex carbohydrates, longer hydraulic retention times (HRTs) are required. The proposed system increased H2 yields via increased substrate utilisation over longer HRTs.

  13. Utilisation of Riverine Dom By Coastal Bacteria

    NASA Astrophysics Data System (ADS)

    Rochelle-Newall, E.; Pizay, M.-D.; Gattuso, J.-P.

    % and 69% and was generally highest in the LMW-DOM incubations. These results fur- ther demonstrate the flexibility of bacteria in their ability to utilise different sources of DOM.

  14. MicroED data collection and processing

    PubMed Central

    Hattne, Johan; Reyes, Francis E.; Nannenga, Brent L.; Shi, Dan; de la Cruz, M. Jason; Leslie, Andrew G. W.; Gonen, Tamir

    2015-01-01

    MicroED, a method at the intersection of X-ray crystallography and electron cryo-microscopy, has rapidly progressed by exploiting advances in both fields and has already been successfully employed to determine the atomic structures of several proteins from sub-micron-sized, three-dimensional crystals. A major limiting factor in X-ray crystallography is the requirement for large and well ordered crystals. By permitting electron diffraction patterns to be collected from much smaller crystals, or even single well ordered domains of large crystals composed of several small mosaic blocks, MicroED has the potential to overcome the limiting size requirement and enable structural studies on difficult-to-crystallize samples. This communication details the steps for sample preparation, data collection and reduction necessary to obtain refined, high-resolution, three-dimensional models by MicroED, and presents some of its unique challenges. PMID:26131894

  15. A Quantitative Content Analysis of Mercer University MEd, EdS, and Doctoral Theses

    ERIC Educational Resources Information Center

    Randolph, Justus J.; Gaiek, Lura S.; White, Torian A.; Slappey, Lisa A.; Chastain, Andrea; Harris, Rose Prejean

    2010-01-01

    Quantitative content analysis of a body of research not only helps budding researchers understand the culture, language, and expectations of scholarship, it helps identify deficiencies and inform policy and practice. Because of these benefits, an analysis of a census of 980 Mercer University MEd, EdS, and doctoral theses was conducted. Each thesis…

  16. TED-Ed lessons & TED-Ed clubs: Educational activities to amplify students' voices

    NASA Astrophysics Data System (ADS)

    Villias, Georgios

    2017-04-01

    TED-Ed lessons and TED-Ed clubs are two powerful educational tools that can be used in today's school classrooms in order to create an educational environment that is engaging for the students and favors their active participation, created and fostered by TED-Ed. TED-Ed is TED's educational initiative, committed to create lessons worth sharing and amplify the voices and ideas of teachers and students around the world. TED-Ed animated lessons are fully organized lessons structured around an animated video that introduces new topics to learners in an exciting, thought-provoking way. These lessons have been created as a result of the cooperation between expert educators and animators and have been uploaded at the TED-Ed platform (http://ed.ted.com). On the other hand, TED-Ed Clubs are also an interesting way to offer students the chance, the voice and the opportunity to express their thoughts, engage actively on these matters and connect with each other, both at a local, as well as at an international level (http://ed.ted.com/clubs). By developing new TED-Ed lessons or by customizing appropriately existing animated TED-Ed lessons (translating, modifying the questions asked, introducing new discussion topics), I have created and implemented in my student-centered, didactic approach, a series of TED-ED animated lessons directly connected with the Greek national science syllabus that were used to spark students curiosity and initiate a further analytical discussion or introduce other relevant educational activities (http://gvillias.wixsite.com/education). Furthermore, at my school, we established Varvakeio TED-Ed Club, an environment that supports and empowers our students to research, develop and disseminate their own personal ideas that worth spreading. During the year, our members were inspired by watching TED talks presented by experts on their field on various different areas, including social, economical, environmental and technological-scientific issues. Our aim

  17. Possibilities for the efficient utilisation of spent geothermal waters.

    PubMed

    Tomaszewska, Barbara; Szczepański, Andrzej

    2014-10-01

    Waters located at greater depths usually exhibit high mineral content, which necessitates the use of closed systems, i.e. re-injecting them into the formation after recovering the heat. This significantly reduces investment efficiency owing to the need to drill absorption wells and to perform anti-corrosion and anti-clogging procedures. In this paper, possibilities for the efficient utilisation of cooled geothermal waters are considered, particularly with respect to open or mixed geothermal water installations. Where cooled water desalination technologies are used, this allows the water to be demineralised and used to meet local needs (as drinking water and for leisure purposes). The retentate left as a by-product of the process contains valuable ingredients that can be used for balneological and/or leisure purposes. Thus, the technology for desalinating spent geothermal waters with high mineral content allows improved water management on a local scale and makes it possible to minimise the environmental threat resulting from the need to dump these waters into waterways or surface water bodies and/or inject them into the formation. The paper is concerned with Polish geothermal system and provides information about the parameters of Polish geothermal waters.

  18. Social determinants of dental health services utilisation of Greek adults.

    PubMed

    Pavi, E; Karampli, E; Zavras, D; Dardavesis, T; Kyriopoulos, J

    2010-09-01

    To identify the determinants of dental care utilisation among Greek adults, with a particular emphasis on socio-economic determinants. Data were collected through a national survey on health and health care services utilisation of a sample of 4,003 Greek adults stratified by geographic region, age and gender. A purpose made questionnaire was used during face-to-face interviews. A 2-stage model was developed to assess the impact of independent variables on dental utilisation likelihood and frequency. 39.6% (1,562) of Greek adults reported having visited a dentist within the last year. Among dental attenders, 32.6% reported prevention as the reason for visit. Statistically significant differences in dental care utilisation were observed in relation to demographic, socioeconomic and lifestyle factors. Logistic regression analysis showed that gender, age, income, education, place of residence, private insurance coverage and self-rated oral health are important determinants of dental services utilisation. Mean number of dental visits within previous year was 1.6. Results from Poisson regression analysis indicated that lower income level correlates to lower number of dental visits, while having visited for treatment (rather than for prevention) correlated to higher number of dental visits. Greek adults do not exhibit satisfactory dental visiting behaviour. Extent of care sought is associated with need for treatment rather than preventive reasons. The findings confirm the existence of socioeconomic inequalities in dental services utilisation among Greek adults.

  19. States leverage telepsychiatry solutions to ease ED crowding, accelerate care.

    PubMed

    2015-02-01

    Many states are having success turning to telepsychiatry-based solutions to connect mental health patients with needed care while also decompressing crowded EDs. Just one year into a statewide telepsychiatry initiative in North Carolina (NC-STeP), administrators say the approach has saved as much as $7 million, and hospital demand for the service is higher than anticipated. In Texas, mental health emergency centers (MHEC) that use telepsychiatry to connect patients in rural areas with needed psychiatric care are freeing up EDs to focus on medical care. In just 11 months, 91 North Carolina hospitals have at least started the process to engage in NC-STeP. Much of the savings from NC-STeP come from involuntary commitment orders being overturned as a result of the telepsychiatry consults, reducing the need for expensive inpatient care. Implementing NC-STeP has involved multiple hurdles including credentialing difficulties and technical/firewall challenges. The Texas model provides 24/7 availability of psychiatrists via telemedicine through a network of MHECs. In-person staff at the MHECs perform basic screening tests and blood draws so that medical clearance can be achieved without the need for an ED visit in most cases. Funding for the MHECs comes from the state, hospitals in the region, and local governmental authorities that reap savings or benefits from the initiative.

  20. One Year Medical Outcomes and ED Recidivism Following ED Observation for Cocaine-Associated Chest Pain

    PubMed Central

    Cunningham, Rebecca; Walton, Maureen A.; Weber, Jim Edward; O'Broin, Samantha; Tripathi, Shanti P; Maio, Ronald F.; Booth, Brenda M.

    2010-01-01

    Chest pain is the most common complaint among cocaine users who present to the ED seeking care and many hospital resources are applied to stratify cocaine users in regard to future cardiac morbidity and mortality. Little is known about the longitudinal cardiac and non cardiac medical outcomes of cocaine users who have been stratified to an ED observation period following their ED visit. Objectives to examine one-year cardiac outcomes in a low-intermediate risk sample of patients with cocaine- associated chest pain in an urban ED, as well as to examine ED recidivism one year for cardiac and non-cardiac complaints. Methods Prospective consecutive cohort study of patients (18–60 years) who presented to an urban Level 1 ED with cocaine-associated chest pain and were risk stratified to low-intermediate cardiac risk. Exclusion criteria: EKG suggestive of AMI, elevated serum cardiac markers, history of AMI or CABG, hemodynamic instability, unstable angina. Baseline interviews using validated measures of health functioning, and substance use were conducted during CPOU stay, and 3, 6, and 12 months. ED utilization during the study year was abstracted from medical chart. Zero-Inflated Poisson regression analyses were conducted to predict recurrent ED visits. Results 219 participants (73% participation) were enrolled, 65% returned to the ED post index visit; 23% returned for chest pain, of these 66% had a positive cocaine urine screen. No patient had an AMI within the one year follow up period. Patients with continued cocaine use were more likely to have a recurrent ED visit (p<0.001) but these repeat visits were most often related to musculoskeletal pain (21%), and injury (30%) rather than potential cardiac complaints. Conclusions Patients with cocaine-associated chest pain who are low to intermediate cardiac risk and complete a CPOU protocol have less then 1% rate of MI in the subsequent 12-months. PMID:18824277

  1. Resource utilization and health care charges associated with the most frequent ED users.

    PubMed

    Ondler, Cory; Hegde, G G; Carlson, Jestin N

    2014-10-01

    Emergency department (ED) visits have continued to rise, and frequent ED users account for up to 8% of all ED visits. Reducing visits by frequent ED users may be one way to help reduce health care costs. We hypothesize that frequent users have unique ED utilization patterns resulting in differences in health care charges. We conducted a retrospective review of electronic medical records from an urban community teaching hospital for the year 2012 comparing the top 108 frequent ED users (>12 visits/year) to a randomly selected group of 108 nonfrequent users (<4 visits/year). We compared demographic characteristics, distance lived from the hospital, medical and psychiatric history, substance abuse history, diagnostic testing, disposition, and amount charged to the patient for each visit. We compared data using χ(2) for proportions and t test or Wilcoxon rank sum based on normality of the data. The top 108 frequent ED users accounted for 1922 visits (2.9%), whereas the 108 nonfrequent users accounted for 150 visits (0.2%), in 2012 (all ED visits n = 65,398). Frequent users were more often unemployed, have public insurance, have mental health conditions, use tobacco, have a greater number of allergies to medications, and live closer to the hospital (P < .01). Disposition and median charge per visit did not differ between frequent and nonfrequent users ($1220 vs $1280). The total charges of the frequent ED users' visits were $10,465,216.07 versus $1,012,610.21 for nonfrequent users. Frequent users have unique medical and social characteristics; however, disposition and visit charges did not differ from nonfrequent users. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial.

    PubMed

    Cunningham, Rebecca M; Chermack, Stephen T; Ehrlich, Peter F; Carter, Patrick M; Booth, Brenda M; Blow, Frederic C; Barry, Kristen L; Walton, Maureen A

    2015-10-01

    This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program. Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED. A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation. Copyright © 2015 by the American Academy of Pediatrics.

  3. Canadian EdGEO National Workshop Program

    NASA Astrophysics Data System (ADS)

    Clinton, L. A.; Haidl, F. M.; Hymers, L. A.; van der Flier-Keller, E.

    2009-05-01

    Established in the early 1970s, EdGEO supports locally driven geosciences workshops for Canadian teachers. Workshops are organized by geoscientists and teachers, and typically have field, laboratory and classroom components. Grants of up to $3000 per workshop are available from the National EdGEO Program. By providing educational opportunities for today's teachers and, through them, their students, EdGEO seeks to cultivate a heightened awareness of our planet. EdGEO workshops provide teachers with potential fieldtrip sites for their students and the knowledge, enthusiasm and materials to inspire their students to engage in geoscience. Networking opportunities with local experts promote the importance of the geoscience profession. The expected result is an improved capacity on the part of Canadians to understand the Earth and to make informed decisions, especially with regard to the use of mineral and energy resources, the maintenance and remediation of the environment, and response to geological hazards. There exists a critical need to provide teachers with training and resources to tackle their Earth science curricula. In 2008, EdGEO supported fourteen workshops, with an unprecedented 521 teachers attending. These teachers then used our resources to reach an estimated 14,000 students during that single academic year. EdGEO workshops are locally driven and are therefore very diverse. Workshops are strongly tied to the provincial curriculum, focus on a specific geoscience topic, or may be largely field-based to demonstrate and practice how field activities could be incorporated into Earth science teaching. Many strive to include all of these important components. Geoscientists and teachers work collaboratively to develop and deliver EdGEO workshops to ensure that the activities can be effectively used in the classroom. The length of these professional development opportunities range from two-hour sessions to several days, and can generally accommodate up to twenty

  4. 34 CFR 85.942 - ED Deciding Official.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false ED Deciding Official. 85.942 Section 85.942 Education Office of the Secretary, Department of Education GOVERNMENTWIDE DEBARMENT AND SUSPENSION (NONPROCUREMENT) Definitions § 85.942 ED Deciding Official. The ED Deciding Official is an ED officer who has...

  5. Jarosite characteristics and its utilisation potentials.

    PubMed

    Pappu, Asokan; Saxena, Mohini; Asolekar, Shyam R

    2006-04-15

    During metallic zinc extraction from zinc sulphide or sulphide ore, huge quantity of jarosite is being released universally as solid residues. The jarosite mainly contains iron, sulphur, zinc, calcium, lead, cadmium and aluminium. Jarosite released from such industrial process is complex and its quality and quantity make the task more complex for safe disposal. Apart from water contamination, jarosite already accumulated and its increasing annual production is a major source of pollution for surrounding environment including soil, vegetation and aquatic life and hence its disposal leads to major concern because of the stringent environmental protection regulations. An attempt was made to evaluate the characteristics of Indian jarosite with an objectives to understand its potentials for recycling and utilising as raw materials for developing value added products. Sand and Coal Combustion Residues (CCRs) was used as an admixture to attain good workability and detoxify the toxic substance in the jarosite. Result revealed that jarosite is silty clay loam in texture having 63.48% silt sized and 32.35% clay sized particles. The particle size of jarosite (D90=16.21+/-0.20 microm) is finer than the CCRs (D90=19.72+/-0.18 microm). The jarosite is nonuniform in structure and shape as compared to the CCRs having spherical, hollow shaped and some of them are cenosphere in nature. The major mineral phase of jarosite is Potassium Iron Sulphate Hydroxide {KFe3(SO4)2(OH)6}and Iron Sulphate Hydrate {2 Fe2O3SO3 x 5 H2O}. In CCRs the dominant phases are quartz {SiO2}, mullite {3 Al2O3 x 2 SiO2} and hematite {Fe2O3}. The high electrical conductivity of jarosite (13.26+/-0.437 dS/m) indicates that the presence of cations and anions are predominant over CCRs (0.498+/-0.007 dS/m). The major portion of jarosite consists of iron (23.66+/-0.18%), sulphur (12.23+/-0.2%) and zinc (8.243+/-0.075%). But CCRs main constituents are silicon (27.41+/-0.74%), aluminium (15.167+/-0.376%) and iron (4

  6. Solving the worldwide emergency department crowding problem - what can we learn from an Israeli ED?

    PubMed

    Pines, Jesse M; Bernstein, Steven L

    2015-01-01

    ED crowding is a prevalent and important issue facing hospitals in Israel and around the world, including North and South America, Europe, Australia, Asia and Africa. ED crowding is associated with poorer quality of care and poorer health outcomes, along with extended waits for care. Crowding is caused by a periodic mismatch between the supply of ED and hospital resources and the demand for patient care. In a recent article in the Israel Journal of Health Policy Research, Bashkin et al. present an Ishikawa diagram describing several factors related to longer length of stay (LOS), and higher levels of ED crowding, including management, process, environmental, human factors, and resource issues. Several solutions exist to reduce ED crowding, which involve addressing several of the issues identified by Bashkin et al. This includes reducing the demand for and variation in care, and better matching the supply of resources to demands in care in real time. However, what is needed to reduce crowding is an institutional imperative from senior leadership, implemented by engaged ED and hospital leadership with multi-disciplinary cross-unit collaboration, sufficient resources to implement effective interventions, access to data, and a sustained commitment over time. This may move the culture of a hospital to facilitate improved flow within and across units and ultimately improve quality and safety over the long-term.

  7. Controlling chromium slag pollution utilising scavengers: a case of Shandong Province, China.

    PubMed

    Liu, Changhao; Côté, Raymond P

    2015-04-01

    The problem of chromium slag pollution is a great challenge for China. It is now an urgent task for China to take effective measures to eliminate chromium slag pollution. This article examines the case of the treatment of chromium slag in Shandong Province and explores how chromium slag pollution can be eliminated in Shandong Province. It shows that the chromium slag stockpiled by the chemical plants was successfully utilised by local steel companies, who act as 'scavenger companies'. The driving mechanism, seeking a potential 'scavenger company' within the local region and the role of the local government on the case of Shandong Province are discussed. This article concludes that local steel companies can be utilised to effectively and efficiently treat the chromium slag while benefiting the steel companies. The local governments need to play multiple roles in solving the problem of chromium slag pollution. Seeking and identifying 'scavenger companies' within a region could be an important approach to reducing pollution within the region.

  8. ED's Oasis: Teacher Support for Internet Use.

    ERIC Educational Resources Information Center

    Gray, Terrie

    1998-01-01

    Describes ED's Oasis, a multifunction Web site funded by the AT&T Foundation, through the AT&T Learning Network program, and developed by a team of educators to help teachers use the Internet with their students. Examples are given of various possible uses, including designing interdisciplinary units. (LRW)

  9. What Should I Know about ED Grants?

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    The Department of Education's ability to create a high-performance education system is directly linked to the public's understanding of how to apply for and make proper use of federal grant funds. This booklet is intended for individuals who are interested in applying to the U.S. Department of Education (ED) for discretionary grants and…

  10. The Consequences of edTPA

    ERIC Educational Resources Information Center

    Greenblatt, Deborah

    2016-01-01

    States and teacher preparation programs across the country are increasingly using a teacher candidate assessment called edTPA. The purpose? To make sure that teacher candidates are ready and able to teach before they begin their careers. The teacher performance assessment requires candidates to compile a portfolio that consists of lesson plans,…

  11. Manufacturing techniques help turn ED around.

    PubMed

    2005-05-01

    Borrowing quality tools from other industries can help give you a new perspective on the operations of your ED. Computer simulations can help you visualize impact of patient arrivals at peak hours. A flexible approach opens up new options for using existing space more efficiently. 'Manufacturing' approach enables you to break down large processes into more manageable subsets.

  12. The Consequences of edTPA

    ERIC Educational Resources Information Center

    Greenblatt, Deborah

    2016-01-01

    States and teacher preparation programs across the country are increasingly using a teacher candidate assessment called edTPA. The purpose? To make sure that teacher candidates are ready and able to teach before they begin their careers. The teacher performance assessment requires candidates to compile a portfolio that consists of lesson plans,…

  13. Measuring the Impact of Re-ED

    ERIC Educational Resources Information Center

    Freado, Mark D.

    2010-01-01

    From its origins nearly a half century ago, the Re-ED model has generated a series of research studies evaluating its efficacy. This article provides a historical perspective on the evidence base for this early strength-based model for working with troubled youth.

  14. Mentoring from Different Social Spheres: How Can Multiple Mentors Help in Doctoral Student Success in Ed.D Programs?

    ERIC Educational Resources Information Center

    Terry, Tarae; Ghosh, Rajashi

    2015-01-01

    Doctoral students leave their programs early due to lack of mentoring relationships needed to support degree completion and success. However, how mentoring contributes to Ed.D degree completion is not widely studied. In this qualitative narrative study, we sought to explore how multiple mentoring relationships reduced attrition in an Ed.D program.…

  15. Mentoring from Different Social Spheres: How Can Multiple Mentors Help in Doctoral Student Success in Ed.D Programs?

    ERIC Educational Resources Information Center

    Terry, Tarae; Ghosh, Rajashi

    2015-01-01

    Doctoral students leave their programs early due to lack of mentoring relationships needed to support degree completion and success. However, how mentoring contributes to Ed.D degree completion is not widely studied. In this qualitative narrative study, we sought to explore how multiple mentoring relationships reduced attrition in an Ed.D program.…

  16. Impact of prospective verification of intravenous antibiotics in an ED.

    PubMed

    Hunt, Allyson; Nakajima, Steven; Hall Zimmerman, Lisa; Patel, Manav

    2016-12-01

    Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. This retrospective, institutional review board-approved preimplementation vs postimplementation study evaluated patients 18years or older who were started on IV antibiotics in the ED. Patients were excluded if pregnant, if the patient is a prisoner, if no cultures were drawn, or if the patient was transferred from an outside facility. Appropriate antibiotic therapy was based on empiric source-specific evidence-based guidelines, appropriate pharmacokinetic and pharmacodynamic properties, and microbiologic data. The primary end point was the time from ED arrival to administration of appropriate antibiotic therapy. Of the 1628 evaluated, 128 patients met the inclusion criteria (64 pre vs 64 post). Patients were aged 65.2±17.0years, with most of infections being pneumonia (44%) and urinary tract infections (18%) and most patients being noncritically ill. Time to appropriate antibiotic therapy was reduced in the postgroup vs pregroup (8.1±8.6 vs 15.2±22.8hours, respectively, P=.03). In addition, appropriate empiric antibiotics were initiated more frequently after the implementation (92% post vs 66% pre; P=.0001). There was no difference in mortality or length of stay between the 2 groups. Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of

  17. Utilisation of wartime nutrition survival experiences.

    PubMed

    Giay, T

    1998-12-01

    In protracted and recurrent conflict, Vietnamese people have learned to minimize food insecurity through governance, mutual social responsibility, infrastructure development, ecological sensitivity, agricultural diversification and emphasis on family needs and traditional food patterns. Drawing on this experience, in 1992 a National Plan of Action for Nutrition was devised. Its goals include increasing energy intake and reducing childhood malnutrition.

  18. Risk factors for ED use among homeless veterans.

    PubMed

    Tsai, Jack; Rosenheck, Robert A

    2013-05-01

    Despite national concern about homeless veterans, there has been little examination of their use of emergency department (ED) services. This study examines factors related to the use of ED services in the Veterans Affairs (VA) healthcare system, where insurance is not a barrier to ambulatory healthcare. National VA administrative data from fiscal year 2010 are used to describe the proportions of ED users among homeless and domiciled VA patients. A case-control design is then used to compare homeless ED and non-ED users on sociodemographic and clinical correlates, as well as use of ambulatory care and psychotropic medications. Sixteen percent of domiciled VA patients used EDs at least once during the year and 1% were frequent ED users (>4 ED visits) compared to 45% of homeless VA patients, 10% who were frequent ED users. Among homeless VA patients, those who used EDs were more likely to have a range of psychiatric and medical conditions, and had more service visits and psychotropic medication prescriptions than non-ED users. Multivariate analyses suggest their risk for psychiatric and medical conditions increase their likelihood of using ED services. The high rate of ED use among homeless veterans is associated with significant morbidity, but also greater use of ambulatory care and psychotropics suggesting their ED use may reflect unmet psychosocial needs.

  19. [Propofol: ED50 and ED90 induction doses in pediatric anesthesia].

    PubMed

    Blanco, D; Montes, A; Moreno, V; Costa, J; Alloza, P; Vidal, F

    1994-01-01

    To study ED50 and ED90 induction doses of propofol in children. Seventy-two children from 1 to 110 months of age and premedicated with pentobarbital 4 mg/kg participated in the study. Seven different doses of propofol (1.5, 2, 2.5, 3, 3.5, 4 and 4.5 mg/kg) were injected into the dorsal hand or foot vein in 30 seconds. We measured the response to application of the mask, corneal reflex and response to trapezius muscle compression 30 and 60 s after administration. A log-probit statistical analysis was used and complications were noted. The doses that produced 50% elimination of reflexes (ED50) or 90% elimination (ED90) in our patients were 1.74 and 3.95 mg/kg for response to mask; 2.47 and 4.26 mg/kg for elimination of corneal reflex; and 3.27 and 4.79 mg/kg for compression of trapezius. Frequency of pain upon injection was 74% and that of spontaneous movement was 12%. Apnea (breathing halted for longer than 20 s) occurred in 7% of our patients. We recorded no cases of broncho or laryngeal spasm, or skin rash. Induction with propofol is appropriate given the rarity of stimulant effects, but there is a high frequency of pain upon injection, limiting the usefulness of this drug for anesthetic induction in pediatrics. ED50 and ED90 varies depending on the stimulus assessed.

  20. Health care utilisation and problems in accessing health care of female undocumented immigrants in the Netherlands

    PubMed Central

    Loeffen, Maartje J.; van den Muijsenbergh, Maria E.; Lagro-Janssen, Antoine L. M.

    2010-01-01

    Objective To obtain information about the actual use of health care facilities by undocumented women and to identify obstacles they experience in accessing health care facilities. Methods A mixed methods study, with structured questionnaires and semi-structured interviews, was chosen to obtain a complete understanding. One-hundred undocumented women were recruited. Diversity was sought according to age, origin and reason for being undocumented. Results Undocumented female immigrants have unmet health care needs (56%) and low health care utilisation. Sixty-nine per cent of the women reported obstacles in accessing health care facilities. These included many personal obstacles such as shame, fear and/or lack of information. Poor language proficiency (OR 0.28;. CI 0.09–0.90) reduces utilisation of primary health care services. Conclusion Health care utilisation of undocumented women is low. Undocumented women refrain from seeking health care because of personal obstacles. These women need to be identified and informed about their rights, the health care system and the duty of professional confidentiality of doctors. Finally, institutional obstacles to access care should be removed since they strengthen reluctance to seek help. PMID:20502936

  1. Health care utilisation and problems in accessing health care of female undocumented immigrants in the Netherlands.

    PubMed

    Schoevers, Marianne A; Loeffen, Maartje J; van den Muijsenbergh, Maria E; Lagro-Janssen, Antoine L M

    2010-10-01

    To obtain information about the actual use of health care facilities by undocumented women and to identify obstacles they experience in accessing health care facilities. A mixed methods study, with structured questionnaires and semi-structured interviews, was chosen to obtain a complete understanding. One-hundred undocumented women were recruited. Diversity was sought according to age, origin and reason for being undocumented. Undocumented female immigrants have unmet health care needs (56%) and low health care utilisation. Sixty-nine per cent of the women reported obstacles in accessing health care facilities. These included many personal obstacles such as shame, fear and/or lack of information. Poor language proficiency (OR 0.28;. CI 0.09-0.90) reduces utilisation of primary health care services. Health care utilisation of undocumented women is low. Undocumented women refrain from seeking health care because of personal obstacles. These women need to be identified and informed about their rights, the health care system and the duty of professional confidentiality of doctors. Finally, institutional obstacles to access care should be removed since they strengthen reluctance to seek help.

  2. The impact of the urban resident basic medical insurance on health services utilisation in China.

    PubMed

    Chen, Gang; Liu, Gordon G; Xu, Fei

    2014-03-01

    The Urban Resident Basic Medical Insurance (URBMI), launched in 2007 by the State Council, aims to cover around 420 million urban residents in China. This study aimed to assess the impact of URBMI on health services access (especially inpatient utilisation) in urban China. Data was drawn from the recent four-wave URBMI Survey (2008-2011). Probit and recursive bivariate probit models have been adopted to handle the possible endogeneity of medical insurance in the utilisation equations. Based on the preferred results from the unbalanced four-wave panel data, we found that the URBMI had significantly increased the likelihood of receiving inpatient treatment in the past year. However, the insurance effect on reducing the refused hospitalisation was insignificant. Finally, the URBMI had also increased the probability of using outpatient services in the past 2 weeks, although the insurance reimburses mainly against critical outpatient care. Given that it is still early days for the URBMI scheme, the positive effect on health services utilisation is appreciable.

  3. Cytoplasmic Streaming - Skylab Student Experiment ED-63

    NASA Technical Reports Server (NTRS)

    1973-01-01

    This chart describes the Skylab student experiment (ED-63), Cytoplasmic Streaming, proposed by Cheryl A. Peitz of Arapahoe High School, Littleton, Colorado. Experiment ED-63 was to observe the effect of zero-gravity on cytoplasmic streaming in the aquatic plant named Elodea, commonly called water weed or water thyme. The phenomenon of cytoplasmic streaming is not well understood, but it is recognized as the circulation mechanism of the internal materials or cytoplasm of a cell. Cytoplasm is a gelatinous substance that has the ability to change its viscosity and flow, carrying various cell materials with it. The activity can be stimulated by sunlight or heat. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  4. Cytoplasmic Streaming - Skylab Student Experiment ED-63

    NASA Technical Reports Server (NTRS)

    1973-01-01

    This chart describes the Skylab student experiment (ED-63), Cytoplasmic Streaming, proposed by Cheryl A. Peitz of Arapahoe High School, Littleton, Colorado. Experiment ED-63 was to observe the effect of zero-gravity on cytoplasmic streaming in the aquatic plant named Elodea, commonly called water weed or water thyme. The phenomenon of cytoplasmic streaming is not well understood, but it is recognized as the circulation mechanism of the internal materials or cytoplasm of a cell. Cytoplasm is a gelatinous substance that has the ability to change its viscosity and flow, carrying various cell materials with it. The activity can be stimulated by sunlight or heat. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  5. ED-WAVE tool design approach: Case of a textile wastewater treatment plant in Blantyre, Malawi

    NASA Astrophysics Data System (ADS)

    Chipofya, V.; Kraslawski, A.; Avramenko, Y.

    The ED-WAVE tool is a PC based package for imparting training on wastewater treatment technologies. The system consists of four modules viz. Reference Library, Process Builder, Case Study Manager, and Treatment Adviser. The principles of case-based design and case-based reasoning as applied in the ED-WAVE tool are utilised in this paper to evaluate the design approach of the wastewater treatment plant at Mapeto David Whitehead & Sons (MDW&S) textile and garments factory, Blantyre, Malawi. The case being compared with MDW&S in the ED-WAVE tool is Textile Case 4 in Sri Lanka (2003). Equalisation, coagulation and rotating biological contactors is the sequencing of treatment units at Textile Case 4 in Sri Lanka. Screening, oxidation ditches and sedimentation is the sequencing of treatment units at MDW&S textile and garments factory. The study suggests that aerobic biological treatment is necessary in the treatment of wastewater from a textile and garments factory. MDW&S incorporates a sedimentation process which is necessary for the removal of settleable matter before the effluent is discharged to the municipal wastewater treatment plant. The study confirmed the practical use of the ED-WAVE tool in the design of wastewater treatment systems, where after encountering a new situation; already collected decision scenarios (cases) are invoked and modified in order to arrive at a particular design alternative. What is necessary, however, is to appropriately modify the case arrived at through the Case Study Manager in order to come up with a design appropriate to the local situation taking into account technical, socio-economic and environmental aspects.

  6. Regulation of methanol utilisation pathway genes in yeasts

    PubMed Central

    Hartner, Franz S; Glieder, Anton

    2006-01-01

    Methylotrophic yeasts such as Candida boidinii, Hansenula polymorpha, Pichia methanolica and Pichia pastoris are an emerging group of eukaryotic hosts for recombinant protein production with an ever increasing number of applications during the last 30 years. Their applications are linked to the use of strong methanol-inducible promoters derived from genes of the methanol utilisation pathway. These promoters are tightly regulated, highly repressed in presence of non-limiting concentrations of glucose in the medium and strongly induced if methanol is used as carbon source. Several factors involved in this tight control and their regulatory effects have been described so far. This review summarises available data about the regulation of promoters from methanol utilisation pathway genes. Furthermore, the role of cis and trans acting factors (e.g. transcription factors, glucose processing enzymes) in the expression of methanol utilisation pathway genes is reviewed both in the context of the native cell environment as well as in heterologous hosts. PMID:17169150

  7. Structural insight into the Clostridium difficile ethanolamine utilisation microcompartment.

    PubMed

    Pitts, Alison C; Tuck, Laura R; Faulds-Pain, Alexandra; Lewis, Richard J; Marles-Wright, Jon

    2012-01-01

    Bacterial microcompartments form a protective proteinaceous barrier around metabolic enzymes that process unstable or toxic chemical intermediates. The genome of the virulent, multidrug-resistant Clostridium difficile 630 strain contains an operon, eut, encoding a bacterial microcompartment with genes for the breakdown of ethanolamine and its utilisation as a source of reduced nitrogen and carbon. The C. difficile eut operon displays regulatory genetic elements and protein encoding regions in common with homologous loci found in the genomes of other bacteria, including the enteric pathogens Salmonella enterica and Enterococcus faecalis. The crystal structures of two microcompartment shell proteins, CD1908 and CD1918, and an uncharacterised protein with potential enzymatic activity, CD1925, were determined by X-ray crystallography. CD1908 and CD1918 display the same protein fold, though the order of secondary structure elements is permuted in CD1908 and this protein displays an N-terminal β-strand extension. These proteins form hexamers with molecules related by crystallographic and non-crystallographic symmetry. The structure of CD1925 has a cupin β-barrel fold and a putative active site that is distinct from the metal-ion dependent catalytic cupins. Thin-section transmission electron microscopy of Escherichia coli over-expressing eut proteins indicates that CD1918 is capable of self-association into arrays, suggesting an organisational role for CD1918 in the formation of this microcompartment. The work presented provides the basis for further study of the architecture and function of the C. difficile eut microcompartment, its role in metabolism and the wider consequences of intestinal colonisation and virulence in this pathogen.

  8. Utilisation of Intensive Foraging Zones by Female Australian Fur Seals

    PubMed Central

    Hoskins, Andrew J.; Costa, Daniel P.; Arnould, John P. Y.

    2015-01-01

    Within a heterogeneous environment, animals must efficiently locate and utilise foraging patches. One way animals can achieve this is by increasing residency times in areas where foraging success is highest (area-restricted search). For air-breathing diving predators, increased patch residency times can be achieved by altering both surface movements and diving patterns. The current study aimed to spatially identify the areas where female Australian fur seals allocated the most foraging effort, while simultaneously determining the behavioural changes that occur when they increase their foraging intensity. To achieve this, foraging behaviour was successfully recorded with a FastLoc GPS logger and dive behaviour recorder from 29 individual females provisioning pups. Females travelled an average of 118 ± 50 km from their colony during foraging trips that lasted 7.3 ± 3.4 days. Comparison of two methods for calculating foraging intensity (first-passage time and first-passage time modified to include diving behaviour) determined that, due to extended surface intervals where individuals did not travel, inclusion of diving behaviour into foraging analyses was important for this species. Foraging intensity ‘hot spots’ were found to exist in a mosaic of patches within the Bass Basin, primarily to the south-west of the colony. However, the composition of benthic habitat being targeted remains unclear. When increasing their foraging intensity, individuals tended to perform dives around 148 s or greater, with descent/ascent rates of approximately 1.9 m•s-1 or greater and reduced postdive durations. This suggests individuals were maximising their time within the benthic foraging zone. Furthermore, individuals increased tortuosity and decreased travel speeds while at the surface to maximise their time within a foraging location. These results suggest Australian fur seals will modify both surface movements and diving behaviour to maximise their time within a foraging patch

  9. Utilisation of intensive foraging zones by female Australian fur seals.

    PubMed

    Hoskins, Andrew J; Costa, Daniel P; Arnould, John P Y

    2015-01-01

    Within a heterogeneous environment, animals must efficiently locate and utilise foraging patches. One way animals can achieve this is by increasing residency times in areas where foraging success is highest (area-restricted search). For air-breathing diving predators, increased patch residency times can be achieved by altering both surface movements and diving patterns. The current study aimed to spatially identify the areas where female Australian fur seals allocated the most foraging effort, while simultaneously determining the behavioural changes that occur when they increase their foraging intensity. To achieve this, foraging behaviour was successfully recorded with a FastLoc GPS logger and dive behaviour recorder from 29 individual females provisioning pups. Females travelled an average of 118 ± 50 km from their colony during foraging trips that lasted 7.3 ± 3.4 days. Comparison of two methods for calculating foraging intensity (first-passage time and first-passage time modified to include diving behaviour) determined that, due to extended surface intervals where individuals did not travel, inclusion of diving behaviour into foraging analyses was important for this species. Foraging intensity 'hot spots' were found to exist in a mosaic of patches within the Bass Basin, primarily to the south-west of the colony. However, the composition of benthic habitat being targeted remains unclear. When increasing their foraging intensity, individuals tended to perform dives around 148 s or greater, with descent/ascent rates of approximately 1.9 m•s-1 or greater and reduced postdive durations. This suggests individuals were maximising their time within the benthic foraging zone. Furthermore, individuals increased tortuosity and decreased travel speeds while at the surface to maximise their time within a foraging location. These results suggest Australian fur seals will modify both surface movements and diving behaviour to maximise their time within a foraging patch.

  10. Making Improvements in the ED: Does ED Busyness Affect Time to Antibiotics in Febrile Pediatric Oncology Patients Presenting to the Emergency Department?

    PubMed

    Benner, Christopher A; Mora, Erika; Mueller, Emily; Seagull, F Jacob; Walkovich, Kelly; Johnson, Kaleena; Halverson, Schuyler; Rothman, Ed; Hucks, George; Younger, John G; Nypaver, Michele M

    2016-10-04

    Febrile neutropenic pediatric patients are at heightened risk for serious bacterial infections, and rapid antibiotic administration (in <60 minutes) improves survival. Our objectives were to reduce the time-to-antibiotic (TTA) administration and to evaluate the effect of overall emergency department (ED) busyness on TTA. This study was a quality improvement initiative with retrospective chart review to reduce TTA in febrile children with underlying diagnosis of cancer or hematologic immunodeficiency who visited the pediatric ED. A multidisciplinary clinical practice guideline (CPG) was implemented to improve TTA. The CPG's main focus was delivery of antibiotics before availability of laboratory data. We collected data on TTA during baseline and intervention periods. Concurrent patient arrivals to the ED per hour served as a proxy of busyness. Time to antibiotic was compared with the number of concurrent arrivals per hour. Analyses included scatter plot and regression analysis. There were 253 visits from October 1, 2010 to March 30, 2012. Median TTA administration dropped from 207 to 89 minutes (P < 0.001). Eight months after completing all intervention periods, the median had dropped again to 44 minutes with 70% of patients receiving antibiotics within 60 minutes of ED arrival. There was no correlation between concurrent patient arrivals and TTA administration during the historical or intervention periods. Implementation of a CPG and process improvements significantly reduced median TTA administration. Total patient arrivals per hour as a proxy of ED crowding did not affect TTA administration. Our data suggest that positive improvements in clinical care can be successful despite fluctuations in ED patient volume.

  11. Determinants analysis of outpatient service utilisation in Georgia: can the approach help inform benefit package design?

    PubMed

    Gotsadze, George; Tang, Wenze; Shengelia, Natia; Zoidze, Akaki

    2017-05-02

    The healthcare financing reforms initiated by the Government of Georgia in 2007 have positively affected inpatient service utilisation and enhanced financial protection, especially for the poor, but they have failed to facilitate outpatient service use among chronic patients. Non-communicable diseases significantly affect Georgia's ageing population. Consequently, in this paper, we look at the evidence emerging from determinants analysis of outpatient service utilisation and if the finding can help identify possible policy choices in Georgia, especially regarding benefit package design for individuals with chronic conditions. We used Andersen's behavioural model of health service utilisation to identify the critical determinants that affect outpatient service use. A multinomial logistic regression was carried out with complex survey design using the data from two nationally representative cross-sectional population-based health utilisation and expenditure surveys conducted in Georgia in 2007 and 2010, which allowed us to assess the relationship between the determinants and outpatient service use. The study revealed the determinants that significantly impede outpatient service use. Low income, 45- to 64-year-old Georgian males with low educational attainment and suffering from a chronic health problem have the lowest odds for service use compared to the rest of the population. Using Andersen's behavioural model and assessing the determinants of outpatient service use has the potential to inform possible policy responses, especially those driving services use among chronic patients. The possible policy responses include reducing financial access barriers with the help of public subsidies for sub-groups of the population with the lowest access to care; focusing/expanding state-funded benefits for the most prevalent chronic conditions, which are responsible for the greatest disease burden; or supporting chronic disease management programs for the most prevalent chronic

  12. EDs pool resources to weather flood.

    PubMed

    2006-10-01

    When disaster strikes your community, creativity can go a long way toward keeping your ED up and running, but cooperating with neighboring facilities can double your available resources in a hurry. Contact all unscheduled staff members and request that they accept additional shifts during the crisis. If nearby facilities are shut down, contact their manager to ascertain availability of their staff and supplies. Seek additional staffing help from local residency programs.

  13. Ethanol elimination rates in an ED population.

    PubMed

    Brennan, D F; Betzelos, S; Reed, R; Falk, J L

    1995-05-01

    Knowledge of the rate of ethanol elimination is essential in the assessment of the intoxicated patient. Surprisingly little literature is available regarding ethanol elimination rates in emergency department (ED) patients; prior studies almost exclusively examined populations of alcoholics or normal controls. Consequently, this prospective observational study was undertaken to assess the rate of ethanol elimination in an ED population. Twenty-four consecutive adult ED patients clinically suspected of intoxication who had serum ethanol determinations drawn were enrolled. Patients underwent serial ethanol determinations via breathalyzer (Intoxilyzer 1400, CMI Inc., Owensboro, KY). Linear regression analysis of the plot of decrease in ethanol level over time was performed to determine the rate of ethanol elimination. Initial ethanol levels in the 24 patients ranged from 58 to 447 mg/dL (mean, 249 +/- 109 [SD] mg/dL). Patients were observed for a minimum of 2 and a maximum of 9 observations (mean, 3.9 +/- 1.7), over a period of 0.5 to 12.1 hours (mean, 4.4 +/-3.5 h). Clinical features of intoxication were poorly correlated with ethanol level (r < .5). The rate of ethanol elimination in the ED population was 19.6 mg/dL/h (r = .83; 95% confidence interval [CI], 16.9 to 22.3 mg/dL/h). Subgroup analysis found differences that were statistically significant but small. Multiple regression analysis showed that time was the major variable useful in predicting changes in ethanol level (P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Regional Energy Deployment System (ReEDS)

    SciTech Connect

    Short, W.; Sullivan, P.; Mai, T.; Mowers, M.; Uriarte, C.; Blair, N.; Heimiller, D.; Martinez, A.

    2011-12-01

    The Regional Energy Deployment System (ReEDS) is a deterministic optimization model of the deployment of electric power generation technologies and transmission infrastructure throughout the contiguous United States into the future. The model, developed by the National Renewable Energy Laboratory's Strategic Energy Analysis Center, is designed to analyze the critical energy issues in the electric sector, especially with respect to potential energy policies, such as clean energy and renewable energy standards or carbon restrictions. ReEDS provides a detailed treatment of electricity-generating and electrical storage technologies and specifically addresses a variety of issues related to renewable energy technologies, including accessibility and cost of transmission, regional quality of renewable resources, seasonal and diurnal generation profiles, variability of wind and solar power, and the influence of variability on the reliability of the electrical grid. ReEDS addresses these issues through a highly discretized regional structure, explicit statistical treatment of the variability in wind and solar output over time, and consideration of ancillary services' requirements and costs.

  15. Impact of continuous Medical Aid utilisation on healthcare utilisation: unique insight using the 2008-2012 Korean Welfare Panel Study (KOWEPS).

    PubMed

    Kim, Jae-Hyun; Kim, Na Rae; Park, Eun-Cheol; Han, Kyu-Tae; Choi, Young; Lee, Sang Gyu

    2016-04-06

    Although there has been considerable discussion about the social safety net, few studies related to effect of duration of continuous receipt of Medical Aid on healthcare utilisation have been conducted. Therefore, we investigate whether the duration of receiving Medical Aid affected medical care utilisation. Data were collected from the Korean Welfare Panel Study conducted from 2008 to 2012. We included 11,783 samples. Estimating changes in their healthcare utilisation during specific time intervals (1, 2 and ≥3 years) after they switched from National Health Insurance to Medical Aid. Number of outpatient visits. The number of outpatient visits per year was 0.0.051-fold higher (p value: 0.434) among those who were Medical Aid beneficiaries for a continuous period of 1 year, 0.0.267-fold higher (p value: 0.000) among those who were beneficiaries for a continuous period of 2 years, and 0.0.562-fold higher (p value:<0.0001) among those who were beneficiaries for a continuous period of 3 years than it was among those who were beneficiaries of National Health Insurance. Our results reflect an association between the number of consecutive years of receiving Medical Aid and number of outpatient visits. Since duration of dependence is correlated with reduced exit rates, limits on length of benefits should be considered to strengthen the incentive to return to work. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  16. Characteristics of patients who accept and decline ED rapid HIV testing.

    PubMed

    Schechter-Perkins, Elissa M; Koppelman, Elisa; Mitchell, Patricia M; Morgan, Jake R; Kutzen, Randie; Drainoni, Mari-Lynn

    2014-09-01

    Understanding differences between patients who accept and decline HIV testing is important for developing methods to reduce decliner rates among patients at risk for undiagnosed HIV. The objectives of this study were to determine the rates of acceptance and reasons for declining, and to determine if differences exist in patient or visit characteristics between those who accept and decline testing. This was a retrospective medical record review of all patients offered an emergency department (ED) HIV test from 11/1/11 to 10/31/12. Patient demographic characteristics, health characteristics, and ED visit characteristics were compared to assess differences between those who accept and those who decline testing. Of 4510 ED patients offered an HIV test, 3470 accepted for an acceptance rate of 77%. The most common reasons for declining were "no perceived risk" and "tested in the last 3 months." Those who accepted testing were more likely to be unmarried, less than age 35, Hispanic or African American, Spanish speaking, foreign born, have no primary care provider, report no pain at triage, have a daytime ED visit, and be discharged from the ED compared to admitted. Sex, employment status, and ED length of stay did not affect whether patients accepted testing. Acceptance of ED-based rapid HIV testing is not universal, and there are both patient and visit characteristics consistently associated with declining testing. This detracts from the goal of using the ED to screen a large number of at-risk patients who do not have access to testing elsewhere. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Optimal radiotherapy utilisation rate in developing countries: An IAEA study.

    PubMed

    Rosenblatt, Eduardo; Barton, Michael; Mackillop, William; Fidarova, Elena; Cordero, Lisbeth; Yarney, Joel; Lim, Gerard; Abad, Anthony; Cernea, Valentin; Stojanovic-Rundic, Suzana; Strojan, Primoz; Kobachi, Lotfi; Quarneti, Aldo

    2015-07-01

    Optimal radiotherapy utilisation rate (RTU) is the proportion of all cancer cases that should receive radiotherapy. Optimal RTU was estimated for 9 Middle Income Countries as part of a larger IAEA project to better understand RTU and stage distribution. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Improving the Utilisation of Management Information Systems in Secondary Schools

    ERIC Educational Resources Information Center

    Bosker, R. J.; Branderhorst, E. M.; Visscher, A. J.

    2007-01-01

    Although most secondary schools do use management information systems (MISs), these systems tend not to be used to support higher order managerial activities but are currently primarily used for clerical purposes. This situation is unsatisfactory as MISs fully utilised could offer invaluable support to schools, which are increasingly being granted…

  19. Redirecting Under-Utilised Computer Laboratories into Cluster Computing Facilities

    ERIC Educational Resources Information Center

    Atkinson, John S.; Spenneman, Dirk H. R.; Cornforth, David

    2005-01-01

    Purpose: To provide administrators at an Australian university with data on the feasibility of redirecting under-utilised computer laboratories facilities into a distributed high performance computing facility. Design/methodology/approach: The individual log-in records for each computer located in the computer laboratories at the university were…

  20. Improving the Utilisation of Management Information Systems in Secondary Schools

    ERIC Educational Resources Information Center

    Bosker, R. J.; Branderhorst, E. M.; Visscher, A. J.

    2007-01-01

    Although most secondary schools do use management information systems (MISs), these systems tend not to be used to support higher order managerial activities but are currently primarily used for clerical purposes. This situation is unsatisfactory as MISs fully utilised could offer invaluable support to schools, which are increasingly being granted…

  1. Redirecting Under-Utilised Computer Laboratories into Cluster Computing Facilities

    ERIC Educational Resources Information Center

    Atkinson, John S.; Spenneman, Dirk H. R.; Cornforth, David

    2005-01-01

    Purpose: To provide administrators at an Australian university with data on the feasibility of redirecting under-utilised computer laboratories facilities into a distributed high performance computing facility. Design/methodology/approach: The individual log-in records for each computer located in the computer laboratories at the university were…

  2. Seat belt utilisation and awareness in UAE.

    PubMed

    Bendak, S; Al-Saleh, K

    2013-01-01

    Seat belts (SBs) are effective devices for reducing injury risk due to traffic accidents. Seat belt wearing was made compulsory in the United Arab Emirates (UAE) in January 1999 for drivers and front seat passengers (FSPs). No comprehensive study has ever assessed SB wearing rates across the country. Also, little is known on drivers' awareness of the importance of wearing seatbelts and how human factors affect wearing habits. This study aims to determine SB wearing rates for drivers and FSPs in UAE through an observational field study. It also aims to investigate perceptions and behaviour of drivers on this issue as well as human factors that affect wearing rate through a randomly distributed questionnaire. The results of the field study show that the overall SB wearing rate across the country was 61% for drivers and 43.4% for FSPs and that there were significant differences between the seven emirates that constitute the country. The questionnaire results show that age, education level, gender, marital status and nationality of drivers affect wearing habits and perceptions. Future implications in terms of improving traffic safety awareness are discussed.

  3. 34 CFR 85.942 - ED Deciding Official.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Definitions § 85.942 ED Deciding Official. The ED Deciding Official is an ED officer who has delegated authority under the procedures of the Department of Education to decide whether to affirm a suspension or enter a debarment. Authority: E.O. 12549 (3 CFR, 1986 Comp., p. 189), E.O. 12689 ( 3 CFR, 1989 Comp., p...

  4. 2 CFR 3485.937 - ED Deciding Official.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false ED Deciding Official. 3485.937 Section 3485.937 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF EDUCATION NONPROCUREMENT DEBARMENT AND SUSPENSION Definitions § 3485.937 ED Deciding Official. The ED Deciding Official...

  5. 2 CFR 3485.937 - ED Deciding Official.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false ED Deciding Official. 3485.937 Section 3485.937 Grants and Agreements Federal Agency Regulations for Grants and Agreements DEPARTMENT OF EDUCATION NONPROCUREMENT DEBARMENT AND SUSPENSION Definitions § 3485.937 ED Deciding Official. The ED Deciding Official...

  6. EDS Coal Liquefaction Process Development. Phase V. Laboratory evaluation of the characteristics of EDS Illinois bottoms

    SciTech Connect

    Lao, T C; Levasseur, A A

    1984-02-01

    This interim report documents work carried out by Combustion Engineering, Inc. under a contract to Exxon Research and Engineering Company to develop a conceptual Hybrid Boiler design fueled by the vacuum distillation residue (vacuum bottoms) derived from Illinois No. 6 coal in the EDS Coal Liquefaction Process. This report was prepared by Combustion Engineering, Inc., and is the first of two reports on the predevelopment phase of the Hybrid Boiler program. This report covers the results of a laboratory investigation to assess the fuel and ash properties of EDS vacuum bottoms. The results of the laboratory testing reported here were used in conjunction with Combustion Engineering's design experience to predict fuel performance and to develop appropriate boiler design parameters. These boiler design parameters were used to prepare the engineering design study reported in EDS Interim Report FE-2893-113, the second of the two reports on the predevelopment phase of the Hybrid Boiler Program. 46 figures, 29 tables.

  7. Effect of a redesigned fracture management pathway and 'virtual' fracture clinic on ED performance.

    PubMed

    Vardy, J; Jenkins, P J; Clark, K; Chekroud, M; Begbie, K; Anthony, I; Rymaszewski, L A; Ireland, A J

    2014-06-13

    Collaboration between the orthopaedic and emergency medicine (ED) services has resulted in standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review. Patients with minor, stable fractures are discharged with no further follow-up arranged. We aimed to examine the time taken to assess and treat these patients in the ED along with the rate of unplanned reattendance. A retrospective study was undertaken that covered 1 year before the change and 1 year after. Prospectively collected administrative data from the electronic patient record system were analysed and compared before and after the change. An ED and orthopaedic unit, serving a population of 300 000, in a publicly funded health system. 2840 patients treated with referral to a traditional fracture clinic and 3374 patients managed according to the newly redesigned protocol. Time for assessment and treatment of patients with orthopaedic injuries not requiring immediate operative management, and 7-day unplanned reattendance. Where plaster backslabs were replaced with removable splints, the consultation time was reduced. There was no change in treatment time for other injuries treated by the new discharge protocol. There was no increase in unplanned ED attendance, related to the injury, within 7 days (p=0.149). There was a decrease in patients reattending the ED due to a missed fracture clinic appointment. This process did not require any new time resources from the ED staff. This process brought significant benefits to the ED as treatment pathways were agreed. The pathway reduced unnecessary reattendance of patients at face-to-face fracture clinics for a review of stable, self-limiting injuries. 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.

  8. Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain.

    PubMed

    Wu, W Kelly; Yiadom, Maame Yaa A B; Collins, Sean P; Self, Wesley H; Monahan, Ken

    2017-01-01

    A triage cardiology program, in which cardiologists provide consultation to the Emergency Department (ED), may safely reduce admissions. For patients with chest pain, the HEART Pathway may obviate the need for cardiology involvement, unless there is a difference between ED and cardiology assessments. Therefore, in a cohort concurrently evaluated by both specialties, we analyzed discordance between ED and cardiology HEART scores. We performed a single-center, cross-sectional, retrospective study of adults presenting to the ED with chest pain who had a documented bedside evaluation by a triage cardiologist. Separate ED and cardiology HEART scores were computed based on documentation by the respective physicians. Discrepancies in HEART score between ED physicians and cardiologists were quantified using Cohen κ coefficient. Thirty-three patients underwent concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, -0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were classified as high risk by the ED physician, but low risk by the cardiologist. There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Use of broad-spectrum antibiotics in French EDs: different trends for third-generation cephalosporins and fluoroquinolones.

    PubMed

    Batard, Eric; Vibet, Marie-Anne; Lemarchand, Cathelle; Navas, Dominique; Lepelletier, Didier; Potel, Gilles; Montassier, Emmanuel

    2017-06-01

    Third-generation cephalosporins and fluoroquinolones are particularly prone to promoting bacterial resistance. Their use in Emergency Departments (EDs) is poorly known. Our objectives were to assess the use of antibacterial agents in French EDs. This study is a retrospective study of antibiotics delivered to the adult units of 11 EDs of French academic centres in 2012, and to six of these EDs between 2009 and 2012. The total antibiotic use was 66.4 defined daily doses (DDD)/1000 ED visits in 2012, and it increased between 2009 and 2012 (yearly estimate, +1.8±0.9 DDD/1000 ED visits, P=0.048). The 3GC-FQ class, which grouped third-generation cephalosporins and fluoroquinolones, accounted for 39.2% of the total antibiotic use, and the use of this class of antibiotics was highly variable among EDs (range, 31.6-49.5% of total antibiotic use). The aminopenicillin and β-lactamase inhibitor/3GC-FQ ratio varied among EDs [median (range), 0.91 (0.52-1.25)]. Between 2009 and 2012, there was a significant decrease in the use of the 3GC-FQ class (yearly estimate, -0.8±0.4% of total antibiotic use), antipneumococcal fluoroquinolones (-0.8±0.3%) and other fluoroquinolones (-0.9%±0.3%), and there was a significant increase in the use of third-generation cephalosporins (+0.7±0.3%), aminoglycosides (+0.4±0.1%), imidazole derivatives (+0.4±0.1%) and lincosamides (+0.1±0.0%). Fluoroquinolones and third-generation cephalosporins are widely used in the ED. Their use is highly variable among EDs. Third-generation cephalosporins were increasingly used between 2009 and 2012, whereas the use of fluoroquinolones decreased. Reduced use of cephalosporins in the ED, without increasing fluoroquinolone use, should be aimed at through antibiotic stewardship programs.

  10. Enriched Medical Home Intervention Using Community Health Worker Home Visitation and ED Use.

    PubMed

    Anugu, Meghana; Braksmajer, Amy; Huang, Jiayu; Yang, Jie; Ladowski, Kristi L; Pati, Susmita

    2017-05-01

    Community health workers (CHWs) have great potential to extend medical home services and reduce emergent health care use, but evidence in pediatrics is scarce. We evaluated the impact of an existing enriched medical home intervention (EMHI) that directly integrates CHWs into emergency department (ED) visits and hospitalizations for pediatric ambulatory care-sensitive conditions (ACSCs). The EMHI group in this prospective cohort study received home visits from trained CHWs to support adherence to recommended care; the comparison group received usual care (UC). Sociodemographic characteristics were compiled from the EMHI database, and ED and hospitalization information was extracted for study participants from a statewide database. The Wilcoxon signed rank test was used to compare ED data and the Wald test was used to compare hospitalization use for ACSCs between the intervention and UC groups after adjusting for different characteristics between groups by using propensity score matching method. The study sample included 922 children (225 intervention, 697 UC). After propensity score matching, the analytic sample included 450 children (225 intervention, 225 UC). After propensity score matching, the intervention group was significantly less likely than the UC group to visit the ED for an ACSC (18.2% vs 35.1%; P = .004). We found no differences in ACSC hospitalizations between the 2 groups. Our findings suggest that EMHIs using trained CHWs may be a cost-effective model to reduce preventable ED utilization, especially among vulnerable children. Copyright © 2017 by the American Academy of Pediatrics.

  11. Effect of a Bolus Dose of Fentanyl on the ED50 and ED95 of Sevoflurane in Neonates

    PubMed Central

    She, Ying-Jun; Wang, Huai-Zhen; Huang, Jun-Xiang; Tan, Yong-Hong; Wang, Zi-Xing; Tian, Hang; Song, Xing-Rong

    2014-01-01

    Background The minimum alveolar concentration (MAC) of sevoflurane in neonates is 3.3%, but this value has not been verified in Chinese neonates and the effect of different doses of fentanyl on MAC in neonates has not been investigated. This study was designed to determine the ED50 and ED95 values of sevoflurane in Chinese neonates with and without fentanyl. Material/Methods Ninety-three neonates were randomly assigned to receive sevoflurane alone (control group, n=30), 1 μg/kg sevoflurane (group fent1, n=29), or 2 μg/kg fentanyl (group fent2, n=32). Following inhalational induction and tracheal intubation, the end-tidal concentration of sevoflurane was adjusted to achieve the designated concentration, which was determined using the modified Dixon’s up-and-down method starting with 3.0% in each group, with a 0.25% step size. Success was defined as no motor response within 60 s of skin incision. Results The MAC (standard deviation) values of sevoflurane were 2.91% (0.27) in the control group, 2.53% (0.31) in the fent1 group, and 2.34% (0.33) in the fent2 group according to Dixon’s up-and-down method. Logistic probit regression analysis revealed that the ED50 and ED95 (95% CI) of sevoflurane in neonates were 2.82% (2.66–2.98) and 3.39% (2.89–3.89), respectively, in the control group; 2.44% (2.19–2.68) and 3.30% (2.51–4.09), respectively, in the fent1 group; and 2.21% (1.97–2.45) and 3.11% (2.35–3.88), respectively, in the fent2 group. Conclusions The MAC value of sevoflurane in Chinese neonates was lower than previously reported and was reduced by the addition of fentanyl. PMID:25503557

  12. The Reduction in ED and Hospital Admissions in Medical Home Practices Is Specific to Primary Care-Sensitive Chronic Conditions.

    PubMed

    Green, Lee A; Chang, Hsiu-Ching; Markovitz, Amanda R; Paustian, Michael L

    2017-03-02

    To determine whether the Patient-Centered Medical Home (PCMH) transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH in our setting. All patients aged 18 years and older in 2,218 primary care practices participating in a statewide PCMH incentive program sponsored by Blue Cross Blue Shield of Michigan (BCBSM) in 2009-2012. Quantitative observational study, jointly modeling PCMH-targeted versus other hospital admissions and ED visits on PCMH score, patient, and practice characteristics in a hierarchical multivariate model using the generalized gamma distribution. Claims data and PCMH scores held by BCBSM. Both hospital and ED utilization were reduced proportionately to PCMH score. Hospital utilization was reduced by 13.9 percent for PCMH-targeted conditions versus only 3.8 percent for other conditions (p = .003), and ED utilization by 11.2 percent versus 3.7 percent (p = .010). Hospital PMPM cost was reduced by 17.2 percent for PCMH-targeted conditions versus only 3.1 percent for other conditions (p < .001), and ED PMPM cost by 9.4 percent versus 3.6 percent (p < .001). PCMH transformation reduces hospital and ED use, and the majority of the effect is specific to PCMH-targeted conditions. © Health Research and Educational Trust.

  13. The use of mechanical ventilation in the ED.

    PubMed

    Easter, Benjamin D; Fischer, Christopher; Fisher, Jonathan

    2012-09-01

    Although EDs are responsible for the initial care of critically ill patients and the amount of critical care provided in the ED is increasing, there are few data examining mechanical ventilation (MV) in the ED. In addition, characteristics of ED-based ventilation may affect planning for ventilator shortages during pandemic influenza or bioterrorist events. The study examined the epidemiology of MV in US EDs, including demographic, clinical, and hospital characteristics; indications for MV; ED length of stay (LOS); and in-hospital mortality. This study was a retrospective review of the 1993 to 2007 National Hospital Ambulatory Medical Care Survey ED data sets. Ventilated patients were compared with ED patients admitted to the intensive care unit (ICU) and to all other ED visits. There were 3.6 million ED MV visits (95% confidence interval [CI], 3.2-4.0 million) over the study period. Sex, age, race, and payment source were similar for mechanically ventilated and ICU patients (P > .05 for all). Approximately 12.5% of ventilated patients underwent cardiopulmonary resuscitation compared with 1.7% of ICU admissions and 0.2% of all other ED visits (P < .0001). Accordingly, in-hospital mortality was significantly higher for ventilated patients (24%; 95% CI, 13.1%-34.9%) than both comparison groups (9.3% and 2.5%, respectively). Median LOS for ventilated patients was 197 minutes (interquartile range, 112-313 minutes) compared with 224 minutes for ICU admissions and 140 minutes for all other ED visits. Patients undergoing ED MV have particularly high in-hospital mortality rates, but their ED LOS is sufficient for implementation of evidence-based ventilator interventions. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Appropriateness of epinephrine use in ED patients with anaphylaxis.

    PubMed

    Baalmann, Damian V; Hagan, John B; Li, James T C; Hess, Erik P; Campbell, Ronna L

    2016-02-01

    Studies have demonstrated low rates of emergency department (ED) epinephrine administration for anaphylaxis patients, suggestive of ED undertreatment of anaphylaxis. Our study assessed the appropriateness of ED epinephrine administration in anaphylaxis management. A prospective observational study was conducted involving ED patients presenting with possible allergic reactions. Patients and ED providers completed questionnaires regarding the suspected trigger, signs and symptoms, and prehospital treatment. Two board-certified allergists-immunologists independently reviewed the questionnaires, as well as electronic health records, to determine whether the cases represented anaphylaxis and whether ED epinephrine administration was appropriate. Among 174 patients enrolled in the study, 61 (35%) were confirmed to have anaphylaxis. Overall, 47 anaphylaxis patients (77%) received epinephrine either before ED arrival or in the ED. In the latter situation, 24 anaphylaxis patients (39%) received epinephrine and 37 (61%) did not. Of the patients who received ED epinephrine, the allergists-immunologists determined that its administration was appropriate in all cases (95% confidence interval [CI], 83%-100%). Among the 37 patients who did not receive ED epinephrine, the allergists-immunologists determined that nonadministration of epinephrine was appropriate in 36 patients (97%; 95% CI, 84%-100%). The allergists-immunologists determined that overall, ED management was appropriate for 60 (98%) of 61 patients with anaphylaxis (95% CI, 90%-100%). Although more than 60% of anaphylaxis patients did not receive epinephrine in the ED, the allergists-immunologists deemed ED management appropriate in 98% of total cases. Previous retrospective studies may underestimate the appropriateness of ED anaphylaxis management, particularly when prehospital epinephrine administration is not reported. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Text message program improves outcomes, decreases ED utilization among ED patients with poorly controlled diabetes.

    PubMed

    2014-02-01

    Diabetic patients who lack access to primary care tend to frequent the ED, often with complications from their disease that could have been prevented with proper management and education. To get around the problem of access, researchers tested an automated program that continuously delivered educational messaging via text to a group of patients who presented to the ED with poorly controlled diabetes. After six months, researchers noted improvements in Hb A1c levels, self-reported medication adherence, and ED utilization when compared with a control group. And the impact was particularly noteworthy among Latinos, according to the researchers. The text messaging program, dubbed TExT-Med, was developed by four physicians and two diabetes educators. The messages were delivered daily, and contained educational as well motivational content derived from the National Diabetes Education Program.There were also medication reminders, healthy living challenges, and trivia questions about diabetes. At six months, Hb A1c levels decreased by 1.05% in the intervention group, compared to 0.60% in the control group, and self-reported medication adherence improved from 4.5 to 5.4 (as measured on an 8 point scale) in the intervention group versus a decrease of 0.1 in the control group. During the six-month study period, 35.9% of patients in the intervention group presented to the ED for care, as compared to 51.6% of patients in the control group.

  16. The prehospital and hospital costs of emergency care for frequent ED patients.

    PubMed

    Solberg, Robert G; Edwards, Brandy L; Chidester, Jeffrey P; Perina, Debra G; Brady, William J; Williams, Michael D

    2016-03-01

    Frequent emergency department (ED) use has been identified as a cause of ED overcrowding and increasing health care costs. Studies have examined the expense of frequent patients (FPs) to hospitals but have not added the cost Emergency Medical Services (EMS) to estimate the total cost of this pattern of care. Data on 2012 ED visits to a rural Level I Trauma Center and public safety net hospital were collected through a deidentified patient database. Transport data and 2012 Medicare Reimbursement Schedules were used to estimate the cost of EMS transport. Health information, outcomes, and costs were compared to find differences between the FP and non-FP group. This study identified 1242 FPs who visited the ED 5 or more times in 2012. Frequent patients comprised 3.25% of ED patients but accounted for 17% of ED visits and 13.7% of hospital costs. Frequent patients had higher rates of chronic disease, severity scores, and mortality. Frequent patients arrived more often via ambulance and accounted for 32% of total transports at an estimated cost of $2.5-$3.2 million. Hospital costs attributable to FPs were $29.1 million, bringing the total cost of emergency care to $31.6-$32.3 million, approximately $25,000 per patient. This study demonstrates that the inclusion of a prehospital cost estimate adds approximately 10% to the cost of care for the FP population. In addition to improving care for a sick population of patients, programs that reduce frequent EMS and ED use have the potential to produce a favorable cost benefit to communities and health systems. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Healthcare utilisation and empowerment among women in Liberia.

    PubMed

    Sipsma, Heather; Callands, Tamora A; Bradley, Elizabeth; Harris, Benjamin; Johnson, Billy; Hansen, Nathan B

    2013-11-01

    Many efforts have been undertaken to improve access to healthcare services in low-income settings; nevertheless, underutilisation persists. Women's lack of empowerment may be a central reason for underutilisation, but empirical literature establishing this relationship is sparse. We conducted a cross-sectional study using data from the 2007 Liberia Demographic and Health Survey. Our sample included all non-pregnant women who were currently married or living with a partner (N=3925 unweighted). We used multivariate logistic regression to assess the associations between constructs derived from the Theory of Gender and Power (TGP) and healthcare utilisation. Two-thirds of women (65.6%) had been to a healthcare facility for herself or her children in the past 12 months. Constructs from the three major theoretical structures were associated with healthcare utilisation. Women with no education, compared with women with some education, were less likely to have been to a healthcare facility (OR=0.76; 95% CI 0.62 to 0.93) as were women who had experienced sexual abuse (OR=0.65; 95% CI 0.45 to 0.95) and women who were married (OR=0.69, 95% CI 0.54 to 0.88). Women in higher wealth quintiles, compared with women in the next lower wealth quintile, and women with more decision-making power had greater odds of having been to a healthcare facility (OR=1.22; 95% CI 1.10 to 1.36 and OR=1.10; 95% CI 1.01 to 1.20; respectively). Strong associations exist between healthcare utilisation and empowerment among women in Liberia, and gender imbalances are prevalent. This fundamental issue likely needs to be addressed before large-scale improvement in health service utilisation can be expected.

  18. The European Space Agency standard for space packet utilisation

    NASA Astrophysics Data System (ADS)

    Kaufeler, J.-F.; Parkes, A.; Pidgeon, A.

    1993-03-01

    This paper presents the ESA concept for the use of CCSDS defined Telemetry and Telecommand Packets at the application level. These Packets are used to monitor and control remotely a space born application. This concept is defined in a Packet Utilisation Standard (PUS) which should become applicable for all ESA missions using Packets. The production of this standard is under the responsibility of an ESA standardization group called 'COES'.

  19. Healthcare Utilisation and Empowerment Among Women in Liberia

    PubMed Central

    Sipsma, Heather; Callands, Tamora A; Bradley, Elizabeth; Harris, Benjamin; Johnson, Billy; Hansen, Nathan B

    2014-01-01

    Background Many efforts have been undertaken to improve access to healthcare services in low-income settings; nevertheless, underutilisation persists. Women’s lack of empowerment may be a central reason for underutilisation, but empirical literature establishing this relationship is sparse. Methods We conducted a cross-sectional study using data from the 2007 Liberia Demographic and Health Survey. Our sample included all non-pregnant women who were currently married or living with a partner (N=3925 unweighted). We used multivariate logistic regression to assess the associations between constructs derived from the Theory of Gender and Power (TGP) and healthcare utilisation. Results Two-thirds of women (65.6%) had been to a healthcare facility for herself or her children in the past 12 months. Constructs from the three major theoretical structures were associated with healthcare utilisation. Women with no education, compared with women with some education, were less likely to have been to a healthcare facility (OR=0.76; 95% CI 0.62 to 0.93) as were women who had experienced sexual abuse (OR=0.65; 95% CI 0.45 to 0.95) and women who were married (OR=0.69, 95% CI 0.54 to 0.88). Women in higher wealth quintiles, compared with women in the next lower wealth quintile, and women with more decision-making power had greater odds of having been to a healthcare facility (OR=1.22; 95% CI 1.10 to 1.36 and OR=1.10; 95% CI 1.01 to 1.20; respectively). Conclusions Strong associations exist between healthcare utilisation and empowerment among women in Liberia, and gender imbalances are prevalent. This fundamental issue likely needs to be addressed before large-scale improvement in health service utilisation can be expected. PMID:23929617

  20. Pivot Nursing: An Alternative to Traditional ED Triage.

    PubMed

    Christensen, Maria; Rosenberg, Mark; Mahon, Eileen; Pineda, Sharon; Rojas, Eva; Soque, Victoria; Johansen, Mary L

    2016-09-01

    A 7.2% increase in patient volume from 130,700 to 140,800 in 2012 prompted St Joseph's Regional Medical Center Emergency Department to review existing triage processes to decrease turnaround time. "Pivot triage" is a new, efficient intake process that entails use of 4 rather than 8 determinants to identify acuity levels. The purpose of this performance improvement project was to create alternatives to traditional triage to decrease ED length of stay and door-to-physician time. After education, the pivot process was implemented using 4 determinants established by a multidisciplinary team. The pivot process was slowly implemented for 6 hours over a 1-week period to work out processing issues. Arrival time, door-to-physician time, and departure time from the emergency department were elements used to calculate the patient's turnaround time. Length of ED stay was collected monthly beginning in the fourth quarter of 2011. Comparisons were made after Pivot implementation in the fourth quarter of 2012. Despite the increasing volume, the mean door-to-physician time decreased from 71 to 40 minutes, a 43.7% reduction. The overall turnaround time decreased from 220 to 181 minutes, representing approximately a 17.7% reduction. The percentage of patients who left without being seen decreased from 2.5% to 1.0%. The pivot process improved patient flow in the emergency department, reducing time spent by the patient in the department. The pivot process is a viable alternative to traditional triage. Nurses are able to accurately pivot patients with a reduced amount of information. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  1. Capillary Study - Skylab Student Experiment ED-72

    NASA Technical Reports Server (NTRS)

    1973-01-01

    This chart describes the Skylab student experiment ED-72, Capillary Study, proposed by Roger G. Johnson of St. Paul, Mirnesota. Johnson theorized that capillary rise might continue to infinity in Skylab's zero-gravity environment. The behavior of fluids, particularly their flow properties in a low-gravity environment, had been important from the time that Robert H. Goddard launched his liquid-fueled rockets in the 1920's to the more sophisticated space systems of the day. It was necessary to design fluid-flow systems that would not only overcome the lack of gravity but also overcome, or take advantage of, the effect of surface tension. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  2. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

    PubMed Central

    2014-01-01

    Background Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania. Methods Using household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider. Results Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members. Conclusions Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity. PMID:24645876

  3. Health care seeking behaviour and utilisation in a multiple health insurance system: does insurance affiliation matter?

    PubMed

    Chomi, Eunice Nahyuha; Mujinja, Phares G M; Enemark, Ulrika; Hansen, Kristian; Kiwara, Angwara Dennis

    2014-03-19

    Many countries striving to achieve universal health insurance coverage have done so by means of multiple health insurance funds covering different population groups. However, existence of multiple health insurance funds may also cause variation in access to health care, due to the differential revenue raising capacities and benefit packages offered by the various funds resulting in inequity and inefficiency within the health system. This paper examines how the existence of multiple health insurance funds affects health care seeking behaviour and utilisation among members of the Community Health Fund, the National Health Insurance Fund and non-members in two districts in Tanzania. Using household survey data collected in 2011 with a sample of 3290 individuals, the study uses a multinomial logit model to examine the influence of predisposing, enabling and need characteristics on the probability of seeking care and choice of provider. Generally, health insurance is found to increase the probability of seeking care and reduce delays. However, the probability, timing of seeking care and choice of provider varies across the CHF and NHIF members. Reducing fragmentation is necessary to provide opportunities for redistribution and to promote equity in utilisation of health services. Improvement in the delivery of services is crucial for achievement of improved access and financial protection and for increased enrolment into the CHF, which is essential for broadening redistribution and cross-subsidisation to promote equity.

  4. Analysis of healthcare financing, supply and utilisation trends in the new EU countries.

    PubMed

    Ruseski, Jane E

    2006-01-01

    The EU expanded in 2004 to include eight transition countries, i.e. Central and Eastern European (CEE) and newly independent states of the former Soviet Union, and two other CEE countries are scheduled to join the EU in 2007. Each of these countries has undertaken substantial healthcare reform efforts over the past 15 years. The paths of healthcare reform are diverse for a number of reasons including differences in initial economic, political and structural conditions. The objective of this article is to evaluate the process and preliminary outcomes of healthcare reform in the new EU and candidate countries by analysing trends in aggregate financing, supply and utilisation indicators using data drawn from the WHO Health for All database. The analysis is done in the context of an analytical framework built around common healthcare reform themes. The key reform measures examined include implementing social insurance systems, implementing payment systems that promote efficiency, and removal of excess capacity. The trend analysis highlights the importance of the economic, political and social context in driving the direction and pace of healthcare reform. For example, the transition to social insurance systems was smoother in countries with stronger economies and political commitment to reform. Policies aimed at improving the efficiency of the healthcare system, reducing utilisation and reducing excess capacity were met with some success in all of the countries. However, the reform effort continues as the countries are still addressing the initial challenges of insufficient funding, informal payments, excess capacity and inefficiencies in the provision of healthcare.

  5. Suicide Prevention in an Emergency Department Population: The ED-SAFE Study.

    PubMed

    Miller, Ivan W; Camargo, Carlos A; Arias, Sarah A; Sullivan, Ashley F; Allen, Michael H; Goldstein, Amy B; Manton, Anne P; Espinola, Janice A; Jones, Richard; Hasegawa, Kohei; Boudreaux, Edwin D

    2017-06-01

    Suicide is a leading cause of deaths in the United States. Although the emergency department (ED) is an opportune setting for initiating suicide prevention efforts, ED-initiated suicide prevention interventions remain underdeveloped. To determine whether an ED-initiated intervention reduces subsequent suicidal behavior. This multicenter study of 8 EDs in the United States enrolled adults with a recent suicide attempt or ideation and was composed of 3 sequential phases: (1) a treatment as usual (TAU) phase from August 2010 to December 2011, (2) a universal screening (screening) phase from September 2011 to December 2012, and (3) a universal screening plus intervention (intervention) phase from July 2012 to November 2013. Screening consisted of universal suicide risk screening. The intervention phase consisted of universal screening plus an intervention, which included secondary suicide risk screening by the ED physician, discharge resources, and post-ED telephone calls focused on reducing suicide risk. The primary outcome was suicide attempts (nonfatal and fatal) over the 52-week follow-up period. The proportion and total number of attempts were analyzed. A total of 1376 participants were recruited, including 769 females (55.9%) with a median (interquartile range) age of 37 (26-47) years. A total of 288 participants (20.9%) made at least 1 suicide attempt, and there were 548 total suicide attempts among participants. There were no significant differences in risk reduction between the TAU and screening phases (23% vs 22%, respectively). However, compared with the TAU phase, patients in the intervention phase showed a 5% absolute reduction in suicide attempt risk (23% vs 18%), with a relative risk reduction of 20%. Participants in the intervention phase had 30% fewer total suicide attempts than participants in the TAU phase. Negative binomial regression analysis indicated that the participants in the intervention phase had significantly fewer total suicide attempts

  6. The Utilisation of Music by Casino Managers: An Interview Study.

    PubMed

    Bramley, Stephanie; Dibben, Nicola; Rowe, Richard

    2016-12-01

    Music is ubiquitous in retail and commercial environments, with some managers believing that music can enhance the customer experience, increase footfall and sales and improve consumer satisfaction. Casino gambling is popular in the United Kingdom and anecdotal evidence suggests that music is often present. However, little is known about the rationale for music use from the perspective of casino managers. In this study semi-structured interviews were conducted with five casino managers to establish their motivations for utilising music, the factors informing their choice of music and the extent to which music is used with the intention of influencing gambling behaviour. Results showed that casino managers utilised two types of music-recorded background music, often sourced via external music supply companies and live music. Live music was often situated away from the gaming floor and used primarily to accompany participation in non-gambling activities. Recorded background music was not used with the direct aim of influencing customers' gambling behaviour, but to create the right atmosphere for gambling and to promote certain moods within the casinos. To achieve these aims casino managers manipulated the tempo, volume and genre of the recorded background music. Casino managers also reported that some gamblers listen to music via portable music players, possibly with the intention of customising their gambling experience. This study is unique as it has provided a first-hand account of casino managers' implicit theories with regards to why they utilise music and the roles which music is considered to fulfil in casinos.

  7. Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research.

    PubMed

    Francis, Jacinta; Martin, Karen; Costa, Beth; Christian, Hayley; Kaur, Simmi; Harray, Amelia; Barblett, Ann; Oddy, Wendy Hazel; Ambrosini, Gina; Allen, Karina; Trapp, Gina

    2017-10-01

    To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people. Eight group interviews with young people (aged 12-25 years). Community groups and secondary schools in Perth, Western Australia. Forty-one young people, 41% of whom were male and 73% of whom consumed EDs. Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption. Two researchers conducted a qualitative content analysis on the data using NVivo software. Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education. Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  8. Formal home-care utilisation by older adults in Ireland: evidence from the Irish Longitudinal Study on Ageing (TILDA).

    PubMed

    Murphy, Catriona M; Whelan, Brendan J; Normand, Charles

    2015-07-01

    The aim of this study was to provide a population-based estimate of the utilisation of publicly financed formal home care by older adults in Ireland and to identify the principal characteristics of those utilising formal home care. Data were collected through computer-aided personal interviews from a representative sample of community living older adults in Ireland. The interviews were conducted between 2009 and 2011 as part of the first wave of the Irish Longitudinal Study on Ageing (TILDA). The study is cross-sectional in design and limited to participants aged 65 years and older (n = 3507). Results reveal that 8.2% (95% CI 7.1%-9.3%) of participants utilised publicly financed formal home care in the form of home help and/or personal care. Key determinants of formal home-care utilisation were Instrumental Activity of Daily Living (IADL) difficulty (Adj OR 3.8, 95% CI 2.7-5.3), older age (Adj OR 3.4, 95% CI 2.4-4.8) and living alone (Adj OR 2.6, 95% CI 1.9-3.8). Almost half of those utilising formal care did not self-report an Activity of Daily Living (ADL) difficulty or an IADL difficulty. Government policy aims to reduce the need for long-term residential care by providing formal home care for older adults with low to moderate levels of dependency. This requires an increasing emphasis on personal care provision in the home. No evidence was found in this study to suggest that a shift in emphasis from formal domestic to personal care is taking place in Ireland. The absence of standardised assessment and eligibility criteria are deemed to be barriers to reorientation of the system. From a health services perspective, the current situation is not sustainable into the future and requires a focused policy response.

  9. Pattern of Utilisation of Dental Health Care Among HIV-positive Adult Nigerians.

    PubMed

    Adedigba, Michael A; Adekanmbi, Victor T; Asa, Sola; Fakande, Ibiyemi

    2016-01-01

    To determine the pattern of dental care utilisation of people living with HIV (PLHIV). A cross-sectional questionnaire survey of 239 PLHIV patients in three care centres was done. Information on sociodemographics, dental visit, risk groups, living arrangement, medical insurance and need of dental care was recorded. The EC Clearinghouse and WHO clinical staging was used to determine the stage of HIV/AIDS infection following routine oral examinations under natural daylight. Multivariate logistic regression models were created after adjusting for all the covariates that were statistically significant at univariate/bivariate levels. The majority of subjects were younger than 50 years, about 93% had not seen a dentist before being diagnosed HIV positive and 92% reported no dental visit after contracting HIV. Among nonusers of dental care, 14.3% reported that they wanted care but were afraid to seek it. Other reasons included poor awareness, lack of money and stigmatisation. Multivariate analysis showed that lack of dental care was associated with employment status, living arrangements, educational status, income per annum and presenting with oral symptoms. The area under the receiver operating curve was 84% for multivariate logistic regression model 1, 70% for model 2, 67% for model 3 and 71% for model 4, which means that the predictive power of the models were good. Contrary to our expectations, dental utilisation among PLHIV was generally poor among this group of patients. There is serious and immediate need to improve the awareness of PLHIVs in African settings and barriers to dental care utilisation should also be removed or reduced.

  10. Factors affecting the utilisation of improved ventilated latrines among communities in Mtwara Rural District, Tanzania

    PubMed Central

    Kema, Koronel; Semali, Innocent; Mkuwa, Serafina; Kagonji, Ignatio; Temu, Florence; Ilako, Festus; Mkuye, Martin

    2012-01-01

    Introduction The Tanzania government, working in partnership with other stakeholders implemented a community-based project aimed at increasing access to clean and safe water basic sanitation and promotion of personal hygiene in Mtwara Rural District. Mid-term evaluation revealed that progress had been made towards improved ventilated latrines; however, there was no adequate information on utilisation of these latrines and associated factors. This study was therefore conducted to establish the factors influencing the utilisation of these latrines. Methods A cross-sectional study was conducted among 375 randomly selected households using a pre-tested questionnaire to determine whether the households owned improved ventilated latrines and how they utilised them. Resuls About half (50.5%) of the households had an improved ventilated latrine and households with earnings of more than 50,000 Tanzanian Shillings were two times more likely to own an improved latrine than those that earned less (AOR 2.1, 95% CI=1.1-4.0, p= 0.034). The likelihood of owning an improved latrine was reduced by more than 60 percent for female-headed households (AOR=0.38; 95% CI=0.20-0.71; p=0.002). Furthermore, it was established that all members of a household were more likely to use a latrine if it was an improved ventilated latrine (AOR=2.4; 95% CI=1.1-5.1; p= 0.024). Conclusion Findings suggest adoption of strategies to improve the wellbeing of households and deploying those who had acquired improved ventilated latrines as resource persons to help train others. Furthermore, efforts are needed to increase access to soft loans for disadvantaged members and increasing community participation. PMID:23467697

  11. Partial Deletion of the Bovine ED1 Gene Causes Anhidrotic Ectodermal Dysplasia in Cattle

    PubMed Central

    Drögemüller, Cord; Distl, Ottmar; Leeb, Tosso

    2001-01-01

    Anhidrotic ectodermal dysplasia (ED1) is characterized by hypotrichosis, reduced number of sweat glands, and incisior anodontia in human, mouse, and cattle. In affected humans and mice, mutations in the ED1 gene coding for ectodysplasin 1 are found. Ectodysplasin 1 is a novel trimeric transmembrane protein with an extracellular TNF-like signaling domain that is believed to be involved in the formation of hair follicles and tooth buds during fetal development. We report the construction of a 480-kb BAC contig harboring the complete bovine ED1 gene on BTA Xq22–Xq24. Physical mapping and sequence analysis of the coding parts of the ED1 gene revealed that a large genomic region including exon 3 of the ED1 gene is deleted in cattle with anhidrotic ectodermal dysplasia in a family of German Holstein cattle with three affected maternal half sibs. [The sequence data described in this paper have been submitted to the EMBL nucleotide database under accession nos. AJ300468, AJ300469, and AJ278907.] PMID:11591646

  12. Efficacy of ketorolac tromethamine versus meperidine in the ED treatment of acute renal colic.

    PubMed

    Larkin, G L; Peacock, W F; Pearl, S M; Blair, G A; D'Amico, F

    1999-01-01

    To compare the efficacy of intramuscular ketorolac and meperidine in the emergency department (ED) treatment of renal colic, a prospective, controlled, randomized, double-blind trial was conducted in an academic ED with 76,000 annual visits. Participants were volunteer ED patients with a diagnosis of ureterolithiasis confirmed by intravenous pyelogram. Subjects were randomized 1:1 to receive a single intramuscular injection of either 60 mg ketorolac or 100 to 150 mg meperidine, based on weight. Of the 70 patients completing the trial, 33 received ketorolac and 37 received meperidine. Demographic characteristics and baseline pain scores of both groups were comparable (P = NS, Mann Whitney U). Ketorolac was significantly (P < .05) more effective than meperidine in reducing renal colic at 40, 60, and 90 minutes as measured on a 10-cm visual analogue scale. Similar proportions of patients in each group were given rescue analgesia and admitted. Of patients who were discharged home without rescue, those treated with ketorolac left the ED significantly earlier than those treated with meperidine (3.46 v 4.33 h, P < .05). These results show that intramuscular ketorolac as a single agent for renal colic is more effective than meperidine and promotes earlier discharge of renal colic patients from the ED.

  13. Paid sick leave is associated with fewer ED visits among US private sector working adults.

    PubMed

    Bhuyan, Soumitra S; Wang, Yang; Bhatt, Jay; Dismuke, S Edward; Carlton, Erik L; Gentry, Dan; LaGrange, Chad; Chang, Cyril F

    2016-05-01

    The United States (US) is the only developed country that does not guarantee short-term or longer-term paid sick leave. This study used a multiyear nationally representative database to examine the association between availability of paid sick leave and frequency of emergency department (ED) use among US private sector employees. We used the National Health Interview Survey data (2012-2014). The final study sample consists of 42,460 US adults between 18 and 64years of age and working in nongovernmental private sector. Our results suggest that availability of paid sick leave is significantly associated with lower likelihood of ED use, for both moderate (1-3 times/year) and repeated users (4 or more times/year). After controlling for confounding factors, respondents with paid sick leave are 14% less likely to be moderate ED users (adjusted odds ratio, 0.86; 95% CI, 0.79-0.93) and 32% less likely to be repeated ED users (adjusted odds ratio, 0.68; 95% CI, 0.50-0.91). Although expansion of health insurance coverage under the Affordable Care Act has not been shown to reduce utilization of high cost health care services such as the ED, our study suggests other factors such as the availability of paid sick leave may do so, by allowing patients to seek care through other more cost-effective mechanisms (eg, primary care providers). To reduce ED utilization, health policymakers should consider alternative reforms including paid sick leave. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Intravenous migraine therapy in children with posttraumatic headache in the ED.

    PubMed

    Chan, Steven; Kurowski, Brad; Byczkowski, Terri; Timm, Nathan

    2015-05-01

    More than 3.8 million children sustain traumatic brain injuries annually. Treatment of posttraumatic headache (PTH) in the emergency department (ED) is variable, and benefits are unclear. The objective of the study is to determine if intravenous migraine therapy reduces pain scores in children with PTH and factors associated with improved response. This was a retrospective study of children, 8 to 21 years old, presenting to a tertiary pediatric ED with mild traumatic brain injury (mTBI) and PTH from November 2009 to June 2013. Inclusion criteria were mTBI (defined by diagnosis codes) within 14 days of ED visit, headache, and administration of one or more intravenous medications: ketorolac, prochlorperazine, metoclopramide, chlorpromazine, and ondansetron. Primary outcome was treatment success defined by greater than or equal to 50% pain score reduction during ED visit. Bivariate analysis and logistic regression were used to determine predictors of treatment success: age, sex, migraine or mTBI history, time since injury, ED head computed tomographic (CT) imaging, and pretreatment with oral analgesics. A total of 254 patients were included. Mean age was 13.8 years, 51% were female, 80% were white, mean time since injury was 2 days, and 114 patients had negative head CTs. Eighty-six percent of patients had treatment success with 52% experiencing complete resolution of headache. Bivariate analysis showed that patients who had a head CT were less likely to respond (80% vs 91%; P = .008). Intravenous migraine therapy reduces PTH pain scores for children presenting within 14 days after mTBI. Further prospective work is needed to determine long-term benefits of acute PTH treatment in the ED. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Take steps to curb violence, improve safety for ED personnel.

    PubMed

    2011-10-01

    While violent eruptions are well documented in the ED, there is a not a lot of research into what strategies are most effective at both curbing violence and managing incidents when they do occur. Experts suggest that ED managers should consider staff training and visible security measures when developing procedures for dealing with violence. In one survey of ED physicians, more than three-quarters reported at least one incident of workplace violence in the previous 12 months. Researchers report that many EDs post security at the point of entry, but lack security coverage in patient care areas. Experts suggest that verbal de-escalation techniques can be helpful in lowering anxiety levels.They also urge ED managers to bring in assistance when the ED is crowded or waiting times are long.

  16. Unplanned 3-day re-attendance rate at Emergency Department (ED) and hospital's bed occupancy rate (BOR).

    PubMed

    Sun, Yan; Heng, Bee Hoon; Tay, Seow Yian; Tan, Kelvin Brian

    2015-12-01

    Unplanned re-attendance at the Emergency Department (ED) is often monitored as a quality indicator of the care accorded to patients during their index ED visit. High bed occupancy rate (BOR) has been considered as a matter of reduced patient comfort and privacy. Most hospitals in Singapore operate under BORs above 85 %. This study aims to explore factors associated with the unplanned 3-day ED re-attendance rate and, in particular, if higher BOR is associated with higher 3-day unplanned ED re-attendance rate. This was a multicenter retrospective study using time series data. Three acute tertiary hospitals were selected from all six adult public hospitals in Singapore based on data availability. Daily data from year 2008 to 2013 were collected from the study hospitals' information systems. These included: ED visit date, day of week, month, year, public holiday, daily hospital BOR, daily bed waiting time (BWT) at ED (both median and 95th percentile), daily ED admission rate, and 3-day ED re-attendance rate. The primary outcome of the study was unplanned 3-day ED re-attendance rate from all reasons. Both univariate analysis and generalized linear regression were respectively applied to study the crude and adjusted association between the unplanned 3-day ED re-attendance rate and its potential associated factors. All analyses were conducted using SPSS 18 (PASW 18, IBM). The average age of patients who visited ED was 35 years old (SD = 2), 37 years old (SD = 2), and 40 years old (SD = 2) in hospitals A, B, and C respectively. The average 3-day unplanned ED re-attendance rate was 4.9 % (SE = 0.47 %) in hospital A, 3.9 % (SE = 0.35 %) in hospital B, and 4.4 % (SE = 0.30 %) in hospital C. After controlling for other covariates, the unplanned 3-day ED re-attendance rates were significantly associated with hospital, time trend, day of week, daily average BOR, and ED admission rate. Strong day-of-week effect on early ED re-attendance rate was

  17. Contribution of ED admissions to inpatient hospital revenue.

    PubMed

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

  18. Completing EdTPA: TSOL Candidate Performance and Reflection

    ERIC Educational Resources Information Center

    Micek, Timothy A.

    2017-01-01

    edTPA is a pre-service assessment process designed to determine if a new teacher is ready for the job. edTPA is part of a national movement towards the use of performance assessments in teacher education. As of 2014, 41 states (a) require a state-approved performance assessment like edTPA for program completion or for state licensure and/or state…

  19. ED crowding and the use of nontraditional beds.

    PubMed

    McNaughton, Candace; Self, Wesley H; Jones, Ian D; Arbogast, Patrick G; Chen, Ning; Dittus, Robert S; Russ, Stephan

    2012-10-01

    In an effort to compensate for crowding, many emergency departments (EDs) evaluate and treat patients in nontraditional settings such as gurneys in hallways and conference rooms. The impact of this practice on ED evaluation time is unknown. A historical cohort of adult ED visits to an academic hospital between August 1, 2009 and August 1, 2010, was used to evaluate the relationship between ED bed assignment (traditional, hallway, or conference room bed) and mean ED evaluation time, defined as the time spent in an ED bed before admission or discharge. Chief complaints were categorized into the 5 most frequent categories: abdominal/genitourinary, joint/muscle, general (fever, malaise), head/neck, and other. Multiple linear regression and marginal prediction were used to calculate the mean ED evaluation times for each bed type, overall, and by chief complaint category. During the study period, 15 073 patient visits met the inclusion criteria. After adjustment for patient and ED factors, assignments to hallway and conference room beds were associated with increases in a mean ED evaluation time of 13.3 minutes (95% confidence interval, 13.2-13.3) and 10.9 minutes (95% confidence interval, 10.8-10.9), respectively, compared with the traditional bed ED evaluation time. This varied by chief complaint category. Use of nontraditional beds is associated with increases in mean ED evaluation time; however, these increases are small and may be further minimized by restricting the use of nontraditional beds to patients with specific chief complaints. Nontraditional beds may have a role in improving ED throughput during times of crowding. Published by Elsevier Inc.

  20. EDs trying not to let the bed bugs bite.

    PubMed

    2010-09-01

    As bed bugs have emerged as a growing problem for EDs, managers have developed strategies for prevention and decontamination. Here are some of the approaches they have shared with ED Management: Educate your staff on what they should look for on patients and in rooms that would indicate the presence of bed bugs. Be proactive. Have an exterminator examine your ED on a regular basis. A decontamination room on the outside of the building will prevent the spread of these bugs in your ED.

  1. Accuracy in ED Triage for Symptoms of Acute Myocardial Infarction.

    PubMed

    Sanders, Susan F; DeVon, Holli A

    2016-07-01

    More than 6 million people present to emergency departments across the United States annually with symptoms of acute myocardial infarction (AMI). Of the 1 million patients with AMI, 350,000 die during the acute phase. Accurate ED triage can reduce mortality and morbidity, yet accuracy rates are low. In this study we explored the relationship between patient and nurse characteristics and accuracy of triage in patients with symptoms of AMI. This retrospective, descriptive study used patient data from electronic medical records. The sample of 286 patients was primarily white, with a mean age of 61.44 years (standard deviation [SD], ±13.02), and no history of heart disease. The sample of triage nurses was primarily white and female, with a mean age of 45.46 years (SD, ±11.72) and 18 years of nursing experience. Nineteen percent of the nurses reported having earned a bachelor's degree. Emergency nurse triage accuracy was 54%. Patient race and presence of chest pain were significant predictors of accuracy. Emergency nurse age was a significant predictor of accuracy in triage, but years of experience in nursing was not a significant predictor. Of the 9 variables investigated, only patient race, symptom presentation, and emergency nurse age were significant predictors of triage accuracy. Inconsistency in triage decisions may be due to other conditions not yet explored, such as critical thinking skills and executive functions. This study adds to the body of evidence regarding ED triage of patients with symptoms of AMI. However, further exploration into decisions at triage is warranted to improve accuracy, expedite care, and improve outcomes. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  2. Carbon substrate utilisation profile of a high concentration effluent degrading microbial consortium.

    PubMed

    Jena, S; Jeanmeure, L F C; Wichukorn, S D; Wright, P C

    2006-08-01

    This paper presents the carbon substrate utilisation profile of a group of microorganisms responsible for the biodegradation of a highly concentrated industrial effluent. A 1 litre bioreactor was used to study this consortium's biodegradation potential, with the chemical oxygen demand (COD) of the waste being reduced by 90% from 24000 mg l(-1) within 456 hours. This study also demonstrates that the consortium is capable of degrading organic solvents, such as isopropanol, at concentrations of 260 mg l(-1). The population distribution and biochemical behaviour were also characterised using denaturing gradient gel electrophoresis (DGGE) and Biolog Eco Plates at various stages of bioreactor operation. The DGGE results indicated that the dominant bands of the microbial population profile were stable at various operational stages, and that only a few bands varied with time. Moreover, four Biolog Eco plates were inoculated with samples drawn from the bioreactor at 0, 24, 72 and 120 hours after inoculation. Based on this Biolog Eco Plate profiling, a carbon source utilisation analysis was conducted to group the substrates according to their colour development patterns. Patterns were quantified via measurement of well optical density. Subsequently, cross-correlation statistical techniques were used to establish the existence of recurrent behavioural responses from each carbon source to the various wastewater samples. From the cross correlation, an attempt was made to classify the metabolic potential for future biodegradation processes. Carbohydrates, amino acids and carboxylic acids were the most predominant groups of sole carbon substrates showing similar growth behaviour in the consortium.

  3. Environmental-benign utilisation of fly ash as low-cost adsorbents.

    PubMed

    Wang, Shaobin; Wu, Hongwei

    2006-08-25

    Fly ash is a waste substance from thermal power plants, steel mills, etc. that is found in abundance in the world. In recent years, utilisation of fly ash has gained much attention in public and industry, which will help reduce the environmental burden and enhance economic benefit. In this paper, the technical feasibility of utilisation of fly ash as a low-cost adsorbent for various adsorption processes for removal of pollutants in air and water systems has been reviewed. Instead of using commercial activated carbon or zeolites, a lot of researches have been conducted using fly ash for adsorption of NO(x), SO(x), organic compounds, and mercury in air, and cations, anions, dyes and other organic matters in waters. It is recognised that fly ash is a promising adsorbent for removal of various pollutants. Chemical treatment of fly ash will make conversion of fly ash into a more efficient adsorbent for gas and water cleaning. Investigations also revealed that unburned carbon component in fly ash plays an important role in adsorption capacity. Directions for future research are also discussed.

  4. Progress towards Sustainable Utilisation and Management of Food Wastes in the Global Economy

    PubMed Central

    Ghosh, Purabi R.; Fawcett, Derek; Sharma, Shashi B.

    2016-01-01

    In recent years, the problem of food waste has attracted considerable interest from food producers, processors, retailers, and consumers alike. Food waste is considered not only a sustainability problem related to food security, but also an economic problem since it directly impacts the profitability of the whole food supply chain. In developed countries, consumers are one of the main contributors to food waste and ultimately pay for all wastes produced throughout the food supply chain. To secure food and reduce food waste, it is essential to have a comprehensive understanding of the various sources of food wastes throughout the food supply chain. The present review examines various reports currently in the literature and quantifies waste levels and examines the trends in wastage for various food sectors such as fruit and vegetable, fisheries, meat and poultry, grain, milk, and dairy. Factors contributing to food waste, effective cost/benefit food waste utilisation methods, sustainability and environment considerations, and public acceptance are identified as hurdles in preventing large-scale food waste processing. Thus, we highlight the need for further research to identify and report food waste so that government regulators and food supply chain stakeholders can actively develop effective waste utilisation practices. PMID:27847805

  5. An environmental analysis of options for utilising wasted food and food residue.

    PubMed

    Oldfield, Thomas L; White, Eoin; Holden, Nicholas M

    2016-12-01

    The potential environmental impact of wasted food minimisation versus its utilisation in a circular bioeconomy is investigated based on a case study of Ireland. The amount of wasted food and food residue (WFFR) produced in 2010 was used for business-as-usual, (a) and four management options were assessed, (b) minimisation, (c) composting, (d) anaerobic digestion and (e) incineration. The environmental impacts Global Warming Potential (GWP), Acidification Potential (AP) and Eutrophication Potential (EP) were considered. A carbon return on investment (CRoI) was calculated for the three processing technologies (c-e). The results showed that a minimisation strategy for wasted food would result in the greatest reduction of all three impacts, -4.5 Mt CO2-e (GWP), -11.4 kt PO4(3)-e (EP) and -43.9 kt SO2-e (AP) compared to business as usual. For WFFR utilisation in the circular bioeconomy, anaerobic digestion resulted in the lowest environmental impact and best CRoI of -0.84 kg CO2-e per Euro. From an economic perspective, for minimisation to be beneficial, 0.15 kg of wasted food would need to be reduced per Euro spent.

  6. Progress towards Sustainable Utilisation and Management of Food Wastes in the Global Economy.

    PubMed

    Ghosh, Purabi R; Fawcett, Derek; Sharma, Shashi B; Poinern, Gerrard Eddy Jai

    2016-01-01

    In recent years, the problem of food waste has attracted considerable interest from food producers, processors, retailers, and consumers alike. Food waste is considered not only a sustainability problem related to food security, but also an economic problem since it directly impacts the profitability of the whole food supply chain. In developed countries, consumers are one of the main contributors to food waste and ultimately pay for all wastes produced throughout the food supply chain. To secure food and reduce food waste, it is essential to have a comprehensive understanding of the various sources of food wastes throughout the food supply chain. The present review examines various reports currently in the literature and quantifies waste levels and examines the trends in wastage for various food sectors such as fruit and vegetable, fisheries, meat and poultry, grain, milk, and dairy. Factors contributing to food waste, effective cost/benefit food waste utilisation methods, sustainability and environment considerations, and public acceptance are identified as hurdles in preventing large-scale food waste processing. Thus, we highlight the need for further research to identify and report food waste so that government regulators and food supply chain stakeholders can actively develop effective waste utilisation practices.

  7. Web Formation - Skylab Student Experiment ED-52

    NASA Technical Reports Server (NTRS)

    1973-01-01

    Judith S. Miles of Lexington High School, Lexington, Massachusetts, proposed skylab student experiment ED-52, Web Formation. This experiment was a study of a spider's behavior in a weightless environment. The geometrical structure of the web of the orb-weaving spider provides a good measure of the condition of its central nervous system. Since the spider senses its own weight to determine the required thickness of web material and uses both the wind and gravity to initiate construction of its web, the lack of gravitational force in Skylab provided a new and different stimulus to the spider's behavioral response. Two common cross spiders, Arabella and Anita, were used for the experiment aboard the Skylab-3 mission. After initial disoriented attempts, both spiders produced almost Earth-like webs once they had adapted to weightlessness. This photograph is of Arabella, a cross spider, in her initial attempt at spirning a web. This picture was taken by the crew of the Skylab 3 mission before Arabella adapted to her new environment.

  8. Web Formation - Skylab Student Experiment ED-52

    NASA Technical Reports Server (NTRS)

    1973-01-01

    Judith S. Miles of Lexington High School, Lexington, Massachusetts, proposed skylab student experiment ED-52, Web Formation. This experiment was a study of a spider's behavior in a weightless environment. The geometrical structure of the web of the orb-weaving spider provides a good measure of the condition of its central nervous system. Since the spider senses its own weight to determine the required thickness of web material and uses both the wind and gravity to initiate construction of its web, the lack of gravitational force in Skylab provided a new and different stimulus to the spider's behavioral response. Two common cross spiders, Arabella and Anita, were used for the experiment aboard the Skylab-3 mission. After initial disoriented attempts, both spiders produced almost Earth-like webs once they had adapted to weightlessness. This photograph is of Arabella, a cross spider, in her initial attempt at spirning a web. This picture was taken by the crew of the Skylab 3 mission before Arabella adapted to her new environment.

  9. Neutron Analysis - Skylab Student Experiment ED-76

    NASA Technical Reports Server (NTRS)

    1973-01-01

    The rate of neutron flow is commonly referred to as a flux. The measurement of neutron fluxes in Skylab was the subject of a proposal by Terry Quist of San Antonio, Texas. This chart describes Quist's experiment, Neutron Analysis, Skylab student experiment ED-76. These measurements were considered important not only by NASA but also by the scientific community for four reasons. High energy neutrons can be harmful to human tissue if they are present in significant quantities. Fluxes of neutrons can damage film and other sensitive experimental equipment in a marner similar to those produced by x-rays or other radiation. Furthermore, neutron fluxes can be used as a calibration source for other space-oriented particle physics experiments. Finally, neutron fluxes can affect sensitive x-ray and gamma-ray astronomy observations. Quist's objectives were to measure the neutron fluxes present in Skylab and, with the assistance of NASA and other physicists, to attempt determination of their origin as well as their energy range or spectrum. This experiment had stimulated interest in further studies of neutron phenomena in space. In March 1972, NASA and the National Science Teachers Association selected 25 experiment proposals for flight on Skylab. Science advisors from the Marshall Space Flight Center aided and assisted the students in developing the proposals for flight on Skylab.

  10. On E.D. Jones' MICROCOSMOLOGY

    SciTech Connect

    Noyes, H. Pierre

    2003-01-08

    By taking seriously the limits on observability which come from combining relativistic quantum mechanics with general relativity, Ed Jones has shown that the current measurements of the cosmological constant density {Omega}{sub {Lambda}} {approx} 0.7 imply that the temperature scale at which it becomes possible to discuss cosmological models is {approx} 5 Tev (5.8 x 10{sup 16} K). This is self-consistent with the assumption that the number of Planck masses which make some sort of ''phase transition'' to this state is N{sub Pk} {approx} 4 x 10{sup 61}. We review Jones' argument and the bit-string physics calculation which gives the baryon-photon ratio at nucleosynthesis as {approx} 2/256{sup 4}, the dark matter-baryon ratio as {approx} 12.7, and hence {Omega}{sub m} {approx} 0.3, in agreement with current observations. Accepting these values for the two energy densities {Omega}{sub {Lambda}} + {Omega}{sub m} {approx} 1 in accord with recent analyses of fluctuations in the CMB showing that space is flat to about 6%. We conclude that experiments with particle accelerators in the 5-10 Tev range must either show that current theory can adequately describe the currently observed structure of our universe or force us to revise our ideas about physics at a very fundamental level.

  11. Fish utilisation of wetland nurseries with complex hydrological connectivity.

    PubMed

    Davis, Ben; Johnston, Ross; Baker, Ronald; Sheaves, Marcus

    2012-01-01

    The physical and faunal characteristics of coastal wetlands are driven by dynamics of hydrological connectivity to adjacent habitats. Wetlands on estuary floodplains are particularly dynamic, driven by a complex interplay of tidal marine connections and seasonal freshwater flooding, often with unknown consequences for fish using these habitats. To understand the patterns and subsequent processes driving fish assemblage structure in such wetlands, we examined the nature and diversity of temporal utilisation patterns at a species or genus level over three annual cycles in a tropical Australian estuarine wetland system. Four general patterns of utilisation were apparent based on CPUE and size-structure dynamics: (i) classic nursery utlisation (use by recently settled recruits for their first year) (ii) interrupted peristence (iii) delayed recruitment (iv) facultative wetland residence. Despite the small self-recruiting 'facultative wetland resident' group, wetland occupancy seems largely driven by connectivity to the subtidal estuary channel. Variable connection regimes (i.e. frequency and timing of connections) within and between different wetland units (e.g. individual pools, lagoons, swamps) will therefore interact with the diversity of species recruitment schedules to generate variable wetland assemblages in time and space. In addition, the assemblage structure is heavily modified by freshwater flow, through simultaneously curtailing persistence of the 'interrupted persistence' group, establishing connectivity for freshwater spawned members of both the 'facultative wetland resident' and 'delayed recruitment group', and apparently mediating use of intermediate nursery habitats for marine-spawned members of the 'delayed recruitment' group. The diversity of utilisation pattern and the complexity of associated drivers means assemblage compositions, and therefore ecosystem functioning, is likely to vary among years depending on variations in hydrological connectivity

  12. Fish Utilisation of Wetland Nurseries with Complex Hydrological Connectivity

    PubMed Central

    Davis, Ben; Johnston, Ross; Baker, Ronald; Sheaves, Marcus

    2012-01-01

    The physical and faunal characteristics of coastal wetlands are driven by dynamics of hydrological connectivity to adjacent habitats. Wetlands on estuary floodplains are particularly dynamic, driven by a complex interplay of tidal marine connections and seasonal freshwater flooding, often with unknown consequences for fish using these habitats. To understand the patterns and subsequent processes driving fish assemblage structure in such wetlands, we examined the nature and diversity of temporal utilisation patterns at a species or genus level over three annual cycles in a tropical Australian estuarine wetland system. Four general patterns of utilisation were apparent based on CPUE and size-structure dynamics: (i) classic nursery utlisation (use by recently settled recruits for their first year) (ii) interrupted peristence (iii) delayed recruitment (iv) facultative wetland residence. Despite the small self-recruiting ‘facultative wetland resident’ group, wetland occupancy seems largely driven by connectivity to the subtidal estuary channel. Variable connection regimes (i.e. frequency and timing of connections) within and between different wetland units (e.g. individual pools, lagoons, swamps) will therefore interact with the diversity of species recruitment schedules to generate variable wetland assemblages in time and space. In addition, the assemblage structure is heavily modified by freshwater flow, through simultaneously curtailing persistence of the ’interrupted persistence’ group, establishing connectivity for freshwater spawned members of both the ‘facultative wetland resident’ and ‘delayed recruitment group’, and apparently mediating use of intermediate nursery habitats for marine-spawned members of the ‘delayed recruitment’ group. The diversity of utilisation pattern and the complexity of associated drivers means assemblage compositions, and therefore ecosystem functioning, is likely to vary among years depending on variations in

  13. Feasibility study for an innovative industrial red mud utilisation method.

    PubMed

    Kounalakis, Petros; Aravossis, Konstantinos; Karayianni, ChS

    2016-02-01

    Red mud is a high volume industrial waste, and its management poses a unique challenge. For the utilisation of red mud, an economical, energy saving, environmental friendly and widely applicable method has been found. The proposed novel method is purely chemical, and achieves the recovery of all the oxides contained in red mud totally and transforms them into high value added products. The present work shows that an investment in an industrial plant, treating red mud and turning a toxic industrial waste in commercial products, is safe and viable. © The Author(s) 2015.

  14. The use of model-based iterative reconstruction to decrease ED radiation exposure.

    PubMed

    Gatewood, Medley O; Grubish, Lindsay; Busey, Janet M; Shuman, William P; Strote, Jared

    2015-04-01

    The radiation risk posed by diagnostic computed tomography (CT) is a growing concern. The use of model-based iterative reconstruction (MBIR) technology reduces radiation exposure but requires additional processing time. The goal of this study was to compare MBIR and a standard CT reconstructive protocols in terms of emergency department (ED) visit duration and reduction in radiation exposure. A retrospective, matched, case-control design was used to compare patients who received MBIR and standard protocol abdomen and pelvis CTs. ED length of stay (LOS) and radiation exposure were the 2 primary outcome variables. During the study period, 121 patients met inclusion criteria and were matched to controls for a total of 242 subjects. Although the low-dose group LOS was slightly longer, there was no significant difference in LOS. Mean differences were 18 minutes overall (520 vs 502 minutes; P = .497), 11 minutes for admitted patients (587 vs 576 minutes; P = .839), and 22 minutes for discharged patients (490 vs 468 minutes; P = .482). The mean volume CT dose index for the standard-dose CT was 11.6 ± 8.3 and 7.7 ± 4.6 mGy for the reduced-dose CT, a 34% decrease (P < .001). Use of MBIR in the ED may provide decreased radiation exposure while minimally impacting ED LOS. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Tired of seeing your patients in the ED? Let's give parent education another look!

    PubMed

    Yoffe, Stuart J; McClellan, David A; Tolson, Homer; Moore, Robert W; McKay, Rebecca

    2012-02-01

    This study was conducted to determine if a parent-oriented educational intervention reduces the use of emergency department (ED) services for the care of infants. Infants aged 7 days to 1 year and older children aged 2 to 10 years were tracked for 3 years in two separate primary care (PC) practices in Washington County, Texas, with the last year being the interventional study period. Also, infants aged 7 days to 1 year and older children aged 7 days to 5 years were tracked in a third PC practice in Burleson County, Texas. The study group consisted of all parents of patients aged 7 days to 1 year seen by the pediatric group in Washington County during the 1-year interventional period. Only parents of infants in the study group received a specific educational intervention booklet. Five separate control groups were followed in this study. The control groups received usual care with standardized patient information, but they did not receive the educational intervention booklet. Each group was evaluated by calculating its monthly ED utilization rate, which is the quotient derived from dividing the number of children from that particular group seen in the ED per month by the number of children from the same group seen in the PC clinic per month. A difference of proportions test was applied to test for statistical significance regarding ED utilization. Compared with parents in the control group, parents receiving the intervention booklet (the study group) showed significantly (P < .05) lower use of ED services for care of their infants. We found no change in ED utilization for children of parents receiving other standard educational information.

  16. MedEdPORTAL: Educational Scholarship for Teaching

    ERIC Educational Resources Information Center

    Reynolds, Robby J.; Candler, Christopher S.

    2008-01-01

    MedEdPORTAL is an online publication service provided at no charge by the Association of American Medical Colleges (AAMC). The intent is to promote collaboration and educational scholarship by helping educators publish and share educational resources. With MedEdPORTAL, users can quickly locate high-quality, peer-reviewed teaching materials in both…

  17. ExpandED Options: Learning beyond High School Walls

    ERIC Educational Resources Information Center

    ExpandED Schools, 2014

    2014-01-01

    Through ExpandED Options by TASC, New York City high school students get academic credit for learning career-related skills that lead to paid summer jobs. Too many high school students--including those most likely to drop out--are bored or see classroom learning as irrelevant. ExpandED Options students live the connection between mastering new…

  18. Teaching Elementary School Social Studies Methods under edTPA

    ERIC Educational Resources Information Center

    An, Sohyun

    2016-01-01

    This article reports a self-study that analyzes my experience as a teacher educator navigating a turbulent educational landscape with the advent of edTPA. The data consist of my journal entries, the syllabi, handouts, work submitted by my students, and course evaluations. Data were analyzed by using an inductive process to describe how the edTPA…

  19. Threats to Validity in the edTPA Video Component

    ERIC Educational Resources Information Center

    Choppin, Jeffrey; Meuwissen, Kevin

    2017-01-01

    The edTPA, a performance assessment designed to generate reliable and valid measures of teaching practice, increasingly is used as a gatekeeping mechanism for beginning teacher licensure in various states, including New York, Washington State, Wisconsin, and Georgia. One of the edTPA's key components is the demonstration of instructional practice…

  20. Measuring the Fidelity of Re-ED Programs.

    ERIC Educational Resources Information Center

    Meadowcroft, Pamela; Cantrell, Mary Lynn; Cantrell, Robert P.

    2002-01-01

    The effectiveness of a comprehensive intervention like Re-ED (Reeducation of Emotional Disturbed Children) requires a clear definition of the essential components of the model. This article describes an ongoing process to create a program assessment tool for Re-ED. Program fidelity requires being able to specify precisely what is meant by certain…

  1. Teaching Elementary School Social Studies Methods under edTPA

    ERIC Educational Resources Information Center

    An, Sohyun

    2016-01-01

    This article reports a self-study that analyzes my experience as a teacher educator navigating a turbulent educational landscape with the advent of edTPA. The data consist of my journal entries, the syllabi, handouts, work submitted by my students, and course evaluations. Data were analyzed by using an inductive process to describe how the edTPA…

  2. MedEdPORTAL: Educational Scholarship for Teaching

    ERIC Educational Resources Information Center

    Reynolds, Robby J.; Candler, Christopher S.

    2008-01-01

    MedEdPORTAL is an online publication service provided at no charge by the Association of American Medical Colleges (AAMC). The intent is to promote collaboration and educational scholarship by helping educators publish and share educational resources. With MedEdPORTAL, users can quickly locate high-quality, peer-reviewed teaching materials in both…

  3. Measuring the Fidelity of Re-ED Programs.

    ERIC Educational Resources Information Center

    Meadowcroft, Pamela; Cantrell, Mary Lynn; Cantrell, Robert P.

    2002-01-01

    The effectiveness of a comprehensive intervention like Re-ED (Reeducation of Emotional Disturbed Children) requires a clear definition of the essential components of the model. This article describes an ongoing process to create a program assessment tool for Re-ED. Program fidelity requires being able to specify precisely what is meant by certain…

  4. Effects of drug price reduction and prescribing restrictions on expenditures and utilisation of antihypertensive drugs in Korea

    PubMed Central

    Yoo, Ki-Bong; Lee, Sang Gyu; Park, Sohee; Kim, Tae Hyun; Ahn, Jeonghoon; Cho, Mee-Hyun; Park, Eun-Cheol

    2015-01-01

    Objectives To evaluate the quantitative effects of the drug price reduction on pharmaceutical expenditures and the new guidelines to restrict prescribing on drug utilisation for antihypertensive drugs. Design We used an interrupted time series design with the National patient sample data of Health Insurance Review and Assessment Service in South Korea. Methods 54 295 participants who were with primary hypertension from the National patient sample data of Health Insurance Review and Assessment Service were included. The study period was from March 2011 to December 2013. The dependent variables were antihypertensive drug costs, antihypertensive drug cost per prescribing day, daily drug utilisation, average number of drugs per month, percentage of original drugs per prescription, drug overutilisation and prohibited combinations. Segmented regression analysis was used. Results The drug price reduction reduced expenditure (US$−1.51, −10.2%), and the new guidelines reduced expenditures even more (US$−2.13; −16.2%). These policies saved US$4.22 (28%) of antihypertensive drug costs per patient in December 2013 compared to March 2012. Drug price reduction policy was introduced in April 2012. We established the policy effect by comparing it before (March 2012) with after(21 months later-December 2012). The effects of the guidelines decreased expenditures, daily drug utilisation and the average number of drugs per month more than did the drug price reduction. Conclusions Both policies saved money. The guidelines were more effective over time and had fewer side effects such as increasing daily drug utilisation and number of drugs than the effects of drug price reduction. PMID:26179644

  5. For success with frequent ED utilizers, take steps to understand patient needs, connect them with appropriate resources.

    PubMed

    2013-05-01

    Through its newly created Consistent Care Program, St. Luke's Hospital in Cedar Rapids, IA, has been able to significantly reduce ED utilization among patients who have been identified as having used the ED at least 12 times in the past year. Patients who meet program criteria are automatically identified once per month. A committee of social workers, nurses, and providers then creates care plans for these individuals, so that when they present to the ED, emergency providers will have a consistent road map to follow. In one year, the program has reduced the number ED visits among frequent utilizers by one-third, saving the hospital close to $1 million. Of the original 103 patients who were first identified for the program in January of 2012, only 10 patients still meet the criteria of visiting the ED 12 times in 12 months. Administrators say that key elements of the program are case manager who can interact with the patients and their providers, a mechanism for flagging these patients when they present to the ED, and engaged providers.

  6. TechEdSat Nano-Satellite Series Fact Sheet

    NASA Technical Reports Server (NTRS)

    Murbach, Marcus; Martinez, Andres; Guarneros Luna, Ali

    2014-01-01

    TechEdSat-3p is the second generation in the TechEdSat-X series. The TechEdSat Series uses the CubeSat standards established by the California Polytechnic State University Cal Poly), San Luis Obispo. With typical blocks being constructed from 1-unit (1U 10x10x10 cm) increments, the TechEdSat-3p has a 3U volume with a 30 cm length. The project uniquely pairs advanced university students with NASA researchers in a rapid design-to-flight experience lasting 1-2 semesters.The TechEdSat Nano-Satellite Series provides a rapid platform for testing technologies for future NASA Earth and planetary missions, as well as providing students with an early exposure to flight hardware development and management.

  7. The full moon and ED patient volumes: unearthing a myth.

    PubMed

    Thompson, D A; Adams, S L

    1996-03-01

    To determine if there is any effect of the full moon on emergency department (ED) patient volume, ambulance runs, admissions, or admissions to a monitored unit, a retrospective analysis of the hospital electronic records of all patients seen in an ED during a 4-year period was conducted in an ED of a suburban community hospital. A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.

  8. ED leadership competency matrix: an administrative management tool.

    PubMed

    Propp, Douglas A; Glickman, Seth; Uehara, Dennis T

    2003-10-01

    A successful ED relies on its leaders to master and demonstrate core competencies to be effective in the many arenas in which they interact and are responsible. A unique matrix model for the assessment of an ED leadership's key administrative skill sets is presented. The model incorporates capabilities related to the individual's cognitive aptitude, experience, acquired technical skills, behavioral characteristics, as well as the ability to manage relationships effectively. Based on the personnel inventory using the matrix, focused evaluation, development, and recruitment of ED key leaders occurs. This dynamic tool has provided a unique perspective for the evaluation and enhancement of overall ED leadership performance. It is hoped that incorporation of such a model will similarly improve the accomplishments of EDs at other institutions.

  9. Healthcare Resource Utilisation Associated with Herpes Zoster in a Prospective Cohort of Older Australian Adults.

    PubMed

    Karki, Surendra; Newall, Anthony T; MacIntyre, C Raina; Heywood, Anita E; McIntyre, Peter; Banks, Emily; Liu, Bette

    2016-01-01

    Herpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age. In this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population. Per HZ case, there was an average of 0.06 (95% CI 0.04-0.08) excess hospitalisations, 1.61 (95% CI 1.51-1.69) excess general practitioner visits, 1.96 (95% CI 1.86-2.15) excess prescriptions filled and 0.11 (95% CI 0.09-0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719-2767); GP visits was highest in those 60-69 years (N = 50567, 95%CI 39958-61105), prescriptions and ED visits were highest in 70-79 years (N = 50524, 95%CI 40634-60471 and N = 2891, 95%CI 2319-3449 respectively). This study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted.

  10. Healthcare Resource Utilisation Associated with Herpes Zoster in a Prospective Cohort of Older Australian Adults

    PubMed Central

    Karki, Surendra; Newall, Anthony T.; MacIntyre, C. Raina; Heywood, Anita E.; McIntyre, Peter; Banks, Emily; Liu, Bette

    2016-01-01

    Background Herpes zoster (HZ) is a common condition that increases in incidence with older age but vaccines are available to prevent the disease. However, there are limited data estimating the health system burden attributable to herpes zoster by age. Methods In this study, we quantified excess healthcare resource usage associated with HZ during the acute/sub-acute period of disease (21days before to 90 days after onset) in 5952 cases and an equal number of controls matched on age, sex, and prior healthcare resource usage. Estimates were adjusted for potential confounders in multivariable regression models. Using population-based estimates of HZ incidence, we calculated the age-specific excess number of health service usage events attributable to HZ in the population. Results Per HZ case, there was an average of 0.06 (95% CI 0.04–0.08) excess hospitalisations, 1.61 (95% CI 1.51–1.69) excess general practitioner visits, 1.96 (95% CI 1.86–2.15) excess prescriptions filled and 0.11 (95% CI 0.09–0.13) excess emergency department visits. The average number of healthcare resource use events, and the estimated excess per 100,000 population increased with increasing age but were similar for men and women, except for higher rates of hospitalisation in men. The excess annual HZ associated burden of hospitalisations was highest in adults ≥80 years (N = 2244, 95%CI 1719–2767); GP visits was highest in those 60–69 years (N = 50567, 95%CI 39958–61105), prescriptions and ED visits were highest in 70–79 years (N = 50524, 95%CI 40634–60471 and N = 2891, 95%CI 2319–3449 respectively). Conclusions This study provides important data to establish the healthcare utilisation associated with HZ against which detailed cost-effectiveness analyses of HZ immunisation in older adults can be conducted. PMID:27483007

  11. Energetic utilisation of refuse derived fuels from landfill mining.

    PubMed

    Rotheut, Martin; Quicker, Peter

    2017-04-01

    The residence of municipal solid waste within a landfill body results in a significant change of material properties. Experiences with the energetic utilisation of the burnable fractions from formerly landfilled waste are hardly documented, the influence of refuse derived fuels (RDF) from such materials on the performance of modern waste-to-energy plants is not sufficiently described in scientific literature. Therefore this study focuses on the energetic utilisation of refuse derived fuel from landfilled waste, processed in a mechanical waste treatment facility, and the impact of the material on the operation of the incineration plant. Additionally, the possibility of direct combustion of non-pre-treated excavated landfill material has been evaluated in the same facility. First, sampling and analysis of the fuel has been carried out. Based on this, a large-scale combustion experiment was planned and conducted in an industrial waste-to-energy plant. Steam mass flow rate, concentration of harmful substances in the raw gas, as well as total emissions of the facility have been monitored in detail. Furthermore, the influence of the landfilled material on the additive consumption has been determined. The combustion residues (bottom ash) were also sampled and analysed. Based on the evaluation of operating data and analysis of both fuel and residue, suitable thermal treatment approaches for the refuse-derived fuel and the non-pre-treated excavated material have been assessed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Application Development for the Utilisation of ENVISAT Data

    NASA Astrophysics Data System (ADS)

    Csornai, G.; Suba, Zs.; Wirnhardt, Cs.; Nádor, G.; Tikász, L.; László, I.; Csekõ, Á.; Martinovich, L.

    2004-05-01

    Natural disasters connected to climatic extremities (floods, waterlog and drought) tend to occur more frequently in Hungary in the past decade. Serious waterlog affecting more than 100 000 hectares of arable land, flood peak records during spring and serious drought in summer causing losses to agriculture and to the whole economy happened yearly between 1998-2002. After the development and application of monitoring methods, FÖMI RSC have started to develop a cost-effective satellite based model to monitor these natural disaster at regional level. The ESA- titled "Application development for the utilisation of ENVISAT data in remote sensing based regional flood/waterlog and drought monitoring (2000-2003)" aimed at the rapid and large scale monitoring of these disasters utilising available low- and medium resolution operational satellite data (NOAA AVHRR, SPOT VEGETATION, IRS-1C/1D WiFS and ERS SAR) involving the new ESA ENVISAT (specially MERIS and ASAR) data. This paper describes the present status of the project and shows several examples about the achievements.

  13. Self-Assembled Hydrogels Utilising Polymer-Nanoparticle Interactions

    PubMed Central

    Appel, Eric A.; Tibbitt, Mark W.; Webber, Matthew J.; Mattix, Bradley A.; Veiseh, Omid

    2015-01-01

    Mouldable hydrogels that flow upon applied stress and rapidly self-heal are increasingly utilised as they afford minimally invasive delivery and conformal application. Here we report a new paradigm for the fabrication of self-assembled hydrogels with shear-thinning and self-healing properties employing rationally engineered polymer-nanoparticle interactions. Biopolymer derivatives are linked together by selective adsorption to nanoparticles. The transient and reversible interactions between biopolymers and nanoparticles enable flow under applied shear stress, followed by rapid self-healing when the stress is relaxed. We develop a physical description of polymer-nanoparticle gel formation that is utilised to design biocompatible gels for minimally-invasive drug delivery. Owing to the hierarchical structure of the gel, both hydrophilic and hydrophobic drugs can be entrapped and delivered with differential release profiles, both in vitro and in vivo. The work introduces a facile and generalizable class of mouldable hydrogels amenable to a range of biomedical and industrial applications. PMID:25695516

  14. Utilisation of community pharmacists by the general public in Malaysia.

    PubMed

    Chua, Siew Siang; Lim, Kien Ping; Lee, Hong Gee

    2013-02-01

    The study was conducted to assess how the general public in the Klang Valley, Malaysia, utilised community pharmacists. This was a prospective observational study which documented interactions between community pharmacists and their customers. A researcher was stationed in 10 participating community pharmacies around the Klang Valley to observe and record all the interactions, using a structured data-collection form. KEYS FINDINGS: Interactions between 1914 customers and the pharmacists of the 10 community pharmacies were recorded. A total of 2199 requests were made by these customers. The main types of request were for medications by brand name (32.2%), advice on minor health problems (25.9%) and for health supplements (11.7%). Only 65 prescriptions were received by the community pharmacies; that is, fewer than two prescriptions per pharmacy per day. The pharmacists provided counselling for only 54.4% of the requests where a medication or health supplement was dispensed. Counselling by pharmacist was significantly associated with the type of request (P < 0.001). The main reason for the general public to visit a community pharmacy in Malaysia was to purchase a particular medication. Few prescriptions were filled at community pharmacies in Malaysia, indicating the under-utilisation of community pharmacists as a safety net for prescribed medications in primary care. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  15. Landscape Utilisation, Animal Behaviour and Hendra Virus Risk.

    PubMed

    Field, H E; Smith, C S; de Jong, C E; Melville, D; Broos, A; Kung, N; Thompson, J; Dechmann, D K N

    2016-03-01

    Hendra virus causes sporadic fatal disease in horses and humans in eastern Australia. Pteropid bats (flying-foxes) are the natural host of the virus. The mode of flying-fox to horse transmission remains unclear, but oro-nasal contact with flying-fox urine, faeces or saliva is the most plausible. We used GPS data logger technology to explore the landscape utilisation of black flying-foxes and horses to gain new insight into equine exposure risk. Flying-fox foraging was repetitious, with individuals returning night after night to the same location. There was a preference for fragmented arboreal landscape and non-native plant species, resulting in increased flying-fox activity around rural infrastructure. Our preliminary equine data logger study identified significant variation between diurnal and nocturnal grazing behaviour that, combined with the observed flying-fox foraging behaviour, could contribute to Hendra virus exposure risk. While we found no significant risk-exposing difference in individual horse movement behaviour in this study, the prospect warrants further investigation, as does the broader role of animal behaviour and landscape utilisation on the transmission dynamics of Hendra virus.

  16. Support groups for dementia caregivers - Predictors for utilisation and expected quality from a family caregiver's point of view: A questionnaire survey PART I*

    PubMed Central

    2010-01-01

    Background Support groups have proved to be effective in reducing the burden on family caregivers of dementia patients. Nevertheless, little is known about the factors that influence utilisation or quality expectations of family caregivers. These questions are addressed in the following paper. Methods The cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in Germany. Qualitative and quantitative data from 404 caregivers were analysed using content analysis and binary logistic regression analysis. Results The only significant predictor for utilisation is assessing how helpful support groups are for the individual care situation. Family caregivers all agree that psycho-educative orientation is a priority requirement. Conclusions In order to increase the rate of utilisation, family caregivers must be convinced of the relevant advantages of using support groups. Support groups which offer an exchange of experiences, open discussion, information and advice meet the requirements of family caregivers. PMID:20667092

  17. Utilisation of inorganic salts in fungal crop disease management in the U.K.

    PubMed

    Deliopoulos, T; Kettlewell, P S; Hare, M C

    2009-01-01

    The overaLl aim of the study described in this communication was to utilise the findings of a global scientific and technical literature survey on the use of inorganic salts against crop fungal diseases in order to assess the potential of using these substances to reduce the reliance of UK growers on conventional fungicides. A summary of the main findings of the Literature survey is provided followed by information on the current commercial use of inorganic salt-based products in fungal disease management. Finally, the scope of potential use of inorganic salts on high disease risk crops in the UK is assessed and specific crop/pathogen combinations are prioritised for further research.

  18. Detailed Analysis of Wheat Straw Node and Internode for their Prospective Efficient Utilisation.

    PubMed

    Ghaffar, Seyed Hamidreza; Fan, Mizi; Zhou, Yonghui; AboMadyan, Omar

    2017-09-27

    In order to efficiently utilise wheat straw, the systematic examination of their cell wall components, chemical structures, morphology and relation to the physicochemical and mechanical properties is necessary. Detailing of node and internode signifies their different features and characteristics which can ultimately lead to their separated processing for enhanced efficiency and higher added-value bio-refinery. In this study, distinct variations were found amongst characteristics of node and internode, inner and outer surface. It was revealed that node has more extractives, Klason lignin and ash content than internode, higher contents of extractives and ash in the node are related to the thicker epidermis tissue. Hot-water followed by mild steam pre-treatment was used to examine the effects on the characteristics of wheat straw. The results showed: 1) reduced level of waxes and Si (weight %) from the outer surface, and 2) significantly lower (P < 0.05) extractives content in both internode and node.

  19. Dekkera and Brettanomyces growth and utilisation of hydroxycinnamic acids in synthetic media.

    PubMed

    Harris, Victoria; Ford, Christopher M; Jiranek, Vladimir; Grbin, Paul R

    2008-04-01

    Dekkera and Brettanomyces yeast are important spoilage organisms in a number of food and beverage products. Isolates of both genera were cultured in a defined medium and supplemented with hydroxycinnamic acids and vinylphenols to investigate their influence on growth and the formation of ethyl phenol derivatives. The growth rate of Brettanomyces species in the presence of acids was reduced, and no significant conversion to vinyl or ethyl derivatives was observed. The growth rate and substrate utilisation rates of Dekkera anomala and Dekkera bruxellensis yeast differed depending on strain and the acid precursor present. Growth of D. bruxellensis was slowed by the presence of ferulic acid with the addition of 1 mM ferulic acid completely inhibiting growth. This study provides an insight into the spoilage potential of these organisms and possible control strategies involving hydroxycinnamic acids.

  20. Real-time tracking data drive process improvements, even while ED volumes continue to climb.

    PubMed

    2012-06-01

    Christiana Hospital in Newark, DE, has been able to dramatically reduce length-of-stay in the ED by making use of data derived from a real-time location system (RTLS) that tracks the movements of patients, providers, and staff. Administrators say that while some efficiencies are gained from the system alone, most of the positive impact is derived from using the RTLS data to focus on specific processes and make refinements. Within one year of implementing the RTLS technology, LOS in the ED was reduced by 40 minutes for admitted patients and 18 to 20 minutes for the treated-and-released population. A work group focused on process improvements in the ED's fast track section reduced the average LOS from 2.5 hours to 60 minutes or less. Similarly, a work group focused on the ESI 3 population reduced the average treatment time for this population from 5 or 6 hours to 3.4 hours. Administrators say key steps toward a successful RTLS implementation are careful planning for how you want to use the technology, and alleviating staff concerns about why their movements are being tracked.

  1. The relationships between sulphate reduction and COD/VFA utilisation using grass cellulose as carbon and energy sources.

    PubMed

    Mulopo, Jean; Greben, Harma; Sigama, Julia; Radebe, Vivian; Mashego, Mlawule; Burke, Lisa

    2011-02-01

    The release of mine effluents can have a damaging impact on receiving water bodies. Therefore, treatment of mine waters before discharge is imperative. A novel biological SO²⁻₄ removal technology has been developed whereby the degradation/fermentation products of grass cellulose, volatile fatty acids (VFA), function as the electron donors and SO²⁻₄ as the electron acceptor. The aim of the study presented here was to elucidate the interactions between the cellulose degradation rate, the chemical oxygen demand (COD), VFA production and its/utilisation rate as well as the sulphate reduction rate. To this end, two stirred batch reactors were operated: a test and a control reactor. The results showed that high COD and VFA concentrations were achieved after cellulose degradation, which resulted in a rapid decrease in the SO²⁻₄ concentration in the test reactor. The VFA results indicated that propionic and butyric acids were preferentially utilised, producing acetate. In the control reactor, the VFA and the COD production increased initially at the same rate, followed later by a decrease at a similar rate. These results suggest that the degradation products formed were utilised by the methanogenic bacteria to produce methane rather than by the sulphate-reducing bacteria, since the control reactor contained no sulphate (Visser 1995). Furthermore, these results showed a clear relationship between the COD/VFA production and the SO²⁻₄reduction in the test reactor and between the COD and VFA pattern in the control reactor.

  2. Advancing Coupled Human-Earth System Models: The Integrated Ecosystem Demography Model (iED) Project

    NASA Astrophysics Data System (ADS)

    Hurtt, G. C.; Chini, L. P.; Clarke, L.; Calvin, K. V.; Chambers, J. Q.; Dubayah, R.; Dolan, K.; Edmonds, J. A.; Fisk, J. P.; Flanagan, S.; Frolking, S.; Janetos, A. C.; LePage, Y.; Morton, D. C.; Patel, P.; Rourke, O.; Sahajpal, R.; Thomson, A. M.; Wise, M.; Ying, Q.

    2012-12-01

    Recent studies with integrated assessment models, models linking human and natural systems at a global scale, highlight the importance of terrestrial systems in climate stabilization efforts. Here we introduce a new modeling framework iED, designed to link advanced remote sensing data (active and passive.), height-structured terrestrial ecosystem dynamics (ED), gridded land-use change projections (GLM), and integrated assessment modeling (GCAM) into a single coupled modeling framework with unprecedented spatial resolution and process-level detail. Our research aims to reduce uncertainties associated with forest modeling within integrated assessments, and to quantify the impacts of climate change on forest growth, mortality, and productivity for integrated assessments of terrestrial carbon management. iED is being used to address key science questions including: (1) What are the opportunities for land-use strategies such as afforestation or woody bioenergy crop production to contribute to stabilization of atmospheric CO2 concentrations? (2) How could potentially altered disturbance rates from tropical cyclones and Amazonian fires affect vegetation, carbon stocks and fluxes, and the development of climate change mitigation strategies? (3) What are the linked remote sensing/ecosystem modeling requirements for improving integrated assessments of climate mitigation strategies? With its strong connections to data and conceptual linkages to other models in development, iED is also designed to inform the next generation of remote sensing and integrated Earth system modeling efforts.

  3. EDS1 contributes to nonhost resistance of Arabidopsis thaliana against Erwinia amylovora.

    PubMed

    Moreau, Manon; Degrave, Alexandre; Vedel, Régine; Bitton, Frédérique; Patrit, Oriane; Renou, Jean-Pierre; Barny, Marie-Anne; Fagard, Mathilde

    2012-03-01

    Erwinia amylovora causes fire blight in rosaceous plants. In nonhost Arabidopsis thaliana, E. amylovora triggers necrotic symptoms associated with transient bacterial multiplication, suggesting either that A. thaliana lacks a susceptibility factor or that it actively restricts E. amylovora growth. Inhibiting plant protein synthesis at the time of infection led to an increase in necrosis and bacterial multiplication and reduced callose deposition, indicating that A. thaliana requires active protein synthesis to restrict E. amylovora growth. Analysis of the callose synthase-deficient pmr4-1 mutant indicated that lack of callose deposition alone did not lead to increased sensitivity to E. amylovora. Transcriptome analysis revealed that approximately 20% of the genes induced following E. amylovora infection are related to defense and signaling. Analysis of mutants affected in NDR1 and EDS1, two main components of the defense-gene activation observed, revealed that E. amylovora multiplied ten times more in the eds1-2 mutant than in the wild type but not in the ndr1-1 mutant. Analysis of mutants affected in three WRKY transcription factors showing EDS1-dependent activation identified WRKY46 and WRKY54 as positive regulators and WRKY70 as a negative regulator of defense against E. amylovora. Altogether, we show that EDS1 is a positive regulator of nonhost resistance against E. amylovora in A. thaliana and hypothesize that it controls the production of several effective defenses against E. amylovora through the action of WRKY46 and WRKY54, while WRKY70 acts as a negative regulator.

  4. Efficiency of energy utilisation and voluntary feed intake in ruminants.

    PubMed

    Tolkamp, B J

    2010-07-01

    Energy requirements of animals are most readily expressed in terms of net energy (NE), while the energy yield of feed is, at least initially, expressed in terms of metabolisable energy (ME). Energy evaluation systems 'translate' NE requirements into ME requirements (ME systems) or assign NE values to feeds (NE systems). Efficiency of ME utilisation is higher for maintenance than for production and the NE yield of a feed varies, therefore, with ME intake. In addition, energetic efficiency for maintenance and production is thought to be different for lactating and non-lactating animals and to be affected by diet quality. As a result, there are currently many national energy evaluation systems that are complex, differ in their approach and are, as a result, difficult to compare. As ruminants in most production systems are fed ad libitum, this is also the most appropriate intake level at which to estimate energetic efficiency. Analyses of older as well as more recent data suggest that ad libitum feeding (i) abolishes the effects of diet quality on energetic efficiency (almost) completely, (ii) abolishes the differences between lactating and non-lactating animals (almost) entirely and (iii) results in overall energetic efficiencies that are always close to 0.6. The paper argues that there is now sufficient information to develop an international energy evaluation system for ad libitum fed ruminants. Such a system should (i) unify ME and NE systems, (ii) avoid the systematic bias and large errors that can be associated with current systems (iii) be simpler than current systems and (iv) have as a starting point a constant efficiency of ME utilisation, with a value of around 0.6. The remarkably constant efficiency of ME utilisation in ad libitum fed ruminants could be the result of energetic efficiency as well as feed intake regulation being affected by the same variables or of a direct role of energetic efficiency in feed intake regulation. Models to predict intake on the

  5. Impact of a bronchiolitis guideline on ED resource use and cost: a segmented time-series analysis.

    PubMed

    Akenroye, Ayobami T; Baskin, Marc N; Samnaliev, Mihail; Stack, Anne M

    2014-01-01

    Bronchiolitis is a major cause of infant morbidity and contributes to millions of dollars in health care costs. Care guidelines may cut costs by reducing unnecessary resource utilization. Through the implementation of a guideline, we sought to reduce unnecessary resource utilization and improve the value of care provided to infants with bronchiolitis in a pediatric emergency department (ED). We conducted an interrupted time series that examined ED visits of 2929 patients with bronchiolitis, aged 1 to 12 months old, seen between November 2007 and April 2013. Outcomes were proportion having a chest radiograph (CXR), respiratory syncytial virus (RSV) testing, albuterol or antibiotic administration, and the total cost of care. Balancing measures included admission rate, returns to the ED resulting in admission within 72 hours of discharge, and ED length of stay (LOS). There were no significant preexisting trends in the outcomes. After guideline implementation, there was an absolute reduction of 23% in CXR (95% confidence interval [CI]: 11% to 34%), 11% in RSV testing (95% CI: 6% to 17%), 7% in albuterol use (95% CI: 0.2% to 13%), and 41 minutes in ED LOS (95% CI: 16 to 65 minutes). Mean cost per patient was reduced by $197 (95% CI: $136 to $259). Total cost savings was $196,409 (95% CI: $135,592 to $258,223) over the 2 bronchiolitis seasons after guideline implementation. There were no significant differences in antibiotic use, admission rates, or returns resulting in admission within 72 hours of discharge. A bronchiolitis guideline was associated with reductions in CXR, RSV testing, albuterol use, ED LOS, and total costs in a pediatric ED.

  6. ED cuts LWBS from 5% to 0.5%.

    PubMed

    2010-04-01

    The leaders at King's Daughters Medical Center in Ashland, KY, firmly believe that solving ED throughput problems must be the responsibility of the entire hospital. They must be on the right track. A recent initiative has slashed the rate of patients who left without being seen from 5% to 0.5%. When beds are available in the ED, presenting patients are moved there immediately and then triaged by the bed nurse. Throughput assessments are conducted hourly so that problems can be addressed immediately. When the ED is in danger of becoming overwhelmed, all department leaders are paged and direct their units to take appropriate action.

  7. Technologies for the utilisation of biogenic waste in the bioeconomy.

    PubMed

    O'Callaghan, Kenneth

    2016-05-01

    A brief review has been done of technologies involved in the exploitation of biogenic wastes, in order to provide an introduction to the subject from the technological perspective. Biogenic waste materials and biomass have historically been utilised for thousands of years, but a new conversation is emerging on the role of these materials in modern bioeconomies. Due to the nature of the products and commodities now required, a modern bioeconomy is not simply a rerun of former ones. This new dialogue needs to help us understand how technologies for managing and processing biogenic wastes--both established and novel--should be deployed and integrated (or not) to meet the requirements of the sustainability, closed-loop and resource-security agendas that evidently sit behind the bioeconomy aspirations now being voiced in many countries and regions of the world. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Clean coal technology. Coal utilisation by-products

    SciTech Connect

    2006-08-15

    The need to remove the bulk of ash contained in flue gas from coal-fired power plants coupled with increasingly strict environmental regulations in the USA result in increased generation of solid materials referred to as coal utilisation by-products, or CUBs. More than 40% of CUBs were sold or reused in the USA in 2004 compared to less than 25% in 1996. A goal of 50% utilization has been established for 2010. The American Coal Ash Association (ACCA) together with the US Department of Energy's Power Plant Improvement Initiative (PPPI) and Clean Coal Power Initiative (CCPI) sponsor a number of projects that promote CUB utilization. Several are mentioned in this report. Report sections are: Executive summary; Introduction; Where do CUBs come from?; Market analysis; DOE-sponsored CUB demonstrations; Examples of best-practice utilization of CUB materials; Factors limiting the use of CUBs; and Conclusions. 14 refs., 1 fig., 5 tabs., 14 photos.

  9. Direct imaging of dehydrogenase activity within living cells using enzyme-dependent fluorescence recovery after photobleaching (ED-FRAP).

    PubMed Central

    Combs, C A; Balaban, R S

    2001-01-01

    Reduced nicotine adenine dinucleotide (NADH) is a key metabolite involved in cellular energy conversion and many redox reactions. We describe the use of confocal microscopy in conjunction with enzyme-dependent fluorescence recovery after photobleaching (ED-FRAP) of NADH as a topological assay of NADH generation capacity within living cardiac myocytes. Quantitative validation of this approach was performed using a dehydrogenase system, in vitro. In intact cells the NADH ED-FRAP was sensitive to temperature (Q(10) of 2.5) and to dehydrogenase activation by dichloroacetate or cAMP (twofold increase for each). In addition, NADH ED-FRAP was correlated with flavin adenine dinucleotide (FAD(+)) fluorescence. These data, coupled with the cellular patterns of NADH ED-FRAP changes with dehydrogenase stimulation, suggest that NADH ED-FRAP is localized to the mitochondria. These results suggest that ED-FRAP enables measurement of regional dynamics of mitochondrial NADH production in intact cells, thus providing information regarding region-specific intracellular redox reactions and energy metabolism. PMID:11259315

  10. Population-based burden of COPD-related visits in the ED: return ED visits, hospital admissions, and comorbidity risks.

    PubMed

    Yeatts, Karin B; Lippmann, Steven J; Waller, Anna E; Hassmiller Lich, Kristen; Travers, Debbie; Weinberger, Morris; Donohue, James F

    2013-09-01

    Little is known about the population-based burden of ED care for COPD. We analyzed statewide ED surveillance system data to quantify the frequency of COPD-related ED visits, hospital admissions, and comorbidities. In 2008 to 2009 in North Carolina, 97,511 COPD-related ED visits were made by adults ≥ 45 years of age, at an annual rate of 13.8 ED visits/1,000 person-years. Among patients with COPD (n = 33,799), 7% and 28% had a COPD-related return ED visit within a 30- and 365-day period of their index visit, respectively. Compared with patients on private insurance, Medicare, Medicaid, and noninsured patients were more likely to have a COPD-related return visit within 30 and 365 days and have three or more COPD-related visits within 365 days. There were no differences in return visits by sex. Fifty-one percent of patients with COPD were admitted to the hospital from the index ED visit. Subsequent hospital admission risk in the cohort increased with age, peaking at 65 to 69 years (risk ratio [RR], 1.41; 95% CI, 1.26-1.57); there was no difference by sex. Patients with congestive heart failure (RR, 1.29; 95% CI, 1.22-1.37), substance-related disorders (RR, 1.35; 95% CI, 1.13-1.60), or respiratory failure/supplemental oxygen (RR, 1.25; 95% CI, 1.19-1.31) were more likely to have a subsequent hospital admission compared with patients without these comorbidities. The population-based burden of COPD-related care in the ED is significant. Further research is needed to understand variations in COPD-related ED visits and hospital admissions.

  11. State Pilots Sweeping Changes in Special Ed

    ERIC Educational Resources Information Center

    Adkins, Gary

    2007-01-01

    The Illinois State Board of Education launched a special education pilot project using a concept called Response to Intervention (RtI) that some experts believe could lead to a sea change in the way special education is provided. RtI places greater emphasis on early intervention and a reduced emphasis on psychological testing and other traditional…

  12. State Pilots Sweeping Changes in Special Ed

    ERIC Educational Resources Information Center

    Adkins, Gary

    2007-01-01

    The Illinois State Board of Education launched a special education pilot project using a concept called Response to Intervention (RtI) that some experts believe could lead to a sea change in the way special education is provided. RtI places greater emphasis on early intervention and a reduced emphasis on psychological testing and other traditional…

  13. A 15-year overview of increasing tramadol utilisation and associated mortality and the impact of tramadol classification in the United Kingdom.

    PubMed

    Chen, Teng-Chou; Chen, Li-Chia; Knaggs, Roger David

    2017-09-24

    This study aimed to develop hypotheses to explain the increasing tramadol utilisation, evaluate the impact of tramadol classification, and explore the trend between tramadol utilisation and related deaths in the United Kingdom. This cross-sectional study used individual patient data, the Clinical Practice Research Datalink from 1993 to 2015, to calculate monthly defined daily dose (DDD)/1000 registrants, monthly prevalence and incidence of tramadol users, annual supply days, and mean daily dose of tramadol. Aggregated-level national statistics and reimbursement data from 2004 to 2015 were also used to quantify annual and monthly tramadol DDD/1000 inhabitants and rate of tramadol-related deaths in England and Wales. Interrupted time-series analysis was used to evaluate the impact of tramadol classification in June 2014. Prevalence of tramadol users increased from 23 to 97.6/10 000 registrants from 2000 to 2015. Both annual dose and annual supply days of existing tramadol users were higher than new users. Level and trend of monthly utilisation (β2 : -12.9, β3 : -1.6) and prevalence of tramadol users (β2 : -6.4, β3 : -0.37) significantly reduced after classification. Both annual tramadol utilisation and rate of tramadol-related deaths increased before tramadol classification and decreased thereafter. Increasing tramadol utilisation was influenced by the increase in prevalence and incidence of tramadol users, mean daily dose, and day of supply. Prevalence of tramadol users, tramadol utilisation, and reported deaths declined after tramadol classification. Future studies need to evaluate the influencing factors to ensure the safety of long-term tramadol use. Copyright © 2017 John Wiley & Sons, Ltd.

  14. Treatment provider is most predictive of ED dismissal in minimally-injured trauma patients: a retrospective review.

    PubMed

    Hunt, Diane L S; Berg, Gina M; Zackula, Rosalee E; Ekengren, Francie H; Lippoldt, Diana; Ablah, Elizabeth; Wetta, Ruth

    2013-05-16

    mechanism of injury. Moreover, ED physicians were more likely to dismiss patients from the ED. A three-tiered internal triaging protocol can redirect resource usage to reduce the burden on the trauma service. This may be increasingly beneficial in trauma models in which the trauma surgeons also serve as critical care intensivists.

  15. Structure of catalase determined by MicroED.

    PubMed

    Nannenga, Brent L; Shi, Dan; Hattne, Johan; Reyes, Francis E; Gonen, Tamir

    2014-10-10

    MicroED is a recently developed method that uses electron diffraction for structure determination from very small three-dimensional crystals of biological material. Previously we used a series of still diffraction patterns to determine the structure of lysozyme at 2.9 Å resolution with MicroED (Shi et al., 2013). Here we present the structure of bovine liver catalase determined from a single crystal at 3.2 Å resolution by MicroED. The data were collected by continuous rotation of the sample under constant exposure and were processed and refined using standard programs for X-ray crystallography. The ability of MicroED to determine the structure of bovine liver catalase, a protein that has long resisted atomic analysis by traditional electron crystallography, demonstrates the potential of this method for structure determination.

  16. 1. Photocopy of photograph (from Stuart, I. L., ed. History ...

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

    1. Photocopy of photograph (from Stuart, I. L., ed. History of Franklin County, Iowa. Chicago: S. J. Clarke, 1914. Date unknown, sometime in period 1866-1890 GENERAL VIEW - Franklin County Courthouse II, Courthouse Square, Hampton, Franklin County, IA

  17. Structure of catalase determined by MicroED

    PubMed Central

    Nannenga, Brent L; Shi, Dan; Hattne, Johan; Reyes, Francis E; Gonen, Tamir

    2014-01-01

    MicroED is a recently developed method that uses electron diffraction for structure determination from very small three-dimensional crystals of biological material. Previously we used a series of still diffraction patterns to determine the structure of lysozyme at 2.9 Å resolution with MicroED (Shi et al., 2013). Here we present the structure of bovine liver catalase determined from a single crystal at 3.2 Å resolution by MicroED. The data were collected by continuous rotation of the sample under constant exposure and were processed and refined using standard programs for X-ray crystallography. The ability of MicroED to determine the structure of bovine liver catalase, a protein that has long resisted atomic analysis by traditional electron crystallography, demonstrates the potential of this method for structure determination. DOI: http://dx.doi.org/10.7554/eLife.03600.001 PMID:25303172

  18. Nuclear Medicine Physics: The Basics. 7th ed.

    PubMed

    Mihailidis, Dimitris

    2012-10-01

    Nuclear Medicine Physics: The Basics. 7th ed. Ramesh Chandra, Lippincott Williams and Wilkins, a Wolters Kluwer Business. Philadelphia, 2012. Softbound, 224 pp. Price: $69.99. ISBN: 9781451109412. © 2012 American Association of Physicists in Medicine.

  19. Re-ED: Forty Years Young, Alive and Lively!

    ERIC Educational Resources Information Center

    Cantrell, Mary Lynn; Cantrell Robert P.

    2002-01-01

    Introduces this special journal issue that addresses Re-Education with troubling youth. Highlights the Re-ED (Reeducation of Emotional Disturbed Children) model and its use over the past 40 years. (GCP)

  20. What Men Need to Know about ED Drugs and Anesthesia

    MedlinePlus

    ... medlineplus.gov/news/fullstory_166880.html What Men Need to Know About ED Drugs and Anesthesia Having ... HealthDay News) -- Men who take erectile dysfunction drugs need to alert the anesthetist before having surgery or ...

  1. Elephants or Dinosaurs? A Call to Action for Ed Schools

    ERIC Educational Resources Information Center

    Murphy, Jerome T.

    2006-01-01

    To conclude this special section, guest editor Murphy examines why Ed Schools should redesign their leadership education programs, explores what it will take to foster change, and presents a model program to stimulate debate and action. (Contains 21 endnotes.)

  2. Incorporating Alternative Care Site Characteristics Into Estimates of Substitutable ED Visits.

    PubMed

    Trueger, Nathan Seth; Chua, Kao-Ping; Hussain, Aamir; Liferidge, Aisha T; Pitts, Stephen R; Pines, Jesse M

    2017-07-01

    Several recent efforts to improve health care value have focused on reducing emergency department (ED) visits that potentially could be treated in alternative care sites (ie, primary care offices, retail clinics, and urgent care centers). Estimates of the number of these visits may depend on assumptions regarding the operating hours and functional capabilities of alternative care sites. However, methods to account for the variability in these characteristics have not been developed. To develop methods to incorporate the variability in alternative care site characteristics into estimates of ED visit "substitutability." Our approach uses the range of hours and capabilities among alternative care sites to estimate lower and upper bounds of ED visit substitutability. We constructed "basic" and "extended" criteria that captured the plausible degree of variation in each site's hours and capabilities. To illustrate our approach, we analyzed data from 22,697 ED visits by adults in the 2011 National Hospital Ambulatory Medical Care Survey, defining a visit as substitutable if it was treat-and-release and met both the operating hours and functional capabilities criteria. Use of the combined basic hours/basic capabilities criteria and extended hours/extended capabilities generated lower and upper bounds of estimates. Our criteria classified 5.5%-27.1%, 7.6%-20.4%, and 10.6%-46.0% of visits as substitutable in primary care offices, retail clinics, and urgent care centers, respectively. Alternative care sites vary widely in operating hours and functional capabilities. Methods such as ours may help incorporate this variability into estimates of ED visit substitutability.

  3. Redefining the EdD: Seeking a Separate Identity

    ERIC Educational Resources Information Center

    Boyce, Barbara Ann

    2012-01-01

    The purpose of this manuscript was to discuss the recommendations and guidelines of the Carnegie Group's 2007 effort to "Reclaim the EdD" as well as to outline the work completed at the University of Virginia related to their re-design of the Doctor of Education (EdD) degree. In order to address the re-envision and re-formulation of the…

  4. Redefining the EdD: Seeking a Separate Identity

    ERIC Educational Resources Information Center

    Boyce, Barbara Ann

    2012-01-01

    The purpose of this manuscript was to discuss the recommendations and guidelines of the Carnegie Group's 2007 effort to "Reclaim the EdD" as well as to outline the work completed at the University of Virginia related to their re-design of the Doctor of Education (EdD) degree. In order to address the re-envision and re-formulation of the…

  5. The financial consequences of lost demand and reducing boarding in hospital emergency departments.

    PubMed

    Pines, Jesse M; Batt, Robert J; Hilton, Joshua A; Terwiesch, Christian

    2011-10-01

    Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested. Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively. Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  6. The Igκ Gene Enhancers, E3′ and Ed, Are Essential for Triggering Transcription

    PubMed Central

    Zhou, Xiaorong; Xiang, Yougui; Garrard, William T.

    2010-01-01

    The mouse Igκ gene locus has three known transcriptional enhancers: an intronic enhancer (Ei), a 3′ enhancer (E3′), and a further downstream enhancer (Ed). Previous studies on B lymphocytes derived from mutant ES cells have shown that deletion of either Ei or E3′ significantly reduces Igκ gene rearrangement, whereas the combined deletion of both Ei and E3′ eliminates such recombination. Furthermore, deletion of either E3′ or Ed significantly reduces rearranged Igκ gene transcription. To determine whether the combined presence of both E3′ and Ed are essential for Igκ gene expression, we generated homozygous double knockout mice (DKO) with targeted deletions in both elements. Significantly, homozygous DKO mice were unable to generate κ+ B cells both in bone marrow and the periphery, and exhibited surface expression almost exclusively of Igλ chains, in spite of the fact that they possessed potentially functional rearranged Igκ genes. Compared with their single-enhancer-deleted counterparts, Igκ loci in homozygous DKO mice exhibited dramatically reduced germline and rearranged gene transcription, lower levels of gene rearrangement and histone H3 acetylation, and markedly increased DNA methylation. This contributed to a partial developmental block at the pre-B cell stage of development. We conclude that the two downstream enhancers are essential in Igκ gene expression and that Ei in homozygous DKO mice is incapable of triggering Igκ gene transcription. Furthermore, these results reveal unexpected compensatory roles for Ed in E3′ knockout mice in triggering germline transcription, and Vκ gene rearrangements to both Jκ and RS elements. PMID:21076060

  7. Impact of newborn follow-up visit timing on subsequent ED visits and hospital readmissions: an instrumental variable analysis.

    PubMed

    O'Donnell, Heather C; Colman, Gregory; Trachtman, Rebecca A; Velazco, Nerissa; Racine, Andrew D

    2014-01-01

    To determine whether newborn first outpatient visit (FOV) within 3 days of discharge is associated with reduced rates of emergency department (ED) visits and hospital readmissions. Retrospective cohort analysis was performed of all newborns who were born and had outpatient follow-up within a large academic medical center to determine whether they had ED visits or hospital readmission within 2 weeks after hospital discharge. Multivariable regression using an instrumental variable for timing of FOV was conducted to estimate the relationship between FOV within 3 days of discharge and ED visits and hospital readmissions within 2 weeks of discharge, adjusting for potential confounders. Stratified analyses assessed this relationship in subpopulations with medical or social risk factors. Of 3282 newborns, 178 (5%) had 1 or more ED visits or hospital readmissions within 2 weeks of hospital discharge. FOV within 3 days was not significantly associated with ED visits and readmissions in the instrumental variable analysis (IVA) (-0.035, P = .11) or the ordinary least squares analysis (OLS) (0.006, P = .52). The difference in coefficients between these analyses, however, suggests that IVA successfully adjusted for some unmeasured bias. In stratified analyses, only newborns born to African American mothers or discharged by family medicine providers demonstrated a significant relationship between FOV within 3 days and reduced odds of ED visits and readmissions. No significant relationship between outpatient visit timing and ED visits and hospital readmissions was found. Further study is needed to assess the impact of early outpatient visits on other newborn outcomes. Copyright © 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  8. New perspectives on nutritional interventions to augment lipid utilisation during exercise.

    PubMed

    Gonzalez, Javier T; Stevenson, Emma J

    2012-02-01

    The enhancement of fat oxidation during exercise is an aim for both recreational exercising individuals and endurance athletes. Nutritional status may explain a large part of the variation in maximal rates of fat oxidation during exercise. This review reveals novel insights into nutritional manipulation of substrate selection during exercise, explaining putative mechanisms of action and evaluating the current evidence. Lowering the glycaemic index of the pre-exercise meal can enhance lipid utilisation by up to 100 % through reduced insulin concentrations, although its application may be restricted to specific training sessions rather than competition. Chronic effects of dietary glycaemic index are less clear and warrant future study before firm recommendations can be made. A flurry of recent advances has overthrown the conventional view of l-carnitine supplementation, with skeletal muscle uptake possible under certain dietary conditions and providing a strategy to influence energy metabolism in an exercise intensity-dependent manner. Use of non-carbohydrate nutrients to stimulate muscle l-carnitine uptake may prove more beneficial for optimising lipid utilisation, but this requires more research. Studies investigating fish oil supplementation on fat oxidation during exercise are conflicting. In spite of some strong putative mechanisms, the only crossover trial showed no significant effect on lipid use during exercise. Ca may increase NEFA availability although it is not clear whether these effects occur. Ca and caffeine can increase NEFA availability under certain circumstances which could theoretically enhance fat oxidation, yet strong experimental evidence for this effect during exercise is lacking. Co-administration of nutrients to maximise their effectiveness needs further investigation.

  9. Surface Nutrient Utilisation and Productivity During Glacial-Interglacial Periods from the Equatorial Indian Ocean

    NASA Astrophysics Data System (ADS)

    R, C. K.; Bhushan, R.; Agnihotri, R.; Sawlani, R.; Jull, A. J. T.

    2016-12-01

    Seawaters and underlying sediments off Sri Lanka provide a unique marine realm affected by both branches of Northern Indian Ocean i.e. Arabian Sea (AS) and Bay of Bengal (BOB). AS and BOB are known for their distinct response to southwest monsoon. AS experiencing mainly winds and upwelling while BOB receives precipitation driven surface runoff from the Indian sub-continent. Multiple proxies were measured on a radiocarbon dated sediment core raised off Sri Lanka; their down core variations were used to understand oceanic history (nutrient utilisation, surface productivity, nature of organic matter) spanning last glacial-interglacial cycle ( 26 to 2.5 ka BP). Variations in CaCO3, biogenic silica (BSi) and δ15N from 26 ka to 12.5 ka BP indicate the region was experiencing high surface productivity with probably reduced surface nutrient utilisation efficiency. Sedimentary δ15N depth profile is decoupled from down core variations of major productivity indices (e.g. CaCO3, OC), hinting plausibly partial utilization of nutrients in the mixed layer (photic zone). δ13C of OC and C/N (wt. ratio) clearly reveal the terrestrial origin of organic matter at 15 ka BP, a period known for witnessing onset of deglaciation in northern hemisphere. δ13C minimum at 9 ka BP indicates intense monsoonal activity during this time coinciding well with solar insolation (June) maximum of the northern hemisphere. With the onset of Holocene ( 11 ka BP), δ15N variations appear to correlate with BSi and Ba/Ti indicating enhanced utilization of available nutrients at surface. Suggesting surface productivity over the region was probably micro-nutrient limited. The increased inventory of terrestrial runoff in Holocene probably demonstrates enhanced carbon sequestration capability of the region.

  10. Utilisation of rheumatology care services in Germany: the case of physical therapy and self-help groups

    PubMed Central

    Thieme, Holm; Borgetto, Bernhard

    2012-01-01

    Physical Therapy (PT) and self-help groups (SHG) are important components of health care in rheumatic diseases. The utilisation of PT and SHG by patients with rheumatic diseases may be influenced by several factors. The aim of this study is to summarize the evidence on PT and SHG utilisation of patients with rheumatic diseases in Germany. We systematically searched the MEDLINE-database for studies that evaluated the utilisation and factors that possibly influence the utilisation of PT and SHG. Eight studies were found for PT-utilisation and one for SHG-utilisation. Between 25 and 59 percent of patients with rheumatic diseases received PT services. Several individual and contextual factors that may influence the utilisation could be identified. In conclusion, evidence exists for wide variations in the utilisation of PT services and an underuse of such services among patients with rheumatic diseases in Germany. By contrast, little evidence exists on the utilisation of SHG. PMID:23133502

  11. Picking up the bill - improving health-care utilisation in the Democratic Republic of Congo through user fee subsidisation: a before and after study.

    PubMed

    Maini, Rishma; Van den Bergh, Rafael; van Griensven, Johan; Tayler-Smith, Katie; Ousley, Janet; Carter, Daniel; Mhatre, Seb; Ho, Lara; Zachariah, Rony

    2014-11-05

    User fees have been shown to constitute a major barrier to the utilisation of health-care, particularly in low-income countries such as the Democratic Republic of Congo (DRC). Importantly, such barriers can lead to the exclusion of vulnerable individuals from health-care. In 2008, a donor-funded primary health-care programme began implementing user fee subsidisation in 20 health zones of the DRC. In this study, we quantified the short and long-term effects of this policy on health-care utilisation. Sixteen health zones were included for analysis. Using routinely collected health-care utilisation data before and after policy implementation, interrupted time series regression was applied to quantify the temporal impact of the user fee policy in the studied health zones. Payment of salary supplements to health-care workers and provision of free drugs - the other components of the programme - were controlled for where possible. Fourteen (88%) health zones showed an immediate positive effect in health-care utilisation rates (overall median increase of 19%, interquartile range 11 to 43) one month after the policy was introduced, and the effect was significant in seven zones (P <0.05). This initial effect was sustained or increased at 24 months in five health zones but was only significant in one health zone at P <0.05. Utilisation reduced over time in the remaining health zones (overall median increase of 4%, interquartile range -10 to 33). The modelled mean health-care utilisation rate initially increased significantly from 43 consultations/1000 population to 51 consultations/1000 population during the first month following implementation (P <0.01). However, the on-going effect was not significant (P =0.69). Our research brings mixed findings on the effectiveness of user fee subsidisation as a strategy to increase the utilisation of services. Future work should focus on feasibility issues associated with the removal or reduction of user fees and how to sustain its

  12. Phytase effects on the efficiency of utilisation and blood concentrations of phosphorus and calcium in Pekin ducks.

    PubMed

    Rodehutscord, M; Hempel, R; Wendt, P

    2006-06-01

    was significantly reduced by phytase supplementation. 6. It was concluded that the efficacy of a microbial phytase varies even under similar experimental conditions. Differences in intrinsic phytase activity of maize/soybean meal-based diets may be responsible for this. The 6-phytase used has the potential to improve the utilisation of plant P in duck feeding. A plateau in response was reached above 1500 U/kg.

  13. Univariate and multivariate spatial models of health facility utilisation for childhood fevers in an area on the coast of Kenya.

    PubMed

    Ouma, Paul O; Agutu, Nathan O; Snow, Robert W; Noor, Abdisalan M

    2017-09-18

    Precise quantification of health service utilisation is important for the estimation of disease burden and allocation of health resources. Current approaches to mapping health facility utilisation rely on spatial accessibility alone as the predictor. However, other spatially varying social, demographic and economic factors may affect the use of health services. The exclusion of these factors can lead to the inaccurate estimation of health facility utilisation. Here, we compare the accuracy of a univariate spatial model, developed only from estimated travel time, to a multivariate model that also includes relevant social, demographic and economic factors. A theoretical surface of travel time to the nearest public health facility was developed. These were assigned to each child reported to have had fever in the Kenya demographic and health survey of 2014 (KDHS 2014). The relationship of child treatment seeking for fever with travel time, household and individual factors from the KDHS2014 were determined using multilevel mixed modelling. Bayesian information criterion (BIC) and likelihood ratio test (LRT) tests were carried out to measure how selected factors improve parsimony and goodness of fit of the time model. Using the mixed model, a univariate spatial model of health facility utilisation was fitted using travel time as the predictor. The mixed model was also used to compute a multivariate spatial model of utilisation, using travel time and modelled surfaces of selected household and individual factors as predictors. The univariate and multivariate spatial models were then compared using the receiver operating area under the curve (AUC) and a percent correct prediction (PCP) test. The best fitting multivariate model had travel time, household wealth index and number of children in household as the predictors. These factors reduced BIC of the time model from 4008 to 2959, a change which was confirmed by the LRT test. Although there was a high correlation of the

  14. University Counselling Service Utilisation by Local and International Students and User Characteristics: A Review

    ERIC Educational Resources Information Center

    Raunic, Adam; Xenos, Sophia

    2008-01-01

    This paper reviews research on students' usage of university counselling services across countries and their demographic and psychological characteristics. In doing so, emphasis is given to reported distinctions between local and international university students. Utilisation rates, encouraging factors and barriers to utilisation, presenting…

  15. Dexmedetomidine use in the ED for control of methamphetamine-induced agitation.

    PubMed

    Lam, Rex Pui Kin; Yip, Wai Lam; Wan, Chi Keung; Tsui, Matthew Sik Hon

    2017-04-01

    Chemical restraint is often required to control agitation induced by methamphetamine. Dexmedetomidine is an α-2 adrenergic receptor agonist with sedative, analgesic, and sympatholytic properties. Its use in the emergency department (ED) to control methamphetamine-induced agitation has not been reported. To report two cases of methamphetamine-induced agitation successfully sedated with dexmedetomidine in the ED. The first case was a 42-year-old man with unstable emotion and violent behaviours after smoking methamphetamine. His agitation did not respond to a large cumulative dose of benzodiazepines (10mg of diazepam and 332mg of midazolam) administered over 48h and sedation was achieved with dexmedetomidine. The second case was a 38-year-old methamphetamine user with unstable emotion and recurrent episodes of agitation despite repeated doses of benzodiazepines, whose agitation was controlled with dexmedetomidine infusion. In both cases, dexmedetomidine apparently reduced the dose of benzodiazepines needed to achieve adequate sedation. Transient falls in blood pressure and slowing of the heart rate were noted, which resolved either spontaneously or after reducing the infusion rate without requiring drug treatment. Dexmedetomidine can be considered as an adjunct for chemical restraint when standard treatment fails to control the agitation induced by methamphetamine, but patient's hemodynamic state should be monitored closely during administration. Its efficacy and safety in the ED warrant further evaluation with prospective controlled trials. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    NASA Astrophysics Data System (ADS)

    Boffi, Francesca R.

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

  17. Epidemiology of elevated blood pressure in the ED.

    PubMed

    Adhikari, Srikar; Mathiasen, Ross

    2014-11-01

    To determine the prevalence and demographics of elevated blood pressure (BP) in emergency department (ED) patients. Retrospective study at an academic ED. ED patients with any systolic blood pressure (SBP) ≥140mm Hg or diastolic blood pressure (DBP) ≥90mm Hg over a 1-year period were included. Data pertaining to frequency of elevated BP across different ethnic categories, age groups, days of the week, shifts, and gender were collected. A total of 44435 patient records were accessed. Overall 47.6% (95% CI, 47.2%-48.1%) of patients had elevated BP (SBP ≥140mm Hg or DBP ≥90mm Hg). Fifty three percent (95% CI, 52%-54%) were women. Among patients with elevated BP, 18% (95% CI, 17.8%-18.9%) had severe BP elevation (SBP ≥180 or DBP ≥110). Overall, patients >45years old were more likely to have elevated BP in ED. Across all ethnic groups, BP increased with age. Significant differences were noted in the prevalence of elevated BP between whites (52%), and other ethnic groups (African Americans [45%] and Hispanics [31%]) (P < .01). Overall, 64% (95% CI, 63.3%-64.6%) of patients with elevated BP were discharged from the ED. Forty four percent (95% CI, 42.4%-45.5%) of patients with severe BP elevation were also discharged from the ED. This study provides knowledge of distribution of elevated BP among different age, gender and ethnic groups in the ED which can be used to develop specific interventions to improve recognition, prevention, detection, and treatment of hypertension. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Trouble-shooting process operations, Second Ed

    SciTech Connect

    Lieberman, N.P.

    1984-01-01

    This expanded edition of the bestselling Trouble-shooting Refinery Process, now includes chapters on fluidized catalytic cracking, natural gas production, and delayed coking. Contents include: Crude unit; Delayed coking cycles; Delayed coking process; Amine regeneration and scrubbing; Sulfur recovery; Alkylation; Fluidized catalyst cracking units; FCU product fractionation; Saving energy at reduced feed rates; Refrigeration systems; Centrifugal pumps; Distillation towers; Vacuum towers; Treating liquid hydrocarbons; Process heaters; Water coolers; Alarms and trips; Unstable gas plant operations; Fouled trays; Dehydrating light end towers; Vapor-liquid separation; Refining metallurgy for novices; Unusual noises and vibrations; Natural gas drying; Enhancing natural gas production; Suggestions for new operations engineers; Planning a performance test; Understanding control board instruments; How to make field measurements; The people problem; Calculating dew point, bubble point, and pressure drop; Index.

  19. Utilising multimedia for training merchant mariners as paramedics.

    PubMed

    Anogianakis, G; Maglavera, S

    2000-01-01

    MERMAID is a telemedicine project with global reach and a 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model is not limited to medical diagnostics but it encompasses all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications are considered while the full range of network choices is explored in terms of the cost/performance tradeoffs inherent to them and the developmental stage each of these options occupies in its life cycle. MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialty care best suited to each particular case. Finally, the development of programme modules for training and education of the seafarers in the use of the MERMAID medical communications system is given top priority as such modules constitute the firmest basis for the promotion of proper practice of telemedicine at sea.

  20. Potential of palm oil utilisation in aquaculture feeds.

    PubMed

    Ng, Wing-Keong

    2002-01-01

    One key ingredient used in the formulation of aquafeed is fish oil, which is produced from small marine pelagic fish and represents a finite fishery resource. At the present time, global fish oil production has reached a plateau and is not expected to increase beyond current levels. Recent estimates suggest that fish oils may be unable to meet demands from the rapidly growing aquaculture industry by as early as 2005. Therefore, there is currently great interest within the aquafeed industry in evaluating alternatives to fish oils. The ever-expanding oil palm cultivation in Malaysia and other tropical countries offers the possibility of an increased and constant availability of palm oil products for aquafeed formulation. Research into the use of palm oil in aquafeed begun around the mid-1990s and this review examines some of the findings from these studies. The use of palm oil in fish diets has generally shown encouraging results. Improved growth, feed efficiency, protein utilisation, reproductive performance and higher concentrations of alpha-tocopherol in fish fillets have been reported. Recent evidence for the ability of palm oil to substitute for fish oil in catfish diets is reviewed. The potential of palm oil use in aquafeed and future experimental directions are suggested. The aquaculture feed industry offers a great avenue to increase and diversify the use of palm oil-based products.

  1. Eye care services utilisation among pregnant women in Nigeria.

    PubMed

    Ibraheem, Waheed A; Ibraheem, Anifat B; Owonikoko, Musliudeen; Tijani, Aramide; Olamoyegun, Michael Adeyemi; AbdSalam, Soliu

    2016-07-01

    One hundred and sixty-five pregnant Nigerian women attending the antenatal clinic of LAUTECH teaching hospital, Ogbomoso, Nigeria between January and April 2014 were interviewed using a structured questionnaire. Socio-demographic characteristics of the respondents were obtained. Respondents were also asked: if they had had their eye examined by an eye specialist during the index pregnancy, frequencies of visit to eye care centers and indications for their visitation. A history of previous eye examination by eye care specialist/visit to eye clinic was considered as eye care utilisation. Selection of eligible subjects who consented to participate in the study was done using simple random technique. Logistic regression model was used to control sociodemographic and obstetric factors in order to determine independent covariate factor influencing the use of eye care services. Among the population studied, only 46 (32%) had eye examination during the index pregnancy. Level of education and occupational status of the respondents were found to be statistically significant factors (p = 0.001 and 0.008, respectively). There is a need for a policy that will encourage regular eye care services usage during pregnancy.

  2. Chronic catecholamine depletion switches myocardium from carbohydrate to lipid utilisation.

    PubMed

    Drake-Holland, A J; Van der Vusse, G J; Roemen, T H; Hynd, J W; Mansaray, M; Wright, Z M; Noble, M I

    2001-03-01

    Chronic cardiac transplantation denervation (i.e., global sympathetic denervation with myocardial catecholamine depletion, plus parasympathetic denervation) is known to inhibit myocardial oxidation of glucose. It is not known whether this is due to increased utilization of lactate, lipid or ketone bodies. The purpose of the present study was to test the hypothesis that the extraction and contribution of blood-borne fatty acids (FA) to overall oxidative energy conversion is increased. In anaesthetised dogs (control n = 6, cardiac denervated n = 6), we investigated fatty acid (FA) utilization. The studies were made at least four weeks after surgical cardiac denervation. Measurements were made of total FAs and with a radio-labelled tracer (U-14C palmitate). The contribution of FA utilisation to overall substrate oxidation rose from 31% (control) to 48% (cardiac denervated). The increase in the ratio (%) of CO2 production from palmitate oxidation to total CO2 production increased from 4.0 +/- 1.8 (control) to 10.6 +/- 5.8 (denervated, p = 0.04). The time from uptake of FA to release of CO2 product was unaltered. We conclude that the contribution of FA oxidation to overall energy conversion is increased in chronically denervated hearts, which is postulated to result from a decline in the active form of pyruvate dehydrogenase. This would appear to be a result of chronic catecholamine depletion.

  3. Biological carbon dioxide utilisation in food waste anaerobic digesters.

    PubMed

    Fernández, Y Bajón; Green, K; Schuler, K; Soares, A; Vale, P; Alibardi, L; Cartmell, E

    2015-12-15

    Carbon dioxide (CO2) enrichment of anaerobic digesters (AD) was previously identified as a potential on-site carbon revalorisation strategy. This study addresses the lack of studies investigating this concept in up-scaled units and the need to understand the mechanisms of exogenous CO2 utilisation. Two pilot-scale ADs treating food waste were monitored for 225 days, with the test unit being periodically injected with CO2 using a bubble column. The test AD maintained a CH4 production rate of 0.56 ± 0.13 m(3) CH4·(kg VS(fed) d)(-1) and a CH4 concentration in biogas of 68% even when dissolved CO2 levels were increased by a 3 fold over the control unit. An additional uptake of 0.55 kg of exogenous CO2 was achieved in the test AD during the trial period. A 2.5 fold increase in hydrogen (H2) concentration was observed and attributed to CO2 dissolution and to an alteration of the acidogenesis and acetogenesis pathways. A hypothesis for conversion of exogenous CO2 has been proposed, which requires validation by microbial community analysis. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Rhinovirus infection and healthcare utilisation in prematurely born infants.

    PubMed

    Drysdale, Simon B; Alcazar-Paris, Mireia; Wilson, Theresa; Smith, Melvyn; Zuckerman, Mark; Broughton, Simon; Rafferty, Gerrard F; Peacock, Janet L; Johnston, Sebastian L; Greenough, Anne

    2013-10-01

    Our aim was to determine whether rhinovirus (RV) lower respiratory tract infections (LRTIs) in prematurely born infants increase health-related cost of care during infancy. 153 infants born at <36 weeks of gestation were prospectively followed to 1 year. Cost of care was calculated from the National Health Service reference costing scheme and healthcare utilisation determined by examining hospital/general practitioner records. 20 infants developed RV LRTIs (RV group), 17 respiratory syncytial virus (RSV) LRTIs (RSV group), 12 both RV and RSV LRTIs (RV/RSV group) and 74 had no LRTI (no LRTI group). Compared with the no LRTI group, the RV/RSV LRTI group had the greatest increase in adjusted mean cost (difference GBP 5769), followed by the RV LRTI group (difference GBP 278) and, finally, the RSV LRTI group (difference GBP 172) (p=0.045). The RV group had more outpatient (p<0.05) and respiratory-related general practitioner (p<0.05) attendances, more wheezed at follow-up (p<0.001) than the no LRTI group and more had respiratory-related outpatient attendances than the RSV LRTI group (p<0.05). We conclude that RV LRTIs were associated with increased health-related cost of care during infancy; our results suggest that the RV group compared with the RSV group suffered greater chronic respiratory morbidity.

  5. Variation in opioid prescribing patterns between ED providers.

    PubMed

    Smulowitz, Peter B; Cary, Chris; Boyle, Katherine L; Novack, Victor; Jagminas, Liudvikas

    2016-12-01

    Abuse of opioid prescription drugs has become an epidemic across the developed world. Despite the fact that emergency physicians overall account for a small proportion of total opioids prescribed, the number of prescriptions has risen dramatically in the past decade and, to some degree, contributes to the available supply of opioids in the community, some of which are diverted for non-medical use. Since successfully reducing opioid prescribing on the individual level first requires knowledge of current prescribing patterns, we sought to determine to what extent variation exists in opioid prescribing patterns at our institution. This was a single-institution observational study at a community hospital with an annual ED volume of 47,000 visits. We determined the number of prescriptions written by each provider, both total number and accounting for the number of patients seen. Our primary outcome measure was the level of variation at the physician level for number of prescriptions written per patient. We also identified the mean number of pills written per prescription. We analyzed data from November 13, 2014 through July 31, 2015 for 21 full-time providers. There were a total of 2211 prescriptions for opioids written over this time period for a total of 17,382 patients seen. On a per-patient basis, the rate of opioid prescriptions written per patient during this period was 127 per 1000 visits (95 % CI 122-132). There was a variation on the individual provider level, with rates ranging from 33 per to 332 per 1000 visits. There was also substantial variation by provider in the number of pills written per prescription with coefficient of variation (standard deviation divided by mean) averaged over different opioids ranging from 16 to 40 %. There was significant variation in opioid prescribing patterns at the individual physician level, even when accounting for the number of patients seen.

  6. A longitudinal cohort study evaluating the impact of a geriatrician-led residential care outreach service on acute healthcare utilisation.

    PubMed

    Hutchinson, A F; Parikh, S; Tacey, M; Harvey, P A; Lim, W K

    2015-05-01

    over the last decade, high demand for acute healthcare services by long-term residents of residential care facilities (RCFs) has stimulated interest in exploring alternative models of care. The Residential Care Intervention Program in the Elderly (RECIPE) service provides expert outreach services to RCFs residents, interventions include comprehensive care planning, management of inter-current illness and rapid access to acute care substitution services. to evaluate whether the RECIPE service decreased acute healthcare utilisation. a retrospective cohort study using interrupted time series analysis to analyse change in acute healthcare utilisation before and after enrolment. a 300-bed metropolitan teaching hospital in Australia and 73 RCFs within its catchment. there were 1,327 patients enrolled in the service with a median age of 84 years; 61% were female. data were collected prospectively on all enrolled patients from 2004 to 2011 and linked to the acute health service administrative data set. Primary outcomes change in admission rates, length of stay and bed days per quarter. in the 2 years prior to enrolment, the mean number of acute care admissions per patient per year was 3.03 (SD 2.9) versus post 2.4 (SD 3.3), the service reducing admissions by 0.13 admissions per patient per quarter (P = 0.046). Prior to enrolment, the mean length of stay was 8.6 (SD 11.0) versus post 3.5 (SD 5.0), a reduction of 1.5 days per patient per quarter (P = 0.003). this study suggests that an outreach service comprising a geriatrician-led multidisciplinary team can reduce acute hospital utilisation rates. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. HIV postexposure prophylaxis practices by US ED practitioners.

    PubMed

    Merchant, Roland C; Keshavarz, Reza

    2003-07-01

    To determine how often US ED practitioners have prescribed HIV post-exposure prophylaxis (HIV PEP) and to discern how willing they are to offer it to patients, the authors surveyed 600 ED practitioners attending a national conference. According to their self-report, 11% had taken HIV PEP themselves. Sixty-eight percent had prescribed HIV PEP at some time. Of these, 92% had treated needlestick-injured health care workers, 48% sexual assault survivors, and 49% nonhealth care needlestick-injured persons. ED practitioners were more willing to offer HIV PEP after exposures to HIV-infected or high-risk sources than unknown or low- risk sources, as well as after sexual assault than consensual sex. Female practitioners, those who had themselves taken HIV PEP, resident physicians, and ED practitioners with fewer than 6 years of clinical practice were generally more apt to offer HIV PEP. Educational campaigns appear to be necessary to help ED practitioners determine when HIV PEP is appropriate.

  8. Chick embryo proliferation studies using EdU labeling.

    PubMed

    Warren, Michelle; Puskarczyk, Karolina; Chapman, Susan C

    2009-04-01

    Cell proliferation studies are an important experimental tool. The most commonly used thymidine analogues, tritiated thymidine and bromodeoxyuridine (BrdU) label cells during S-phase. Both methods have significant drawbacks: low sensitivity in the case of tritiated thymidine and a denaturation step during BrdU detection that destroys most cellular epitopes, requiring careful optimization. The antibody against BrdU is also large and tissue penetration can be difficult. EdU (5'-ethynyl-2'-deoxyuridine) is closely chemically related to BrdU, with detection achieved by a copper catalyzed reaction requiring a small fluorescently conjugated azide. Cell cultures, flow cytometry and high throughput studies using EdU-labeled cells is exceptionally fast and does not require denaturation or antibodies. We have developed a tissue-labeling technique in chick embryos using EdU. Following EdU chemistry to detect proliferating cells, the tissue can undergo immunolabeling. We demonstrate fluorescent EdU chemistry followed by Tuj1 antibody staining resulting in multiplex fluorescent tissues.

  9. The impact on hospital resource utilisation of treatment of hepatic encephalopathy with rifaximin-α.

    PubMed

    Orr, James G; Currie, Craig J; Berni, Ellen; Goel, Anurag; Moriarty, Kieran J; Sinha, Ashish; Gordon, Fiona; Dethier, Anne; Dillon, John F; Clark, Katie; Richardson, Paul; Middleton, Paul; Patel, Vishal; Shawcross, Debbie; Preedy, Helen; Aspinall, Richard J; Hudson, Mark

    2016-09-01

    Rifaximin-α reduces the risk of recurrence of overt hepatic encephalopathy. However, there remain concerns regarding the financial cost of the drug. We aimed to study the impact of treatment with rifaximin-α on healthcare resource utilisation using data from seven UK liver treatment centres. All seven centres agreed a standardised data set and data characterising clinical, demographic and emergency hospital admissions were collected retrospectively for the time periods 3, 6 and 12 months before and following initiation of rifaximin-α. Admission rates and hospital length of stay before and during therapy were compared. Costs of admissions and drug acquisition were estimated using published sources. Multivariate analyses were carried out to assess the relative impact of various factors on hospital length of stay. Data were available from 326 patients. Following the commencement of rifaximin, the total hospital length of stay reduced by an estimated 31-53%, equating to a reduction in inpatient costs of between £4858 and £6607 per year. Taking into account drug costs of £3379 for 1-year treatment with rifaximin-α, there was an estimated annual mean saving of £1480-£3228 per patient. Initiation of treatment with rifaximin-α was associated with a marked reduction in the number of hospital admissions and hospital length of stay. These data suggest that treatment of patients with rifaximin-α for hepatic encephalopathy was generally cost saving. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis.

    PubMed

    Tak, Casey R; Malheiro, Marty C; Bennett, Heather K W; Crouch, Barbara I

    2017-03-01

    The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study

    PubMed Central

    Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

    2016-01-01

    Objective While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. Design We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. Setting We interviewed participants at Japan Clubs and their offices. Participants 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. Results We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. Conclusions The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. PMID:27006344

  12. Outpatient echocardiography in the evaluation of innocent murmurs in children: utilisation benchmarking.

    PubMed

    Frias, Patricio A; Oster, Matthew; Daley, Patricia A; Boris, Jeffrey R

    2016-03-01

    We sought to benchmark the utilisation of echocardiography in the outpatient evaluation of heart murmurs by evaluating two large paediatric cardiology centres. Although criteria exist for appropriate use of echocardiography, there are no benchmarking data demonstrating its utilisation. We performed a retrospective cohort study of outpatients aged between 0 and 18 years at the Sibley Heart Center Cardiology and the Children's Hospital of Philadelphia Division of Cardiology, given a sole diagnosis of "innocent murmur" from 1 July, 2007 to 31 October, 2010. Using internal claims data, we compared the utilisation of echocardiography according to centre, patient age, and physician years of service. Of 23,114 eligible patients (Sibley Heart Center Cardiology: 12,815, Children's Hospital of Philadelphia Division of Cardiology: 10,299), 43.1% (Sibley Heart Center Cardiology: 45.2%, Children's Hospital of Philadelphia Division of Cardiology: 40.4%; p1-5 years had the lowest utilisation (32.7%). In two large paediatric cardiology practices, the overall utilisation of echocardiography by physicians with a sole diagnosis of innocent murmur was similar. There was significant and similar variability in utilisation by provider at both centres. Although these data serve as initial benchmarking, the variability in utilisation highlights the importance of appropriate use criteria.

  13. Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study.

    PubMed

    Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

    2016-03-22

    While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. We interviewed participants at Japan Clubs and their offices. 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Automated SEM-EDS GSR Analysis for Turkish Ammunitions

    NASA Astrophysics Data System (ADS)

    Cakir, Ismail; Uner, H. Bulent

    2007-04-01

    In this work, Automated Scanning Electron Microscopy with Energy Dispersive X-ray Spectrometry (SEM-EDS) was used to characterize 7.65 and 9mm cartridges Turkish ammunition. All samples were analyzed in a SEM Jeol JSM-5600LV equipped BSE detector and a Link ISIS 300 (EDS). A working distance of 20mm, an accelerating voltage of 20 keV and gunshot residue software was used in all analysis. Automated search resulted in a high number of particles analyzed containing gunshot residues (GSR) unique elements (PbBaSb). The obtained data about the definition of characteristic GSR particles was concordant with other studies on this topic.

  15. Automated SEM-EDS GSR Analysis for Turkish Ammunitions

    SciTech Connect

    Cakir, Ismail; Uner, H. Bulent

    2007-04-23

    In this work, Automated Scanning Electron Microscopy with Energy Dispersive X-ray Spectrometry (SEM-EDS) was used to characterize 7.65 and 9mm cartridges Turkish ammunition. All samples were analyzed in a SEM Jeol JSM-5600LV equipped BSE detector and a Link ISIS 300 (EDS). A working distance of 20mm, an accelerating voltage of 20 keV and gunshot residue software was used in all analysis. Automated search resulted in a high number of particles analyzed containing gunshot residues (GSR) unique elements (PbBaSb). The obtained data about the definition of characteristic GSR particles was concordant with other studies on this topic.

  16. Microbiologic Methods Utilized in the MAL-ED Cohort Study

    PubMed Central

    Houpt, Eric; Gratz, Jean; Kosek, Margaret; Zaidi, Anita K. M.; Qureshi, Shahida; Kang, Gagandeep; Babji, Sudhir; Mason, Carl; Bodhidatta, Ladaporn; Samie, Amidou; Bessong, Pascal; Barrett, Leah; Lima, Aldo; Havt, Alexandre; Haque, Rashidul; Mondal, Dinesh; Taniuchi, Mami; Stroup, Suzanne; McGrath, Monica; Lang, Dennis

    2014-01-01

    A central hypothesis of The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study is that enteropathogens contribute to growth faltering. To examine this question, the MAL-ED network of investigators set out to achieve 3 goals: (1) develop harmonized protocols to test for a diverse range of enteropathogens, (2) provide quality-assured and comparable results from 8 global sites, and (3) achieve maximum laboratory throughput and minimum cost. This paper describes the rationale for the microbiologic assays chosen and methodologies used to accomplish the 3 goals. PMID:25305291

  17. Multivariate statistical analysis of low-voltage EDS spectrum images

    SciTech Connect

    Anderson, I.M.

    1998-03-01

    Whereas energy-dispersive X-ray spectrometry (EDS) has been used for compositional analysis in the scanning electron microscope for 30 years, the benefits of using low operating voltages for such analyses have been explored only during the last few years. This paper couples low-voltage EDS with two other emerging areas of characterization: spectrum imaging and multivariate statistical analysis. The specimen analyzed for this study was a finished Intel Pentium processor, with the polyimide protective coating stripped off to expose the final active layers.

  18. New psych unit eases patient burden in ED.

    PubMed

    2008-06-01

    Creating a special unit for psychiatric patients frees up beds in your ED, ensures better care for that patient population, and improves the atmosphere in the main department for the rest of your patients. Consider these suggestions: The creation of a psych unit can be extremely costly. Be prepared to demonstrate projected savings when pitching the idea to administration. Make sure an ED physician has overall responsibility for each patient at all times. Keep a regular group of nurses in rotation. This setup will help ensure smooth handoffs.

  19. Utilisation of Wearable Computing for Space Programmes Test Activities Optimasation

    NASA Astrophysics Data System (ADS)

    Basso, V.; Lazzari, D.; Alemanni, M.

    2004-08-01

    New technologies are assuming a relevant importance in the Space business domain also in the Assembly Integration and Test (AIT) activities allowing process optimization and capability that were unthinkable only few years ago. This paper has the aim to describe Alenia Spazio (ALS) gained experience on the remote interaction techniques as a results of collaborations established both on European Communities (EC) initiatives, with Alenia Aeronautica (ALA) and Politecnico of Torino (POLITO). The H/W and S/W components performances increase and costs reduction due to the home computing massive utilization (especially demanded by the games business) together with the network technology possibility (offered by the web as well as the hi-speed links and the wireless communications) allow today to re-think the traditional AIT process activities in the light of the multimedia data exchange: graphical, voice video and by sure more in the future. Aerospace business confirm its innovation vocation which in the year '80 represents the cradle of the CAD systems and today is oriented to the 3D data visualization/ interaction technologies and remote visualisation/ interaction in collaborative way on a much more user friendly bases (i.e. not for specialists). Fig. 1 collects AIT extended scenario studied and adopted by ALS in these years. ALS experimented two possibilities of remote visualization/interaction: Portable [e.g. Fig.2 Personal Digital Assistant (PDA), Wearable] and walls (e.g.VR-Lab) screens as both 2D/3D visualisation and interaction devices which could support many types of traditional (mainly based on EGSE and PDM/CAD utilisation/reports) company internal AIT applications: 1. design review support 2. facility management 3. storage management 4. personnel training 5. integration sequences definition 6. assembly and test operations follow up 7. documentation review and external access to AIT activities for remote operations (e.g. tele-testing) EGSE Portable Clean room

  20. Equality in Maternal and Newborn Health: Modelling Geographic Disparities in Utilisation of Care in Five East African Countries

    PubMed Central

    Ruktanonchai, Nick W.; Nove, Andrea; Lopes, Sofia; Pezzulo, Carla; Bosco, Claudio; Alegana, Victor A.; Burgert, Clara R.; Ayiko, Rogers; Charles, Andrew SEK; Lambert, Nkurunziza; Msechu, Esther; Kathini, Esther; Matthews, Zoë; Tatem, Andrew J.

    2016-01-01

    Background Geographic accessibility to health facilities represents a fundamental barrier to utilisation of maternal and newborn health (MNH) services, driving historically hidden spatial pockets of localized inequalities. Here, we examine utilisation of MNH care as an emergent property of accessibility, highlighting high-resolution spatial heterogeneity and sub-national inequalities in receiving care before, during, and after delivery throughout five East African countries. Methods We calculated a geographic inaccessibility score to the nearest health facility at 300 x 300 m using a dataset of 9,314 facilities throughout Burundi, Kenya, Rwanda, Tanzania and Uganda. Using Demographic and Health Surveys data, we utilised hierarchical mixed effects logistic regression to examine the odds of: 1) skilled birth attendance, 2) receiving 4+ antenatal care visits at time of delivery, and 3) receiving a postnatal health check-up within 48 hours of delivery. We applied model results onto the accessibility surface to visualise the probabilities of obtaining MNH care at both high-resolution and sub-national levels after adjusting for live births in 2015. Results Across all outcomes, decreasing wealth and education levels were associated with lower odds of obtaining MNH care. Increasing geographic inaccessibility scores were associated with the strongest effect in lowering odds of obtaining care observed across outcomes, with the widest disparities observed among skilled birth attendance. Specifically, for each increase in the inaccessibility score to the nearest health facility, the odds of having skilled birth attendance at delivery was reduced by over 75% (0.24; CI: 0.19–0.3), while the odds of receiving antenatal care decreased by nearly 25% (0.74; CI: 0.61–0.89) and 40% for obtaining postnatal care (0.58; CI: 0.45–0.75). Conclusions Overall, these results suggest decreasing accessibility to the nearest health facility significantly deterred utilisation of all

  1. Equality in Maternal and Newborn Health: Modelling Geographic Disparities in Utilisation of Care in Five East African Countries.

    PubMed

    Ruktanonchai, Corrine W; Ruktanonchai, Nick W; Nove, Andrea; Lopes, Sofia; Pezzulo, Carla; Bosco, Claudio; Alegana, Victor A; Burgert, Clara R; Ayiko, Rogers; Charles, Andrew Sek; Lambert, Nkurunziza; Msechu, Esther; Kathini, Esther; Matthews, Zoë; Tatem, Andrew J

    2016-01-01

    Geographic accessibility to health facilities represents a fundamental barrier to utilisation of maternal and newborn health (MNH) services, driving historically hidden spatial pockets of localized inequalities. Here, we examine utilisation of MNH care as an emergent property of accessibility, highlighting high-resolution spatial heterogeneity and sub-national inequalities in receiving care before, during, and after delivery throughout five East African countries. We calculated a geographic inaccessibility score to the nearest health facility at 300 x 300 m using a dataset of 9,314 facilities throughout Burundi, Kenya, Rwanda, Tanzania and Uganda. Using Demographic and Health Surveys data, we utilised hierarchical mixed effects logistic regression to examine the odds of: 1) skilled birth attendance, 2) receiving 4+ antenatal care visits at time of delivery, and 3) receiving a postnatal health check-up within 48 hours of delivery. We applied model results onto the accessibility surface to visualise the probabilities of obtaining MNH care at both high-resolution and sub-national levels after adjusting for live births in 2015. Across all outcomes, decreasing wealth and education levels were associated with lower odds of obtaining MNH care. Increasing geographic inaccessibility scores were associated with the strongest effect in lowering odds of obtaining care observed across outcomes, with the widest disparities observed among skilled birth attendance. Specifically, for each increase in the inaccessibility score to the nearest health facility, the odds of having skilled birth attendance at delivery was reduced by over 75% (0.24; CI: 0.19-0.3), while the odds of receiving antenatal care decreased by nearly 25% (0.74; CI: 0.61-0.89) and 40% for obtaining postnatal care (0.58; CI: 0.45-0.75). Overall, these results suggest decreasing accessibility to the nearest health facility significantly deterred utilisation of all maternal health care services. These results

  2. Utilisation of malaria preventive measures during pregnancy and birth outcomes in Ibadan, Nigeria

    PubMed Central

    2011-01-01

    Background Malaria remains a major public health problem in sub Saharan Africa and the extent of utilisation of malaria preventive measures may impact on the burden of malaria in pregnancy. This study sought to determine the association between malaria preventive measures utilized during pregnancy and the birth outcomes of birth weight and preterm delivery. Methods This cross sectional survey involved 800 mothers who delivered at the University College Hospital, and Adeoyo Maternity Hospital, Ibadan. Data obtained included obstetric information, gestational age, birth weight and self reported use of malaria prevention strategies in index pregnancy. Results Most (95.6%) mothers used one or more malaria control measures. The most commonly used vector control measures were window net (84.0%), insecticide spray (71.5%) and insecticide treated bed nets (20.1%), while chemoprophylactic agents were pyrimethamine (23.5%), Intermittent Preventive Treatments with Sulphadoxine-Pyrimethamine (IPTsp) (18.5%) and intermittent chloroquine (9.5%) and 21.7% used herbal medications. The mean ± SD birthweight and gestational age of the babies were 3.02 kg ± 0.56 and 37.9 weeks ± 2.5 respectively. Preterm delivery rate was 19.4% and 9% had low birth weight. Comparing babies whose mothers had IPTsp with those who did not, mean birth weight was 3.13 kg ± 0.52 versus 3.0 kg ± 0.56 (p = 0.016) and mean gestational age was 38.5 weeks ± 2.1 versus 37.8 weeks ± 2.5 (p = 0.002). The non-use of IPTsp was associated with increased risk of having low birth weight babies (AOR: 2.27, 95% CI: 0.98; 5.28) and preterm birth (AOR: 1.93, 95% CI: 1.08, 3.44). The non use of herbal preparations (AOR: 0.55, 95% CI: 0.36, 0.85) was associated with reduced risk of preterm birth. The mean ± SD birth weight and gestational ages of babies born to mothers who slept under ITNs were not significantly different from those who did not (p = 0.07 and 0.09 respectively). Conclusions There is a need for

  3. System-wide flow initiative slashes patient wait times in the ED, boosts volume by 25%.

    PubMed

    2012-06-01

    Emergency department administrators at Cambridge Health Alliance, a three-hospital health care organization in Cambridge, MA, implemented a system-wide flow initiative that has reduced the average length-of-stay for rapid assessment patients from three hours to just over an hour. Under the approach, patients are immediately placed in a room, and providers and registration staff come to the patients rather than the traditional approach of having patients constantly move from place to place with wait times in between each interval of care. The approach relies on "patient partners," non-clinical personnel who are trained in customer service, to greet and quick-register patients who present to the ED for care. Administrators say 97% of patients who present to the ED are in a room within five minutes, and over 90% of them are seen by a provider within 14 minutes. The leave-without-being-seen (LWBS) rate has been slashed from 4.5% to 0.6%. System-wide ED volume, which was dropping before the new approach was implemented, has gone from 77,000 patients per year to nearly 100,000 patients per year.

  4. Advances in EBSD and EBSD/EDS integration for the characterization of mineralogical samples

    NASA Astrophysics Data System (ADS)

    Palasse, L.; Goran, D.; Schwager, T.

    2013-12-01

    Electron BackScatter Diffraction (EBSD) is a well-known powerful technique for petrofabric studies using Scanning Electron Microscope. By assessing the quantitative microstructural information, i.e. crystallographic orientation data, it allows a large variety of applications: understanding the deformation mechanisms, seismic properties, metamorphic processes; and more recently, performing phase identification and discrimination when combined with Energy Dispersive X-Ray Spectroscopy (EDS). However, it is known that for multiphase mineralogical samples, the information delivered either by EBSD or by EDS alone is not enough to successfully distinguish the present phases. Typical examples for EBSD related indexing issues are phases creating similar patterns; and for EDS technique alone, phases with similar chemical composition like calcite and aragonite, quartz and cristobalite. Recent software and hardware developments have significantly improved the data quality as well as the efficiency/productivity. This presentation aims to reveal the latest development in data processing that has transformed the combination of the two complementary techniques into a powerful tool for characterizing multiphase materials. Through geosciences application examples, we will present the advantages brought by this new approach which uses the quantified EDS results and EBSP to identify the correct phase, reducing the need of data cleaning, and without spending extra time at the SEM. We will also demonstrate how powerful EBSD indexing algorithm can overcome the limitation from sample preparation, with some examples of high hit rate achieved on polyphase mineralogical specimen and even on shock-metamorphosed minerals. Last but not least, recent developments also enable the investigation of nanostructured materials in the scanning electron microscope (SEM) by Transmission Kikuchi Diffraction (TKD). Through some mineralogical applications, we will demonstrate the high spatial resolution

  5. 34 CFR 84.400 - What are my responsibilities as a(n) ED awarding official?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false What are my responsibilities as a(n) ED awarding... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Responsibilities of ED Awarding Officials § 84.400 What are my responsibilities as a(n) ED awarding official? As a(n) ED awarding official, you...

  6. 34 CFR 84.400 - What are my responsibilities as a(n) ED awarding official?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false What are my responsibilities as a(n) ED awarding... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Responsibilities of ED Awarding Officials § 84.400 What are my responsibilities as a(n) ED awarding official? As a(n) ED awarding official, you...

  7. 34 CFR 84.400 - What are my responsibilities as a(n) ED awarding official?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 1 2012-07-01 2012-07-01 false What are my responsibilities as a(n) ED awarding... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Responsibilities of ED Awarding Officials § 84.400 What are my responsibilities as a(n) ED awarding official? As a(n) ED awarding official, you...

  8. 34 CFR 84.400 - What are my responsibilities as a(n) ED awarding official?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false What are my responsibilities as a(n) ED awarding... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Responsibilities of ED Awarding Officials § 84.400 What are my responsibilities as a(n) ED awarding official? As a(n) ED awarding official, you...

  9. 34 CFR 84.400 - What are my responsibilities as a(n) ED awarding official?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false What are my responsibilities as a(n) ED awarding... REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Responsibilities of ED Awarding Officials § 84.400 What are my responsibilities as a(n) ED awarding official? As a(n) ED awarding official, you...

  10. Authentic Field-Based Learning Experiences for EdD Students

    ERIC Educational Resources Information Center

    Hershberger, Jane Boag

    2009-01-01

    This EPP examines the problem of EdD coursework not having sufficient connection to the work that EdD students will eventually assume as leaders of school districts or other educational systems. It reviews literature critical of EdD programs and websites of educational administration professional organizations with recommended curriculum for EdD…

  11. Effects of feeding raw or reconstituted high tannin red sorghum on nutrient utilisation and certain welfare parameters of broiler chickens.

    PubMed

    Kumar, V; Elangovan, A V; Mandal, A B; Tyagi, P K; Bhanja, S K; Dash, B B

    2007-04-01

    1. A feeding trial was conducted on 360 1-d-old chicks from 0 to 6 weeks of age to assess the effect of processed high tannin red sorghum in the diet of broiler chickens on nutrient utilisation and certain welfare parameters. 2. Each of 9 dietary treatments was allotted to 4 groups (replicates) of chicks in a completely randomised design. The treatments were a maize-soy based standard broiler diet (control, RS(0)) and eight test diets formulated by incorporating either raw red sorghum (RS(25), RS(50), RS(75), RS(100)) or reconstituted red sorghum (RS(25)(R), RS(50)(R), RS(75)(R), RS(100)(R)) replacing 25, 50, 75 or 100% of maize from the control diet. 3. The tannin content was reduced from 23 to 16 g/kg in reconstituted red sorghum. 4. Utilisations of nitrogen, calcium and phosphorus retention were similar in all the dietary groups. 5. The cell-mediated immune response measured as footpad index (FPI) value of birds given raw red sorghum was significantly higher than in control and reconstituted red sorghum groups. Similarly, comparatively better humoral response measured as HA titre value was observed in raw red sorghum based groups than in reconstituted ones. 6. Plasma albumin, globulin, protein, glucose, calcium, phosphorus, SGOT, SGPT and uric acid levels did not differ significantly due to dietary treatments. 7. Mild histopathological changes were observed in liver and kidney tissues of birds given raw red sorghum. 8. From the present study, it is concluded that (1) the reconstitution of high tannin red sorghum resulted in about 30% reduction in its tannin concentration; (2) the feeding of reconstituted sorghum based diets to broiler chickens did not exert any appreciable influence on nutrient utilisation, blood biochemicals and enzymes and gross pathological changes; and (3) the birds fed on raw red sorghum exhibited higher immuno-responsiveness in comparison to their reconstituted counterparts.

  12. Effect of partial replacement of oats with sugar beet pulp and maize oil on nutrient utilisation in horses.

    PubMed

    Lindberg, J E; Karlsson, C P

    2001-11-01

    The objective of the present work was to assess the influence of partial replacement of oats with dried unmolassed sugar beet pulp (SBP) and/or maize oil on nutrient utilisation in horses fed a traditional hay and concentrate diet. The total tract digestibility of nutrients, urinary excretion and plasma parameters were studied in a 4 x 4 Latin-square design experiment with purebred Arabian geldings. Horses fed the SBP diets responded with a reduced (P<0.05) apparent digestibility of crude protein and feeding of maize oil resulted in an increased (P<0.05) apparent digestibility of crude fat. The apparent energy digestibility was unaffected by the replacement of oats with SBP, but increased (P<0.05) when maize oil replaced part of the oats. The urinary excretion of nitrogen increased (P<0.05) when maize oil replaced oats and the excretion of energy was higher (P<0.05) on the diets where oats were replaced by maize oil and SBP. There was a significant (P<0.05) effect across treatments of postprandial blood sampling time on plasma glucose and insulin concentrations. Also, plasma concentrations of glucose and insulin tended to be higher on the oats than on the SBP diets. In conclusion, the limited effects on the digestibility of nutrients and energy suggest that it should be possible to partially replace oats with maize oil and/or SBP in diets for horses without any impairing effects on the overall nutrient utilisation. However, the dietary-induced changes in the urinary excretion of energy and on plasma glucose and insulin levels, indicate a possible influence of dietary carbohydrate composition on nutrient utilisation at the organ level, which requires further study.

  13. Distance and utilisation of out-of-hours services in a Norwegian urban/rural district: an ecological study

    PubMed Central

    2013-01-01

    Background Long travel distances limit the utilisation of health services. We wanted to examine the relationship between the utilisation of a Norwegian out-of-hours service and the distance from the municipality population centroid to the associated casualty clinic. Methods All first contacts from ten municipalities in Arendal out-of-hours district were registered from 2007 through 2011. The main outcomes were contact and consultation rates for each municipality for each year. The associations between main outcomes and distance from the population centroid of the participating municipalities to the casualty clinic and were examined by linear regression. Demographic and socioeconomic factors were included in multivariate linear regression. Secondary endpoints include association between distance and rates of different first actions taken and priority grades assessed by triage nurses. Age and gender specific subgroup analyses were performed. Results 141 342 contacts were included in the analyses. Increasing distance was associated with marked lower rates of all contact types except telephone consultations by doctor. Moving 43 kilometres away from the casualty clinic led to a 50 per cent drop in the rate of face-to-face consultations with a doctor. Availability of primary care doctors and education level contributed to a limited extent to the variance in consultation rate. The rates of all priority grades decreased significantly with increasing distance. The rate of acute events was reduced by 22 per cent when moving 50 kilometres away. The proportion of patients above 66 years increased with increasing distance, while the proportion of 13- to 19 year olds decreased. The proportion of female patients decreased with increasing distance. Conclusions The results confirm that increasing distance is associated with lower utilisation of out-of-hours services, even for the most acute cases. Extremely long distances might compromise patient safety. This must be taken into

  14. Violence prevention in the ED: linkage of the ED to a social service agency.

    PubMed

    Zun, Leslie S; Downey, La Vonne; Rosen, Jodi

    2003-10-01

    was a strong positive correlation of using services and case management (Pearson coefficient = 0.728, significance =.00). The referral of young victims of violence from the ED to psychosocial services could be successful using a case management model and an alliance between a healthcare system and a social service agency.

  15. Perceived Influence of Cooperating Teachers on edTPA Performance

    ERIC Educational Resources Information Center

    Behney, Jennifer

    2016-01-01

    The Education Teaching Performance Assessment (edTPA) is a performance assessment of teacher effectiveness that is increasingly used to make decisions about licensure for teacher candidates, including candidates seeking certification in world languages. Because of the high-stakes nature of this assessment, it is important to isolate and better…

  16. SSF1deg-Month Terra Ed4

    Atmospheric Science Data Center

    2017-03-08

    ... Search and Order:  ASDC Order Tool Order Data:  Earthdata Search:  Earthdata Search Guide ... Detailed CERES SSF1deg-lite Product Information Data Products Catalog: DPC_SSF1deg-Month_Ed4_R6V1 Readme Files:  ...

  17. SSF1deg-Day Terra Ed4

    Atmospheric Science Data Center

    2017-03-08

    ... Search and Order:  ASDC Order Tool Order Data:  Earthdata Search:  Earthdata Search Guide ... Detailed CERES SSF1deg-lite Product Information Data Products Catalog: DPC_SSF1deg-Day_Ed4_R5V1 Readme Files:  ...

  18. SSF1deg-Day Aqua Ed4

    Atmospheric Science Data Center

    2017-03-08

    ... Search and Order:  ASDC Order Tool Order Data:  Earthdata Search:  Earthdata Search Guide ... Detailed CERES SSF1deg-lite Product Information Data Products Catalog: DPC_SSF1deg-Day_Ed4_R6V1 Readme Files:  ...

  19. Skylab-4 Mission Onboard Photograph - Astronaut Ed Gibson at Work

    NASA Technical Reports Server (NTRS)

    1974-01-01

    This Skylab-4 mission onboard photograph shows Astronaut Ed Gibson at the complex control and display console for the Apollo Telescope Mount solar telescopes located in the Skylab Multiple Docking Adapter. Astronauts watched the Sun, and photographed and recorded the solar activities, such as the birth of a solar flare.

  20. Embracing the Common Cause Advocating for Ed Tech

    ERIC Educational Resources Information Center

    Roland, Jennifer

    2006-01-01

    This is a common response from educators confronted with the notion of advocating for educational technology funding. But, in a time when U.S. funding for Ed Tech is in danger of being cut from the budget, ISTE believes that all of its members, and in fact, all U.S. educators, must become advocates for our common cause. "Effective advocacy from…

  1. 5 Ways That edX Could Change Education

    ERIC Educational Resources Information Center

    Parry, Marc

    2012-01-01

    Since MIT and Harvard started edX, their joint experiment with free online courses, the venture has attracted enormous attention for opening the ivory tower to the world. But in the process, the world will become part of an expensive and ambitious experiment testing some of the most interesting--and difficult--questions in digital education. Can…

  2. Three Ways edTPA Prepared Me for the Classroom

    ERIC Educational Resources Information Center

    Butler, Matthew

    2015-01-01

    edTPA, a capstone assessment designed to assess whether new teachers are ready for the job by evaluating their teaching and their analysis of their teaching, helped prepare the author for the classroom in three ways. First, he became accountable to his students. Second, he learned to analyze his teaching. Third, he discovered how to relate…

  3. Creating a Minnesota Statewide SNAP-Ed Program Evaluation

    ERIC Educational Resources Information Center

    Gold, Abby; Barno, Trina Adler; Sherman, Shelley; Lovett, Kathleen; Hurtado, G. Ali

    2013-01-01

    Systematic evaluation is an essential tool for understanding program effectiveness. This article describes the pilot test of a statewide evaluation tool for the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). A computer algorithm helped Community Nutrition Educators (CNEs) build surveys specific to their varied educational settings…

  4. Creating a Minnesota Statewide SNAP-Ed Program Evaluation

    ERIC Educational Resources Information Center

    Gold, Abby; Barno, Trina Adler; Sherman, Shelley; Lovett, Kathleen; Hurtado, G. Ali

    2013-01-01

    Systematic evaluation is an essential tool for understanding program effectiveness. This article describes the pilot test of a statewide evaluation tool for the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). A computer algorithm helped Community Nutrition Educators (CNEs) build surveys specific to their varied educational settings…

  5. HAZ-ED Classroom Activities for Understanding Hazardous Waste.

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Washington, DC.

    The Federal Superfund Program investigates and cleans up hazardous waste sites throughout the United States. Part of this program is devoted to informing the public and involving people in the process of cleaning up hazardous waste sites from beginning to end. The Haz-Ed program was developed to assist the Environmental Protection Agency's (EPA)…

  6. EdMOO: One Approach to a Multimedia Collaborative Environment.

    ERIC Educational Resources Information Center

    Holkner, Bernard

    The nature of the multiuser object oriented (MOO) environment lends itself to flexible and rich interactive collaboration space providing interactive discussion, mail, mailing list, and news features to its virtual denizens. EdMOO (HREF1) was created in mid-1995 as an environment for teachers to experience the text based virtual reality…

  7. Perceived Influence of Cooperating Teachers on edTPA Performance

    ERIC Educational Resources Information Center

    Behney, Jennifer

    2016-01-01

    The Education Teaching Performance Assessment (edTPA) is a performance assessment of teacher effectiveness that is increasingly used to make decisions about licensure for teacher candidates, including candidates seeking certification in world languages. Because of the high-stakes nature of this assessment, it is important to isolate and better…

  8. Candidate Success and edTPA: Looking at the Data

    ERIC Educational Resources Information Center

    Evans, Lesley A.; Kelly, Mary K.; Baldwin, Joni L.; Arnold, Jackie M.

    2016-01-01

    This descriptive study looks at the correlations between Teacher Performance Assessment (edTPA) data and numerous program data points, including GPA, major GPA, and benchmark assignment scores, gathered in an Early Childhood Education (ECE) program. Previous studies have looked to correlate grade point average (GPA) with pre-service teacher…

  9. The Theater of Confrontation: Ed Bullins, Up Against the Wall

    ERIC Educational Resources Information Center

    Evans, Don

    1974-01-01

    Discusses ed Bullins' role in bringing together in the summer of 1968 a representative collection of works from the Black Arts Movement; the controversy surrounding his 1971 Lincoln Center production of his play, "The Duplex"; and his play, "House Party," a collage of voices and images from Blacktown mounted at The American…

  10. 5 Ways That edX Could Change Education

    ERIC Educational Resources Information Center

    Parry, Marc

    2012-01-01

    Since MIT and Harvard started edX, their joint experiment with free online courses, the venture has attracted enormous attention for opening the ivory tower to the world. But in the process, the world will become part of an expensive and ambitious experiment testing some of the most interesting--and difficult--questions in digital education. Can…

  11. Skylab-4 Mission Onboard Photograph - Astronaut Ed Gibson at Work

    NASA Technical Reports Server (NTRS)

    1974-01-01

    This Skylab-4 mission onboard photograph shows Astronaut Ed Gibson at the complex control and display console for the Apollo Telescope Mount solar telescopes located in the Skylab Multiple Docking Adapter. Astronauts watched the Sun, and photographed and recorded the solar activities, such as the birth of a solar flare.

  12. Inside the Sex Ed Studio: An Interview with Peggy Brick

    ERIC Educational Resources Information Center

    Taverner, William J.

    2008-01-01

    "Inside the Sex Ed Studio" profiles leaders in the field of sexuality education. Peggy Brick, former director of Planned Parenthood of Greater Northern New Jersey's Center for Family Life Education (CFLE) and author of numerous sexuality education resources used worldwide, is the subject of this interview. Ms. Brick was interviewed by…

  13. Three Ways edTPA Prepared Me for the Classroom

    ERIC Educational Resources Information Center

    Butler, Matthew

    2015-01-01

    edTPA, a capstone assessment designed to assess whether new teachers are ready for the job by evaluating their teaching and their analysis of their teaching, helped prepare the author for the classroom in three ways. First, he became accountable to his students. Second, he learned to analyze his teaching. Third, he discovered how to relate…

  14. Candidate Success and edTPA: Looking at the Data

    ERIC Educational Resources Information Center

    Evans, Lesley A.; Kelly, Mary K.; Baldwin, Joni L.; Arnold, Jackie M.

    2016-01-01

    This descriptive study looks at the correlations between Teacher Performance Assessment (edTPA) data and numerous program data points, including GPA, major GPA, and benchmark assignment scores, gathered in an Early Childhood Education (ECE) program. Previous studies have looked to correlate grade point average (GPA) with pre-service teacher…

  15. Weck Ed. Weck Educational Development Program. Final Performance Report.

    ERIC Educational Resources Information Center

    Coplin, Jennifer; And Others

    This document includes a final performance report and evaluation report from the Weck Ed program, through which job-linked adult basic education and General Educational Development (GED) test preparation courses that were jointly developed by the company Pilling Weck and Durham Technical Community College were offered to Pilling Weck employees on…

  16. FETC, TCEA Commemorate 25 Years of Serving Ed Tech Industry

    ERIC Educational Resources Information Center

    T.H.E. Journal, 2005

    2005-01-01

    There's only one way to prepare for all of the exciting things that the ed tech market has in store for 2005-- by attending a conference. That's why T.H.E. Journal hopes readers will join them at this year's FETC (Booth 1505) and TCEA (Booth 1934) conferences to help celebrate their 25th anniversaries. Overviews are provided for both conferences…

  17. Lifeworld and Textualism: Reassembling the Researcher/ed and "Others"

    ERIC Educational Resources Information Center

    Payne, Phillip G.

    2005-01-01

    This response to McKenzie's "post-post" concerns about environmental education research draws upon empirical, conceptual, anecdotal, metaphorical, imaged and poetic means to help the researcher "reassemble" the researcher/ed by attending to her/his relational body and embodiment of various, often hegemonic, socially constructed environmental…

  18. SYN1deg-1Hour Ed1A

    Atmospheric Science Data Center

    2017-10-04

    ... Tool: CERES Order Tool Order Data:  Earthdata Search:  Order Data Guide Documents:  SYN1deg Description/Abstract ... Detailed CERES SYN1deg Product Information Data Products Catalog: DPC_SYN1deg-Hour_Ed4_R6V1 (PDF) Readme ...

  19. SSF1deg-Month Aqua Ed4

    Atmospheric Science Data Center

    2017-08-21

    ... Guide Documents:  Detailed CERES SSF1deg-lite Product Information Data Products Catalog: DPC_SSF1deg-Month_Ed4_R6V1 Readme Files:  Readme ... Spatial Coverage: Relevant to each product Full Product Page ...

  20. Engaging the public through writing an op-ed

    NASA Astrophysics Data System (ADS)

    Labosier, Chris; Zhu, Laiyin; Quiring, Steven

    2012-10-01

    In May, prior to the start of the 2012 hurricane season, AGU asked us to write an op-ed for the Houston Chronicle on the importance of funding hurricane research. We were excited to be asked and pleased that AGU facilitated the process by providing us with some guidance on writing the op-ed. Given the impact that Hurricane Ike had in Texas just a few years ago, we felt it was important to remind the citizens of the greater Houston metropolitan area of the societal benefits of funding hurricane research. Thanks to the assistance of AGU staff, writing the article required only a few hours of time. Our op-ed was published in the print edition of the Houston Chronicle on 1 June 2012, the official start of the hurricane season (http://www.chron.com/default/article/Tight-budgets-posing-threat-to-Texas-hurricane-3600363.php). It was picked up by the media relations office in the College of Geosciences at Texas A&M University and featured on the college's Web site in the dean's biweekly briefing and on its Facebook page. As a result, the op-ed reached a large and diverse audience.

  1. Preparing Ed.D. Students to Conduct Group Dissertations

    ERIC Educational Resources Information Center

    Browne-Ferrigno, Tricia; Jensen, Jane McEldowney

    2012-01-01

    In this article we present an overview of a recently launched cohort-based Ed.D. program that prepares participants to conduct group dissertations. The program, a hybrid model of online learning activities and monthly face-to-face class sessions, is delivered through a partnership between a university's college of education and the administrative…

  2. Something Happened on the Way to Completing the edTPA: A Case Study of Teacher Candidates' Perceptions of the edTPA

    ERIC Educational Resources Information Center

    Heil, Leila; Berg, Margaret H.

    2017-01-01

    This case study addresses a need for evidence of teacher candidates' perceptions of the edTPA. Data were collected via a focus group interview, a survey, and miscellaneous documents. Perceptions of the edTPA were informed by external influences including alumni experiences and internet resources. Perceived positive features of the edTPA included…

  3. Impact Evaluation of a System-Wide Chronic Disease Management Program on Health Service Utilisation: A Propensity-Matched Cohort Study.

    PubMed

    Billot, Laurent; Corcoran, Kate; McDonald, Alina; Powell-Davies, Gawaine; Feyer, Anne-Marie

    2016-06-01

    The New South Wales Health (NSW Health) Chronic Disease Management Program (CDMP) delivers interventions to adults at risk of hospitalisation for five target chronic conditions that respond well to ambulatory care: diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and coronary artery disease. The intervention consists of two main components: (1) care coordination across sectors (acute, ambulatory, and community care from both public and private sectors) and clinical specialties, facilitated by program care coordinators, and (2) health coaching including management of lifestyle risk factors and medications and self-management. These components were broadly prescribed by the head office of NSW Health, which funded the program, and were implemented by regional health services (local health districts) in ways that best suited their own history, environment, workforce, and patient need. We used a propensity-matched cohort study to evaluate health service utilisation after enrolment in the CDMP. The evaluation cohort included 41,303 CDMP participants enrolled between 1 January 2011 and 31 December 2013 who experienced at least one hospital admission or emergency department (ED) presentation for a target condition in the 12 mo preceding enrolment. Potential controls were selected from patients not enrolled in the CDMP but experiencing at least one hospital admission or ED presentation over the same period. Each CDMP patient in the evaluation cohort was matched to one control using 1:1 propensity score matching. The primary outcome was avoidable hospitalisations. Secondary outcomes included avoidable readmissions, avoidable bed days, unplanned hospitalisations, unplanned readmissions, unplanned bed days, ED presentations, and all-cause death. The primary analysis consisted of 30,057 CDMP participants and 30,057 matched controls with a median follow-up of 15 mo. Of those, 25,638 (85.3%) and 25,597 (85.2%) were alive by the end of

  4. Effect of an electronic medical record alert for severe sepsis among ED patients.

    PubMed

    Narayanan, Navaneeth; Gross, A Kendall; Pintens, Megan; Fee, Christopher; MacDougall, Conan

    2016-02-01

    Severe sepsis and septic shock are a major health concern worldwide. The objective of this study is to determine if Severe Sepsis Best Practice Alert (SS-BPA) implementation was associated with improved processes of care and clinical outcomes among patients with severe sepsis or septic shock presenting to the emergency department (ED). This is a single-center, before-and-after observational study. The intervention group (n = 103) consisted of adult patients presenting to the ED with severe sepsis or septic shock during a 7-month period after implementation of the SS-BPA. The control group (n = 111) consisted of patients meeting the same criteria over a prior 7-month period. The SS-BPA primarily acts by automated, real-time, algorithm-based detection of severe sepsis or septic shock via the electronic medical record system. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), time to antibiotic administration, and proportion of patients who received antibiotics within the target 60 minutes. Time to antibiotics was significantly reduced in the SS-BPA cohort (29 vs 61.5 minutes, P < .001). In addition, there was a higher proportion of patients who received antibiotics within 60 minutes (76.7 vs 48.6%; P < .001). On multivariable analysis, in-hospital mortality was not significantly reduced in the intervention group (odds ratio, 0.64; 95% confidence interval, 0.26-1.57). Multivariable analysis of LOS indicated a significant reduction among patients in the SS-BPA cohort (geometric mean ratio, 0.66; 95% confidence interval, 0.53-0.82). Implementation of the SS-BPA for severe sepsis or septic shock among ED patients is associated with significantly improved timeliness of antibiotic administration and reduced hospital LOS. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Expenditure and resource utilisation for cervical screening in Australia

    PubMed Central

    2012-01-01

    Background The National Cervical Screening Program in Australia currently recommends that women aged 18–69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010. Methods A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination. Results The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing $96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing $21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that $20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities. Conclusions Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the

  6. Target prediction utilising negative bioactivity data covering large chemical space.

    PubMed

    Mervin, Lewis H; Afzal, Avid M; Drakakis, Georgios; Lewis, Richard; Engkvist, Ola; Bender, Andreas

    2015-01-01

    In silico analyses are increasingly being used to support mode-of-action investigations; however many such approaches do not utilise the large amounts of inactive data held in chemogenomic repositories. The objective of this work is concerned with the integration of such bioactivity data in the target prediction of orphan compounds to produce the probability of activity and inactivity for a range of targets. To this end, a novel human bioactivity data set was constructed through the assimilation of over 195 million bioactivity data points deposited in the ChEMBL and PubChem repositories, and the subsequent application of a sphere-exclusion selection algorithm to oversample presumed inactive compounds. A Bernoulli Naïve Bayes algorithm was trained using the data and evaluated using fivefold cross-validation, achieving a mean recall and precision of 67.7 and 63.8 % for active compounds and 99.6 and 99.7 % for inactive compounds, respectively. We show the performances of the models are considerably influenced by the underlying intraclass training similarity, the size of a given class of compounds, and the degree of additional oversampling. The method was also validated using compounds extracted from WOMBAT producing average precision-recall AUC and BEDROC scores of 0.56 and 0.85, respectively. Inactive data points used for this test are based on presumed inactivity, producing an approximated indication of the true extrapolative ability of the models. A distance-based applicability domain analysis was also conducted; indicating an average Tanimoto Coefficient distance of 0.3 or greater between a test and training set can be used to give a global measure of confidence in model predictions. A final comparison to a method trained solely on active data from ChEMBL performed with precision-recall AUC and BEDROC scores of 0.45 and 0.76. The inclusion of inactive data for model training produces models with superior AUC and improved early recognition capabilities, although

  7. Expenditure and resource utilisation for cervical screening in Australia.

    PubMed

    Lew, Jie-Bin; Howard, Kirsten; Gertig, Dorota; Smith, Megan; Clements, Mark; Nickson, Carolyn; Shi, Ju-Fang; Dyer, Suzanne; Lord, Sarah; Creighton, Prudence; Kang, Yoon-Jung; Tan, Jeffrey; Canfell, Karen

    2012-12-05

    The National Cervical Screening Program in Australia currently recommends that women aged 18-69 years are screened with conventional cytology every 2 years. Publicly funded HPV vaccination was introduced in 2007, and partly as a consequence, a renewal of the screening program that includes a review of screening recommendations has recently been announced. This study aimed to provide a baseline for such a review by quantifying screening program resource utilisation and costs in 2010. A detailed model of current cervical screening practice in Australia was constructed and we used data from the Victorian Cervical Cytology Registry to model age-specific compliance with screening and follow-up. We applied model-derived rate estimates to the 2010 Australian female population to calculate costs and numbers of colposcopies, biopsies, treatments for precancer and cervical cancers in that year, assuming that the numbers of these procedures were not yet substantially impacted by vaccination. The total cost of the screening program in 2010 (excluding administrative program overheads) was estimated to be A$194.8M. We estimated that a total of 1.7 million primary screening smears costing $96.7M were conducted, a further 188,900 smears costing $10.9M were conducted to follow-up low grade abnormalities, 70,900 colposcopy and 34,100 histological evaluations together costing $21.2M were conducted, and about 18,900 treatments for precancerous lesions were performed (including retreatments), associated with a cost of $45.5M for treatment and post-treatment follow-up. We also estimated that $20.5M was spent on work-up and treatment for approximately 761 women diagnosed with invasive cervical cancer. Overall, an estimated $23 was spent in 2010 for each adult woman in Australia on cervical screening program-related activities. Approximately half of the total cost of the screening program is spent on delivery of primary screening tests; but the introduction of HPV vaccination, new

  8. Effect of dietary calcium level and source on mineral utilisation by piglets fed diets containing exogenous phytase.

    PubMed

    Schlegel, P; Gutzwiller, A

    2016-11-21

    Calcium and phosphorus are essential minerals, closely linked in digestive processes and metabolism. With widespread use of low P diets containing exogenous phytase, the optimal dietary Ca level was verified. The 40-day study evaluated the effects of Ca level (4, 7 and 10 g/kg diet) and Ca source (Ca from CaCO3 and from Lithothamnium calcareum) on mineral utilisation in 72 piglets (7.9 ± 1.0 kg BW) fed an exogenous phytase containing diet with 2.9 g digestible P/kg. Measured parameters were growth performance, stomach mineral solubility, bone breaking strength and urinary, serum and bone mineral concentration. The apparent total tract digestibility of minerals was also assessed in the two diets with 7 g Ca/kg, using 12 additional pigs. Regardless of Ca source, increasing dietary Ca impaired feed conversion ratio, increased urinary pH, increased serum and urinary Ca, decreased serum and urinary P, decreased serum Mg and increased urinary Mg, increased serum AP activity, decreased bone Mg increased bone Zn. Bone breaking strength was improved with 7 compared to 4 g Ca/kg. Compared to CaCO3 , Ca from Lithothamnium calcareum increased serum Mg and with, 10 g Ca/kg, it limited body weight gain. The dose response of Ca in a diet with 2.9 g digestible P/kg and including exogenous phytase indicated that: (i) a low dietary Ca was beneficial for piglet growth, but was limiting the metabolic use of P; (ii) a high dietary Ca level impaired P utilisation; (iii) the optimal P utilisation and bone breaking strength was obtained with a dietary Ca-to-digestible P ratio of 2.1 to 2.4:1; (iv). Increasing dietary Ca reduced Mg utilisation, but not Zn status, when fed at adequate level. Finally, Ca from Lithothamnium calcareum had similar effects on Ca and P metabolism as CaCO3 , but impaired growth when fed at the highest inclusion level.

  9. Muscle glycogen utilisation during Rugby match play: Effects of pre-game carbohydrate.

    PubMed

    Bradley, Warren J; Morehen, James C; Haigh, Julian; Clarke, Jon; Donovan, Timothy F; Twist, Craig; Cotton, Caroline; Shepherd, Sam; Cocks, Matthew; Sharma, Asheesh; Impey, Samuel G; Cooper, Robert G; Maclaren, Don P M; Morton, James P; Close, Graeme L

    2016-12-01

    Although the physical demands of Rugby League (RL) match-play are well-known, the fuel sources supporting energy-production are poorly understood. We therefore assessed muscle glycogen utilisation and plasma metabolite responses to RL match-play after a relatively high (HCHO) or relatively low CHO (LCHO) diet. Sixteen (mean±SD age; 18±1 years, body-mass; 88±12kg, height 180±8cm) professional players completed a RL match after 36-h consuming a non-isocaloric high carbohydrate (n=8; 6gkgday(-1)) or low carbohydrate (n=8; 3gkgday(-1)) diet. Muscle biopsies and blood samples were obtained pre- and post-match, alongside external and internal loads quantified using Global Positioning System technology and heart rate, respectively. Data were analysed using effects sizes ±90% CI and magnitude-based inferences. Differences in pre-match muscle glycogen between high and low carbohydrate conditions (449±51 and 444±81mmolkg(-1)d.w.) were unclear. High (243±43mmolkg(-1)d.w.) and low carbohydrate groups (298±130mmolkg(-1)d.w.) were most and very likely reduced post-match, respectively. For both groups, differences in pre-match NEFA and glycerol were unclear, with a most likely increase in NEFA and glycerol post-match. NEFA was likely lower in the high compared with low carbohydrate group post-match (0.95±0.39mmoll(-1) and 1.45±0.51mmoll(-1), respectively), whereas differences between the 2 groups for glycerol were unclear (98.1±33.6mmoll(-1) and 123.1±39.6mmoll(-1)) in the high and low carbohydrate groups, respectively. Professional RL players can utilise ∼40% of their muscle glycogen during a competitive match regardless of their carbohydrate consumption in the preceding 36-h. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  10. The utilisation of health research in policy-making: concepts, examples and methods of assessment

    PubMed Central

    Hanney, Stephen R; Gonzalez-Block, Miguel A; Buxton, Martin J; Kogan, Maurice

    2003-01-01

    The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies. PMID:12646071

  11. Breast cancer screening in England and the United States: a comparison of provision and utilisation.

    PubMed

    Williams, Joseph; Garvican, Linda; Tosteson, Anna N A; Goodman, David C; Onega, Tracy

    2015-12-01

    Comparing breast cancer screening across countries within the context of some of the benefits and harms offers the opportunity to improve effectiveness through mutual learning. This paper describes the provision of breast cancer screening in England and the United States. The various recommendations for accessing breast cancer screening in the two countries are set out and the organisation of services including quality assurance, incentives and performance mechanisms considered. In the United States, younger women are routinely screened; they are less likely to benefit and more likely to be harmed. The utilisation of breast cancer screening amongst eligible women is broadly comparable in the two countries. However, there are differences in technical performance; the reasons for these including radiological reading procedures and cultural factors are explored. Despite a well-functioning screening programme, breast cancer mortality and survival in England are poor relative to other countries. Emphasis for American improvement should be on reducing false-positive recall rates, while the English NHS could supplement existing efforts to understand and improve comparatively poor survival and mortality.

  12. Utilisation and Safety of Deferasirox: Results from an Observational Cohort Study in England.

    PubMed

    Osborne, Vicki; Davies, Miranda; Layton, Deborah; Shakir, Saad A W

    2017-10-10

    Deferasirox (EXJADE(®), Novartis, UK) is an oral iron-chelating agent primarily used to reduce chronic iron overload in patients receiving blood transfusions for various chronic anaemias and some non-transfusion dependant anaemias. The aim of this study was to examine the utilisation and safety of deferasirox used in general practice in England. A single exposure observational cohort study design was used. Patients were identified from dispensed prescriptions for deferasirox between September 2006 and September 2014. Outcome data were collected via postal questionnaires sent to prescribers ≥ 6 months after first dispensed prescription for an individual patient. Summary descriptive statistics were calculated. The evaluable cohort consisted of 122 patients, of which 41.8% were aged 2-17 years. Frequent reasons for prescribing were sickle cell anaemia (27/103 where specified, 26.2%) and beta thalassaemia (26, 25.2%). The majority of patients (43/51, 84.3%) were prescribed the licensed doses of 10 or 20 mg/kg/day at start. Prior measurements of serum creatinine were only reported for a small proportion this study (18/122, 14.8%). In total, 91 incident events were reported, including two of raised serum creatinine. These results show that deferasirox is largely being prescribed for its licensed indications in general practice in England and events reported were consistent with the known safety profile.

  13. Tolerance of pentose utilising yeast to hydrogen peroxide-induced oxidative stress

    PubMed Central

    2014-01-01

    Background Bioethanol fermentations follow traditional beverage fermentations where the yeast is exposed to adverse conditions such as oxidative stress. Lignocellulosic bioethanol fermentations involve the conversion of pentose and hexose sugars into ethanol. Environmental stress conditions such as osmotic stress and ethanol stress may affect the fermentation performance; however, oxidative stress as a consequence of metabolic output can also occur. However, the effect of oxidative stress on yeast with pentose utilising capabilities has yet to be investigated. Results Assaying for the effect of hydrogen peroxide-induced oxidative stress on Candida, Pichia and Scheffersomyces spp. has demonstrated that these yeast tolerate hydrogen peroxide-induced oxidative stress in a manner consistent with that demonstrated by Saccharomyces cerevisiae. Pichia guillermondii appears to be more tolerant to hydrogen peroxide-induced oxidative stress when compared to Candida shehatae, Candida succiphila or Scheffersomyces stipitis. Conclusions Sensitivity to hydrogen peroxide-induced oxidative stress increased in the presence of minimal media; however, addition of amino acids and nucleobases was observed to increase tolerance. In particular adenine increased tolerance and methionine reduced tolerance to hydrogen peroxide-induced oxidative stress. PMID:24636079

  14. Utilisation of preharvest dropped apple peels as a flour substitute for a lower glycaemic index and higher fibre cake.

    PubMed

    Jun, Yujin; Bae, In Young; Lee, Suyong; Lee, Hyeon Gyu

    2014-02-01

    Fibre-enriched materials (FEMs) obtained from preharvest dropped apple peels were utilised as a source of dietary fibre in baked cakes and their effects on the textural/nutritional qualities and starch digestibility (glucose release behaviour, starch digestion fraction, predicted glycaemic index) of the cakes were evaluated. When FEMs were incorporated into the cake formulation (3 g and 6 g of dietary fibre per serving (100 g)), the volume of the cakes seemed to be reduced and their texture become harder. However, 3 g of FEMs did not degrade the cake qualities. The use of FEMs in cakes significantly reduced the levels of rapidly digestible starch and slowly digestible starch, while the levels of resistant starch increased. Additionally, the cake samples prepared with FEMs exhibited a lower predicted glycaemic index. This study may give rise to multi-functional bakery products with acceptable quality and low glycaemic index.

  15. Floodwater utilisation values of wetland services - a case study in Northeastern China

    NASA Astrophysics Data System (ADS)

    Lü, S. B.; Xu, S. G.; Feng, F.

    2012-02-01

    Water plays a significant role in wetlands. Floodwater utilisation in wetlands brings a wide range of wetland services, from goods production and water regulation to animal protection and aesthetics related to water supply in wetlands. In this study, the floodwater utilisation values of wetland services were estimated within the Momoge wetland and Xianghai wetland in western Jilin province of northeastern China. From 2003 to 2008, the floodwater diverted from the Nenjiang and Tao'er River is 381 million m3, which translates into a monetary value of approximately 1.35 billion RMB in 2008 (RMB: Chinese Currency, RMB 6.80 = US 1), and the ratio of economic value, eco-environmental value, and social value is 1:12:2. Besides the monetary value of the water itself, excessive floodwater utilisation may bring losses to wetlands; the threshold floodwater utilisation volumes in wetlands are discussed. Floodwater utilisation can alleviate water shortages in wetlands, and the evaluation of floodwater utilisation in wetland services in monetary terms is a guide for the effective use of the floodwater resources and for the conservation of wetlands.

  16. Utilisation of aromatic organosulfur compounds as sulfur sources by Lipomyces starkeyi CBS 1807.

    PubMed

    Linder, Tomas

    2016-10-01

    Aromatic organosulfur compounds that contain aryl carbon-sulfur bonds are rare in nature but occur frequently in industrial processes and products. The utilisation of aryl sulfur compounds as a sulfur source has not been described previously among the budding yeasts (phylum Ascomycota, sub-phylum Saccharomycotina). A total of 31 strains representing 30 species and 28 genera of the budding yeasts were assayed for utilisation of benzene sulfonate as source of sulfur. Lipomyces starkeyi CBS 1807 was the only strain in this screen that was able to utilise benzene sulfonate as a sulfur source. Further study of L. starkeyi demonstrated that it could also utilise methyl phenyl sulfoxide, 1-naphthalene sulfonate, 2-naphthalene sulfonate, 1-anthraquinone sulfonate and 2-anthraquinone sulfonate as sulfur sources but not diphenylsulfone. This study represents the first reported case of the utilisation of sulfonated naphthalenes and anthraquinones as sulfur sources by a fungus. However, it should be stressed that the remaining 30 strains in this study were not assayed for the utilisation of these additional aryl sulfur compounds as sulfur sources. The present study highlights the potential of L. starkeyi and related species as a source of novel enzyme activities with possible applications in chemical manufacturing, disposal of xenobiotics and bioremediation.

  17. Evaluation and development of an ED management model: an effort to optimize patient-centered care.

    PubMed

    McDonough, Kelly S; Pemberton, Meg

    2013-09-01

    In 2008, the emergency department at Mary Washington Hospital was in the midst of a crisis marked by increasing volumes, increasing numbers of left without being seen (LWBS) patients, falling patient satisfaction numbers and a staff dissatisfied with ED leadership. The existing ED model of charge nurses, a nurse manager, and an administrative director was not working. The single nurse manager could not effectively manage the over 200 staff members he/she was assigned. Based upon the findings from the employee satisfaction survey the inability of the nurse managers to properly manage such large numbers of employees was at the core of the issue. Through benchmarking with a similar healthcare system, an evidence based leadership model was identified, developed, and implemented. The model included the addition of six patient care managers with 24-hour coverage in the department, led to a reduced number of direct reports per manager, and an increased connection with employees. The goal was to engage employees in the effort to provide patient centered, quality care. Residual benefits of our change effort improved the patient satisfaction scores as evidenced by meeting organizational goals within 12 months; goal was exceeded in the following year. Additionally, the walk out rate was reduced 75% over 18 months. The correlation between satisfied employees, patient satisfaction, and reduced walk-outs cannot be ignored. Engaged employees positively impact service and quality.

  18. Ethynyldeoxyuridine (EdU) suppresses in vitro population expansion and in vivo tumor progression of human glioblastoma cells.

    PubMed

    Ross, Heather H; Rahman, Maryam; Levkoff, Lindsay H; Millette, Sebastien; Martin-Carreras, Teresa; Dunbar, Erin M; Reynolds, Brent A; Laywell, Eric D

    2011-12-01

    Thymidine analogs (TAs) are synthetic nucleosides that incorporate into newly synthesized DNA. Halogenated pyrimidines (HPs), such as bromodeoxyuridine (BrdU), are a class of TAs that can be detected with antibodies and are commonly used for birthdating individual cells and for assessing the proliferative index of cell populations. It is well established that HPs can act as radiosensitizers when incorporated into DNA chains, but they are generally believed not to impair normal cell function in the absence of secondary stressors. However, we and others have shown that HP incorporation leads to a sustained suppression of cell cycle progression in mammalian cells, resulting in cellular senescence in somatic cells. In addition, we have shown that HP incorporation results in delayed tumor progression in a syngeneic rat model of glioma. Here we examine ethynyldeoxyuridine (EdU), a newly developed and alkylated TA, for its anti-cancer activity, both in vitro and in vivo. We show that EdU, like HPs, leads to a severe reduction in the proliferation rate of normal and transformed cells in vitro. Unlike HPs, however, EdU incorporation also causes DNA damage resulting in the death of a substantial subset of treated cells. When administered over an extended time as a monotherapy to mice bearing subcutaneous xenografts of human glioblastoma multiforme tumors, EdU significantly reduces tumor volume and increases survival without apparent significant toxicity. These results, combined with the fact that EdU readily crosses the blood-brain barrier, support the continued investigation of EdU as a potential therapy for malignant brain tumors.

  19. Physical activity and other health-related factors predict health care utilisation in older adults: the ActiFE Ulm study.

    PubMed

    Denkinger, M D; Lukas, A; Herbolsheimer, F; Peter, R; Nikolaus, T

    2012-06-01

    Health care utilisation (HCU) can be a useful outcome for estimating costs and patient needs. It can also be used as a surrogate parameter for healthy ageing. The aim of this study was to analyse the associations of formerly described and potentially new parameters influencing health care utilisation in older adults in Germany. The ActiFE Ulm (Activity and Function in the Elderly in Ulm) study is a population-based study in 1,506 community dwelling older adults aged 65-90 years in Ulm and surrounding areas in southwestern Germany. Between March 2009 and April 2010 a full geriatric assessment was performed including accelerometer-based average daily walking duration, comorbidity, medication, physical and psychological functioning, health care utilisation, sociodemographic factors etc. The association between above named measures and health care utilisation, represented by the number of drugs, the days in hospital and the number of physician contacts over one year was calculated in multiple regression models. Analysis was conducted among subjects with complete information (n = 1,059, mean age 76 years, 55% male). The average number of drugs was 4.5 and over 95% of participants visited a physician at least once a year while still more than 65% contacted their physician more than twice a year. Reduced physical activity, BMI, self-rated health and/or comorbidity and male sex were the best predictors of health care utilisation in community dwelling older adults when looking at both the number of drugs and the number of physician contacts over 12 months together. With regard to single diseases entities the best predictors of both the number of drugs and the number of physician contacts were asthma, chronic obstructive pulmonary disease (COPD)/chronic bronchitis and chronic neurological diseases (mostly Parkinson's disease). The number of drugs was most strongly associated with coronary heart disease, diabetes, and high blood pressure. Reduced walking activity, self

  20. The arrival of the ED-based POISINDEX: perceived impact on poison control center use.

    PubMed

    Wax, P M; Rodewald, L; Lawrence, R

    1994-09-01

    The purpose of this study was to determine the prevalence of emergency department-based POISINDEX (Micromedex Inc, Denver, CO) and assess its perceived impact on use of poison control centers. Survey methodology was used. A written questionnaire was distributed to all emergency departments (EDs) in the state of New York. ED directors or their designee (n = 239) were surveyed regarding the presence of POISINDEX in their ED and their perceptions of its impact on ED use of poison control centers. Completed questionnaires were returned from 180 of 239 (75%) EDs. Of the returned questionnaires, 42 of 180 (23%) have their own POISINDEX. In 32 of 42 (76%) of these EDs that have their own POISINDEX, it was perceived that ED-based POISINDEX decreased poison control center use. Use of ED-based POISINDEX may decrease ED use of poison control centers.

  1. Patient's jewelry stolen as she rests in the ED.

    PubMed

    2007-12-01

    In a hospital ED in Rhode Island, a 96-year-old patient was robbed of her jewelry while she rested in her room. The thief was dressed in scrubs. Identification badges are only one way of keeping unwanted intruders out and your patients' belongings safe. Other suggestions: Have different groups of staff members, i.e., ED doctors and nurses, wear color-coded scrubs that distinguish them from other hospital personnel. If your staff see a strangely dressed person or someone who looks lost or like they don't fit in, they should question them about their identity. Create protocols for the removal and safekeeping of patients' jewelry that cover several different scenarios.

  2. Fuel management and reloading optimization at EdF

    SciTech Connect

    Rosset, F.D.; Barral, J.C. )

    1993-01-01

    Technical and economical pressurized water reactor (PWR) performances are strongly influenced by fuel management, e.g., fuel utilization and core design. Because of the large number of standardized French PWR units, this question is of considerable importance for Electricite de France (EdF). At present, EdF operates two standardized types of PWR: thirty-four 900-MW and twenty 1300-MW PWRS. Economic optimization will lead to global management of the nuclear power plants in the coming years through three main types of fuel management: four-batch 3.7% UO[sub 2] management and plutonium recycling management for the 900-MW PWRs and extended cycle management for the 1300-MW PWRS. The best optimization is made on each reactor by computing a loading pattern that flattens the power map to ensure a certain flexibility of operation (early shutdown, stretch-out).

  3. Microbiologic methods utilized in the MAL-ED cohort study.

    PubMed

    Houpt, Eric; Gratz, Jean; Kosek, Margaret; Zaidi, Anita K M; Qureshi, Shahida; Kang, Gagandeep; Babji, Sudhir; Mason, Carl; Bodhidatta, Ladaporn; Samie, Amidou; Bessong, Pascal; Barrett, Leah; Lima, Aldo; Havt, Alexandre; Haque, Rashidul; Mondal, Dinesh; Taniuchi, Mami; Stroup, Suzanne; McGrath, Monica; Lang, Dennis

    2014-11-01

    A central hypothesis of The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study is that enteropathogens contribute to growth faltering. To examine this question, the MAL-ED network of investigators set out to achieve 3 goals: (1) develop harmonized protocols to test for a diverse range of enteropathogens, (2) provide quality-assured and comparable results from 8 global sites, and (3) achieve maximum laboratory throughput and minimum cost. This paper describes the rationale for the microbiologic assays chosen and methodologies used to accomplish the 3 goals. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  4. ED Utilization Trends in Sports-Related Traumatic Brain Injury

    PubMed Central

    Pomerantz, Wendy J.; Gittelman, Mike

    2013-01-01

    BACKGROUND: Emergency department (ED) visits for sports-related traumatic brain injuries (TBIs) have risen. This study evaluated how the number and severity of admissions have changed as ED visits for sports-related TBIs have increased. METHODS: A retrospective study of children aged 0 to 19 years at a level 1 trauma center was performed. Patients from 2002 to 2011 with a primary or secondary diagnosis of TBI were identified from the hospital’s inpatient and outpatient trauma registries. Frequencies were used to characterize the population, χ2 analysis was performed to determine differences between groups, and regression analysis looked at relationship between year and injury severity score or length of stay. RESULTS: Sport was responsible for injury in 3878 (15.4%) cases during the study period; 3506 (90.4%) were discharged from the hospital, and 372 (9.6%) were admitted. Seventy-three percent were male patients and 78% Caucasian; mean age was 13 ± 3.5 years. ED visits for sports-related TBIs increased 92% over the study period, yet there was no significant change (χ2 = 9.8, df = 9, P = .37) in the percentage of children admitted. Mean injury severity score for those admitted decreased from 7.8 to 4.8 (β = –0.46; P = .006); length of stay trended downward (β = –0.05; P = .05). CONCLUSIONS: The percentage of children being admitted from the ED with sports-related TBI has not changed over the past 10 years. The severity of admitted sports-related TBI is decreasing. Additional research is needed to correlate these trends with other TBI mechanisms. PMID:24081999

  5. Evaluation de l'intergiciel de communication DDS pour son utilisation dans le domaine avionique

    NASA Astrophysics Data System (ADS)

    Levesque-Landry, Kevin

    Les aeronefs modernes doivent combler de plus en plus de fonctionnalites afin de satisfaire les besoins de la clientele. De ce fait, les besoins en communications des systemes avioniques sont grandissants. De plus, la portabilite et la reutilisabilite des applications sont des defis d'actualite dans le domaine avionique. De ce fait, ce projet de recherche vise a faire une evaluation de la technologie d'intergiciel de service de distribution de donnees (DDS) pour son utilisation dans le domaine avionique. Cette technologie permettrait de reduire la complexite des communications et faciliter la portabilite et reutilisabilite des applications grâce a son interface standardisee. Dans ce projet de recherche, la norme DDS est tout d'abord etudiee pour cibler les fonctionnalites qui sont utiles au domaine avionique. Les differentes polices de qualite de services sont ainsi etudiees et denotent la flexibilite de la technologie DDS. Un intergiciel DDS est egalement evalue dans un environnement de laboratoire afin de mesurer l'impact de l'utilisation de cette technologie sur les performances de latence ainsi que sur l'utilisation de la bande passante. Les resultats montrent une faible augmentation de la latence moyenne lorsque l'intergiciel DDS est utilise. L'intergiciel DDS est egalement utilise dans une etude de cas avec un AFCS (automatic flight control system) afin de quantifier les effets de son utilisation sur une application avionique. Les resultats montrent que l'utilisation de l'intergiciel DDS n'empeche pas l'AFCS d'atteindre la stabilite, mais qu'elle ralentit l'atteinte de cette derniere. Finalement, une etude de cas est effectuee afin de valider que la technologie DDS peut etre utilisee pour construire des systemes redondants. Les resultats montrent que l'intergiciel DDS permet de faire de la redondance de reserve sans avoir un impact visible sur les performances du systeme redondant.

  6. The experiences of culturally and linguistically diverse family caregivers in utilising dementia services in Australia

    PubMed Central

    2013-01-01

    Background Older people from culturally and linguistically diverse groups are underrepresented in residential aged care but overrepresented in community aged care in Australia. However, little is known about culturally and linguistically diverse family caregivers in utilising dementia services in Australia because previous studies mainly focused on the majority cultural group. Experiences of caregivers from culturally and linguistically diverse groups who are eligible to utilise dementia services in Australia are needed in order to optimize the utilisation of dementia services for these caregivers. Methods The aim of the study was to explore the experiences of family caregivers from Chinese, Greek, Italian and Vietnamese groups in utilising dementia services. Gadamer's philosophical hermeneutics was used to interpret the experiences of the participants. Focus group discussions and in-depth individual interviews were used to collect data. Data collection was conducted over a six month period in 2011. In total, 46 family caregivers who were caring for 39 persons with dementia participated. Results Four themes were revealed: (1) negotiating services for the person with dementia; (2) the impact of acculturation on service utilisation; (3) the characteristics of satisfactory services; and (4) negative experiences in utilising services. The present study revealed that the participation of caregivers from culturally and linguistically diverse groups in planning and managing dementia services ranged markedly from limited participation to full participation. Conclusions The findings of this study suggest that caregivers from culturally and linguistically diverse groups need to be fully prepared so they can participate in the utilisation of dementia services available to them in Australia. PMID:24148155

  7. Nutrient utilisation and intestinal fermentation are differentially affected by the consumption of resistant starch varieties and conventional fibres in pigs.

    PubMed

    Rideout, Todd C; Liu, Qiang; Wood, Peter; Fan, Ming Z

    2008-05-01

    This study examined the influence of different resistant starch (RS) varieties and conventional fibres on the efficiency of nutrient utilisation and intestinal fermentation in pigs. Thirty-six pigs (30 kg) were fed poultry meal-based diets supplemented with 10 % granular resistant corn starch (GCS), granular resistant potato starch (GPS), retrograded resistant corn starch (RCS), guar gum (GG) or cellulose for 36 d according to a completely randomised block design. Distal ileal and total tract recoveries were similar (P>0.05) among the RS varieties. Distal ileal starch recovery was higher (P < 0.05) in pigs consuming the RS diets (27-42 %) as compared with the control group (0.64 %). Consumption of GCS reduced (P < 0.05) apparent total tract digestibility and whole-body retention of crude protein in comparison with the control group. Consumption of GPS reduced (P < 0.05) total tract Ca digestibility and whole-body retention of Ca and P compared with the control group. However, consumption of RCS increased (P < 0.05) total tract Ca digestibility compared with the control group. Caecal butyrate concentration was increased (P < 0.05) following consumption of RCS and GG in comparison with the control group. Consumption of all the RS varieties reduced (P < 0.05) caecal indole concentrations compared with the control. Caecal butyrate concentrations were positively correlated (P < 0.05; r 0.63-0.83) with thermal properties among the RS varieties. We conclude that nutrient utilisation and intestinal fermentation are differentially affected by the consumption of different RS varieties and types of fibres. Thermal properties associated with different RS varieties may be useful markers for developing RS varieties with specific functionality.

  8. Lean-driven solutions slash ED wait times, LOS.

    PubMed

    2012-12-01

    The ED at The Aroostook Medical Center (TAMC) in Presque Isle, ME, is a level II trauma center. It is the largest in the region, with only 89 beds. It has undergone a transformation in recent months, with average wait times to see a provider going from four to five hours down to less than five minutes, and the left-without-being-seen (LWBS) rate has been slashed from a high of 7% down to less than 1%. The hospital says the improvements are the result of lean-driven, staff-designed solutions, coupled with administrative engagement and oversight. And administrators say more improvements are on the way in 2013 when a hospital-wide workgroup will try to clear away obstacles and inefficiencies from the hospital admissions process. To tackle long wait times among patients with lower triage levels, the ED instituted a fast-track system, manned by mid-level providers and a tech or LPN. Responsibilities for charge nurses have been redesigned so that they have the power to monitor and facilitate patient flow. The ED has initiated more point-of-care testing so that nurses and techs can conduct many routine tests on their own. While the lean model relies on staff-driven solutions, administrators make the difference when it comes to sustaining changes and minimizing employee resistance.

  9. Edward (Ed) T. Schneider preparing for an F-104 flight

    NASA Technical Reports Server (NTRS)

    1989-01-01

    NASA research pilot Edward T. Scheider is shown standing in the cockpit of a two-seat F-104. He is wearing a full pressure suit, which is required on all flights above 50,000 feet. Ed served in the U.S. Navy from 1968 to 1983. He attended the U.S. Naval Test Pilot School and graduated in 1973. He was then assigned as an engineering test pilot, and as an instructor at the Naval Test Pilot School. He first arrived at what was then called the Ames-Dryden Flight Research Facility (now the Dryden Flight Research Center) as a Navy Liaison Officer on July 5, 1982. He joined NASA as a research pilot a year later. Ed was a project pilot on the F-18 High Angle-of-Attack program, the F-15 aeronautical research aircraft, the B-52 launch aircraft, and the NASA-operated SR-71 Blackbirds. Ed retired as a NASA research pilot in September 2000.

  10. Health care utilization before and after an outpatient ED visit in older people.

    PubMed

    Horney, Carolyn; Schmader, Kenneth; Sanders, Linda L; Heflin, Mitchell; Ragsdale, Luna; McConnell, Eleanor; Hocker, Michael; Hastings, S Nicole

    2012-01-01

    Older adults in the United States receive a significant amount of care in the emergency department (ED), yet the associations between ED and other types of health care utilization have not been adequately studied in this population. The goals of this study were to examine the relationships between health care use before and after an ED visit among older adults. This retrospective cohort study examined health care use among 308 patients 65 years or older discharged from a university-affiliated ED. Proportional-hazards models were used to assess the relationship between pre-ED health care use (primary care physician [PCP], specialist, ED, and hospital) and risk of return ED visits. Older ED patients in this study had visited other types of providers frequently in the previous year (median number of PCP and specialist visits, 4). Patients who used the ED on 2 or more occasions in the previous year were found to have visited their PCP more often than those without frequent ED use (median number of visits, 7.0 vs 4.0; P < .001). Despite more PCP use in this population, frequent ED use was associated with increased risk of a repeat ED visit (hazard ratio, 2.20; 95% confidence interval, 1.15-4.21), in models adjusted for demographics and health status. Older adults who use the ED are also receiving significant amounts of care from other sources; simply providing additional access to care may not improve outcomes for these vulnerable individuals. Published by Elsevier Inc.

  11. Imaging utilization from the ED: no difference between observation and admitted patients.

    PubMed

    Prabhakar, Anand M; Misono, Alexander S; Harvey, H Benjamin; Yun, Brian J; Saini, Sanjay; Oklu, Rahmi

    2015-08-01

    This study aims to determine the use of diagnostic imaging in emergency department (ED) observation units, particularly relative to inpatients admitted from the ED. Retrospective, descriptive analysis. Our database of ED patients was retrospectively reviewed to identify patients managed in the observation unit or admitted to inpatient services. In February 2014, we randomly selected 105 ED observation patients and 108 patients admitted to inpatient services from the ED. Electronic medical records were reviewed to assess diagnosis as well as type and quantity of imaging tests obtained. Eighty (76%) ED observation patients underwent imaging tests (radiographs, 39%; computed tomography, 25%; magnetic resonance imaging (MRI), 24%; ultrasound, 8%; other, 4%); 85 inpatients (79%) underwent imaging tests while in the ED (radiographs, 52%; computed tomography, 30%; MRI, 8%; ultrasound, 9%; other, 1%). There was no significant difference in overall imaging use between ED observation patients and inpatients, but ED observation patients were more likely to undergo MRI (P=.0243). The most common presenting diagnoses to the ED observation unit were neurologic complaints (25%), abdominal pain (17%), and cardiac symptoms (16%). There is no difference in the overall use of imaging in patients transferred to the ED observation unit vs those directly admitted from the ED. However, because ED observation unit patients tend to be accountable for a higher proportion of their health care bill, the impact of imaging in these patients is likely substantive. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. EDS coal liquefaction process development. Phase V. EDS commercial plant study design update. Illinois coal. Volume 1. Main report

    SciTech Connect

    Epperly, W. R.

    1981-03-01

    The objectives of the Study Design Update (SDU) were to identify the technical issues facing a potential commercial-size EDS plant design; to provide a reliable basis for estimating the cost of EDS products; and to furnish research guidance to the EDS Project. The SDU consists of two distinct studies in which different processing schemes are used to produce the hydrogen and fuel gas required by the plant. These studies are referred to as the Base Case and the Market Flexibility Sensitivity Case. In the Base Case, hydrogen is generated by steam reforming of the light hydrocarbon gases produced in the plant. Fuel gas is generated by feeding the bottoms stream from the liquefaction section vacuum pipestill to a FLEXICOKING unit. In the FLEXICOKING unit reactor, the bottoms stream is converted to coke; additional liquid product is also recovered. The coke is converted to low-Btu fuel gas in the FLEXICOKING unit gasifier. In the Market Flexibility Sensitivity (MFS) Case, the bottoms stream from the vacuum pipestill is split, and about half is sent to the FLEXICOKING unit for recovery of additional liquid product and production of fuel gas. The remainder of the bottoms stream is converted to hydrogen in a Partial Oxidation Unit. Hence the MFS Case does not consume light hydrocarbon gases produced and they are available for sale. The study of these two cases has demonstrated the importance of bottoms process selection to the economics and thermal efficiency of an EDS plant. Volume 1 - Main Report has been developed to be a stand-alone document. Both the Base Case and Market Flexibility Sensitivity (MFS) Case are covered. This volume includes an overview and detailed case summaries. It also covers economics, product recovery factors, material and energy balances, cost estimates and enviromental considerations.

  13. Time utilisation trends of supported employment services by persons with mental disability in South Africa.

    PubMed

    Van Niekerk, Lana; Coetzee, Zelda; Engelbrecht, Madri; Hajwani, Zerina; Terreblanche, Santie

    2015-01-01

    This paper reports on the second phase of a two-phased study that was undertaken to determine the feasibility of supported employment (SE) as a strategy with which to facilitate the employment of persons with disability in competitive work contexts. The study population comprised people with mental disabilities receiving SE in the Western Cape Province, South Africa. To describe the components of SE utilised by persons with mental disability (i.e. psychiatric or intellectual disability) in terms of type and time utilisation patterns over 12 months. Criterion sampling, a form of purposive sampling, was used to identify 29 study participants - 19 with intellectual disability and 10 with psychiatric disability. Data collection commenced for each participant when a work placement had been identified and preparation for such ensued. Data was collected prospectively for a period of 12 months. SE service components utilised by participants were captured using a data capture sheet that was developed for this purpose. Time utilisation indicated a steep downwards trend for both cohorts. The decrease in utilisation of SE service components over a period of one year was more pronounced in the psychiatric disability (PD) cohort, who utilized almost half the total SE services in the first month. SE services can be considered as a viable option for return to work in resource-constrained environments. Providers of SE services will need to modify approaches in order to meet contextual realities.

  14. EDS coal liquefaction process development, Phase V. Engineering design study of an EDS Illinois bottoms fired hybrid boiler

    SciTech Connect

    1984-04-01

    This interim report documents work carried out by Combustion Engineering, Inc. under a contract to Exxon Research and Engineering Company and was prepared by Combustion Engineering, Inc. This report is the second of two reports by Combustion Engineering, Inc. on the predevelopment phase of the Hybrid Boiler program and covers the results of an engineering design study of a Hybrid Boiler firing the vacuum distillation residue (vacuum bottoms) derived from processing Illinois No. 6 coal in the EDS Coal Liquefaction Process. The function of the Hybrid Boiler is to heat the coal slurry feed for an EDS coal liquefaction plant by a process coil in the convection section and to generate high pressure steam in the radiant section. The Hybrid Boiler design developed in this phase of the program is based on the results of a laboratory characterization program (reported in EDS Interim Report FE-2893-112), on Combustion Engineering, Inc.'s extensive experience as a designer and supplier of steam generating equipment, and on Exxon Research and Engineering Co.'s experience with the design and operation of process heaters.

  15. Utilisation of biochar and superabsorbent polymers for soil amendment.

    PubMed

    Ekebafe, M O; Ekebafe, L O; Maliki, M

    2013-01-01

    The application of superabsorbent polymers (SAPs) and/or biochars to stressed lands offer solutions to several critical ecological, energy and economic challenges posed by degraded lands due to human activities. These substances are like, 'artificial humus' as they are hydrophilic and contain carboxylic groups (SAPs) which enable them to bind cations and water and sequester carbon from air to reverse global warming (biochars). Several research studies using these substances point to their ability to increase the plant-available water in the soil which enables the plants to survive longer with water shortage, increase soil fertility and agricultural yields, improve soil structure, aeration and water penetration, reduce use of synthetic fertilisers and pesticides, reduce nitrous oxide and methane emission from soil, reduce nitrate and farm chemicals leaching into watersheds, convert green and brown wastes into valuable resources, and reduce the evapotranspiration rate of the plants. SAPs and biochars induce a significantly higher growth rate in plants; they bind heavy metals and mitigate their action on plants as well as mitigate the effects of salinity. This paper reviews what is known about these claims and considers the wider environmental implications of the adoption of these processess. The intention is not just to summarise the current knowledge but also to identify gaps that require further research.

  16. Replica exchange enveloping distribution sampling (RE-EDS): A robust method to estimate multiple free-energy differences from a single simulation.

    PubMed

    Sidler, Dominik; Schwaninger, Arthur; Riniker, Sereina

    2016-10-21

    In molecular dynamics (MD) simulations, free-energy differences are often calculated using free energy perturbation or thermodynamic integration (TI) methods. However, both techniques are only suited to calculate free-energy differences between two end states. Enveloping distribution sampling (EDS) presents an attractive alternative that allows to calculate multiple free-energy differences in a single simulation. In EDS, a reference state is simulated which "envelopes" the end states. The challenge of this methodology is the determination of optimal reference-state parameters to ensure equal sampling of all end states. Currently, the automatic determination of the reference-state parameters for multiple end states is an unsolved issue that limits the application of the methodology. To resolve this, we have generalised the replica-exchange EDS (RE-EDS) approach, introduced by Lee et al. [J. Chem. Theory Comput. 10, 2738 (2014)] for constant-pH MD simulations. By exchanging configurations between replicas with different reference-state parameters, the complexity of the parameter-choice problem can be substantially reduced. A new robust scheme to estimate the reference-state parameters from a short initial RE-EDS simulation with default parameters was developed, which allowed the calculation of 36 free-energy differences between nine small-molecule inhibitors of phenylethanolamine N-methyltransferase from a single simulation. The resulting free-energy differences were in excellent agreement with values obtained previously by TI and two-state EDS simulations.

  17. Eldecalcitol (ED-71), an analog of 1α,25-dihydroxyvitamin D3 as a potential anti-cancer agent for oral squamous cell carcinomas.

    PubMed

    Shintani, T; Rosli, S N Z; Takatsu, F; Choon, Y F; Hayashido, Y; Toratani, S; Usui, E; Okamoto, T

    2016-11-01

    We have previously reported that 1,25(OH)2D3 inhibits NF-κB activity and thus inhibits growth of OSCC cells in serum-free culture and down-regulates HBp17/FGFBP-1 expression, which is important for cancer cell growth and angiogenesis. Here, we have investigated the effects of ED-71, an analog of vitamin D3 (VD) on OSCC cell lines in serum-free culture. It is known that ED-71 has a stronger inhibitory effect on bone resorption compared to VD and other VD analogs. To the best of our knowledge, there was no report examining the potential of ED-71 as an anti-cancer agent for OSCC. We found that ED-71 is able to inhibit the growth of cancer cell lines at a concentration of hundred times lower than calcitriol. As Cyp24A1 was reportedly induced in cancer cells, we measured the expression of CYP24A1 in OSCC cell lines (NA and UE), A431 epidermoid carcinoma and normal fibroblast cell (gfi) in serum-free culture. As a result, CYP24A1 mRNA and the protein expression in the OSCC cells treated with ED-71 increased in a dose-dependent manner. However, in vivo experiment, in which the A431 cells were implanted in mice, tumor formation was reduced by the ED-71 treatment with no significant difference between Cyp24A1 expression in the tumors of ED-71-treated and control group, as analyzed by western blotting and immunohistochemistry. These results suggest that ED-71 is a potential anti-cancer agent for OSCC.

  18. Service utilisation by carers of people with dementia in rural Victoria.

    PubMed

    Ervin, Kaye; Reid, Carol

    2015-12-01

    To explore the use of community and dementia-specific services by informal carers caring for someone with dementia in a rural setting. Carers of people with dementia were recruited through a variety of rural community services and invited to complete a survey related to the utilisation of community services. A total of 39 carers completed surveys. Despite 84% reporting use of the Aged Care Assessment Service and 61% reporting provision of printed information on the services available, less than half of the carers utilised commonly available support services. Only 46% received financial compensation for their carer role. Rural carers of care recipients with behavioural and psychological symptoms of dementia underutilise community services. Services that may assist with carer stress and depression and services that provide advice on the management of distressing behavioural and psychological symptoms of dementia were utilised by less than half of the carers surveyed. © 2014 AJA Inc.

  19. Availability, utilisation and quality of basic and comprehensive emergency obstetric care services in Malawi.

    PubMed

    Kongnyuy, Eugene J; Hofman, Jan; Mlava, Grace; Mhango, Chisale; van den Broek, Nynke

    2009-09-01

    To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi. Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183). There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed. The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.

  20. Light Levels Affect Carbon Utilisation in Tropical Seagrass under Ocean Acidification

    PubMed Central

    2016-01-01

    Under future ocean acidification (OA), increased availability of dissolved inorganic carbon (DIC) in seawater may enhance seagrass productivity. However, the ability to utilise additional DIC could be regulated by light availability, often reduced through land runoff. To test this, two tropical seagrass species, Cymodocea serrulata and Halodule uninervis were exposed to two DIC concentrations (447 μatm and 1077 μatm pCO2), and three light treatments (35, 100, 380 μmol m-2 s-1) for two weeks. DIC uptake mechanisms were separately examined by measuring net photosynthetic rates while subjecting C. serrulata and H. uninervis to changes in light and addition of bicarbonate (HCO3-) use inhibitors (carbonic anhydrase inhibitor, acetazolamide) and TRIS buffer (pH 8.0). We observed a strong dependence on energy driven H+-HCO3- co-transport (TRIS, which disrupts H+ extrusion) in C. serrulata under all light levels, indicating greater CO2 dependence in low light. This was confirmed when, after two weeks exposure, DIC enrichment stimulated maximum photosynthetic rates (Pmax) and efficiency (α) more in C. serrulata grown under lower light levels (36–60% increase) than for those in high light (4% increase). However, C. serrulata growth increased with both DIC enrichment and light levels. Growth, NPP and photosynthetic responses in H. uninervis increased with higher light treatments and were independent of DIC availability. Furthermore, H. uninervis was found to be more flexible in HCO3- uptake pathways. Here, light availability influenced productivity responses to DIC enrichment, via both carbon fixation and acquisition processes, highlighting the role of water quality in future responses to OA. PMID:26938454

  1. Effects of glyceryl polyethylene glycol ricinoleate on nutrient utilisation and performance of broiler chickens.

    PubMed

    Kaczmarek, Sebastian Andrzej; Bochenek, Maciej; Samuelsson, Anne-Cathrine; Rutkowski, Andrzej

    2015-01-01

    A completely randomised design study with a 2 × 2 factorial arrangement was conducted to observe effects of an emulsifier (glyceryl polyethylene glycol ricinoleate (GPR)) on nutrient utilisation and performance of broiler chickens. A total of 384 male broiler chickens were used to determine the influence of GPR (without addition or added at 0.04% of diet) and two levels of apparent metabolisable energy (AMEN) (according to standard requirements (Diets SE) or energy reduced by 0.4 MJ/kg diet (Diets LE)) on birds' performance and apparent total tract digestibility (ATTD). ATTD of ether extract (EE) and AMEN were measured on d 14 and 35, and ATTD of neutral detergent fibre (NDF) was measured on d 35. All diets were based on wheat-maize-soybean meal with rapeseed oil and lard (blend of 50:50) as fat sources. During the grower period and the whole trial, birds fed Diets supplemented with GPR were characterised by higher body weight gain (BWG) and lower feed conversion ratio (FCR) compared to chicken receiving diets without GPR (p < 0.05). At the end of experiment, birds fed Diet LE without GPR were characterised by lower BWG and higher FCR (p < 0.05). Supplementation with GPR caused a higher ATTD of EE for diets SE and LE at d 14 and 35 (p < 0.05). Moreover, the GPR addition to Diet LE improved ATTD of NDF at d 35 (p < 0.05). In conclusion, the findings suggest that GPR effects the digestion of a blend of animal fat/rapeseed oil positively, even in a practical maize-wheat-based broiler diet with decreased AMEN level.

  2. Light Levels Affect Carbon Utilisation in Tropical Seagrass under Ocean Acidification.

    PubMed

    Ow, Yan X; Uthicke, Sven; Collier, Catherine J

    2016-01-01

    Under future ocean acidification (OA), increased availability of dissolved inorganic carbon (DIC) in seawater may enhance seagrass productivity. However, the ability to utilise additional DIC could be regulated by light availability, often reduced through land runoff. To test this, two tropical seagrass species, Cymodocea serrulata and Halodule uninervis were exposed to two DIC concentrations (447 μatm and 1077 μatm pCO2), and three light treatments (35, 100, 380 μmol m(-2) s(-1)) for two weeks. DIC uptake mechanisms were separately examined by measuring net photosynthetic rates while subjecting C. serrulata and H. uninervis to changes in light and addition of bicarbonate (HCO3-) use inhibitors (carbonic anhydrase inhibitor, acetazolamide) and TRIS buffer (pH 8.0). We observed a strong dependence on energy driven H+-HCO3- co-transport (TRIS, which disrupts H+ extrusion) in C. serrulata under all light levels, indicating greater CO2 dependence in low light. This was confirmed when, after two weeks exposure, DIC enrichment stimulated maximum photosynthetic rates (Pmax) and efficiency (α) more in C. serrulata grown under lower light levels (36-60% increase) than for those in high light (4% increase). However, C. serrulata growth increased with both DIC enrichment and light levels. Growth, NPP and photosynthetic responses in H. uninervis increased with higher light treatments and were independent of DIC availability. Furthermore, H. uninervis was found to be more flexible in HCO3- uptake pathways. Here, light availability influenced productivity responses to DIC enrichment, via both carbon fixation and acquisition processes, highlighting the role of water quality in future responses to OA.

  3. Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED. A prospective randomized controlled study.

    PubMed

    Gulacti, Umut; Lok, Ugur

    2017-07-19

    Consultation, the process of an Emergency Physician seeking an opinion from other specialties, occurs frequently in the Emergency Department (ED). The aim of this study was to determine the effect of secure messaging application (WhatsApp) usage for medical consultations on Emergency Department Length of Stay (ED LOS) and consult time. We conducted a prospective, randomized controlled trial in the ED using allocation concealment over three months. Consultations requested in the ED were allocated into two groups: consultations requested via the secure messaging application and consultations requested by telephone as verbal. A total of 439 consultations requested in the ED were assessed for eligibility and 345 were included in the final analysis: 173 consultations were conducted using secure messaging application and 172 consultations were conducted using standard telephone communications. The median ED LOS was 240 minutes (IQR:230-270, 95% CI:240 to 255.2) for patients in the secure messaging application group and 277 minutes (IQR:270-287.8, 95% CI:277 to 279) for patients in the telephone group. The median total ED LOS was significantly lower among consults conducted using Secure messaging application relative to consults conducted by telephone (median dif: -30, 95%CI:-37to-25, p<0.0001). The median consult time was 158 minutes (IQR:133 to 177.25, 95% CI:150 to 169) for patients in the Secure messaging application group and 170 minutes (IQR:165 to 188.5, 95% CI:170-171) for patients in the Telephone group (median dif: -12, 95%CI:-19 to-7,p<0.0001). Consultations completed without ED arrival was 61.8% in the secure messaging group and 33.1% in the Telephone group (dif: 28.7, 95% CI:48.3 to 66, p<0.001). Use of secure messaging application for consultations in the ED reduces the total ED LOS and consultation time. Consultation with secure messaging application eliminated more than half of in-person ED consultation visits.

  4. The Pediatric Asthma Control and Communication Instrument for the Emergency Department (PACCI-ED) improves physician assessment of asthma morbidity in pediatric emergency department patients.

    PubMed

    Goldberg, Elizabeth M; Laskowski-Kos, Ursula; Wu, Dominic; Gutierrez, Julia; Bilderback, Andrew; Okelo, Sande O; Garro, Aris

    2014-03-01

    PACCI-ED can be used to improve provider assessment of asthma morbidity during pediatric ED visits for asthma exacerbations, and to identify children who may benefit from interventions to reduce asthma morbidity.

  5. EDS1 mediates pathogen resistance and virulence function of a bacterial effector in soybean

    USDA-ARS?s Scientific Manuscript database

    Enhanced disease susceptibility 1 (EDS1) and phytoalexin deficient 4 (PAD4) are well known regulators of both basal and resistance (R) protein-mediated plant defense. We identified two EDS1- (GmEDS1a/b) and one PAD4-like (GmPAD4) protein that are required for resistance signaling in soybean. Consist...

  6. Self-Esteem and Emotional Intelligence among B.Ed Trainees of Tsunami Affected Coastal Belt

    ERIC Educational Resources Information Center

    Babu M, Sameer

    2008-01-01

    Through this study the author investigates the relationship between self-esteem and emotional intelligence among B.Ed trainees of Tsunami affected coastal belt of Alappey district of Kerala, India. Stream of study, marital status and age based comparisons were made among the B.Ed trainees. 92 B.Ed trainees were the participants in the study. It…

  7. 34 CFR 110.17 - Age distinctions contained in ED's regulations.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 1 2012-07-01 2012-07-01 false Age distinctions contained in ED's regulations. 110.17... FINANCIAL ASSISTANCE Standards for Determining Age Discrimination § 110.17 Age distinctions contained in ED's regulations. Any age distinction contained in regulations issued by ED is presumed to be...

  8. Uncovering the Identities of Students and Graduates in a CPED-Influenced EdD Program

    ERIC Educational Resources Information Center

    Zambo, Debby; Buss, Ray R.; Zambo, Ron

    2015-01-01

    The educational doctorate (EdD) is being re-envisioned as a distinct professional degree. Today's EdD graduates are envisioned as scholarly practitioners. Given this it may be reasoned these individuals have unique identities comprised of several layers. In this study, we examined how 18 entering students and 17 graduating students from an EdD…

  9. 34 CFR 110.1 - What is the purpose of ED's age discrimination regulations?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 1 2013-07-01 2013-07-01 false What is the purpose of ED's age discrimination... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General § 110.1 What is the purpose of ED's age discrimination regulations? The purpose of these regulations is to set out ED's rules for implementing the...

  10. 34 CFR 110.1 - What is the purpose of ED's age discrimination regulations?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 1 2014-07-01 2014-07-01 false What is the purpose of ED's age discrimination... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General § 110.1 What is the purpose of ED's age discrimination regulations? The purpose of these regulations is to set out ED's rules for implementing the...

  11. 34 CFR 110.1 - What is the purpose of ED's age discrimination regulations?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 1 2011-07-01 2011-07-01 false What is the purpose of ED's age discrimination... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General § 110.1 What is the purpose of ED's age discrimination regulations? The purpose of these regulations is to set out ED's rules for implementing the...

  12. 34 CFR 110.1 - What is the purpose of ED's age discrimination regulations?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 1 2012-07-01 2012-07-01 false What is the purpose of ED's age discrimination... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General § 110.1 What is the purpose of ED's age discrimination regulations? The purpose of these regulations is to set out ED's rules for implementing the...

  13. 34 CFR 110.1 - What is the purpose of ED's age discrimination regulations?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false What is the purpose of ED's age discrimination... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE General § 110.1 What is the purpose of ED's age discrimination regulations? The purpose of these regulations is to set out ED's rules for implementing the...

  14. Health services utilisation disparities between English speaking and non-English speaking background Australian infants

    PubMed Central

    2010-01-01

    Background To examine the differences in health services utilisation and the associated risk factors between infants from non-English speaking background (NESB) and English speaking background (ESB) within Australia. Methods We analysed data from a national representative longitudinal study, the Longitudinal Study of Australian Children (LSAC) which started in 2004. We used survey logistic regression coupled with survey multiple linear regression to examine the factors associated with health services utilisation. Results Similar health status was observed between the two groups. In comparison to ESB infants, NESB infants were significantly less likely to use the following health services: maternal and child health centres or help lines (odds ratio [OR] 0.56; 95% confidence intervals [CI], 0.40-0.79); maternal and child health nurse visits (OR 0.68; 95% CI, 0.49-0.95); general practitioners (GPs) (OR 0.58; 95% CI, 0.40-0.83); and hospital outpatient clinics (OR 0.54; 95% CI, 0.31-0.93). Multivariate analysis results showed that the disparities could not be fully explained by the socioeconomic status and language barriers. The association between English proficiency and the service utilised was absent once the NESB was taken into account. Maternal characteristics, family size and income, private health insurance and region of residence were the key factors associated with health services utilisation. Conclusions NESB infants accessed significantly less of the four most frequently used health services compared with ESB infants. Maternal characteristics and family socioeconomic status were linked to health services utilisation. The gaps in health services utilisation between NESB and ESB infants with regard to the use of maternal and child health centres or phone help, maternal and child health nurse visits, GPs and paediatricians require appropriate policy attentions and interventions. PMID:20374663

  15. Determinants of utilisation differences for cancer medicines in Belgium, Scotland and Sweden.

    PubMed

    Ferrario, Alessandra

    2016-12-09

    Little comparative evidence is available on utilisation of cancer medicines in different countries and its determinants. The aim of this study was to develop a statistical model to test the correlation between utilisation and possible determinants in selected European countries. A sample of 31 medicines for cancer treatment that obtained EU-wide marketing authorisation between 2000 and 2012 was selected. Annual data on medicines' utilisation covering the in- and out-patient public sectors were obtained from national authorities between 2008 and 2013. Possible determinants of utilisation were extracted from HTA reports and complemented by contacts with key informants. A longitudinal mixed effect model was fitted to test possible determinants of medicines utilisation in Belgium, Scotland and Sweden. In the all-country model, the number of indications reimbursed positively correlated with increased consumption of medicines [one indication 2.6, 95% CI (1.8-3.6); two indications 2.4, 95% CI (1.4-4.3); three indications 4.9, 95% CI (2.2-10.9); all P < 0.01], years since EU-wide marketing authorisation [1.2, 95% CI (1.02-1.4); p < 0.05], price per DDD [0.9, 95% CI (0.998-0.999), P < 0.01], and Prescrire rating [0.5, 95% CI (0.3-0.9), P < 0.05] after adjusting for time and other covariates. In this study, the most important correlates of increased utilisation in a sample of cancer medicines introduced in the past 15 years were: medicines coverage and time since marketing authorisation. Prices had a negative effect on consumption in Belgium and Sweden. The positive impact of financial MEAs in Scotland suggests that the latter may remove the regressive effect of list prices on consumption.

  16. EDS V26 Containment Vessel Explosive Qualification Test Report

    SciTech Connect

    Crocker, Robert W.; Haroldsen, Brent L.; Stofleth, Jerome H.

    2013-11-01

    The objective of the test was to qualify the vessel for its intended use by subjecting it to a 1.25 times overtest. The criteria for success are that the measured strains do not exceed the calculated strains from the vessel analysis, there is no significant additional plastic strain on subsequent tests at the rated design load (shakedown), and there is no significant damage to the vessel and attached hardware that affect form, fit, or function. Testing of the V25 Vessel in 2011 established a precedent for testing V26 [2]. As with V25, two tests were performed to satisfy this objective. The first test used 9 pounds of Composition C-4 (11.25 lbs. TNT-equivalent), which is 125 percent of the design basis load. The second test used 7.2 pounds of Composition C-4 (9 lbs. TNT-equivalent) which is 100 percent of the design basis load. The first test provided the required overtest while the second test served to demonstrate shakedown and the absence of additional plastic deformation. Unlike the V25 vessel, which was mounted in a shipping cradle during testing, the V26 vessel was mounted on the EDS P2U3 trailer prior to testing. Visual inspections of the EDS vessel, surroundings, and diagnostics were completed before and after each test event. This visual inspection included analyzing the seals, fittings, and interior surfaces of the EDS vessel and documenting any abnormalities or damages. Photographs were used to visually document vessel conditions and findings before and after each test event.

  17. Impact of point-of-care ultrasonography on ED time to disposition for patients with nontraumatic shock.

    PubMed

    Hall, M Kennedy; Taylor, R Andrew; Luty, Seth; Allen, I Elaine; Moore, Chris L

    2016-06-01

    Nontraumatic shock in the emergency department (ED) has multiple causes and carries in-hospital mortality approaching 20%, underscoring the need for prompt diagnosis and treatment. Diagnostic ultrasonography at the point of care is one method that may improve the ability of ED physicians to quickly diagnose and treat. This study assesses the effect of the use and timing of point-of-care (POC) ultrasonography on time to disposition request. This retrospective study across 4 Connecticut EDs compared propensity score matched shock patients who did and did not receive POC ultrasonography. Two propensity score matches were performed: the first using covariates of time to disposition from previous literature and the second using 25 novel covariates identified from electronic health records using machine learning to reduce variable selection biases. A total of 3834 unique patients presented with shock during an 18-month period, and 703 (18.3%) patients received POC ultrasonography. Mean time to disposition for all patients was 255.4minutes (interquartile range, 163.8). After propensity score matching, patients had a mean reduction of 26.7minutes (95% confidence interval [CI], 2.8-58.3) in time to disposition when POC ultrasonography was performed within 1hour of ED arrival and a lesser reduction of 16.7minutes (95% CI, -2.8 to 35.5) when POC ultrasonography was performed within 2hours. There was no evidence of reduction in time to disposition when ultrasonography was performed after 2hours (16.7minutes; 95% CI, -14.3 to 29.9). Propensity score models using machine learning-selected variables yielded similar results. Performance of POC ultrasonography likely improves time to disposition when performed early on ED patients with shock. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. ED case managers are crucial to help maximize reimbursement.

    PubMed

    2011-08-01

    As payers tighten their belts and recoup payments for inappropriate care and regulators increase penalties for fraud and abuse, hospitals need to ensure all admissions are appropriate and patient are placed in the right level of care. Hospitals are likely to have to return reimbursement for patients who don't meet inpatient criteria. Improper admissions can exacerbate capacity problems and result in hospital-acquired conditions. Correcting inappropriate admissions retrospectively can be a red flag to auditors. ED case managers can impact length of stay by ensuring that care starts in the emergency department.

  19. Pilot Ed Lewis with T-34C aircraft on ramp

    NASA Image and Video Library

    1998-03-04

    NASA pilot Ed Lewis with the T-34C aircraft on the Dryden Flight Research Center Ramp. The aircraft was previously used at the Lewis Research Center in propulsion experiments involving turboprop engines, and was used as a chase aircraft at Dryden for smaller and slower research projects. Chase aircraft accompany research flights for photography and video purposes, and also as support for safety and research. At Dryden, the T-34 is used mainly for smaller remotely piloted vehicles which fly slower than NASA's F-18's, used for larger scale projects. This aircraft was returned to the U.S. Navy in May of 2002.

  20. SEM/EDS Characterization of Ambient PM during Agricultural Burns

    NASA Astrophysics Data System (ADS)

    Wagner, J.; Wall, S.

    2010-12-01

    Ambient particulate matter (PM) samples were collected with UNC passive samplers during agricultural burns in Imperial Valley, California. Four Bermuda grass field burn events were sampled at 3-8 locations surrounding each burn. Sampling began at the start of each burn (30-60 min) and continued for 24-120 hours. During 3 of the 4 burn events, winds were calm and plumes were observed to travel straight up to the inversion layer. In one event, winds created a ground-level plume that enveloped two UNC samplers mounted on telephone poles very close to the field (0.2-0.3 miles away). Computer-controlled scanning electron microscopy / energy-dispersive x-ray spectroscopy (CCSEM/EDS) was used to measure particle sizes and elemental composition, from which mass concentrations and size distributions were calculated. The median PM2.5 and PM10 levels measured in this study were 3.4 and 20 ug/m3, respectively. To determine quantitative accuracy, UNC sampler PM2.5 results (PM< 2.5 um) were compared to PM2.5 results from four co-located, continuous-reading beta-attenuation monitors (EBAMs). The median agreement (EBAM - UNC) was 3.8 ug/m3. Manual SEM/EDS detected various distinctive species in these samples, including sea salt, spores, plant fragments, and large soot agglomerates. During the ‘plume event’, 24-hour PM2.5 exposures downwind were up to 17 times higher than that measured upwind. Numerous submicron combustion particles with carbon and oxygen only were directly observed by manual SEM/EDS in the two plume-impacted samples, along with larger ash particles enriched in potassium, sulfur, chlorine, calcium, sodium, and phosphorus. CCSEM/EDS data from this event was grouped into 5 particle classes to generate size-fraction-specific pie charts. Burn-related particle types contributed 95% of the PM2.5 in the location directly impacted by the ground-level plume, compared to only 12% in the upwind location. A sample of Imperial County Bermuda grass analyzed in bulk and

  1. Pilot explores organ donation in the ED--challenges raised.

    PubMed

    2010-06-01

    A pilot program for ED organ donation at University of Pittsburgh Medical Center (UPMC)--Presbyterian Hospital is seeking much-needed organs, while maintaining optimal medical care for the living and avoiding potential conflicts of interest. Separate teams are involved with organ donation and with patient care, creating a "firewall" to prevent conflicts of interest. After failed CPR, a minimum of two minutes of no-CPR time is allowed to pass after death is pronounced to be certain there is no occult cardiac activity. Infusions of cold fluids are used to give enough time for the transplant surgeon to arrive and determine if any organs can be procured.

  2. Utilisation trends of rosiglitazone and pioglitazone in Australia before and after safety warnings

    PubMed Central

    2014-01-01

    Background A see on cardiovascular diseases and bladder cancer. The changes to the patterns of rosiglitazone and pioglitazone utilisation in Australia following the timing of these various health authority warnings such as the Australian Therapeutic Good Administration (TGA), European Medicines Agency (EMA) press releases or U.S. Food and Drug Administration (FDA) is unknown. This study investigated the utilisation patterns of rosiglitazone and pioglitazone in Australia before and after warnings of major drug authorities. Methods We evaluated rosiglitazone and pioglitazone dispensing using the Pharmaceutical Benefit Scheme (PBS) subsidised drug dispensing data for the Australian population from February 2004 to July 2012. The World Health Organisation Anatomic Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) system was used to compare the drug utilisation patterns following the announcements of EMA, FDA, and TGA safety warnings, which first occurred in May 2007. The DDD/1000population/day were examined in a series of time-series regression analysis with the drug safety warnings specified as interventions. Results Rosiglitazone utilisation increased steadily from 2004 until reaching a peak at 1.96/1000population/day in January 2007. Then rosiglitazone use decreased significantly after the initial EMA press release and FDA warning on cardiovascular risk in May 2007 (with a 15.04% average monthly decline, p-value <0.001), however use did not significantly decrease after the TGA warning or subsequent EMA and FDA warnings. Pioglitazone utilisation proceeded rosiglitazone in September 2008 and remained above 1.5/1000/day during 2009–2010. However, pioglitazone utilisation has slightly declined after the FDA, EMA, and TGA warnings related to bladder cancer. Conclusions Drug safety warnings were associated with a decrease in rosiglitazone and pioglitazone utilisation in Australia. Rosiglitazone began to decline prior to TGA warnings in December 2007, which suggests

  3. Variation in nitrogen source utilisation by nine Amanita muscaria genotypes from Australian Pinus radiata plantations.

    PubMed

    Sawyer, Nicole A; Chambers, Susan M; Cairney, John W G

    2003-08-01

    The abilities of nine genotypes of Amanita muscaria (L.:Fr) Pers. to utilise a range of inorganic and organic nitrogen sources for growth was examined in axenic liquid cultures. Considerable intraspecific variation was observed in biomass yields on all substrates; however biomass yield was highest on glutamine and/or NH4+ for all genotypes. Yields on aspartic acid, glutamic acid and histidine were generally low relative to NH4+, while utilisation of arginine and glycine showed marked variation between genotypes. Eight genotypes produced significantly less biomass on bovine serum albumin than on NH4+, raising questions regarding classification of A. muscaria as a 'protein fungus'.

  4. An early deployment strategy for carbon capture, utilisation, and storage

    SciTech Connect

    Carter, L.D.

    2012-11-01

    This report describes the current use of CO2 for EOR, and discusses potential expansion of EOR using CO2 from power plants. Analysis of potential EOR development in the USA, where most current CO2-based EOR production takes place, indicates that relatively low cost, traditional sources of CO2 for EOR (CO2 domes and CO2 from natural gas processing plants) are insufficient to exploit the full potential of EOR. To achieve that full potential will require use of CO2 from combustion and gasification systems, such as fossil fuel power plants, where capture of CO2 is more costly. The cost of current CCUS systems, even with the revenue stream for sale of the CO2 for EOR, is too high to result in broad deployment of the technology in the near term. In the longer term, research and development may be sufficient to reduce CO2 capture costs to a point where CCUS would be broadly deployed. This report describes a case study of conditions in the USA to explore a financial incentive to promote early deployment of CCUS, providing a range of immediate benefits to society, greater likelihood of reducing the long-term cost of CCUS, and greater likelihood of broad deployment of CCUS and CCS in the long term. Additionally, it may be possible to craft such an incentive in a manner that its cost is more than offset by taxes flowing from increased domestic oil production. An example of such an incentive is included in this report.

  5. Reducing Frequent Visits to the Emergency Department: A Systematic Review of Interventions

    PubMed Central

    Soril, Lesley J. J.; Leggett, Laura E.; Lorenzetti, Diane L.; Noseworthy, Tom W.; Clement, Fiona M.

    2015-01-01

    Objective The objective of this study was to establish the effectiveness of interventions to reduce frequent emergency department (ED) use among a general adult high ED-use population. Methods Systematic review of the literature from 1950-January 2015. Studies were included if they: had a control group (controlled trials or comparative cohort studies), were set in an ED or acute care facility, and examined the impact of an intervention to reduce frequent ED use in a general adult population. Studies reporting non-original data or focused on a specific patient population were excluded. Study design, patient population, intervention, the frequency of ED visits, and costs of frequent ED use and/or interventions were extracted and narratively synthesized. Results Among 17 included articles, three intervention categories were identified: case management (n = 12), individualized care plans (n = 3), and information sharing (n = 2). Ten studies examining case management reported reductions in mean (-0.66 to -37) or median (-0.1 to -20) number of ED visits after 12-months; one study reported an increase in mean ED visits (+2.79); and one reported no change. Of these, 6 studies also reported reduced hospital costs. Only 1 study evaluating individualized care plans examined ED utilization and found no change in median ED visits post-intervention. Costs following individualized care plans were also only evaluated in 1 study, which reported savings in hospital costs of $742/patient. Evidence was mixed regarding information sharing: 1 study reported no change in mean ED visits and did not examine costs; whereas the other reported a decrease in mean ED visits (-16.9) and ED cost savings of $15,513/patient. Conclusions The impact of all three frequent-user interventions was modest. Case management had the most rigorous evidence base, yielded moderate cost savings, but with variable reductions in ED use. Future studies evaluating non-traditional interventions, tailoring to patient

  6. The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.

    PubMed

    Khojah, Imad; Li, Suhui; Luo, Qian; Davis, Griffin; Galarraga, Jessica E; Granovsky, Michael; Litvak, Ori; Davis, Samuel; Shesser, Robert; Pines, Jesse M

    2017-09-01

    We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012-December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. "Hospital admission" was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition. The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions. For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. The collection of MicroED data for macromolecular crystallography

    PubMed Central

    Shi, Dan; Nannenga, Brent L; de la Cruz, M Jason; Liu, Jinyang; Sawtelle, Steven; Calero, Guillermo; Reyes, Francis E; Hattne, Johan; Gonen, Tamir

    2017-01-01

    The formation of large, well-ordered crystals for crystallographic experiments remains a crucial bottleneck to the structural understanding of many important biological systems. To help alleviate this problem in crystallography, we have developed the MicroED method for the collection of electron diffraction data from 3D microcrystals and nanocrystals of radiation-sensitive biological material. In this approach, liquid solutions containing protein microcrystals are deposited on carbon-coated electron microscopy grids and are vitrified by plunging them into liquid ethane. MicroED data are collected for each selected crystal using cryo-electron microscopy, in which the crystal is diffracted using very few electrons as the stage is continuously rotated. This protocol gives advice on how to identify microcrystals by light microscopy or by negative-stain electron microscopy in samples obtained from standard protein crystallization experiments. The protocol also includes information about custom-designed equipment for controlling crystal rotation and software for recording experimental parameters in diffraction image metadata. Identifying microcrystals, preparing samples and setting up the microscope for diffraction data collection take approximately half an hour for each step. Screening microcrystals for quality diffraction takes roughly an hour, and the collection of a single data set is ~10 min in duration. Complete data sets and resulting high-resolution structures can be obtained from a single crystal or by merging data from multiple crystals. PMID:27077331

  8. Domestic violence in an inner-city ED.

    PubMed

    Ernst, A A; Nick, T G; Weiss, S J; Houry, D; Mills, T

    1997-08-01

    A confidential written survey was conducted at the emergency department (ED) of Charity Hospital in New Orleans to determine the prevalence of domestic violence (DV) for male and female ED patients and to determine the demographics of DV. Four violence parameters were calculated for patients who had a partner at the time of presentation: 1) present physical; 2) present nonphysical; 3) past physical; and 4) past nonphysical. Out of the 516 patients enrolled, 283 were women and 233 were men. On the basis of Index of Spouse Abuse scoring, 14% of men and 22% of women had experienced past nonphysical violence, and 28% of men and 33% of women had experienced past physical violence. Of the 157 men and 207 women with partners at the time of presentation, 11% men and 15% women reported present nonphysical violence, and 20% men and 19% of the women reported present physical violence. Logistic-regression models demonstrated that women experienced significantly more past and present nonphysical violence but not physical violence than men. Alcohol, drug use, and suicidal ideation were found to be significant predictors associated with DV. In conclusion, DV rates were high in the New Orleans population, with nearly equal rates of past and present physical violence for men and women.

  9. The collection of MicroED data for macromolecular crystallography.

    PubMed

    Shi, Dan; Nannenga, Brent L; de la Cruz, M Jason; Liu, Jinyang; Sawtelle, Steven; Calero, Guillermo; Reyes, Francis E; Hattne, Johan; Gonen, Tamir

    2016-05-01

    The formation of large, well-ordered crystals for crystallographic experiments remains a crucial bottleneck to the structural understanding of many important biological systems. To help alleviate this problem in crystallography, we have developed the MicroED method for the collection of electron diffraction data from 3D microcrystals and nanocrystals of radiation-sensitive biological material. In this approach, liquid solutions containing protein microcrystals are deposited on carbon-coated electron microscopy grids and are vitrified by plunging them into liquid ethane. MicroED data are collected for each selected crystal using cryo-electron microscopy, in which the crystal is diffracted using very few electrons as the stage is continuously rotated. This protocol gives advice on how to identify microcrystals by light microscopy or by negative-stain electron microscopy in samples obtained from standard protein crystallization experiments. The protocol also includes information about custom-designed equipment for controlling crystal rotation and software for recording experimental parameters in diffraction image metadata. Identifying microcrystals, preparing samples and setting up the microscope for diffraction data collection take approximately half an hour for each step. Screening microcrystals for quality diffraction takes roughly an hour, and the collection of a single data set is ∼10 min in duration. Complete data sets and resulting high-resolution structures can be obtained from a single crystal or by merging data from multiple crystals.

  10. Progress and opportunities in EELS and EDS tomography.

    PubMed

    Collins, Sean M; Midgley, Paul A

    2017-09-01

    Electron tomography using energy loss and X-ray spectroscopy in the electron microscope continues to develop in rapidly evolving and diverse directions, enabling new insight into the three-dimensional chemistry and physics of nanoscale volumes. Progress has been made recently in improving reconstructions from EELS and EDS signals in electron tomography by applying compressed sensing methods, characterizing new detector technologies in detail, deriving improved models of signal generation, and exploring machine learning approaches to signal processing. These disparate threads can be brought together in a cohesive framework in terms of a model-based approach to analytical electron tomography. Models incorporate information on signal generation and detection as well as prior knowledge of structures in the spectrum image data. Many recent examples illustrate the flexibility of this approach and its feasibility for addressing challenges in non-linear or limited signals in EELS and EDS tomography. Further work in combining multiple imaging and spectroscopy modalities, developing synergistic data acquisition, processing, and reconstruction approaches, and improving the precision of quantitative spectroscopic tomography will expand the frontiers of spatial resolution, dose limits, and maximal information recovery. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Micro Slot Generation by μ-ED Milling

    NASA Astrophysics Data System (ADS)

    Dave, H. K.; Mayanak, M. K.; Rajpurohit, S. R.; Mathai, V. J.

    2016-08-01

    Micro electro discharge machining is one of the most widely used advanced micro machining technique owing to its capability to fabricate micro features on any electrically conductive materials irrespective of its material properties. Despite its wide acceptability, the process is always adversely affected by issues like wear that occurred on the tool electrode, which results into generation of inaccurate features. Micro ED milling, a process variant in which the tool electrode simultaneously rotated and scanned during machining, is reported to have high process efficiency for generation of 3D complicated shapes and features with relatively less electrode wear intensity. In the present study an attempt has been made to study the effect of two process parameters viz. capacitance and scanning speed of tool electrode on end wear that occurs on the tool electrode and overcut of micro slots generated by micro ED milling. The experiment has been conducted on Al 1100 alloy with tungsten electrode having diameter of 300 μm. Results suggest that wear on the tool electrode and overcut of the micro features generated are highly influenced by the level of the capacitance employed during machining. For the parameter usage employed for present study however, no significant effect of variation of scanning speed has been observed on both responses.

  12. Utilisation of Waste Marble Dust as Fine Aggregate in Concrete

    NASA Astrophysics Data System (ADS)

    Vigneshpandian, G. V.; Aparna Shruthi, E.; Venkatasubramanian, C.; Muthu, D.

    2017-07-01

    Concrete is the important construction material and it is used in the construction industry due to its high compressive strength and its durability. Now a day’s various studies have been conducted to make concrete with waste material with the intention of reducing cost and unavailability of conventional materials. This paper investigates the strength properties of concrete specimens cast using waste marble dust as replacement of fine aggregate. The marble pieces are finely crushed to powdered and the gradation is compared with conventional fine aggregate. Concrete specimen were cast using wmd in the laboratory with different proportion (25%, 50% and 100%) by weight of cement and from the studies it reveals that addition of waste marble dust as a replacement of fine aggregate marginally improves compressive, tensile and flexural strength in concrete.

  13. Edward (Ed) T. Schneider in Front of SR-71 Blackbird

    NASA Technical Reports Server (NTRS)

    1995-01-01

    SR-71 research pilot Ed Schneider is pictured here in front of an SR-71 Blackbird on the ramp at the Dryden Flight Research Center, Edwards, California. Schneider became a NASA research pilot at Dryden in 1983. Data from the SR-71 program will be used to aid designers of future supersonic aircraft and propulsion systems. He retired as a NASA research pilot in September 2000. Two SR-71 aircraft have been used by NASA as testbeds for high-speed and high-altitude aeronautical research. The aircraft, an SR-71A and an SR-71B pilot trainer aircraft, have been based here at NASA's Dryden Flight Research Center, Edwards, California. They were transferred to NASA after the U.S. Air Force program was cancelled. As research platforms, the aircraft can cruise at Mach 3 for more than one hour. For thermal experiments, this can produce heat soak temperatures of over 600 degrees Fahrenheit (F). This operating environment makes these aircraft excellent platforms to carry out research and experiments in a variety of areas -- aerodynamics, propulsion, structures, thermal protection materials, high-speed and high-temperature instrumentation, atmospheric studies, and sonic boom characterization. The SR-71 was used in a program to study ways of reducing sonic booms or over pressures that are heard on the ground, much like sharp thunderclaps, when an aircraft exceeds the speed of sound. Data from this Sonic Boom Mitigation Study could eventually lead to aircraft designs that would reduce the 'peak' overpressures of sonic booms and minimize the startling affect they produce on the ground. One of the first major experiments to be flown in the NASA SR-71 program was a laser air data collection system. It used laser light instead of air pressure to produce airspeed and attitude reference data, such as angle of attack and sideslip, which are normally obtained with small tubes and vanes extending into the airstream. One of Dryden's SR-71s was used for the Linear Aerospike Rocket Engine, or

  14. Improving ED specimen TAT using Lean Six Sigma.

    PubMed

    Sanders, Janet H; Karr, Tedd

    2015-01-01

    Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens. This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma's Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean's primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change. The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time. This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve

  15. Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue?

    PubMed

    Chang, Wen; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Liu, Hsueh-Erh; Han, Chin-Yen

    2016-10-01

    Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.

  16. GPU-based Space Situational Awareness Simulation utilising Parallelism for Enhanced Multi-sensor Management

    NASA Astrophysics Data System (ADS)

    Hobson, T.; Clarkson, V.

    2012-09-01

    As a result of continual space activity since the 1950s, there are now a large number of man-made Resident Space Objects (RSOs) orbiting the Earth. Because of the large number of items and their relative speeds, the possibility of destructive collisions involving important space assets is now of significant concern to users and operators of space-borne technologies. As a result, a growing number of international agencies are researching methods for improving techniques to maintain Space Situational Awareness (SSA). Computer simulation is a method commonly used by many countries to validate competing methodologies prior to full scale adoption. The use of supercomputing and/or reduced scale testing is often necessary to effectively simulate such a complex problem on todays computers. Recently the authors presented a simulation aimed at reducing the computational burden by selecting the minimum level of fidelity necessary for contrasting methodologies and by utilising multi-core CPU parallelism for increased computational efficiency. The resulting simulation runs on a single PC while maintaining the ability to effectively evaluate competing methodologies. Nonetheless, the ability to control the scale and expand upon the computational demands of the sensor management system is limited. In this paper, we examine the advantages of increasing the parallelism of the simulation by means of General Purpose computing on Graphics Processing Units (GPGPU). As many sub-processes pertaining to SSA management are independent, we demonstrate how parallelisation via GPGPU has the potential to significantly enhance not only research into techniques for maintaining SSA, but also to enhance the level of sophistication of existing space surveillance sensors and sensor management systems. Nonetheless, the use of GPGPU imposes certain limitations and adds to the implementation complexity, both of which require consideration to achieve an effective system. We discuss these challenges and

  17. Science Teachers' Utilisation of Innovative Strategies for Teaching Senior School Science in Ilorin, Nigeria

    ERIC Educational Resources Information Center

    Oyelekan, Oloyede Solomon; Igbokwe, Emoyoke Faith; Olorundare, Adekunle Solomon

    2017-01-01

    Efforts have been made to improve science teaching in secondary schools in Nigeria, yet, students continue to perform poorly in science subjects. Many innovative teaching strategies have been developed by educators and found to impact significantly on students' academic performance when utilised. Hence, this study was aimed at examining science…

  18. ICT and OTs: a model of information and communication technology acceptance and utilisation by occupational therapists.

    PubMed

    Schaper, Louise K; Pervan, Graham P

    2007-06-01

    There is evidence to suggest that health professionals are reluctant to accept and utilise information and communication technologies (ICT) and concern is growing within health informatics research that this is contributing to the lag in adoption and utilisation of ICT across the health sector. Technology acceptance research within the field of information systems has been limited in its application to health and there is a concurrent need to develop and gain empirical support for models of technology acceptance within health and to examine acceptance and utilisation issues amongst health professionals to improve the success of information system implementation in this arena. This paper outlines a project that examines ICT acceptance and utilisation by Australian occupational therapists. It describes the theoretical basis behind the development of a research model and the methodology being employed to empirically validate the model using substantial quantitative, qualitative and longitudinal data. Preliminary results from Phase II of the study are presented. The theoretical significance of this work is that it uses a thoroughly constructed research model, with potentially the largest sample size ever tested, to extend technology acceptance research into the health sector.

  19. The Utilisation of Psychological Support Services in Primary Schools in Gauteng

    ERIC Educational Resources Information Center

    Pillay, Jace; Wasielewski, Tanya

    2007-01-01

    This qualitative study was conducted in four Gauteng public primary schools to assess the utilisation of psychological support services. Individual and focus group interviews were conducted with various stakeholders. The results indicated an underutilisation of Psychological Support Services attributed to lack of staff within the support…

  20. Utilisation of Local Inputs in the Funding and Administration of Education in Nigeria

    ERIC Educational Resources Information Center

    Akiri, Agharuwhe A.

    2014-01-01

    The article discussed how, why and who is in charge of administering and funding schools in Nigeria. The author utilised the relevant statistical approach which examined and discussed various political and historical trends affecting education. Besides this, relevant documented statistical data were used to both buttress and substantiate related…

  1. To fractionate municipal solid waste incineration bottom ash: Key for utilisation?

    PubMed

    Sormunen, Laura Annika; Rantsi, Riina

    2015-11-01

    For the past decade, the Finnish waste sector has increasingly moved from the landfilling of municipal solid waste towards waste incineration. New challenges are faced with the growing amounts of municipal solid waste incineration bottom ash, which are mainly landfilled at the moment. Since this is not a sustainable or a profitable solution, finding different utilisation applications for the municipal solid waste incineration bottom ash is crucial. This study reports a comprehensive analysis of bottom ash properties from one waste incineration plant in Finland, which was first treated with a Dutch bottom ash recovery technique called advanced dry recovery. This novel process separates non-ferrous and ferrous metals from bottom ash, generating mineral fractions of different grain sizes (0-2 mm, 2-5 mm, 5-12 mm and 12-50 mm). The main aim of the study was to assess, whether the advanced bottom ash treatment technique, producing mineral fractions of different grain sizes and therefore properties, facilitates the utilisation of municipal solid waste incineration bottom ash in Finland. The results were encouraging; the bottom ash mineral fractions have favourable behaviour against the frost action, which is especially useful in the Finnish conditions. In addition, the leaching of most hazardous substances did not restrict the utilisation of bottom ash, especially for the larger fractions (>5 mm). Overall, this study has shown that the advanced bottom ash recovering technique can be one solution to increase the utilisation of bottom ash and furthermore decrease its landfilling in Finland.

  2. Public Health Knowledge Utilisation by Policy Actors: An Evaluation Study in Midden-Holland, the Netherlands

    ERIC Educational Resources Information Center

    de Goede, Joyce; Steenkamer, Betty; Treurniet, Henriëtte; Putters, Kim; van Oers, Hans

    2011-01-01

    A comprehensive report has been prepared on the state of public health and healthcare in the Midden-Holland region of the Netherlands. This study describes the development of the report and the mechanisms behind public health knowledge utilisation by three groups of health policy actors: local authorities, public health professionals and regional…

  3. Uncontrolled diabetes and health care utilisation: panel data evidence from Spain.

    PubMed

    Gil, Joan; Sicras-Mainar, Antoni; Zucchelli, Eugenio

    2017-08-10

    Despite size and relevance of uncontrolled diabetes, robust evidence on its effects on health care utilisation is very limited, especially among European countries. We employed longitudinal administrative data from Spain (2004-2010) to explore the relationship between uncontrolled type 2 diabetes and health care utilisation. We used a biomarker (glycated haemoglobin, HbA1c) to detect the presence of uncontrolled diabetes and explore its effects on both primary and secondary health care. We estimated a range of panel count data models, including negative binomials with random effects, dynamic and hurdle specifications to account for unobserved heterogeneity, previous utilisation and selection. We found uncontrolled diabetes in between 27 and 30% of patients of both genders. Our estimates suggested that although women appeared to systematically consume more health care compared to men, their consumption levels did not seem to be influenced by uncontrolled diabetes. Conversely, among men uncontrolled diabetes increased the average number of GP visits per year by between 3 and 3.4%, specialist visits by 5.3-6.1%, depending on specifications, and also extended annual hospital length of stay by 15%. We also found some evidence of heterogeneity in utilisation based on the level of uncontrolled diabetes among male individuals. Overall, our results suggested the need for different diabetes management plans depending on gender and levels of glycaemic control.

  4. Coping and health service utilisation in a UK study of paediatric sickle cell pain

    PubMed Central

    Anie, K; Steptoe, A; Ball, S; Dick, M; Smalling, B

    2002-01-01

    Aims: To assess sickle cell pain and coping in children and to examine the relation between these factors and the utilisation of health services. Methods: Cross sectional study involving 67 children with sickle cell disease attending three London hospitals. Interviews and questionnaires involved measures of pain, health service utilisation, and coping responses (measured with the Coping Strategies Questionnaire (CSQ), revised for children with sickle cell disease). Medical data on complications, haemoglobin (Hb) levels, and foetal haemoglobin (HbF) percentage were also collected. Results: Pain accounted for about 24% of hospital service use, independent of age, sex, number of with sickle cell disease complications, and Hb levels. However, 42% of patients had not utilised hospital services in the past 12 months. Three higher order factors emerged from analysis of the CSQ (active coping, affective coping, passive adherence coping). Pain severity was predicted by passive adherence coping, while utilisation of hospital services was predicted by active coping. Conclusions: Sickle cell disease in children involves severe recurrent pain leading to hospitalisation in some cases. Psychological coping patterns are relevant to both pain experience, and the use of acute hospital services. It is likely that children would benefit from community based interventions that incorporate both medical and psychological assessments. PMID:11970920

  5. Utilisation of Local Inputs in the Funding and Administration of Education in Nigeria

    ERIC Educational Resources Information Center

    Akiri, Agharuwhe A.

    2014-01-01

    The article discussed how, why and who is in charge of administering and funding schools in Nigeria. The author utilised the relevant statistical approach which examined and discussed various political and historical trends affecting education. Besides this, relevant documented statistical data were used to both buttress and substantiate related…

  6. Infant care practices in rural China and their relation to prenatal care utilisation.

    PubMed

    Nwaru, B I; Wu, Z; Hemminki, E

    2011-01-01

    Studies describing postpartum childcare practices and the influence of prenatal care on infant care outcomes in rural China are scarce. This study looked at data for 1479 women who had given birth during the preceding 2 years (median age of the child was 8 months). Data were available from a Knowledge, Attitude and Perception cross-sectional survey collected from 2001 to 2003, after a prenatal care intervention in Anhui County, China, with a response rate of 97%. Prenatal care utilisation was categorised using the Adequacy of Prenatal Care Utilisation index. Logistic regression was used to study the association between prenatal care utilisation and infant care practices. Mothers' uptake of breastfeeding, introduction of milk formula, cereal/porridge, meat and uptake of any immunisation were found to be in accordance with national recommendations. Intermediate prenatal care uptake was positively associated with never breastfeeding and early introduction of cereal/porridge. Inadequate care was positively associated with never breastfeeding, early introduction of milk formula and cereal/porridge, and early start of work after delivery. Initiation to prenatal care after the third month was positively associated with early introduction of milk formula and cereal/porridge. Having no prenatal care was positively associated with never breastfeeding and early introduction of milk formula. Mothers' uptake of infant care practices in this population was largely in accordance with national recommendations. Women with less than adequate utilisation of prenatal care and those who had initiated prenatal care late were less likely to follow recommendations on infant care.

  7. Skills Utilisation at Work, the Quality of the Study Programme and Fields of Study

    ERIC Educational Resources Information Center

    Støren, Liv Anne; Arnesen, Clara Åse

    2016-01-01

    This paper examines the factors that may have impact on the extent to which the knowledge and skills of master's degree graduates in Norway are utilised at work, three years after graduation. The focus is on the impact of the quality of the study programme as well as the graduates' fields of study, when also taking into account other factors…

  8. Utilisation of Used Palm Oil as an Alternative Fuel in Thailand

    NASA Astrophysics Data System (ADS)

    Permchart, W.; Tanatvanit, S.

    2007-10-01

    This paper summarises the overview of the current situation of alternative energies in Thailand. The utilisation of bio-diesel as an alternative energy in two economic sectors (i.e. transport and industrial sectors), which have the largest energy consumption in the country, is mainly presented because it has seemed to be the most promising project among various energy conservation projects of the Thai government. Actually, there is another bio-fuel project, namely, the ethanol project for blending with gasoline to produce gasohol (E10) used in gasoline engines, which has been developed and already become to an important policy for energy conservation of the country. Due to much more large number of diesel has been utilised, the bio-diesel project has been the first priority one to solve the petroleum crisis problems. However, it is remarked that the utilisation of bio-diesel as an alternative fuel seems to be unsatisfactory because of various reasons. Some issues in terms of both government policies and technical problems have not been clearly addressed. Therefore, this paper not only presents the utilisation of bio-diesel in these two sectors but also discusses the production processes, characterisations and some experimental testing results of bio-diesel.

  9. Extent of ESL Teachers' Access To, Utilisation and Production of Research

    ERIC Educational Resources Information Center

    Sibanda, Jabulani; Begede, Martin P.

    2015-01-01

    This study employed the survey design on a purposive sample of 100 English Second Language (ESL) teachers from Swaziland and South Africa's Eastern Cape Province, to investigate the extent to which they accessed, utilised and conducted research to better their practice. A survey questionnaire and follow-up structured interviews generated…

  10. Exploring the Extent to Which ELT Students Utilise Smartphones for Language Learning Purposes

    ERIC Educational Resources Information Center

    Yaman, Ismail; Senel, Müfit; Yesilel, Deren Basak Akman

    2015-01-01

    The advent of smartphones has had dramatic influences on our daily lives and has rendered human beings "walking computers." This holds important reflections in the realm of language learning, as well as in many other areas. This study aimed to explore the extent to which English Language Teaching (ELT) students utilise smartphones for…

  11. Interventions to improve patient access to and utilisation of genetic and genomic counselling services

    PubMed Central

    Benjamin, Caroline M; Thomas, Lois H; Skirton, Heather; Gustafson, Shanna; Coupe, Jacqueline; Patch, Christine; Belk, Rachel; Tishkovskaya, Svetlana; Calzone, Kathleen; Payne, Katherine

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective The primary objective is to assess the effectiveness of interventions to improve patient identification, access to and utilisation of genetic and genomic counselling services when compared to: No intervention; Usual or current practice; and Other active intervention. Secondary objective The secondary objective is to explore the resource use and costs associated with interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. We will report on factors that may explain variation in the effectiveness of interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. Another secondary objective is to explore how interventions which target improved patient identification, access to and utilisation of genetic and genomic counselling services affect the subsequent appropriate use of health services for the prevention or early detection of disease. It is also possible that the genetic counselling interaction itself will contribute to the possible use of preventative services. PMID:26989348

  12. Closing the Gap between Research Evidence and Clinical Practice: Jordanian Nurses' Perceived Barriers to Research Utilisation

    ERIC Educational Resources Information Center

    Al Khalaileh, Murad; Al Qadire, Mohammad; Musa, Ahmad S.; Al-Khawaldeh, Omar A.; Al Qudah, Hani; Alhabahbeh, Atalla

    2016-01-01

    Background: The nursing profession is a combination of theory and practical skill, and nurses are required to generate and develop knowledge through implementing research into clinical practice. Considerable number of barriers could hind implementing research findings into practice. Barriers to research utilisation are not identified in the…

  13. Utilising Benchmarking to Inform Decision-Making at the Institutional Level: A Research-Informed Process

    ERIC Educational Resources Information Center

    Booth, Sara

    2013-01-01

    Benchmarking has traditionally been viewed as a way to compare data only; however, its utilisation as a more investigative, research-informed process to add rigor to decision-making processes at the institutional level is gaining momentum in the higher education sector. Indeed, with recent changes in the Australian quality environment from the…

  14. Utilising green and bluespace to mitigate urban heat island intensity.

    PubMed

    Gunawardena, K R; Wells, M J; Kershaw, T

    2017-04-15

    It has long been recognised that cities exhibit their own microclimate and are typically warmer than the surrounding rural areas. This 'mesoscale' influence is known as the urban heat island (UHI) effect and results largely from modification of surface properties leading to greater absorption of solar radiation, reduced convective cooling and lower water evaporation rates. Cities typically contain less vegetation and bodies of water than rural areas, and existing green and bluespace is often under threat from increasing population densities. This paper presents a meta-analysis of the key ways in which green and bluespace affect both urban canopy- and boundary-layer temperatures, examined from the perspectives of city-planning, urban climatology and climate science. The analysis suggests that the evapotranspiration-based cooling influence of both green and bluespace is primarily relevant for urban canopy-layer conditions, and that tree-dominated greenspace offers the greatest heat stress relief when it is most needed. However, the magnitude and transport of cooling experienced depends on size, spread, and geometry of greenspaces, with some solitary large parks found to offer minimal boundary-layer cooling. Contribution to cooling at the scale of the urban boundary-layer climate is attributed mainly to greenspace increasing surface roughness and thereby improving convection efficiency rather than evaporation. Although bluespace cooling and transport during the day can be substantial, nocturnal warming is highlighted as likely when conditions are most oppressive. However, when both features are employed together they can offer many synergistic ecosystem benefits including cooling. The ways in which green and bluespace infrastructure is applied in future urban growth strategies, particularly in countries expected to experience rapid urbanisation, warrants greater consideration in urban planning policy to mitigate the adverse effects of the UHI and enhance climate

  15. Has the rescheduling of hydrocodone changed ED prescribing practices?

    PubMed

    Oehler, Elizabeth C; Day, Rachel L; Robinson, David B; Brown, Lawrence H

    2016-12-01

    The objective was to examine the effect of hydrocodone-containing product (HCP) rescheduling on the proportion of prescriptions for HCPs given to patients discharged from the emergency department (ED). Electronic queries of ED records were used to identify patients aged 15 years and older discharged with a pain-related prescription in the 12 months before and after HCP rescheduling. Prescriptions were classified as HCPs; other Schedule II medications (eg, oxycodone products); other Schedule III medications (eg, codeine products); and non-Schedule II/III products (eg, nonsteroidal anti-inflammatory drugs). We compared the proportions of patients receiving each type of prescription before and after rescheduling using χ(2) analysis and used logistic regression to explore the relationship between prescription type and time period while controlling for age, sex, race, and ethnicity. Before rescheduling, 58.1% (95% confidence interval [CI], 57.4-58.7) of patients receiving a pain-related prescription received an HCP; after rescheduling, 13.2% (95% CI, 12.7-13.7) received an HCP (P < .001). Concurrently, other Schedule III prescriptions increased (pre: 11.7% [CI, 11.3-12.2] vs post: 44.9% [CI, 44.2-45.6], P < .001)), as did non-Schedule II/III prescriptions (pre: 51.8% [CI, 51.2-52.5] vs post: 59.3% [CI, 58.6-60.0], P < .001). When controlling for demographic characteristics, patients remained less likely to receive an HCP after rescheduling (adjusted odds ratio [AOR], 0.11; CI, 0.10-0.11) and more likely to receive other Schedule III (AOR, 6.1; CI, 5.8-6.5) and non-Schedule II/III (AOR, 1.4; CI, 1.3-1.4) products. Rescheduling HCPs from Schedule III to Schedule II led to a substantial decrease in HCP prescriptions in our ED and an increase in prescriptions for other Schedule III and non-Schedule II/III products. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. ED services: the impact of caring behaviors on patient loyalty.

    PubMed

    Liu, Sandra S; Franz, David; Allen, Monette; Chang, En-Chung; Janowiak, Dana; Mayne, Patricia; White, Ruth

    2010-09-01

    This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city. Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information. Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P < .05) at all sites. The study results raised considerations for ED caregivers, particularly with regard

  17. Validity of self reported utilisation of primary health care services in an urban population in Spain

    PubMed Central

    Bellon, J. A.; Lardelli, P.; Luna, J. d.; Delgado, A.

    2000-01-01

    STUDY OBJECTIVE—To assess the validity and factors related with the validity of self reported numbers of visits to a primary health care centre, in comparison with the recorded number.
DESIGN—Cross sectional study.
SETTING—The urban area served by the Zaidín-Sur Primary Health Care Centre (Granada, Spain).
PARTICIPANTS—Two population samples (236 high users and 420 normal users) who were seen at the centre from 1985 to 1991 were interviewed in 1993.
MAIN RESULTS—A net tendency to overreport the actual number of visits was observed. Absolute concordance between self reported and recorded utilisation decreased as time interval lengthened, although this mainly reflected the increase in maximum variability both with time interval length and with the number of recorded visits. Corrected Spearman ρ coefficients obtained between the number of self reported and recorded visits ranged from 0.602 for the two weeks before the interview to 0.678 for the year before. Regression slopes of self reported utilisation upon recorded utilisation did not change between periods. In multiple regression analyses the actual number of visits was the main factor associated with both underreporting and overreporting. Older age was also significantly associated with underreporting. Poor health status and high satisfaction with health care were significantly associated with overreporting.
CONCLUSIONS—There was a substantial degree of inaccuracy in self reported utilisation, with a net tendency to overreport the number of visits. In relative terms, however, accuracy of self reports did not seem to decrease appreciably as the recall time lengthened. To compare the accuracy of different measures, it is important to take into account the maximum variability of each one. Otherwise, contradictory results may be obtained.


Keywords: self reported utilisation; primary health care; validity PMID:10846198

  18. Better health outcomes at lower costs: the benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia's Northern Territory.

    PubMed

    Zhao, Yuejen; Thomas, Susan L; Guthridge, Steven L; Wakerman, John

    2014-10-04

    Indigenous residents living in remote communities in Australia's Northern Territory experience higher rates of preventable chronic disease and have poorer access to appropriate health services compared to other Australians. This study compared health outcomes and costs at different levels of primary care utilisation to determine if primary care represents an efficient use of resources for Indigenous patients with common chronic diseases namely hypertension, diabetes, ischaemic heart disease, chronic obstructive pulmonary disease and renal disease. This was an historical cohort study involving a total of 14,184 Indigenous residents, aged 15 years and over, who lived in remote communities and used a remote clinic or public hospital from 2002 to 2011. Individual level demographic and clinical data were drawn from primary care and hospital care information systems using a unique patient identifier. A propensity score was used to improve comparability between high, medium and low primary care utilisation groups. Incremental cost-effectiveness ratios and acceptability curves were used to analyse four health outcome measures: total and, avoidable hospital admissions, deaths and years of life lost. Compared to the low utilisation group, medium and high levels of primary care utilisation were associated with decreases in total and avoidable hospitalisations, deaths and years of life lost. Higher levels of primary care utilisation for renal disease reduced avoidable hospitalisations by 82-85%, deaths 72-75%, and years of life lost 78-81%. For patients with ischaemic heart disease, the reduction in avoidable hospitalisations was 63-78%, deaths 63-66% and years of life lost 69-73%. In terms of cost-effectiveness, primary care for renal disease and diabetes ranked as more cost-effective, followed by hypertension and ischaemic heart disease. Primary care for chronic obstructive pulmonary disease was the least cost-effective of the five conditions. Primary care in remote

  19. Improving hospital bed utilisation through simulation and optimisation: with application to a 40% increase in patient volume in a Norwegian General Hospital.

    PubMed

    Holm, Lene Berge; Lurås, Hilde; Dahl, Fredrik A

    2013-02-01

    , as the latter tends to sacrifice entire wards where length of stay is long and patient turnover is slow. Prevalence optimisation was therefore used. The main results show that when the bed distribution is optimised, the share of crowding patient nights is reduced from 6.5% to 4.2%. This model provides a powerful tool for optimising hospital bed utilisation, and the application showed an important reduction in crowding bed usage. The generic model is flexible, as the level of detail in the modelling of arrivals and length of stay can vary according to the data available and accuracy required. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Synthesis and evaluation of 2,5-dihydrochorismate analogues as inhibitors of the chorismate-utilising enzymes.

    PubMed

    Payne, Richard J; Bulloch, Esther M M; Toscano, Miguel M; Jones, Michelle A; Kerbarh, Olivier; Abell, Chris

    2009-06-07

    A library of 2,5-dihydrochorismate analogues were designed as inhibitors of the chorismate-utilising enzymes including anthranilate synthase, isochorismate synthase, salicylate synthase and 4-amino-4-deoxychorismate synthase. The inhibitors were synthesised in seven or eight steps from shikimic acid, sourced from star anise. The compounds exhibited moderate but differential inhibition against the four chorismate-utilising enzymes.

  1. A hybrid ED/RO process for TDS reduction of produced waters

    SciTech Connect

    Tsai, S.P.; Datta, R.; Frank, J.R.

    1995-12-31

    Large volumes of produced waters are generated from natural gas production. In the United States the prevailing management practice for produced waters is deep well injection, but this practice is costly. Therefore minimizing the need for deep well injection is desirable. A major treatment issue for produced waters is the reduction of total dissolved solids (TDS), which consist mostly of inorganic salts. A hybrid electrodialysis/reverse-osmosis (ED/RO) treatment process is being developed to concentrate the salts in produced waters and thereby reduce the volume of brine that needs to be managed for disposal. The desalted water can be used beneficially or discharged. In this study, laboratory feasibility experiments were conducted by using produced waters from multiple sites. A novel-membrane configuration approach to prevent fouling and scale formation was developed and demonstrated. Results of laboratory experiments and plans for field demonstration are discussed.

  2. EDS V25 containment vessel explosive qualification test report.

    SciTech Connect

    Rudolphi, John Joseph

    2012-04-01

    The V25 containment vessel was procured by the Project Manager, Non-Stockpile Chemical Materiel (PMNSCM) as a replacement vessel for use on the P2 Explosive Destruction Systems. It is the first EDS vessel to be fabricated under Code Case 2564 of the ASME Boiler and Pressure Vessel Code, which provides rules for the design of impulsively loaded vessels. The explosive rating for the vessel based on the Code Case is nine (9) pounds TNT-equivalent for up to 637 detonations. This limit is an increase from the 4.8 pounds TNT-equivalency rating for previous vessels. This report describes the explosive qualification tests that were performed in the vessel as part of the process for qualifying the vessel for explosive use. The tests consisted of a 11.25 pound TNT equivalent bare charge detonation followed by a 9 pound TNT equivalent detonation.

  3. Softball injuries treated in US EDs, 1994 to 2010.

    PubMed

    Birchak, John C; Rochette, Lynne M; Smith, Gary A

    2013-06-01

    Softball is a popular participant sport in the United States. This study investigated the epidemiology of softball injuries with comparisons between children and adults. Data from the National Electronic Injury Surveillance System for patients 7 years and older treated in an emergency department (ED) for a softball injury from 1994 through 2010 were analyzed. An estimated 2107823 (95% confidence interval [CI], 1736417-2479229) patients were treated in US EDs for a softball injury during the 17-year study period. The annual number of injuries decreased by 23.0% from 1994 to 2010 (P < .001); however, during the last 6 years of the study, injuries increased by 11.7% (P = .008). The annual rate of softball injuries increased significantly during the study period (P = .035). The most commonly injured body regions were the hand/wrist (22.2%) and face (19.3%). Being hit by a ball was the most common mechanism of injury (52.4%) and accounted for most of face (89.6%) and head (75.7%) injuries. Injuries associated with running (relative risk, 2.36; 95% CI, 1.97-2.82) and diving for a ball (relative risk, 4.61; 95% CI, 3.50-6.09) were more likely to occur among adult than pediatric patients. To our knowledge, this is the first study to investigate softball injuries using a nationally representative sample. Softball is a common source of injury among children and adults. Increased efforts are needed to promote safety measures, such as face guards, mouth guards, safety softballs, and break-away bases, to decrease these injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Antenatal Care Utilisation and Content between Low-Risk and High-Risk Pregnant Women

    PubMed Central

    Yeoh, Ping Ling; Hornetz, Klaus; Dahlui, Maznah

    2016-01-01

    Background The purpose of antenatal care is to monitor and improve the wellbeing of the mother and foetus. The World Health Organization recommends risk-oriented strategy that includes: (i) routine care to all women, (ii) additional care for women with moderately severe diseases and complications, (iii) specialised obstetrical and neonatal care for women with severe diseases and complications. Antenatal care is concerned with adequate care in order to be effective. Measurement for adequacy of antenatal care often applies indexes that assess initiation of care and number of visits. In addition, adequacy of care content should also be assessed. Results of studies in developed settings demonstrate that women without risk factors use antenatal services more frequently than recommended. Such over-utilisation is problematic for low-resourced settings. Moreover, studies show that a substantial proportion of high-risk women had utilisation or content of care below the recommended standard. Yet studies in developing countries have seldom included a comparison between low-risk and high-risk women. The purpose of the study was therefore to assess adequacy of care and pregnancy outcomes for the different risk groups. Methods A retrospective study using a multistage sampling technique, at public-funded primary health care clinics was conducted. Antenatal utilisation level was assessed using a modified Adequacy of Prenatal Care Utilisation index that measures the timing for initiation of care and observed-to-expected visits ratio. Adequacy of antenatal care content assessed compliance to routine care based on the local guidelines. Results Intensive or “adequate-plus” antenatal care utilisation as defined by the modified index was noted in over half of the low-risk women. On the other hand, there were 26% of the high-risk women without the expected intensive utilisation. Primary- or non-educated high-risk women were less likely to have a higher antenatal care utilisation

  5. The ingestion of protein with a maltodextrin and fructose beverage on substrate utilisation and exercise performance.

    PubMed

    Tarpey, Michael D; Roberts, Justin D; Kass, Lindsy S; Tarpey, Richard J; Roberts, Michael G

    2013-12-01

    The study investigated the ingestion of maltodextrin, fructose, and protein on exogenous carbohydrate oxidation (CHOEXO) and exercise performance. Seven trained cyclists and (or) triathletes (maximal oxygen consumption, 59.20 ± 9.00 mL · kg(-1) · min(-1)) performed 3 exercise trials that consisted of 150 min of cycling at 50% maximal power output (160 ± 11 W), followed by a 60-km time trial. One of 3 beverages were randomly assigned during each trial and consumed at 15-min intervals: (i) 0.84 g · min(-1) maltodextrin + 0.52 g · min(-1) fructose + 0.34 g · min(-1) protein (MD+F+P); (ii) 1.10 g · min(-1) maltodextrin + 0.60 g · min(-1) fructose (MD+F); or (iii) 1.70 g · min(-1) maltodextrin (MD). CHO(EXO) and fuel utilisation were assessed via measurement of expired air (13)C content and indirect calorimetry, respectively. Mean total CHO oxidation (CHOTOT) rates were 2.35 ± 0.18, 2.76 ± 0.08, and 2.61 ± 0.17 g · min(-1) with MD, MD+F, and MD+F+P, respectively, although not significantly different. Peak CHO(EXO) rates with MD+F were significantly greater by 41.4% (p = 0.001) and 45.4% (p = 0.0001) compared with MD+F+P and MD, respectively (1.57 ± 0.22 g · min(-1), 1.11 ± 0.08 g · min(-1), and 1.08 ± 0.11 g · min(-1), respectively). Performance times were 2.2% and 5.0% faster with MD+F compared with MD+F+P and MD, respectively; however, they were not statistically significant. Ingestion of an MD-fructose-protein commercial sports beverage significantly reduced peak and mean CHO(EXO) rates compared with MD+F, but did not significantly influence CHOTOT. The addition of protein to an MD+F beverage did not enhance performance times.

  6. Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain

    PubMed Central

    Buron, Andrea; Cots, Francesc; Garcia, Oscar; Vall, Oriol; Castells, Xavier

    2008-01-01

    Background The recent increase in the number of immigrants of Barcelona represents a challenge for the public healthcare system, the emergency department being the most used healthcare service by this group. However, utilisation rates in our environment have not yet been studied. We aimed to compare emergency department utilisation rates between Spanish-born and foreign-born residents in a public hospital of Barcelona. Methods The study population included all adults residing in the area of study and visiting the emergency department of Hospital del Mar in 2004. The emergency care episodes were selected from the Emergency Department register, and the population figures from the Statistics Department of Barcelona. Emergency care episodes were classified into five large clinical categories. Adjusted rate ratios (RR) of utilisation among foreign-born vs. Spanish-born residents were assessed through negative binomial regression. Results The overall utilisation rate was 382 emergency contacts per 1,000 persons-years. The RR for foreign-born versus Spanish-born residents was 0.62 (95% CI: 0.52; 0.74%). The RR was also significantly below one in surgery (0.51, 95% CI: 0.42; 0.63), traumatology (0.47, 95% CI: 0.38; 0.59), medicine (0.48, 95% CI: 0.38; 0.59) and psychiatry (0.42, 95% CI: 0.18; 0.97). No differences were found in utilisation of gynaecology and minor emergency services. Conclusion The overall lower utilisation rates obtained for foreign-born residents is consistent with previous studies and is probably due to the "healthy immigrant effect". Thus, the population increase due to immigration does not translate directly into a corresponding increase in the number of emergency contacts. The lack of differences in minor and gynaecological emergency care supports the hypothesis that immigrants overcome certain barriers by using the emergency department to access to health services. The issue of healthcare barriers should therefore be addressed, especially among

  7. SED-ED, a workflow editor for computational biology experiments written in SED-ML.

    PubMed

    Adams, Richard R

    2012-04-15

    The simulation experiment description markup language (SED-ML) is a new community data standard to encode computational biology experiments in a computer-readable XML format. Its widespread adoption will require the development of software support to work with SED-ML files. Here, we describe a software tool, SED-ED, to view, edit, validate and annotate SED-ML documents while shielding end-users from the underlying XML representation. SED-ED supports modellers who wish to create, understand and further develop a simulation description provided in SED-ML format. SED-ED is available as a standalone Java application, as an Eclipse plug-in and as an SBSI (www.sbsi.ed.ac.uk) plug-in, all under an MIT open-source license. Source code is at https://sed-ed-sedmleditor.googlecode.com/svn. The application itself is available from https://sourceforge.net/projects/jlibsedml/files/SED-ED/.

  8. RESPECT-ED: Rates of Pulmonary Emboli (PE) and Sub-Segmental PE with Modern Computed Tomographic Pulmonary Angiograms in Emergency Departments: A Multi-Center Observational Study Finds Significant Yield Variation, Uncorrelated with Use or Small PE Rates

    PubMed Central

    Chu, Kevin; Joseph, Anthony; Read, Catherine; Blecher, Gabriel; Furyk, Jeremy; Bharat, Chrianna; Velusamy, Karthik; Munro, Andrew; Baker, Kylie; Kinnear, Frances; Mukherjee, Ahses; Watkins, Gina; Buntine, Paul; Livesay, Georgia

    2016-01-01

    Introduction Overuse of CT Pulmonary Angiograms (CTPA) for diagnosing pulmonary embolism (PE), particularly in Emergency Departments (ED), is considered problematic. Marked variations in positive CTPA rates are reported, with American 4–10% yields driving most concerns. Higher resolution CTPA may increase sub-segmental PE (SSPE) diagnoses, which may be up to 40% false positive. Excessive use and false positives could increase harm vs. benefit. These issues have not been systematically examined outside America. Aims To describe current yield variation and CTPA utilisation in Australasian ED, exploring potential factors correlated with variation. Methods A retrospective multi-centre review of consecutive ED-ordered CTPA using standard radiology reports. ED CTPA report data were inputted onto preformatted data-sheets. The primary outcome was site level yield, analysed both intra-site and against a nominated 15.3% yield. Factors potentially associated with yield were assessed for correlation. Results Fourteen radiology departments (15 ED) provided 7077 CTPA data (94% ≥64-slice CT); PE were reported in 1028 (yield 14.6% (95%CI 13.8–15.4%; range 9.3–25.3%; site variation p <0.0001) with four sites significantly below and one above the 15.3% target. Admissions, CTPA usage, PE diagnosis rates and size of PE were uncorrelated with yield. Large PE (≥lobar) were 55% (CI: 52.1–58.2%) and SSPE 8.8% (CI: 7.1–10.5%) of positive scans. CTPA usage (0.2–1.5% adult attendances) was correlated (p<0.006) with PE diagnosis but not SSPE: large PE proportions. Discussion/ Conclusions We found significant intra-site CTPA yield variation within Australasia. Yield was not clearly correlated with CTPA usage or increased small PE rates. Both SSPE and large PE rates were similar to higher yield historical cohorts. CTPA use was considerably below USA 2.5–3% rates. Higher CTPA utilisation was positively correlated with PE diagnoses, but without evidence of increased proportions

  9. The prognostic role of non-critical lactate levels for in-hospital survival time among ED patients with sepsis.

    PubMed

    Aluisio, Adam R; Jain, Ashika; Baron, Bonny J; Sarraf, Saman; Sinert, Richard; Legome, Eric; Zehtabchi, Shahriar

    2016-02-01

    This study describes emergency department (ED) sepsis patients with non-critical serum venous lactate (LAC) levels (LAC <4.0 mmol/L) who suffered in-hospital mortality and examines LAC in relation to survival times. An ED based retrospective cohort study accrued September 2010 to August 2014. Inclusion criteria were ED admission, LAC sampling, >2 systemic inflammatory response syndrome criteria with an infectious source (sepsis), and in-hospital mortality. Kaplan-Meier curves were used for survival estimates. An a priori sub-group analysis for patients with repeat LAC within 6 hours of initial sampling was undertaken. The primary outcome was time to in-hospital death evaluated using rank-sum tests and regression models. One hundred ninety-seven patients met inclusion criteria. Pulmonary infections were the most common (44%) and median LAC was 1.9 mmol/L (1.5, 2.5). Thirteen patients (7%) died within 24 hours and 79% by ≤28 days. Median survival was 11 days (95% CI, 8.0-13). Sixty-two patients had repeat LAC sampling with 14 (23%) and 48 (77%) having decreasing increasing levels, respectively. No significant differences were observed in treatment requirements between the LAC subgroups. Among patients with decreasing LAC, median survival was 24 days (95% CI, 5-32). For patients with increasing LAC median survival was significantly shorter (7 days; 95% CI, 4-11, P = .04). Patients with increasing LAC had a non-significant trend toward reduced survival (HR = 1.6 95% CI, 0.90-3.0, P = .10). In septic ED patients experiencing in-hospital death, non-critical serum venous lactate may be utilized as a risk-stratifying tool for early mortality, while increasing LAC levels may identify those in danger of more rapid deterioration. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Comparative Analgesic Efficacy of Oxycodone/Acetaminophen vs Codeine/Acetaminophen for Short-Term Pain Management Following ED Discharge.

    PubMed

    Chang, Andrew K; Bijur, Polly E; Lupow, Jason B; Gallagher, E John

    2015-12-01

    To test the hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen following emergency department (ED) discharge. Prospective, randomized, double-blind, trial. Adult inner city ED. ED patients with acute extremity pain who were discharged home. Patients randomized to oxycodone/acetaminophen (5 mg/325 mg) or codeine/acetaminophen (30 mg/300 mg). The primary outcome, obtained via telephone one day after ED discharge, was the between-group difference in improvement in numerical rating scale (NRS) pain scores over a 2-hour period following the most recent ingestion of study drug. Secondary outcomes included proportion of patients with >50% pain reduction, side-effect profile, and patient satisfaction. Two hundred and forty patients were enrolled. Mean baseline NRS scores were 7.9 in both groups. Mean decrease over 2 hours was 4.5 NRS units in the oxycodone/acetaminophen group vs 4.2 NRS units in the codeine/acetaminophen group, for a clinically and statistically nonsignificant difference of 0.2 NRS units (95% CI -0.4-0.9 NRS units). Similarly, 66% vs 61% achieved >50% pain relief for a nonsignificant difference of 5% (95% CI -8% to 17%). Side-effect profile and patient satisfaction were similar. Our hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen was rejected. Although pain within each group was reduced by more than half, the between-group difference was not significant. Pending independent validation, these unexpected findings suggest that codeine/acetaminophen, a Schedule III agent, may be a clinically reasonable outpatient opioid alternative to oxycodone/acetaminophen, a more tightly restricted Schedule II agent thought to be more prone to misuse. Wiley Periodicals, Inc.

  11. Improving predictions of carbon fluxes in the tropics undre climatic changes using ED2

    NASA Astrophysics Data System (ADS)

    Feng, X.; Uriarte, M.

    2016-12-01

    Tropical forests play a critical role in the exchange of carbon between land and atmosphere, highlighting the urgency of understanding the effects of climate change on these ecosystems. The most optimistic predictions of climate models indicate that global mean temperatures will increase by up to 2 0C with some tropical regions experiencing extreme heat. Drought and heat-induced tree mortality will accelerate the release of carbon to the atmosphere creating a positive feedback that greatly exacerbates global warming. Thus, under a warmer and drier climate, tropical forests may become net sources, rather than sinks, of carbon. Earth system models have not reached a consensus on the magnitude and direction of climate change impacts on tropical forests, calling into question the reliability of their predictions. Thus, there is an immediate need to improve the representation of tropical forests in earth system models to make robust predictions. The goal of our study is to quantify the responses of tropical forests to climate variability and improve the predictive capacity of terrestrial ecosystem models. We have collected species-specific physiological and functional trait data from 144 tree species in a Puerto Rican rainforest to parameterize the Ecosystem Demography model (ED2). The large amount of data generated by this research will lead to better validation and lowering the uncertainty in future model predictions. To best represent the forest landscape in ED2, all the trees have been assigned to three plant functional types (PFTs): early, mid, and late successional species. Trait data for each PFT were synthesized in a Bayesian meta-analytical model and posterior distributions of traits were used to parameterize the ED2 model. Model predictions show that biomass production of late successional PFT (118.89 ton/ha) was consistently higher than mid (71.33 ton/ha) and early (13.21 ton/ha) PFTs. However, mid successional PFT had the highest contributions to NPP for the

  12. Are family physicians the answer to ED doctor shortage, or 'blasphemy'?

    PubMed

    2011-01-01

    Some organizations maintain that family physicians have the skills and training necessary to practice in the ED and help combat the current physician shortage, while others maintain their training is inadequate. Here are some issues to take into consideration with such candidates: Have they obtained thorough experience the necessary skills to practice in the ED? Have they received a significant amount of clinical training in an ED? Has their training progress been monitored by a teaching attending?

  13. EdF`s Mercier on the biggest maintenance program in the world

    SciTech Connect

    Mercier, E.F.

    1993-08-01

    This article presents an interview with Jean-Pierre Mercier, present vice president of operations and maintenance engineering at Electricite de France (EdF). The maintenance budget for EdF is in the range of 1.5 to 1.7 billion US dollars per year. Mercier discusses the changing direction of the EdF maintenance program, with increasing emphasis on human performance, safety culture, and professionalism at the power station sites and among the many outside contractors.

  14. The ED use and non-urgent visits of elderly patients.

    PubMed

    Gulacti, Umut; Lok, Ugur; Celik, Murat; Aktas, Nurettin; Polat, Haci

    2016-12-01

    To evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits. This cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively. A total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001). While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001). For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001). The prevalence of upper respiratory tract infection (URTI) was the highest within the elderly population (17.5%, CI: 17.1-17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units. The proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries.

  15. Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

    PubMed Central

    Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.

    2013-01-01

    Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields. Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion. Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals are promising avenues for reducing diversion. PMID:24106548

  16. SEM-EDS analysis and discrimination of forensic soil.

    PubMed

    Cengiz, Salih; Cengiz Karaca, Ali; Cakir, Ismail; Bülent Uner, H; Sevindik, Aytekin

    2004-04-20

    Soils vary among different areas, and have some characteristics because of the natural effects and transfers made by human and other living beings in time. So that forensic examination of soil is not only concerned with the analysis of naturally occurring rocks, minerals, vegetation, and animal matter. It also includes the detection of such manufactured materials such as ions from synthetic fertilizers and from different environments (e.g., nitrate, phosphate, and sulfate) as environmental artifacts (e.g., lead or objects as glass, paint chips, asphalt, brick fragments, and cinders) whose presence may impart soil with characteristics that will make it unique to a particular location. Many screening and analytical methods have been applied for determining the characteristics which differentiate and discriminate the forensic soil samples but none of them easily standardized. Some of the methods that applied in forensic laboratories in forensic soil discrimination are the color comparison of the normal air-dried (dehumidified) and overheated soil samples, macroscopic observation, and low-power stereo-microscopic observation, determination of anionic composition by capillary electrophoresis (CE), and the elemental composition by scanning electron microscope (SEM)-energy dispersive X-ray spectrometer (EDS) and other high sensitivity techniques. The objective of this study was to show the effect of the application of 9 tonnes/cm2 pressure on the elemental compositions obtained by SEM-EDS technique and comparing the discrimination power of the pressed-homogenized and not homogenized forensic soil samples. For this purpose soil samples from 17 different locations of Istanbul were collected. Aliquots of the well mixed samples were dried in an oven at 110-120 degrees C and sieved by using 0.5 mm sieve and then the undersieve fraction(<0.5 mm) of these samples put on an adhesive tape placed on a stub. About 100-150 mg aliquots of dried, sieved samples were pressed under 9

  17. Life cycle assessment of biohydrogen and biomethane production and utilisation as a vehicle fuel.

    PubMed

    Patterson, Tim; Esteves, Sandra; Dinsdale, Richard; Guwy, Alan; Maddy, Jon

    2013-03-01

    Environmental burdens for the production and utilisation of biomethane vehicle fuel or a biohydrogen/biomethane blend produced from food waste or wheat feed, based on data from two different laboratory experiments, have been compared. For food waste treated by batch processes the two stage system gave high hydrogen yields (84.2l H2kg(-1) VS added) but a lower overall energy output than the single stage system. Reduction in environmental burdens compared with diesel was achieved, supported by the diversion of waste from landfill. For wheat feed, the semi continuously fed two stage process gave low hydrogen yields (7.5l H2kg(-1) VS added) but higher overall energy output. The process delivers reduction in fossil fuel burdens, and improvements in process efficiencies will lead to reduction in CO2 burdens compared with diesel. The study highlights the importance of understanding and optimising biofuel production parameters according to the feedstock utilised.

  18. Sustainability indicator system and policy processes in Malaysia: a framework for utilisation and learning.

    PubMed

    Hezri, A A

    2004-12-01

    Formulation of effective sustainability indicators for national assessment demands a comprehensive understanding of the utilisation, diffusion and dissemination of information in policy processes. To illustrate the dynamic of sustainability assessment within the context of policy processes, this paper uses a case study of national sustainability indicators development in Malaysia. Subsequently, this paper ascribes the limited achievement of national sustainability assessment in Malaysia to four types of constraints: meta-policy issues; technical capacities; communication concerns; and the inherent knowledge gaps within the indicator developer community vis-a-vis their theoretical limitations. It is proposed that such constraints will be encountered in many countries. Drawing from the literature on public policy, this paper outlines a framework for investigating indicator behaviour within policy processes based on well-established concepts such as knowledge utilisation and policy learning. I conclude this paper by elaborating on the corresponding future challenges that must be addressed before effective integration of sustainability indicators within policy systems can occur.

  19. Effect of a sports food bar on fat utilisation and exercise duration.

    PubMed

    Kolkhorst, F W; MacTaggart, J N; Hansen, M R

    1998-06-01

    The manufacturer claims that using the Access Fat Conversion Activity Bar increases fat utilisation, which would have a glycogen-sparing effect and delay the onset of fatigue from endurance exercise. This claim was tested using seven trained distance runners who performed two trials of treadmill running at 73% of VO2max to exhaustion. In a counterbalanced design, subjects ingested either one Access Bar with water or water only prior to treadmill running. Times to exhaustion for the control and Access treatment trials were 104.6 +/- 24.9 min and 93.9 +/- 21.4 min, respectively, and were not significantly different (p > .05). Differences between trials were not observed for the respiratory exchange ratio, blood lactate or glucose concentrations, plasma glycerol concentration, or perceived exertion. Based on results from this study, it was concluded that the Access Bar does not affect fat or carbohydrate utilisation and does not improve exercise endurance.

  20. The specificity of energy utilisation by trained and untrained adolescent boys.

    PubMed

    Armstrong, N; Davies, B; Heal, M

    1983-09-01

    This study examined the relationship between estimates of alactacid anaerobic power, lactacid anaerobic power and aerobic power in a sample of trained swimmers (age 14.4 yr., n = 8) and a sample of untrained boys (age 13.7 yr., n = 13). The anaerobic power outputs were estimated using a modification of the Wingate Anaerobic Test and aerobic power was estimated using a continuous, incremental cycle ergometer test. In addition to leg power outputs the swimmers' arm power using each energy system was estimated and compared with the corresponding leg value. There was no relationship between the estimates of the power of the three energy systems with either the trained or untrained boys. Furthermore with the trained boys there was no relationship between estimates of the power of the same energy system utilised by different limbs. The data support a specificity hypothesis of energy utilisation during exercise with both trained and untrained adolescent boys.

  1. FormEd: An X Window System application for managing first-order formulas

    SciTech Connect

    Henry, T.L.; McCune, W.W.

    1990-11-01

    FormEd is a window-based program for constructing, displaying, and managing first-order logic formulas. The main motivation for constructing FormEd was the desire to have formulas displayed in a readable, two-dimensional format. Users of FormEd can make two kinds of transformation on formulas: logic transformations, such as negation normal form translation, which preserve the meaning of a formula, and edit transformations, which can be used to make arbitrary changes, such as adding a hypothesis to a subformula. FormEd was written by using the X Window System, Version 11, and code from the theorem prover OTTER. 4 refs.

  2. Curvature sensing MARCKS-ED peptides bind to membranes in a stereo-independent manner.

    PubMed

    Yan, Lei; de Jesus, Armando Jerome; Tamura, Ryo; Li, Victoria; Cheng, Kui; Yin, Hang

    2015-07-01

    Membrane curvature and lipid composition plays a critical role in interchanging of matter and energy in cells. Peptide curvature sensors are known to activate signaling pathways and promote molecular transport across cell membranes. Recently, the 25-mer MARCKS-ED peptide, which is derived from the effector domain of the myristoylated alanine-rich C kinase substrate protein, has been reported to selectively recognize highly curved membrane surfaces. Our previous studies indicated that the naturally occurring L-MARCKS-ED peptide could simultaneously detect both phosphatidylserine and curvature. Here, we demonstrate that D-MARCKS-ED, composed by unnatural D-amino acids, has the same activities as its enantiomer, L-MARCKS-ED, as a curvature and lipid sensor. An atomistic molecular dynamics simulation suggests that D-MARCKS-ED may change from linear to a boat conformation upon binding to the membrane. Comparable enhancement of fluorescence intensity was observed between D- and L-MARCKS-ED peptides, indicating similar binding affinities. Meanwhile, circular dichroism spectra of D- and L-MARCKS-ED are almost symmetrical both in the presence and absence of liposomes. These results suggest similar behavior of artificial D- and natural L-MARCKS-ED peptides when binding to curved membranes. Our studies may contribute to further understanding of how MARCKS-ED senses membrane curvature as well as provide a new direction to develop novel membrane curvature probes.

  3. Validity and reliability of the Evidence Utilisation in Policymaking Measurement Tool (EUPMT).

    PubMed

    Imani-Nasab, M H; Yazdizadeh, B; Salehi, M; Seyedin, H; Majdzadeh, R

    2017-08-04

    As a well-known theory in studying the effective factors on behaviour, the theory of planned behaviour (TPB) is frequently used in evaluating the health behaviour of people and healthcare providers, but rarely applied in studying the behaviour of health policymakers. The aim of the present study is to design and validate a TPB-based measurement tool for evidence utilisation in health policymaking (the EUPMT) through a mixed approach using confirmatory factor analysis. The study population consisted of all the specialised units and their employees in the five deputies of Iran's Ministry of Health and Medical Education in 2013. All those eligible were invited to participate in the study, which comprised 373 persons. The reliability of the EUPMT was determined through test-retest and internal consistency. Additionally, its validity was determined by face, content, convergent, discriminant and construct validities. SPSS-20 and LISREL-8.8 were employed to analyse the data. To assess the fitness of the measurement models, three groups of indices were used, i.e. absolute, relative and parsimonious. The content and face validities of the tool were 83% and 67%, respectively. Cronbach's alpha of different constructs ranged from 0.7 to 0.9. In the test-retest method, the intra-class correlations were between 0.75 and 0.87. Confirmatory factor analysis showed that the penta-factorial structure of the experimental data had acceptable fitness with the TPB (GFI = 0.86, NFI = 0.94, RSMEA = 0.075). TPB is able to explain the behaviour of evidence utilisation in health policymaking. The finalised TPB-based tool has relatively good reliability and validity to assess evidence utilisation in health policymaking. The EUPMT can be applied to determine the status quo of evidence utilisation in health policymaking, whilst designing interventions for its improvement and assessing their outcomes.

  4. Characteristics of unturned eggs: critical period, retarded embryonic growth and poor albumen utilisation.

    PubMed

    Deeming, D C

    1989-06-01

    1. The physiological effects of egg turning during incubation are described. 2. There was a critical period for turning, from days 3 to 7 of incubation, which affected hatchability, embryo growth and utilisation of extra-embryonic fluids. 3. Failure to turn eggs retarded formation of allantoic and amniotic fluids, restricted alumen uptake and retarded growth of the embryo, but only after day 12 of incubation.

  5. A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India

    PubMed Central

    2014-01-01

    Background A major aspect of providing mental healthcare is access to and use of psychotropic medications. Bihar is a state in northeast India with limited mental healthcare provision; consequently access to and utilisation of psychotropic medications are likely to be limited. However, to date there has been no research assessing the situation. This study therefore aims to analyse the psychotropic medications management cycle (selection, procurement, distribution and use), and identify the barriers to access and utilisation, and their underlying causes. Method A rapid appraisal method was used in which primary and secondary data sources were collected and analysed. Semi-structured interviews were conducted with twenty-two stakeholders and twenty-one service users from the government, non-governmental organisation (NGO) and private sectors. The qualitative data collected was analysed using a comparative thematic approach. The research was supported by the NGOs BasicNeeds and Nav Bharat Jagriti Kendra. Results Availability, distance and cost were the main barriers to access and utilisation. At the medical college hospital level a lack of supply appears to be due to a discrepancy between orders made by the hospital and medications supplied by the manufacturers. At the primary health centre and district hospital level the main barrier is a cycle between lack of demand for treatments for mental illness by doctors and patients. Conclusion Further investigation and monitoring is necessary to ensure the availability of psychotropic medications at the medical college hospital level. In addition, implementation of the District Mental Health Programme is likely to address the access and utilisation barriers due to its potential to break the current cycle of lack of demand. PMID:25053976

  6. Automatic Detection of Military Targets Utilising Neural Networks and Scale Space Analysis

    DTIC Science & Technology

    2001-04-01

    Detection of Military Targets utilising Neural Networks and Scale Space Analysis A. Khashman Chairman, Department of Computer Engineering Near East...and 3) high computational cost. This required for the employment of neural networks and new approach to edge detection is formalized in the providing...analysis, edge detection and of the Laplacian of the Gaussian (FLoG) edge neural networks . The result is an automatic edge detection operator [1][2], as

  7. Mental Health Status, Health Care Utilisation, and Service Satisfaction among Immigrants in Montreal: An Epidemiological Comparison.

    PubMed

    Whitley, Rob; Wang, JiaWei; Fleury, Marie-Josee; Liu, Aihua; Caron, Jean

    2017-08-01

    To examine variations between immigrants and nonimmigrants in 1) prevalence of common mental disorders and other mental health variables; 2) health service utilisation for emotional problems, mental disorders, and addictions, and 3) health service satisfaction. This article is based on a longitudinal cohort study conducted from May 2007 to the present: the Epidemiological Catchment Area Study of Montreal South-West (ZEPSOM). Participants were followed up at 4 time points (T1, n = 2433; T4, n = 1095). Core exposure variables include immigrant status (immigrant vs. nonimmigrant), duration of residence, and region of origin. Key outcome variables included mental health status, health service utilisation, and health service satisfaction. Data were analysed both cross-sectionally and longitudinally. Immigrants had been in Canada for 20 years on average. Immigrants had significantly lower rates of high psychological distress (32.6% vs. 39.1%, P = 0.016), alcohol dependence (1.4% vs. 3.9%, P =0.010), depression (5.2% vs. 9.2%, P = 0.008), and various other mental disorders. They had significantly higher scores of mental well-being (48.9 vs. 47.1 score, P = 0.014) and satisfaction with social (34.0 vs. 33.4 score, P = 0.021) and personal relationships (16.7 vs. 15.6 score, P < 0.001). Immigrants had significantly lower rates of health service utilisation for emotional problems, mental disorders, and addictions and significantly higher rates of health service satisfaction at all time points. Asian and African immigrants had particularly low rates of utilisation and high rates of satisfaction. Immigrants had better overall mental health than nonimmigrants.

  8. Prevalence and risk factors associated with hepatitis C in ED patients.

    PubMed

    Brillman, Judith C; Crandall, Cameron S; Florence, Christopher S; Jacobs, Joshua L

    2002-09-01

    The objective of this study was to measure the prevalence of and identify risk factors associated with hepatitis C virus (HCV) in emergency department (ED) patients. Adults presenting to an urban university teaching hospital, having blood drawn as part of their routine evaluation, had an extra tube drawn and tested for HCV. English-speaking adults consenting to participate in the survey portion of the study were administered an in-depth risk factor questionnaire. A case-control analysis was used to identify risk factors in HCV+ compared with HCV- subjects. Contingency table analyses using the Fisher exact test, odds ratios (OR), and 95% confidence intervals (CI) were used for risk factor identification. Of 223 blood samples, 38 (17%) were positive for antibodies for HCV. One hundred twenty-one subjects (54%) agreed to the risk factor survey, 18 (15%) of whom were HCV+. Of the 18 HCV+ survey participants, 12 new diagnoses of HCV were made. A history of injection drug use was the most significant risk factor associated with HCV (OR 858.5, CI 61.8-22,026.5). A high prevalence of HCV is found in selected urban ED patients. Most of these patients have a constellation of risk factors including a history of injection drug use. Efforts to identify at risk patients for serologic testing and follow-up should be initiated. Identifying undiagnosed HCV can lead to interventions to decrease transmission as well as reduce the morbidity and mortality of disease. Copyright 2002, Elsevier Science (USA). All rights reserved.

  9. Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis.

    PubMed

    Patel, Tyag K; Weis, James C

    2017-06-01

    Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54year old man who presented to the emergency department. The neck pain is due to inflammation caused by calcium hydroxyapatite crystal deposition in the tendons on the longus colli muscles. This is non-infectious. The gold standard for diagnosis is a CT neck which best shows the calcifications in the anterior vertebral column of C1-C4, where the tendons of these muscles insert bilaterally. Longus colli calcific tendinitis is not life-threatening and patients will make a full recovery after treatment with NSAIDs. However, this condition is often confused with life-threatening conditions such as infection (meningitis or retropharyngeal abscess), intracranial hemorrhage, trauma, herniation of cervical discs, or malignancy (Estimable et al. (2015) [1]). Symptoms associated with calcific tendinitis of the longus colli muscle are non-specific and include mild fever, moderate-severe headache, neck pain, and drastically reduced range of motion of the neck. More specific symptoms are the presence of dysphagia and odynophagia. Lab findings usually are significant for mild leukocytosis, and elevated ESR and CRP. Awareness of this condition by E.D. physicians can avoid unnecessary invasive interventions, increased costs, and delays that result from incorrect diagnosis and treatment. This is a unique case in which a patient who was afebrile with a normal ESR was worked up for meningitis and an intracranial process, and also empirically treated for meningitis before finally being diagnosed with acute calcific tendinitis of the longus colli muscle in the E.D. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. The FAST-ED App: A Smartphone Platform for the Field Triage of Patients With Stroke.

    PubMed

    Nogueira, Raul G; Silva, Gisele S; Lima, Fabricio O; Yeh, Yu-Chih; Fleming, Carol; Branco, Daniel; Yancey, Arthur H; Ratcliff, Jonathan J; Wages, Robert Keith; Doss, Earnest; Bouslama, Mehdi; Grossberg, Jonathan A; Haussen, Diogo C; Sakano, Teppei; Frankel, Michael R

    2017-05-01

    The Emergency Medical Services field triage to stroke centers has gained considerable complexity with the recent demonstration of clinical benefit of endovascular treatment for acute ischemic stroke. We sought to describe a new smartphone freeware application designed to assist Emergency Medical Services professionals with the field assessment and destination triage of patients with acute ischemic stroke. Review of the application's platform and its development as well as the different variables, assessments, algorithms, and assumptions involved. The FAST-ED (Field Assessment Stroke Triage for Emergency Destination) application is based on a built-in automated decision-making algorithm that relies on (1) a brief series of questions assessing patient's age, anticoagulant usage, time last known normal, motor weakness, gaze deviation, aphasia, and hemineglect; (2) a database of all regional stroke centers according to their capability to provide endovascular treatment; and (3) Global Positioning System technology with real-time traffic information to compute the patient's eligibility for intravenous tissue-type plasminogen activator or endovascular treatment as well as the distances/transportation times to the different neighboring stroke centers in order to assist Emergency Medical Services professionals with the decision about the most suitable destination for any given patient with acute ischemic stroke. The FAST-ED smartphone application has great potential to improve the triage of patients with acute ischemic stroke, as it seems capable to optimize resources, reduce hospital arrivals times, and maximize the use of both intravenous tissue-type plasminogen activator and endovascular treatment ultimately leading to better clinical outcomes. Future field studies are needed to properly evaluate the impact of this tool in stroke outcomes and resource utilization. © 2017 American Heart Association, Inc.

  11. Socioeconomic determinants of psychotropic drug utilisation among elderly: a national population-based cross-sectional study

    PubMed Central

    2010-01-01

    Background Psychotropic drugs are commonly utilised among the elderly. This study aimed to analyse whether two socioeconomic determinants - income and marital status - are associated with differences in utilisation of psychotropic drugs and potentially inappropriate psychotropic drugs among elderly in Sweden. Methods All individuals aged 75 years and older who had purchased a psychotropic drug in Sweden during 2006 were included (68.7% women, n = 384712). Data was collected from national individual-based registers. Outcome measures were utilisation of three or more psychotropic drugs and utilisation of potentially inappropriate psychotropic drugs, as classified by the Swedish National Board of Health and Welfare. Results Individuals with low income were more likely to utilise three or more psychotropic drugs compared to those with high income; adjusted odds ratio (aOR) 1.12 (95% confidence interval [CI] 1.10-1.14). The non-married had a higher probability for utilising three or more psychotropic drugs compared to the married (aOR 1.22; CI 1.20-1.25). The highest probability was observed among the divorced and the never married. Potentially inappropriate psychotropic drugs were more common among individuals with low compared to high income (aOR 1.14; CI 1.13-1.16). Compared to the married, potentially inappropriate psychotropic drug utilisation occurred more commonly among the non-married (aOR 1.08; CI 1.06-1.10). The never married and the divorced had the highest probability. Conclusions There was an association between socioeconomic determinants and psychotropic drug utilisation. The probability for utilising potentially inappropriate psychotropics was higher among individuals with low income and among the non-married. PMID:20214796

  12. How are policy makers using evidence? Models of research utilisation and local NHS policy making

    PubMed Central

    Elliott, H.; Popay, J.

    2000-01-01

    STUDY OBJECTIVE—This paper is based on a qualitative study that aimed to identify factors that facilitate or impede evidence-based policy making at a local level in the UK National Health Service (NHS). It considers how models of research utilisation drawn from the social sciences map onto empirical evidence from this study.
DESIGN—A literature review and case studies of social research projects that were initiated by NHS health authority managers or GP fundholders in one region of the NHS. In depth interviews and document analysis were used.
SETTING—One NHS region in England.
PARTICIPANTS—Policy makers, GPs and researchers working on each of the social research projects selected as case studies.
MAIN RESULTS—The direct influence of research evidence on decision making was tempered by factors such as financial constraints, shifting timescales and decision makers' own experiential knowledge. Research was more likely to impact on policy in indirect ways, including shaping policy debate and mediating dialogue between service providers and users.
CONCLUSIONS—The study highlights the role of sustained dialogue between researchers and the users of research in improving the utilisation of research-based evidence in the policy process.


Keywords: evidence-based policy making; research/policy interface; research utilisation PMID:10818123

  13. Influence of palm olein on protein utilisation in the growing rat.

    PubMed

    Henry, C J; Ghusain-Choueiri, A; Gurr, M I

    1999-03-01

    In view of our preliminary findings that refined palm oil (RPOL) enhanced protein utilisation, and because of the growing importance of palm oil in human diets, two separate studies were conducted. The first study aimed to investigate the effect of the palm oil source and fraction on protein utilisation, as determined by net protein utilization (NPU) in growing rats. The second study aimed to investigate the influence of the dietary concentration of one particular palm oil fraction, refined palm olein (RPO) on net protein utilisation. The fat source of each of the semi-purified diets was as follows: crude palm oil (CPO), refined palm kernel oil (RKO), refined palm olein (RPO), refined palm stearin (RPS), and refined palm oil (RPOL). A sixth control group was offered an identical diet but with olive oil (OO, control) as the fat source. Both the oil source (P < 0.01) and the oil level (P < 0.05) influenced NPU in rats. NPU values were generally higher for rats given the RPO-containing diets, particularly at the 20% dietary level (P < 0.01) compared to the diets containing ground nut oil (GNO). The results of these two experiments indicate that RPO influences protein metabolism specifically at a concentration of at least 20% in the diet. This may suggest that RPO is superior to GNO as a source of fat for the rehabilitation of malnourished children. Human trials notably during the rehabilitation of malnourished children may therefore be the next step in this line of research.

  14. Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda.

    PubMed

    Musoke, David; Boynton, Petra; Butler, Ceri; Musoke, Miph Boses

    2014-12-01

    The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs. To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda. The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish. While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities. There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.

  15. Utilisation of prey by antlion larvae (Neuroptera: Myrmeleontidae) in terms of energy and nutrients.

    PubMed

    De K Van Der Linde, T C.; Van Der Westhuizen, M C.; Van Zyl, A

    1997-07-01

    Prey utilisation at low prey densities was determined for third instar Cueta sp., Furgella intermedia (Markl) and Palpares annulatus (Stitz) larvae in terms of wet weight, dry weight, energy and nutrients. Prey utilisation was similar to other insects on a wet weight (42-47%), dry weight (46-49%), energetic (40-58%) and nutritive basis (62-79%). Lipids (33-36%) provided energetically the highest contribution of the nutrients ingested. The quantities of water, proteins, nucleic acids, lipids and carbohydrates extracted by the antlion larvae were in proportion to their availability in their prey, the Hodotermes mossambicus larvae. The quantities of nutrients extracted by the antlion larvae at low prey densities were not significantly influenced by the differences in mandible size, antlion body weight or the trapping method (building a pit or not) of the antlion species. It is proposed that a low metabolic rate and the accumulation of fat reserves, and not the extent of prey utilisation, enable P. annulatus larvae to tolerate a 123-d starvation period in which 22.3% of their body weight is lost.

  16. Health service utilisation of rural-to-urban migrants in Guangzhou, China: does employment status matter?

    PubMed

    Song, Xiaolei; Zou, Guanyang; Chen, Wen; Han, Siqi; Zou, Xia; Ling, Li

    2017-01-01

    To describe the self-reported health status and service utilisation of employed, retired and unemployed migrants in Guangzhou, a megacity in southern China. A cross-sectional study adapted from the National Health Service Survey was conducted between September and December in 2014. Based on the distribution of occupation of migrants, multistage sampling was used to recruit individuals. Logistic regression was applied to explore the factors influencing their service utilisation. Of 2906 respondents, 76.6% were employed, 9.2% retired and 14.2% unemployed. Only 8.1% reported having an illness in the previous 2 weeks, and 6.5% reported having been hospitalised in the previous year. Employed migrants had the lowest recent physician consultation rate (3.4%) and the lowest annual hospitalisation rate (4.5%) (P < 0.05); unemployed migrants had the highest rates (6.8% and 14.5% respectively, P < 0.05). Retired migrants were more likely to return to their hometown for health care (8.6%) than employed (1.5%) and unemployed migrants (3.4%) (P < 0.05). After adjusting for age and gender, employment status remained significant in explaining the recent two-week treatment-seeking behaviour of migrants (P < 0.05). Disparity of service utilisation continues to be a problem for migrants due to the poor health awareness, lack of time and inconvenience of medical insurance reimbursement. Employed migrants make the least use of health services. © 2016 John Wiley & Sons Ltd.

  17. How to identify, assess and utilise mobile medical applications in clinical practice.

    PubMed

    Aungst, T D; Clauson, K A; Misra, S; Lewis, T L; Husain, I

    2014-02-01

    There are thousands of medical applications for mobile devices targeting use by healthcare professionals. However, several factors related to the structure of the existing market for medical applications create significant barriers preventing practitioners from effectively identifying mobile medical applications for individual professional use. To define existing market factors relevant to selection of medical applications and describe a framework to empower clinicians to identify, assess and utilise mobile medical applications in their own practice. Resources available on the Internet regarding mobile medical applications, guidelines and published research on mobile medical applications. Mobile application stores (e.g. iTunes, Google Play) are not effective means of identifying mobile medical applications. Users of mobile devices that desire to implement mobile medical applications into practice need to carefully assess individual applications prior to utilisation. Searching and identifying mobile medical applications requires clinicians to utilise multiple references to determine what application is best for their individual practice methods. This can be done with a cursory exploration of mobile application stores and then moving onto other available resources published in the literature or through Internet resources (e.g. blogs, medical websites, social media). Clinicians must also take steps to ensure that an identified mobile application can be integrated into practice after carefully reviewing it themselves. Clinicians seeking to identify mobile medical application for use in their individual practice should use a combination of app stores, published literature, web-based resources, and personal review to ensure safe and appropriate use. © 2014 John Wiley & Sons Ltd.

  18. Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

    PubMed

    Enosolease, M E; Imarengiaye, C O; Awodu, O A

    2004-08-01

    Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

  19. ED plaster-of-Paris jacket for infantile scoliosis.

    PubMed

    Morin, Christian; Kulkarni, Shrirang

    2014-07-01

    There are various articles published in last few years which consider surgical methods like growing rod instrumentation and modulation of the growth as a "gold standard" for the treatment of early onset severe scoliosis. We emphasize orthopaedic correction with serial casting as another option for such progressive deformity. The key to the success of this treatment is to understand the strategy and the technique involved in the effective casting. The conventional technique of elongation, derotation, flexion cast (named EDF by Cotrel) is described with some modifications like wedging the cast (gypsotomy) in order to produce the flexion component. Serial casting with ED casts for the treatment of progressive idiopathic infantile scoliosis is an effective tool for the benign types of curves (Mehta) and spinal fusion was not necessary in two-third of our cases. Surgical option for treatment of early onset scoliosis is not a "gold standard". Orthopaedic treatment with serial elongation, derotation casts remain the centerpiece of this treatment. Each detail to understand the technique must be known in order to obtain the best result.

  20. The utility of transvaginal ultrasound in the ED evaluation of complications of first trimester pregnancy.

    PubMed

    Panebianco, Nova L; Shofer, Frances; Fields, J Matthew; Anderson, Kenton; Mangili, Alessandro; Matsuura, Asako C; Dean, Anthony J

    2015-06-01

    For patients with early intrauterine pregnancy (IUP), the sonographic signs of the gestation may be below the resolution of transabdominal ultrasound (TAU); however, it may be identified by transvaginal ultrasound (TVU). We sought to determine how often TVU performed in the emergency department (ED) reveals a viable IUP after a nondiagnostic ED TAU and the impact of ED TVU on patient length of stay (LOS). This was a retrospective cohort study of women presenting to our ED with complications of early pregnancy from January 1, 2007 to February 28, 2009 in a single urban adult ED. Abstractors recorded clinical and imaging data in a database. Patient imaging modality and results were recorded and compared with respect to ultrasound (US) findings and LOS. Of 2429 subjects identified, 795 required TVU as part of their care. Emergency department TVU was performed in 528 patients, and 267 went to radiology (RAD). Emergency department TVU identified a viable IUP in 261 patients (49.6%). Patients having initial ED US had shorter LOS than patients with initial RAD US (median 4.0 vs 6.0 hours; P < .001). Emergency department LOS was shorter for women who had ED TVU performed compared with those sent for RAD TVU regardless of the findings of the US (median 4.9 vs 6.7 hours; P < .001). There was no increased LOS for patients who needed further RAD US after an indeterminate ED TVU (7.0 vs 7.1 hours; P = .43). There was no difference in LOS for those who had a viable IUP confirmed on ED TAU vs ED (median 3.1 vs 3.2 hours, respectively; P < .32). When an ED TVU was performed, a viable IUP was detected 49.6% of the time. Emergency department LOS was significantly shorter for women who received ED TVU after indeterminate ED TAU compared with those sent to RAD for TVU, with more marked time savings among those with live IUP diagnosed on ED TVU. For patients who do not receive a definitive diagnosis of IUP on ED TVU, this approach does not result in increased LOS. Copyright © 2015

  1. A Preliminary Examination of Loss of Control Eating Disorder (LOC-ED) in Middle Childhood

    PubMed Central

    Matherne, Camden E.; Tanofsky-Kraff, Marian; Altschul, Anne M.; Shank, Lisa M.; Schvey, Natasha A.; Brady, Sheila M.; Galescu, Ovidiu; Demidowich, Andrew P.; Yanovski, Susan Z.; Yanovski, Jack A.

    2015-01-01

    Loss of Control Eating Disorder (LOC-ED) has been proposed as a diagnostic category for children 6–12y with binge-type eating. However, characteristics of youth with LOC-ED have not been examined. We tested the hypothesis that the proposed criteria for LOC-ED would identify children with greater adiposity, more disordered eating attitudes, and greater mood disturbance than those without LOC-ED. Participants were 251 youth (10.29y ± 1.54, 53.8% female, 57.8 % White, 35.5% Black, 2.0% Asian, 4.8% Hispanic, 53.0% overweight). Youth were interviewed regarding eating attitudes and behaviors, completed questionnaires to assess general psychopathology, and underwent measurements of body fat mass. Using previously proposed criteria for LOC-ED, children were classified as LOC-ED (n = 19), LOC in the absence of the full disorder (subLOC, n = 33), and youth not reporting LOC (noLOC, n = 199). LOC-ED youth had higher BMIz (p = 0.001) and adiposity (p = 0.003) and reported greater disordered eating concerns (p < 0.001) compared to noLOC youth. Compared to subLOC youth, LOC-ED youth had non-significantly higher BMIz (p = 0.11), and significantly higher adiposity (p = 0.04) and disordered eating attitudes (p = 0.02). SubLOC youth had greater disordered eating concerns (p < 0.001) and BMIz (p = 0.03) but did not differ in adiposity (p = 0.33) compared to noLOC youth. These preliminary data suggest that LOC-ED youth are elevated on disordered eating cognitions and anthropometric measures compared to youth without LOC-ED. Longitudinal studies are needed to determine if those with LOC-ED are at particularly increased risk for progression of disordered eating and excess weight gain. PMID:25913008

  2. A preliminary examination of Loss of Control Eating Disorder (LOC-ED) in middle childhood.

    PubMed

    Matherne, Camden E; Tanofsky-Kraff, Marian; Altschul, Anne M; Shank, Lisa M; Schvey, Natasha A; Brady, Sheila M; Galescu, Ovidiu; Demidowich, Andrew P; Yanovski, Susan Z; Yanovski, Jack A

    2015-08-01

    Loss of Control Eating Disorder (LOC-ED) has been proposed as a diagnostic category for children 6-12years with binge-type eating. However, characteristics of youth with LOC-ED have not been examined. We tested the hypothesis that the proposed criteria for LOC-ED would identify children with greater adiposity, more disordered eating attitudes, and greater mood disturbance than those without LOC-ED. Participants were 251 youth (10.29years±1.54, 53.8% female, 57.8% White, 35.5% Black, 2.0% Asian, 4.8% Hispanic, 53.0% overweight). Youth were interviewed regarding eating attitudes and behaviors, completed questionnaires to assess general psychopathology, and underwent measurements of body fat mass. Using previously proposed criteria for LOC-ED, children were classified as LOC-ED (n=19), LOC in the absence of the full disorder (subLOC, n=33), and youth not reporting LOC (noLOC, n=199). LOC-ED youth had higher BMIz (p=0.001) and adiposity (p=0.003) and reported greater disordered eating concerns (p<0.001) compared to noLOC youth. Compared to subLOC youth, LOC-ED youth had non-significantly higher BMIz (p=0.11), and significantly higher adiposity (p=0.04) and disordered eating attitudes (p=0.02). SubLOC youth had greater disordered eating concerns (p<0.001) and BMIz (p=0.03) but did not differ in adiposity (p=0.33) compared to noLOC youth. These preliminary data suggest that LOC-ED youth are elevated on disordered eating cognitions and anthropometric measures compared to youth without LOC-ED. Longitudinal studies are needed to determine if those with LOC-ED are at particularly increased risk for progression of disordered eating and excess weight gain.

  3. Preventing avoidable incidents leading to a presentation to the emergency department (ED) by older adults with cognitive impairment: protocol for a scoping review

    PubMed Central

    Provencher, Véronique; Généreux, Mélissa; Gagnon-Roy, Mireille; Veillette, Nathalie; Egan, Mary; Sirois, Marie-Josée; Lacasse, Francis; Rose, Kathy; Stocco, Stéphanie

    2016-01-01

    Introduction Older adults with cognitive impairment represent a large portion (21–42%) of people (65+) who consult at an emergency department (ED). Because this sub-group is at higher risk for hospitalisation and mortality following an ED visit, awareness about ‘avoidable’ incidents should be increased in order to prevent presentations to the ED due to such incidents. This study aims to synthetise the actual knowledge related to ‘avoidable’ incidents (ie, traumatic injuries, poisoning and other consequences of external causes) (WHO, 2016) leading to ED presentations in older people with cognitive impairment. Methodology and analysis A scoping review will be performed. Scientific and grey literature (1996–2016) will be searched using a combination of key words pertaining to avoidable incidents, ED presentations, older adults and cognitive impairment. A variety of databases (MEDLINE, CINAHL, Ageline, SCOPUS, ProQuest Dissertations/theses, EBM Reviews, Healthstar), online library catalogues, governmental websites and published statistics will be examined. Included sources will pertain to community-dwelling older adults presenting to the ED as a result of an avoidable incident, with the main focus on those with cognitive impairment. Data (eg, type, frequency, severity, circumstances of incidents, preventive measures) will be extracted and analysed using a thematic chart and content analysis. Discussion and dissemination This scoping review will provide a picture of the actual knowledge on the subject and identify knowledge gaps in existing literature to be filled by future primary researches. Findings will help stakeholders to develop programmes in order to promote safe and healthy environments and behaviours aimed at reducing avoidable incidents in seniors, especially those with cognitive impairment. PMID:26873049

  4. Using edTPA to Compare Online and Face to Face Teacher Preparation Programs

    ERIC Educational Resources Information Center

    Heafner, Tina; Petty, Teresa

    2016-01-01

    Central to determining the effectiveness of technology to support learning and the value of technology-mediated instruction is the quality of programs. edTPA is a widely accepted, national measure of teacher readiness and preparation. Using edTPA score reports for teacher candidates completing a teacher education program, this study provides data…

  5. Evaluation of the Demonstration Sites in the ConnectEd Network

    ERIC Educational Resources Information Center

    Farr, Beverly; Bradby, Denise; Hartry, Ardice; Sipes, Laurel; Hall, Leslie; Tasoff, Shayna

    2009-01-01

    In California, the James Irvine Foundation created ConnectEd: The California Center for College and Career to promote multiple pathways that link to the state's 15 major industry sectors. The ConnectEd Network of Schools, a demonstration project supported by Irvine, plays a critical role in expanding student options through multiple pathways and…

  6. Multiple Intelligence and Digital Learning Awareness of Prospective B.Ed Teachers

    ERIC Educational Resources Information Center

    Gracious, F. L. Antony; Shyla, F. L. Jasmine Anne

    2012-01-01

    The present study Multiple Intelligence and Digital Learning Awareness of prospective B.Ed teachers was probed to find the relationship between Multiple Intelligence and Digital Learning Awareness of Prospective B.Ed Teachers. Data for the study were collected using self made Multiple Intelligence Inventory and Digital Learning Awareness Scale.…

  7. Connecting Teachers and Ed-Tech Developers: Lessons from NYC's "Gap App" Program. Report

    ERIC Educational Resources Information Center

    Villavicencio, Adriana; Siman, Nina; Lafayette, Camille; Kang, David

    2016-01-01

    In 2011, with support from a federal Investing in Innovation grant, the NYC Department of Education launched Innovate NYC Schools. The initiative was designed to address two, related challenges to effectively integrating education technology (ed-tech) into classrooms: First, procurement of ed-tech tools is often hampered by a disconnect between…

  8. G. ED. Paper-Book 1974-1984. The Process of Growth of an Innovation.

    ERIC Educational Resources Information Center

    Verduin-Muller, Henriette, Ed.

    Fifteen papers presented at conferences throughout Europe and in the USSR, Nigeria, Japan, Jamaica, and Tunesia provide an introduction to the research work being done by the graduate level Department of Geography for Education (G.ED.) at the University of Utrecht in the Netherlands. An introductory chapter describes the three G.ED. modules, which…

  9. Economic Development Network (ED>Net): 1995-96 Report to the Governor and the Legislature.

    ERIC Educational Resources Information Center

    California Community Colleges, Sacramento. Office of the Chancellor.

    The Economic Development Network (ED>Net) of the California Community Colleges was designed to advance the state's economic growth and competitiveness by coordinating and facilitating workforce improvement, technology deployment, and business development initiatives. This report reviews outcomes for ED>Net for 1995-96 based on reports…

  10. Is There a Future for Teacher Ed Curriculum? An Answer from History and Moral Philosophy

    ERIC Educational Resources Information Center

    Null, J. Wesley

    2008-01-01

    Is there a future for teacher ed "curriculum"? The author contends that he is not sure if there is a future for teacher ed curriculum, but if such a future is to exist, the answer will come only from history and moral philosophy. In this article, the author opines that individuals cannot make good decisions about the future of teacher ed…

  11. 75 FR 11937 - EDS, HP Company, Fairfield Township, OH; Notice of Termination of Investigation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration EDS, HP Company, Fairfield Township, OH; Notice of Termination of... response to a petition filed on October 29, 2009 by the State on behalf of workers of EDS, HP Company...

  12. A Review of "Older, Wiser, Sexually Smarter: 30 Sex Ed Lessons for Adults Only"

    ERIC Educational Resources Information Center

    Garrity, Joan Mogul

    2010-01-01

    While virtually all sex ed curricula are designed to be used with children, teens and young adults, "Older, Wiser, Sexually Smarter: 30 Sex Ed Lessons for Adults Only" ([C] 2009, Planned Parenthood of Greater Northern New Jersey) offers lessons to help participants fully embrace the possibility of sexual pleasure and intimacy from mid-life through…

  13. A Review of "Older, Wiser, Sexually Smarter: 30 Sex Ed Lessons for Adults Only"

    ERIC Educational Resources Information Center

    Garrity, Joan Mogul

    2010-01-01

    While virtually all sex ed curricula are designed to be used with children, teens and young adults, "Older, Wiser, Sexually Smarter: 30 Sex Ed Lessons for Adults Only" ([C] 2009, Planned Parenthood of Greater Northern New Jersey) offers lessons to help participants fully embrace the possibility of sexual pleasure and intimacy from mid-life through…

  14. Connecting Teachers and Ed-Tech Developers: Lessons from NYC's "Gap App" Program. Technical Appendices

    ERIC Educational Resources Information Center

    Villavicencio, Adriana; Siman, Nina; Lafayette, Camille; Kang, David

    2016-01-01

    In 2011, with support from a federal Investing in Innovation grant, the NYC Department of Education launched Innovate NYC Schools. The initiative was designed to address two, related challenges to effectively integrating education technology (ed-tech) into classrooms: First, procurement of ed-tech tools is often hampered by a disconnect between…

  15. Emotional Disturbance and School Personnel's Interactions: Perspectives of Families of Youth with ED

    ERIC Educational Resources Information Center

    Smith-Quinn, Renee

    2012-01-01

    Nearly eight percent of the six million students, ages 6 to 21 years, who are receiving special education or related services are identified as having Emotional Disturbance (ED). Students with ED have been identified among all students with disabilities as having the worst student outcomes such as lower grades, high failing rates, higher…

  16. ED-B fibronectin expression is a marker of epithelial-mesenchymal transition in translational oncology.

    PubMed

    Petrini, Iacopo; Barachini, Serena; Carnicelli, Vittoria; Galimberti, Sara; Modeo, Letizia; Boni, Roberto; Sollini, Martina; Erba, Paola Anna

    2017-01-17

    Fibronectin is a component of the extracellular matrix that links collagen fibers to integrins on the cell's surface. The splicing isoforms, containing the ED-B domain, are not expressed in adult tissues but only in tumor stroma or during embryonic development. Fibroblasts and endothelial cells express ED-B fibronectin during angiogenesis. Also cancer cells can synthetize ED-B fibronectin, but its function in tumor growth needs to be further elucidated.We evaluated the expression of ED-B fibronectin in prostate cancer cell lines: PC3 and DU145. Using TGF-β, we induced epithelial to mesenchymal transition in culture and observed an increase of ED-B fibronectin expression. Thereafter, we evaluated the expression of ED-B fibronectin in multipotent mesangiogenic progenitor cells, and in mesenchymal stromal cells. The expression of ED-B fibronectin was much higher in mesenchymal than prostate cancer cells even after the epithelial to mesenchymal transition.Epithelial to mesenchymal transition is a key step for tumor progression contributing to the metastatic spread. Therefore, circulating cancer cells could seed into the metastatic niche taking advantage from the ED-B fibronectin that secrete their own.

  17. Unstandardized Responses to a "Standardized" Test: The edTPA as Gatekeeper and Curriculum Change Agent

    ERIC Educational Resources Information Center

    Ledwell, Katherine; Oyler, Celia

    2016-01-01

    We examine edTPA (a teacher performance assessment) implementation at one private university during the first year that our state required this exam for initial teaching certification. Using data from semi-structured interviews with 19 teacher educators from 12 programs as well as public information on edTPA pass rates, we explore whether the…

  18. Characteristics of Reading Disability Types in Middle School Students Classified ED

    ERIC Educational Resources Information Center

    Mattison, Richard E.

    2008-01-01

    Types of reading disabilities (RD) have not yet been investigated in students classified with emotional disturbance (ED). The prevalence of RD and differentiating characteristics were examined in 118 middle school students attending a self-contained school for ED students by defining RDs with reading standard scores less than 85 on the two…

  19. Evaluating Prospective Teachers: Testing the Predictive Validity of the edTPA. Working Paper 157

    ERIC Educational Resources Information Center

    Goldhaber, Dan; Cowan, James; Theobald, Roddy

    2016-01-01

    We use longitudinal data from Washington State to provide estimates of the extent to which performance on the edTPA, a performance-based, subject-specific assessment of teacher candidates, is predictive of the likelihood of employment in the teacher workforce and value-added measures of teacher effectiveness. While edTPA scores are highly…

  20. Race to the Top District Competition: The Data Quality Campaign's Comments on ED's Proposed Criteria

    ERIC Educational Resources Information Center

    Data Quality Campaign, 2012

    2012-01-01

    The Data Quality Campaign (DQC) submits these comments in response to the US Department of Education's (ED) draft requirements, priorities, selection criteria, and definitions for the Race to the Top District (RTT-D) competition. DQC applauds ED for including the following components of the proposal: (1) Data is acknowledged throughout the…