2013 Los Alamos National Laboratory Hazardous Waste Minimization Report

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

Salzman, Sonja L.; English, Charles J.

2015-08-24

Waste minimization and pollution prevention are inherent goals within the operating procedures of Los Alamos National Security, LLC (LANS). The US Department of Energy (DOE) and LANS are required to submit an annual hazardous waste minimization report to the New Mexico Environment Department (NMED) in accordance with the Los Alamos National Laboratory (LANL or the Laboratory) Hazardous Waste Facility Permit. The report was prepared pursuant to the requirements of Section 2.9 of the LANL Hazardous Waste Facility Permit. This report describes the hazardous waste minimization program (a component of the overall Waste Minimization/Pollution Prevention [WMin/PP] Program) administered by the Environmentalmore » Stewardship Group (ENV-ES). This report also supports the waste minimization and pollution prevention goals of the Environmental Programs Directorate (EP) organizations that are responsible for implementing remediation activities and describes its programs to incorporate waste reduction practices into remediation activities and procedures. LANS was very successful in fiscal year (FY) 2013 (October 1-September 30) in WMin/PP efforts. Staff funded four projects specifically related to reduction of waste with hazardous constituents, and LANS won four national awards for pollution prevention efforts from the National Nuclear Security Administration (NNSA). In FY13, there was no hazardous, mixedtransuranic (MTRU), or mixed low-level (MLLW) remediation waste generated at the Laboratory. More hazardous waste, MTRU waste, and MLLW was generated in FY13 than in FY12, and the majority of the increase was related to MTRU processing or lab cleanouts. These accomplishments and analysis of the waste streams are discussed in much more detail within this report.« less

Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

PubMed

Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L

2005-10-01

To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

Comprehensive Truck Size and Weight (TS&W) Study. Phase 1-synthesis, working paper 8 : logistics and truck size and weight regulations

DOT National Transportation Integrated Search

2012-04-01

This report presents the Safety Data Test Plan for the national evaluation of the Los Angeles County Congestion Reduction Demonstration (CRD) under the United States Department of Transportation (U.S. DOT) Urban Partnership Agreement (UPA) Program. T...

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.

PubMed

Alshabanat, Abdulmajeed; Otterstatter, Michael C; Sin, Don D; Road, Jeremy; Rempel, Carmen; Burns, Jane; van Eeden, Stephan F; FitzGerald, J M

2017-01-01

COPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing. The aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD. We retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation. A total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention ( P <0.001). In addition, patients' mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 ( P <0.05). A comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

Lessons Learned From Community-Based Approaches to Sodium Reduction

PubMed Central

Kane, Heather; Strazza, Karen; Losby PhD, Jan L.; Lane, Rashon; Mugavero, Kristy; Anater, Andrea S.; Frost, Corey; Margolis, Marjorie; Hersey, James

2017-01-01

Purpose This article describes lessons from a Centers for Disease Control and Prevention initiative encompassing sodium reduction interventions in six communities. Design A multiple case study design was used. Setting This evaluation examined data from programs implemented in six communities located in New York (Broome County, Schenectady County, and New York City); California (Los Angeles County and Shasta County); and Kansas (Shawnee County). Subjects Participants (n = 80) included program staff, program directors, state-level staff, and partners. Measures Measures for this evaluation included challenges, facilitators, and lessons learned from implementing sodium reduction strategies. Analysis The project team conducted a document review of program materials and semi structured interviews 12 to 14 months after implementation. The team coded and analyzed data deductively and inductively. Results Five lessons for implementing community-based sodium reduction approaches emerged: (1) build relationships with partners to understand their concerns, (2) involve individuals knowledgeable about specific venues early, (3) incorporate sodium reduction efforts and messaging into broader nutrition efforts, (4) design the program to reduce sodium gradually to take into account consumer preferences and taste transitions, and (5) identify ways to address the cost of lower-sodium products. Conclusion The experiences of the six communities may assist practitioners in planning community-based sodium reduction interventions. Addressing sodium reduction using a community-based approach can foster meaningful change in dietary sodium consumption. PMID:24575726

Length of stay and economic consequences with rivaroxaban vs enoxaparin/vitamin K antagonist in patients with DVT and PE: findings from the North American EINSTEIN clinical trial program.

PubMed

Bookhart, Brahim K; Haskell, Lloyd; Bamber, Luke; Wang, Maria; Schein, Jeff; Mody, Samir H

2014-10-01

Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [(PE]) represents a substantial economic burden to the healthcare system. Using data from the randomized EINSTEIN DVT and PE trials, this North American sub-group analysis investigated the potential of rivaroxaban to reduce the length of initial hospitalization in patients with acute symptomatic DVT or PE. A post-hoc analysis of hospitalization and length-of-stay (LOS) data was conducted in the North American sub-set of patients from the randomized, open-label EINSTEIN trial program. Patients received either rivaroxaban (15 mg twice daily for 3 weeks followed by 20 mg once daily; n = 405) or dose-adjusted subcutaneous enoxaparin overlapping with (guideline-recommended 'bridging' therapy) and followed by a vitamin K antagonist (VKA) (international normalized ratio = 2.0-3.0; n = 401). The open-label study design allowed for the comparison of LOS between treatment arms under conditions reflecting normal clinical practice. LOS was evaluated using investigator records of dates of admission and discharge. Analyses were carried out in the intention-to-treat population using parametric tests. Costs were applied to the LOS based on weighted mean cost per day for DVT and PE diagnoses obtained from the Healthcare Cost and Utilization Project dataset. Of 382 patients hospitalized, 321 (84%), had acute symptomatic PE; few DVT patients required hospitalization. Similar rates of VTE patients were hospitalized in the rivaroxaban and enoxaparin/VKA treatment groups, 189/405 (47%) and 193/401 (48%), respectively. In hospitalized VTE patients, rivaroxaban treatment produced a 1.6-day mean reduction in LOS (median = 1 day) compared with enoxaparin/VKA (mean = 4.5 vs 6.1; median = 3 vs 4), translating to total costs that were $3419 lower in rivaroxaban-treated patients. In hospitalized North American patients with VTE, treatment with rivaroxaban produced a statistically significant reduction in LOS. When treating DVT and PE patients, clinicians should consider newer anti-coagulants with less complex treatment regimens.

2016 Los Alamos National Laboratory Hazardous Waste Minimization Report

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

Salzman, Sonja L.; English, Charles Joe

Waste minimization and pollution prevention are goals within the operating procedures of Los Alamos National Security, LLC (LANS). The US Department of Energy (DOE), inclusive of the National Nuclear Security Administration (NNSA) and the Office of Environmental Management, and LANS are required to submit an annual hazardous waste minimization report to the New Mexico Environment Department (NMED) in accordance with the Los Alamos National Laboratory (LANL or the Laboratory) Hazardous Waste Facility Permit. The report was prepared pursuant to the requirements of Section 2.9 of the LANL Hazardous Waste Facility Permit. This report describes the hazardous waste minimization program, whichmore » is a component of the overall Pollution Prevention (P2) Program, administered by the Environmental Stewardship Group (EPC-ES). This report also supports the waste minimization and P2 goals of the Associate Directorate of Environmental Management (ADEM) organizations that are responsible for implementing remediation activities and describes its programs to incorporate waste reduction practices into remediation activities and procedures. This report includes data for all waste shipped offsite from LANL during fiscal year (FY) 2016 (October 1, 2015 – September 30, 2016). LANS was active during FY2016 in waste minimization and P2 efforts. Multiple projects were funded that specifically related to reduction of hazardous waste. In FY2016, there was no hazardous, mixed-transuranic (MTRU), or mixed low-level (MLLW) remediation waste shipped offsite from the Laboratory. More non-remediation hazardous waste and MLLW was shipped offsite from the Laboratory in FY2016 compared to FY2015. Non-remediation MTRU waste was not shipped offsite during FY2016. These accomplishments and analysis of the waste streams are discussed in much more detail within this report.« less

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

Not Available

Vanpooling is a new, exciting, and attractive low-capital transportation mode that can help to alleviate the transportation problems of many segments of the population--the daily commuter, the elderly, the outlying employer, and the economically disadvantaged. The implementation of a Southern California multi-employer vanpool program will benefit the general public, large and small employers, and, of course, the commuter participant. The several corporations throughout the country that have started programs involving vans have reported success in the following areas: reduction of pollution, energy consumption, and traffic congestion; lower parking requirements; increasing the level of punctuality and reducing absenteeism; large savings inmore » commuting costs to members of vanpools; improvement of morale within each company as a result of the close relationship between driver/rider; and saving of vehicle miles travelled (VMT). In order to formulate a vanpooling plan in the Los Angeles area, three major companies were visited during the study to observe operation of their vanpooling programs. Some data are presented from Houston, Texas (Continental Oil Co.), Minneapolis, Minnesota (Minnesota Mining and Manufacturing Co.), and Los Angeles (The Aerospace Corporation). Applying a formula to the downtown Los Angeles area, it has been proposed that the vanpool program not be that of an individual company, but rather a multi-company effort utilizing the services of Commuter Computer, an area-wide carpool matching service and non-profit corporation. (MCW)« less

The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.

PubMed

Jones, Craig A; Clement, Loran T; Hanley-Lopez, Jean; Morphew, Tricia; Kwong, Kenny Yat Choi; Lifson, Francene; Opas, Lawrence; Guterman, Jeffrey J

2005-08-01

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.

Hospitalist management of vaso-occlusive pain crisis in patients with sickle cell disease using a pathway of care.

PubMed

Allen Liles, Edmund; Kirsch, Jonathan; Gilchrist, Michael; Adem, Mukhtar

2014-04-01

Patients with sickle cell disease (SCD) suffer from intermittent vaso-occlusive pain crises (VOCs). These crises lead to frequent hospitalizations, significant morbidity, and increased mortality risk. Care pathways can enhance efficiency and quality of care. Our study sought to evaluate the development and implementation of a care pathway for patients with SCD experiencing VOCs. The University of North Carolina (UNC) Comprehensive Sickle Cell Program provides all levels of care for a large population of patients with sickle cell anemia. All patients admitted to UNC Hospitals with SCD VOCs from January 2009 through June 2011 were evaluated. During this time period, we also assessed sequential prospective cohorts during progressive phases of developing and implementing a quality improvement and pathway of care program for this patient population in our study. The developed pathway entailed geographic localization for VOC patients, a single group of faculty physicians caring for these patients, and early use of patient-controlled analgesia (PCA) to achieve pain control. Physicians from the UNC Hospital Medicine Program were responsible for the initiatives. Cohorts were compared to a baseline historical control. Outcomes of interest included patient length of stay (LOS) in the hospital, 30-day readmission rate, need for transfusion, incidence of acute chest syndrome, use of naloxone, and use of PCA. Compared with an historical baseline cohort, the development and implementation of a VOC care pathway for patients with SCD led to reduction in average hospital LOS by 1.44 days (P < 0.05) and an increase in use of PCAs (P < 0.05). Patient readmission rates, number of transfusions, incidence of acute chest syndrome, and use of naloxone did not significantly change. Hospitalist-led management of patients with SCD VOCs using a care pathway that emphasizes early, aggressive PCA-based pain control is associated with reduced hospital LOS. The LOS reduction seen in our study is clinically meaningful. Notably, other measures of patient outcomes and quality of care metrics did not change significantly, and some trended towards improvement.

Computerized Provider Order Entry Reduces Length of Stay in a Community Hospital

PubMed Central

Peters, K.; Shaha, S.H.

2014-01-01

Summary Objective Does computerized provider order entry (CPOE) improve clinical, cost, and efficiency outcomes as quantified in shortened hospital length of stay (LOS)? Most prior studies were done in university settings with home-grown electronic records, and are now 20 years old. This study asked whether CPOE exerts a downward force on LOS in the current era of HITECH incentives, using a vendor product in a community hospital. Methods The methodology retrospectively evaluated correlation between CPOE and LOS on a perpatient, per-visit basis over 22 consecutive quarters, organized by discipline. All orders from all areas were eligible, except verbals, and medication orders in the emergency department which were not available via CPOE. These results were compared with quarterly case mix indices organized by discipline. Correlational and regression analyses were cross-checked to ensure validity of R-square coefficients, and data were smoothed for ease of display. Standard models were used to calculate the inflection point. Results Gains in CPOE adoption occurred iteratively house-wide, and in each discipline. LOS decreased in a sigmoid shaped curve. The inflection point shows that once CPOE adoption approaches 60%, further lowering of LOS accelerates. Overall there was a 20.2% reduction in LOS correlated with adoption of CPOE. Case mix index increased during the study period showing that reductions in LOS occurred despite increased patient complexity and resource utilization. Conclusions There was a 20.2% reduction in LOS correlated with rising adoption of CPOE. CPOE contributes to improved clinical, cost, and efficiency outcomes as quantified in reduced LOS, over and above other processes introduced to lower LOS. CPOE enabled a reduction in LOS despite an increase in the case mix index during the time frame of this study. PMID:25298809

Evaluation of costs associated with tolvaptan-mediated length-of-stay reduction among heart failure patients with hyponatremia in the US, based on the EVEREST trial.

PubMed

Chiong, Jun R; Kim, Sonnie; Lin, Jay; Christian, Rudell; Dasta, Joseph F

2012-01-01

The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial showed that tolvaptan use improved heart failure (HF) signs and symptoms without serious adverse events. To evaluate the potential cost savings associated with tolvaptan usage among hospitalized hyponatremic HF patients. The Healthcare Cost and Utilization Project (HCUP) 2008 Nationwide Inpatient Sample (NIS) database was used to estimate hospital cost and length of stay (LOS), for diagnosis-related group (DRG) hospitalizations of adult (age ≥18 years) HF patients with complications and comorbidities or major complications and comorbidities. EVEREST trial data for patients with hyponatremia were used to estimate tolvaptan-associated LOS reductions. A cost offset model was constructed to evaluate the impact of tolvaptan on hospital cost and LOS, with univariate and multivariate Monte Carlo sensitivity analyses. Tolvaptan use among hyponatremic EVEREST trial HF patients was associated with shorter hospital LOS than placebo patients (9.72 vs 11.44 days, respectively); 688,336 hospitalizations for HF DRGs were identified from the HCUP NIS database, with a mean LOS of 5.4 days and mean total hospital costs of $8415. Using an inpatient tolvaptan treatment duration of 4 days with a wholesale acquisition cost of $250 per day, the cost offset model estimated a LOS reduction among HF hospitalizations of 0.81 days and an estimated total cost saving of $265 per admission. Univariate and multivariate sensitivity analysis demonstrated that cost reduction associated with tolvaptan usage is consistent among variations of model variables. The estimated LOS reduction and cost savings projected by the cost offset model suggest a clinical and economic benefit to tolvaptan use in hyponatremic HF patients. The EVEREST trial data may not generalize well to the US population. Clinical trial patient profiles and relative LOS reductions may not be applicable to real-world patient populations.

The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort.

PubMed

Grant, Michael C; Pio Roda, Claro M; Canner, Joseph K; Sommer, Philip; Galante, Daniel; Hobson, Deborah; Gearhart, Susan; Wu, Christopher L; Wick, Elizabeth

2018-05-17

Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70-0.85); P < .001) compared to low compliance (0-2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68-0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67-0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51-0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.

Los Angeles Area Permit Holder Estimated Trash Load Reduction

EPA Pesticide Factsheets

The Los Angeles River has been designated as an impaired waterbody due to the large volume of trash it receives from the watershed. To address this problem a Total Maximum Daily Load (TMDL), which establishes baseline trash loads to the river from the watershed, has been incorporated into the area stormwater permit. The permit requires each permittee to implement trash reduction measures for discharges through the storm drain system with an emphasis on the installation of full capture devices. The stormwater permit incorporates progressive reductions in trash discharges to the Los Angeles River, reaching a zero level in 2016.

ACHP | Working Together to Build a More Inclusive Preservation Program

Science.gov Websites

Dennis Arguelles, Los Angeles Program Manager, National Parks Conservation Association; Former Director of Programs for Search To Involve Pilipino Americans Dennis G. Arguelles is currently the Los Angeles Filipinotown community of Los Angeles and Filipino Americans throughout Los Angeles County. He is the former

Length of stay benchmarks for inpatient rehabilitation after stroke.

PubMed

Meyer, Matthew; Britt, Eileen; McHale, Heather A; Teasell, Robert

2012-01-01

In Canada, no standardized benchmarks for length of stay (LOS) have been established for post-stroke inpatient rehabilitation. This paper describes the development of a severity specific median length of stay benchmarking strategy, assessment of its impact after one year of implementation in a Canadian rehabilitation hospital, and establishment of updated benchmarks that may be useful for comparison with other facilities across Canada. Patient data were retrospectively assessed for all patients admitted to a single post-acute stroke rehabilitation unit in Ontario, Canada between April 2005 and March 2008. Rehabilitation Patient Groups (RPGs) were used to establish stratified median length of stay benchmarks for each group that were incorporated into team rounds beginning in October 2009. Benchmark impact was assessed using mean LOS, FIM(®) gain, and discharge destination for each RPG group, collected prospectively for one year, compared against similar information from the previous calendar year. Benchmarks were then adjusted accordingly for future use. Between October 2009 and September 2010, a significant reduction in average LOS was noted compared to the previous year (35.3 vs. 41.2 days; p < 0.05). Reductions in LOS were noted in each RPG group including statistically significant reductions in 4 of the 7 groups. As intended, reductions in LOS were achieved with no significant reduction in mean FIM(®) gain or proportion of patients discharged home compared to the previous year. Adjusted benchmarks for LOS ranged from 13 to 48 days depending on the RPG group. After a single year of implementation, severity specific benchmarks helped the rehabilitation team reduce LOS while maintaining the same levels of functional gain and achieving the same rate of discharge to the community. © 2012 Informa UK, Ltd.

Air quality impacts of a CicLAvia event in Downtown Los Angeles, CA.

PubMed

Shu, Shi; Batteate, Christina; Cole, Brian; Froines, John; Zhu, Yifang

2016-01-01

CicLAvia in Los Angeles, CA is the open streets program that closes streets to motorized vehicles and invites people to walk, run, play or ride their bicycles on these streets, allowing them to experience the city in a new way and get exercise at the same time. Since the events reduce the motorized traffic flow, which is a significant source of air pollution, on the streets, it is reasonable to hypothesize that the CicLAvia events can reduce the concentrations of traffic-emitted air pollutants during the road closure. This study is the first experiment to test this hypothesis. The on-road and community-wide ultrafine particle (UFP) and PM2.5 were measured on the Event-Sunday (October 5th, 2014) and the Pre- and Post- Sundays (September 28(th) and October 12(th), 2014). Data analysis results showed the on-road UFP and PM2.5 reduction was 21% and 49%, respectively, and the community-wide PM2.5 reduction was 12%. Copyright © 2015 Elsevier Ltd. All rights reserved.

Reductions in Average Lengths of Stays for Surgical Procedures Between the 2008 and 2014 United States National Inpatient Samples Were Not Associated With Greater Incidences of Use of Postacute Care Facilities.

PubMed

Dexter, Franklin; Epstein, Richard H

2018-03-01

Diagnosis-related group (DRG) based reimbursement creates incentives for reduction in hospital length of stay (LOS). Such reductions might be accomplished by lesser incidences of discharges to home. However, we previously reported that, while controlling for DRG, each 1-day decrease in hospital median LOS was associated with lesser odds of transfer to a postacute care facility (P = .0008). The result, though, was limited to elective admissions, 15 common surgical DRGs, and the 2013 US National Readmission Database. We studied the same potential relationship between decreased LOS and postacute care using different methodology and over 2 different years. The observational study was performed using summary measures from the 2008 and 2014 US National Inpatient Sample, with 3 types of categories (strata): (1) Clinical Classifications Software's classes of procedures (CCS), (2) DRGs including a major operating room procedure during hospitalization, or (3) CCS limiting patients to those with US Medicare as the primary payer. Greater reductions in the mean LOS were associated with smaller percentages of patients with disposition to postacute care. Analyzed using 72 different CCSs, 174 DRGs, or 70 CCSs limited to Medicare patients, each pairwise reduction in the mean LOS by 1 day was associated with an estimated 2.6% ± 0.4%, 2.3% ± 0.3%, or 2.4% ± 0.3% (absolute) pairwise reduction in the mean incidence of use of postacute care, respectively. These 3 results obtained using bivariate weighted least squares linear regression were all P < .0001, as were the corresponding results obtained using unweighted linear regression or the Spearman rank correlation. In the United States, reductions in hospital LOS, averaged over many surgical procedures, are not accomplished through a greater incidence of use of postacute care.

Is length of stay in hospital a stable proxy for injury severity?

PubMed

Cryer, C; Gulliver, P; Langley, J D; Davie, G

2010-08-01

Is length of stay (LoS) in hospital a stable proxy for severity of injury when monitoring time trends in serious injury incidence? To investigate whether LoS metrics (mean, median and proportion exceeding several LoS thresholds) have changed over time for injury diagnoses with known severity. Time series investigation. New Zealand population admitted to hospital for injury and discharged during the period 1989 to 1998. Interpolated median and geometric mean lengths of stay, as well as the proportion of cases that have an LoS greater than or equal to 3, 4, 7 and 14 days in hospital. ICD-9-CM diagnoses that are approximately homogeneous in regard to severity of injury (ICD-HS diagnoses) were identified. Trends were investigated in the LoS statistics for: injury and non-injury diagnoses combined; all injury diagnoses; major body sites of injury; severity strata; and ICD-HS diagnoses. Almost without exception, there was a decline in the LoS statistics over time for all diagnoses, all injury diagnoses, each body site of injury investigated, severity strata, and the ICD-HS diagnoses. Reductions in median and geometric mean LoS over time, as well as reductions in the proportion exceeding selected LoS thresholds, were due to factors other than reductions in the incidence of serious injury; for example, changes in service delivery over time. An LoS threshold should not be used as a proxy for severity of injury if the goal is to monitor time trends in injury incidence.

Simulation-based multidisciplinary team training decreases time to critical operations for trauma patients.

PubMed

Murphy, Margaret; Curtis, Kate; Lam, Mary K; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea

2018-05-01

Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p < 0.001) and had a higher incidence of falls and assaults (p < 0.001). There was a reduction in time to critical operation, from 2.63 h (IQR 1.23-5.12) in the PRE-group to 0.55 h (IQR 0.22-1.27) in the POST-group, p < 0.001. The overall ED LOS increased, and there was no reduction in mortality. Post-hoc analysis found LOS in ED was reduced in the cohort requiring critical operations, p < 0.001. The implementation of trauma team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. Retrospective comparative therapeutic/care management study, Level III evidence. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

Variations in 30-day readmissions and length of stay among spine surgeons: a national study of elective spine surgery among US Medicare beneficiaries.

PubMed

Singh, Siddhartha; Sparapani, Rodney; Wang, Marjorie C

2018-06-01

OBJECTIVE Pay-for-performance programs are targeting hospital readmissions. These programs have an underlying assumption that readmissions are due to provider practice patterns that can be modified by a reduction in reimbursement. However, there are limited data to support the role of providers in influencing readmissions. To study this, the authors examined variations in readmission rates by spine surgeon within 30 days among Medicare beneficiaries undergoing elective lumbar spine surgery for degenerative conditions. METHODS The authors applied validated ICD-9-CM algorithms to 2003-2007 Medicare data to select beneficiaries undergoing elective inpatient lumbar spine surgery for degenerative conditions. Mixed models, adjusting for patient demographics, comorbidities, and surgery type, were used to estimate risk of 30-day readmission by the surgeon. Length of stay (LOS) was also studied using these same models. RESULTS A total of 39,884 beneficiaries were operated on by 3987 spine surgeons. The mean readmission rate was 7.2%. The mean LOS was 3.1 days. After adjusting for patient characteristics and surgery type, 1 surgeon had readmission rates significantly below the mean, and only 5 surgeons had readmission rates significantly above the mean. In contrast, for LOS, the patients of 288 surgeons (7.2%) had LOS significantly lower than the mean, and the patients of 397 surgeons (10.0%) had LOS significantly above the mean. These findings were robust to adjustments for surgeon characteristics and clustering by hospital. Similarly, hospital characteristics were not significantly associated with readmission rates, but LOS was associated with hospital for-profit status and size. CONCLUSIONS The authors found almost no variations in readmission rates by surgeon. These findings suggest that surgeon practice patterns do not affect the risk of readmission. Likewise, no significant variation in readmission rates by hospital characteristics were found. Strategies to reduce readmissions would be better targeted at factors other than providers.

Reduction of admit wait times: the effect of a leadership-based program.

PubMed

Patel, Pankaj B; Combs, Mary A; Vinson, David R

2014-03-01

Prolonged admit wait times in the emergency department (ED) for patients who require hospitalization lead to increased boarding time in the ED, a significant cause of ED congestion. This is associated with decreased quality of care, higher morbidity and mortality, decreased patient satisfaction, increased costs for care, ambulance diversion, higher numbers of patients who leave without being seen (LWBS), and delayed care with longer lengths of stay (LOS) for other ED patients. The objective was to assess the effect of a leadership-based program to expedite hospital admissions from the ED. This before-and-after observational study was undertaken from 2006 through 2011 at one community hospital ED. A team of ED and hospital leaders implemented a program to reduce admit wait times, using a computerized hospital-wide tracking system to monitor inpatient and ED bed status. The team collaboratively and consistently moved ED patients to their inpatient beds within an established goal of 60 minutes after an admission decision was reached. Top leadership actively intervened in real time by contacting staff whenever delays occurred to expedite immediate solutions to achieve the 60-minute goal. The primary outcome measures were the percentage of ED patients who were admitted to inpatient beds within 60 minutes from the time the beds were requested and ED boarding time. LOS, patient satisfaction, LWBS rate, and ambulance diversion hours were also measured. After ED census, hospital admission rates, and ED bed capacity were controlled for using a multivariable linear regression analysis, the admit wait time reduction program contributed to an increase in patients being admitted to the hospital within 60 minutes by 16 percentage points (95% confidence intervals [CI] = 10 to 22 points; p < 0.0001) and a decrease in boarding time per admission of 46 minutes (95% CI = 63 to 82 minutes; p < 0.0001). LOS decreased for admitted patients by 79 minutes (95% CI = 55 to 104 minutes; p < 0.0001), for discharged patients by 17 minutes (95% CI = 12 to 23 minutes; p < 0.0001), and for all patients by 34 minutes (95% CI = 25 to 43 minutes; p < 0.0001). Patient satisfaction increased 4.9 percentage points (95% CI = 3.8 to 6.0 points; p < 0.0001). LWBS patients decreased 0.9 percentage points (95% CI = 0.6 to 1.2 points; p < 0.0001) and monthly ambulance diversion decreased 8.2 hours (95% CI = 4.6 to 11.8 hours; p < 0.0001). A leadership-based program to reduce admit wait times and boarding times was associated with a significant increase in the percentage of patients admitted to the hospital within 60 minutes and a significant decrease in boarding time. Also associated with the program were decreased ED LOS, LWBS rate, and ambulance diversion, as well as increased patient satisfaction. © 2014 by the Society for Academic Emergency Medicine.

Risk-Based Causal Modeling of Airborne Loss of Separation

NASA Technical Reports Server (NTRS)

Geuther, Steven C.; Shih, Ann T.

2015-01-01

Maintaining safe separation between aircraft remains one of the key aviation challenges as the Next Generation Air Transportation System (NextGen) emerges. The goals of the NextGen are to increase capacity and reduce flight delays to meet the aviation demand growth through the 2025 time frame while maintaining safety and efficiency. The envisioned NextGen is expected to enable high air traffic density, diverse fleet operations in the airspace, and a decrease in separation distance. All of these factors contribute to the potential for Loss of Separation (LOS) between aircraft. LOS is a precursor to a potential mid-air collision (MAC). The NASA Airspace Operations and Safety Program (AOSP) is committed to developing aircraft separation assurance concepts and technologies to mitigate LOS instances, therefore, preventing MAC. This paper focuses on the analysis of causal and contributing factors of LOS accidents and incidents leading to MAC occurrences. Mid-air collisions among large commercial aircraft are rare in the past decade, therefore, the LOS instances in this study are for general aviation using visual flight rules in the years 2000-2010. The study includes the investigation of causal paths leading to LOS, and the development of the Airborne Loss of Separation Analysis Model (ALOSAM) using Bayesian Belief Networks (BBN) to capture the multi-dependent relations of causal factors. The ALOSAM is currently a qualitative model, although further development could lead to a quantitative model. ALOSAM could then be used to perform impact analysis of concepts and technologies in the AOSP portfolio on the reduction of LOS risk.

A study of the effectiveness of a workplace violence intervention for small retail and service establishments.

PubMed

Casteel, Carri; Peek-Asa, Corinne; Greenland, Sander; Chu, Lawrence D; Kraus, Jess F

2008-12-01

Examine the effectiveness of a robbery and violence prevention program in small businesses in Los Angeles. Gas/convenience, liquor and grocery stores, bars/restaurants, and motels were enrolled between 1997 and 2000. Intervention businesses (n = 305) were provided training, program implementation materials, and recommendations for a comprehensive security program. Control businesses (n = 96) received neither training nor program materials. Rate ratios comparing intervention to control businesses were 0.90 for violent crime (95% confidence limits [CL] = 0.53, 1.53) and 0.81 for robbery (95% CL = 0.38, 1.73). The reduction in violent crime was concentrated in high-compliance intervention businesses (risk ratio = 0.74, 95% CL = 0.40, 1.36). Low-compliance intervention businesses had practically the same postintervention crime as the control businesses. Our results suggest that the workplace violence intervention may reduce violent crime among high-risk businesses, especially those with high program compliance.

A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

PubMed Central

Akpan, Mary Richard; Ahmad, Raheelah; Shebl, Nada Atef; Ashiru-Oredope, Diane

2016-01-01

The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP. PMID:27025520

Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

PubMed

Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D

2016-02-01

In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of vials and prefilled pens of a rapid-acting insulin analog on pharmacy budgets in a long-term care setting.

PubMed

Eby, Elizabeth L; Smolen, Lee J; Pitts, Amber C; Krueger, Linda A; Andrews, Jeffrey Scott

2014-12-01

Estimate budgetary impact for skilled nursing facility converting from individual patient supply (IPS) delivery of rapid-acting insulin analog (RAIA) 10-mL vials or 3-mL prefilled pens to 3-mL vials. A budget-impact model used insulin volume purchased and assumptions of length of stay (LOS), daily RAIA dose, and delivery protocol to estimate the cost impact of using 3-mL vials. Skilled nursing facility. Medicare Part A patients. Simulations conducted using 12-month current and future scenarios. Comparisons of RAIA use for 13- and 28-day LOS. RAIA costs and savings, waste reduction. For patients with 13-day LOS using 20 units/day of IPS insulin, the model estimated a 70% reduction in RAIA costs and units purchased and a 95% waste reduction for the 3-mL vial compared with the 10-mL vial. The estimated costs for prefilled pen use were 58% lower than for use of 10-mL vials. The incremental savings associated with 3-mL vial use instead of prefilled pens was 28%, attributable to differences in per-unit cost of insulin in vials versus prefilled pens. Using a more conservative scenario of 28-day LOS at 20 units/day, the model estimated a 40% reduction in RAIA costs and units purchased, resulting in a 91% reduction in RAIA waste for the 3-mL vial, compared with 10-mL vial. Budget-impact analysis of conversion from RAIA 10-mL vials or 3-mL prefilled pens to 3-mL vials estimated reductions in both insulin costs and waste across multiple scenarios of varying LOS and patient daily doses for skilled nursing facility stays.

Research to Support California Greenhouse Gas Reduction Programs

NASA Astrophysics Data System (ADS)

Croes, B. E.; Charrier-Klobas, J. G.; Chen, Y.; Duren, R. M.; Falk, M.; Franco, G.; Gallagher, G.; Huang, A.; Kuwayama, T.; Motallebi, N.; Vijayan, A.; Whetstone, J. R.

2016-12-01

Since the passage of the California Global Warming Solutions Act in 2006, California state agencies have developed comprehensive programs to reduce both long-lived and short-lived climate pollutants. California is already close to achieving its goal of reducing greenhouse (GHG) emissions to 1990 levels by 2020, about a 30% reduction from business as usual. In addition, California has developed strategies to reduce GHG emissions another 40% by 2030, which will put the State on a path to meeting its 2050 goal of an 80% reduction. To support these emission reduction goals, the California Air Resources Board (CARB) and the California Energy Commission have partnered with NASA's Carbon Monitoring System (CMS) program on a comprehensive research program to identify and quantify the various GHG emission source sectors in the state. These include California-specific emission studies and inventories for carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) emission sources; a Statewide GHG Monitoring Network for these pollutants integrated with the Los Angeles Megacities Carbon Project funded by several federal agencies; efforts to verify emission inventories using inversion modeling and other techniques; mobile measurement platforms and flux chambers to measure local and source-specific emissions; and a large-scale statewide methane survey using a tiered monitoring and measurement program, which will include satellite, airborne, and ground-level measurements of the various regions and source sectors in the State. In addition, there are parallel activities focused on black carbon (BC) and fluorinated gases (F-gases) by CARB. This presentation will provide an overview of results from inventory, monitoring, data analysis, and other research efforts on Statewide, regional, and local sources of GHG emissions in California.

An economic evaluation of the Enhanced Recovery After Surgery (ERAS) multisite implementation program for colorectal surgery in Alberta

PubMed Central

Thanh, Nguyen X.; Chuck, Anderson W.; Wasylak, Tracy; Lawrence, Jeannette; Faris, Peter; Ljungqvist, Olle; Nelson, Gregg; Gramlich, Leah M.

2016-01-01

Background In February 2013, Alberta Health Services established an Enhanced Recovery After Surgery (ERAS) implementation program for adopting the ERAS Society colorectal guidelines into 6 sites (initial phase) that perform more than 75% of all colorectal surgeries in the province. We conducted an economic evaluation of this initiative to not only determine its cost-effectiveness, but also to inform strategy for the spread and scale of ERAS to other surgical protocols and sites. Methods We assessed the impact of ERAS on patients’ health services utilization (HSU; length of stay [LOS], readmissions, emergency department visits, general practitioner and specialist visits) within 30 days of discharge by comparing pre- and post-ERAS groups using multilevel negative binomial regressions. We estimated the net health care costs/savings and the return on investment (ROI) associated with those impacts for post-ERAS patients using a decision analytic modelling technique. Results We included 331 pre- and 1295 post-ERAS patients in our analyses. ERAS was associated with a reduction in all HSU outcomes except visits to specialists. However, only the reduction in primary LOS was significant. The net health system savings were estimated at $2 290 000 (range $1 191 000–$3 391 000), or $1768 (range $920–$2619) per patient. The probability for the program to be cost-saving was 73%–83%. In terms of ROI, every $1 invested in ERAS would bring $3.8 (range $2.4–$5.1) in return. Conclusion The initial phase of ERAS implementation for colorectal surgery in Alberta is cost-saving. The total savings has the potential to be more substantial when ERAS is spread for other surgical protocols and across additional sites. PMID:28445024

Managing sepsis: Electronic recognition, rapid response teams, and standardized care save lives.

PubMed

Guirgis, Faheem W; Jones, Lisa; Esma, Rhemar; Weiss, Alice; McCurdy, Kaitlin; Ferreira, Jason; Cannon, Christina; McLauchlin, Laura; Smotherman, Carmen; Kraemer, Dale F; Gerdik, Cynthia; Webb, Kendall; Ra, Jin; Moore, Frederick A; Gray-Eurom, Kelly

2017-08-01

Sepsis can lead to poor outcomes when treatment is delayed or inadequate. The purpose of this study was to evaluate outcomes after initiation of a hospital-wide sepsis alert program. Retrospective review of patients ≥18years treated for sepsis. There were 3917 sepsis admissions: 1929 admissions before, and 1988 in the after phase. Mean age (57.3 vs. 57.1, p=0.94) and Charlson Comorbidity Scores (2.52 vs. 2.47, p=0.35) were similar between groups. Multivariable analyses identified significant reductions in the after phase for odds of death (OR 0.62, 95% CI 0.39-0.99, p=0.046), mean intensive care unit LOS (2.12days before, 95%CI 1.97, 2.34; 1.95days after, 95%CI 1.75, 2.06; p<0.001), mean overall hospital LOS (11.7days before, 95% CI 10.9, 12.7days; 9.9days after, 95% CI 9.3, 10.6days, p<0.001), odds of mechanical ventilation use (OR 0.62, 95% CI 0.39, 0.99, p=0.007), and total charges with a savings of $7159 per sepsis admission (p=0.036). There was no reduction in vasopressor use (OR 0.89, 95% CI 0.75, 0.1.06, p=0.18). A hospital-wide program utilizing electronic recognition and RRT intervention resulted in improved outcomes in patients with sepsis. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of increased mobility on morbidity in the neurointensive care unit.

PubMed

Titsworth, W Lee; Hester, Jeannette; Correia, Tom; Reed, Richard; Guin, Peggy; Archibald, Lennox; Layon, A Joseph; Mocco, J

2012-06-01

The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients. All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus. Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections. Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.

Regional Economic Development

Science.gov Websites

Search Site submit About Us Los Alamos National LaboratoryRichard P. Feynman Center for Innovation Innovation protecting tomorrow Los Alamos National Laboratory The Richard P. Feynman Center for Innovation key programs to achieve regional technology commercialization from Los Alamos. The programs below help

Employability Planning Process. STIP II (Skill Training Improvement Programs Round II).

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA.

Four reports are presented detailing procedures for improving the employability of students enrolled in the Los Angeles Community College District's Skill Training Improvement Programs (STIP II). Each report was submitted by one of the four STIP II programs: Los Angeles Southwest College's program for computer programming; the programs for…

ORBSIM- ESTIMATING GEOPHYSICAL MODEL PARAMETERS FROM PLANETARY GRAVITY DATA

NASA Technical Reports Server (NTRS)

Sjogren, W. L.

1994-01-01

The ORBSIM program was developed for the accurate extraction of geophysical model parameters from Doppler radio tracking data acquired from orbiting planetary spacecraft. The model of the proposed planetary structure is used in a numerical integration of the spacecraft along simulated trajectories around the primary body. Using line of sight (LOS) Doppler residuals, ORBSIM applies fast and efficient modelling and optimization procedures which avoid the traditional complex dynamic reduction of data. ORBSIM produces quantitative geophysical results such as size, depth, and mass. ORBSIM has been used extensively to investigate topographic features on the Moon, Mars, and Venus. The program has proven particulary suitable for modelling gravitational anomalies and mascons. The basic observable for spacecraft-based gravity data is the Doppler frequency shift of a transponded radio signal. The time derivative of this signal carries information regarding the gravity field acting on the spacecraft in the LOS direction (the LOS direction being the path between the spacecraft and the receiving station, either Earth or another satellite). There are many dynamic factors taken into account: earth rotation, solar radiation, acceleration from planetary bodies, tracking station time and location adjustments, etc. The actual trajectories of the spacecraft are simulated using least squares fitted to conic motion. The theoretical Doppler readings from the simulated orbits are compared to actual Doppler observations and another least squares adjustment is made. ORBSIM has three modes of operation: trajectory simulation, optimization, and gravity modelling. In all cases, an initial gravity model of curved and/or flat disks, harmonics, and/or a force table are required input. ORBSIM is written in FORTRAN 77 for batch execution and has been implemented on a DEC VAX 11/780 computer operating under VMS. This program was released in 1985.

Understanding of urban hazards, fire, and tsunamis

USGS Publications Warehouse

Hays, Walter W.; ,

1997-01-01

Understanding of the causes and solutions of an urban area's (e.g., Los Angeles, San Diego, San Francisco, Oakland, Seattle, Portland, Anchorage, Salt Lake City, Memphis, St. Louis, Charleston, Boston, San Juan) vulnerability to earthquakes, fire, and tsunamis has increased significantly during the past 50 years, and during the current International Decade for Natural Disaster Reduction (IDNDR). Vulnerability is caused by flaws in planning, siting, design, construction, and use. It is fundamentally dependent upon the hazard, built, and policy environments of the urban area. Reduction of vulnerability is directly related to the decision-making process that calls for the adoption and enforcement of risk management programs (e.g., mitigation, preparedness, emergency response, and recovery measures) that are designed to make the urban area resilient to earthquakes, fires, and, as appropriate, tsunamis.

Level of Service Program for INDOT Operations : [Technical Summary

DOT National Transportation Integrated Search

2012-01-01

In 2008 the JTRP study SPR-3130, Performance Based : Contracting for Roadway Maintenance Operations, : revealed the state agencies that have developed a : Level of Service (LOS) program benefit. A LOS program : can evaluate and determine maintenance ...

The California State University, Los Angeles Biomedical Sciences Program.

ERIC Educational Resources Information Center

Gutierrez, Carlos G.; Brown, Costello L.

The Biomedical Sciences Program at California State University, Los Angeles (CSULA), is described. The federally funded program was designed to help economically disadvantaged students to pursue careers in biomedical sciences. The program provided academic support in mathematics, science, and English; study skills development; experiences in…

Level of Service Program for INDOT Operations : [Technical Summary

DOT National Transportation Integrated Search

2012-01-01

In 2008 the JTRP study SPR-3130, Performance Based Contracting for Roadway Maintenance Operations, revealed the state agencies that have developed a Level of Service (LOS) program benefit. A LOS program can evaluate and determine maintenance performa...

Program Activity/Training Plans. STIP II (Skill Training Improvement Programs Round II).

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA.

Detailed operational guidelines, training objectives, and learning activities are provided for the Los Angeles Community College District's Skill Training Improvement Programs (STIP II), which are designed to train students for immediate employment. The first of four reports covers Los Angeles Southwest College's computer programming trainee…

Space/time explicit Hestia version 2.0 fossil fuel CO2 emissions for the Los Angeles Basin: comparison to atmospheric monitoring, emission drivers, and policy implications

NASA Astrophysics Data System (ADS)

Gurney, K. R.; Liang, J.; Patarasuk, R.; O'Keeffe, D.; Newman, S.; Rao, P.; Hutchins, M.; Huang, J.

2016-12-01

The Los Angeles Basin represents one of the largest metropolitan areas in the United States and is home to the Megacity Carbon Project, a multi-institutional effort led by NASA JPL to understand the total carbon budget of the Los Angeles Basin. A key component of that effort is the Hestia bottom-up fossil fuel CO2 emissions data product, which quantifies FFCO2 every hour to the spatial scale of individual buildings and road segments. This data product has undergone considerable revision in the last year and the version 2.0 data product is now complete covering the 2011-2014 time period. In this presentation, we highlight the advances in the Hestia version 2.0 including the improvements to onroad, building and industrial emissions. We make comparisons to the independently reported GHG reporting program of the EPA and to in-situ atmospheric measurement of CO2 at two monotiring locations in Pasadena and Palos Verdes. We provide an analysis of the socioeconomic drivers of emissions in the building and onroad transportation sectors across the domain highlighting hotspots of emissions and spatially-specific opportunities for reductions.

Health status, job stress and work-related injury among Los Angeles taxi drivers.

PubMed

Wang, Pin-Chieh; Delp, Linda

2014-01-01

Taxi drivers work long hours for low wages and report hypertension, weight gain, and musculoskeletal pain associated with the sedentary nature of their job, stressful working conditions, and poor dietary habits. They also experience a high work-related fatality rate. The objective of this study is to examine the association of taxi drivers' health status and level of job stress with work-related injury and determine if a potential interaction exists. A survey of 309 Los Angeles taxi drivers provides basic data on health status, job stress, and work-related injuries. We further analyzed the data using a Modified Poisson regression approach with a robust error variance to estimate the relative risk (RR) and the 95% confidence intervals (CI) of work-related injuries. Focus group results supplemented and helped interpret the quantitative data. The joint effect of good health and low job stress was associated with a large reduction in the incidence of injuries, consistent with the hypothesis that health status and stress levels modify each other on the risk of work-related injury. These results suggest that the combination of stress reduction and health management programs together with changes in the stressful conditions of the job may provide targeted avenues to prevent injuries.

Understanding Sediment Processes of Los Laureles Canyon in the Binational Tijuana River Watershed

NASA Astrophysics Data System (ADS)

Yuan, Yongping; Biggs, Trent; Liden, Douglas

2015-04-01

Tijuana River Basin originates in Mexico and drains 4465 km2 into the Tijuana River Estuary National Research Reserve, a protected coastal wetland in California that supports 400 species of birds. Excessive erosion in Tijuana during storms produces sediment loads that bury native vegetation and block the tidal channels. Erosion also threatens human life, causing roads and houses in Mexico to collapse and the Tijuana River Valley in the U.S. to flood. Government agencies in US and Mexico spend millions annually to remove sediment. The EPA-SEMARNAT Border 2020 program identified the reduction of sediment to the Tijuana Estuary as a high priority. Gully formation on unpaved roads, channel erosion, and sheetwash and rill erosion from vacant lots in Tijuana are the primary sources of sediment (Biggs et al, 2009). Because 73% of the watershed is located in Mexico, the problem is likely to worsen as Tijuana continues to urbanize. EPA, with support from USDA, San Diego State University, and CICESE, is developing a model to estimate the sediment loss from a sub-basin of the watershed (Los Laureles Canyon) under existing conditions and under future development. This study will evaluate the reduction/prevention of sediment loss from green infrastructure projects, sediment basins, road paving, and conservation easements.

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

Johnston, Mariann R.; Clow, Shandra Deann

The UC/Los Alamos Entrepreneurial Postdoctoral Fellowship Pilot Program (Pilot) for existing postdoctoral researchers at Los Alamos National Laboratory (Los Alamos) to gain skills in entrepreneurship and commercializing technology as part of their postdoctoral experience. This program will incorporate training and mentoring during the first 6-month period, culminating in a focused 6-month Fellowship aimed at creating a new business in Northern New Mexico.

Coca-Cola Hispanic Education Fund: Los Angeles Program Description.

ERIC Educational Resources Information Center

Coca Cola Bottling Co. of Los Angeles, CA.

The Coca-Cola Hispanic Education Fund was created in response to the high school dropout problem in Los Angeles. The Fund enables the Coca-Cola Bottling Company of Los Angeles to build upon the successful relationship it has developed in the Hispanic community and maximizes the effectiveness of existing student support programs by directing needy…

Recurrent laryngeal nerve injury with incomplete loss of electromyography signal during monitored thyroidectomy-evaluation and outcome.

PubMed

Wu, Che-Wei; Hao, Min; Tian, Mengzi; Dionigi, Gianlorenzo; Tufano, Ralph P; Kim, Hoon Yub; Jung, Kwang Yoon; Liu, Xiaoli; Sun, Hui; Lu, I-Cheng; Chang, Pi-Ying; Chiang, Feng-Yu

2017-06-01

During monitored thyroidectomy, a partially or completely disrupted point of nerve conduction on the exposed recurrent laryngeal nerve (RLN) indicates true electrophysiologic nerve injury. Complete loss of signal (LOS; absolute threshold value <100 μV) at the end of operation often indicates a postoperative vocal cord (VC) palsy. However, the evaluation for the injured RLN with incomplete LOS and its functional outcome has not been well described. Three hundred twenty-three patients with 522 RLNs at risk who underwent standardized monitored thyroidectomy were enrolled. The RLN was routinely stimulated at the most proximal (R 2p signal) and distal (R 2d signal) ends of exposure after thyroid resection to determine if there was an injured point on the RLN. Pre- and postoperative VC function was routinely examined. Twenty-nine RLNs (5.6 %) were detected with an injury point. Five nerves had complete LOS and other 24 nerves had incomplete LOS where the R 2p /R 2d reduction (% of amplitude reduction compared with proximal to distal RLN stimulation) ranged from 22 to 79 %. Postoperative temporary VC palsy was noted in those five RLNs with complete LOS (final vagal signal, V 2  < 100 μV) and four RLNs with incomplete LOS (R 2p /R 2d reduction 62-79 %; V 2 181-490 μV). In the remaining 20 nerves with R 2p /R 2d reduction ≤53 % (V 2 373-1623 μV), all showed normal VC mobility. Overall, false negative results were found in two RLNs (0.4 %) featuring unchanged V 2 and R 2p /R 2d but developed VC palsy. Testing and comparing the R 2p /R 2d signal is a simple and useful procedure to evaluate RLN injury after its dissection and predict functional outcome. When the relative threshold value R 2p /R 2d reduction reaches over 60 %, surgeon should consider the possibility of postoperative VC palsy.

Stockpile Stewardship: Los Alamos

ScienceCinema

McMillan, Charlie; Morgan, Nathanial; Goorley, Tom; Merrill, Frank; Funk, Dave; Korzekwa, Deniece; Laintz, Ken

2018-01-16

"Heritage of Science" is a short video that highlights the Stockpile Stewardship program at Los Alamos National Laboratory. Stockpile Stewardship was conceived in the early 1990s as a national science-based program that could assure the safety, security, and effectiveness of the U.S. nuclear deterrent without the need for full-scale underground nuclear testing. This video was produced by Los Alamos National Laboratory for screening at the Lab's Bradbury Science Museum in Los Alamos, NM and is narrated by science correspondent Miles O'Brien.

PM 10 and ozone control strategy to improve visibility in the los angeles basin

NASA Astrophysics Data System (ADS)

Farber, Robert J.; Welsing, Peter R.; Rozzi, Carlo

The greater Los Angeles metropolitan area is in violation of the United States Environmental Protection Agency (USEPA) ambient standards for both ozone and PM 10. Accompanying these violations are hazy summer conditions, with current annual median visibility in the inland portions of Los Angeles running about 13 km, and visibilities decreasing to about 3 km on the 90th percentile days (worst days). The USEPA has given the local air pollution control agency until 2010 to bring the area into compliance with these standards. Because of continued population growth, accompanying light industry, dependence on private motor vehicles, and adverse natural meteorological conditions, emission reductions costing billions of dollars will be needed between now and 2010. The combination of emission reductions which will result in the fastest ozone and PM 10 cleanup at the lowest cost are presented. Substantial emission reductions in NO x, reactive hydrocarbons, SO x, ammonia, soot and fugitive dust will result in visibility improvements in the Los Angeles area. However, enactment of this comprehensive control strategy will only improve the annual median visibility to about 20 km and the 90th percentile days to 6.5 km. Significant changes in fine mass will result in relatively small changes in perceived visibility since the human eye is unable to differentiate visual range changes even as large as 40% in an urban landscape typical of Los Angeles.

Los Alamos National Laboratory Prepares for Fire Season

ScienceCinema

L’Esperance, Manny

2018-01-16

Through the establishment of a Wildland Fire Program Office, and the Interagency Fire Base located on Laboratory property, Los Alamos National Laboratory is continuing and improving a program to prepare for wildland fire.

Los Alamos National Laboratory Prepares for Fire Season

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

L’Esperance, Manny

Through the establishment of a Wildland Fire Program Office, and the Interagency Fire Base located on Laboratory property, Los Alamos National Laboratory is continuing and improving a program to prepare for wildland fire.

The economic and clinical impact of an inpatient palliative care consultation service: a multifaceted approach.

PubMed

Ciemins, Elizabeth L; Blum, Linda; Nunley, Marsha; Lasher, Andrew; Newman, Jeffrey M

2007-12-01

While there has been a rapid increase of inpatient palliative care (PC) programs, the financial and clinical benefits have not been well established. Determine the effect of an inpatient PC consultation service on costs and clinical outcomes. Multifaceted study included: (1) interrupted time-series design utilizing mean daily costs preintervention and postintervention; (2) matched cohort analysis comparing PC to usual care patients; and (3) analysis of symptom control after consultation. Large private, not-for-profit, academic medical center in San Francisco, California, 2004-2006. Time series analysis included 282 PC patients; matched cohorts included 27 PC with 128 usual care patients; clinical outcome analysis of 48 PC patients. Mean daily patient costs and length of stay (LOS); pain, dyspnea, and secretions assessment scores. Mean daily costs were reduced 33% (p < 0.01) from preintervention to postintervention period. Mean length of stay (LOS) was reduced 30%. Mean daily costs for PC patients were 14.5% lower compared to usual care patients (p < 0.01). Pain, dyspnea, and secretions scores were reduced by 86%, 64%, and 87%, respectively. Over the study period, time to PC referral as well as overall ALOS were reduced by 50%. The large reduction in mean daily costs and LOS resulted in an estimated annual savings of $2.2 million in the study hospital. Our results extend the evidence base of financial and clinical benefits associated with inpatient PC programs. We recommend additional study of best practices for identifying patients and providing consultation services, in addition to progressive management support and reimbursement policy.

Upward Bound/Los Angeles County Probation Department Program Report.

ERIC Educational Resources Information Center

Burke, David

During the summer of 1969, 16 youths from the Los Angeles County Probation Department's facilities participated in the Upward Bound program at the Claremont colleges together with 60 other students from surrounding communities. This program was established to provide the probation department with information useful in establishing similar joint…

Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services

PubMed Central

Vasquez, Carolina; Martinez, Carlos; Tseng, Chi-Hong; Mangione, Carol M.

2017-01-01

Importance Diabetic retinopathy (DR) is the leading cause of blindness in adults of working age in the United States. In the Los Angeles County safety net, a nonvertically integrated system serving underinsured and uninsured patients, the prevalence of DR is approximately 50%, and owing to limited specialty care resources, the average wait times for screening for DR have been 8 months or more. Objective To determine whether a primary care–based teleretinal DR screening (TDRS) program reduces wait times for screening and improves timeliness of needed care in the Los Angeles County safety net. Design, Setting, and Participants Quasi-experimental, pretest-posttest evaluation of exposure to primary care–based TDRS at 5 of 15 Los Angeles County Department of Health Services safety net clinics from September 1, 2013, to December 31, 2015, with a subgroup analysis of random samples of 600 patients before and after the intervention (1200 total). Exposure Primary care clinic–based teleretinal screening for DR. Main Outcomes and Measures Annual rates of screening for DR before and after implementation of the TDRS program across the 5 clinics, time to screening for DR in a random sample of patients from these clinics, and a description of the larger framework of program implementation. Results Among the 21 222 patients who underwent the screening (12 790 female, 8084 male, and 348 other gender or not specified; mean [SD] age, 57.4 [9.6] years), the median time to screening for DR decreased from 158 days (interquartile range, 68-324 days) before the intervention to 17 days (interquartile range, 8-50 days) after initiation of the program (P < .001). Overall annual screening rates for DR increased from 5942 of 14 633 patients (40.6%) before implementation to 7470 of 13 133 patients (56.9%) after initiation of the program at all 15 targeted clinics (odds ratio, 1.9; 95% CI, 1.3-2.9; P = .002). Of the 21 222 patients who were screened, 14 595 (68.8%) did not require referral to an eye care professional, 4160 (19.6%) were referred for treatment or monitoring of DR, and 2461 (11.6%) were referred for other ophthalmologic conditions. Conclusions and Relevance A digital TDRS program was successfully implemented for the largest publicly operated county safety net population in the United States, resulting in the elimination of the need for more than 14 000 visits to specialty care professionals, a 16.3% increase in annual rates of screening for DR, and an 89.2% reduction in wait times for screening. Teleretinal DR screening programs have the potential to maximize access and efficiency in the safety net, where the need for such programs is most critical. PMID:28346590

Saving Water at Los Alamos National Laboratory

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

Erickson, Andy

Los Alamos National Laboratory decreased its water usage by 26 percent in 2014, with about one-third of the reduction attributable to using reclaimed water to cool a supercomputing center. The Laboratory's goal during 2014 was to use only re-purposed water to support the mission at the Strategic Computing Complex. Using reclaimed water from the Sanitary Effluent Reclamation Facility, or SERF, substantially decreased water usage and supported the overall mission. SERF collects industrial wastewater and treats it for reuse. The reclamation facility contributed more than 27 million gallons of re-purposed water to the Laboratory's computing center, a secured supercomputing facility thatmore » supports the Laboratory’s national security mission and is one of the institution’s larger water users. In addition to the strategic water reuse program at SERF, the Laboratory reduced water use in 2014 by focusing conservation efforts on areas that use the most water, upgrading to water-conserving fixtures, and repairing leaks identified in a biennial survey.« less

Saving Water at Los Alamos National Laboratory

ScienceCinema

Erickson, Andy

2018-01-16

Los Alamos National Laboratory decreased its water usage by 26 percent in 2014, with about one-third of the reduction attributable to using reclaimed water to cool a supercomputing center. The Laboratory's goal during 2014 was to use only re-purposed water to support the mission at the Strategic Computing Complex. Using reclaimed water from the Sanitary Effluent Reclamation Facility, or SERF, substantially decreased water usage and supported the overall mission. SERF collects industrial wastewater and treats it for reuse. The reclamation facility contributed more than 27 million gallons of re-purposed water to the Laboratory's computing center, a secured supercomputing facility that supports the Laboratory’s national security mission and is one of the institution’s larger water users. In addition to the strategic water reuse program at SERF, the Laboratory reduced water use in 2014 by focusing conservation efforts on areas that use the most water, upgrading to water-conserving fixtures, and repairing leaks identified in a biennial survey.

Reinforcing E.S.L. with Los Cumbancheros Choral Performance Group (Los Cumbancheros). Final Evaluation Report, 1992-93. OREA Report.

ERIC Educational Resources Information Center

Baez, Raquel

Reinforcing E.S.L. with Los Cumbancheros Choral Performance Group was a state-funded program functioning at seven elementary and junior high schools in the Bronx (New York) in 1992-93, its fifth year. the program served 244 Latino students primarily of limited English proficiency (LEP); a few English-proficient and special education students were…

Effectiveness of Alternative Desegregation Strategies: The Issue of Voluntary versus Mandatory Policies in Los Angeles. Part 1: 1979. Revised.

ERIC Educational Resources Information Center

Ross, J. Michael

A careful review of the literature and an examination of desegregation programs in Los Angeles, show that the claim that voluntary programs produce almost no desegregation, and certainly less than mandatory programs, is open to question. Most comparisons between voluntary and mandatory programs have been between cities and have not taken into…

Los Alamos Programming Models

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

Bergen, Benjamin Karl

This is the PDF of a powerpoint presentation from a teleconference on Los Alamos programming models. It starts by listing their assumptions for the programming models and then details a hierarchical programming model at the System Level and Node Level. Then it details how to map this to their internal nomenclature. Finally, a list is given of what they are currently doing in this regard.

Civilian Nuclear Program

Science.gov Websites

Los Alamos National Laboratory Search Site submit About Mission Business Newsroom Publications Los Innovation in New Mexico Los Alamos Collaboration for Explosives Detection (LACED) SensorNexus Exascale Computing Project (ECP) User Facilities Center for Integrated Nanotechnologies (CINT) Los Alamos Neutron

STEM Education Programs

Science.gov Websites

Los Alamos National Laboratory Search Site submit About Mission Business Newsroom Publications Los Innovation in New Mexico Los Alamos Collaboration for Explosives Detection (LACED) SensorNexus Exascale Computing Project (ECP) User Facilities Center for Integrated Nanotechnologies (CINT) Los Alamos Neutron

Applied Energy Program

Science.gov Websites

Los Alamos National Laboratory Search Site submit About Mission Business Newsroom Publications Los Innovation in New Mexico Los Alamos Collaboration for Explosives Detection (LACED) SensorNexus Exascale Computing Project (ECP) User Facilities Center for Integrated Nanotechnologies (CINT) Los Alamos Neutron

Workplace ESL Literacy Program of the Los Angeles Herald Examiner Newspaper.

ERIC Educational Resources Information Center

Herald Examiner, Los Angeles, CA.

This packet of materials from the Los Angeles Herald Examiner's English-as-a-Second-Language (ESL) workplace literacy program, defunct since the newspaper's closing, contains the following items: an overview of the program; a list of units and subunits; two sample lesson plans; teacher guidelines about evaluation and progress; lists of specific…

Grandparents and Books. Trainer's Manual. Revised Edition.

ERIC Educational Resources Information Center

Wade, Maureen; And Others

Based on a pilot program developed in the Los Angeles (California) Public Library, this guide provides the materials and information needed for introducing a "Grandparents and Books" (GAB) program in a public library. The Los Angeles program was designed to bring together the city's elderly population with children who have no one to…

Probiotic Supplementation in Preterm Infants Does Not Affect the Risk of Bronchopulmonary Dysplasia: A Meta-Analysis of Randomized Controlled Trials

PubMed Central

Mosca, Fabio; Kramer, Boris

2017-01-01

Probiotic supplementation reduces the risk of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants, but it remains to be determined whether this reduction translates into a reduction of other complications. We conducted a systematic review and meta-analysis to evaluate the possible role of probiotics in altering the risk of bronchopulmonary dysplasia (BPD). Fifteen randomized controlled trials (4782 infants; probiotics: 2406) were included. None of the included studies assessed BPD as the primary outcome. Meta-analysis confirmed a significant reduction of NEC (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.33 to 0.81, p = 0.004; random effects model), and an almost significant reduction of LOS (RR 0.82, 95% CI 0.65 to 1.03, p = 0.084). In contrast, meta-analysis could not demonstrate a significant effect of probiotics on BPD, defined either as oxygen dependency at 28 days of life (RR 1.01, 95% CI 0.91 to 1.11, p = 0.900, 6 studies) or at 36 weeks of postmenstrual age (RR 1.07, 95% CI 0.96 to 1.20, p = 0.203, 12 studies). Meta-regression did not show any significant association between the RR for NEC or LOS and the RR for BPD. In conclusion, our results suggest that NEC and LOS prevention by probiotics does not affect the risk of developing BPD in preterm infants. PMID:29088103

Critical partnerships: Los Alamos, universities, and industry

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

Berger, C.L.

1997-04-01

Los Alamos National Laboratory, situated 35 miles northwest of Santa Fe, NM, is one of the Department of Energy`s three Defense Programs laboratories. It encompasses 43 square miles, employees approximately 10,000 people, and has a budget of approximately $1.1B in FY97. Los Alamos has a strong post-cold war mission, that of reducing the nuclear danger. But even with that key role in maintaining the nation`s security, Los Alamos views partnerships with universities and industry as critical to its future well being. Why is that? As the federal budget for R&D comes under continued scrutiny and certain reduction, we believe thatmore » the triad of science and technology contributors to the national system of R&D must rely on and leverage each others capabilities. For us this means that we will rely on these partners to help us in 5 key ways: We expect that partnerships will help us maintain and enhance our core competencies. In doing so, we will be able to attract the best scientists and engineers. To keep on the cutting edge of research and development, we have found that partnerships maintain the excellence of staff through new and exciting challenges. Additionally, we find that from our university and corporate partners we often learn and incorporate {open_quotes}best practices{close_quotes} in organizational management and operations. Finally, we believe that a strong national system of R&D will ensure and enhance our ability to generate revenues.« less

The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry.

PubMed

Gandré, Coralie; Gervaix, Jeanne; Thillard, Julien; Macé, Jean-Marc; Roelandt, Jean-Luc; Chevreul, Karine

2017-03-21

International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients', psychiatric sectors' and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients' characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.

Estimating the potential health impact and costs of implementing a local policy for food procurement to reduce the consumption of sodium in the county of Los Angeles.

PubMed

Gase, Lauren N; Kuo, Tony; Dunet, Diane; Schmidt, Steven M; Simon, Paul A; Fielding, Jonathan E

2011-08-01

We examined approaches to reduce sodium content of food served in settings operated or funded by the government of the County of Los Angeles, California. We adapted health impact assessment methods to mathematically simulate various levels of reduction in the sodium content of food served by the County of Los Angeles and to estimate the reductions' potential impacts on mean systolic blood pressure (SBP) among food-service customers. We used data provided by county government food-service vendors to generate these simulations. Our analysis predicted that if the postulated sodium-reduction strategies were implemented, adults would consume, on average, 233 fewer milligrams of sodium each day. This would correspond to an average decrease of 0.71 millimeters of mercury in SBP among adult hypertensives, 388 fewer cases of uncontrolled hypertension in the study population, and an annual decrease of $629,724 in direct health care costs. Our findings suggest that a food-procurement policy can contribute to positive health and economic effects at the local level. Our approach may serve as an example of sodium-reduction analysis for other jurisdictions to follow.

Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

PubMed Central

2010-01-01

Background One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS). Methods Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups. Results There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence. Conclusion Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction. PMID:20819224

Los Alamos Scientific Laboratory energy-related history, research, managerial reorganization proposals, actions taken, and results. History report, 1945--1979

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

Hammel, E.F.

1997-03-01

This report documents the development of major energy-related programs at the Los Alamos Scientific Laboratory between 1945 and 1979. Although the Laboratory`s primary mission during that era was the design and development of nuclear weapons and most of the Laboratory`s funding came from a single source, a number of factors were at work that led to the development of these other programs. Some of those factors were affected by the Laboratory`s internal management structure and organization; others were the result of increasing environmental awareness within the general population and the political consequences of that awareness; still others were related tomore » the increasing demand for energy and the increasing turmoil in the energy-rich Middle East. This report also describes the various activities in Los Alamos, in Washington, and in other areas of the world that contributed to the development of major energy-related programs at Los Alamos. The author has a unique historical perspective because of his involvement as a scientist and manager at the Los Alamos Scientific Laboratory during the time period described within the report. In addition, in numerous footnotes and references, he cites a large body of documents that include the opinions and perspectives of many others who were involved at one time or another in these programs. Finally the report includes a detailed chronology of geopolitical events that led to the development of energy-related programs at Los Alamos.« less

Disabled Students in Vocational Education Programs: Los Angeles Community Colleges, 1981-1982--Success.

ERIC Educational Resources Information Center

Holzkamper, Charlot

This report reviews efforts by the Los Angeles Community College District (LACCD) to meet the needs of handicapped students in its vocational education programs. The report begins with a summary of district statistics and California and federal legislation regarding access for the disabled in vocational programs. Part II focuses on the students…

Teaching Students to Write across a Border: A Writing Curriculum for Inner-City College Access Programs

ERIC Educational Resources Information Center

Dobbs, Jennifer Kwon

2012-01-01

This article explores the development of the Summer Tools, Information, Motivation, and Education (SummerTIME) Writing Program, the only program of its kind in Los Angeles that conducts self-assessment. The author describes the geographical and political boundaries separating inner-city Los Angeles high school graduates from higher education,…

40 CFR 81.17 - Metropolitan Los Angeles Air Quality Control Region.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 17 2011-07-01 2011-07-01 false Metropolitan Los Angeles Air Quality...) AIR PROGRAMS (CONTINUED) DESIGNATION OF AREAS FOR AIR QUALITY PLANNING PURPOSES Designation of Air Quality Control Regions § 81.17 Metropolitan Los Angeles Air Quality Control Region. The Metropolitan Los...

40 CFR 81.17 - Metropolitan Los Angeles Air Quality Control Region.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 18 2012-07-01 2012-07-01 false Metropolitan Los Angeles Air Quality...) AIR PROGRAMS (CONTINUED) DESIGNATION OF AREAS FOR AIR QUALITY PLANNING PURPOSES Designation of Air Quality Control Regions § 81.17 Metropolitan Los Angeles Air Quality Control Region. The Metropolitan Los...

40 CFR 81.17 - Metropolitan Los Angeles Air Quality Control Region.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 18 2014-07-01 2014-07-01 false Metropolitan Los Angeles Air Quality...) AIR PROGRAMS (CONTINUED) DESIGNATION OF AREAS FOR AIR QUALITY PLANNING PURPOSES Designation of Air Quality Control Regions § 81.17 Metropolitan Los Angeles Air Quality Control Region. The Metropolitan Los...

40 CFR 81.17 - Metropolitan Los Angeles Air Quality Control Region.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 18 2013-07-01 2013-07-01 false Metropolitan Los Angeles Air Quality...) AIR PROGRAMS (CONTINUED) DESIGNATION OF AREAS FOR AIR QUALITY PLANNING PURPOSES Designation of Air Quality Control Regions § 81.17 Metropolitan Los Angeles Air Quality Control Region. The Metropolitan Los...

40 CFR 81.17 - Metropolitan Los Angeles Air Quality Control Region.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Metropolitan Los Angeles Air Quality...) AIR PROGRAMS (CONTINUED) DESIGNATION OF AREAS FOR AIR QUALITY PLANNING PURPOSES Designation of Air Quality Control Regions § 81.17 Metropolitan Los Angeles Air Quality Control Region. The Metropolitan Los...

Approaches to Program Accounting for Public Schools. Presentations and Discussions of the National Conference on Program Accounting for Public Schools (University of California, Los Angeles, July 1968).

ERIC Educational Resources Information Center

Lindman, Erick L., Ed.

This volume contains papers presented at The National Conference on Program Accounting for Public Schools held at The University of California at Los Angeles, in July 1968. The papers describe six public school expenditure classification systems designed to facilitate program budgeting and cost analysis. The account classification systems are…

Can’t We All Just Get Along?: Civil Support and Interagency Cooperation in the 1992 Los Angeles Riots

DTIC Science & Technology

2007-05-10

Angeles Police 3 Department ( LAPD ).4 The departure of industry and reductions in federal aid during the Reagan administration contributed to economic...Marines. The Task Force operated in Los Angeles County supporting the LAPD , LA County Sheriff’s Department , and other agencies in restoring order until...2006). http://www4.law.cornell.edu/uscode/ (accessed 1 May 2007). Los Angeles Police Department

An Affirmative Action Program for Ethnic Minorities. Part I: Present Practices and Procedures of Los Rios District.

ERIC Educational Resources Information Center

Los Rios Community Coll. District, Sacramento, CA.

The components and present status of programs for ethnic minorities at American River, Sacramento City, and Cosumnes River Colleges of the Los Rios Community College District (California) are explained in this Part I of a larger study. The programs aim to enhance minority students' opportunities to succeed in college, provide equal opportunity for…

Electrification of the freight train network from the Ports of Los Angeles and Long Beach to the Inland Empire.

DOT National Transportation Integrated Search

2008-05-01

The goal of this project was to evaluate the benefits of electrifying the freight railroads connecting the Ports of Los Angeles and Long Beach with the Inland Empire. These benefits include significant reduction in air pollution, and improvements in ...

Engineering Institute

Science.gov Websites

Search Site submit National Security Education Center Los Alamos National LaboratoryEngineering Institute Addressing national needs by fostering specialized recruiting and strategic partnerships Los Alamos National LaboratoryEngineering Institute Menu NSEC Educational Programs Los Alamos Dynamics Summer

Enablers and Obstacles to Democratic Consolidation and Civil-Military Relations Reform: A Comparative Analysis of Argentina and Guatemala

DTIC Science & Technology

2014-03-01

the war. Even the Procuraduría de los Derechos Humanos (PDH, or Human Rights Ombudsman), which was established in 1985, was infested with racist...Procuraduría de los Derechos Humanos (PDH)145 The PDH’s purpose was to document human rights abuses in order to promote their reduction and eventual...conditions. In addition to the Madres, the Asamblea Permanente por los Derechos 61 Fagen

Health care reform at trauma centers--mortality, complications, and length of stay.

PubMed

Shafi, Shahid; Barnes, Sunni; Nicewander, David; Ballard, David; Nathens, Avery B; Ingraham, Angela M; Hemmila, Mark; Goble, Sandra; Neal, Melanie; Pasquale, Michael; Fildes, John J; Gentilello, Larry M

2010-12-01

The Trauma Quality Improvement Program has demonstrated existence of significant variations in risk-adjusted mortality across trauma centers. However, it is unknown whether centers with lower mortality rates also have reduced length of stay (LOS), with associated cost savings. We hypothesized that LOS is not primarily determined by unmodifiable factors, such as age and injury severity, but is primarily dependent on the development of potentially preventable complications. The National Trauma Data Bank (2002-2006) was used to include patients (older than 16 years) with at least one severe injury (Abbreviated Injury Scale score ≥ 3) from Level I and II trauma centers (217,610 patients, 151 centers). A previously validated risk-adjustment algorithm was used to calculate observed-to-expected mortality ratios for each center. Poisson regression was used to determine the relationship between LOS, observed-to-expected mortality ratios, and complications while controlling for confounding factors, such as age, gender, mechanism, insurance status, comorbidities, and injuries and their severity. Large variations in LOS (median, 4-8 days) were observed across trauma centers. There was no relationship between mortality and LOS. The most important predictor of LOS was complications, which were associated with a 62% increase. Injury severity score, shock, gunshot wounds, brain injuries, intensive care unit admission, and comorbidities were less important predictors of LOS. Quality improvement programs focusing on mortality alone may not be associated with reduced LOS. Hence, the Trauma Quality Improvement Program should also focus on processes of care that reduce complications, thereby shortening LOS, which may lead to significant cost savings at trauma centers.

A toolbox for alleviating traffic congestion and enhancing mobility

DOT National Transportation Integrated Search

2012-06-01

This report presents the Tolling Data Test Plan for the national evaluation of the Los Angeles (LA) Congestion Reduction Demonstration (Metro ExpressLanes) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Demonstra...

Share the road campaign research study : final report

DOT National Transportation Integrated Search

2012-07-01

This report presents the Environmental Data Test Plan for the national evaluation of the Los Angeles (LA) Congestion Reduction Demonstration (Metro ExpressLanes) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Dem...

Dexterity test data contribute to reduction in leaded glovebox gloves use

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

Cournoyer, Michael E; Lawton, Cindy M; Castro, Amanda M

2009-01-01

Programmatic operations at the Los Alamos National Laboratory Plutonium Facility (T A-55) involve working with various amounts of plutonium and other highly toxic, alpha-emitting materials. The spread of radiological contamination on surfaces, airborne contamination, and excursions of contaminants into the operator's breathing zone are prevented through the use of a variety of gloveboxes. Using an integrated approach, controls have been developed and implemented through an efficient Glovebox Glove Integrity Program. A key element of this program is to consider measures that lower the overall risk of glovebox operations. Line management who own glovebox processes through this program make decisions onmore » which type of glovebox gloves (hereafter referred to as gloves), the weakest component of this safety-significant system, would perform best in these aggressive environments. As Low as Reasonably Achievable considerations must be balanced with glove durability and worker dexterity, both of which affect the final overall risk of the operation. In the past, lead-loaded (leaded) gloves made from Hypalon(reg.) were the primary glove for programmatic operations at TA55. Replacing leaded gloves with unleaded gloves for certain operations would lower the overall risk as well as reduce the amount of mixed transuranic waste. This effort contributes to the Los Alamos National Laboratory Continuous Improvement Program by improving the efficiency, cost-effectiveness, and formality of glovebox operations. In this report, the pros and cons of wearing leaded gloves, the effect of leaded gloves versus unleaded gloves on task performance using standard dexterity tests, the justification for switching from leaded to unleaded gloves, and the pollution prevention benefits of this dramatic change in the glovebox system are presented.« less

Dexterity tests data contribute to reduction in leaded glovebox gloves use

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

Cournoyer, Michael E; Lawton, Cindy M; Castro, Amanda M

2008-01-01

Programmatic operations at the Los Alamos National Laboratory Plutonium Facility (TA-55) involve working with various amounts of plutonium and other highly toxic, alphaemitting materials. The spread of radiological contamination on surfaces and airborne contamination and excursions of contaminants into the operator's breathing zone are prevented through the use of a variety of gloveboxes. Through an integrated approach, controls have been developed and implemented through an efficient Glovebox Glove Integrity Program (GGJP). A key element of this program is to consider measures that lower the overall risk of glovebox operations. Line management owning glovebox processes through this program make decisions onmore » which type of glovebox gloves (the weakest component of this safety significant system) would perform in these aggressive environments. As Low As Reasonably Achievable (ALARA) considerations must be balanced with glove durability and worker dexterity, both of which affect the final overall risk of the operation. In the past, lead-loaded (leaded) glovebox gloves made from Hypalon(reg.) had been the workhorse of programmatic operations at TA-55. Replacing leaded gloves with unleaded gloves for certain operations would lower the overall risk as well as reduced the amount of mixed TRU waste. This effort contributes to Los Alamos National Laboratory Continuous Improvement Program by improving the efficiency, cost effectiveness, and formality of glovebox operations. In the following report, the pros and cons of wearing leaded glovebox gloves, the effect of leaded gloves versus unleaded gloves on task performance using standard dexterity tests, the justification for switching from leaded to unleaded gloves, and pollution prevention benefits of this dramatic change in the glovebox system are presented.« less

A review of the Los Alamos effort in the development of nuclear rocket propulsion

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

Durham, F.P.; Kirk, W.L.; Bohl, R.J.

1991-01-01

This paper reviews the achievements of the Los Alamos nuclear rocket propulsion program and describes some specific reactor design and testing problems encountered during the development program along with the progress made in solving these problems. The relevance of these problems to a renewed nuclear thermal rocket development program for the Space Exploration Initiative (SEI) is discussed. 11 figs.

Seventy Years of Computing in the Nuclear Weapons Program

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

Archer, Billy Joe

Los Alamos has continuously been on the forefront of scientific computing since it helped found the field. This talk will explore the rich history of computing in the Los Alamos weapons program. The current status of computing will be discussed, as will the expectations for the near future.

The Los Angeles Community College District Crisis, 1981-1987.

ERIC Educational Resources Information Center

Erickson, Lowell Janes

This document describes a crisis in enrollment, funding, and governance that occurred in the Los Angeles Community College District (LACCD) between 1981 and 1987. Following introductory materials, chapter 1 reviews the history of the LACCD and the effect of funding reductions caused by 1978's Proposition 13. The next two chapters review the…

Institutional plan FY 1999--FY 2004

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

NONE

1998-10-01

Los Alamos has a well-defined and nationally important mission: to reduce the global nuclear danger. This central national security mission consists of four main elements: stockpile stewardship, nuclear materials management, nonproliferation and arms control, and cleanup of the environmental legacy of nuclear weapons activities. The Laboratory provides support for and ensures confidence in the nation`s nuclear stockpile without nuclear testing. This challenge requires the Laboratory to continually hone its scientific acumen and technological capabilities to perform this task reliably using an interdisciplinary approach and advanced experimental and modeling techniques. In the last two National Defense Authorization Acts, Congress identified themore » need to protect the nation from the proliferation of weapons of mass destruction, which includes nuclear, chemical, and biological weapons, and their potential use by terrorists. Los Alamos is applying multidisciplinary science and engineering skills to address these problems. In addition, the Laboratory`s critical programmatic roles in stockpile stewardship and threat reduction are complemented by its waste management operations and environmental restoration work. Information on specific programs is available in Section 2 of this document.« less

Performance Contracting and Quality Improvement in Outpatient Treatment: Effects on Waiting Time and Length of Stay

PubMed Central

Stewart, Maureen T.; Horgan, Constance M.; Garnick, Deborah W.; Ritter, Grant; McLellan, A. Thomas

2012-01-01

We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes. PMID:22445031

Fiscal Year 2013 Trails Management Program Mitigation Action Plan Annual Report, October 2013

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

Pava, Daniel S.

This Trails Management Program Mitigation Action Plan Annual Report (Trails MAPAR) has been prepared for the Department of Energy (DOE)/National Nuclear Security Administration (NNSA) as part of implementing the 2003 Final Environmental Assessment for the Proposed Los Alamos National Laboratory Trails Management Program (DOE 2003). The Trails Mitigation Action Plan (MAP) is now a part of the Site-Wide Environmental Impact Statement for the Continued Operation of Los Alamos National Laboratory (DOE/EIS 0380) Mitigation Action Plan (2008 SWEIS MAP) (DOE 2008). The MAP provides guidance for the continued implementation of the Trails Management Program at Los Alamos National Laboratory (LANL) andmore » integration of future mitigation actions into the 2008 SWEIS MAP to decrease impacts associated with recreational trails use at LANL. This eighth MAPAR includes a summary of Trails Management Program activities and actions during Fiscal Year (FY) 2013, from October 2012 through September 2013.« less

The impact of a multifaceted intervention including sepsis electronic alert system and sepsis response team on the outcomes of patients with sepsis and septic shock.

PubMed

Arabi, Yaseen M; Al-Dorzi, Hasan M; Alamry, Ahmed; Hijazi, Ra'ed; Alsolamy, Sami; Al Salamah, Majid; Tamim, Hani M; Al-Qahtani, Saad; Al-Dawood, Abdulaziz; Marini, Abdellatif M; Al Ehnidi, Fatimah H; Mundekkadan, Shihab; Matroud, Amal; Mohamed, Mohamed S; Taher, Saadi

2017-12-01

Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department. This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital. We recorded baseline characteristics and processes of care in adult patients presenting with sepsis or septic shock. The primary outcome measures were hospital mortality. Secondary outcomes were the need for mechanical ventilation and length of stay in the intensive unit and in the hospital. After implementing the multifaceted intervention including e-alert and SRT, cases were identified with less severe clinical and laboratory abnormalities and the processes of care improved. When adjusted to propensity score, the interventions were associated with reduction in hospital mortality [for intervention phase II compared to pre-intervention: adjusted odds ratio (aOR) 0.71, 95% CI 0.58-0.85, p = 0.003], reduction in the need for mechanical ventilation (aOR 0.45, 95% CI 0.37-0.55, p < 0.0001) and reduction in ICU LOS and hospital LOS for all patients as well as ICU LOS for survivors. Implementing a multifaceted intervention including sepsis e-alert with SRT was associated with earlier identification of sepsis, increase in compliance with sepsis resuscitation bundle and reduction in the need for mechanical ventilation and reduction in hospital mortality and LOS.

10 Stimulating Ideas

ERIC Educational Resources Information Center

Kennedy, Mike

2009-01-01

This fall, the Los Angeles Unified School District sold about $2 billion in bonds to finance more projects in its massive school construction program. But the cost of repaying that debt won't be as burdensome as it could have been. Los Angeles took advantage of two federal programs available to school systems through the American Reinvestment and…

The Southern California Earthquake Survival Program

USGS Publications Warehouse

Harris, J.M.

1989-01-01

In July 1988, the Los Angeles County Board of Supervisors directed the Chief Administrative Office to develop an educational program aimed at improving earthquake preparedness among Los Angeles County residents. the board recognized that current earthquake education efforts were not only insufficient, but also often confusing and costly. The board unanimously approved the development of a program that would make earthquake preparedness a year-long effort by encouraging residents to take a different precaution each month. 

Enhanced recovery clinical education programme improves quality of post-operative care.

PubMed

McDonald, Ruth

2015-01-01

Quality is the driving principle of Enhanced Recovery (ER). It improves the patient experience by getting patients better sooner and changes clinical practice to make care safer and more efficient. As a consequence of ER patients spend less time in hospital. A successful ER programme began to fail after organisational restructuring and staff changes. Patients did not meet their ER goals and length of stay (LOS) increased. An ER nurse was appointed to get the programme back on track. This involved a multidisciplinary approach to an ER clinical education programme. The programme aimed to develop knowledge of the physiology of post-operative recovery and the evidence underpinning the interventions required. This was considered crucial to secure longer term staff engagement while avoiding unthinking protocol driven compliance. Success of the education programme was measured by improved outcomes in patient LOS and readmission statistics. During the four months of the clinical education programme there were no significant changes in monthly LOS. At six months post implementation of the programme there was a reduction in LOS of 0.6 days compared to the previous six months. At 12 months there was a reduction in 1.1 days compared with previous 12 months. There was a mean reduction of 28 day readmissions for all elective gynaecology surgery of 1.1 patients per month in the 12 months post programme implementation compared to the 12 months before. Delivering a multidisciplinary participatory education programme improved overall understanding of ER, and achieved sustained improvement in ER for patient benefit.

77 FR 13360 - Energy Employees Occupational Illness Compensation Program Act of 2000, as Amended

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-06

... Sands Missile Range. 1945. Hangar 481, Kirtland AFB Albuquerque 1989-1996. Kirtland Operations Office, Kirtland Albuquerque 1964-Present. AFB. Los Alamos Medical Center Los Alamos 1952-1963. Los Alamos National.... Institute, Kirtland AFB. Project Gasbuggy Nuclear Explosion Site Farmington 1967-1973; 1978; 1992-Present...

La Participacion de los Padres en los Programas Preescolares. (Hispanic Parent Involvement in Early Childhood Programs.) ERIC Digest.

ERIC Educational Resources Information Center

Espinosa, Linda M.

To determine effective strategies for involving Hispanic parents in their children's early childhood programs, educators need to develop a greater understanding of the features of the Hispanic culture that influence parents' childrearing practices and orientation toward formal education. Educators should be aware of Hispanics' diversity in terms…

Impact of payments for environmental services and protected areas on local livelihoods and forest conservation in northern Cambodia

PubMed Central

Clements, Tom; Milner-Gulland, E J

2015-01-01

The potential impacts of payments for environmental services (PES) and protected areas (PAs) on environmental outcomes and local livelihoods in developing countries are contentious and have been widely debated. The available evidence is sparse, with few rigorous evaluations of the environmental and social impacts of PAs and particularly of PES. We measured the impacts on forests and human well-being of three different PES programs instituted within two PAs in northern Cambodia, using a panel of intervention villages and matched controls. Both PES and PAs delivered additional environmental outcomes relative to the counterfactual: reducing deforestation rates significantly relative to controls. PAs increased security of access to land and forest resources for local households, benefiting forest resource users but restricting households’ ability to expand and diversify their agriculture. The impacts of PES on household well-being were related to the magnitude of the payments provided. The two higher paying market-linked PES programs had significant positive impacts, whereas a lower paying program that targeted biodiversity protection had no detectable effect on livelihoods, despite its positive environmental outcomes. Households that signed up for the higher paying PES programs, however, typically needed more capital assets; hence, they were less poor and more food secure than other villagers. Therefore, whereas the impacts of PAs on household well-being were limited overall and varied between livelihood strategies, the PES programs had significant positive impacts on livelihoods for those that could afford to participate. Our results are consistent with theories that PES, when designed appropriately, can be a powerful new tool for delivering conservation goals whilst benefiting local people. El Impacto de los Pagos por Servicios Ambientales y Áreas Protegidas sobre la Subsistencia Local y la Conservación del Bosque en el Norte de Camboya Resumen Los impactos potenciales de los pagos por servicios ambientales (PSA) y áreas protegidas (APs) sobre los resultados ambientales y las subsistencias locales en los países en desarrollo son polémicos y se han debatido ampliamente. La evidencia disponible es escasa; ha habido pocas evaluaciones rigurosas de los impactos ambientales y sociales de las APs y particularmente los PSA. Medimos el impacto sobre los bosques y el bienestar humano en tres diferentes programas de PSA que se llevan a cabo dentro de dos APs en el norte de Camboya usando un panel de aldeas de intervención y controles emparejados. Tanto los PSA como las APs brindaron resultados ambientales adicionales en relación a los contrafácticos, esto quiere decir que redujeron las tasas de deforestación significativamente en relación a los controles. Las áreas protegidas incrementaron el acceso seguro a los recursos del suelo y el bosque para las viviendas locales, beneficiando a los usuarios de los recursos del bosque pero restringiendo la habilidad de las viviendas para expandirse y diversificar su agricultura. Los impactos de los pagos por servicios ambientales sobre el bienestar de las viviendas estuvieron relacionados con la magnitud de los pagos proporcionados. Los dos programas de PSA de mayor paga y con conexión al mercado tuvieron impactos positivos significativos, mientras que un programa de menor paga con el objetivo de proteger a la biodiversidad no tuvo un efecto detectable sobre las viviendas, a pesar de sus resultados ambientales positivos. Las viviendas que se inscribieron a los programas de PSA con mayor paga, sin embargo, necesitaban típicamente más bienes capitales, por lo que eran menos pobres y tenían mayor seguridad alimentaria que otros aldeanos. Por esto, mientras los impactos de las APs sobre el bienestar de las viviendas fueron limitados en general y variaron dependiendo de las estrategias de subsistencia, los programas de PSA tuvieron impactos positivos significativos sobre las viviendas para aquellos que podían costear participar. Nuestros resultados son congruentes con las teorías de que los PSA, cuando se designan apropiadamente, pueden ser una herramienta poderosa y novedosa para obtener objetivos de conservación mientras se beneficia a la gente local. PMID:25492724

Developing intelligent transportation systems using the national ITS archetecture: an executive edition for senior transportation managers

DOT National Transportation Integrated Search

2012-07-01

This report presents the Cost Benefit Analysis Test Plan for the national evaluation of the Los Angeles County Congestion Reduction Demonstration (LAC CRD) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Demonstra...

Opportunities at Independent Colleges and Universities in New York State through the Higher Education Opportunity Program = Oportunidades en los colegios y universidades independientes en el Estado de Nueva York a traves de los programas de oportunidad en educacion.

ERIC Educational Resources Information Center

State Univ. of New York, Albany.

Information on programs that address special needs of students from disadvantaged backgrounds who attend private colleges and universities in New York State is provided in separate English and Spanish reports. The Higher Education Opportunity Program (HEOP) provides supportive services and financial aid. Information is provided on: eligibility for…

Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project.

PubMed

McWilliams, David; Weblin, Jonathan; Atkins, Gemma; Bion, Julian; Williams, Jenny; Elliott, Catherine; Whitehouse, Tony; Snelson, Catherine

2015-02-01

Prolonged periods of mechanical ventilation are associated with significant physical and psychosocial adverse effects. Despite increasing evidence supporting early rehabilitation strategies, uptake and delivery of such interventions in Europe have been variable. The objective of this study was to evaluate the impact of an early and enhanced rehabilitation program for mechanically ventilated patients in a large tertiary referral, mixed-population intensive care unit (ICU). A new supportive rehabilitation team was created within the ICU in April 2012, with a focus on promoting early and enhanced rehabilitation for patients at high risk for prolonged ICU and hospital stays. Baseline data on all patients invasively ventilated for at least 5 days in the previous 12 months (n = 290) were compared with all patients ventilated for at least 5 days in the 12 months after the introduction of the rehabilitation team (n = 292). The main outcome measures were mobility level at ICU discharge (assessed via the Manchester Mobility Score), mean ICU, and post-ICU length of stay (LOS), ventilator days, and in-hospital mortality. The introduction of the ICU rehabilitation team was associated with a significant increase in mobility at ICU discharge, and this was associated with a significant reduction in ICU LOS (16.9 vs 14.4 days, P = .007), ventilator days (11.7 vs 9.3 days, P < .05), total hospital LOS (35.3 vs 30.1 days, P < .001), and in-hospital mortality (39% vs 28%, P < .05). A quality improvement strategy to promote early and enhanced rehabilitation within this European ICU improved levels of mobility at critical care discharge, and this was associated with reduced ICU and hospital LOS and reduced days of mechanical ventilation. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Community-Based Mindfulness Program for Disease Prevention and Health Promotion: Targeting Stress Reduction.

PubMed

Galla, Brian M; O'Reilly, Gillian A; Kitil, M Jennifer; Smalley, Susan L; Black, David S

2015-01-01

Poorly managed stress leads to detrimental physical and psychological consequences that have implications for individual and community health. Evidence indicates that U.S. adults predominantly use unhealthy strategies for stress management. This study examines the impact of a community-based mindfulness training program on stress reduction. This study used a one-group pretest-posttest design. The study took place at the UCLA Mindful Awareness Research Center in urban Los Angeles. A sample of N = 127 community residents (84% Caucasian, 74% female) were included in the study. Participants received mindfulness training through the Mindful Awareness Practices (MAPs) for Daily Living I. Mindfulness, self-compassion, and perceived stress were measured at baseline and postintervention. Paired-sample t-tests were used to test for changes in outcome measures from baseline to postintervention. Hierarchical regression analysis was fit to examine whether change in self-reported mindfulness and self-compassion predicted postintervention perceived stress scores. There were statistically significant improvements in self-reported mindfulness (t = -10.67, p < .001, d = .90), self-compassion (t = -8.50, p < .001, d = .62), and perceived stress (t = 9.28, p < .001, d = -.78) at postintervention. Change in self-compassion predicted postintervention perceived stress (β = -.44, t = -5.06, p < .001), but change in mindfulness did not predict postintervention perceived stress (β = -.04, t = -.41, p = .68). These results indicate that a community-based mindfulness training program can lead to reduced levels of psychological stress. Mindfulness training programs such as MAPs may offer a promising approach for general public health promotion through improving stress management in the urban community.

Physical training programs for public safety personnel.

PubMed

Moulson-Litchfield, M; Freedson, P S

1986-07-01

The nature of public safety jobs often reflects sudden strenuous exertion at a moment's notice. In the 1970s, police and fire departments became acutely aware of high numbers of on-the-job injuries and illnesses related to coronary heart disease. Disability payments for premature cardiovascular problems were being linked to cardiovascular risk factors accrued while on the job. This prompted public safety departments to initiate fitness programs for their employees. The fitness level of public safety personnel is not high. Job-related benefits have been linked to consistent physical training; high aerobic capacity, high muscular strength and endurance, above-average lean body weight, and minimal body fat are necessary for efficient job performance. In light of the physical benefits gained through regular exercise, pioneer departments began exercise programs for their personnel. These included the fire departments in Lawrence, Kansas, Alexandria, Virginia and Los Angeles, and the Dallas police department. Mealey documents psychologic improvements with exercise. Pioneer fitness programs such as that of the Los Angeles fire department have noted evidence of risk-factor reduction following institution of a mandatory program. The Alexandria department has instituted mandatory entrance requirements for their recruits, such as a no-smoking policy while on the job and mandatory exercise participation. Many community departments are not able to justify the institution of fitness programs. They may cite cost, lack of space, or lack of administrative support for the inability to initiate these programs. Legal and union ramifications may also deter the effort of program implementation. Considerations when implementing programs should involve cost of equipment, space, employee input, and determination of mandatory versus voluntary status. Preliminary medical screening and fitness evaluations should reliably evaluate an employee's physical ability to perform job-related tasks. The tests should be performed on a regular basis during employment. It is important, therefore, to convey the benefits of exercise to administrators. Frequent exercise testing should record progress of participants during exercise training and goals should be constantly updated. Pioneer programs should be used as models to follow when implementing a public safety physical training program. However, individual departments should evaluate the needs of their own personnel with respect to equipment, exercise schedule and type, and place of training.(ABSTRACT TRUNCATED AT 400 WORDS)

77 FR 9200 - Los Padres National Forest: California; Environmental Impact Statement for the Removal of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

... Los Padres National Forest (LPNF) proposes to control the invasive species tamarisk in portions of the... infestations become any larger. Successful invasive species control programs are implemented at the landscape... Impact Statement for the Removal of the Noxious Weed Tamarisk on the Los Padres National Forest AGENCY...

Los Angeles County Steps to Excellence Project: QRS Profile. The Child Care Quality Rating System (QRS) Assessment

ERIC Educational Resources Information Center

Child Trends, 2010

2010-01-01

This paper presents a profile of Los Angeles County's Steps to Excellence Project prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs;…

Factors affecting length of stay after isolated femoral shaft fractures.

PubMed

Pendleton, Albert M; Cannada, Lisa K; Guerrero-Bejarano, Maria

2007-03-01

Controlling escalating health care costs is important for hospitals and has far reaching implications for society. Hospital length of stay (LOS) is one of the most reliable predictors of cost after trauma. Our purpose was to establish LOS after isolated femur fractures treated by intramedullary (IM) nail. The trauma registry was queried to identify patients. Patients were excluded if they required assistive ambulatory devices before injury, had chronic/terminal illness or compromised brain function. There were 102 patients with an average age of 27 years. Statistical analysis was completed. The average LOS was 3.9 days. In all, 27 patients stayed longer than 4 days. Reasons included social (7), medical (10), and hospital delays (10). The average time from arrival to surgery was 17 hours. The average time from surgery to physical therapy was 1.3 days. Patients who had surgery more than 24 hours after arrival stayed longer. Patients requiring placement stayed 2.4 days longer until placement was found. Factors the hospital can control to reduce LOS include time to surgery, time for physical therapy evaluation, and radiology delays (for spine clearance radiographs). Physical therapy availability within 24 hours of surgery is important and should include weekends and holidays. Early evaluation of social factors including homelessness or obstacles to independent living may reduce time to find placement. LOS reduction after femur fractures will decrease the cost of trauma to the hospital. In addition, LOS reduction will possibly increase bed availability and minimize the time spent on diversion yielding greater revenues and increasing patient satisfaction.

A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia.

PubMed

Bindawas, Saad M; Mawajdeh, Hussam; Vennu, Vishal; Alhaidary, Hisham

2016-08-01

Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P < 0.001) and subscores: FIM motor ranging from 20 to 26 (P < 0.001); FIM cognitive ranging from 1.8 to 3 (P < 0.001). The mean LOS remained constant, from 52 days in 2011 to 40 days in 2013. The FIM efficiency was stable between years and ranged from 0.52 to 0.72. The rates of discharge (to home) were significantly unstable and ranged from 100% in 2010 and 2011 to 92% in 2013.Our results suggest that functional outcomes in patients with stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.

Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project.

PubMed

Hoyer, Erik H; Friedman, Michael; Lavezza, Annette; Wagner-Kosmakos, Kathleen; Lewis-Cherry, Robin; Skolnik, Judy L; Byers, Sherrie P; Atanelov, Levan; Colantuoni, Elizabeth; Brotman, Daniel J; Needham, Dale M

2016-05-01

To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Comprehensive Truck Size and Weight (TS&W) Study. Phase 1-synthesis, working paper 7 : truck costs and truck size and weight regulations

DOT National Transportation Integrated Search

2012-07-01

This report presents the Cost Benefit Analysis Test Plan for the national evaluation of the Los Angeles County Congestion Reduction Demonstration (LAC CRD) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Demonstra...

Comprehensive Truck Size and Weight (TS&W) Study. Phase 1-synthesis, working paper 6 : traffic operations and truck size and weight regulations

DOT National Transportation Integrated Search

2012-04-01

This report presents the Exogenous Factors Test Plan for the national evaluation of the Los Angeles County Congestion Reduction Demonstration (LAC CRD) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Demonstration...

Enhanced recovery clinical education programme improves quality of post-operative care

PubMed Central

McDonald, Ruth

2015-01-01

Quality is the driving principle of Enhanced Recovery (ER). It improves the patient experience by getting patients better sooner and changes clinical practice to make care safer and more efficient. As a consequence of ER patients spend less time in hospital. A successful ER programme began to fail after organisational restructuring and staff changes. Patients did not meet their ER goals and length of stay (LOS) increased. An ER nurse was appointed to get the programme back on track. This involved a multidisciplinary approach to an ER clinical education programme. The programme aimed to develop knowledge of the physiology of post-operative recovery and the evidence underpinning the interventions required. This was considered crucial to secure longer term staff engagement while avoiding unthinking protocol driven compliance. Success of the education programme was measured by improved outcomes in patient LOS and readmission statistics. During the four months of the clinical education programme there were no significant changes in monthly LOS. At six months post implementation of the programme there was a reduction in LOS of 0.6 days compared to the previous six months. At 12 months there was a reduction in 1.1 days compared with previous 12 months. There was a mean reduction of 28 day readmissions for all elective gynaecology surgery of 1.1 patients per month in the 12 months post programme implementation compared to the 12 months before. Delivering a multidisciplinary participatory education programme improved overall understanding of ER, and achieved sustained improvement in ER for patient benefit. PMID:26734343

PIA Program | CTIO

Science.gov Websites

se cuenta con los fondos necesarios para efectuar el Programa PIA para el 2018. We do, on occasion Observatorio Inter-Americano de Cerro Tololo es el centro nacional de los Estados Unidos para el desarrollo de unos 400 kms al norte de Santiago. Los telescopios se ubican en la cima de Cerro Tololo, a 90 kms al

Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period.

PubMed

Redondo-González, O; Tenías-Burillo, J M; Ruiz-Gonzalo, J

2017-07-01

Vaccination has reduced rotavirus hospitalizations by 25% in European regions with low-moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003-2005)- and post-vaccine (2007-2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007-2009 (β-coefficient = -0·43, 95% confidence intervals (95% CI) -0·68 to -0·17; and odds ratio 0·62, 95% CI 0·50-0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI -365 to -123); the decrease in DRG group III was €2269 per patient (95% CI -4098 to -380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.

A life cycle carbon dioxide inventory of the Million Trees Los Angeles Program

Treesearch

E. Gregory McPherson; Alissa Kendall

2014-01-01

PurposeThis study seeks to answer the question, “Will the Million Trees LA (Million Trees Los Angeles, MTLA) program be a carbon dioxide (CO2) sink or source?” Because there has never been a full accounting of CO2 emissions, it is unclear if urban tree planting initiatives (TPIs) are likely to be...

Los Angeles Community College District Campus Child Development Centers' Measures of Effectiveness Project. Second Evaluation Report, Fiscal Year 1983-1984.

ERIC Educational Resources Information Center

Carfagna-Hunt, Karen; And Others

The Los Angeles Community College District (LACCD) provides a Campus Child Development Center (CCDC) educational program for the preschool children of its college students at all nine of its campuses. In 1983-84, on-site, peer review team visits were conducted to evaluate the centers in terms of their achievement of six program objectives. The…

Response of ozone to changes in hydrocarbon and nitrogen oxide concentrations in outdoor smog chambers filled with Los Angeles air

NASA Astrophysics Data System (ADS)

Kelly, Nelson A.; Gunst, Richard F.

During the summer portion of the 1987 Southern California Air Quality Study (SCAQS), outdoor smog chamber experiments were performed on Los Angeles air to determine the response of maximum ozone levels, O 3(max), to changes in the initial concentrations of hydrocarbons, HC, and nitrogen oxides, NO x. These captive-air experiments were conducted in downtown Los Angeles and in the downwind suburb of Claremont. Typically, eight chambers were filled with LA air in the morning. In some chambers the initial HC and/or NO x concentrations were changed by 25% to 50% by adding various combinations of a mixture of HC, clean air, or NO x. The O 3 concentration in each chamber was monitored throughout the day to determine O 3(max). An empirical mathematical model for O 3(max) was developed from regression fits to the initial HC and NO x concentrations and to the average daily temperature at both sites. This is the first time that a mathematical expression for the O 3-precursor relationship and the positive effect of temperature on O 3(max) have been quantified using captive-air experiments. An ozone isopleth diagram prepared from the empirical model was qualitatively similar to those prepared from photochemical mechanisms. This constitutes the first solely empirical corroboration of the O 3 contour shape for Los Angeles. To comply with the Federal Ozone Standard in LA, O 3(max) must be reduced by approximately 50%. Several strategies for reducing O 3(max) by 50% were evaluated using the empirical model. For the average initial conditions that we measured in LA, the most efficient strategy is one that reduces HC by 55-75%, depending on the ambient HC/NO x ratio. Any accompanying reduction in NO x would be counter-productive to the benefits of HC reductions. In fact, reducing HC and NO x simultaneously requires larger percentage reductions for both than the reduction required when HC alone is reduced. The HC-reduction strategy is the most efficient on average, but no single strategy is the optimum every day.

Estimating the Potential Health Impact and Costs of Implementing a Local Policy for Food Procurement to Reduce the Consumption of Sodium in the County of Los Angeles

PubMed Central

Kuo, Tony; Dunet, Diane; Schmidt, Steven M.; Simon, Paul A.; Fielding, Jonathan E.

2011-01-01

Objectives. We examined approaches to reduce sodium content of food served in settings operated or funded by the government of the County of Los Angeles, California. Methods. We adapted health impact assessment methods to mathematically simulate various levels of reduction in the sodium content of food served by the County of Los Angeles and to estimate the reductions’ potential impacts on mean systolic blood pressure (SBP) among food-service customers. We used data provided by county government food-service vendors to generate these simulations. Results. Our analysis predicted that if the postulated sodium-reduction strategies were implemented, adults would consume, on average, 233 fewer milligrams of sodium each day. This would correspond to an average decrease of 0.71 millimeters of mercury in SBP among adult hypertensives, 388 fewer cases of uncontrolled hypertension in the study population, and an annual decrease of $629 724 in direct health care costs. Conclusions. Our findings suggest that a food-procurement policy can contribute to positive health and economic effects at the local level. Our approach may serve as an example of sodium-reduction analysis for other jurisdictions to follow. PMID:21680933

Percutaneous freezing of sensory nerves prior to total knee arthroplasty.

PubMed

Dasa, Vinod; Lensing, Gabriel; Parsons, Miles; Harris, Justin; Volaufova, Julia; Bliss, Ryan

2016-06-01

Total knee arthroplasty (TKA) is a common procedure resulting in significant post-operative pain. Percutaneous cryoneurolysis targeting the infrapatellar branch of the saphenous nerve and anterior femoral cutaneous nerve could relieve post-operative knee pain by temporarily blocking sensory nerve conduction. A retrospective chart review of 100 patients who underwent TKA was conducted to assess the value of adding perioperative cryoneurolysis to a multimodal pain management program. The treatment group consisted of the first 50 patients consecutively treated after the practice introduced perioperative (five days prior to surgery) cryoneurolysis as part of its standard pain management protocol. The control group consisted of the 50 patients treated before cryoneurolysis was introduced. Outcomes included hospital length of stay (LOS), post-operative opioid requirements, and patient-reported outcomes of pain and function. A significantly lower proportion of patients in the treatment group had a LOS of ≥2days compared with the control group (6% vs. 67%, p<0.0001) and required 45% less opioids during the first 12weeks after surgery. The treatment group reported a statistically significant reduction in symptoms at the six- and 12-week follow-up compared with the control group and within-group significant reductions in pain intensity and pain interference at two- and six-week follow-up, respectively. Perioperative cryoneurolysis in combination with multimodal pain management may significantly improve outcomes in patients undergoing TKA. Promising results from this preliminary retrospective study warrant further investigation of this novel treatment in prospective, randomized trials. III. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

The relationship between the Balanced Budget Act and length of stay for Medicare patients in US hospitals.

PubMed

Younis, Mustafa Z; Forgione, Dana A

2009-02-01

The Balanced Budget Act (BBA) of 1997 and Balanced Budget Refinement Act (BBRA) of 1999 led to deep financial cuts for hospitals and nursing homes. We examine the effects of these acts on hospital length of stay (LOS) for Medicare recipients. Using data for all short-stay community hospitals in the country, we compared LOS for Medicare patients before and after the BBA/BBRA relative to known determinants of LOS, e.g., hospital ownership, region, beds, financial performance, and conversion/change in ownership type. Hospital LOS was reduced as a result of the acts. Reductions were more apparent for larger urban hospitals that provided safety-net services. LOS varied slightly by hospital ownership. This study is among the first to evaluate the impact of BBA and BBRA on hospital services. These acts had a negative effect on the ability of hospitals to continue offering safety-net services and negatively affected LOS.

An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

PubMed

Terra, Sandra M

2007-01-01

This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of reduction in LOS, improvement in quality, and delivery of care.

A hospital perspective on the cost-effectiveness of beta-blockade for prophylaxis of atrial fibrillation after cardiothoracic surgery.

PubMed

Gillespie, Effie L; White, C Michael; Kluger, Jeffrey; Sahni, Jasmine; Gallagher, Robert; Coleman, Craig I

2005-12-01

Prophylactic beta-blockade is the recommended strategy for suppressing atrial fibrillation after cardiothoracic surgery (CTS). However, beta-blockade's impact on the hospital length of stay (LOS) and other economic end points has not been adequately assessed. The present evaluation sought to determine whether beta-blocker use after CTS is a cost-effective strategy for the prevention of postoperative atrial fibrillation (POAF). This was a piggyback cost-effectiveness analysis of a prospective cohort evaluation comprising 1660 patients undergoing CTS at an urban academic hospital from October 1999 to October 2003. Patients receiving beta-blocker prophylaxis were matched 1:1 with control patients not receiving prophylaxis based on age >70 years, valvular surgery, history of atrial fibrillation, male sex, and use of preoperative digoxin or beta-blockers. The incidence of POAF, total hospital costs, and LOS were compared in each group. Nonparametric bootstrapping analysis was performed to examine the study results as part of a quadrant analysis and to calculate CIs for the incremental cost-effectiveness ratio. LOS and total costs were also compared in patients with and without POAF, regardless of beta-blocker use. Use of prophylactic beta-blockade was associated with a 17.3 % reduction in the incidence of POAF (P = 0.02) and a 2.2-day reduction in LOS (P = 0.001) compared with nonuse. It also was associated with a 25.7% reduction in total hospital costs compared with nonuse (mean [SD], $30,978 [$33,108] vs $41,700 [$67,369], respectively; P < 0.001), possibly due to a 27.6% reduction in room and board costs ($11,144 [$15,398] vs $14,920 [$22,132]; P < 0.001). In the bootstrapping analysis, 99.0% of the time prophylactic beta-blockade fell into quadrant IV, which indicated superior effectiveness and lower total costs. Regardless of beta-blocker use, patients who developed POAF had a significantly longer LOS compared with those who did not develop POAF (14.7 [19.1] days vs 10.1 [11.1] days, respectively; P < 0.001) and higher total costs ($47,240 [$85,941] vs $32,516 [$34,644]; P < 0.001). At the institution studied, beta-blocker prophylaxis against POAF after CTS was associated with significantly reduced total costs compared with nonuse of beta-blocker prophylaxis. Patients who developed POAF had significantly increased LOS and total costs compared with those who did not develop POAE An adequately powered prospective, randomized, placebo-controlled trial is necessary to confirm the results of this evaluation.

The association between intradialytic exercise and hospital usage among hemodialysis patients.

PubMed

Parker, Kristen; Zhang, Xin; Lewin, Adriane; MacRae, Jennifer M

2015-04-01

Hemodialysis (HD) patients have high hospitalization rates. Benefits of intradialytic exercise have been proven in numerous studies yet exercise programs are still rarely used in the treatment of end-stage kidney disease (ESKD). Our objective was to determine if there was an association between a 6-month intradialytic bicycling program and hospitalization rates and length of stay (LOS) in ESKD patients. This was a retrospective cohort study that took place 6 months prior to and 6 months during an intradialtyic exercise program at an outpatient HD unit in Calgary, Alberta, Canada. Participants comprised 102 patients who had commenced HD <6 months (incident) or >6 months (prevalent) prior to starting exercise. The intervention comprised a 6-month intradialytic bicycling program. Main outcome measures were hospitalization rate, cause of hospitalization, and LOS. Patients were predominantly male (67.6%) aged 65.6 ± 13.5 years and median HD vintage 1 year (range: 0-12). Comorbidities included diabetes mellitus (50%) and cardiac disease (38.2%). The hospitalization incidence rate ratio (IRR) was 0.48 (0.23-0.98; P = 0.04) in incident and 0.89 (0.56-1.42; P = 0.64) in prevalent patients. The LOS decreased from 7.8 (95% confidence interval (CI): 7.3-8.4) to 3.1 (95% CI: 2.8-3.4) days and LOS IRR was 0.39 (0.35-0.45; P < 0.001). The main predictors of hospitalization were lower albumin levels (P = 0.007) and lack of intradialytic exercise program participation (P < 0.001). In conclusion, 6 months of intradialytic exercise was associated with decreased LOS in both incident and prevalent HD patients.

Changing Patient Expectations Decreases Length of Stay in an Enhanced Recovery Program for THA.

PubMed

Tanzer, Dylan; Smith, Karen; Tanzer, Michael

2018-02-01

The implementation of care pathways in hip arthroplasty programs has been shown to result in a decreased length of stay (LOS), but often multiple elements of a care pathway are implemented at the same time. As a result, it is difficult to understand the impact each of the individual modifications has made to the patient's prepathway care. In particular, it is unknown what the role of patient expectations pertaining to anticipated LOS alone is on the LOS after primary THA. (1) Does changing the patient's expectations regarding his or her anticipated LOS, without intentionally changing the rest of the care pathway, result in a change in the patient's LOS after primary THA? (2) Is the resultant LOS associated with the patient's age, gender, or day of the week the surgery was performed? We retrospectively compared the LOS in 100 consecutive patients undergoing THA immediately after the implementation of a 4-day care pathway (4-day Group) with 100 consecutive patients, 3 months later, who were also in the same pathway but were told by their surgeon preoperatively and in the hospital to expect a LOS of 2 days (2-day Group). Aside from reeducation by the surgeon, there was no difference in the surgery or intentional changes to the intraoperative or postoperative management of the two groups. Only the patient and the surgeon were made aware of the accelerated discharge plan. We compared the LOS between the two groups and the number of patients who met their discharge goal. As well, the ability to meet the discharge goal for each group was further determined based on age, gender, and day of the week the surgery was performed. Overall, patients in the 2-day Group had a shorter LOS than those in the 4-day Group (2.9 ± 0.88 days versus 3.9 ± 1.71 days; mean difference 1 day; 95% confidence interval [CI], 0.60-1.36; p = 0.001). In the 2-day Group, the LOS was 2 days in 32% compared with 8% in the 4-day Group (odds ratio, 4.0; 95% CI, 1.76-9.11; p < 0.001). Men in the 4-day Group had a shorter LOS than women (3.4 ± 1.22 days versus 4.2 ± 1.89 days; mean difference 0.8 days; 95% CI, 0.17-1.78; p = 0.019), but there was no difference in LOS by gender in the 2-day Group (2.8 ± 0.81 days versus 3.1 ± 0.93 days; mean difference 0.3 days; 95% CI, -0.14 to 0.61; p = 0.219). For all patients > 40 years and < 90 years of age, a greater percentage of patients in the 2-day Group went home by postoperative day 2 than those in the 4-day Group (32% compared with 7%; odds ratio, 4.6; p < 0.001). In both groups, there was no difference in the LOS if the surgery was on Friday compared with an earlier day of the week (4-day Group: 3.4 ± 0.67 days versus 4.0 ± 1.80 days; p = 0.477 and 2-day Group: 2.8 ± 0.62 days versus 3.0 ± 0.93 days; p = 0.547). We found that a surgeon who sets a clear expectation in terms of LOS could achieve a reduction in this parameter. Although it is impossible to be certain in the context of a retrospective study whether other caregivers adjusted the pathway in response to the surgeon's preferences, and we suspect this probably did occur, this still points to an opportunity on the topic of expectations setting that future studies should explore. This study highlights the influence patient education and expectations has on the effectiveness of care pathways in THA as well as the importance of continuous reinforcement of discharge planning both preoperatively and in the hospital. Level III, therapeutic study.

Emissions reduction policies and recent trends in Southern California's ambient air quality.

PubMed

Lurmann, Fred; Avol, Ed; Gilliland, Frank

2015-03-01

To assess accountability and effectiveness of air regulatory policies, we reviewed more than 20 years of monitoring data, emissions estimates, and regulatory policies across several southern California communities participating in a long-term study of children's health. Between 1994 and 2011, air quality improved for NO2 and PM2.5 in virtually all the monitored communities. Average NO2 declined 28% to 53%, and PM2.5 decreased 13% to 54%. Year-to-year PM2.5 variability at lower pollution sites was large compared to changes in long-term trends. PM10 and O3 decreases were largest in communities that were initially among the most polluted. Trends in annual average NO2, PM2.5, and PM10 concentrations in higher pollution communities were generally consistent with NOx, ROG, SOx, PM2.5, and PM10 emissions decreases. Reductions observed at one of the higher PM2.5 sites, Mira Loma, were generally within the range expected from reductions observed in ROG, NOx, SOx, and PM2.5 emissions. Despite a 38% increase in regional motor vehicle activity, vigorous economic growth, and a 30% population increase, total estimated emissions of NOx, ROG, SOx, PM2.5, and PM10 decreased by 54%, 65%, 40%, 21%, and 15%, respectively, during the 20-year time period. Emission control strategies in California have achieved dramatic reductions in ambient NO2, O3, PM2.5, and PM10. However, additional reductions will still be needed to achieve current health-based clean air standards. For many cities facing the challenge of reducing air pollution to meet health-based standards, the emission control policies and pollution reduction programs adopted in southern California should serve as an example of the potential success of aggressive, comprehensive, and integrated approaches. Policies targeting on-road mobile emissions were the single most important element for observed improvements in the Los Angeles region. However, overall program success was the result of a much broader approach designed to achieve emission reductions across all major pollutants and emissions categories.

East Los High: Transmedia Edutainment to Promote the Sexual and Reproductive Health of Young Latina/o Americans

PubMed Central

Singhal, Arvind

2016-01-01

Latina/o Americans are at high risk for sexually transmitted infections and adolescent pregnancies. Needed urgently are innovative health promotion approaches that are engaging and culturally sensitive. East Los High is a transmedia edutainment program aimed at young Latina/o Americans. It embeds educational messages in entertainment narratives across digital platforms to promote sexual and reproductive health. We employed online analytics tracking (2013–2014), an online viewer survey (2013), and a laboratory experiment (El Paso, TX, 2014) for season 1 program evaluation. We found that East Los High had a wide audience reach, strong viewer engagement, and a positive cognitive, emotional, and social impact on sexual and reproductive health communication and education. Culturally sensitive transmedia edutainment programs are a promising health promotion strategy for minority populations and warrant further investigation. PMID:27077336

Antihypertensive effect of a fixed-dose combination of losartan/hydrochlorothiazide in patients with uncontrolled hypertension: a multicenter study.

PubMed

Hosoya, Tatsuo; Kuriyama, Satoru; Ohno, Iwao; Kawamura, Tetsuya; Ogura, Makoto; Ikeda, Masato; Ishikawa, Masahiro; Hayashi, Fumihiro; Kanai, Tatsuya; Tomonari, Haruo; Soejima, Michimasa; Akaba, Kiyoaki; Tokudome, Goro; Endo, S; Fukui, A; Gomi, H; Hamaguchi, A; Hanaoka, K; Hara, Y; Hara, Y; Hasegawa, T; Hayakawa, H; Hikida, M; Hirano, K; Horiguchi, M; Hosoya, M; Ichida, K; Imai, T; Ishii, T; Ishikawa, H; Kameda, C; Kasai, T; Kobayashi, A; Kobayashi, H; Kurashige, M; Kusama, Y; Maezawa, H; Maezawa, Y; Maruyama, Y; Matsuda, H; Matsuo, N; Matsuo, T; Miura, Y; Miyajima, M; Miyakawa, M; Miyazaki, Y; Mizuguchi, M; Nakao, M; Nokano, H; Ohkido, I; Ohtsuka, Y; Okada, K; Okamoto, H; Okonogi, H; Saikawa, H; Saito, H; Sekiguchi, C; Suetsugu, Y; Sugano, N; Suzuki, T; Suzuki, T; Takahashi, H; Takahashi, Y; Takamizawa, S; Takane, K; Morita, T; Takazoe, K; Tanaka, H; Tanaka, S; Terawaki, H; Toyoshima, R; Tsuboi, N; Udagawa, T; Ueda, H; Ueda, Y; Uetake, M; Unemura, S; Utsunomiya, M; Utsunomiya, Y; Yamada, T; Yamada, Y; Yamaguchi, Y; Yamamoto, H; Yokoo, T; Yokoyama, K; Yonezawa, H; Yoshida, H; Yoshida, M; Yoshizawa, T

2012-04-01

Achieving adequate blood pressure (BP) control often requires more than one antihypertensive agent. The purpose of this study was to determine whether a fixed-dose formulation of losartan (LOS) plus hydrochlorothiazide (HCTZ) (LOS/HCTZ) is effective in achieving a greater BP lowering in patients with uncontrolled hypertension. The study was a prospective, multicenter, observational trial exploring the antihypertensive effect of a single tablet of LOS 50 mg/HCTZ 12.5 mg. A total of 228 patients whose BP had previously been treated with more than one antihypertensive agents without having achieved BP goal below 130/80 mmHg enrolled in the study. A significant decrease in systolic and diastolic BP was observed in both clinic and home measurement after switching from the previous treatment to LOS/HCTZ. There was a significant decrease in both B-type natriuretic peptide (BNP) and urinary albumin creatinine (Cr) excretion ratio (ACR), especially in patients with elevated values. In contrast, there was a significant increase in serum Cr concentration in conjunction with a decrease in estimated glomerular filtration rate (eGFR). Overall serum uric acid (UA) concentration increased, whereas in patients with hyperuricemia there was a significant reduction in this value. Switching to LOS/HCTZ provides a greater reduction in clinic and home BP in patients with uncontrolled hypertension. This combination therapy may lead to cardio-, reno protection and improve UA metabolism.

76 FR 67020 - Notice of Availability of the Final Environmental Impact Statement: Los Angeles County, CA

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... viewed at the following locations: City of Los Angeles Bureau of Engineering, Bridge Improvement Program... 1st Street, Los Angeles, CA 90033 The report can also be accessed through the project Web site at http://www.la6thstreetviaduct.org ; City Web site at http://eng.lacity.org/techdocs/emg/Environmental_Review...

I Can Carry On from Here: The Relocation of American Indians to Los Angeles.

ERIC Educational Resources Information Center

Blackhawk, Ned

1995-01-01

Draws on experiences of American Indian women relocated to Los Angeles during the 1950s-60s to take part in Bureau of Indian Affairs job training and placement programs. These women faced the double burden of racial discrimination and white sex-role expectations, but adjusted to life in Los Angeles with the support of Indian community…

Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial

PubMed Central

2013-01-01

Background The use of osteopathic manipulative treatment (OMT) in preterm infants has been documented and results from previous studies suggest the association between OMT and length of stay (LOS) reduction, as well as significant improvements in several clinical outcomes. The aim of the present study is to investigate the effect of OMT on LOS in premature infants. Methods A randomized controlled trial was conducted on preterm newborns admitted to a single NICU between 2008-2009. N=110 subjects free of medical complications and with gestational age >28 and < 38 weeks were enrolled and randomized in two groups: study group (N=55) and control group (N=55). All subjects received routine pediatric care and OMT was performed to the study group for the entire period of hospitalization. Endpoints of the study included differences in LOS and daily weight gain. Results Results showed a significant association between OMT and LOS reduction (mean difference between treated and control group: -5.906; 95% C.I. -7.944, -3.869; p<0.001). OMT was not associated to any change in daily weight gain. Conclusions The present study suggests that OMT may have an important role in the management of preterm infants hospitalization. Trial registration ClinicalTrials.gov, NCT01544257. PMID:23622070

Comprehensive Truck Size and Weight (TS&W) Study. Phase 1-synthesis, working paper 9 : the effects of TS&W regulations on truck travel and mode share

DOT National Transportation Integrated Search

2012-04-01

This report presents the Transit System Data Test Plan for the national evaluation of the Los Angeles Congestion Reduction Demonstration (Metro ExpressLanes) under the United States Department of Transportation (U.S. DOT) Congestion Reduction Demonst...

Los Angeles Downtown People Mover (DPM) Operational Analysis

DOT National Transportation Integrated Search

1981-06-01

Two different studies were performed by the Research and Special Programs Administration of the Transportation Systems Center in response to the concerns of the Urban Mass Transportation Administration about the ability of the planned Los Angeles Dow...

The unauthorized Mexican immigrant population and welfare in Los Angeles County: a comparative statistical analysis.

PubMed

Marcelli, E A; Heer, D M

1998-01-01

"Using a unique 1994 Los Angeles County Household Survey of foreign-born Mexicans and the March 1994 and 1995 Current Population Surveys, we estimate the number of unauthorized Mexican immigrants (UMIs) residing in Los Angeles County, and compare their use of seven welfare programs with that of other non-U.S. citizens and U.S. citizens. Non-U.S. citizens were found to be no more likely than U.S. citizens to have used welfare, and UMIs were 11% (14%) less likely than other non-citizens (U.S.-born citizens).... We demonstrate how results differ depending on the unit of analysis employed, and on which programs constitute ¿welfare'." excerpt

Laboratory and field studies related to the Hydrologic Resources Management Program. Progress report, October 1, 1992--September 30, 1993

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

Thompson, J.L.; Hawkins, W.L.; Mathews, M.

This report describes research done at Los Alamos in FY 1993 for the Hydrologic Resources Management Program. The US Department of Energy funds this research through two programs at the Nevada Test Site (NTS): defense and groundwater characterization. Los Alamos personnel have continued to study the high-pressure zone created in the aquifer under Yucca Flat. We analyzed data from a hole in this area (U-7cd) and drilled another hole and installed a water monitoring tube at U-4t. We analyzed water from a number of locations on the NTS where we know there are radionuclides in the groundwater and critiqued themore » effectiveness of this monitoring effort. Our program for analyzing postshot debris continued with material from the last nuclear test in September 1992. We supported both the defense program and the groundwater characterization program by analyzing water samples from their wells and by reviewing documents pertaining to future drilling. We helped develop the analytical methodology to be applied to water samples obtained in the environmental restoration and waste management efforts at the NTS. Los Alamos involvement in the Hydrologic Resources Management Program is reflected in the appended list of documents reviewed, presentations given, papers published, and meetings attended.« less

Reducing length of stay provides key to improvement in Veterans Administration Medical Center.

PubMed

Huebler, L A; Christian, J A; Marcella, L W

1980-02-01

Concerted resolve and coordinated planning on the part of both administrative and patient care staff at the medical center made it possible to treat more patients in fewer beds than ever before and to improve the core staffing ratio at the same time. Staffing was enhanced and new programs were developed using available resources. Reduction of the average LOS for patients throughout the medical center was a primary factor in these achievements. In addition, formal quality assurance activities were strengthened; with careful planning and increased funding, the renovation of facilities and purchase of new equipment was also possible, thus making the improvement project comprehensive. These changes have had a major, beneficial impact on the delivery of health care a the Dublin Veterans Administration Medical Center.

Los Alamos Climatology 2016 Update

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

Bruggeman, David Alan

The Los Alamos National Laboratory (LANL or the Laboratory) operates a meteorology monitoring network to support LANL emergency response, engineering designs, environmental compliance, environmental assessments, safety evaluations, weather forecasting, environmental monitoring, research programs, and environmental restoration. Weather data has been collected in Los Alamos since 1910. Bowen (1990) provided climate statistics (temperature and precipitation) for the 1961– 1990 averaging period, and included other analyses (e.g., wind and relative humidity) based on the available station locations and time periods. This report provides an update to the 1990 publication Los Alamos Climatology (Bowen 1990).

Does Sodium Knowledge Affect Dietary Choices and Health Behaviors? Results From a Survey of Los Angeles County Residents

PubMed Central

Dewey, George; Wickramasekaran, Ranjana N.; Kuo, Tony

2017-01-01

Introduction In 2010, the Los Angeles County Department of Public Health launched a local sodium-reduction initiative to address the rising prevalence of high blood pressure (hypertension) and related cardiovascular conditions in the population. To inform this effort, we evaluated self-reported knowledge and health behaviors related to sodium intake among Los Angeles County residents. Methods We administered 3 cross-sectional Internet panel surveys on knowledge about dietary sodium to a sample of Los Angeles County adults, at intervals from December 2014 through August 2016. Multinomial and logistic regression models were constructed to describe associations between sodium knowledge and self-reported health behaviors. Results A total of 7,067 panel subjects clicked into the online survey, and 2,862 completed the survey (adjusted response rate = 40.5%). Only 102 respondents (3.6%) were able to accurately report the recommended milligrams of sodium that an average adult should consume daily (1,500 mg to 2300 mg). Knowing about daily sodium intake recommendations was associated with increased odds of using Nutrition Facts labels to make food purchase decisions (adjusted odds ratio [AOR], 3.48; 95% confidence interval [CI], 1.59–7.60) and with decreased odds of taking measures to prevent hypertension (AOR, 0.38; 95% CI, 0.19–0.74). Conclusions Los Angeles County residents had a limited knowledge of recommended daily sodium intake. Efforts to increase understanding of these recommendations may encourage wider engagement in healthy behaviors. Health agencies should integrate sodium reduction messages in their diet and nutrition educational efforts. PMID:29166247

Does Sodium Knowledge Affect Dietary Choices and Health Behaviors? Results From a Survey of Los Angeles County Residents.

PubMed

Dewey, George; Wickramasekaran, Ranjana N; Kuo, Tony; Robles, Brenda

2017-11-22

In 2010, the Los Angeles County Department of Public Health launched a local sodium-reduction initiative to address the rising prevalence of high blood pressure (hypertension) and related cardiovascular conditions in the population. To inform this effort, we evaluated self-reported knowledge and health behaviors related to sodium intake among Los Angeles County residents. We administered 3 cross-sectional Internet panel surveys on knowledge about dietary sodium to a sample of Los Angeles County adults, at intervals from December 2014 through August 2016. Multinomial and logistic regression models were constructed to describe associations between sodium knowledge and self-reported health behaviors. A total of 7,067 panel subjects clicked into the online survey, and 2,862 completed the survey (adjusted response rate = 40.5%). Only 102 respondents (3.6%) were able to accurately report the recommended milligrams of sodium that an average adult should consume daily (1,500 mg to 2300 mg). Knowing about daily sodium intake recommendations was associated with increased odds of using Nutrition Facts labels to make food purchase decisions (adjusted odds ratio [AOR], 3.48; 95% confidence interval [CI], 1.59-7.60) and with decreased odds of taking measures to prevent hypertension (AOR, 0.38; 95% CI, 0.19-0.74). Los Angeles County residents had a limited knowledge of recommended daily sodium intake. Efforts to increase understanding of these recommendations may encourage wider engagement in healthy behaviors. Health agencies should integrate sodium reduction messages in their diet and nutrition educational efforts.

Field evaluation of the Los Angeles Police Department drug detection procedure.

DOT National Transportation Integrated Search

1986-12-01

The Los Angeles Police Department (LAPD) has developed a drug recognition program designed to provide trained officers the ability to detect drug-impaired drivers and to identify the responsible drug class (e.g., stimulant, depressant, etc. ). As par...

Steroids for surgery during cardiopulmonary bypass in adults: a meta-analysis.

PubMed

Guay, Joanne; Ochroch, E Andrew

2014-02-01

To evaluate the effect of steroid administration on myocardial infarction (MI), stroke, renal insufficiency, death, intensive care (ICU) length of stay (LOS) and hospital LOS of patients undergoing cardiopulmonary bypass (CPB). Meta-analysis of parallel randomized controlled trials. University hospital. A search was conducted in PubMed, EMBASE, MEDLINE(R) and the Cochrane Central Register of Controlled Trials of studies on adults undergoing surgery with CPB who received steroid administration. Effect size (risk ratio or mean difference) for MI, stroke, renal insufficiency, death, ICU LOS, and hospital LOS were evaluated. 48 RCTs published between 1977 and 2012 were retained for analysis. Steroids had no effect on the MI risk ratio (RR) 0.91 (95% confidence interval [CI] 0.63, 1.32); death at 30 days RR 0.84 (0.59, 1.20); stroke RR 0.92 (0.60, 1.42) or renal insufficiency RR 0.83 (0.52, 1.32). Administration of steroids reduced ICU LOS (P = 0.00001; I(2) 87.5%) and hospital LOS (P = 0.03; I(2) 81.1%). Metaregressions showed that duration of steroid administration was correlated with the reduction in ICU LOS (P = 0.0004) and hospital LOS (P < 0.00001). Increasing the duration of steroid administration may reduce ICU and hospital LOS greater than increasing the dose. Copyright © 2014 Elsevier Inc. All rights reserved.

Destructive analysis capabilities for plutonium and uranium characterization at Los Alamos National Laboratory

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

Tandon, Lav; Kuhn, Kevin J; Drake, Lawrence R

Los Alamos National Laboratory's (LANL) Actinide Analytical Chemistry (AAC) group has been in existence since the Manhattan Project. It maintains a complete set of analytical capabilities for performing complete characterization (elemental assay, isotopic, metallic and non metallic trace impurities) of uranium and plutonium samples in different forms. For a majority of the customers there are strong quality assurance (QA) and quality control (QC) objectives including highest accuracy and precision with well defined uncertainties associated with the analytical results. Los Alamos participates in various international and national programs such as the Plutonium Metal Exchange Program, New Brunswick Laboratory's (NBL' s) Safeguardsmore » Measurement Evaluation Program (SME) and several other inter-laboratory round robin exercises to monitor and evaluate the data quality generated by AAC. These programs also provide independent verification of analytical measurement capabilities, and allow any technical problems with analytical measurements to be identified and corrected. This presentation will focus on key analytical capabilities for destructive analysis in AAC and also comparative data between LANL and peer groups for Pu assay and isotopic analysis.« less

Teaching case studies on earthquake preparedness efforts in the transportation sector, Los Angeles metropolitan area.

DOT National Transportation Integrated Search

2013-01-01

Through the development of a Harvard Kennedy School case study (intended for : use as curriculum in graduate-level and executive education programs), this project : examines earthquake preparedness and planning processes in the Los Angeles : metropol...

Scaffold Attachment Factor B1: A Novel Chromatin Regulator of Prostate Cancer Metabolism

DTIC Science & Technology

2016-10-01

INVESTIGATOR: SUNGYONG YOU PhD CONTRACTING ORGANIZATION: Cedars-Sinai Medical Center Los Angeles, CA 90048 REPORT DATE: October 2016 TYPE OF REPORT...NUMBER CEDARS-SINAI MEDICAL CENTER 8700 BEVERLY BLVD LOS ANGELES CA 90048-1804 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR...Bioinformatics. The Urologic Oncology Program, held in Cedars- Sinai Medical Center, Los Angeles, California, March 10, 2015. Oral Presentation: 1. You S

Santa Ana River Main Stem Including Santiago Creek and Oak Street Drain. Phase I GDM (General Design Memorandum). Appendix G. Recreation.

DTIC Science & Technology

1980-09-01

NUMBER(&) US ARMY CORPS OF ENGINEERS LOS ANGELES DISTRICT P.O. BOZ 2711, LOS ANGELES, CA 90053 s. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ...control purposes, and acquisitions or improvments required outside these limits will be the sole responsibility of the local entity. 2 PROJECTA ...natural heritage preserve area, with another $20 million dollars programmed over the next 5 years. More than one-half of the area is in slopes

Economic evaluation of the one-hour rule-out and rule-in algorithm for acute myocardial infarction using the high-sensitivity cardiac troponin T assay in the emergency department.

PubMed

Ambavane, Apoorva; Lindahl, Bertil; Giannitsis, Evangelos; Roiz, Julie; Mendivil, Joan; Frankenstein, Lutz; Body, Richard; Christ, Michael; Bingisser, Roland; Alquezar, Aitor; Mueller, Christian

2017-01-01

The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists. Length of stay (LoS), resource utilization (RU), and predicted diagnostic accuracy of the 1-h algorithm compared to standard of care (SoC) in the ED were estimated. The ED LoS, RU, and accuracy of the 1-h algorithm was compared to that achieved by the SoC at ED discharge. Expert opinion was sought to characterize clinical implementation of the 1-h algorithm, which required blood draws at ED presentation and 1h, after which "rule-in" patients were transferred for coronary angiography, "rule-out" patients underwent outpatient stress testing, and "observation" patients received SoC. Unit costs were for the United Kingdom, Switzerland, and Germany. The sensitivity and specificity for the 1-h algorithm were 87% and 96%, respectively, compared to 69% and 98% for SoC. The mean ED LoS for the 1-h algorithm was 4.3h-it was 6.5h for SoC, which is a reduction of 33%. The 1-h algorithm was associated with reductions in RU, driven largely by the shorter LoS in the ED for patients with a diagnosis other than AMI. The estimated total costs per patient were £2,480 for the 1-h algorithm compared to £4,561 for SoC, a reduction of up to 46%. The analysis shows that the use of 1-h algorithm is associated with reduction in overall AMI diagnostic costs, provided it is carefully implemented in clinical practice. These results need to be prospectively validated in the future.

Los Medanos College Fact Book.

ERIC Educational Resources Information Center

MacDonald, Ross; And Others

Prepared to support the self-study and strategic planning processes at Los Medanos College (LMC), in Pittsburgh, California, this fact book offers information about LMC's students, staff, programs, services, facilities, and expenditures. The first section focuses on the student population, including a trend analysis and longitudinal data on…

UCLA's outreach program of science education in the Los Angeles schools.

PubMed

Palacio-Cayetano, J; Kanowith-Klein, S; Stevens, R

1999-04-01

The UCLA School of Medicine's Interactive Multi-media Exercises (IMMEX) Project began its outreach into pre-college education in the Los Angeles area in 1993. The project provides a model in which software and technology are effectively intertwined with teaching, learning, and assessment (of both students' and teachers' performances) in the classroom. The project has evolved into a special collaboration between the medical school and Los Angeles teachers. UCLA faculty and staff work with science teachers and administrators from elementary, middle, and high schools. The program benefits ethnically and racially diverse groups of students in schools ranging from the inner city to the suburbs. The project's primary goal is to use technology to increase students' achievement and interest in science, including medicine, and thus move more students into the medical school pipeline. Evaluations from outside project evaluators (West Ed) as well as from teachers and IMMEX staff show that the project has already had a significant effect on teachers' professional development, classroom practice, and students' achievement in the Los Angeles area.

The use of a weaning and extubation protocol to facilitate effective weaning and extubation from mechanical ventilation in patients suffering from traumatic injuries: a non-randomized experimental trial comparing a prospective to retrospective cohort.

PubMed

Plani, Natascha; Becker, Piet; van Aswegen, Helena

2013-04-01

Many patients who have suffered traumatic injuries require mechanical ventilation (MV). Weaning is the transition from ventilatory support to spontaneous breathing. The purpose of this study was to determine whether the use of a nurse and a physiotherapist-driven protocol to wean and extubate patients from MV resulted in decreased MV days and intensive care unit (ICU) length of stay (LOS). A prospective cohort of 28 patients (Phase I), weaned according to the protocol developed for the Union Hospital Trauma Unit, was matched retrospectively with a historical cohort of 28 patients (Phase II), weaned according to physician preference. Pairs in the two groups were matched for gender, age, type, and severity of injury. For mean MV days, the groups did not differ statistically significantly (p 0.3; 14.4 days vs. 16.3 days), although the reduction in MV is clinically significant in view of the complications of additional MV days. The difference of 0.2 days for ICU LOS was not statistically significant (p = 0.9; 20.8 days vs. 21.0 days) demonstrating that the reduction in MV days may not result in the reduction of ICU LOS. The rate of re-intubation was similar between the groups (Phase I = 3/28 vs. Phase II = 4/24). The use of a weaning and extubation protocol led by nursing staff and physiotherapists resulted in a clinically significant reduction in MV time, reducing risk of ventilator-associated complications. The role of physiotherapists and nursing staff in weaning and extubation from MV could be greatly expanded in South African ICUs.

User manual for the NTS ground motion data base retrieval program: ntsgm

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

App, F.N.; Tunnell, T.W.

1994-05-01

The NTS (Nevada Test Site) Ground Motion Data Base is composed of strong motion data recorded during the normal execution of the US underground test program. It contains surface, subsurface, and structure motion data as digitized waveforms. Currently the data base contains information from 148 underground explosions. This represents about 4,200 measurements and nearly 12,000 individual digitized waveforms. Most of the data was acquired by Los Alamos National Laboratory (LANL) in connection with LANL sponsored underground tests. Some was acquired by Los Alamos on tests conducted by the Defense Nuclear Agency (DNA) and Lawrence Livermore National Laboratory (LLNL), and theremore » are some measurements that were acquired by the other test sponsors on their events and provided for inclusion in this data base. Data acquisition, creation of the data base, and development of the data base retrieval program (ntsgm) are the result of work in support of the Los Alamos Field Test Office and the Office of Nonproliferation and Arms Control.« less

Analysis of harmonic spline gravity models for Venus and Mars

NASA Technical Reports Server (NTRS)

Bowin, Carl

1986-01-01

Methodology utilizing harmonic splines for determining the true gravity field from Line-Of-Sight (LOS) acceleration data from planetary spacecraft missions was tested. As is well known, the LOS data incorporate errors in the zero reference level that appear to be inherent in the processing procedure used to obtain the LOS vectors. The proposed method offers a solution to this problem. The harmonic spline program was converted from the VAX 11/780 to the Ridge 32C computer. The problem with the matrix inversion routine that improved inversion of the data matrices used in the Optimum Estimate program for global Earth studies was solved. The problem of obtaining a successful matrix inversion for a single rev supplemented by data for the two adjacent revs still remains.

Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.

PubMed

Froemke, Cecily C; Wang, Lian; DeHart, Matthew L; Williamson, Ronda K; Ko, Laura Matsen; Duwelius, Paul J

2015-10-01

Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case. Copyright © 2015 Elsevier Inc. All rights reserved.

Epidural Steroids at Closure After Microdiscectomy/Laminectomy for Reduction of Postoperative Analgesia: Systematic Review and Meta-Analysis.

PubMed

Wilson-Smith, Ash; Chang, Nicholas; Lu, Victor M; Mobbs, Ralph J; Fadhil, Matthew; Lloyd, Declan; Kim, Sara; Phan, Kevin

2018-02-01

This review assessed the efficacy of epidural steroid administration on the reduction of pain, hospital stay time, and use of opioid analgesics postoperatively. We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies using epidural steroids through any route after lumbar surgery. The primary study outcomes included preoperative and postoperative pain as assessed with a visual analogue scale (VAS), length of hospital stay (LOS), and postoperative use of opioid analgesics. The data were extracted and stratified according to the steroid administered. Data were then assessed for heterogeneity, subgroup differences, and ultimately tabulated in a Forest plot. A total of 17 randomized controlled trials were included in this review, with 16 undergoing quantitative analysis. Steroids were shown to be superior in terms of VAS outcome at 24 hours, with triamcinolone and dexamethasone performing similarly. Methylprednisolone paradoxically performed worse at the 24-hour mark. At 1 month, all steroids illustrated superiority in terms of VAS outcome. Steroids also proved superior in reducing LOS and postoperative use of opioid analgesia. Intraoperative or perioperative epidural administration of steroids offers significant benefits in terms of pain control, reduction in LOS, and use of postoperative opioid analgesia. Before steroids are routinely used by spinal surgeons, however, significantly more research is required. A particular emphasis should be placed on quality study protocols and data recording, to allow for more thorough analyses in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

Factors in hospice patients' length of stay.

PubMed

Frantz, T T; Lawrence, J C; Somov, P G; Somova, M J

1999-01-01

Many hospice patients are referred comparatively late in the course of their disease progression, therefore minimizing the time of services to the patient, caregivers, and families. Untimely referrals can create organizational, clinical, and emotional problems for all involved; a better understanding of the factors related to length of stay (LOS) in hospice is necessary. This study investigated the relationship between LOS and selected variables. There were significant differences in LOS by diagnosis, physician type, and referral source. No significant differences were found in LOS by gender or insurance type. Factors related to LOS can assist hospices in identifying those particular patients more likely to have longer stays. Additionally, administrators may tailor their programs to meet the needs of the individual hospice.

The Effect of Blowsand Reduction on the Abundance of the Fringe-Toed Lizard (Uma inornata) in the Coachella Valley, California,

DTIC Science & Technology

1981-10-01

HD-RI37 364 THE EFFECT OF BLOWSAND REDUCTION ON THE ABUNDANCE OF 1/2 THE FRINGE-TOED LIZA..(U) CALIFORNIA UNIV LOS RNGELES LA B OF NUCLER MEDICINE...accomplished, but the idea is worth testing. The added power of more than two samples is enormous in improving capture-recapture estimates of numbers. A chain

Origin of methane and sources of high concentrations in Los Angeles groundwater

USGS Publications Warehouse

Kulongoski, Justin; McMahon, Peter B.; Land, Michael; Wright, Michael; Johnson, Theodore; Landon, Matthew K.

2018-01-01

In 2014, samples from 37 monitoring wells at 17 locations, within or near oil fields, and one site >5 km from oil fields, in the Los Angeles Basin, California, were analyzed for dissolved hydrocarbon gas isotopes and abundances. The wells sample a variety of depths of an aquifer system composed of unconsolidated and semiconsolidated sediments under various conditions of confinement. Concentrations of methane in groundwater samples ranged from 0.002 to 150 mg/L—some of the highest concentrations reported in a densely populated urban area. The δ13C and δ2H of the methane ranged from −80.8 to −45.5 per mil (‰) and −249.8 to −134.9‰, respectively, and, along with oxidation‐reduction processes, helped to identify the origin of methane as microbial methanogenesis and CO2 reduction as its main formation pathway. The distribution of methane concentrations and isotopes is consistent with the high concentrations of methane in Los Angeles Basin groundwater originating from relatively shallow microbial production in anoxic or suboxic conditions. Source of the methane is the aquifer sediments rather than the upward migration or leakage of thermogenic methane associated with oil fields in the basin.

Origin of Methane and Sources of High Concentrations in Los Angeles Groundwater

NASA Astrophysics Data System (ADS)

Kulongoski, J. T.; McMahon, P. B.; Land, M.; Wright, M. T.; Johnson, T. A.; Landon, M. K.

2018-03-01

In 2014, samples from 37 monitoring wells at 17 locations, within or near oil fields, and one site >5 km from oil fields, in the Los Angeles Basin, California, were analyzed for dissolved hydrocarbon gas isotopes and abundances. The wells sample a variety of depths of an aquifer system composed of unconsolidated and semiconsolidated sediments under various conditions of confinement. Concentrations of methane in groundwater samples ranged from 0.002 to 150 mg/L—some of the highest concentrations reported in a densely populated urban area. The δ13C and δ2H of the methane ranged from -80.8 to -45.5 per mil (‰) and -249.8 to -134.9‰, respectively, and, along with oxidation-reduction processes, helped to identify the origin of methane as microbial methanogenesis and CO2 reduction as its main formation pathway. The distribution of methane concentrations and isotopes is consistent with the high concentrations of methane in Los Angeles Basin groundwater originating from relatively shallow microbial production in anoxic or suboxic conditions. Source of the methane is the aquifer sediments rather than the upward migration or leakage of thermogenic methane associated with oil fields in the basin.

76 FR 68438 - Environmental Impacts Statements; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... Los Angeles River between Mateo and Mill Streets, Los Angeles County, CA, Review Period Ends: 12/05..., USFWS, CA, Southern Sea Otters (Enhydra lutris nereis) Translocation Program, Updated Information to the.../species_information/so_sea_otter/index.html . Revision of FR Notice Published 08/26/2011: Reopening...

Los Angeles County Parks and Recreation.

ERIC Educational Resources Information Center

Iowa Univ., Iowa City. Recreation Education Program.

Presented are duplications of the responses given by the Los Angeles County Parks and Recreation Rehabilitation Unit (California) as part of a project to collect, share, and compile information about, and techniques in the operation of 18 community action models for recreation services to the disabled. Model programs are categorized as consumer,…

Symbol signing design for older drivers

DOT National Transportation Integrated Search

2012-09-01

This report presents the Surveys, Interviews, and Workshops Test Plan for the national evaluation of the Los Angeles (LA) Congestion Reduction Demonstration (Metro ExpressLanes) under the United States Department of Transportation (U.S. DOT) Congesti...

Community noise

NASA Astrophysics Data System (ADS)

Bragdon, C. R.

Airport and community land use planning as they relate to airport noise reduction are discussed. Legislation, community relations, and the physiological effect of airport noise are considered. Noise at the Logan, Los Angeles, and Minneapolis/St. Paul airports is discussed.

Community noise

NASA Technical Reports Server (NTRS)

Bragdon, C. R.

1982-01-01

Airport and community land use planning as they relate to airport noise reduction are discussed. Legislation, community relations, and the physiological effect of airport noise are considered. Noise at the Logan, Los Angeles, and Minneapolis/St. Paul airports is discussed.

The Origin and Evolution of U.S. Naval Strategic Nuclear Policy to 1960

DTIC Science & Technology

1986-12-01

program at Los Alamos that would actually build the bomb. Groves named Captain William S. Parsons who had graduated in 1922 from Annapolis and later from...the Naval Postgraduate School. Parsons went to Los Alamos after having worked extensively in developing and fleet testing proximity fuses. Upon his...arrival at the security gate of Los Alamos the dearth of naval personnel at work on the project contributed to his arrest by the guard on duty. The

Final safety analysis report for the Ground Test Accelerator (GTA), Phase 2

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

NONE

1994-10-01

This document is the third volume of a 3 volume safety analysis report on the Ground Test Accelerator (GTA). The GTA program at the Los Alamos National Laboratory (LANL) is the major element of the national Neutral Particle Beam (NPB) program, which is supported by the Strategic Defense Initiative Office (SDIO). A principal goal of the national NPB program is to assess the feasibility of using hydrogen and deuterium neutral particle beams outside the Earth`s atmosphere. The main effort of the NPB program at Los Alamos concentrates on developing the GTA. The GTA is classified as a low-hazard facility, exceptmore » for the cryogenic-cooling system, which is classified as a moderate-hazard facility. This volume consists of appendices C through U of the report« less

Tiger Team Assessment of the Los Alamos National Laboratory

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

Not Available

1991-11-01

The purpose of the safety and health assessment was to determine the effectiveness of representative safety and health programs at the Los Alamos National Laboratory (LANL). Within the safety and health programs at LANL, performance was assessed in the following technical areas: Organization and Administration, Quality Verification, Operations, Maintenance, Training and Certification, Auxiliary Systems, Emergency Preparedness, Technical Support, Packaging and Transportation, Nuclear Criticality Safety, Security/Safety Interface, Experimental Activities, Site/Facility Safety Review, Radiological Protection, Personnel Protection, Worker Safety and Health (OSHA) Compliance, Fire Protection, Aviation Safety, Explosives Safety, Natural Phenomena, and Medical Services.

Institutional computing (IC) information session

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

Koch, Kenneth R; Lally, Bryan R

2011-01-19

The LANL Institutional Computing Program (IC) will host an information session about the current state of unclassified Institutional Computing at Los Alamos, exciting plans for the future, and the current call for proposals for science and engineering projects requiring computing. Program representatives will give short presentations and field questions about the call for proposals and future planned machines, and discuss technical support available to existing and future projects. Los Alamos has started making a serious institutional investment in open computing available to our science projects, and that investment is expected to increase even more.

Measures of Progress: 1995 Project Follow-Up, Los Rios Community College District (American River College, Cosumnes River College, Sacramento City College). Results of a Survey of 1993-94 Graduates and Non-Returning Students. Volume I of II--Frequencies and Percents by District, College and Academic Program.

ERIC Educational Resources Information Center

Beachler, Judith A.; Pagtalunan, Jose

In 1995, the three colleges in California's Los Rios Community College District (LRCCD) surveyed 6,151 former students from 1993-94 to gather information on student outcomes and characteristics. This report presents districtwide findings related to the frequencies and percents of responses by academic program. Following an executive summary and…

A Handbook for Derivative Classifiers at Los Alamos National Laboratory

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

Sinkula, Barbara Jean

The Los Alamos Classification Office (within the SAFE-IP group) prepared this handbook as a resource for the Laboratory’s derivative classifiers (DCs). It contains information about United States Government (USG) classification policy, principles, and authorities as they relate to the LANL Classification Program in general, and to the LANL DC program specifically. At a working level, DCs review Laboratory documents and material that are subject to classification review requirements, while the Classification Office provides the training and resources for DCs to perform that vital function.

The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.

PubMed

Brusco, Natasha K; Paratz, Jennifer

2006-12-01

Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide strong evidence to indicate effective reduction in patient LOS or improving patient discharge mobility status or discharge destination. Investigation should continue in this area, but future trials should ensure factors such as random allocation, groups equal at baseline, blinded investigators, and proven intervention are included in the study design.

Intraoperative Goal-directed Fluid Therapy in Elective Major Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials.

PubMed

Rollins, Katie E; Lobo, Dileep N

2016-03-01

To compare the effects of intraoperative goal-directed fluid therapy (GDFT) with conventional fluid therapy, and determine whether there was a difference in outcome between studies that did and did not use Enhanced Recovery After Surgery (ERAS) protocols. Meta-analysis of randomized controlled trials of adult patients undergoing elective major abdominal surgery comparing intraoperative GDFT versus conventional fluid therapy. The outcome measures were postoperative morbidity, length of stay, gastrointestinal function and 30-day mortality. A total of 23 studies were included with 2099 patients: 1040 who underwent GDFT and 1059 who received conventional fluid therapy. GDFT was associated with a significant reduction in morbidity (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.66-0.89, P = 0.0007), hospital length of stay (LOS; mean difference -1.55 days, 95% CI -2.73 to -0.36, P = 0.01), intensive care LOS (mean difference -0.63 days, 95% CI -1.18 to -0.09, P = 0.02), and time to passage of feces (mean difference -0.90 days, 95% CI -1.48 to -0.32 days, P = 0.002). However, no difference was seen in mortality, return of flatus, or risk of paralytic ileus. If patients were managed in an ERAS pathway, the only significant reductions were in intensive care LOS (mean difference -0.63 days, 95% CI -0.94 to -0.32, P < 0.0001) and time to passage of feces (mean difference -1.09 days, 95% CI -2.03 to -0.15, P = 0.02). If managed in a traditional care setting, a significant reduction was seen in both overall morbidity (RR 0.69, 95% CI 0.57 to -0.84, P = 0.0002) and total hospital LOS (mean difference -2.14, 95% CI -4.15 to -0.13, P = 0.04). GDFT may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in an ERAS setting.

Evaluating the effect of clinical decision units on patient flow in seven Canadian emergency departments.

PubMed

Schull, Michael J; Vermeulen, Marian J; Stukel, Therese A; Guttmann, Astrid; Leaver, Chad A; Rowe, Brian H; Sales, Anne

2012-07-01

To evaluate the effect of emergency department (ED) clinical decision units (CDUs) on overall ED patient flow in a pilot project funded in 2008 by the Ontario Ministry of Health and Long-Term Care (MOHLTC). A retrospective analysis of unscheduled ED visits at seven CDU pilot and nine control sites was conducted using administrative data. The authors examined trends in CDU utilization and compared outcomes between pilot-CDU and control sites 1 year prior to implementation, with the first 18 months of CDU operation. Sites that were unsuccessful in their applications for CDU program funding served as controls. Outcomes included ED length of stay (LOS), admission rates, and ED revisit rates. At CDU sites, roughly 4% of ED patients were admitted to CDUs. The presence of a pilot-CDU was independently associated with a small reduction in ED LOS for all low-acuity patients (-0.14 hour, 95% confidence interval [CI]=-0.22 to -0.07) and nonadmitted patients (-0.11 hour, 95% CI=-0.16 to -0.07). A small independent effect on absolute hospital admission rate for all high-acuity patients (-0.8%, 95% CI=-1.5% to -0.03%) and moderate-acuity patients (-0.6%, 95% CI=-1.1% to -0.2%) was also observed. Pilot-CDUs were not associated with changes in ED revisit rates. With only 4% of ED patients admitted to CDUs, the potential for efficiency gains in these EDs was limited. Nonetheless, these findings suggest small improvements in the operation of the ED through CDU implementation. Although marginal, the observed effects of CDU operation were in the desired direction of reduced ED LOS, reduced admission rate, and no increase in ED revisit rate. © 2012 by the Society for Academic Emergency Medicine.

Can robotic surgery be done efficiently while training residents?

PubMed

Honaker, Michael Drew; Paton, Beverly L; Stefanidis, Dimitrios; Schiffern, Lynnette M

2015-01-01

Robotic surgery is a rapidly growing area in surgery. In an era of emphasis on cost reduction, the question becomes how do you train residents in robotic surgery? The aim of this study was to determine if there was a difference in operative time and complications when comparing general surgery residents learning robotic cholecystectomies to those learning standard laparoscopic cholecystectomies. A retrospective analysis of adult patients undergoing robotic and laparoscopic cholecystectomy by surgical residents between March 2013 and February 2014 was conducted. Demographic data, operative factors, length of stay (LOS), and complications were examined. Univariate and multivariate analyses were performed. The significance was set at p < 0.05. A total of 58 patients were included in the study (18 in the robotic cholecystectomy group and 40 in the laparoscopic group). Age, diagnosis, and American Society of Anesthesiologists score were not significantly different between groups. There was only 1 complication in the standard laparoscopic group in which a patient had to be taken back to surgery because of an incarcerated port site. LOS was significantly higher in the standard laparoscopic group (mean = 2.28) than in the robotic group (mean = 0.56; p < 0.0001). Operating room (OR) time was not statistically different between the standard laparoscopic group (mean = 90.98 minutes) and the robotic group (mean = 97.00 minutes; p = 0.4455). When intraoperative cholangiogram was evaluated, OR time was shorter in the robotic group. Robotic training in general surgery residency does not amount to extra OR time. LOS in our study was significantly longer in the standard laparoscopic group. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Special Degree Programs for Adults

ERIC Educational Resources Information Center

Continuing Education for Adults, 1970

1970-01-01

Briefly describes Bachelor of Liberal Studies programs at six colleges and universities, the Master of Liberal Studies program at Boston University, and the Master of Engineering degree at the University of California at Los Angeles, as well as programs being conducted on a graduate level by Arthur D. Little, Inc. for government and industrial…

Los Alamos National Laboratory Science Education Program. Annual progress report, October 1, 1995--September 30, 1996

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

Gill, D.H.

1997-01-01

The National Teacher Enhancement program (NTEP) is a three-year, multi-laboratory effort funded by the National Science Foundation and the Department of Energy to improve elementary school science programs. The Los Alamos National Laboratory targets teachers in northern New Mexico. FY96, the third year of the program, involved 11 teams of elementary school teachers (grades 4-6) in a three-week summer session, four two-day workshops during the school year and an on-going planning and implementation process. The teams included twenty-one teachers from 11 schools. Participants earned a possible six semester hours of graduate credit for the summer institute and two hours formore » the academic year workshops from the University of New Mexico. The Laboratory expertise in the earth and environmental science provided the tie between the Laboratory initiatives and program content, and allowed for the design of real world problems.« less

The Effectiveness of the Los Angeles County School-Based Probation Program: High School Administrators' Perceptions

ERIC Educational Resources Information Center

Jones, Rickey

2012-01-01

Purpose: The Los Angeles County Probation Department is currently receives millions of dollars through the Juvenile Justice Crime Prevention Act to fund deputy probation officers (DPOs) on high school campuses who provide services to increase student attendance, decrease student behavioral infractions, and decrease student recidivism. The purpose…

Status 1968; Report of the Special Education Branch, Los Angeles Unified School District.

ERIC Educational Resources Information Center

Los Angeles Unified School District, CA.

Included in the report on special education services of Los Angeles schools are chapters on an overview of the special education branch programs; the educationally handicapped, aphasic, and trainable mentally retarded; development centers for handicapped minors; the aurally and visually handicapped; the orthopedically handicapped or other health…

The Rise in Methamphetamine Use among American Indians in Los Angeles County

ERIC Educational Resources Information Center

Spear, Suzanne; Crevecoeur, Desiree A.; Rawson, Richard A.; Clark, Rose

2007-01-01

A preliminary review of substance abuse treatment admission data from 2001-2005 was conducted to explore the use of methamphetamine among American Indians in treatment programs funded by Los Angeles County. Comparisons were made between primary methamphetamine users and users whose primary drug was a substance other than methamphetamine. In that…

Endeavour Lands at LAX

NASA Image and Video Library

2012-09-21

The space shuttle Endeavour, atop the Shuttle Carrier Aircraft, or SCA, lands at Los Angeles International Airport on Tuesday, Sept. 21, 2012 in Los Angeles where it will be placed on public display at the California Science Center. Today's flight marks the final scheduled ferry flight of the Space Shuttle Program. Photo Credit: (NASA/Matt Hedges)

Endeavour Lands at LAX

NASA Image and Video Library

2012-09-21

The space shuttle Endeavour, atop the Shuttle Carrier Aircraft, or SCA, performs a fly-by of Los Angeles International Airport on Tuesday, Sept. 21, 2012 in Los Angeles where it will be placed on public display at the California Science Center. Today's flight marks the final scheduled ferry flight of the Space Shuttle Program. Photo Credit: (NASA/Joel Kowsky)

Overview and Status of the Los Alamos PSR Injection Upgrade Project

NASA Astrophysics Data System (ADS)

Fitzgerald, D. H.; Ahn, H.; Blind, B.; Borden, M. J.; Macek, R. J.; Neri, F.; Rose, C. R.; Thiessen, H. A.; Wilkinson, C. A.; Zumbro, M. V.

1997-05-01

An upgrade is in progress to the Los Alamos Proton Storage Ring (PSR) to allow direct injection of the H^- beam into the ring and provide a beam bump system to move the circulating beam off the stripper foil. The primary benefits of this upgrade are matching the transverse phase space of the injected beam to the PSR acceptance and reduction of foil hits by the circulating beam by a factor of ten. Foil thickness is optimized to minimize the combination of circulating-beam losses plus losses due to excited H^0 states produced at injection. An overall factor of four reduction in losses is expected. The project comprises extensive modifications of the injection line, the injection section of the ring, and the waste-beam transport line. We will discuss the goals of the project, present an overview of the technical design, and describe the status of the implementation plan.

Historical Roots of the Spatial, Temporal, and Diversity Scales of Agricultural Decision-Making in Sierra de Santa Marta, Los Tuxtlas

NASA Astrophysics Data System (ADS)

Negrete-Yankelevich, Simoneta; Porter-Bolland, Luciana; Blanco-Rosas, José Luis; Barois, Isabelle

2013-07-01

Land degradation is a serious problem in tropical mountainous areas. Market prices, technological development, and population growth are often invoked as the prime causes. Using historical agrarian documents, literature sources, and historical population data, we (1) provide quantitative and qualitative evidence that the land degradation present at Sierra de Santa Marta (Los Tuxtlas, Mexico) has involved a historical reduction in the temporal, spatial, and diversity scales, in which individual farmers make management decisions, and has resulted in decreased maize productivity; and (2) analyze how these three scalar changes can be linked to policy, population growth, and agrarian history. We conclude that the historical reduction in the scales of land use decision-making and practices constitutes a present threat to indigenous agricultural heritage. The long-term viability of agriculture requires that initiatives consider incentives for co-responsibility with an initial focus on self-sufficiency.

Historical roots of the spatial, temporal, and diversity scales of agricultural decision-making in sierra de santa marta, los tuxtlas.

PubMed

Negrete-Yankelevich, Simoneta; Porter-Bolland, Luciana; Blanco-Rosas, José Luis; Barois, Isabelle

2013-07-01

Land degradation is a serious problem in tropical mountainous areas. Market prices, technological development, and population growth are often invoked as the prime causes. Using historical agrarian documents, literature sources, and historical population data, we (1) provide quantitative and qualitative evidence that the land degradation present at Sierra de Santa Marta (Los Tuxtlas, Mexico) has involved a historical reduction in the temporal, spatial, and diversity scales, in which individual farmers make management decisions, and has resulted in decreased maize productivity; and (2) analyze how these three scalar changes can be linked to policy, population growth, and agrarian history. We conclude that the historical reduction in the scales of land use decision-making and practices constitutes a present threat to indigenous agricultural heritage. The long-term viability of agriculture requires that initiatives consider incentives for co-responsibility with an initial focus on self-sufficiency.

The role of risk-based prioritization in total quality management

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

Bennett, C.T.

1994-10-01

The climate in which government managers must make decisions grows more complex and uncertain. All stakeholders - the public, industry, and Congress - are demanding greater consciousness, responsibility, and accountability of programs and their budgets. Yet, managerial decisions have become multifaceted, involve greater risk, and operate over much longer time periods. Over the last four or five decades, as policy analysis and decisions became more complex, scientists from psychology, operations research, systems science, and economics have developed a more or less coherent process called decision analysis to aid program management. The process of decision analysis - a systems theoretic approachmore » - provides the backdrop for this paper. The Laboratory Integrated Prioritization System (LIPS) has been developed as a systems analytic and risk-based prioritization tool to aid the management of the Tri-Labs` (Lawrence Livermore, Los Alamos, and Sandia) operating resources. Preliminary analyses of the effects of LIPS has confirmed the practical benefits of decision and systems sciences - the systematic, quantitative reduction in uncertainty. To date, the use of LIPS - and, hence, its value - has been restricted to resource allocation within the Tri-Labs` operations budgets. This report extends the role of risk-based prioritization to the support of DOE Total Quality Management (TQM) programs. Furthermore, this paper will argue for the requirement to institutionalize an evolutionary, decision theoretic approach to the policy analysis of the Department of Energy`s Program Budget.« less

Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program.

PubMed

Cohen, Mark E; Bilimoria, Karl Y; Ko, Clifford Y; Richards, Karen; Hall, Bruce L

2009-12-01

Length of postoperative stay (LOS) has gained increasing attention as a potential indicator of surgical efficiency. Our objective was to examine the feasibility of assessing LOS at 182 hospitals to identify institutions with outlying performance. Patients were identified who underwent colorectal surgery at 182 hospitals participating in the American College of Surgeon's National Surgical Quality Improvement Program (ACS NSQIP) from 2006 to 2007. Regression models for extended LOS (greater than the 75th percentile) were developed to identify hospitals whose ratios of observed to expected events (O/E) were significantly better (low outlier) or worse (high outlier) than expected after adjustment for case mix. To evaluate strategies for evaluating LOS that would be minimally influenced by the occurrence of complications, separate models were developed for patients categorized either by (1) the nonoccurrence or occurrence of any postoperative complication or (2) tercile of preoperative morbidity risk. The 23,098 patients selected for this study were partitioned into groups without complications (0% complications), with complications (100%) or into terciles of preoperative morbidity risk (with 22.4%, 38.7%, and 60.0% of patients having complications, respectively). In general, the greater the complication rate the longer the LOS and the fewer the number of statistical outliers that were identified. ACS NSQIP data can provide individual hospitals with riskadjusted LOS measures that can be used to identify outlying performance and motivate quality improvement efforts.

The Australian National Sub-acute and Non-acute Patient Casemix Classification (AN-SNAP): its application and value in a stroke rehabilitation programme.

PubMed

Lowthian, P; Disler, P; Ma, S; Eagar, K; Green, J; de Graaff, S

2000-10-01

To investigate whether the Australian National Sub-acute and Non-acute Patient Casemix Classification (SNAP) and Functional Independence Measure and Functional Related Group (Version 2) (FIM-FRG2) casemix systems can be used to predict functional outcome, and reduce the variance of length of stay (LOS) of patients undergoing rehabilitation after strokes. The study comprised a retrospective analysis of the records of patients admitted to the Cedar Court Healthsouth Rehabilitation Hospital for rehabilitation after stroke. The sample included 547 patients (83.3% of those admitted with stroke during this period). Patient data were stratified for analysis into the five SNAP or nine FIM-FRG2 groups, on the basis of the admission FIM scores and age. The AN-SNAP classification accounted for a 30.7% reduction of the variance of LOS, and 44.2% of motor FIM, and the FIM-FRG2 accounts for 33.5% and 56.4% reduction respectively. Comparison of the Cedar Court with the national AN-SNAP data showed differences in the LOS and functional outcomes of older, severely disabled patients. Intensive rehabilitation in selected patients of this type appears to have positive effects, albeit with a slightly longer period of inpatient rehabilitation. Casemix classifications can be powerful management tools. Although FIM-FRG2 accounts for more reduction in variance than SNAP, division into nine groups meant that some contained few subjects. This paper supports the introduction of AN-SNAP as the standard casemix tool for rehabilitation in Australia, which will hopefully lead to rational, adequate funding of the rehabilitation phase of care.

Final safety analysis report for the Ground Test Accelerator (GTA), Phase 2

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

NONE

1994-10-01

This document is the first volume of a 3 volume safety analysis report on the Ground Test Accelerator (GTA). The GTA program at the Los Alamos National Laboratory (LANL) is the major element of the national Neutral Particle Beam (NPB) program, which is supported by the Strategic Defense Initiative Office (SDIO). A principal goal of the national NPB program is to assess the feasibility of using hydrogen and deuterium neutral particle beams outside the Earth`s atmosphere. The main effort of the NPB program at Los Alamos concentrates on developing the GTA. The GTA is classified as a low-hazard facility, exceptmore » for the cryogenic-cooling system, which is classified as a moderate-hazard facility. This volume consists of an introduction, summary/conclusion, site description and assessment, description of facility, and description of operation.« less

Outreach and education in urban Los Angeles Schools: integration of research into middle and high school science curriculum through the NSF GK-12 SEE-LA program

NASA Astrophysics Data System (ADS)

Daniel, J. C.; Hogue, T. S.; Moldwin, M. B.; Nonacs, P.

2012-12-01

A National Science Foundation Graduate Teaching Fellows in K- 12 Education program at UCLA (SEE-LA; http://measure.igpp.ucla.edu/GK12-SEE-LA/ ) partners UCLA faculty and graduate students (fellows) with urban middle and high school science teachers and their students to foster programs of science and engineering exploration that bring the environment of Los Angeles into the classroom. UCLA science and engineering graduate fellows serve as scientists-in-residence at four partner schools to integrate inquiry-based science lessons, facilitate advancements in science content teaching, and ultimately, to improve their own science communication skills. As part of their fellowship, graduate students are required to develop three "major" lessons, including one based on their PhD research at UCLA. During the first four years of the project, the SEE-LA fellows have developed a range of research-based activities, including lessons on sustainable fisheries, ecosystems and remote sensing, earthquakes, urban water quality including invertebrate observations, and post-fire soil chemistry, among others. This presentation will provide an overview of the SEE-LA GK-12 program and development of research lessons that also address California State Science Standards. We also discuss potential sustainability of GK-12 type outreach and education programs. The SEE-LA program has provided development of graduate student communication and teaching skills while also contributing significantly to the integration of science education into K-12 curriculum in Los Angeles schools.

Report on a Needs Assessment and Evaluation of a Drug Education Program.

ERIC Educational Resources Information Center

West, Phyllis; And Others

The Los Angeles Valley College Drug Education Program was established in 1970 as a central community resource agency specializing in narcotic and drug abuse prevention and education. The program included two components: a training component (short courses, seminars, speakers bureau) and a resource center (library, publications program). Because of…

Curbing Teen Dating Violence: Evidence from a School Prevention Program. RB-9194-CDC

ERIC Educational Resources Information Center

Jaycox, Lisa H.; McCaffrey, Daniel F.; Weidmer Ocampo, Beverly; Marshall, Grant N.; Collins, Rebecca L.; Hickman, Laura J.; Quigley, Denise D.

2006-01-01

This research brief summarizes a survey about the effectiveness of programs from Break the Cycle, a nonprofit organization dedicated to developing and fielding dating-violence prevention programs. The study evaluated "Ending Violence," a three-class-session prevention program. Developed by a Los Angeles-based nonprofit group called Break…

Final safety analysis report for the Ground Test Accelerator (GTA), Phase 2

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

NONE

1994-10-01

This document is the second volume of a 3 volume safety analysis report on the Ground Test Accelerator (GTA). The GTA program at the Los Alamos National Laboratory (LANL) is the major element of the national Neutral Particle Beam (NPB) program, which is supported by the Strategic Defense Initiative Office (SDIO). A principal goal of the national NPB program is to assess the feasibility of using hydrogen and deuterium neutral particle beams outside the Earth`s atmosphere. The main effort of the NPB program at Los Alamos concentrates on developing the GTA. The GTA is classified as a low-hazard facility, exceptmore » for the cryogenic-cooling system, which is classified as a moderate-hazard facility. This volume consists of failure modes and effects analysis; accident analysis; operational safety requirements; quality assurance program; ES&H management program; environmental, safety, and health systems critical to safety; summary of waste-management program; environmental monitoring program; facility expansion, decontamination, and decommissioning; summary of emergency response plan; summary plan for employee training; summary plan for operating procedures; glossary; and appendices A and B.« less

Improvements in Symbol Sign Design To Aid Older Drivers

DOT National Transportation Integrated Search

2012-08-01

This report presents the Traffic System Data Test Plan for the national evaluation of the Los Angeles County Congestion Reduction Demonstration (CRD) under the United States Department of Transportation (U.S. DOT) Urban Partnership Agreement (UPA) Pr...

Cost-effectiveness of omega-3 fatty acid supplements in parenteral nutrition therapy in hospitals: a discrete event simulation model.

PubMed

Pradelli, Lorenzo; Eandi, Mario; Povero, Massimiliano; Mayer, Konstantin; Muscaritoli, Maurizio; Heller, Axel R; Fries-Schaffner, Eva

2014-10-01

A recent meta-analysis showed that supplementation of omega-3 fatty acids in parenteral nutrition (PN) regimens is associated with a statistically and clinically significant reduction in infection rate, and length of hospital stay (LOS) in medical and surgical patients admitted to the ICU and in surgical patients not admitted to the ICU. The objective of this present study was to evaluate the cost-effectiveness of the addition of omega-3 fatty acids to standard PN regimens in four European countries (Italy, France, Germany and the UK) from the healthcare provider perspective. Using a discrete event simulation scheme, a patient-level simulation model was developed, based on outcomes from the Italian ICU patient population and published literature. Comparative efficacy data for PN regimens containing omega-3 fatty acids versus standard PN regimens was taken from the meta-analysis of published randomised clinical trials (n = 23 studies with a total of 1502 patients), and hospital LOS reduction was further processed in order to split the reduction in ICU stay from that in-ward stays for patients admitted to the ICU. Country-specific cost data was obtained for Italian, French, German and UK healthcare systems. Clinical outcomes included in the model were death rates, nosocomial infection rates, and ICU/hospital LOS. Probabilistic and deterministic sensitivity analyses were undertaken to test the reliability of results. PN regimens containing omega-3 fatty acids were more effective on average than standard PN both in ICU and in non-ICU patients in the four countries considered, reducing infection rates and overall LOS, and resulting in a lower total cost per patient. Overall costs for patients receiving PN regimens containing omega-3 fatty acids were between €14 144 to €19 825 per ICU patient and €5484 to €14 232 per non-ICU patient, translating into savings of between €3972 and €4897 per ICU patient and savings of between €561 and €1762 per non-ICU patient. Treatment costs were completely offset by the reduction in hospital stay costs and antibiotic costs. Sensitivity analyses confirmed the robustness of these findings. These results suggest that the supplementation of PN regimens with omega-3 fatty acids would be cost effective in Italian, French, German and UK hospitals. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

A framework for mobilizing communities to advance local tobacco control policy: the Los Angeles County experience.

PubMed

Weber, Mark D; Simon, Paul; Messex, Monty; Aragon, Linda; Kuo, Tony; Fielding, Jonathan E

2012-05-01

The Los Angeles County Tobacco Control and Prevention Program was significantly restructured in 2004 to improve capacity for local policy adoption. Restructuring included creating a fully staffed and trained policy unit; partnering with state-funded tobacco control organizations to provide high-quality, continuous technical assistance and training; implementing a highly structured policy adoption approach; expanding community capacity building; and establishing local coalitions to mobilize communities. Over the ensuing 6 years (2004-2010), 97 tobacco control policies were enacted in the county's 88 cities and unincorporated area, including 79 that were attributable to the program. By comparison, only 15 policies were enacted from 1998 to 2003. Expanding policy adoption capacity through program restructuring may be achievable in other local jurisdictions.

[An automated registry program for nosocomial infections].

PubMed

Castañón-González, Jorge Alberto; Polanco-González, Carlos; Samaniego-Mendoza, José Lino; Buhse, Thomas

2014-12-01

Las infecciones nosocomiales presentan un gran reto para la medicina hospitalaria, en general, y para las Unidades de Cuidados Intensivos, en particular. Su elevada prevalencia, la gran morbilidad y mortalidad asociadas, el incremento de la estancia hospitalaria y, en consecuencia, los costos de la atención médica han hecho que los programas de vigilancia, control y prevención de infecciones nosocomiales sean una parte toral de los protocolos de seguridad para el paciente y un indicador de calidad de la atención médica.

Annual Report for Los Alamos National Laboratory Technical Area 54, Area G Disposal Facility - Fiscal Year 2016

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

Birdsell, Kay Hanson; Stauffer, Philip H.; Atchley, Adam Lee

As a condition to the disposal authorization statement issued to Los Alamos National Laboratory (LANL or the Laboratory) on March 17, 2010, a comprehensive performance assessment and composite analysis (PA/CA) maintenance program must be implemented for the Technical Area 54, Area G disposal facility. Annual determinations of the adequacy of the PA/CA are to be conducted under the maintenance program to ensure that the conclusions reached by those analyses continue to be valid. This report summarizes the results of the fiscal year (FY) 2016 annual review for Area G.

Integrating Point-of-Care Testing into a Community Emergency Department: A Mixed-Methods Evaluation.

PubMed

Pines, Jesse M; Zocchi, Mark S; Carter, Caitlin; Marriott, Charles Z; Bernard, Matthew; Warner, Leah H

2018-05-13

Point-of-care testing (POCT) is a commonly used technology that hastens the time to laboratory results in emergency departments (ED). We evaluated an ED-based POCT program on ED length of stay and time to care, coupled with qualitative interviews of local ED stakeholders. We conducted a mixed-methods study (2012-16) to examine the impact of point-of-care testing in a single, community ED. The quantiative analysis involved an observational before-after study comparing time to laboratory test result (POC troponin or POC chemistry) and ED length of stay after implementation of POCT, using a propensity-weighted interrupted time series analysis (ITSA). A complementary qualitative analysis involved five semi-structured interviews with staff using grounded theory on the benefits and challenges to ED POCT. A total of 47,399 ED visits were included in the study (24,705 in pre-intervention period and 22,694 in post-intervention). After POCT implementation, overall laboratory testing increased marginally from 61 to 62%. Central laboratory troponin and chemistry declined by >50% and was replaced by POCT. Prior to POCT implementation, time to troponin and chemistry had declined steadily due to other improvements in laboratory efficiency. After POCT implementation, there was an immediate 20 minute further decline (p<0.001) in both time to troponin and time to chemistry results using the propensity-weighted comparisons. However, the declining trend observed prior to POCT implementation did not continue at the same rate post implementation. Similarly, prior to POCT implementation, ED length of stay (LOS) declined due to other quality improvements. After POCT implementation, LOS continued declined at a similar rate. Because of this prior trend, the ITSA did not show a significant decline in LOS attributable to POCT. Common benefits of POCT perceived by staff in qualitative interviews included improved quality of care (64%), and reductions in time to test results (44%). Common challenges included concerns over POCT accuracy (32%), and technical barriers (29%). In the study ED, implementation of POCT was associated with a reduction in time to test result for both troponin and chemistry. Local staff felt that faster time to test result improved quality of care; however, concerns were raised with POCT accuracy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Educational Needs, Goals, and Resources: Planning Issues for the Los Angeles Community Colleges, 1984-89.

ERIC Educational Resources Information Center

Avila, Arthur; Stevens, Thomas

Designed to aid in the planning process of the Los Angeles Community College District (LACCD) for 1984-1989, this report assesses educational and resource needs; discusses the community college mission and functions; and points to changing directions in educational programs and services in the district during the coming years. Introductory…

76 FR 41810 - Francis Proposed Low-Effect Habitat Conservation Plan for the Morro Shoulderband Snail, Los Osos...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-15

...] Francis Proposed Low-Effect Habitat Conservation Plan for the Morro Shoulderband Snail, Los Osos, San Luis... conservation program to minimize and mitigate project activities as described in their low-effect habitat conservation plan. We invite comments from the public on the application, which includes the Francis Low-Effect...

Parents Ask about Standards = Los padres preguntan acerca de los estandares.

ERIC Educational Resources Information Center

RMC Research Corp., Portsmouth, NH.

This publication, which includes both English and Spanish versions, explains that standards describe what students should know and be able to do at each grade level. Every school that receives money from Title I, the federal educational aid program that provides extra educational services for children who are behind in school, must have standards…

Following-Up with Former Students: A Summary of Seven Program Studies. Research Brief

ERIC Educational Resources Information Center

Glyer-Culver, Betty

2004-01-01

Beginning in the 2000-01 Academic Year, the Los Rios Community College District Office of Institutional Research (IR) began a collaboration with Occupational and Area Deans as well as Faculty from each of the four Los Rios Colleges located in Sacramento, CA (American River College, Cosumnes River College, Folsom Lake College and Sacramento City…

76 FR 3209 - West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Draft Master Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-19

... Federal Register Notice announces an opportunity for public comment on the West Los Angeles (WLA... to ``Notice: Draft Master Plan.'' All comments received will be available for public inspection in...-recurring filming and single-day event agreements. The purpose of the Draft Master Plan is to satisfy the...

Los Angeles Free Clinic [and]"Adolescent Health Care Programs That Work."

ERIC Educational Resources Information Center

Rainwater, Mary; De Caprio, Chris

The first paper describes The Los Angeles Free Clinic and its services, which are specifically designed to respond to the needs of low-income and homeless youth within the community. The paper describes a free-of-charge, free-of-judgment comprehensive response system that exists because of collaboration with other health facilities such as…

Preliminary Evaluation Report on the Los Angeles City Schools SB 28 Demonstration Program in Mathematics. CSE Working Paper No. 1.

ERIC Educational Resources Information Center

Gordon, C. Wayne

The objectives of the Los Angeles Model Mathematics Project (LAMMP) are stated by the administration as improvement of mathematical skills and understanding of mathematical concepts; improvement of the pupils' self-image; identification of specific assets and limitations relating to the learning process; development and use of special…

Preliminary Evaluation Report on the Los Angeles City Schools, SB 28 Demonstration Program in Mathematics.

ERIC Educational Resources Information Center

Gordon, C. Wayne

The purpose of this preliminary report is to describe and evaluate the Los Angeles Model Mathematics Project (LAMMP). The objectives of this project include the improvement of mathematical skills and understanding of mathematical concepts, the improvement of students' self-image, the development of instructional materials and the assessment of…

The Arboretum: A living laboratory

Treesearch

Constance I. Millar

1977-01-01

...The Arboretum must be viable...the Arboretum must be dynamic, offering programs, new programs, and repeat programs, to share the knowledge that we have accumulated..." Francis Ching, Director, Los Angeles State and County Arboretum.¹ ¹Excerpt from: Proceedings of a Symposium: The Urban Arboretum in a Time of Crisis....

Instructional Development Grant Program.

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA. Div. of Educational Planning and Development.

The Instructional Development Grant Program of the Los Angeles Community College District encourages developmental work by faculty members towards innovative approaches that are designed to have a positive impact on the learning process. The goals of the program are to: (1) provide incentives for faculty contributions beyond the normal assignment…

Annual Report: Doctoral Program Committee, Academic Year 1996-97.

ERIC Educational Resources Information Center

Lievrouw, Leah A.; Leazer, Greg; Lynch, Beverly; Abler, Susan; Mediavilla, Cynthia

This document summarizes the activities of the University of California, Los Angeles's (UCLA's) Department of Library and Information Science (DLIS) Doctoral Program Committee, 1996-97. These activities are organized into two main areas: Operations and Students. Doctoral Program Committee (DPC) operations outlined include: preparing major policy…

Recovering Radioactive Materials with OSRP team

ScienceCinema

None

2017-12-09

The National Nuclear Security Administration sponsors a program, executed by Los Alamos National Laboratory, to recover radioisotopes used by industry and academia and no longer needed. Called the "Offsite Source Recovery Program (OSRP), it has recovered

An independent evaluation of plutonium body burdens in populations near Los Alamos Laboratory using human autopsy data.

PubMed

Gaffney, Shannon H; Donovan, Ellen P; Shonka, Joseph J; Le, Matthew H; Widner, Thomas E

2013-06-01

In the mid-1940s, the United States began producing atomic weapon components at the Los Alamos National Laboratory (LANL). In an attempt to better understand historical exposure to nearby residents, this study evaluates plutonium activity in human tissue relative to residential location and length of time at residence. Data on plutonium activity in the lung, vertebrae, and liver of nearby residents were obtained during autopsies as a part of the Los Alamos Tissue Program. Participant residential histories and the distance from each residence to the primary plutonium processing buildings at LANL were evaluated in the analysis. Summary statistics, including Student t-tests and simple regressions, were calculated. Because the biological half-life of plutonium can vary significantly by organ, data were analyzed separately by tissue type (lung, liver, vertebrae). The ratios of plutonium activity (vertebrae:liver; liver:lung) were also analyzed in order to evaluate the importance of timing of exposure. Tissue data were available for 236 participants who lived in a total of 809 locations, of which 677 were verified postal addresses. Residents of Los Alamos were found to have higher plutonium activities in the lung than non-residents. Further, those who moved to Los Alamos before 1955 had higher lung activities than those who moved there later. These trends were not observed with the liver, vertebrae, or vertebrae:liver and liver:lung ratio data, however, and should be interpreted with caution. Although there are many limitations to this study, including the amount of available data and the analytical methods used to analyze the tissue, the overall results indicate that residence (defined as the year that the individual moved to Los Alamos) may have had a strong correlation to plutonium activity in human tissue. This study is the first to present the results of Los Alamos Autopsy Program in relation to residential status and location in Los Alamos. Copyright © 2012 Elsevier GmbH. All rights reserved.

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

PubMed Central

Ferket, Bart S.; Shi, Wei; Rosen, Alexander; Welsh, Stacey; Bagiella, Emilia; Neill, Alexis E.; Williams, Deborah L.; Greenberg, Ann; Browndyke, Jeffrey N.; Gillinov, A. Marc; Mayer, Mary Lou; Keim-Malpass, Jessica; Gupta, Lopa S.; Hohmann, Samuel F.; Gelijns, Annetine C.; O'Gara, Patrick T.; Moskowitz, Alan J.

2016-01-01

OBJECTIVE The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status. RESEARCH DESIGN AND METHODS Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses. RESULTS In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (−12,886 to −222), hospital LOS reductions of 1.6 days (−3.7 to 0.4), infection reductions of 4.1% (−9.1 to 0.0), and reductions in respiratory complication of 12.5% (−22.4 to −3.0). In patients with non–insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present. CONCLUSIONS Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status. PMID:26786574

Reducing air pollutant emissions at airports by controlling aircraft ground operations

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

Gelinas, C.G.; Fan, H.S.L.

1979-02-01

Potential reductions in air pollutant emissions were determined for four stategies to control aircraft ground operations at two case study airports, Los Angeles and San Francisco International Airports. Safety, cost, and fuel savings associated with strategy implementation were examined. Two strategies, aircraft towing and shutdown of one engine during taxi operations, provided significant emission reductions. However, there are a number of safety problems associated with aircraft towing. The shutdown of one engine while taxiing was found to be the most viable strategy because of substantial emission reductions, cost benefits resulting from fuel savings, and no apparent safety problems.

Administrative Plans. STIP II (Skill Training Improvement Programs Round II).

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA.

Personnel policies, job responsibilities, and accounting procedures are summarized for the Los Angeles Community College District's Skill Training Improvement Programs (STIP II). This report first cites references to the established personnel and affirmative action procedures governing the program and then presents an organizational chart for the…

Mountain Roads, Lonely Mesas: A Career Program for Northern New Mexico.

ERIC Educational Resources Information Center

Strong, Kathryn Ringhand

Educational outreach programs of Los Alamos National Laboratory assist rural educators in strengthening science curricula; encourage students to take science, math, and English courses; and create a good neighbor policy between the laboratory and rural communities/schools in predominantly Hispanic/American Indian northern New Mexico. The program,…

Kindergarten Program for Four-Year-OIds: An Early intervention Strategy.

ERIC Educational Resources Information Center

Klentschy, Michael P.; Hoge, Suzi

The Pasadena Unified School District, in northwest Los Angeles County, recognized that an early intervention program for economically disadvantaged children should be part of its comprehensive district revitalizing and restructuring plan. Consequently, staff developed the Kindergarten Program for Four-Year-Olds, which was designed to provide: (1)…

Level of Service Program for INDOT Operations : APPENDIX C Los Inspection Manual

DOT National Transportation Integrated Search

2012-01-01

INDOT has used an inspection program named Maintenance Quality Survey (MQS) to perform a statewide inspection of their roadway assets, rightofway to rightofway. This inspection requires two twoperson teams approximately 18 months to...

The immediate effects of the severe acute respiratory syndrome (SARS) epidemic on childbirth in Taiwan.

PubMed

Lee, Cheng-Hua; Huang, Nicole; Chang, Hong-Jen; Hsu, Yea-Jen; Wang, Mei-Chu; Chou, Yiing-Jenq

2005-04-04

When an emerging infectious disease like severe acute respiratory syndrome (SARS) strikes suddenly, many wonder the public's overwhelming fears of SARS may deterred patients from seeking routine care from hospitals and/or interrupt patient's continuity of care. In this study, we sought to estimate the influence of pregnant women's fears of severe acute respiratory syndrome (SARS) on their choice of provider, mode of childbirth, and length of stay (LOS) for the delivery during and after the SARS epidemic in Taiwan. The National Health Insurance data from January 01, 2002 to December 31, 2003 were used. A population-based descriptive analysis was conducted to assess the changes in volume, market share, cesarean rate, and average LOS for each of the 4 provider levels, before, during and after the SARS epidemic. Compared to the pre-SARS period, medical centers and regional hospitals dropped 5.2% and 4.1% in market share for childbirth services during the peak SARS period, while district hospitals and clinics increased 2.1% and 7.1%, respectively. For changes in cesarean rates, only a significantly larger increase was observed in medical centers (2.2%) during the peak SARS period. In terms of LOS, significant reductions in average LOS were observed in all hospital levels except for clinics. Average LOS was shortened by 0.21 days in medical centers (5.6%), 0.21 days in regional hospitals (5.8%), and 0.13 days in district hospitals (3.8%). The large amount of patients shifting from the maternity wards of more advanced hospitals to those of less advanced hospitals, coupled with the substantial reduction in their length of maternity stay due to their fears of SARS could also lead to serious concerns for quality of care, especially regarding a patient's accessibility to quality providers and continuity of care.

The immediate effects of the severe acute respiratory syndrome (SARS) epidemic on childbirth in Taiwan

PubMed Central

Lee, Cheng-Hua; Huang, Nicole; Chang, Hong-Jen; Hsu, Yea-Jen; Wang, Mei-Chu; Chou, Yiing-Jenq

2005-01-01

Background When an emerging infectious disease like severe acute respiratory syndrome (SARS) strikes suddenly, many wonder the public's overwhelming fears of SARS may deterred patients from seeking routine care from hospitals and/or interrupt patient's continuity of care. In this study, we sought to estimate the influence of pregnant women's fears of severe acute respiratory syndrome (SARS) on their choice of provider, mode of childbirth, and length of stay (LOS) for the delivery during and after the SARS epidemic in Taiwan. Methods The National Health Insurance data from January 01, 2002 to December 31, 2003 were used. A population-based descriptive analysis was conducted to assess the changes in volume, market share, cesarean rate, and average LOS for each of the 4 provider levels, before, during and after the SARS epidemic. Results Compared to the pre-SARS period, medical centers and regional hospitals dropped 5.2% and 4.1% in market share for childbirth services during the peak SARS period, while district hospitals and clinics increased 2.1% and 7.1%, respectively. For changes in cesarean rates, only a significantly larger increase was observed in medical centers (2.2%) during the peak SARS period. In terms of LOS, significant reductions in average LOS were observed in all hospital levels except for clinics. Average LOS was shortened by 0.21 days in medical centers (5.6%), 0.21 days in regional hospitals (5.8%), and 0.13 days in district hospitals (3.8%). Conclusion The large amount of patients shifting from the maternity wards of more advanced hospitals to those of less advanced hospitals, coupled with the substantial reduction in their length of maternity stay due to their fears of SARS could also lead to serious concerns for quality of care, especially regarding a patient's accessibility to quality providers and continuity of care. PMID:15804368

The Role of an Aligned Curriculum Design in the Achievement of Learning Outcomes

ERIC Educational Resources Information Center

Alfauzan, Abdullah A. H.; Tarchouna, Nessima

2017-01-01

The importance of learning outcomes (LOs) as a central component of LOs-based curriculum design has been emphasized by many higher education experts and researchers (Biggs, 1999; Adam, 2006; Kennedy et al., 2006; Biggs and Tang, 2007; Warnier et al., 2010). However, the important role played by program and course curriculum design in securing a…

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles.

PubMed

Dowling, Patrick T; Bholat, Michelle Anne

2012-12-01

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial. Copyright © 2012 Elsevier Inc. All rights reserved.

Design of an ITS-Level advanced traffic management system: a human factors perspective

DOT National Transportation Integrated Search

2012-07-01

This report presents the Ridesharing Data Test Plan for the national evaluation of the Los Angeles (L.A.) County Congestion Reduction Demonstration (CRD) under the United States Department of Transportation (U.S. DOT) Urban Partnership Agreement (UPA...

Los Angeles congestion reduction demonstration (Metro ExpressLanes). National evaluation : cost benefit analysis test plan.

DOT National Transportation Integrated Search

2002-04-01

The Theory of Operations document is one of a series of deliverables documenting the National Intelligent Transportation System (ITS) Architecture developed under contract to the U.S. Department of Transportation (DOT). The Theory of Operations Docum...

Media Outlet and Consumer Reactions to Promotional Activities of the Choose Health LA Restaurants Program in Los Angeles County.

PubMed

Gase, Lauren N; Montes, Christine; Robles, Brenda; Tyree, Rachel; Kuo, Tony

2016-01-01

This study sought to assess promotional activities undertaken to raise public awareness of the Choose Health LA Restaurants program in Los Angeles County, an environmental change strategy that recognizes restaurants for offering reduced-size and healthier menu options. We used multiple methods to assess public awareness of and reactions to the promotional activities, including an assessment of the reach of core promotional activities, a content analysis of earned media, and an Internet panel survey. The study was conducted in Los Angeles County, home to more than 10 million residents. An online survey firm recruited participants for an Internet panel survey; to facilitate generalization of results to the county's population, statistical weights were applied to analyses of the survey data. Promotional activities to raise awareness of the program included community engagement, in-store promotion, and a media campaign. Outcomes included media impressions, the number of people who reported seeing the Choose Health LA Restaurants logo, and a description of the themes present in earned media. Collectively, paid media outlets reported 335 587 229 total impressions. The Internet panel survey showed that 12% of people reported seeing the program logo. Common themes in earned media included the Choose Health LA Restaurants program aims to provide restaurant patrons with more choices, represents a new opportunity for restaurants and public health to work together, will benefit participating restaurants, and will positively impact health. Promotional activities for the Choose Health LA Restaurants program achieved modest reach and positive reactions from media outlets and consumers. The program strategy and lessons learned can help inform present and future efforts to combine environmental and individually focused strategies that target key influences of consumer food selection.

Annual Report for Los Alamos National Laboratory Technical Area 54, Area G Disposal Facility – Fiscal Year 2015

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

French, Sean B.; Stauffer, Philip H.; Birdsell, Kay H.

As a condition to the disposal authorization statement issued to Los Alamos National Laboratory (LANL or the Laboratory) on March 17, 2010, a comprehensive performance assessment and composite analysis maintenance program must be implemented for the Technical Area 54, Area G disposal facility. Annual determinations of the adequacy of the performance assessment and composite analysis (PA/CA) are to be conducted under the maintenance program to ensure that the conclusions reached by those analyses continue to be valid. This report summarizes the results of the fiscal year (FY) 2015 annual review for Area G.

Safeguards and security research and development: Progress report, October 1994--September 1995

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

Rutherford, D.R.; Henriksen, P.W.

The primary goal of the Los Alamos Safeguards and Security Technology Development Program, International Safeguards, and other Safeguards and Security Programs is to continue to be the center of excellence in the field of Safeguards and Security. This annual report for 1995 describes those scientific and engineering projects that contribute to all of the aforementioned programs. The authors have presented the information in a different format from previous annual reports. Part I is devoted to Nuclear Material Measurement Systems. Part II contains projects that are specific to Integrated Safeguards Systems. Part III highlights Safeguards Systems Effectiveness Evaluations and Part IVmore » is a compilation of highlights from Information Assurance projects. Finally Part V highlights work on the projects at Los Alamos for International Safeguards. The final part of this annual report lists titles and abstracts of Los Alamos Safeguards and Security Technology Development reports, technical journal articles, and conference papers that were presented and published in 1995. This is the last annual report in this format. The authors wish to thank all of the individuals who have contributed to this annual report and made it so successful over the years.« less

Intraoperative Goal-directed Fluid Therapy in Elective Major Abdominal Surgery

PubMed Central

Rollins, Katie E.; Lobo, Dileep N.

2016-01-01

Objectives: To compare the effects of intraoperative goal-directed fluid therapy (GDFT) with conventional fluid therapy, and determine whether there was a difference in outcome between studies that did and did not use Enhanced Recovery After Surgery (ERAS) protocols. Methods: Meta-analysis of randomized controlled trials of adult patients undergoing elective major abdominal surgery comparing intraoperative GDFT versus conventional fluid therapy. The outcome measures were postoperative morbidity, length of stay, gastrointestinal function and 30-day mortality. Results: A total of 23 studies were included with 2099 patients: 1040 who underwent GDFT and 1059 who received conventional fluid therapy. GDFT was associated with a significant reduction in morbidity (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.66–0.89, P = 0.0007), hospital length of stay (LOS; mean difference −1.55 days, 95% CI −2.73 to −0.36, P = 0.01), intensive care LOS (mean difference −0.63 days, 95% CI −1.18 to −0.09, P = 0.02), and time to passage of feces (mean difference −0.90 days, 95% CI −1.48 to −0.32 days, P = 0.002). However, no difference was seen in mortality, return of flatus, or risk of paralytic ileus. If patients were managed in an ERAS pathway, the only significant reductions were in intensive care LOS (mean difference −0.63 days, 95% CI −0.94 to −0.32, P < 0.0001) and time to passage of feces (mean difference −1.09 days, 95% CI −2.03 to −0.15, P = 0.02). If managed in a traditional care setting, a significant reduction was seen in both overall morbidity (RR 0.69, 95% CI 0.57 to −0.84, P = 0.0002) and total hospital LOS (mean difference −2.14, 95% CI −4.15 to −0.13, P = 0.04). Conclusions: GDFT may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in an ERAS setting. PMID:26445470

A New Model for a Multi-Disciplinary Engineering Summer Research Program for High School Seniors: Program Overview, Effectiveness, and Outcomes

ERIC Educational Resources Information Center

Kittur, H.; Shaw, L.; Herrera, W.

2017-01-01

The High School Summer Research Program (HSSRP) is a rigorous eight-week research experience that challenges high school students to a novel scientific question in an engineering laboratory at the Henry Samueli School of Engineering and Applied Science (HSSEAS) at the University of California, Los Angeles (UCLA). The program collates highly…

"2 + 2 + 2" Articulated Programs: Benefits for Educators and Students.

ERIC Educational Resources Information Center

Stanley, Patricia

1992-01-01

In Los Angeles, a secondary regional occupational program, a community college, and a university department developed an articulated 2+2+2 program in fashion merchandising that opens doors to college degrees for students who would otherwise not participate in college prep. The complexities of negotiating agreements are outweighed by the benefits…

Enhancements to the Image Analysis Tool for Core Punch Experiments and Simulations (vs. 2014)

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

Hogden, John Edward; Unal, Cetin

A previous paper (Hogden & Unal, 2012, Image Analysis Tool for Core Punch Experiments and Simulations) described an image processing computer program developed at Los Alamos National Laboratory. This program has proven useful so developement has been continued. In this paper we describe enhacements to the program as of 2014.

Post-Evaluation of an Entrepreneurship Program for Inner-City Youth

ERIC Educational Resources Information Center

Doucet, LaRon

2010-01-01

This study evaluated program graduates of National Foundation for Teaching Entrepreneurship 1 to years after completing the program in inner city schools of Los Angeles, California. Twenty-seven out of 150 graduates participated in 2 semi-structured interviews in Northern and Southern California, or long semi-structured telephone interviews for…

California Librarians Black Caucus/UCLA Mentor Program Handbook.

ERIC Educational Resources Information Center

California Univ., Los Angeles. Graduate School of Library and Information Science.

This handbook for the Mentor Program of the California Librarians Black Caucus (CLBC) and the University of California Los Angeles (UCLA) Graduate School of Library and Information Science (GSLIS) begins by stating that the purpose of the program is to increase the number of African American librarians and other information professionals in…

The influence of institutional characteristics on length of stay for psychiatric patients: a national database study in South Korea.

PubMed

Chung, Woojin; Cho, Woo Hyun; Yoon, Chung Won

2009-03-01

The institutionalization of psychiatric patients has put a tremendous burden on many societies, but few studies have examined the effects of institutional characteristics on patient length of stay (LOS). This paper investigated the association between institutional characteristics and LOS for 160,517 psychiatric patients in South Korea by applying a two-level modeling technique to administrative claims databases covering the entire patient population. Patient LOS, expressed in terms of days, was analyzed by taking account of institutional type, ownership, location, inpatient capacity, staffing, and patient demographics. The characteristics of inpatients were used as control variables and consisted of gender, age, sub-diagnosis, and the type of national health security program. The main findings of this study are: (1) patient LOS was 69% longer at psychiatric hospitals than at tertiary-care hospitals; (2) neither location nor inpatient capacity was associated with LOS; (3) larger staffs reduced LOS; and (4), LOS increased with a higher proportion of male inpatients, inpatients > or =65 years old, or inpatients diagnosed with organic or schizophrenic disorders, possibly through contextual effects. The results of this study suggest that researchers and policy makers could improve their assessment of psychiatric patient LOS and its association with health outcome by taking into account institutional characteristics and using multi-level analyses.

Rib fractures in trauma patients: does operative fixation improve outcome?

PubMed

Majak, Peter; Næss, Pål A

2016-12-01

Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

The Story of Ferris Urbanowski: California, Here We Come!

PubMed Central

Zwelling, Elaine

2001-01-01

Although childbirth educators may not all have known her by name, the lovely redhead who was the star childbirth educator in the 1970s film The Story of Eric was a familiar face. After viewing the film numerous times in our classes, early childbirth educators all felt that we knew her. Ferris Urbanowski was an early crusader for the Lamaze method of childbirth preparation in California in the 1960s. She worked to convince physicians in the Los Angeles area of the merits of the method, to establish classes for expectant parents, and to start a chapter of ASPO (now, Lamaze International, Inc.) in Los Angeles. Her book about yoga illustrated how additional methods of relaxation could benefit pregnant women. Today, Urbanowski attributes her past involvement in childbirth education to her current professional role as a teacher and counselor in the field of stress reduction at the Stress Reduction Clinic at the University of Massachusetts Medical Center. PMID:17273248

Engagement in community music classes sparks neuroplasticity and language development in children from disadvantaged backgrounds.

PubMed

Kraus, Nina; Hornickel, Jane; Strait, Dana L; Slater, Jessica; Thompson, Elaine

2014-01-01

Children from disadvantaged backgrounds often face impoverished auditory environments, such as greater exposure to ambient noise and fewer opportunities to participate in complex language interactions during development. These circumstances increase their risk for academic failure and dropout. Given the academic and neural benefits associated with musicianship, music training may be one method for providing auditory enrichment to children from disadvantaged backgrounds. We followed a group of primary-school students from gang reduction zones in Los Angeles, CA, USA for 2 years as they participated in Harmony Project. By providing free community music instruction for disadvantaged children, Harmony Project promotes the healthy development of children as learners, the development of children as ambassadors of peace and understanding, and the development of stronger communities. Children who were more engaged in the music program-as defined by better attendance and classroom participation-developed stronger brain encoding of speech after 2 years than their less-engaged peers in the program. Additionally, children who were more engaged in the program showed increases in reading scores, while those less engaged did not show improvements. The neural gains accompanying music engagement were seen in the very measures of neural speech processing that are weaker in children from disadvantaged backgrounds. Our results suggest that community music programs such as Harmony Project provide a form of auditory enrichment that counteracts some of the biological adversities of growing up in poverty, and can further support community-based interventions aimed at improving child health and wellness.

Targeting Neuromimicry in Prostate Cancer Metastasis

DTIC Science & Technology

2016-10-01

CONTRACTING ORGANIZATION: Cedars-Sinai Medical Center Los Angeles, CA 90048 REPORT DATE: October 2016 TYPE OF REPORT: Annual PREPARED FOR: U.S...ADDRESS(ES) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Cedars-Sinai Medical Center 8700 Beverly Blvd Los Angeles, CA 90048-1804 9...by activation of axon guidance genes Jason Boyang Wu, Haiyen E. Zhau, and Leland W.K. Chung Uro -Oncology Research Program, Department of

Implementing municipal tree planting: Los Angeles million tree initiative

Treesearch

S. Pincetl

2010-01-01

Urban forests are increasingly being seen as an important infrastructure that can help cities remediate their environmental impacts. This work reports on the first steps in implementing a million tree program in Los Angeles and the ways such a biogenic—living—infrastructure has been approached. Numbers of studies have been done to quantify the benefits of urban forests...

Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy.

PubMed

Rodriguez-Larrad, Ana; Vellosillo-Ortega, Juan Manuel; Ruiz-Muneta, Carlos; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

2016-07-01

To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Quasi-experimental study. Tertiary referral academic hospital. 208 patients undergoing lobectomy by open thoracotomy. Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

Intense X-ray machine for penetrating radiography

NASA Astrophysics Data System (ADS)

Lucht, Roy A.; Eckhouse, Shimon

Penetrating radiography has been used for many years in the nuclear weapons research programs. Infrequently penetrating radiography has been used in conventional weapons research programs. For example the Los Alamos PHERMEX machine was used to view uranium rods penetrating steel for the GAU-8 program, and the Ector machine was used to see low density regions in forming metal jets. The armor/anti-armor program at Los Alamos has created a need for an intense flash X-ray machine that can be dedicated to conventional weapons research. The Balanced Technology Initiative, through DARPA, has funded the design and construction of such a machine at Los Alamos. It will be an 8- to 10-MeV diode machine capable of delivering a dose of 500 R at 1 m with a spot size of less than 5 mm. The machine used an 87.5-stage low inductance Marx generator that charges up a 7.4-(Omega), 32-ns water line. The water line is discharged through a self-breakdown oil switch into a 12.4-(Omega) water line that rings up the voltage into the high impendance X-ray diode. A long (233-cm) vacuum drift tube is used to separate the large diameter oil-insulated diode region from the X-ray source area that may be exposed to high overpressures by the explosive experiments. The electron beam is selffocused at the target area using a low pressure background gas.

COMPLETE REDUCTION OF TELLURITE TO PURE TELLURIUM METAL BY MICROORGANISMS

PubMed Central

Tucker, Fayne L.; Walper, John F.; Appleman, Milo Don; Donohue, Jerry

1962-01-01

Tucker, Fayne L. (University of Southern California, Los Angeles), John F. Walper, Milo Don Appleman, and Jerry Donohue. Complete reduction of tellurite to pure tellurium metal by microorganisms. J. Bacteriol. 83:1313–1314. 1962—The black precipitate produced in the presence of potassium tellurite by growing cells of Streptococcus faecalis N83 and Corynebacterium diphtheriae was shown, by X-ray diffraction analysis, to consist of metallic tellurium. The metal was not complexed, to any significant degree, with any organic material. PMID:13922991

Epidemiology of UK neonatal infections: the neonIN infection surveillance network.

PubMed

Cailes, Benjamin; Kortsalioudaki, Christina; Buttery, Jim; Pattnayak, Santosh; Greenough, Anne; Matthes, Jean; Bedford Russell, Alison; Kennea, Nigel; Heath, Paul T

2017-12-05

To describe the epidemiology of neonatal infection over the past decade in UK neonatal units. Retrospective analysis of prospectively collected infection surveillance network data from 2005 to 2014. 30 neonatal units in the UK. Newborns on participating neonatal units who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of appropriate antibiotics. 2171 episodes of neonatal infection in 1922 infants were recorded. The incidence of infection was 6.1/1000 live births and 48.8/1000 neonatal admissions (2.9 and 23.5 respectively if coagulase-negative staphylococci (CoNS) cultures excluded). The incidence of infection showed a statistically significant reduction over time with reductions in the rates of both early-onset sepsis (EOS) and late-onset sepsis (LOS).The majority of episodes (76%) represented LOS (diagnosed > 48 hours after birth), and infection was more common in premature (<37 weeks gestation) and low birth weight (<2500 g) neonates (84% and 81%, respectively). Commonly identified pathogens included group B streptococci (43%) and Escherichia coli (18%) for EOS, while E. coli (15%), Staphylococcus aureus (14%) and CoNS were prominent causes of LOS. This paper describes the epidemiology of neonatal infection in the UK over the past decade. These data enable benchmarking of practice and inform areas of future research and guideline development. The results support the hypothesis that the introduction of infection prevention care bundles and antibiotic stewardship programmes in the UK has reduced the burden of LOS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effectiveness of assertive community management in Singapore.

PubMed

Low, Lambert; Tan, Yu Yuan; Lim, Boon Leng; Poon, Weng Cheong; Lee, Cheng

2013-03-01

Assertive Community Treatment (ACT) was introduced in the 1970s as a comprehensive and assertive approach to community-based case management of patients with chronic and serious mental illness. Launched in Singapore in 2003, the Assertive Community Management (ACM) was modelled after the ACT, but with the main difference of 24 hour availability for the latter only. In line with the move towards de-institutionalisation of psychiatric patients, ACM was introduced to provide a mobile community-based multidisciplinary team approach to manage patients with severe chronic psychiatric illness. This article aims to evaluate and provide an update on this service programme in Singapore following an earlier study by Fam Johnson in 2007. A naturalistic and retrospective study was conducted. One hundred and fifty-five patients recruited into ACM from 1 September 2008 to 1 September 2009 and had completed 1 year of ACM were included in our study. Outcomes were defined as number of admissions (NOA) and length of stay (LOS) one year before and one year following induction into the programme. Baseline socio-demographic factors were also investigated to see if they predicted outcome with ACM. The mean NOA was 1.9 pre-ACM and 0.6 post-ACM, with mean reduction in NOA of 1.3 (P <0.01). The mean LOS was 72.2 days pre-ACM and 17.1 days post ACM, mean reduction in LOS 55.1 days (P <0.01). In addition, it was found that gender, diagnoses and ethnicity were not predictive of the outcome measures of NOA or LOS. ACM in Singapore had been well established since its inception and continued to show effectiveness in reducing inpatient hospitalisation among the chronically mentally ill.

Dual ACE-inhibition and AT1 receptor antagonism improves ventricular lusitropy without affecting cardiac fibrosis in the congenic mRen2.Lewis rat.

PubMed

Jessup, Jewell A; Westwood, Brian M; Chappell, Mark C; Groban, Leanne

2009-08-01

Hypertension and left ventricular (LV) hypertrophy often precede diastolic dysfunction and are risk factors for diastolic heart failure. Although pharmacologic inhibition of the renin-angiotensin system (RAS) improves diastolic function and functional capacity in hypertensive patients with LV hypertrophy, the effects of combination therapy with an angiotensin converting enzyme inhibitor (ACEi) and an angiotensin receptor blocker (ARB) are unclear. We assessed the effects of the combined 10-week administration of lisinopril (10 mg/kg/ day, p.o.) and losartan (10 mg/kg/day, p.o.) (LIS/LOS) on diastolic function and LV structure in seven young (5 weeks), prehypertensive congenic mRen2.Lewis male rat, a model of tissue renin overexpression and angiotensin II (Ang II)-dependent hypertension compared to vehicle (VEH) treated (n = 7), age-matched rats. Systolic blood pressures were 64% lower with the combination therapy (p < 0.001), but there were no differences in heart rate or systolic function between groups. RAS inhibition increased myocardial relaxation, defined by tissue Doppler mitral annular descent (e') by 2.2 fold (p < 0.001). The preserved lusitropy in the LIS/LOS-treated rats was accompanied by a reduction in phospholamban-to-SERCA2 ratio (p < 0.001). Despite lower relative wall thicknesses (VEH: 1.56+/-0.17 versus LIS/LOS: 0.78+/-0.05) and filling pressures, defined by the transmitral Doppler-to-mitral annular descent ratio (E/e', VEH: 28.7+/-1.9 versus LIS/LOS: 17.96+/-1.5), no differences in cardiac collagen were observed. We conclude that the lusitropic benefit of early dual RAS blockade may be due to improved vascular hemodynamics and/or cardiac calcium handling rather than effects on extracellular matrix reduction.

Improved clinical and economic outcomes in severe bronchiolitis with pre-emptive nCPAP ventilatory strategy.

PubMed

Essouri, Sandrine; Laurent, Marie; Chevret, Laurent; Durand, Philippe; Ecochard, Emmanuelle; Gajdos, Vincent; Devictor, Denis; Tissières, Pierre

2014-01-01

Severe bronchiolitis is the leading cause of admission to the pediatric intensive care unit (PICU). Nasal continuous positive airway pressure (nCPAP) has become the primary respiratory support, replacing invasive mechanical ventilation (MV). Our objective was to evaluate the economic and clinical consequences following implementation of this respiratory strategy in our unit. This was a retrospective cohort analysis of 525 infants with bronchiolitis requiring respiratory support and successively treated during two distinct periods with invasive MV between 1996 and 2000, P1 (n = 193) and nCPAP between 2006 and 2010, P2 (n = 332). Costs were estimated using the hospital cost billing reports. Patients' baseline characteristics were similar between the two periods. P2 is associated with a significant decrease in the length of ventilation (LOV) (4.1 ± 3.5 versus 6.9 ± 4.6 days, p < 0.001), PICU length of stay (LOS) (6.2 ± 4.6 versus 9.7 ± 5.5 days, p < 0.001) and hospital LOS. nCPAP was independently associated with a shorter duration of ventilatory support than MV (hazard ratio 1.8, 95% CI 1.5-2.2, p < 0.001). nCPAP was also associated with a significant decrease in ventilation-associated complications, and less invasive management. The mean cost of acute viral bronchiolitis-related PICU hospitalizations was significantly decreased, from 17,451 to 11,205 € (p < 0.001). Implementation of nCPAP led to a reduction of the total annual cost of acute viral bronchiolitis hospitalizations of 715,000 €. nCPAP in severe bronchiolitis is associated with a significant improvement in patient management as shown by the reduction in invasive care, LOV, PICU LOS, hospital LOS, and economic burden.

Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial

PubMed Central

2010-01-01

Background The Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) is a registered, double-blinded, randomized, controlled trial designed to assess the efficacy of osteopathic manipulative treatment (OMT) as an adjunctive treatment in elderly patients with pneumonia. Methods 406 subjects aged ≥ 50 years hospitalized with pneumonia at 7 community hospitals were randomized using concealed allocation to conventional care only (CCO), light-touch treatment (LT), or OMT groups. All subjects received conventional treatment for pneumonia. OMT and LT groups received group-specific protocols for 15 minutes, twice daily until discharge, cessation of antibiotics, respiratory failure, death, or withdrawal from the study. The primary outcomes were hospital length of stay (LOS), time to clinical stability, and a symptomatic and functional recovery score. Results Intention-to-treat (ITT) analysis (n = 387) found no significant differences between groups. Per-protocol (PP) analysis (n = 318) found a significant difference between groups (P = 0.01) in LOS. Multiple comparisons indicated a reduction in median LOS (95% confidence interval) for the OMT group (3.5 [3.2-4.0] days) versus the CCO group (4.5 [3.9-4.9] days), but not versus the LT group (3.9 [3.5-4.8] days). Secondary outcomes of duration of intravenous antibiotics and treatment endpoint were also significantly different between groups (P = 0.05 and 0.006, respectively). Duration of intravenous antibiotics and death or respiratory failure were lower for the OMT group versus the CCO group, but not versus the LT group. Conclusions ITT analysis found no differences between groups. PP analysis found significant reductions in LOS, duration of intravenous antibiotics, and respiratory failure or death when OMT was compared to CCO. Given the prevalence of pneumonia, adjunctive OMT merits further study. PMID:20302619

Impact of process improvements on measures of emergency department efficiency.

PubMed

Leung, Alexander K; Whatley, Shawn D; Gao, Dechang; Duic, Marko

2017-03-01

To study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures. This was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained. Patients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005). A combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

Should All Patients Be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?

PubMed

Rozell, Joshua C; Courtney, Paul M; Dattilo, Jonathan R; Wu, Chia H; Lee, Gwo-Chin

2016-09-01

Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson comorbidity index >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

National trends in pediatric blunt spleen and liver injury management and potential benefits of an abbreviated bed rest protocol.

PubMed

Dodgion, Christopher M; Gosain, Ankush; Rogers, Andrew; St Peter, Shawn D; Nichol, Peter F; Ostlie, Daniel J

2014-06-01

Recent reports suggest that an abbreviated bed rest protocol (ABRP) may safely reduce length of stay (LOS) and resource utilization in pediatric blunt spleen and liver injury (BSLI) patients. This study evaluates national temporal trends in BLSI management and estimates national reduction in LOS using an ABRP. Pediatric patients (<18 years old) sustaining BLSI were identified in the Kids' Inpatient Database from 2000 to 2009. Yearly rates of injury and operative intervention were examined and stratified by type of injury. APSA guidelines and the reported ABRP were applied based on abbreviated injury score (AIS) and compared with actual LOS. 22,153 patients were identified. Over the study period, operative rates for spleen and liver injuries and overall mortality significantly declined: LOS=3.1 days (±1.6) and 2.7 days (±1.9) for spleen and liver, respectively. If APSA guidelines were followed, the rates were LOS=3.7 days (±1.1) and 3.4 days (±0.7), respectively. Application of the ABRP would result in LOS=1.3 days (±0.5) for all BSLI patients. An ABRP could potentially save 1.7 hospital days/patient or 36,964 patient hospital days nationally. Our study confirms a significant national decrease in operative intervention and overall mortality in patients with BSLI. Additionally, it appears that a shorter observation period than the APSA guidelines is being utilized. The implementation of ABRP holds potential in further reducing LOS and resource utilization. Copyright © 2014 Elsevier Inc. All rights reserved.

Biological Assessment of the Continued Operation of Los Alamos National Laboratory on Federally Listed Threatened and Endangered Species

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

Hansen, Leslie A.

2006-09-19

This biological assessment considers the effects of continuing to operate Los Alamos National Laboratory on Federally listed threatened or endangered species, based on current and future operations identified in the 2006 Site-wide Environmental Impact Statement for the Continued Operation of Los Alamos National Laboratory (SWEIS; DOE In Prep.). We reviewed 40 projects analyzed in the SWEIS as well as two aspects on ongoing operations to determine if these actions had the potential to affect Federally listed species. Eighteen projects that had not already received U.S. Fish and Wildlife Service (USFWS) consultation and concurrence, as well as the two aspects ofmore » ongoing operations, ecological risk from legacy contaminants and the Outfall Reduction Project, were determined to have the potential to affect threatened or endangered species. Cumulative impacts were also analyzed.« less

In California, 5 decades of decreasing emissions

NASA Astrophysics Data System (ADS)

Bhattacharya, Atreyee

2012-10-01

Volatile organic compounds (VOCs), which are emitted by vehicles and are a leading source of air pollution, have been on the decline in Los Angeles, Calif., one of the densest and most poorly ventilated cities in the United States, a new study finds. Comparing detailed measurements from two aircraft campaigns in the Los Angeles basin in 2002 and 2010, Warneke et al. found that the VOC concentrations in the region's atmosphere declined significantly during those 8 years. Using data from literature statistics and a monitoring network, the authors further show that in the Los Angeles basin, concentrations of VOCs and carbon monoxide (CO) have declined by 2 orders of magnitude compared to the 1960s—a reduction of 7.5% every year since the 1960s in spite of the fact that the sale of fuels has increased threefold during the same interval of time.

Statistical analysis to assess automated level of suspicion scoring methods in breast ultrasound

NASA Astrophysics Data System (ADS)

Galperin, Michael

2003-05-01

A well-defined rule-based system has been developed for scoring 0-5 the Level of Suspicion (LOS) based on qualitative lexicon describing the ultrasound appearance of breast lesion. The purposes of the research are to asses and select one of the automated LOS scoring quantitative methods developed during preliminary studies in benign biopsies reduction. The study has used Computer Aided Imaging System (CAIS) to improve the uniformity and accuracy of applying the LOS scheme by automatically detecting, analyzing and comparing breast masses. The overall goal is to reduce biopsies on the masses with lower levels of suspicion, rather that increasing the accuracy of diagnosis of cancers (will require biopsy anyway). On complex cysts and fibroadenoma cases experienced radiologists were up to 50% less certain in true negatives than CAIS. Full correlation analysis was applied to determine which of the proposed LOS quantification methods serves CAIS accuracy the best. This paper presents current results of applying statistical analysis for automated LOS scoring quantification for breast masses with known biopsy results. It was found that First Order Ranking method yielded most the accurate results. The CAIS system (Image Companion, Data Companion software) is developed by Almen Laboratories and was used to achieve the results.

Study on rejection characteristic of current loop to the base disturbance of optical communication system

NASA Astrophysics Data System (ADS)

Mao, Yao; Deng, Chao; Liu, Qiong; Cao, Zheng

2016-10-01

As laser has narrow transmitting beam and small divergence angle, the LOS (Line of Sight) stabilization of optical communication system is a primary precondition of laser communication links. Compound axis control is usually adopted in LOS stabilization of optical communication system, in which coarse tracking and fine tracking are included. Rejection against high frequency disturbance mainly depends on fine tracking LOS stabilization platform. Limited by different factors such as mechanical characteristic of the stabilization platform and bandwidth/noise of the sensor, the control bandwidth of LOS stabilization platform is restricted so that effective rejection of high frequency disturbance cannot be achieved as it mainly depends on the isolation characteristic of the platform itself. It is proposed by this paper that current loop may reject the effect of back-EMF. By adopting the method of electric control, high frequency isolation characteristic of the platform can be improved. The improvement effect is similar to increasing passive vibration reduction devices. Adopting the double closed loop control structure of velocity and current with the combining of the rejection effect of back-EMF caused by current loop is equivalent to reducing back-EMF coefficient, which can enhance the isolation ability of the LOS stabilization platform to high frequency disturbance.

Recovering Radioactive Materials with ORSP Team

ScienceCinema

LANL

2017-12-09

The National Nuclear Security Administration sponsors a program, executed by Los Alamos National Laboratory, to recover radioisotopes used by industry and academia and no longer needed. Called the "Offsite Source Recovery Program (OSRP), it has recovered more than 16,000 orphan sources as of 2008.

CLSA's Effort To Walk the Talk for Beginning Administrators.

ERIC Educational Resources Information Center

Kim, Lori

1996-01-01

In fall 1994, California State University, Los Angeles, initiated a pilot program reflecting the California Commission on Teacher Credentialing's new standards for administrator preparation and professional development. The program stresses five areas: organizational and cultural environment, strategic issues management, ethical and reflective…

[Teacher Preparation Program.

ERIC Educational Resources Information Center

Immaculate Heart Coll., Los Angeles, CA.

Immaculate Heart College, Los Angeles, California developed a self-initiated and self-directed curriculum in the Teacher Preparation Program. The curriculum was based on a spiral planning model. Emphasis was placed on continuous evaluation, exploration of the learning experience, development of experimental teacher training experiences in the…

Interactive radio: distance education in the classroom.

PubMed

1988-01-01

The Honduran Association for Socioeconomic Growth and Development (AVANCE) in conjunction with the U.S. Agency for International Development's Radio Learning Project has developed and promoted programs for radio that encourage interactive learning in Latin America. The Second Interamerican Conference on Interactive Radio was recently held in Tela, Honduras where educators and participants came to attend workshops on scriptwriting, instructional design, community support and other related topics. The participants had the opportunity to study the second generation of interactive radio. Beginning in 1973, Nicaragua began an interactive radio program written for early grade mathematics students. Currently, Honduras is marketing a mathematics program entitled, La Familia de los Numeros," or the Family of Numbers to other countries. In Bolivia, an organization called, "Fe y Alegria," or Faith and Happiness is broadcasting educational programs through the use of interactive radio. In Ecuador, testing has begun to study the viability of interactive radio for their educational system, and in Costa Rica, replication of Honduras' "Familia de los Numeros" has begun. Teachers have noted an improved grasp of subject matter and better attentiveness through the use of interactive radio programs. The programs present 30 minutes of mathematics information and 30 minutes of language information. For each grade, 170 programs have been developed.

Cost-effectiveness of 'Program We Care' for patients with chronic obstructive pulmonary disease: A case-control study.

PubMed

Wong, Eliza Mi Ling; Lo, Shuk Man; Ng, Ying Chu; Lee, Larry Lap Yip; Yuen, T M Y; Chan, Jimmy Tak Shing; Chair, Sek Ying

2016-07-01

To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department. Copyright © 2015 Elsevier Ltd. All rights reserved.

26-Hours at Cal Poly: A Recruitment Strategy Targeting Underrepresented Groups.

ERIC Educational Resources Information Center

Flores, Bob; Kellogg, Bill

The Agriculture Education Department at California Polytechnic State University conducted a program to recruit Black and Hispanic students for the school's agriculture programs during spring 1988 and twice since then. High school sophomores and juniors in Los Angeles were invited to Cal Poly for a 26-hour program of workshops designed to include a…

Los Angeles County Juvenile Justice Crime Prevention Act. RAND Quarterly Report, October 2008. TR-621-LACPD

ERIC Educational Resources Information Center

Fain, Terry; Turner, Susan; Ridgeway, Greg

2008-01-01

In July 2008, RAND Corporation staff conducted Correctional Program Checklist (CPC) assessments of five home-based programs (Asian Youth Center, Communities in Schools, Inter-Agency Drug Abuse Recovery Programs, Soledad Enrichment Action, and Stars Behavioral Health Group) as part of its ongoing evaluation of Juvenile Justice Crime Prevention Act…

The Student Counseling Program: Criticism and Analysis.

ERIC Educational Resources Information Center

Dyste, Ron

In the spring of 1968, Los Angeles City College inaugurated a program designed to test the efficacy of peer counseling for students from low income families of minority ethnic background. The first 11 months of the program's operation are reviewed in this paper which is written by one of the original 29 students hired as counseling assistants.…

Evaluation of the Advanced Subsonic Technology Program Noise Reduction Benefits

NASA Technical Reports Server (NTRS)

Golub, Robert A.; Rawls, John W., Jr.; Russell, James W.

2005-01-01

This report presents a detailed evaluation of the aircraft noise reduction technology concepts developed during the course of the NASA/FAA Advanced Subsonic Technology (AST) Noise Reduction Program. In 1992, NASA and the FAA initiated a cosponsored, multi-year program with the U.S. aircraft industry focused on achieving significant advances in aircraft noise reduction. The program achieved success through a systematic development and validation of noise reduction technology. Using the NASA Aircraft Noise Prediction Program, the noise reduction benefit of the technologies that reached a NASA technology readiness level of 5 or 6 were applied to each of four classes of aircraft which included a large four engine aircraft, a large twin engine aircraft, a small twin engine aircraft and a business jet. Total aircraft noise reductions resulting from the implementation of the appropriate technologies for each class of aircraft are presented and compared to the AST program goals.

Regulation and Function of Cytokines that Predict Prostate Cancer Metastasis

DTIC Science & Technology

2011-08-01

Ph.D. Cedar-Sinai Medical Center Los Angeles, CA 90048 W81XWH-09-1-0503 11 bhowmickn@cshs.org Table of Contents Introduction...Professor, Medicine Uro -Oncology Research Program Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center 8750 Beverly Blvd...Atrium 103 Los Angeles, CA 90048 Tel: (310) 423-5992 Fax: (310) 423-8543 Email: bhowmickn@cshs.org Please note the grant has been transferred

A Novel Anti-Beta2-Microglobulin Antibody Inhibition of Androgen Receptor Expression, Survival, and Progression in Prostate Cancer Cells

DTIC Science & Technology

2011-05-01

Chung, Uro -Oncology Research Program, Department ofMedicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA... Los Angeles, CA 90048 REPORT DATE: May 2011 TYPE OF REPORT: Annual...1973;12(24):4811-22. 5. Pedersen LO , Hansen AS, Olsen AC, Gerwien J, Nissen MH, Buus S. The interaction between beta 2- microglobulin (beta 2m) and

A Parent's Guide to Infant/Toddler Programs = Guia para los padres sobre los programas de cuidado infantil de 0-3 anos.

ERIC Educational Resources Information Center

Dodge, Diane Trister; Dombro, Amy Laura; Colker, Laura J.

Information on how warm and responsive care can help shape infants' and toddlers' development and their ability to learn can be reassuring for concerned parents. This guide, in English and Spanish versions, presents quality child care as a partnership between the child caregiver and the parents with the primary goal of benefiting the child. The…

Showing Off What We Do and How Well We Do It: Or How the Child Development Center Program at Nine Los Angeles Community Colleges Demonstrates Accountability.

ERIC Educational Resources Information Center

Crummer, Karen; And Others

Based on on-site review team visits conducted during spring 1982, this report evaluates the Educational Campus Child Development Centers (CCDC's) operating at 9 to the 10 campuses in the Los Angeles Community College District (LACCD). After introducing the evaluation project and its participants, the report outlines the educational philosophy of…

Pulsed Discharge in Aerosol for Waste Water Clean-up.

NASA Astrophysics Data System (ADS)

Bystritskii, V. M.; Gonzales, A.; Olson, T.; Puchkarev, V.; Rosocha, L.; Wessel, F.; Yankelevich, Y.

1996-11-01

Aerosol (drop diameter of 10-100 μm) is injected into a discharge reactor with a repetitively pulsed voltage of 40--60 kV, 50--150 ns, 10^2--10^3 Hz. The relatively large water dielectric constant and high degree of atomization result in efficient degradation of organic molecules. Results on the characterization of operational parameters of the device and on degradation performance for a variety of organic pollutants (paranitrophenol, di-Chlorophenol, per-chloro-ethylene) are discussed. Work was supported by the Los Alamos National Laboratories 96 LACOR Program. ^AUniversity of Southern California, Los Angeles, CA 94007 ^BLos Alamos National Laboratory, Los Alamos, NM 87545

Investigation of SSME alternate high pressure fuel turbopump lift-off seal fluid and structural dynamic interaction

NASA Technical Reports Server (NTRS)

Elrod, David A.

1989-01-01

The Space Shuttle main engine (SSME) alternate turbopump development program (ATD) high pressure fuel turbopump (HPFTP) design utilizes an innovative lift-off seal (LOS) design that is located in close proximity to the turbine end bearing. Cooling flow exiting the bearing passes through the lift-off seal during steady state operation. The potential for fluid excitation of lift-off seal structural resonances is investigated. No fluid excitation of LOS resonances is predicted. However, if predicted LOS natural frequencies are significantly lowered by the presence of the coolant, pressure oscillations caused by synchronous whirl of the HPFTP rotor may excite a resonance.

Vertical Transport of Aerosol Particles across Mountain Topography near the Los Angeles Basin

NASA Astrophysics Data System (ADS)

Murray, J. J.; Schill, S.; Freeman, S.; Bertram, T. H.; Lefer, B. L.

2015-12-01

Transport of aerosol particles is known to affect air quality and is largely dependent on the characteristic topography of the surrounding region. To characterize this transport, aerosol number distributions were collected with an Ultra-High Sensitivity Aerosol Spectrometer (UHSAS, DMT) during the 2015 NASA Student Airborne Research Program (SARP) in and around the Los Angeles Basin in Southern California. Increases in particle number concentration and size were observed over mountainous terrain north of Los Angeles County. Chemical analysis and meteorological lagrangian trajectories suggest orographic lifting processes, known as the "chimney effect". Implications for spatial transport and distribution will be discussed.

The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul

PubMed Central

Kim, Jungah; Shon, Changwoo

2018-01-01

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care. PMID:29673147

Intermittent losartan administration triggers cardiac post-conditioning in isolated rat hearts: role of BK2 receptors.

PubMed

Sgarra, Luca; Leo, Valentina; Addabbo, Francesco; Iacobazzi, Dominga; Carratù, Maria Rosaria; Montagnani, Monica; Potenza, Maria Assunta

2014-01-01

The angiotensin (Ang) and bradykinin (BK) tissue-system plays a pivotal role in post-conditioning, but the efficacy of angiotensin type 1 receptor (AT1R) blockers (ARBs) in post-ischemic strategies is still under investigation. We evaluated functional and morphological outcomes, together with activation of cytosolic RISK pathway kinases, in rat hearts subjected to losartan (LOS) or irbesartan (IRB) post-ischemic administration. Isolated rat hearts underwent 30 min ischemia and 120 min reperfusion. Post-conditioning was obtained by intermittent (10 s/each) or continuous drug infusion during the first 3 min of reperfusion. Left ventricular end-diastolic pressure (LVEDP), left ventricular developed pressure (dLVP), coronary flow (CF), and left ventricular infarct mass (IM) were measured together with the activation status of RISK kinases Akt, p42/44 MAPK and GSK3β. When compared to hearts subjected to ischemia/reperfusion (iI/R) alone, continuous IRB or LOS administration did not significantly reduce total infarct mass (cIRB or cLOS vs. iI/R, p = 0.2). Similarly, intermittent IRB (iIRB) was not able to enhance cardioprotection. Conversely, intermittent LOS administration (iLOS) significantly ameliorated cardiac recovery (iLOS vs iI/R, p<0.01). Differences between iLOS and iIRB persisted under continuous blockade of AT2R (iLOS+cPD vs. iIRB+cPD, p<0.05). Interestingly, iLOS cardioprotection was lost when BK2R was simultaneously blocked (iLOS+cHOE vs. iI/R, p = 0.6), whereas concurrent administration of iBK and iIRB replicated iLOS effects (iIRB+iBK vs. iLOS, p = 0.7). At the molecular level, iIRB treatment did not significantly activate RISK kinases, whereas both iLOS and iBK treatments were associated with activation of the Akt/GSK3β branch of the RISK pathways (p<0.05 vs. iI/R, for both). Our results suggest that intermittent losartan is effective in mediating post-conditioning cardioprotection, whereas irbesartan is not. The infarct mass reduction by intermittent losartan seem mainly related on its specific ability to modulate BK2R, and only modestly associated on AT1R blocking properties.

Intermittent Losartan Administration Triggers Cardiac Post-Conditioning in Isolated Rat Hearts: Role of BK2 Receptors

PubMed Central

Sgarra, Luca; Leo, Valentina; Addabbo, Francesco; Iacobazzi, Dominga; Carratù, Maria Rosaria; Montagnani, Monica; Potenza, Maria Assunta

2014-01-01

Introduction The angiotensin (Ang) and bradykinin (BK) tissue-system plays a pivotal role in post-conditioning, but the efficacy of angiotensin type 1 receptor (AT1R) blockers (ARBs) in post-ischemic strategies is still under investigation. We evaluated functional and morphological outcomes, together with activation of cytosolic RISK pathway kinases, in rat hearts subjected to losartan (LOS) or irbesartan (IRB) post-ischemic administration. Methods Isolated rat hearts underwent 30 min ischemia and 120 min reperfusion. Post-conditioning was obtained by intermittent (10 s/each) or continuous drug infusion during the first 3 min of reperfusion. Left ventricular end-diastolic pressure (LVEDP), left ventricular developed pressure (dLVP), coronary flow (CF), and left ventricular infarct mass (IM) were measured together with the activation status of RISK kinases Akt, p42/44 MAPK and GSK3β. Results When compared to hearts subjected to ischemia/reperfusion (iI/R) alone, continuous IRB or LOS administration did not significantly reduce total infarct mass (cIRB or cLOS vs. iI/R, p = 0.2). Similarly, intermittent IRB (iIRB) was not able to enhance cardioprotection. Conversely, intermittent LOS administration (iLOS) significantly ameliorated cardiac recovery (iLOS vs iI/R, p<0.01). Differences between iLOS and iIRB persisted under continuous blockade of AT2R (iLOS+cPD vs. iIRB+cPD, p<0.05). Interestingly, iLOS cardioprotection was lost when BK2R was simultaneously blocked (iLOS+cHOE vs. iI/R, p = 0.6), whereas concurrent administration of iBK and iIRB replicated iLOS effects (iIRB+iBK vs. iLOS, p = 0.7). At the molecular level, iIRB treatment did not significantly activate RISK kinases, whereas both iLOS and iBK treatments were associated with activation of the Akt/GSK3β branch of the RISK pathways (p<0.05 vs. iI/R, for both). Conclusions Our results suggest that intermittent losartan is effective in mediating post-conditioning cardioprotection, whereas irbesartan is not. The infarct mass reduction by intermittent losartan seem mainly related on its specific ability to modulate BK2R, and only modestly associated on AT1R blocking properties. PMID:24520397

Studies on the Composition of the Solids in the Fumes Released in the Calciometric Process for Uranium Production; ESTUDIOS SOBRE LA COMPOSICION DE LOS SOLIDOS EN LOS HUMOS DESPRENDIDOS EN EL PROCESO CALCIOTERMICO DE OBTENCION DE URANIO

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

Travesi, A.; de la Cruz, F.; Cellini, R.F.

1958-01-01

In the dust produced during the thermal reduction of uranium tetrafluoride with calcium, the existence of a beta activity which decays with time was confirmed. The activity was assigned to Th/sup 234/. An enrichment in Th/sup 234/ of approximately 68% over the equilibrium value was found in the dust. An anomalous enrichment in the dust was found for the trace elements Zn, Sn, Pb, and Cu. No enrichment was detected for Fe and Ni. (tr-auth)

Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

PubMed

Silberman, Jordan; Schwartz, Steven; Giuseffi, Danielle L; Wang, Chun; Nevedal, Dana; Bedrosian, Richard

2011-12-01

To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

Evaluation of emission control strategies for airfield operations at the Los Angeles and San Francisco International Airports. Final report

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

Gelinas, C.G.

1978-08-01

This report reviews potential air pollutant emission reductions which could be achieved by various strategies to control airfield operations at Los Angeles and San Francisco International Airports, and examines safety problems, cost impacts, potential fuel savings, time frame for strategy implementation, and potential regulatory and jurisdictional conflicts associated with each strategy. Airfield emission sources studied included aircraft operation in the idle, taxi, takeoff, and landing modes; ground service vehicles; fuel handling and storage; and aircraft engine maintenance. Nineteen potential strategies were identified, and seven strategies were selected for detailed analysis and examination after a preliminary evaluation. Two strategies, aircraft towingmore » and reducing the number of operating engines on the ground, appear to provide the most significant emission reduction. Both of these strategies offer potential reductions in the range of 20 to 40 percent of the carbon monoxide and nitrogen oxides which are currently emitted by ground operations. The aircraft towing strategy also offers a comparable improvement in suspended particulate matter emissions. When the overall feasibility of each strategy is evaluated, the strategy to reduce the number of operating engines appears to be the most viable since its implementation would result in fuel savings, no apparent safety problems, and it can be implemented immediately.« less

76 FR 70408 - Information Collection; Understanding Value Trade-Offs Regarding Fire Hazard Reduction Programs...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... Regarding Fire Hazard Reduction Programs in the Wildland-Urban Interface AGENCY: Forest Service, USDA... Regarding Fire Hazard Reduction Programs in the Wildland-Urban Interface. DATES: Comments must be received... holidays. SUPPLEMENTARY INFORMATION: Title: Understanding Value Trade-offs Regarding Fire Hazard Reduction...

Improving performances of the knee replacement surgery process by applying DMAIC principles.

PubMed

Improta, Giovanni; Balato, Giovanni; Romano, Maria; Ponsiglione, Alfonso Maria; Raiola, Eliana; Russo, Mario Alessandro; Cuccaro, Patrizia; Santillo, Liberatina Carmela; Cesarelli, Mario

2017-12-01

The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve quality and reduce costs related to the prosthetic knee replacement surgery by decreasing patients' length of hospital stay (LOS) METHODS: The DMAIC cycle has been adopted to decrease the patients' LOS. The University Hospital "Federico II" of Naples, one of the most important university hospitals in Southern Italy, participated in this study. Data on 148 patients who underwent prosthetic knee replacement between 2010 and 2013 were used. Process mapping, statistical measures, brainstorming activities, and comparative analysis were performed to identify factors influencing LOS and improvement strategies. The study allowed the identification of variables influencing the prolongation of the LOS and the implementation of corrective actions to improve the process of care. The adopted actions reduced the LOS by 42%, from a mean value of 14.2 to 8.3 days (standard deviation also decreased from 5.2 to 2.3 days). The DMAIC approach has proven to be a helpful strategy ensuring a significant decreasing of the LOS. Furthermore, through its implementation, a significant reduction of the average costs of hospital stay can be achieved. Such a versatile approach could be applied to improve a wide range of health care processes. © 2017 John Wiley & Sons, Ltd.

Comprehensive Truck Size and Weight (TS&W) Study. Phase 1-synthesis, working paper 10 : enforcement and truck size and weight regulations

DOT National Transportation Integrated Search

2012-04-01

This report presents the Content Analysis Test Plan for the national evaluation of the Los Angeles County Congestion Reduction Demonstration (CRD) under the United States Department of Transportation (U.S. DOT) Urban Partnership Agreement (UPA) Progr...

Restaurant owners' perspectives on a voluntary program to recognize restaurants for offering reduced-size portions, Los Angeles County, 2012.

PubMed

Gase, Lauren; Dunning, Lauren; Kuo, Tony; Simon, Paul; Fielding, Jonathan E

2014-03-20

Reducing the portion size of food and beverages served at restaurants has emerged as a strategy for addressing the obesity epidemic; however, barriers and facilitators to achieving this goal are not well characterized. In fall 2012, the Los Angeles County Department of Public Health conducted semistructured interviews with restaurant owners to better understand contextual factors that may impede or facilitate participation in a voluntary program to recognize restaurants for offering reduced-size portions. Interviews were completed with 18 restaurant owners (representing nearly 350 restaurants). Analyses of qualitative data revealed 6 themes related to portion size: 1) perceived customer demand is central to menu planning; 2) multiple portion sizes are already being offered for at least some food items; 3) numerous logistical barriers exist for offering reduced-size portions; 4) restaurant owners have concerns about potential revenue losses from offering reduced-size portions; 5) healthful eating is the responsibility of the customer; and 6) a few owners want to be socially responsible industry leaders. A program to recognize restaurants for offering reduced-size portions may be a feasible approach in Los Angeles County. These findings may have applications for jurisdictions interested in engaging restaurants as partners in reducing the obesity epidemic.

Restaurant Owners’ Perspectives on a Voluntary Program to Recognize Restaurants for Offering Reduced-Size Portions, Los Angeles County, 2012

PubMed Central

Dunning, Lauren; Kuo, Tony; Simon, Paul; Fielding, Jonathan E.

2014-01-01

Introduction Reducing the portion size of food and beverages served at restaurants has emerged as a strategy for addressing the obesity epidemic; however, barriers and facilitators to achieving this goal are not well characterized. Methods In fall 2012, the Los Angeles County Department of Public Health conducted semistructured interviews with restaurant owners to better understand contextual factors that may impede or facilitate participation in a voluntary program to recognize restaurants for offering reduced-size portions. Results Interviews were completed with 18 restaurant owners (representing nearly 350 restaurants). Analyses of qualitative data revealed 6 themes related to portion size: 1) perceived customer demand is central to menu planning; 2) multiple portion sizes are already being offered for at least some food items; 3) numerous logistical barriers exist for offering reduced-size portions; 4) restaurant owners have concerns about potential revenue losses from offering reduced-size portions; 5) healthful eating is the responsibility of the customer; and 6) a few owners want to be socially responsible industry leaders. Conclusion A program to recognize restaurants for offering reduced-size portions may be a feasible approach in Los Angeles County. These findings may have applications for jurisdictions interested in engaging restaurants as partners in reducing the obesity epidemic. PMID:24650622

High-Speed Jet Noise Reduction NASA Perspective

NASA Technical Reports Server (NTRS)

Huff, Dennis L.; Handy, J. (Technical Monitor)

2001-01-01

History shows that the problem of high-speed jet noise reduction is difficult to solve. the good news is that high performance military aircraft noise is dominated by a single source called 'jet noise' (commercial aircraft have several sources). The bad news is that this source has been the subject of research for the past 50 years and progress has been incremental. Major jet noise reduction has been achieved through changing the cycle of the engine to reduce the jet exit velocity. Smaller reductions have been achieved using suppression devices like mixing enhancement and acoustic liners. Significant jet noise reduction without any performance loss is probably not possible! Recent NASA Noise Reduction Research Programs include the High Speed Research Program, Advanced Subsonic Technology Noise Reduction Program, Aerospace Propulsion and Power Program - Fundamental Noise, and Quiet Aircraft Technology Program.

Economic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes.

PubMed

O'Sullivan, Ronan; Murphy, Aileen; O'Caoimh, Rónán; Cornally, Nicola; Svendrovski, Anton; Daly, Brian; Fizgerald, Carol; Twomey, Cillian; McGlade, Ciara; Molloy, D William

2016-04-26

Although advance care planning (ACP) and the use of advanced care directives (ACD) and end-of-life care plans are associated with a reduction in inappropriate hospitalisation, there is little evidence supporting the economic benefits of such programmes. We assessed the economic impact (gross savings) of the Let Me Decide (LMD) ACP programme in Ireland, specifically the impact on hospitalisations, bed days and location of resident deaths, before and after systematic implementation of the LMD-ACP combined with a palliative care education programme. The LMD-ACP was introduced into three long-term care (LTC) facilities in Southern Ireland and outcomes were compared pre and post implementation. In addition, 90 staff were trained in a palliative care educational programme. Economic analysis including probabilistic sensitivity analysis was performed. The uptake of an ACD or end-of-life care post-implementation rose from 25 to 76%. Post implementation, there were statistically significant decreases in hospitalisation rates from baseline (hospitalisation incidents declined from 27.8 to 14.6%, z = 3.96, p < 0.001; inpatient hospital days reduced from 0.54 to 0.36%, z = 8.85, p < 0.001). The percentage of hospital deaths also decreased from 22.9 to 8.4%, z = 3.22, p = 0.001. However, length of stay (LOS) increased marginally (7-9 days). Economic analysis suggested a cost-reduction related to reduced hospitalisations ranging between €10 and €17.8 million/annum and reduction in ambulance transfers, estimated at €0.4 million/annum if these results were extrapolated nationally. When unit costs and LOS estimates were varied in scenario analyses, the expected cost reduction owing to reduced hospitalisations, ranged from €17.7 to €42.4 million nationally. Implementation of the LMD-ACP (ACD/end-of-life care plans combined with palliative care education) programme resulted in reduced rates of hospitalisation. Despite an increase in LOS, likely reflecting more complex care needs of admitted residents, gross costs were reduced and scenario analysis projected large annual savings if these results were extrapolated to the wider LTC population in Ireland.

Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All-Referral Neonatal Intensive Care Unit.

PubMed

Jadcherla, Sudarshan R; Dail, James; Malkar, Manish B; McClead, Richard; Kelleher, Kelly; Nelin, Leif

2016-07-01

We hypothesized that the implementation of a feeding quality improvement (QI) program among premature neonates accelerates feeding milestones, safely lowering hospital length of stay (LOS) compared with the baseline period. Baseline data were collected for 15 months (N = 92) prior to initiating the program, which involved development and implementation of a standardized feeding strategy in eligible premature neonates. Process optimization, implementation of feeding strategy, monitoring compliance, multidisciplinary feeding rounds, and continuous education strategies were employed. The main outcomes included the ability and duration to reach enteral feeds-120 (mL/kg/d), oral feeds-120 (mL/kg/d), and ad lib oral feeding. Balancing measures included growth velocities, comorbidities, and LOS. Comparing baseline versus feeding program (N = 92) groups, respectively, the feeding program improved the number of infants receiving trophic feeds (34% vs 80%, P < .002), trophic feeding duration (14.8 ± 10.3 days vs 7.6 ± 8.1 days, P < .0001), time to enteral feeds-120 (16.3 ± 15.4 days vs 11.4 ± 10.4 days, P < .04), time from oral feeding onset to oral feeds-120 (13.2 ± 16.7 days vs 19.5 ± 15.3 days, P < .0001), time from oral feeds-120 to ad lib feeds at discharge (22.4 ± 27.2 days vs 18.6 ± 21.3 days, P < .01), weight velocity (24 ± 6 g/d vs 27 ± 11 g/d, P < .03), and LOS (104.2 ± 51.8 vs 89.3 ± 46.0, P = .02). Mortality, readmissions within 30 days, and comorbidities were similar. Process optimization and the implementation of a standardized feeding strategy minimize practice variability, accelerating the attainment of enteral and oral feeding milestones and decreasing LOS without increasing adverse morbidities. © 2015 American Society for Parenteral and Enteral Nutrition.

LANL: Weapons Infrastructure Briefing to Naval Reactors, July 18, 2017

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

Chadwick, Frances

Presentation slides address: The Laboratory infrastructure supports hundreds of high hazard, complex operations daily; LANL’s unique science and engineering infrastructure is critical to delivering on our mission; LANL FY17 Budget & Workforce; Direct-Funded Infrastructure Accounts; LANL Org Chart; Weapons Infrastructure Program Office; The Laboratory’s infrastructure relies on both Direct and Indirect funding; NA-50’s Operating, Maintenance & Recapitalization funding is critical to the execution of the mission; Los Alamos is currently executing several concurrent Line Item projects; Maintenance @ LANL; NA-50 is helping us to address D&D needs; We are executing a CHAMP Pilot Project at LANL; G2 = Main Toolmore » for Program Management; MDI: Future Investments are centered on facilities with a high Mission Dependency Index; Los Alamos hosted first “Deep Dive” in November 2016; Safety, Infrastructure & Operations is one of the most important programs at LANL, and is foundational for our mission success.« less

A Plan for Development of an Educational Telephone Network (ETN) to Extend Access to Educational Programs.

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA. Div. of Educational Planning and Development.

The outreach development process described in this document is designed to provide a model for planning and implementing a program to extend access to educational opportunity for members of the community served by the Los Angeles Community College District. There are four steps required to initiate such a program: (1) Identification--each college…

Guia Legal para Ciudadanos Envejeciente: Leyes y Programas Afectando los Ciudadanos Envejeciente de Kansas. (Legal Guide for Senior Citizens: Laws and Programs Affecting Kansas Senior Citizens).

ERIC Educational Resources Information Center

Hollinger, Judith A.

This booklet, translated into Spanish, is intended to inform (not advise) older Kansans about eligibility requirements and benefits provided by state and federal programs. Financial assistance programs discussed are Social Security, railroad retirements, veterans' benefits, unrestricted general assistance, Employee Retirement Income Security Act,…

Three Independent Evaluations of Healthy Kids Programs Find Substantial Gains in Children's Dental Health Care. In Brief, September 2008, Number 2

ERIC Educational Resources Information Center

Hughes, Dana; Howell, Embry; Trenholm, Christopher; Hill, Ian; Dubay, Lisa

2008-01-01

This brief presents highlights from rigorous, independent evaluations of the Healthy Kids programs in three California counties: Los Angeles, San Mateo, and Santa Clara. Launched by Children's Health Initiatives (CHIs) in these counties between 2001 and 2003, the three Healthy Kids programs provide children with comprehensive health insurance…

Community Involvement in Career Education: A Metropolitan Area Example.

ERIC Educational Resources Information Center

Barlow, Melvin L.

This is a survey of some of the career education programs existing in the Los Angeles area which are collaborative efforts among the agencies of labor, business, industry, and education. The majority of the programs are for grades 10-12. Included are one or more page descriptions of programs developed at UCLA such as the "Kingdom of Could Be…

Free-space laser communication technologies II; Proceedings of the Meeting, Los Angeles, CA, Jan. 15-17, 1990

NASA Technical Reports Server (NTRS)

Begley, David L. (Editor); Seery, Bernard D. (Editor)

1990-01-01

Various papers on free-space laser communication technologies are presented. Individual topics addressed include: optical intersatellite link experiment between the earth station and ETS-VI, the Goddard optical communications program, technologies and techniques for lasercom terminal size, weight, and cost reduction, laser beam acquisition and tracking system for ETS-VI laser communication equipment, analog dividers for acquisition and tracking signal normalization, fine pointing mechanism using multilayered piezoelectric actuator for optical ISL system, analysis of SILEX tracking sensor performance, new telescope concept for space communication, telescope considered as a very high gain antenna, design of compact transceiver optical systems for optical intersatellite links, ultralightweight optics for laser communications, highly sensitive measurement method for stray light and retroreflected light, depolarization effects on free space laser transceiver communication systems, in-orbit measurements of microaccelerations of ESA's communication satellite Olympus, high-performance laser diode transmitter for optical free space communication, diode-pumped Nd:host laser transmitter for intersatellite optical communications, single-frequency diode-pumped laser for free-space communication.

At-risk elementary school children with one year of classroom music instruction are better at keeping a beat.

PubMed

Slater, Jessica; Tierney, Adam; Kraus, Nina

2013-01-01

Temporal processing underlies both music and language skills. There is increasing evidence that rhythm abilities track with reading performance and that language disorders such as dyslexia are associated with poor rhythm abilities. However, little is known about how basic time-keeping skills can be shaped by musical training, particularly during critical literacy development years. This study was carried out in collaboration with Harmony Project, a non-profit organization providing free music education to children in the gang reduction zones of Los Angeles. Our findings reveal that elementary school children with just one year of classroom music instruction perform more accurately in a basic finger-tapping task than their untrained peers, providing important evidence that fundamental time-keeping skills may be strengthened by short-term music training. This sets the stage for further examination of how music programs may be used to support the development of basic skills underlying learning and literacy, particularly in at-risk populations which may benefit the most.

Air Traffic Sector Configuration Change Frequency

NASA Technical Reports Server (NTRS)

Chatterji, Gano B.; Drew, Michael

2010-01-01

A Mixed Integer Linear Programming method is used for creating sectors in Fort Worth, Cleveland, and Los Angeles centers based on several days of good-weather traffic data. The performance of these sectors is studied when they are subjected to traffic data from different days. Additionally, the advantage of using different sector designs at different times of day with varying traffic loads is examined. Specifically, traffic data from 10 days are used for design, and 47 other days are played back to test if the traffic-counts stay below the design values used in creating the partitions. The primary findings of this study are as follows. Sectors created with traffic from good-weather days can be used on other good-weather days. Sector configurations created with two hours of traffic can be used for 6 to 12 hours without exceeding the peak-count requirement. Compared to using a single configuration for the entire day, most of the sector-hour reduction is achieved by using two sector configurations -one during daytime hours and one during nighttime hours.

Targeting Neuropilin-1 in Prostate Cancer Bone Metastasis

DTIC Science & Technology

2011-04-01

USA; Dr. Leland W. K. Chung (Email: Leland.Chung@cshs.org), Uro -Oncology Research Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA...Association for Cancer Research Annual Meeting, Los Angeles, CA, 2007. 25 Zhang S, Zhau HE, Iqbal S, Chung LWK, Wu D. Vascular endothelial growth...15. Pedersen LO , Hansen AS, Olsen AC, et al. The interaction between h2-microglobulin (h2m) and puri- fied class-I major histocompatibility (MHC

Where Are the Young Men in HIV Prevention Efforts? Comments on HIV Prevention Programs and Research from Young Men Who Sex with Men in Los Angeles County

ERIC Educational Resources Information Center

Holloway, Ian W.; Cederbaum, Julie A.; Ajayi, Antonette; Shoptaw, Steven

2012-01-01

Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N = 100, M[subscript age] = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to…

Impact of care coaching on hospital length of stay, readmission rates, postdischarge phone calls, and patient satisfaction after bariatric surgery.

PubMed

Jalilvand, Anahita; Suzo, Andrew; Hornor, Melissa; Layton, Kristina; Abdel-Rasoul, Mahmoud; Macadam, Luke; Mikami, Dean; Needleman, Bradley; Noria, Sabrena

2016-11-01

Bariatric surgery is well established as an effective means of treating obesity; however, 30-day readmission rates remain high. The Bariatric Care Coaching Program was developed in response to a perceived need for better communication with patients upon discharge from hospital and prior to being seen at their first postoperative visit. The lack of communication was apparent from the number of patient phone calls to clinic and readmissions to hospital. The aim of this study was to evaluate the impact of the care coaching program on hospital length of stay (LOS), readmission rates, patient phone calls, and patient satisfaction. The study was conducted at The Ohio State University Wexner Medical Center. A retrospective review was conducted on patients who had primary bariatric surgery from July 1, 2013 to June 30, 2015. The control group included patients who underwent surgery from July 1, 2013 to June 30, 2014, before development of the program, and the experimental group was composed of patients who received care coaching from July 1, 2014 to June 30, 2015. Demographics, postoperative complications, LOS, clinic phone calls, and hospital readmissions, prior to the first postoperative visit, were collected from medical records. Patient satisfaction scores were collected from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey [HCAHPS]. Differences between study groups were assessed and P values <0.05 were considered statistically significant. There were 261 and 264 patients in the care-coach and control groups, respectively. The care-coached group had fewer patients with intractable nausea/vomiting (P = .0164) and a shorter mean LOS (P = .032). Subgroup analysis indicated that the difference in LOS was evident for laparoscopic sleeve gastrectomy (P = .002). There was no difference in readmission rates (P = .841) or phone calls to clinic (P = .407). HCAHPS scores demonstrated an improvement in patients' perception of communication regarding medications (59th versus 27th percentile), discharge information (98th versus 93rd percentile), and likelihood of recommending the hospital (85th versus 74th percentile). The Bariatric Care Coaching Program is an important new adjunct in the care of our bariatric inpatients. It has had the greatest impact on postoperative nausea/vomiting, LOS for sleeve gastrectomy, and patient satisfaction. Further studies are needed to evaluate how to use this program to reduce readmission rates and phone calls to the clinic. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

78 FR 33810 - Fishing Capacity Reduction Program for the Southeast Alaska Purse Seine Salmon Fishery

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... Capacity Reduction Program for the Southeast Alaska Purse Seine Salmon Fishery AGENCY: National Marine... reduction loan for the fishing capacity reduction program in the Southeast Alaska purse seine salmon fishery... July 22, 2012. Since then, all harvesters of Southeast Alaska purse seine salmon must pay the fee and...

Predictors of hospitalization of tuberculosis patients in Montreal, Canada: a retrospective cohort study.

PubMed

Ronald, Lisa A; FitzGerald, J Mark; Benedetti, Andrea; Boivin, Jean-François; Schwartzman, Kevin; Bartlett-Esquilant, Gillian; Menzies, Dick

2016-11-15

Hospitalization is the most costly health system component of tuberculosis (TB) control programs. Our objectives were to identify how frequently patients are hospitalized, and the factors associated with hospitalizations and length-of-stay (LOS) of TB patients in a large Canadian city. We extracted data from the Montreal TB Resource database, a retrospective cohort of all active TB cases reported to the Montreal Public Health Department between January 1996 and May 2007. Data included patient demographics, clinical characteristics, and dates of treatment and hospitalization. Predictors of hospitalization and LOS were estimated using logistic regression and Cox proportional hazards regression, respectively. There were 1852 active TB patients. Of these, 51% were hospitalized initially during the period of diagnosis and/or treatment initiation (median LOS 17.5 days), and 9.0% hospitalized later during treatment (median LOS 13 days). In adjusted models, patients were more likely to be hospitalized initially if they were children, had co-morbidities, smear-positive symptomatic pulmonary TB, cavitary or miliary TB, and multi- or poly-TB drug resistance. Factors predictive of longer initial LOS included having HIV, renal disease, symptomatic pulmonary smear-positive TB, multi- or poly-TB drug resistance, and being in a teaching hospital. We found a high hospitalization rate during diagnosis and treatment of patients with TB. Diagnostic delay due to low index of suspicion may result in patients presenting with more severe disease at the time of diagnosis. Earlier identification and treatment, through interventions to increase TB awareness and more targeted prevention programs, might reduce costly TB-related hospital use.

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger.

PubMed

Aronson, Paul L; Lyons, Todd W; Cruz, Andrea T; Freedman, Stephen B; Okada, Pamela J; Fleming, Alesia H; Arms, Joseph L; Thompson, Amy D; Schmidt, Suzanne M; Louie, Jeffrey; Alfonzo, Michael J; Monuteaux, Michael C; Nigrovic, Lise E

2017-10-01

To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result. Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4). Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation. Copyright © 2017 Elsevier Inc. All rights reserved.

Microbial degradation of chloroethenes in groundwater systems

NASA Astrophysics Data System (ADS)

Bradley, Paul M.

The chloroethenes, tetrachloroethene (PCE) and trichloroethene (TCE) are among the most common contaminants detected in groundwater systems. As recently as 1980, the consensus was that chloroethene compounds were not significantly biodegradable in groundwater. Consequently, efforts to remediate chloroethene-contaminated groundwater were limited to largely unsuccessful pump-and-treat attempts. Subsequent investigation revealed that under reducing conditions, aquifer microorganisms can reductively dechlorinate PCE and TCE to the less chlorinated daughter products dichloroethene (DCE) and vinyl chloride (VC). Although recent laboratory studies conducted with halorespiring microorganisms suggest that complete reduction to ethene is possible, in the majority of groundwater systems reductive dechlorination apparently stops at DCE or VC. However, recent investigations conducted with aquifer and stream-bed sediments have demonstrated that microbial oxidation of these reduced daughter products can be significant under anaerobic redox conditions. The combination of reductive dechlorination of PCE and TCE under anaerobic conditions followed by anaerobic microbial oxidation of DCE and VC provides a possible microbial pathway for complete degradation of chloroethene contaminants in groundwater systems. Résumé Les chloroéthanes, tétrachloroéthane (PCE) et trichloroéthane (TCE) sont parmi les polluants les plus communs trouvés dans les aquifères. Depuis les années 1980, on considère que les chloroéthanes ne sont pas significativement biodégradables dans les aquifères. Par conséquent, les efforts pour dépolluer les nappes contaminées par des chloroéthanes se sont limités à des tentatives de pompage-traitement globalement sans succès. Des travaux ultérieurs ont montré que dans des conditions réductrices, des micro-organismes présents dans les aquifères peuvent, par réduction, dégrader les PCE et TCE en composés moins chlorés, comme le dichloréthane (DCE) et le chlorure de vinyl (VC). Bien que des études de laboratoire réalisées avec des micro-organismes adaptés aux composés halogénés montrent que la réduction complète en éthane est possible, dans la plupart des nappes la réaction de déchloration par réduction s'arrête apparemment au DCE et au VC. Cependant, des recherches récentes menées sur des sédiments d'un aquifère et d'alluvions ont démontré que l'oxydation microbienne de ces descendants réduits peut se produire de manière significative dans des conditions de redox anérobies. La déchloration par réduction de PCE et de TCE dans des conditions anérobies suivie par une oxydation microbienne anérobie des DCE et VC fournit une piste microbienne possible pour obtenir une dégradation complète des chloroéthanes polluants dans les aquifères. Resumen Los cloroetanos (tetracloroetano PCE y tricloroetano TCE) son contaminantes muy habituales en los acuíferos. Hasta 1980 se consideraba que los cloroetanos no eran biodegradables y, por tanto, los métodos de rehabilitación en acuíferos contaminados con cloroetanos se limitaban al pump-and-treat, generalmente con poco éxito. Posteriormente se vio que, en condiciones reductoras, algunos microorganismos pueden reducir PCE y TCE a unos subproductos menos clorados, como el dicloroetano (DCE) y el cloruro de vinilo (VC). Aunque estudios de laboratorio recientes sugieren que la reducción completa a etano es posible, en la mayoría de los sistemas acuíferos la decloración suele detenerse en los DCE o VC. Sin embargo, investigaciones más recientes en acuíferos y sedimentos fluviales demuestran que la oxidación microbiana de estos subproductos puede ser importante bajo condiciones redox anaerobias. La combinación de la reducción de PCE y TCE en condiciones anaerobias seguida de la oxidación microbiana anaerobia de DCE y VC proporciona un método potencial para la degradación total de los cloroetanos en los sistemas acuíferos.

Implementing and Sustaining School-Located Influenza Vaccination Programs: Perspectives from Five Diverse School Districts

ERIC Educational Resources Information Center

Wilson, Dulmini; Sanchez, Kathleen M.; Blackwell, Susan H.; Weinstein, Eva; El Amin, A. Nelson

2013-01-01

Local health departments have typically led school-located influenza vaccination (SLIV) programs, assuming resource-intensive roles in design, coordination, and vaccination. This level of involvement is often not financially sustainable over time. Five diverse school districts in Los Angeles County designed, implemented, refined, and…

Improving Vocational Education in Post-High School Institutions. Final Report.

ERIC Educational Resources Information Center

MacArthur, Earl W.

Four ongoing programs in postsecondary vocational-technical education were examined in a national institute attended by 59 representatives from 31 states. Institutions reporting programs were: (1) Los Angeles Trade and Technical College, California, (2) Washtenaw Community College, Ann Arbor, Michigan, (3) Rockingham Community College, Wentworth,…

KiloPower Program

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

McClure, Patrick Ray

2016-08-04

These are the slides for a phone interview with Aerospace America magazine of the AIAA. It goes over the KiloPower Program at Los Alamos National Laboratory (LANL), and covers the following: 1 kWe Kilopower, 10 kWe Kilopower, Kilopower Reactor Using Stirling Technology (KRUSTY) Integration Test (DAF), Reactor Configuration, and Platen Positions.

Acknowledging Spanish and English Resources during Mathematical Reasoning

ERIC Educational Resources Information Center

LópezLeiva, Carlos A.; Torres, Zayoni; Khisty, Lena L.

2013-01-01

As English-only efforts continue in the US schooling system, dual-language programs have served as attempts to preserve students' home language. An after-school, dual-language, Spanish-English, mathematics program, Los Rayos was developed in a predominantly Mexican/Mexican-American neighborhood in Chicago. As participant observers with a…

Recruiting for Rehabilitation Counselor Education Programs: Twenty Years Later

ERIC Educational Resources Information Center

Paul, Heidi; Brodwin, Martin G.

2017-01-01

Purpose: To examine changes in recruitment procedures over the past 20 years and the effect of these changes on the number of students entering rehabilitation programs at California State University, Los Angeles (CSULA). Method: The authors reviewed recruitment practices at CSULA and student enrollment of graduates and undergraduates in…

Highlighting Changes in the Classrooms of a Successful One-to-One Program in Rural Argentina: Case Studies of "Todos los Chicos en la Red" in San Luis

ERIC Educational Resources Information Center

Light, Daniel; Pierson, Elizabeth

2012-01-01

One-to-one computing programs and laptop programs have been a popular approach to education reform in developing countries over the last decade. A motivation behind so many one-to-one laptop programs is the desire to overcome with one powerful resource the historical lack of educational tools and resources available in developing countries.…

Indicators to assess the quality of programs to prevent occupational risk for tuberculosis: are they feasible?

PubMed

Santos, Talita Raquel Dos; Padoveze, Maria Clara; Nichiata, Lúcia Yasuko Izumi; Takahashi, Renata Ferreira; Ciosak, Suely Itsuko; Gryschek, Anna Luiza de Fátima Pinho Lins

2016-06-07

to analyze the feasibility of quality indicators for evaluation of hospital programs for preventing occupational tuberculosis. a descriptive cross-sectional study. We tested indicators for evaluating occupational tuberculosis prevention programs in six hospitals. The criterion to define feasibility was the time spent to calculate the indicators. time spent to evaluate the indicators ranged from 2h 52min to 15h11min 24sec. The indicator for structure evaluation required less time; the longest time was spent on process indicators, including the observation of healthcare workers' practices in relation to the use of N95 masks. There was an hindrance to test one of the indicators for tuberculosis outcomes in five situations, due to the lack of use of tuberculin skin test in these facilities. The time requires to calculate indicators in regarding to the outcomes for occupational tuberculosis largely depends upon the level of organizational administrative structure for gathering data. indicators to evaluate the structure for occupational tuberculosis prevention are highly feasible. Nevertheless, the feasibility of indicators for process and outcome is limited due to relevant variations in administrative issues at healthcare facilities. analisar a viabilidade de indicadores de qualidade para avaliação de programas hospitalares de prevenção de tuberculose ocupacional. estudo descritivo transversal. Testaram-se indicadores de avaliação de programas de prevenção de tuberculose ocupacional em seis hospitais. O critério para definir a viabilidade foi o tempo necessário para aplicar os indicadores. o tempo necessário para avaliar os indicadores variou de 02'52'' até 15h11'24''. O indicador para a avaliação da estrutura demandou menor tempo; o maior tempo foi utilizado com os indicadores de processo, incluindo a observação das práticas dos trabalhadores de saúde em relação ao uso de máscaras N95. Um dos indicadores de resultados de tuberculose deixou de ser testado em cinco situações devido à falta de uso do teste tuberculínico nessas instituições. O tempo necessário para aplicar indicadores em relação aos resultados de tuberculose ocupacional depende em grande parte do nível da organização da estrutura administrativa para a coleta de dados. os indicadores de avaliação da estrutura de prevenção de tuberculose ocupacional são altamente viáveis. No entanto, a viabilidade de aplicação dos indicadores de processo e de resultado é limitada devido a variações relevantes em questões administrativas nas instituições de saúde. analizar la viabilidad de los indicadores de calidad de la evaluación de los programas hospitalarios para la prevención de la tuberculosis en el trabajo. estudio descriptivo transversal. Se probaron los indicadores dirigidos a evaluar los programas para la prevención de la tuberculosis laboral en seis hospitales. El criterio para definir la viabilidad fue el tiempo para aplicar los indicadores. el tiempo empleado para la evaluación de los los indicadores varió desde 02'52 '' hasta 15h11'24 ''. El indicador para la evaluación de la estructura requiere menos tiempo; se invirtió más tiempo en los indicadores de proceso, lo que incluye la observación de las prácticas de los empleados del cuidado de salud en relación con el uso de máscaras N95. No se pudo probar uno de los indicadores de resultados de tuberculosis en cinco situaciones debido a la falta de uso de la prueba de la tuberculina en estas centros. El tiempo necesario para aplicar los indicadores en relación con los resultados por tuberculosis laboral depende en gran medida del nivel de organización de la estructura administrativa para la recopilación de datos. los indicadores para evaluar la estructura para la prevención de la tuberculosis laboral son altamente factibles. Sin embargo, la viabilidad de aplicación de los indicadores de proceso y el resultado es limitada debido a las variaciones relevantes en cuestiones administrativas en los centros sanitarios.

78 FR 10135 - Fishing Capacity Reduction Program for the Longline Catcher Processor Subsector of the Bering Sea...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

... reduction loan to finance the non-pollock groundfish fishing capacity reduction program. DATES: The non... finance reduction program costs. Subpart L of 50 CFR part 600 is the framework rule generally implementing... higher fee rate will be credited to future landings. Fee collection and submission shall follow...

40 CFR 93.165 - Early emission reduction credit programs at Federal facilities and installation subject to...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Early emission reduction credit... Federal Actions to State or Federal Implementation Plans § 93.165 Early emission reduction credit programs... the SIP or TIP in that area, create an early emissions reductions credit program. The Federal agency...

40 CFR 93.165 - Early emission reduction credit programs at Federal facilities and installation subject to...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 20 2011-07-01 2011-07-01 false Early emission reduction credit... Federal Actions to State or Federal Implementation Plans § 93.165 Early emission reduction credit programs... the SIP or TIP in that area, create an early emissions reductions credit program. The Federal agency...

Limited-scope probabilistic safety analysis for the Los Alamos Meson Physics Facility (LAMPF)

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

Sharirli, M.; Rand, J.L.; Sasser, M.K.

1992-01-01

The reliability of instrumentation and safety systems is a major issue in the operation of accelerator facilities. A probabilistic safety analysis was performed or the key safety and instrumentation systems at the Los Alamos Meson Physics Facility (LAMPF). in Phase I of this unique study, the Personnel Safety System (PSS) and the Current Limiters (XLs) were analyzed through the use of the fault tree analyses, failure modes and effects analysis, and criticality analysis. Phase II of the program was done to update and reevaluate the safety systems after the Phase I recommendations were implemented. This paper provides a brief reviewmore » of the studies involved in Phases I and II of the program.« less

Limited-scope probabilistic safety analysis for the Los Alamos Meson Physics Facility (LAMPF)

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

Sharirli, M.; Rand, J.L.; Sasser, M.K.

1992-12-01

The reliability of instrumentation and safety systems is a major issue in the operation of accelerator facilities. A probabilistic safety analysis was performed or the key safety and instrumentation systems at the Los Alamos Meson Physics Facility (LAMPF). in Phase I of this unique study, the Personnel Safety System (PSS) and the Current Limiters (XLs) were analyzed through the use of the fault tree analyses, failure modes and effects analysis, and criticality analysis. Phase II of the program was done to update and reevaluate the safety systems after the Phase I recommendations were implemented. This paper provides a brief reviewmore » of the studies involved in Phases I and II of the program.« less

Use of Prolonged Travel to Improve Pediatric Risk-Adjustment Models

PubMed Central

Lorch, Scott A; Silber, Jeffrey H; Even-Shoshan, Orit; Millman, Andrea

2009-01-01

Objective To determine whether travel variables could explain previously reported differences in lengths of stay (LOS), readmission, or death at children's hospitals versus other hospital types. Data Source Hospital discharge data from Pennsylvania between 1996 and 1998. Study Design A population cohort of children aged 1–17 years with one of 19 common pediatric conditions was created (N=51,855). Regression models were constructed to determine difference for LOS, readmission, or death between children's hospitals and other types of hospitals after including five types of additional illness severity variables to a traditional risk-adjustment model. Principal Findings With the traditional risk-adjustment model, children traveling longer to children's or rural hospitals had longer adjusted LOS and higher readmission rates. Inclusion of either a geocoded travel time variable or a nongeocoded travel distance variable provided the largest reduction in adjusted LOS, adjusted readmission rates, and adjusted mortality rates for children's hospitals and rural hospitals compared with other types of hospitals. Conclusions Adding a travel variable to traditional severity adjustment models may improve the assessment of an individual hospital's pediatric care by reducing systematic differences between different types of hospitals. PMID:19207591

Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion Is Not Attributable to Baseline Illness Severity or Postoperative Complications.

PubMed

Adogwa, Owoicho; Lilly, Daniel T; Vuong, Victoria D; Desai, Shyam A; Ouyang, Bichun; Khalid, Syed; Khanna, Ryan; Bagley, Carlos A; Cheng, Joseph

2018-04-22

Health care systems are increasing efforts to minimize postoperative hospital stays to improve resource use. Common explanations for extended postoperative stay are baseline patient sickness, postoperative complications, or physician practice differences. However, the degree to which extended length of stay (LOS) represents patient illness or postoperative complications remains unknown. The aim is to investigate the influence of postoperative complications and elderly patient comorbidities on extended LOS after anterior cervical discectomy and fusion. This retrospective study was performed from January 1, 2008, to December 31, 2014, on data from the American College of Surgeons National Surgical Quality Improvement Program. Patient demographics, comorbidities, LOS, and inpatient complications were recorded. Multivariable logistic regression analysis was used to determine the odds ratio for risk-adjusted extended LOS. The primary outcome was the degree extended LOS represented patient illness or postoperative complications. Of 4730 participants, 1351 (28.56%) had extended LOS. A minority of patients with extended LOS had a history of relevant comorbidities-diabetes (29.53%), chronic obstructive pulmonary disease (9.4%), congestive heart failure (1.04%), myocardial infarction (0.33%), acute renal failure (0.3%), and stroke (5.92%). Among patients with normal LOS, 96.8% had no complications, 2.7% had 1 complication, and 0.5% had greater than 1 complication. In patients with extended LOS, 79.4% had no complications, 14.5% had 1 complication, and 6.1% had greater than 1 complication (P < 0.0001). Our study suggests much of LOS variation after an anterior cervical discectomy and fusion is not attributable to baseline patient illness or complications and most likely represents differences in practice style or surgeon preference. Copyright © 2018 Elsevier Inc. All rights reserved.

Nuclear thermal source transfer unit, post-blast soil sample drying system

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

Wiser, Ralph S.; Valencia, Matthew J

Los Alamos National Laboratory states that its mission is “To solve national security challenges through scientific excellence.” The Science Undergraduate Laboratory Internship (SULI) programs exists to engage undergraduate students in STEM work by providing opportunity to work at DOE facilities. As an undergraduate mechanical engineering intern under the SULI program at Los Alamos during the fall semester of 2016, I had the opportunity to contribute to the mission of the Laboratory while developing skills in a STEM discipline. I worked with Technology Applications, an engineering group that supports non-proliferation, counter terrorism, and emergency response missions. This group specializes in toolmore » design, weapons engineering, rapid prototyping, and mission training. I assisted with two major projects during my appointment Los Alamos. The first was a thermal source transportation unit, intended to safely contain a nuclear thermal source during transit. The second was a soil drying unit for use in nuclear postblast field sample collection. These projects have given me invaluable experience working alongside a team of professional engineers. Skills developed include modeling, simulation, group design, product and system design, and product testing.« less

Critical assembly: A technical history of Los Alamos during the Oppenheimer years, 1943--1945

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

Hoddeson, L.; Henriksen, P.W.; Meade, R.A.

1993-11-01

This volume treats the technical research that led to the first atomic bombs. The authors explore how the ``critical assembly`` of scientists, engineers, and military Personnel at Los Alamos collaborated during World War II, blending their traditions to create a new approach to large-scale research. The research was characterized by strong mission orientation, multidisciplinary teamwork, expansion of the scientists` traditional methodology with engineering techniques, and a trail-and-error methodology responding to wartime deadlines. The book opens with an introduction laying out major themes. After a synopsis of the prehistory of the bomb project, from the discovery of nuclear fission to themore » start of the Manhattan Engineer District, and an overview of the early materials program, the book examines the establishment of the Los Alamos Laboratory, the implosion and gun assembly programs, nuclear physics research, chemistry and metallurgy, explosives, uranium and plutonium development, confirmation of spontaneous fission in pile-produced plutonium, the thermonuclear bomb, critical assemblies, the Trinity test, and delivery of the combat weapons.« less

Pulling Museum Education Purse Strings

ERIC Educational Resources Information Center

Raiguel, Faith

2010-01-01

The economic downturn has hit everyone hard. The author's organization, the Los Angeles Opera, has completed two years of downsizing, resulting in an almost 25% reduction in staff and overall budget cutting. Change that is not "nipping and tucking," but changing the dynamic and culture of the institution. However, if the organization hadn't done…

Comparative Studies of Collaborative Team Depression Care Adoption in Safety Net Clinics

ERIC Educational Resources Information Center

Ell, Kathleen; Wu, Shinyi; Guterman, Jeffrey; Schulman, Sandra-Gross; Sklaroff, Laura; Lee, Pey-Jiuan

2018-01-01

Purpose: To evaluate three approaches adopting collaborative depression care model in Los Angeles County safety net clinics with predominantly Latino type 2 diabetes patients. Methods: Pre-post differences in treatment rates and symptom reductions were compared between baseline, 6-month, and 12-month follow-ups for each approach: (a) Multifaceted…

Congestion reduction through efficient empty container movement : a research report from the National Center for Sustainable Transportation.

DOT National Transportation Integrated Search

2017-08-01

In 2015, the Ports of Los Angeles and Long Beach moved 15.3 million twenty-foot Equivalent Units (TEU). There is a significant body of work on moving loaded containers efficiently, however there has been little research on the movement of empty conta...

Implementation of 1978-1979 Contingency Plans. Reports 1, 3 & 4.

ERIC Educational Resources Information Center

Los Angeles Community Coll. District, CA.

Three reports are presented that address the problem of implementing 1978-79 contingency plans developed by the Los Angeles Community College District in response to a June 1978 property tax reduction initiative, Proposition 13. Report No. 1 provides an overview of district problems resulting from the tax limitation measure. Fiscal and educational…

Menu labeling as a potential strategy for combating the obesity epidemic: a health impact assessment.

PubMed

Kuo, Tony; Jarosz, Christopher J; Simon, Paul; Fielding, Jonathan E

2009-09-01

We conducted a health impact assessment to quantify the potential impact of a state menu-labeling law on population weight gain in Los Angeles County, California. We utilized published and unpublished data to model consumer response to point-of-purchase calorie postings at large chain restaurants in Los Angeles County. We conducted sensitivity analyses to account for uncertainty in consumer response and in the total annual revenue, market share, and average meal price of large chain restaurants in the county. Assuming that 10% of the restaurant patrons would order reduced-calorie meals in response to calorie postings, resulting in an average reduction of 100 calories per meal, we estimated that menu labeling would avert 40.6% of the 6.75 million pound average annual weight gain in the county population aged 5 years and older. Substantially larger impacts would be realized if higher percentages of patrons ordered reduced-calorie meals or if average per-meal calorie reductions increased. Our findings suggest that mandated menu labeling could have a sizable salutary impact on the obesity epidemic, even with only modest changes in consumer behavior.

Design and methodology of the LA Sprouts nutrition, cooking and gardening program for Latino youth: A randomized controlled intervention.

PubMed

Martinez, Lauren C; Gatto, Nicole M; Spruijt-Metz, Donna; Davis, Jaimie N

2015-05-01

The LA Sprouts 12-week nutrition, cooking and gardening intervention targets obesity reduction in Latino children. While other gardening and nutrition programs are shown to improve dietary intake, LA Sprouts is unique in that it utilized a curriculum demonstrated to decrease obesity. This methodology paper outlines the design and processes of the LA Sprouts study, and discusses key strategies employed to foster successful implementation of the program. After-school program in four Los Angeles elementary schools. 3rd-5th grade students. Randomized controlled trial. Gardens were built on two of four school campuses, and the 90-minute weekly lessons focused on strategies to increase fruit and vegetable consumption, gardening at school and home, and cooking healthy meals/snacks. Data collection was conducted pre- and post-intervention and included basic clinical and anthropometric measures, dietary intake and psychosocial constructs measured by questionnaire, and an optional fasting blood draw. Baseline data was collected from 364 children, and 320 (88%) completed follow-up. No participants withdrew from the program (data were missing for other reasons). Intervention students attended 9.7 ± 2.3 lessons. Fasting blood samples were collected on 169 children at baseline, and 113 (67%) at follow-up. Questionnaire scales had good internal consistency (IC) and intra-rater reliability (IRR; in child scales: 88% items with IC > 0.7 and 70% items with IRR > 0.50; in parent scales: 75% items with IC > 0.7). The intervention was successfully implemented in the schools and scales appear appropriate to evaluate psychosocial constructs relevant to a gardening intervention. Copyright © 2015 Elsevier Inc. All rights reserved.

Design and methodology of the LA Sprouts nutrition, cooking and gardening program for Latino youth: a randomized controlled intervention

PubMed Central

Martinez, Lauren C.; Gatto, Nicole M.; Spruijt-Metz, Donna; Davis, Jaimie N.

2015-01-01

Objective The LA Sprouts 12-week nutrition, cooking and gardening intervention targets obesity reduction in Latino children. While other gardening and nutrition programs are shown to improve dietary intake, LA Sprouts is unique in that it utilized a curriculum demonstrated to decrease obesity. This methodology paper outlines the design and processes of the LA Sprouts study, and discusses key strategies employed to foster successful implementation of the program. Setting After-school program in four Los Angeles elementary schools. Subjects 3rd–5th grade students. Design Randomized controlled trial. Gardens were built on two of four school campuses, and the 90-minute weekly lessons focused on strategies to increase fruit and vegetable consumption, gardening at school and home, and cooking healthy meals/snacks. Data collection was conducted pre- and post-intervention and included basic clinical and anthropometric measures, dietary intake and psychosocial constructs measured by questionnaire, and an optional fasting blood draw. Results Baseline data was collected from 364 children, and 320 (88%) completed follow-up. No participants withdrew from the program (data were missing for other reasons). Intervention students attended 9.7 ± 2.3 lessons. Fasting blood samples were collected on 169 children at baseline, and 113 (67%) at follow-up. Questionnaire scales had good internal consistency (IC) and intra-rater reliability (IRR; in child scales: 88% items with IC >0.7 and 70% items with IRR > 0.50; in parent scales: 75% items with IC > 0.7). Conclusions The intervention was successfully implemented in the schools and scales appear appropriate to evaluate psychosocial constructs relevant to a gardening intervention. PMID:25896115

Recommended HSE-7 documents hierarchy

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

Klein, R.B.; Jennrich, E.A.; Lund, D.M.

1990-12-12

This report recommends a hierarchy of waste management documents at Los Alamos National Laboratory (LANL or Laboratory''). The hierarchy addresses documents that are required to plan, implement, and document waste management programs at Los Alamos. These documents will enable the waste management group and the six sections contained within that group to satisfy requirements that are imposed upon them by the US Department of Energy (DOE), DOE Albuquerque Operations, US Environmental Protection Agency, various State of New Mexico agencies, and Laboratory management.

Recommended HSE-7 documents hierarchy

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

Klein, R.B.; Jennrich, E.A.; Lund, D.M.

1990-12-12

This report recommends a hierarchy of waste management documents at Los Alamos National Laboratory (LANL or ``Laboratory``). The hierarchy addresses documents that are required to plan, implement, and document waste management programs at Los Alamos. These documents will enable the waste management group and the six sections contained within that group to satisfy requirements that are imposed upon them by the US Department of Energy (DOE), DOE Albuquerque Operations, US Environmental Protection Agency, various State of New Mexico agencies, and Laboratory management.

Effects of a new medical insurance payment system for hospice patients in palliative care programs in Korea.

PubMed

Lee, Youngin; Lee, Seung Hun; Kim, Yun Jin; Lee, Sang Yeoup; Lee, Jeong Gyu; Jeong, Dong Wook; Yi, Yu Hyeon; Tak, Young Jin; Hwang, Hye Rim; Gwon, Mieun

2018-03-07

This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p <  0.001); however, the new system registers lower patient out-of-pocket expenses (p <  0.001). The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.

NASA supported research programs

NASA Technical Reports Server (NTRS)

Libby, W. F.

1975-01-01

A summary of the scientific NASA grants and achievements accomplished by the University of California, Los Angles, is presented. The development of planetary and space sciences as a major curriculum of the University, and statistical data on graduate programs in aerospace sciences are discussed. An interdisciplinary approach to aerospace science education is emphasized. Various research programs and scientific publications that are a direct result of NASA grants are listed.

Impact of a Comprehensive Whole Child Intervention and Prevention Program among Youths at Risk of Gang Involvement and Other Forms of Delinquency

ERIC Educational Resources Information Center

Koffman, Stephen; Ray, Alice; Berg, Sarah; Covington, Larry; Albarran, Nadine M.; Vasquez, Max

2009-01-01

Youths in gang-ridden neighborhoods are at risk for trauma-related mental health disorders, which are early indicators of likely school failure and delinquency. Such youths rarely seek out services for these problems. The Juvenile Intervention and Prevention Program (JIPP), a school-based gang intervention and prevention program in Los Angeles,…

Predicting Treatment Success in Social Skills Training for Adolescents with Autism Spectrum Disorders: The UCLA Program for the Education and Enrichment of Relational Skills

ERIC Educational Resources Information Center

Chang, Ya-Chih; Laugeson, Elizabeth A.; Gantman, Alexander; Ellingsen, Ruth; Frankel, Fred; Dillon, Ashley R.

2014-01-01

This study seeks to examine the predictors of positive social skills outcomes from the University of California, Los Angeles Program for the Education and Enrichment of Relational Skills, an evidence-based parent-assisted social skills program for high-functioning middle school and high school adolescents with autism spectrum disorders. The…

The Role of Discussion Boards in a University Blended Learning Program (El papel de los foros de discusión en un programa universitario de aprendizaje mixto)

ERIC Educational Resources Information Center

González Moreno, Rosa Isabel

2011-01-01

Discussion boards as tools in blended "English language" learning programs have unique characteristics when compared to other synchronous and asynchronous communication tools that are different. Therefore, it is important to investigate the way they operate, their role within a given program and the students', teachers' and tutors'…

The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Does Not Accurately Predict Risk of 30-Day Complications Among Patients Undergoing Microvascular Head and Neck Reconstruction.

PubMed

Arce, Kevin; Moore, Eric J; Lohse, Christine M; Reiland, Matthew D; Yetzer, Jacob G; Ettinger, Kyle S

2016-09-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC) is a novel universal risk calculator designed to aid in risk stratification of patients undergoing various types of major surgery. The purpose of this study was to assess the validity of the ACS NSQIP SRC in predicting postoperative complications in patients undergoing microvascular head and neck reconstruction. A retrospective cohort study of patients undergoing head and neck microvascular reconstruction with fibular free flaps at a single institution was completed. The NSQIP SRC was used to compute complication risk estimates and length of stay (LOS) estimates for all patients under study. Associations between complication risk estimates generated by the SRC and actual rates of observed complications were evaluated using logistic regression models. Logistic regression models also were used to evaluate the SRC estimates for LOS duration compared with the actual observed LOS after surgery. Of 153 patients under study, 46 (30%) developed a postoperative complication corresponding to those defined by NSQIP SRC. Thirty-eight patients (25%) developed a postoperative complication categorized as severe in the parameters of the NSQIP SRC. None of the SRC complication estimates showed a statistically relevant association with the corresponding observed rates of complications. The mean LOS predicted by the SRC was 8.0 days (median, 7.5 days; interquartile range [IQR], 6.5 to 9; range, 5.0 to 18.5 days). The mean observed LOS for the study group was 9.6 days (median, 7.0 days; IQR, 6 to 9; range, 5 to 67 days). Lin's (Biometrics 45:255, 1989) concordance correlation coefficient to measure agreement between observed and predicted LOS was 0.10, indicating only slight agreement between the 2 values. The ACS NSQIP SRC is not a useful risk-stratifying metric for patients undergoing major head and neck reconstruction with microvascular fibular free flaps. The SRC also does not accurately predict hospital LOS for this same patient cohort. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

The older persons' assessment and liaison team 'OPAL': evaluation of comprehensive geriatric assessment in acute medical inpatients.

PubMed

Harari, D; Martin, F C; Buttery, A; O'Neill, S; Hopper, A

2007-11-01

Reducing hospital length of stay (LOS) in older acute medical inpatients is a key productivity measure. Evidence-based predictors of greater LOS may be targeted through Comprehensive Geriatric Assessment (CGA). Evaluate a novel service model for CGA screening of older acute medical inpatients linked to geriatric intervention. Urban teaching hospital. Acute medical inpatients aged 70+ years. Multidisciplinary CGA screening of all acute medical admissions aged 70+ years leading to (a) rapid transfer to geriatric wards or (b) case-management on general medical wards by Older Persons Assessment and Liaison team (OPAL). Prospective pre-post comparison with statistical adjustment for baseline factors, and use of national benchmarking LOS data. Pre-OPAL (n = 46) and post-OPAL (n = 49) cohorts were similarly identified as high-risk by the CGA screening tool, but only post-OPAL patients received the intervention. Pre-OPAL, 0% fallers versus 92% post-OPAL were specifically assessed and/or referred to a falls service post-discharge. Management of delirium, chronic pain, constipation, and urinary incontinence similarly improved. Over twice as many patients were transferred to geriatric wards, with mean days from admission to transfer falling from 10 to 3. Mean LOS fell by 4 days post-OPAL. Only the OPAL intervention was associated with LOS (P = 0.023) in multiple linear regression including case-mix variables (e.g. age, function, 'geriatric giants'). Benchmarking data showed the LOS reduction to be greater than comparable hospitals. CGA screening of acute medical inpatients leading to early geriatric intervention (ward-based case management, appropriate transfer to geriatric wards), improved clinical effectiveness and general hospital performance.

The effects of losartan on memory performance and leptin resistance induced by obesity and high-fat diet in adult male rats.

PubMed

Sharieh Hosseini, Seyydeh Gohar; Khatamsaz, Saeed; Shariati, Mehrdad

2014-01-01

Leptin is a hormone secreted by adipose tissue and is involved not only in the regulation of feeding and energy expenditure, but also its role in memory enhancement has been demonstrated as well. The partial transfer of leptin across the blood-brain barrier in obese individuals causes leptin resistance and prevents leptin reaching brain. On the other hand, studies have shown that angiotensin antagonists such as losartan can improve memory and learning abilities. The aim of this study was to evaluate the effects of losartan on improving memory and leptin resistance induced by high fat diet in obese rats. 40 Wistar male rats were divided in 4 groups: control (C), losartan (LOS), high-fat diet (HFD) and high-fat diet and losartan (HFD and LOS). The spatial memory performances of the rats were assessed in the Morris water maze after 2 months of treatment. Then they were weighed and serum levels of leptin and triglyceride were measured. In spite of receiving high-fat diet, no significant differences in body weight were observed in the (HFD & LOS) group. In the Morris water maze trial, the (LOS) and (HFD & LOS) groups also showed a significant reduction (P <0.05) in latency and path length. In addition, a significant decrease (P <0.05) in serum levels of leptin and no significant difference in serum levels of triglyceride was observed in the (HFD & LOS) group. Losartan can improve leptin resistance induced by obesity and high fat diet. At the same time, it modulates body weight and enhances learning and memory.

Comprehensive Group Therapy of Obesity and Its Impact on Selected Anthropometric and Postural Parameters.

PubMed

Horák, Stanislav; Sovová, Eliška; Pastucha, Dalibor; Konečný, Petr; Radová, Lenka; Calabová, Naděžda; Janoutová, Jana; Janout, Vladimír

2017-12-01

Obesity is a multifactorial disease. This non-infectious epidemic has reached pandemic proportions in the 21 century. Posture is a dynamic process referring to an active maintenance of body movement segments against the action of external forces. The aim of the study was to investigate the effect of comprehensive group therapy for obese persons on selected anthropometric and postural parameters. The study comprised 53 females with a mean age of 44.5 years (range 29–65 years, standard deviation 9.42 years, median 44 years), who completed a controlled weight loss programme. At the beginning and at the end of the programme, anthropometric parameters (Body Mass Index (BMI), weight and waist circumference) were measured and the posturography tests Limits of Stability (LOS) and Motor Control Test (MCT) were performed using the NeuroCom's SMART EquiTest system. The data were statistically analyzed using R software at a level of significance of 0.05. There were positive changes after the controlled weight loss programme in anthropometric parameters (BMI reduction, with p<0.001; waist circumference reduction, with p<0.001; and weight loss, with p<0.001), postural stability with statistically significant (p<0.05) improvements in both postural activity (LOS test parameters) and reactions (MCT parameters). The study showed a statistically significant effect of comprehensive group therapy for obesity in terms of reductions in waist circumference, body weight and BMI, and thus the overall reduction of both cardiovascular and metabolic risks, as well as improved postural skills (activity and reactions). Copyright© by the National Institute of Public Health, Prague 2017

Impact of programming strategies aimed at reducing nonessential implantable cardioverter defibrillator therapies on mortality: a systematic review and meta-analysis.

PubMed

Tan, Vern Hsen; Wilton, Stephen B; Kuriachan, Vikas; Sumner, Glen L; Exner, Derek V

2014-02-01

Patients who receive implantable cardioverter defibrillator therapies are at higher risk of death versus those who do not. Programmed settings to reduce nonessential implantable cardioverter defibrillator therapies (therapy reduction programming) have been developed but may have adverse effects. This systematic review and meta-analysis assessed the relationship between therapy reduction programming with the risks of death from any cause, implantable cardioverter defibrillator shocks, and syncope. MEDLINE, EMBASE, and clinicaltrials.gov databases were searched to identify relevant studies. Those that followed patients for ≥6 months and reported mortality were included. Six met the inclusion criteria; 4 randomized (Comparison of Empiric to Physician-Tailored Programming of ICDs [EMPIRIC], Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy [MADIT-RIT], Avoid Delivering Therapies for Non-sustained Arrhythmias in ICD Patients III [ADVANCE III], and Programming Implantable Cardioverter-Defibrillators in Patients with Primary Prevention Indication to Prolong Time to First Shock [PROVIDE]) and 2 prospective studies (Role of Long Detection Window Programming in Patients With Left Ventricular Dysfunction, Non-ischemic Etiology in Primary Prevention Treated with a Biventricular ICD [RELEVANT] and Primary Prevention Parameters Evaluation [PREPARE]). These 6 studies included 7687 (3598 conventional and 4089 therapy reduction programming) patients. Most (77%) participants were men, had a history of ischemic heart disease (56%), and were prescribed β-blockers (84%). Therapy reduction programming was associated with a 30% relative reduction in mortality (95% confidence interval, 16%-41%; P<0.001). No significant heterogeneity among studies was observed (P=0.6). A similar 26% reduction in mortality was observed when only the 4 randomized trials were included (95% confidence interval, 11%-40%; P=0.002). These results were not significantly altered after adjustment for baseline characteristics. No significant difference in the risk of syncope was observed with conventional versus therapy reduction programming (P=0.5). Therapy reduction programming results in a large, significant, and consistent reduction in mortality, with no apparent increase in the risk of syncope.

Determinants of psychogeriatric inpatient length of stay and direct medical costs: a 6-year longitudinal study using a national database in Taiwan.

PubMed

Liu, Chin-Ming; Li, Chu-Shiu; Liu, Chwen-Chi; Tu, Chu-Chin

2012-08-01

This research examined factors related to the average length of hospital stay (LOS) and average direct medical costs (DMC) for 2291 psychogeriatric inpatients (aged 65 and over) admitted for the first time to a psychiatric ward in 2002. Hospitalization claim data of these inpatients were traced for the subsequent 6 years (2002-2007) from the dataset of Taiwan's National Health Insurance program. Analysis was carried out using the t-test, χ(2) -test and zero truncated Tobit regression. Mean LOS and mean DMC were significantly different according to sex, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations, but age was the exception. Both LOS and DMC exhibited downward U-shape for the number of hospitalizations. Factors significantly associated with longer LOS and higher DMC were: male sex; schizophrenic and delusional disorders (compared with dementia); and public institution (compared with private hospital). Compared with dementia, organic mental and anxiety disorders had significantly shorter LOS, and affective disorders had shorter LOS but higher DMC. Community and psychiatric hospitals (compared with general hospital) significantly influenced LOS but not DMC. Our results can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out National Health Insurance financial reform for psychogeriatric inpatients. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

SUMO Nitrogen Labeling Experiment and Soil Biogeochemistry

DOE Data Explorer

Grossiord, Charlotte [Swiss Federal Research Institute WSL; Gessler, Arthur [Swiss Federal Research Institute WSL; Reed, Sasha [USGS; Borrego, Isaac [USGS; Collins, Adam [Los Alamos National Laboratory; Dickman, Turin L. [Los Alamos National Laboratory; Ryan, Max [Los Alamos National Laboratory; Schönbeck, Leonie [Swiss Federal Research Institute WSL; Sevanto, Sanna [Los Alamos National Laboratory; Villagrosa, Alberto [University of Alicante; McDowell, Nate [Pacific Northwest National Laboratory (PNNL)

2018-01-01

The Los Alamos Survival–Mortality experiment (SUMO) is located on Frijoles Mesa near Los Alamos, New Mexico, USA, at an elevation of 2150 m. This was a tree manipulation study that investigated the relative impacts of drought and warming on plant function and reveals how trees adapt to drought and heat in semi-arid regions. The study factored the role of tree hydraulic acclimation to both precipitation and temperature and separated their effects.The experiment is located in a pinon-juniper woodland near the ponderosa pine (Pinus ponderosa) forest ecotone. In a semi-arid woodland, adult trees (piñon and juniper) were exposed to chronic warming (+4 °C) and precipitation reduction (-45 %). After five years of continuous treatment exposure, soil and plant nitrogen isotopic composition were measured to assess plant nitrogen allocation. See SUMO Target Tree Information data package (doi:10.15485/1440544) for additional information. Data released by Los Alamos National Lab for public use under LA-UR-18-23656.

Space-based observations of megacity carbon dioxide

NASA Astrophysics Data System (ADS)

Kort, Eric A.; Frankenberg, Christian; Miller, Charles E.; Oda, Tom

2012-09-01

Urban areas now house more than half the world's population, and are estimated to contribute over 70% of global energy-related CO2 emissions. Many cities have emission reduction policies in place, but lack objective, observation-based methods for verifying their outcomes. Here we demonstrate the potential of satellite-borne instruments to provide accurate global monitoring of megacity CO2 emissions using GOSAT observations of column averaged CO2 dry air mole fraction (XCO2) collected over Los Angeles and Mumbai. By differencing observations over the megacity with those in nearby background, we observe robust, statistically significant XCO2 enhancements of 3.2 ± 1.5 ppm for Los Angeles and 2.4 ± 1.2 ppm for Mumbai, and find these enhancements can be exploited to track anthropogenic emission trends over time. We estimate that XCO2 changes as small as 0.7 ppm in Los Angeles, corresponding to a 22% change in emissions, could be detected with GOSAT at the 95% confidence level.

76 FR 40320 - Risk Reduction Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... identifying and analyzing applicable hazards and (2) develops plans to mitigate that risk. Each RRP is...-2009-0038] RIN 2130-AC11 Risk Reduction Program AGENCY: Federal Railroad Administration (FRA... certain railroads to develop a Risk Reduction Program (RRP). The Rail Safety Improvement Act of 2008...

Engagement in community music classes sparks neuroplasticity and language development in children from disadvantaged backgrounds

PubMed Central

Kraus, Nina; Hornickel, Jane; Strait, Dana L.; Slater, Jessica; Thompson, Elaine

2014-01-01

Children from disadvantaged backgrounds often face impoverished auditory environments, such as greater exposure to ambient noise and fewer opportunities to participate in complex language interactions during development. These circumstances increase their risk for academic failure and dropout. Given the academic and neural benefits associated with musicianship, music training may be one method for providing auditory enrichment to children from disadvantaged backgrounds. We followed a group of primary-school students from gang reduction zones in Los Angeles, CA, USA for 2 years as they participated in Harmony Project. By providing free community music instruction for disadvantaged children, Harmony Project promotes the healthy development of children as learners, the development of children as ambassadors of peace and understanding, and the development of stronger communities. Children who were more engaged in the music program—as defined by better attendance and classroom participation—developed stronger brain encoding of speech after 2 years than their less-engaged peers in the program. Additionally, children who were more engaged in the program showed increases in reading scores, while those less engaged did not show improvements. The neural gains accompanying music engagement were seen in the very measures of neural speech processing that are weaker in children from disadvantaged backgrounds. Our results suggest that community music programs such as Harmony Project provide a form of auditory enrichment that counteracts some of the biological adversities of growing up in poverty, and can further support community-based interventions aimed at improving child health and wellness. PMID:25566109

Directrices de los Servicios de Salud para Estudiantes Migratorios (Guidelines for Health Services for Migrant Students).

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento. Bureau of Community Services and Migrant Education.

To promote uniformity and continuity, standards have been established for planning, implementing, and evaluating student health programs provided by grade K-12 migrant education programs throughout California. In this Spanish language edition, state-mandated health requirements, the rationale for supplemental services, methods of providing…

Justice for All? Suspension Bans and Restorative Justice Programs in the Los Angeles Unified School District

ERIC Educational Resources Information Center

Hashim, Ayesha K.; Strunk, Katharine O.; Dhaliwal, Tasminda K.

2018-01-01

To address disproportionalities in suspensions for students of color, many districts have prohibited schools from suspending students for willful defiance of school authorities and implemented restorative justice programs (RJP) that address student misconduct using alternative conflict resolution practices. However, there is limited evidence on…

Meeting the Needs of Rural Gifted Students with Handicapping Conditions.

ERIC Educational Resources Information Center

Poppe, Roger L.; Gabaldon, Thomas

This paper describes a rural Hispanic community's efforts to identify and develop a program for gifted students in grades 2-6 who are also mildly to moderately handicapped (learning disabled, behavior disordered, or communication disordered). The "Twice Exceptional" (2E) program, in Los Lunas, New Mexico, is a modified full-time separate…

User Problems Associated with the Services of Federal and Quasi-Federal Technical Information Producing Agencies.

ERIC Educational Resources Information Center

Los Angeles Regional Technical Information Users Council, CA.

Nine reports of the Los Angeles Regional Technical Information Users Council, which identify and discuss user problem areas and recommend solutions, comprise this document. The topics of the reports are: (1) Air Force Technical Objective Document Release Program (AFTOD); (2) Army Qualitative Requirements Information Program (QDRI); (3)…

The Los Alamos National Laboratory precision double crystal spectrometer

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

Morgan, D.V.; Stevens, C.J.; Liefield, R.J.

1994-03-01

This report discusses the following topics on the LANL precision double crystal X-ray spectrometer: Motivation for construction of the instrument; a brief history of the instrument; mechanical systems; motion control systems; computer control system; vacuum system; alignment program; scan programs; observations of the copper K{alpha} lines; and characteristics and specifications.

76 FR 69734 - Public Water System Supervision Program Revision for the State of New Mexico

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-09

... Water System Supervision Program. New Mexico has adopted the Lead and Copper Rule Short Term Revisions... water. EPA has determined that this rule revision submitted by New Mexico is no less stringent than the... the following offices: New Mexico Environment Department, Drinking Water Bureau, 525 Camino De Los...

Science Programs

Science.gov Websites

Research Library Science Briefs Science News Science Highlights Lab Organizations Science Programs Applied Innovation Research Capabilities Deploying Innovation Technology Opportunities Innovation in New Mexico Los Laboratory Delivering science and technology to protect our nation and promote world stability Science &

Guia para los padres sobre educacion preescolar (A Parents' Guide to Early Childhood Education).

ERIC Educational Resources Information Center

Dodge, Diane Trister; Phinney, Joanna

This handbook, entirely in Spanish, was originally intended for parents whose children attend programs which use "The Creative Curriculum for Early Childhood" (CCEC), but the information is also useful to parents whose children attend early childhood programs using other curriculum models based on child development theories. The purpose…

PROJECT EARNING POWER, GRANT RD-1806-G. HISTORY AND FINAL REPORT.

ERIC Educational Resources Information Center

LANGDON, MARGARET

THE PURPOSE OF THE PROJECT WAS TO APPLY CURRENT KNOWLEDGE, METHODS, AND TECHNIQUES IN INDUSTRIAL DESIGN AND PRODUCT DEVELOPMENT TO REHABILITATING THE HANDICAPPED BY USING THE LABOR FORCE AVAILABLE IN SHELTERED WORKSHOPS AND HOMEBOUND PROGRAMS. DEMONSTRATION PROGRAMS WERE ESTABLISHED AS TASK FORCES IN CHICAGO, NEW YORK, AND LOS ANGELES WITH THE…

Evaluation of a School-Based Multicomponent Nutrition Education Program to Improve Young Children's Fruit and Vegetable Consumption

ERIC Educational Resources Information Center

Prelip, Michael; Kinsler, Janni; Thai, Chan Le; Erausquin, Jennifer Toller; Slusser, Wendelin

2012-01-01

Objective: To assess the impact of a multicomponent nutrition education program on student knowledge, attitudes, and behaviors related to consumption of fruits and vegetables (FVs). Design: Quasi-experimental pretest/posttest research design; 3 study conditions (Intervention+, Intervention, Comparison). Setting: Six schools from the Los Angeles…

Arts Impact: Lessons from ArtsBridge

ERIC Educational Resources Information Center

Shimshon-Santo, Amy R.

2010-01-01

Arts Impact summarizes lessons learned at the ArtsBridge Program. It is informed by in-depth participant observation, logic modeling, and quantitative evaluation of program impact on K-12 students in inner city schools and arts students at the University of California Los Angeles over a two year period. The case study frames its analysis through a…

Innovative Use of Existing Housing Resources.

ERIC Educational Resources Information Center

Baldwin, Leo E., Ed.; Schreter, Carol A., Ed.

These five symposium papers describe housing programs designed for older adults. "Agency-Sponsored Co-op House for Older People," by Janet L. Witkin, discusses a co-op house for nine people in the Los Angeles area. Development of the program is outlined in terms of funding and leasing arrangements, architectural changes to the property,…

Space nuclear safety program

NASA Astrophysics Data System (ADS)

George, T. G.

1990-02-01

This quarterly report describes studies related to the use of Pu(238)O sub 2 in radioisotope power systems, carried out of the Office of Defense Energy Programs and Special Applications of the U.S. Department of Energy by Los Alamos National Laboratory. The studies are ongoing; the results and conclusions described may change as the work progresses.

Employability Competencies for Entry Level Emergency Medical Aides.

ERIC Educational Resources Information Center

Werner, Claire

This document describes competencies needed by persons who complete the Los Angeles Schools' emergency medical aide competency-based program, which is designed to enhance their ability to obtain certification as an Emergency Medical Technician (EMT). The overall competency statement ("goal") of the program heads each page and is defined by one or…

Inventory of Assets.

ERIC Educational Resources Information Center

Kline, Lanaii

A computer program that produces three reports based on asset inventory data--i.e. facilities and equipment data--is described. Written in FORTRAN IV (Level G), the program was used on the IBM 360 Model 91 at the University of California at Los Angeles (UCLA). The first report is a listing of data sorted by local, user-assigned identification…

Public health impact of the 1992 Los Angeles civil unrest.

PubMed Central

Evans, C A

1993-01-01

The Los Angeles civil unrest in April 1992 stunned the nation. The days of violence resulted in 53 deaths, 2,325 reported injuries, more than 600 buildings completely destroyed by fire, and approximately $735 million in total damages. The purpose of this paper is to give an overview of the activities of the Public Health Programs and Services Branch of the Los Angeles County Department of Health Services during and after the civil unrest and to illustrate the types of public health issues and problems that may result from large-scale civil disturbance. Public health agencies and jurisdictions should consider these issues in their disaster planning. Public Health Programs and Services Branch activities were directly affected by the violence and destruction. Women, Infants and Children Program vouchering sites and 20 drug program and alcohol recovery sites were damaged or burned and 15 county health centers closed during the unrest. At least 38 private medical and dental offices and 45 pharmacies were destroyed or damaged. County health authorities offered facilities to house relocated private care providers and filled prescriptions for medications where needed. The environmental health impact required the inspection of 2,827 burned and damaged sites for hazardous waste including asbestos; at 9 percent of the inspected sites, waste required special disposal. More than 1,000 food facilities suffered damage and required inspection before reopening. In the 3 months following the unrest, a 20-percent increase in disposal capacity was authorized at four county landfills to accommodate the disposal of debris. Violence was a public health issue of particular concern.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8497562

Marked reduction in length of stay for patients with psychiatric emergencies after implementation of a comanagement model.

PubMed

Polevoi, Steven K; Jewel Shim, J; McCulloch, Charles E; Grimes, Barbara; Govindarajan, Prasanthi

2013-04-01

Patients with psychiatric emergencies often spend excessive time in an emergency department (ED) due to limited inpatient psychiatric bed capacity. The objective was to compare traditional resident consultation with a new model (comanagement) to reduce length of stay (LOS) for patients with psychiatric emergencies. The costs of this model were compared to those of standard care. This was a before-and-after study conducted in the ED of an urban academic medical center without an inpatient psychiatry unit from January 1, 2007, through December 31, 2009. Subjects were all adult patients seen by ED clinicians and determined to be a danger to self or others or gravely disabled. At baseline, psychiatry residents evaluated patients and made therapeutic recommendations after consultation with faculty. The comanagement model was fully implemented in September 2008. In this model, psychiatrists directly ordered pharmacotherapy, regularly monitored effects, and intensified efforts toward appropriate disposition. Additionally, increased attending-level involvement expedited focused evaluation and disposition of patients. An interrupted time series analysis was used to study the effects of this intervention on LOS for all psychiatric patients transferred for inpatient psychiatric care. Secondary outcomes included mean number of hours on ambulance diversion per month and the mean number of patients who left without being seen (LWBS) from the ED. A total of 1,884 patient visits were considered. Compared to the preintervention phase, median LOS for patients transferred for inpatient psychiatric care decreased by about 22% (p < 0.0005, 95% confidence interval [CI] = 15% to 28%) in the postintervention phase. Ambulance diversion hours increased by about 40 hours per month (p = 0.008, 95% CI = 11 to 69 hours) and the mean number of patients who LWBS decreased by about 26 per month (p = 0.106; 95% CI = -60 to 5.9 visits per month) in the postintervention phase. A comanagement model was associated with a marked reduction in the LOS for this patient population. © 2013 by the Society for Academic Emergency Medicine.

Impact of Palliative Care Screening and Consultation in the ICU: A Multihospital Quality Improvement Project.

PubMed

Zalenski, Robert J; Jones, Spencer S; Courage, Cheryl; Waselewsky, Denise R; Kostaroff, Anna S; Kaufman, David; Beemath, Afzal; Brofman, John; Castillo, James W; Krayem, Hicham; Marinelli, Anthony; Milner, Bradley; Palleschi, Maria Teresa; Tareen, Mona; Testani, Sheri; Soubani, Ayman; Walch, Julie; Wheeler, Judy; Wilborn, Sonali; Granovsky, Hanna; Welch, Robert D

2017-01-01

There are few multicenter studies that examine the impact of systematic screening for palliative care and specialty consultation in the intensive care unit (ICU). To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was used to estimate the conditional probability of receiving a PCC and to balance important covariates. For patients with and without PCCs, outcomes studied were as follows: 1) change to "do not resuscitate" (DNR), 2) discharge to hospice, 3) 30-day readmission, 4) hospital length of stay (LOS), 5) total direct hospital costs. In 405 patients with positive screens, 161 (40%) who received a PCC were compared to 244 who did not. Patients receiving PCCs had higher rates of DNR-adjusted odds ratio (AOR) = 7.5; 95% CI 5.6-9.9) and hospice referrals-(AOR = 7.6; 95% CI 5.0-11.7). They had slightly lower 30-day readmissions-(AOR = 0.7; 95% CI 0.5-1.0); no overall difference in direct costs or LOS was found between the two groups. When patients receiving PCCs were stratified by time to PCC initiation, early consultation-by Day 4 of admission-was associated with reductions in LOS (1.7 days [95% CI -3.1, -1.2]) and average direct variable costs (-$1815 [95% CI -$3322, -$803]) compared to those who received no PCC. Receiving a PCC in the ICUs was significantly associated with more frequent DNR code status and hospice referrals, but not 30-day readmissions or hospital utilization. Early PCC was associated with significant LOS and direct cost reductions. Providing PCC early in the ICU should be considered. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

77 FR 31587 - Fishing Capacity Reduction Program for the Pacific Coast Groundfish Fishery

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-29

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC048 Fishing Capacity Reduction Program for the Pacific Coast Groundfish Fishery AGENCY: National Marine Fisheries...-loan in the fishing capacity reduction program for the Pacific Coast Groundfish Fishery has been repaid...

77 FR 55191 - Fishing Capacity Reduction Program for the Pacific Coast Groundfish Fishery

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-07

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC219 Fishing Capacity Reduction Program for the Pacific Coast Groundfish Fishery AGENCY: National Marine Fisheries... sub-loan in the fishing capacity reduction program for the Pacific Coast Groundfish Fishery has been...

Field Measurement and Model Evaluation Program for Assessment of the Environmental Effects of Military Smokes: Evaluation of Atmospheric Dispersion Models for Fog-Oil Smoke Dispersion

DTIC Science & Technology

1989-02-01

EK 111. TRIAL 19, L 2. \\ (,’, i / ඘ I€ m m B-02 I SMOKE WEEK IV -TRIAL 3 -- LOS1 DOSAGE 0.06 COMESIC U ACT II.......... MAD PUFF 0m0 _LUDWIG (1977...PUFF, AND LUDWIG (1977) WITH FIELD DATA FROM SMOKE WEEK IV. TRIAL 3. LOS1 l (c) For short release times and the calculation of dosages, the randomization

Los Alamos National Laboratory Meteorology Monitoring Program: 2016 Data Completeness/ Quality Report

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

Bruggeman, David Alan

This report summarizes data completeness by tower and by instrument for 2016 and compares that data with the Los Alamos National Laboratory (LANL) and American National Standards Institute (ANSI) 2015 standards. This report is designed to make data users aware of data completeness and any data quality issues. LANL meteorology monitoring goals include 95% completeness for all measurements. The ANSI 2015 standard requires 90% completeness for all measurements. This report documents instrument/tower issues as they impact data completeness.

Effect of Flexible Duty Hour Policies on Length of Stay for Complex Intra-Abdominal Operations: A Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial Analysis.

PubMed

Stulberg, Jonah J; Pavey, Emily S; Cohen, Mark E; Ko, Clifford Y; Hoyt, David B; Bilimoria, Karl Y

2017-02-01

Changes to resident duty hour policies in the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial could impact hospitalized patients' length of stay (LOS) by altering care coordination. Length of stay can also serve as a reflection of all complications, particularly those not captured in the FIRST trial (eg pneumothorax from central line). Programs were randomized to either maintaining current ACGME duty hour policies (Standard arm) or more flexible policies waiving rules on maximum shift lengths and time off between shifts (Flexible arm). Our objective was to determine whether flexibility in resident duty hours affected LOS in patients undergoing high-risk surgical operations. Patients were identified who underwent hepatectomy, pancreatectomy, laparoscopic colectomy, open colectomy, or ventral hernia repair (2014-2015 academic year) at 154 hospitals participating in the FIRST trial. Two procedure-stratified evaluations of LOS were undertaken: multivariable negative binomial regression analysis on LOS and a multivariable logistic regression analysis on the likelihood of a prolonged LOS (>75 th percentile). Before any adjustments, there was no statistically significant difference in overall mean LOS between study arms (Flexible Policy: mean [SD] LOS 6.03 [5.78] days vs Standard Policy: mean LOS 6.21 [5.82] days; p = 0.74). In adjusted analyses, there was no statistically significant difference in LOS between study arms overall (incidence rate ratio for Flexible vs Standard: 0.982; 95% CI, 0.939-1.026; p = 0.41) or for any individual procedures. In addition, there was no statistically significant difference in the proportion of patients with prolonged LOS between study arms overall (Flexible vs Standard: odds ratio = 1.028; 95% CI, 0.871-1.212) or for any individual procedures. Duty hour flexibility had no statistically significant effect on LOS in patients undergoing complex intra-abdominal operations. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Derechos Educacionales de los Padres: Una Explicacion de los Procedimientos de Seguridad para los Padres de Ninos con Discapacidades. Bajo la Clausula del Acta de Educacion para Individuos con Discapacidades (IDEA) y las Reglas para la Administracion del Acta de Educacion para Ninos Excepcionales (Educational Rights of Parents: An Explanation of Procedural Safeguards Available to Parents of Children with Disabilities. Under Provisions of the Individuals with Disabilities Education Act (IDEA) and the Rules for the Administration of the Exceptional Children's Educational Act [ECEA]).

ERIC Educational Resources Information Center

Mountain Plains Regional Resource Center, Des Moines, IA.

This pamphlet, in Spanish, describes Colorado parents' educational rights under federal and state special education rules and regulations. It addresses: (1) free appropriate public education and termination of services; (2) required prior notice to parents if there is a proposed change or refusal to change a child's special education program; (3)…

Penetrating radiation: applications at Los Alamos National Laboratory

NASA Astrophysics Data System (ADS)

Watson, Scott; Hunter, James; Morris, Christopher

2013-09-01

Los Alamos has used penetrating radiography extensively throughout its history dating back to the Manhattan Project where imaging dense, imploding objects was the subject of intense interest. This interest continues today as major facilities like DARHT1 have become the mainstay of the US Stockpile Stewardship Program2 and the cornerstone of nuclear weapons certification. Meanwhile, emerging threats to national security from cargo containers and improvised explosive devices (IEDs) have invigorated inspection efforts using muon tomography, and compact x-ray radiography. Additionally, unusual environmental threats, like those from underwater oil spills and nuclear power plant accidents, have caused renewed interest in fielding radiography in severe operating conditions. We review the history of penetrating radiography at Los Alamos and survey technologies as presently applied to these important problems.

Extended Length of Stay in Elderly Patients After Lumbar Decompression and Fusion Surgery is May Not be Attributable to Baseline Illness Severity or Postoperative Complications.

PubMed

Adogwa, Owoicho; Desai, Shyam A; Vuong, Victoria D; Lilly, Daniel T; Ouyang, Bichun; Davison, Mark; Khalid, Syed; Bagley, Carlos A; Cheng, Joseph

2018-05-31

Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended stay are baseline patient illness, postoperative complications, or physician practice differences. However, the degree extended length of stay (LOS) represents illness severity or postoperative complications remains unknown. The aim is to investigate the influence of postoperative complications and patient comorbidities on extended length of stay after lumbar spine surgery in elderly patients. In this retrospective cohort study from 2008-2014, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine the odds-ratio for risk-adjusted LOS. The primary outcome was the degree extended LOS represented patient illness or postoperative complications. Of 9,482 cases, 1,909 (20.13%) had extended LOS. A minority of extended LOS patients had a history of relevant comorbidities-diabetes (21.76%), COPD (8.17%), CHF (0.94%), MI (0%), acute renal failure (0.47%), and stroke (2.23%). 93% of patients with normal LOS had no complication, 5.19% had one complication, and 1.69% had greater than one complication. Among extended LOS patients, 73.65% had no complications, 18.96% had one complication, and 7.39% had greater than one complication (p<0.000). Our study suggests much of the variation in LOS for elderly lumbar spine surgery patients is not attributable to baseline patient illness or postoperative complications and therefore, most likely represents differences in practice style or surgeon preference. Copyright © 2018 Elsevier Inc. All rights reserved.

77 FR 26744 - Fishing Capacity Reduction Program for the Southeast Alaska Purse Seine Salmon Fishery

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

... Capacity Reduction Program for the Southeast Alaska Purse Seine Salmon Fishery AGENCY: National Marine... of reduction payment tender of Southeast Alaska purse seine salmon permits. SUMMARY: The National... Southeast Alaska purse seine salmon fishery. The program authorizes NMFS to make payments to permit holders...

Identification of complications that have a significant effect on length of stay after spine surgery and predictive value of 90-day readmission rate.

PubMed

Yadla, Sanjay; Ghobrial, George M; Campbell, Peter G; Maltenfort, Mitchell G; Harrop, James S; Ratliff, John K; Sharan, Ashwini D

2015-12-01

Complications after spine surgery have an impact on overall outcome and health care expenditures. The increased cost of complications is due in part to associated prolonged hospital stays. The authors propose that certain complications have a greater impact on length of stay (LOS) than others and that those complications should be the focus of future targeted prevention efforts. They conducted a retrospective analysis of a prospectively maintained database to identify complications with the greatest impact on LOS as well as the predictive value of these complications with respect to 90-day readmission rates. Data on 249 patients undergoing spine surgery at Thomas Jefferson University from May to December 2008 were collected by a study auditor. Any complications occurring within 30 days of surgery were recorded as was overall LOS for each patient. Stepwise regression analysis was performed to determine whether specific complications had a statistically significant effect on LOS. For correlation, all readmissions within 90 days were recorded and organized by complication for comparison with those complications affecting LOS. The mean LOS for patients without postoperative complications was 6.9 days. Patients who developed pulmonary complications had an associated increase in LOS of 11.1 days (p < 0.005). The development of a urinary tract infection (UTI) was associated with an increase in LOS of 3.4 days (p = 0.002). A new neurological deficit was associated with an increase in LOS of 8.2 days (p = 0.004). Complications requiring return to the operating room (OR) showed a trend toward an increase in LOS of 4.7 days (p = 0.09), as did deep wound infections (3.3 days, p = 0.08). The most common reason for readmission was for wound drainage (n = 21; surgical drainage was required in 10 [4.01%] of these 21 cases). The most common diagnoses for readmission, in decreasing order of incidence, were categorized as hardware malpositioning (n = 4), fever (n = 4), pulmonary (n = 2), UTI (n = 2), and neurological deficit (n = 1). Complications affecting LOS were not found to be predictive of readmission (p = 0.029). Postoperative complications in patients who have undergone spine surgery are not uncommon and are associated with prolonged hospital stays. In the current cohort, the occurrence of pulmonary complications, UTI, and new neurological deficit had the greatest effect on overall LOS. Further study is required to determine the causative factors affecting readmission. These specific complications may be high-yield targets for cost reduction and/or prevention efforts.

Altered nuclear tRNA metabolism in La-deleted Schizosaccharomyces pombe is accompanied by a nutritional stress response involving Atf1p and Pcr1p that is suppressible by Xpo-t/Los1p.

PubMed

Cherkasova, Vera; Maury, Luis Lopez; Bacikova, Dagmar; Pridham, Kevin; Bähler, Jürg; Maraia, Richard J

2012-02-01

Deletion of the sla1(+) gene, which encodes a homologue of the human RNA-binding protein La in Schizosaccharomyces pombe, causes irregularities in tRNA processing, with altered distribution of pre-tRNA intermediates. We show, using mRNA profiling, that cells lacking sla1(+) have increased mRNAs from amino acid metabolism (AAM) genes and, furthermore, exhibit slow growth in Edinburgh minimal medium. A subset of these AAM genes is under control of the AP-1-like, stress-responsive transcription factors Atf1p and Pcr1p. Although S. pombe growth is resistant to rapamycin, sla1-Δ cells are sensitive, consistent with deficiency of leucine uptake, hypersensitivity to NH4, and genetic links to the target of rapamycin (TOR) pathway. Considering that perturbed intranuclear pre-tRNA metabolism and apparent deficiency in tRNA nuclear export in sla1-Δ cells may trigger the AAM response, we show that modest overexpression of S. pombe los1(+) (also known as Xpo-t), encoding the nuclear exportin for tRNA, suppresses the reduction in pre-tRNA levels, AAM gene up-regulation, and slow growth of sla1-Δ cells. The conclusion that emerges is that sla1(+) regulates AAM mRNA production in S. pombe through its effects on nuclear tRNA processing and probably nuclear export. Finally, the results are discussed in the context of stress response programs in Saccharomyces cerevisiae.

Altered nuclear tRNA metabolism in La-deleted Schizosaccharomyces pombe is accompanied by a nutritional stress response involving Atf1p and Pcr1p that is suppressible by Xpo-t/Los1p

PubMed Central

Cherkasova, Vera; Lopez Maury, Luis; Bacikova, Dagmar; Pridham, Kevin; Bähler, Jürg; Maraia, Richard J.

2012-01-01

Deletion of the sla1+ gene, which encodes a homologue of the human RNA-binding protein La in Schizosaccharomyces pombe, causes irregularities in tRNA processing, with altered distribution of pre-tRNA intermediates. We show, using mRNA profiling, that cells lacking sla1+ have increased mRNAs from amino acid metabolism (AAM) genes and, furthermore, exhibit slow growth in Edinburgh minimal medium. A subset of these AAM genes is under control of the AP-1–like, stress-responsive transcription factors Atf1p and Pcr1p. Although S. pombe growth is resistant to rapamycin, sla1-Δ cells are sensitive, consistent with deficiency of leucine uptake, hypersensitivity to NH4, and genetic links to the target of rapamycin (TOR) pathway. Considering that perturbed intranuclear pre-tRNA metabolism and apparent deficiency in tRNA nuclear export in sla1-Δ cells may trigger the AAM response, we show that modest overexpression of S. pombe los1+ (also known as Xpo-t), encoding the nuclear exportin for tRNA, suppresses the reduction in pre-tRNA levels, AAM gene up-regulation, and slow growth of sla1-Δ cells. The conclusion that emerges is that sla1+ regulates AAM mRNA production in S. pombe through its effects on nuclear tRNA processing and probably nuclear export. Finally, the results are discussed in the context of stress response programs in Saccharomyces cerevisiae. PMID:22160596

Case report: a balance training program using the Nintendo Wii Fit to reduce fall risk in an older adult with bilateral peripheral neuropathy.

PubMed

Hakim, Renée Marie; Salvo, Charles J; Balent, Anthony; Keyasko, Michael; McGlynn, Deidre

2015-02-01

A recent systematic review supported the use of strength and balance training for older adults at risk for falls, and provided preliminary evidence for those with peripheral neuropathy (PN). However, the role of gaming systems in fall risk reduction was not explored. The purpose of this case report was to describe the use of the Nintendo® Wii™ Fit gaming system to train standing balance in a community-dwelling older adult with PN and a history of recurrent near falls. A 76-year-old patient with bilateral PN participated in 1 h of Nintendo® Wii™ Fit balance training, two times a week for 6 weeks. Examination was conducted using a Computerized Dynamic Posturography system (i.e. Sensory Organization Test (SOT), Limits of Stability (LOS), Adaptation Test (ADT) and Motor Control Test (MCT) and clinical testing with the Berg Balance Scale (BBS), Timed Up and Go (TUG), Activities-specific Balance Confidence (ABC) scale and 30-s Chair Stand. Following training, sensory integration scores on the SOT were unchanged. Maximum excursion abilities improved by a range of 37-86% on the LOS test. MCT scores improved for amplitude with forward translations and ADT scores improved for downward platform rotations. Clinical scores improved on the BBS (28/56-34/56), ABC (57.5-70.6%) and TUG (14.9-10.9 s) which indicated reduced fall risk. Balance training with a gaming system showed promise as a feasible, objective and enjoyable method to improve physical performance and reduce fall risk in an individual with PN.

Pharmacy syringe purchase test of nonprescription syringe sales in San Francisco and Los Angeles in 2010.

PubMed

Lutnick, Alexandra; Cooper, Erin; Dodson, Chaka; Bluthenthal, Ricky; Kral, Alex H

2013-04-01

The two main legal sources of clean needles for illicit injection drug users (IDUs) in California are syringe exchange programs (SEPs) and nonprescription syringe sales (NPSS) at pharmacies. In 2004, California became one of the last states to allow NPSS. To evaluate the implementation of NPSS and the California Disease Prevention Demonstration Project (DPDP), we conducted syringe purchase tests in San Francisco (SF) and Los Angeles (LA) between March and July of 2010. Large differences in implementation were observed in the two cities. In LA, less than one-quarter of the enrolled pharmacies sold syringes to our research assistant (RA), and none sold a single syringe. The rate of successful purchase in LA is the lowest reported in any syringe purchase test. In both sites, there was notable variation among the gauge size available, and price and quantity of syringes required for a purchase. None of the DPDP pharmacies in LA or SF provided the requisite health information. The findings suggest that more outreach needs to be conducted with pharmacists and pharmacy staff. The pharmacies' failure to disseminate the educational materials may result in missed opportunities to provide needed harm reduction information to IDUs. The varied prices and required quantities may serve as a barrier to syringe access among IDUs. Future research needs to examine reasons why pharmacies do not provide the mandated information, whether the omission of disposal options is indicative of pharmacies' reluctance to serve as disposal sites, and if the dual opt-in approach of NPSS/DPDP is a barrier to pharmacy enrollment.

Joint Optics Structures Experiment (JOSE)

NASA Technical Reports Server (NTRS)

Founds, David

1987-01-01

The objectives of the JOSE program is to develop, demonstrate, and evaluate active vibration suppression techniques for Directed Energy Weapons (DEW). DEW system performance is highly influenced by the line-of-sight (LOS) stability and in some cases by the wave front quality. The missions envisioned for DEW systems by the Strategic Defense Initiative require LOS stability and wave front quality to be significantly improved over any current demonstrated capability. The Active Control of Space Structures (ACOSS) program led to the development of a number of promising structural control techniques. DEW structures are vastly more complex than any structures controlled to date. They will be subject to disturbances with significantly higher magnitudes and wider bandwidths, while holding higher tolerances on allowable motions and deformations. Meeting the performance requirements of the JOSE program requires upgrading the ACOSS techniques to meet new more stringent requirements, the development of requisite sensors and acturators, improved control processors, highly accurate system identification methods, and the integration of hardware and methodologies into a successful demonstration.

Promoting the University Social Responsibility in the Capacity Development Program for Landslide Risk Reduction in Indonesia

NASA Astrophysics Data System (ADS)

Karnawati, D.; Wilopo, W.; Verrier, M.; Fathani, T. F.; Andayani, B.

2011-12-01

One of the most challenges efforts for landslides disaster risk reduction in Indonesia is to provide an effective program for capacity development of the community living in the vulnerable area. Limited access for appropriate information and knowledge about the geology and landslide phenomena as well as the social-security constrains are the major challenges in capacity development program in the landslide prone area. Accordingly, an action for conducting community-based research and education program with respect to landslide mitigation and disaster risk reduction at the village level was established by implementing the University Social Responsibility Program. Such program has been conducted regularly in every academic semester as a part of the formal academic program at Universitas Gadjah Mada , Indonesia. Twenty students with multi-discipline backgrounds and supported by their lectures/advisers have to be deployed at the village for two months to carry out such mission. This action is also conducted under the coordination with the local/ national Government together with the local community, and may also with the private sectors. A series of research actions such as landslide investigation and hazard-risk mapping, social mapping and development of landslide early warning system were carried out in parallel with public education and evacuation drill for community empowerment and landslide risk reduction. A Community Task Force for Disaster Risk Reduction was also established during the community empowerment program, in order to guarantee the affectivity and sustainability of the disaster risk reduction program at the village level. It is crucial that this program is not only beneficial for empowering the village community to tackle the landslide problems, but also important to support the education for sustainable development program at the disaster prone area. Indeed, this capacity development program may also be considered as one best practice for transforming the knowledge into action and the action into knowledge enhancement, with respect to landslide disaster risk reduction.
Scope of problems and the actions conducted by Universitas Gadjah Mada as The University Social Responsibility Program for Landslide Disaster Risk Reduction in Indonesia

Linking Indices for Biodiversity Monitoring to Extinction Risk Theory

PubMed Central

Mccarthy, Michael A; Moore, Alana L; Krauss, Jochen; Morgan, John W; Clements, Christopher F

2014-01-01

Biodiversity indices often combine data from different species when used in monitoring programs. Heuristic properties can suggest preferred indices, but we lack objective ways to discriminate between indices with similar heuristics. Biodiversity indices can be evaluated by determining how well they reflect management objectives that a monitoring program aims to support. For example, the Convention on Biological Diversity requires reporting about extinction rates, so simple indices that reflect extinction risk would be valuable. We developed 3 biodiversity indices that are based on simple models of population viability that relate extinction risk to abundance. We based the first index on the geometric mean abundance of species and the second on a more general power mean. In a third index, we integrated the geometric mean abundance and trend. These indices require the same data as previous indices, but they also relate directly to extinction risk. Field data for butterflies and woodland plants and experimental studies of protozoan communities show that the indices correlate with local extinction rates. Applying the index based on the geometric mean to global data on changes in avian abundance suggested that the average extinction probability of birds has increased approximately 1% from 1970 to 2009. Conectando Índices para el Monitoreo de la Biodiversidad con la Teoría de Riesgo de Extinción Resumen Los índices de biodiversidad combinan frecuentemente los datos de diferentes especies cuando se usan en los programas de monitoreo. Las propiedades heurísticas pueden sugerir índices preferidos, pero carecemos de medios objetivos para discriminar a los índices con propiedades heurísticas similares. Los índices de biodiversidad pueden evaluarse al determinar qué tan bien reflejan los objetivos de manejo que un programa de monitoreo busca apoyar. Por ejemplo, la Convención sobre la Diversidad Biológica requiere reportar las tasas de extinción, así que los índices que reflejan el riesgo de extinción serían valiosos. Desarrollamos 3 índices de biodiversidad que se basan en modelos sencillos de viabilidad de población y que relacionan el riesgo de extinción con la abundancia. Basamos el primer índice en la media geométrica de la abundancia de especies, y el segundo en una media de poder más general. En el tercer índice integramos la media geométrica y la tendencia. Estos índices requieren los mismos datos que índices previos, pero también se relacionan directamente con el riesgo de extinción. La información de campo sobre mariposas y plantas de bosque, y los estudios experimentales de comunidades protozoarias, muestran que los índices se correlacionan con las tasas locales de extinción. Al aplicar el índice basado en la media geométrica sobre los datos globales de los cambios en la abundancia de aves, sugirió que la probabilidad de extinción promedio de aves ha incrementado aproximadamente 1% desde 1970 hasta 2009. Palabras Clave Índice de biodiversidad, media geométrica, medida de la biodiversidad, riesgo de extinción PMID:24820139

The Impact of Two Los Angeles County Teen Courts on Youth Recidivism: Comparing Two Informal Probation Programs.

PubMed

Gase, Lauren N; Kuo, Tony; Lai, Elaine; Stoll, Michael A; Ponce, Ninez

2016-03-01

This study sought to examine the impact of two Teen Courts operating in Los Angeles County, a juvenile justice system diversion program in which youth are judged by their peers and given restorative sentences to complete during a period of supervision. A quasi-experimental design was used to compare youth who participated in Teen Court (n=112) to youth who participated in another diversion program administered by the Probation Department (the 654 Contract program) (n=194). Administrative data were abstracted from Probation records for all youth who participated in these programs between January 1, 2012 and June 20, 2014. Logistic and survival models were used to examine differences in recidivism - measured as whether the minor had any subsequent arrest or arrests for which the charge was filed. Comparison group participants had higher rates of recidivism than Teen Court participants, after controlling for age, gender, race/ethnicity, and risk level. While the magnitude of the program effects were fairly consistent across model specifications (odd ratios comparing Teen Court [referent] to school-based 654 Contract ranging from 1.95 to 3.07, hazard ratios ranging from 1.62 to 2.27), differences were not statistically significant in all scenarios. While this study provides modest support for the positive impact of Teen Court, additional research is needed to better understand how juvenile diversion programs can improve youth outcomes.

75 FR 33570 - Magnuson-Stevens Act Provisions; Fishing Capacity Reduction Framework

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-14

.... 100330171-0232-01] RIN 0648-AY79 Magnuson-Stevens Act Provisions; Fishing Capacity Reduction Framework... regulations specifying procedures for implementing fishing capacity reduction programs (reduction programs) in... either to surrender their fishing permits including relevant fishing histories for that fishery, or...

Regulation of oxygen utilization by angiotensin II in chronic kidney disease

PubMed Central

Deng, Aihua; Tang, Tong; Singh, Prabhleen; Wang, Chen; Satriano, Joe; Thomson, Scott C; Blantz, Roland C

2010-01-01

Angiotensin II (ANG II) blockade delays progression of chronic kidney disease (CKD) by modifying intrarenal hemodynamics, but the effect on metabolic adaptations has not been examined. Using renal ablation/infarction (A/I) model of CKD in rats at one week, the effects of ANG II blockade by captopril (CAP) and losartan (LOS) on renal O2 consumption (QO2), renal nitric oxide (NO) activity and nitric oxide synthase (NOS) protein expression was examined. A/I kidneys exhibited proteinuria, reduced GFR, renal blood flow (RBF) and NOS-1 protein expression, while QO2 factored by sodium reabsorption (QO2/TNa) was markedly increased. CAP + LOS treatment increased GFR, RBF, and TNa, while QO2 remained unchanged, thus normalizing QO2/TNa. NOS-1 expression was normalized with CAP + LOS, as was proteinuria. Triple antihypertensive therapy administered to control for the blood pressure reduction, and lysine administration to increase GFR and RBF, did not normalize QO2/TNa, suggesting a specific effect of ANG II in elevating QO2/TNa. NOS blockade, to test functional NO activity on QO2 and QO2/TNa, increased QO2 in shams, but not in untreated A/I. The increase in QO2 was restored in CAP + LOS treated A/I. CAP + LOS treatment normalized the increased QO2/TNa and functional NO activity in A/I independent of the blood pressure and GFR effects, providing evidence for an additional mechanism underlying the benefits of ANG II inhibition therapy. PMID:18818681

Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs.

PubMed

Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki; Ohe, Kazuhiko

2005-09-01

In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine.

Early Impacts of a Healthy Food Distribution Program on the Availability and Price of Fresh Fruits and Vegetables in Small Retail Venues in Los Angeles.

PubMed

DeFosset, Amelia R; Gase, Lauren N; Webber, Eliza; Kuo, Tony

2017-10-01

Healthy food distribution programs that allow small retailers to purchase fresh fruits and vegetables at wholesale prices may increase the profitability of selling produce. While promising, little is known about how these programs affect the availability of fresh fruits and vegetables in underserved communities. This study examined the impacts of a healthy food distribution program in Los Angeles County over its first year of operation (August 2015-2016). Assessment methods included: (1) a brief survey examining the characteristics, purchasing habits, and attitudes of stores entering the program; (2) longitudinal tracking of sales data examining changes in the volume and variety of fruits and vegetables distributed through the program; and (3) the collection of comparison price data from wholesale market databases and local grocery stores. Seventeen stores participated in the program over the study period. One-fourth of survey respondents reported no recent experience selling produce. Analysis of sales data showed that, on average, the total volume of produce distributed through the program increased by six pounds per week over the study period (95% confidence limit: 4.50, 7.50); trends varied by store and produce type. Produce prices offered through the program approximated those at wholesale markets, and were lower than prices at full-service grocers. Results suggest that healthy food distribution programs may reduce certain supply-side barriers to offering fresh produce in small retail venues. While promising, more work is needed to understand the impacts of such programs on in-store environments and consumer behaviors.

Indio and Hispano Child: Improving His Self Image.

ERIC Educational Resources Information Center

Gallegos, Katherine Powers, Ed.

Prepared under a Title IV Civil Rights program grant, this document consists of social studies units for grades 1 and 4, suggestions for a culturally oriented arts program, biographical sketches of cultural models, and brief historical sketches of communities in the area of Los Lunas, New Mexico. The purpose of the units of instruction and related…

Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2004-2005. Report Summary

ERIC Educational Resources Information Center

Turner, Susan; Fain, Terry; MacDonald, John; Sehgal, Amber

2007-01-01

This document summarizes a report focusing on California counties receiving funds from Juvenile Justice Crime Prevention Act (JJCPA) programs. These counties are required to report six outcome measures to the California State Legislature on an annual basis to measure the success of the program. These outcome measures are (1) successful completion…

Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2005-2006. Report Summary

ERIC Educational Resources Information Center

Turner, Susan; Fain, Terry; Sehgal, Amber

2007-01-01

This document summarizes a study relating to California counties receiving state funds for Juvenile Justice Crime Prevention Act (JJCPA) programs. These counties are required to report six outcome measures to the California State Legislature on an annual basis to measure the success of the program. These outcome measures are (1) successful…

Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2004-2005 Report

ERIC Educational Resources Information Center

Turner, Susan; Fain, Terry; MacDonald, John; Sehgal, Amber

2007-01-01

California counties receiving funds from Juvenile Justice Crime Prevention Act (JJCPA) programs are required to report six outcome measures to the California State Legislature on an annual basis to measure the success of the program. These outcome measures are (1) successful completion of probation, (2) arrests, (3) probation violations, (4)…

Education and Outreach Programs at the Reagan Library.

ERIC Educational Resources Information Center

Cumming, Gregory G.

This exploration of the need and potential for education and outreach programs at the Reagan Library begins by examining factors that make the Reagan library unique, i.e., its proximity to Los Angeles and a small town setting, closeness to the Nixon Library and birthplace, and Ronald Reagan's popularity. It is noted that, since the Reagan Library…

78 FR 39769 - National Register of Historic Places; Notification of Pending Nominations and Related Actions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

... Chautauqua Blvd., Los Angeles, 13000513 Community Clubhouse, 1200 N. Vista St., West Hollywood, 13000510... Study House No. 23A, (Case Study House Program MPS) 2342 Rue de Anne, La Jolla, 13000520 Case Study House No. 23C, (Case Study House Program MPS) 2339 Rue de Anne, La Jolla, 13000521 Ventura County Case...

A Needs Assessment for a Community College Outreach Program: Implications for Curriculum Development.

ERIC Educational Resources Information Center

Smith, Jack E.

An educational needs assessment of the seven-community service area of Los Angeles Harbor College (California) was conducted to identify sources of demographic information, and to analyze and compile this information to provide a resource for both college and community committees in drafting plans for an expanded outreach program. A four-point…

ICT, Literacy and Teacher Change: The Effectiveness of ICT Options in Kenya

ERIC Educational Resources Information Center

Piper, Benjamin

2014-01-01

There is a dearth of literature that use research design for causal inference that estimate the effect of information and communications technology (ICT) programs on literacy outcomes in early primary, particularly in Sub-Saharan Africa. There are several programs that have used ICT at a large scale, including Los Angeles, Peru, Nicaragua, Rwanda…

Reemployment Assistance for Engineers, Scientists, and Technicians Unemployed Because of Aerospace and Defense Cutbacks. Report to Congress.

ERIC Educational Resources Information Center

Comptroller General of the U.S., Washington, DC.

As a report on the Department of Labor's Technology Mobilization and Reemployment (TMR) program, findings and conclusions from an evaluative review are presented in this volume. Information is obtained from state eployment security offices in Los Angeles and Van Nuys, California; Seattle; Denver; and New Orleans. The program accomplishments are…

Third Year Report: Evaluation of the Artful Learning Program. CRESST Report 760

ERIC Educational Resources Information Center

Griffin, Noelle C.; Miyoshi, Judy N.

2009-01-01

The National Center for Research on Evaluation, Standards, and Student Testing (CRESST) at University of California, Los Angeles (UCLA) was contracted to undertake a three-year external evaluation of the Artful Learning program, an arts-based school improvement model developed from the work and philosophy of the late composer Leonard Bernstein.…

The Coded Schoolhouse: One-to-One Tablet Computer Programs and Urban Education

ERIC Educational Resources Information Center

Crooks, Roderic N.

2016-01-01

Using a South Los Angeles charter school of approximately 650 students operated by a non-profit charter management organization (CMO) as the primary field site, this two-year, ethnographic research project examines the implementation of a one-to-one tablet computer program in a public high school. This dissertation examines the variety of ways…

"We Could Do That!" A Guide to Diversity Practices in California Community Colleges.

ERIC Educational Resources Information Center

Gabriner, Robert; Schiorring, Eva; Waldron, Gail

This document describes three different programs at three California Community Colleges, each of which has as its aim to improve their ability to serve an expanding and increasingly diverse student population. The programs are: (1) Project MATCH (Mentors Act To Change History) at the Los Angeles Community College District (LACCD); (2) The Disabled…

The effects of losartan on memory performance and leptin resistance induced by obesity and high-fat diet in adult male rats

PubMed Central

Sharieh Hosseini, Seyydeh Gohar; Khatamsaz, Saeed; Shariati, Mehrdad

2014-01-01

Objective(s): Leptin is a hormone secreted by adipose tissue and is involved not only in the regulation of feeding and energy expenditure, but also its role in memory enhancement has been demonstrated as well. The partial transfer of leptin across the blood-brain barrier in obese individuals causes leptin resistance and prevents leptin reaching brain. On the other hand, studies have shown that angiotensin antagonists such as losartan can improve memory and learning abilities. The aim of this study was to evaluate the effects of losartan on improving memory and leptin resistance induced by high fat diet in obese rats. Materials and Methods: 40 Wistar male rats were divided in 4 groups: control (C), losartan (LOS), high-fat diet (HFD) and high-fat diet and losartan (HFD and LOS). The spatial memory performances of the rats were assessed in the Morris water maze after 2 months of treatment. Then they were weighed and serum levels of leptin and triglyceride were measured. Results: In spite of receiving high-fat diet, no significant differences in body weight were observed in the (HFD & LOS) group. In the Morris water maze trial, the (LOS) and (HFD & LOS) groups also showed a significant reduction (P <0.05) in latency and path length. In addition, a significant decrease (P <0.05) in serum levels of leptin and no significant difference in serum levels of triglyceride was observed in the (HFD & LOS) group. Conclusion: Losartan can improve leptin resistance induced by obesity and high fat diet. At the same time, it modulates body weight and enhances learning and memory. PMID:24592306

Impact of a Web-based worksite health promotion program on absenteeism.

PubMed

Niessen, Maurice A J; Kraaijenhagen, Roderik A; Dijkgraaf, Marcel G W; Van Pelt, Danielle; Van Kalken, Coen K; Peek, Niels

2012-04-01

To evaluate the effect of participation in a comprehensive, Web-based worksite health promotion program on absenteeism. Study population consists of Dutch workers employed at a large financial services company. Linear regression was used to assess the impact of program attendance on the difference between baseline and follow-up absenteeism rates, controlling for gender, age, job level, years of employment, and noncompletion of the program. Data from 20,797 individuals were analyzed; 3826 individuals enrolled in the program during the study period. A 20.3% reduction in absenteeism was shown among program attendees compared with nonparticipants during a median follow-up period of 23.3 months. Participating in the worksite health promotion program led to an immediate reduction in absenteeism. Improved psychological well-being, increased exercise, and weight reduction are possible pathways toward this reduction.

Evaluation of a Worksite-Controlled Smoking Program.

ERIC Educational Resources Information Center

Glasgow, Russell E.; And Others

1984-01-01

Evaluated the relative effectiveness of three versions of a controlled smoking program conducted in the worksite: abrupt reduction, gradual reduction, or gradual reduction plus feedback on nicotine consumption. All conditions were effective. There was some indication that the gradual reduction condition was more effective than the abrupt…

5 CFR 362.306 - Reduction in force and termination.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Reduction in force and termination. 362.306 Section 362.306 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PATHWAYS PROGRAMS Recent Graduates Program § 362.306 Reduction in force and termination. (a) Reduction in...

5 CFR 362.306 - Reduction in force and termination.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Reduction in force and termination. 362.306 Section 362.306 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PATHWAYS PROGRAMS Recent Graduates Program § 362.306 Reduction in force and termination. (a) Reduction in...

75 FR 62326 - Magnuson-Stevens Act Provisions; Fishing Capacity Reduction Framework

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-08

.... 100330171-0388-02] RIN 0648-AY79 Magnuson-Stevens Act Provisions; Fishing Capacity Reduction Framework... implementing fishing capacity reduction programs (reduction programs) in accordance with the Magnuson-Stevens... pays harvesters in a fishery that has more vessels than capacity either to surrender their fishing...

Summer of Innovation Kick Off

NASA Image and Video Library

2010-06-09

Performers from Los Angeles Hamilton High School's Kid Tribe entertain teachers and middle school students during the kick off of NASA's Summer of Innovation program at the Jet Propulsion Laboratory in Pasadena, Calif., Thursday, June 10, 2010. Through the program, NASA will engage thousands of middle school students and teachers in stimulating math and science-based education programs with the goal of increasing the number of future scientists, mathematicians, and engineers. Photo Credit: (NASA/Bill Ingalls)

Summer of Innovation Kick Off

NASA Image and Video Library

2010-06-09

A performer from Los Angeles Hamilton High School's Kid Tribe entertains teachers and middle school students during the kick off of NASA's Summer of Innovation program at the Jet Propulsion Laboratory in Pasadena, Calif., Thursday, June 10, 2010. Through the program, NASA will engage thousands of middle school students and teachers in stimulating math and science-based education programs with the goal of increasing the number of future scientists, mathematicians, and engineers. Photo Credit: (NASA/Bill Ingalls)

Summer of Innovation Kick Off

NASA Image and Video Library

2010-06-09

Teachers and middle school students react to performers from Los Angeles Hamilton High School's Kid Tribe during the kick off of NASA's Summer of Innovation program at the Jet Propulsion Laboratory in Pasadena, Calif., Thursday, June 10, 2010. Through the program, NASA will engage thousands of middle school students and teachers in stimulating math and science-based education programs with the goal of increasing the number of future scientists, mathematicians, and engineers. Photo Credit: (NASA/Bill Ingalls)

Variability in the gas phase composition of fluids discharged from Los Azufres geothermal field, Mexico

NASA Astrophysics Data System (ADS)

Santoyo, E.; Verma, S. P.; Nieva, D.; Portugal, E.

1991-07-01

Studies related to hydrological structure of the Los Azufres geothermal field and its effects on the exploitation of the field for generation of electrical energy have included a program of sampling and chemical analysis of fluids discharged by a number of deep wells in continuous production. Chemical analysis of the gaseous phase includes monitoring of CO 2, H 2S, NH 3, H 2, He, N 2, CH 4 and 222Rn. Five wells in Los Azufres field were periodically sampled during 1983-1988. The monitoring program has shown considerable variability in the gas concentrations of fluids. Before mid-1985, the 'base-line' concentrations of the gases showed standard deviations between 8 and 28%. During the later period, the average concentrations of different gases ranged from 37% to much higher values above the 'base-line'. The largest variations are observed in He, CO 2 and 222Rn. This variability is interpreted in terms of (1) addition of 'excess steam', (2) a possible relationship with earthquake events that occurred in México during September 19-21, 1985, and early May to early June of 1987 and, (3) more recent variations (after mid-1987), increased exploitation of the field.

Statistical analyses of the background distribution of groundwater solutes, Los Alamos National Laboratory, New Mexico.

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

Longmire, Patrick A.; Goff, Fraser; Counce, D. A.

2004-01-01

Background or baseline water chemistry data and information are required to distingu ish between contaminated and non-contaminated waters for environmental investigations conducted at Los Alamos National Laboratory (referred to as the Laboratory). The term 'background' refers to natural waters discharged by springs or penetrated by wells that have not been contaminated by LANL or other municipal or industrial activities, and that are representative of groundwater discharging from their respective aquifer material. These investigations are conducted as part of the Environmental Restoration (ER) Project, Groundwater Protection Program (GWPP), Laboratory Surveillance Program, the Hydrogeologic Workplan, and the Site-Wide Environmental Impact Statement (SWEIS).more » This poster provides a comprehensive, validated database of inorganic, organic, stable isotope, and radionuclide analyses of up to 136 groundwater samples collected from 15 baseline springs and wells located in and around Los Alamos National Laboratory, New Mexico. The region considered in this investigation extends from the western edge of the Jemez Mountains eastward to the Rio Grande and from Frijoles Canyon northward to Garcia Canyon. Figure 1 shows the fifteen stations sampled for this investigation. The sampling stations and associated aquifer types are summarized in Table 1.« less

Theatre as a Learning Tool.

ERIC Educational Resources Information Center

Goldman, Jeffrey

1991-01-01

Describes the Los Angeles Theatre Center's educational outreach project, "Theatre as a Learning Tool." Discusses the program, its effect on high school students, and the process of providing study guides for the teachers. (PRA)

Multifaceted intervention including education, rounding checklist implementation, cost feedback, and financial incentives reduces inpatient laboratory costs.

PubMed

Yarbrough, Peter M; Kukhareva, Polina V; Horton, Devin; Edholm, Karli; Kawamoto, Kensaku

2016-05-01

Inappropriate laboratory testing is a contributor to waste in healthcare. To evaluate the impact of a multifaceted laboratory reduction intervention on laboratory costs. A retrospective, controlled, interrupted time series (ITS) study. University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah. All patients 18 years or older admitted to the hospital to a service other than obstetrics, rehabilitation, or psychiatry. Multifaceted quality-improvement initiative in a hospitalist service including education, process change, cost feedback, and financial incentive. Primary outcomes of lab cost per day and per visit. Secondary outcomes of number of basic metabolic panel (BMP), comprehensive metabolic panel (CMP), complete blood count (CBC), and prothrombin time/international normalized ratio tests per day; length of stay (LOS); and 30-day readmissions. A total of 6310 hospitalist patient visits (intervention group) were compared to 25,586 nonhospitalist visits (control group). Among the intervention group, the unadjusted mean cost per day was reduced from $138 before the intervention to $123 after the intervention (P < 0.001), and the unadjusted mean cost per visit decreased from $618 to $558 (P = 0.005). The ITS analysis showed significant reductions in cost per day, cost per visit, and the number of BMP, CMP, and CBC tests per day (P = 0.034, 0.02, <0.001, 0.004, and <0.001). LOS was unchanged and 30-day readmissions decreased in the intervention group. A multifaceted approach to laboratory reduction demonstrated a significant reduction in laboratory cost per day and per visit, as well as common tests per day at a major academic medical center. Journal of Hospital Medicine 2016;11:348-354. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Contingent valuation of fuel hazard reduction treatments

Treesearch

John B. Loomis; Armando Gonzalez-Caban

2008-01-01

This chapter presents a stated preference technique for estimating the public benefits of reducing wildfires to residents of California, Florida, and Montana from two alternative fuel reduction programs: prescribed burning, and mechanical fuels reduction. The two fuel reduction programs under study are quite relevant to people living in California, Florida, and...

Health Care Usage and Related Costs in Fibular Plating for AO Type 44-B Ankle Fractures in a Belgian University Hospital: An Exploratory Analysis.

PubMed

Smeets, Bart; Nijs, Stefaan; Nderlita, Meri; Vandoren, Cindy; Hoekstra, Harm

2016-01-01

Open reposition and internal fixation (ORIF) is the reference standard for unstable Arbeitsgemeinschaft für Osteosynthesefragen (AO)-type 44-B ankle fractures. Age, comorbidity, delayed-staged surgery, and length-of-stay (LOS) are all factors that presumably correlate positively with health care costs. We performed an exploratory analysis of the health care costs associated with the treatment of this type of fracture and hypothesized that these costs will be significantly greater for the elderly. A total of 217 patients with an acute AO type 44-B ankle fracture were included. We studied 14 variables, and 5 main cost categories were defined. The health care costs associated with the treatment of ankle fractures in the present study constituted more than one half (53%) of the hospitalization costs, which, in turn, were strongly related to the LOS. Delayed-staged surgery and age were the most important clinical variables driving the total health care costs and LOS (p < .001). The median LOS before ORIF was 6 times greater (12 versus 2 days) for patients treated using a delayed-staged surgery protocol. The cutoff age above which the costs differed significantly was 65 years. Thus, the median total health care costs for the treatment of these fractures were doubled in the older group ($9207 versus $4559), mainly owing to a 2 times greater LOS before ORIF (2 versus 4 days) and 3 times greater total LOS (4 versus 12.5 days) in the elderly. Surprisingly, the complication rate was equal (27.7% versus 29.3%) in the 2 groups. Therefore, to decrease the total health care costs, we should focus on a reduction of the costly LOS before ORIF in the elderly population. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Cost and Cost-Effectiveness of Students for Nutrition and eXercise (SNaX).

PubMed

Ladapo, Joseph A; Bogart, Laura M; Klein, David J; Cowgill, Burton O; Uyeda, Kimberly; Binkle, David G; Stevens, Elizabeth R; Schuster, Mark A

2016-04-01

To examine the cost and cost-effectiveness of implementing Students for Nutrition and eXercise (SNaX), a 5-week middle school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Five intervention and 5 control middle schools (mean enrollment, 1520 students) from the Los Angeles Unified School District participated in a randomized controlled trial of SNaX. Acquisition costs for materials and time and wage data for employees involved in implementing the program were used to estimate fixed and variable costs. Cost-effectiveness was determined using the ratio of variable costs to program efficacy outcomes. The costs of implementing the program over 5 weeks were $5433.26 per school in fixed costs and $2.11 per student in variable costs, equaling a total cost of $8637.17 per school, or $0.23 per student per day. This investment yielded significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks. The cost-effectiveness of the program, per student over 5 weeks, was $1.20 per additional fruit served during meals, $8.43 per additional full-priced lunch served, $2.11 per additional reduced-price/free lunch served, and $1.69 per reduction in snacks sold. SNaX demonstrated the feasibility and cost-effectiveness of a middle school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Its cost is modest and unlikely to be a significant barrier to adoption for many schools considering its implementation. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Social media and gamification: Engaging vulnerable parents in an online evidence-based parenting program.

PubMed

Love, Susan M; Sanders, Matthew R; Turner, Karen M T; Maurange, Marianne; Knott, Theresa; Prinz, Ronald; Metzler, Carol; Ainsworth, Andrew T

2016-03-01

The aim of this study was to examine the feasibility (accessibility, engagement and impact) of adding social media and gaming features (e.g., social sharing with anonymity, badges to incentivize skills practice, an accredited facilitator for support) and access via smartphones to an evidenced-based parenting program, Triple P Online. The highly vulnerable population included 155 disadvantaged, high-risk parents (e.g., 76% had a family annual income of less than $15,000; 41% had been incarcerated; 38% were in drug/alcohol treatment; and 24% had had a child removed due to maltreatment). The ethnic groups most commonly identified were African American (24%) and Hispanic (66%). Respondents were primarily mothers (86%) from five community programs in Los Angeles. The study used a single group repeated measures design (pre, post, 6-month follow-up). Data collected included standardized self-report measures, post-intervention focus groups and interviews, website usage reports, and Google Analytics. Significant multivariate ANOVA time effects were found, demonstrating reductions in child behavioral problems, reduced lax/permissive and over-reactive parenting, and decreased parental stress. No effects were found for parental confidence, attributions, or depression and anxiety (which were in the normal range at baseline). Positive effects were maintained or improved at 6-month follow-up. The participants engaged in the online community and valued its flexibility, anonymity, and shared learning. This foundational implementation trial provides support for future rigorous evaluation of social media and gaming features as a medium for increasing parental engagement in evidence-based parenting programs online--a public health approach to protect and improve the development of vulnerable children. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Group-Based Motivational Interviewing Brief Intervention to Reduce Substance Use and Sexual Risk Behavior among Homeless Young Adults

PubMed Central

Tucker, Joan S.; D’Amico, Elizabeth J.; Ewing, Brett A.; Miles, Jeremy N. V.; Pedersen, Eric R.

2017-01-01

Homeless young adults ages 18–25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8 years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3 month and past 30 day alcohol use (ps ≤ .05), motivation to change drug use (ps < .05), and condom use self-efficacy (p = .05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p < .05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes. PMID:28340904

Cost and Cost-effectiveness of Students for Nutrition and Exercise (SNaX)

PubMed Central

Ladapo, Joseph A.; Bogart, Laura M.; Klein, David J.; Cowgill, Burton O.; Uyeda, Kimberly; Binkle, David G.; Stevens, Elizabeth R.; Schuster, Mark A.

2015-01-01

Objective To examine the cost and cost-effectiveness of implementing Students for Nutrition and eXercise (SNaX), a 5-week middle-school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Methods Five intervention and five control middle schools (mean enrollment = 1,520 students) from the Los Angeles Unified School District participated in a randomized controlled trial of SNaX. Acquisition costs for materials and time and wage data for employees involved in implementing the program were used to estimate fixed and variable costs. Cost-effectiveness was determined using the ratio of variable costs to program efficacy outcomes. Results The costs of implementing the program over 5 weeks were $5,433.26 per school in fixed costs and $2.11 per student in variable costs, equaling a total cost of $8,637.17 per school, or $0.23 per student per day. This investment yielded significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks. The cost-effectiveness of the program, per student over 5 weeks, was $1.20 per additional fruit served during meals, $8.43 per additional full-priced lunch served, $2.11 per additional reduced-price/free lunch served, and $1.69 per reduction in snacks sold. Conclusions SNaX demonstrated the feasibility and cost-effectiveness of a middle-school-based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Its cost is modest and unlikely to be a significant barrier to adoption for many schools considering its implementation. PMID:26427719

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

Barber, Laura Jeaneen

The purpose of the L’Innovator is to assemble unique, state-of-the-art IP bundles developed at the national labs that aggregate synergistic technologies in furtherance of the emerging hydrogen and fuel cell market. The first L’Innovator IP bundle consists of Oxygen Reduction Reaction (ORR) Catalyst technology developed at Brookhaven National Laboratory (BNL), combined with Membrane Electrode Assembly (MEA) technology developed at Los Alamos National Laboratory (LANL).

Environmental surveillance at Los Alamos during 2008

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

Fuehne, David; Gallagher, Pat; Hjeresen, Denny

2009-09-30

Environmental Surveillance at Los Alamos reports are prepared annually by the Los Alamos National Laboratory (the Laboratory) Environmental Programs Directorate, as required by US Department of Energy Order 450.1, General Environmental Protection Program, and US Department of Energy Order 231.1A, Environment, Safety, and Health Reporting. These annual reports summarize environmental data that are used to determine compliance with applicable federal, state, and local environmental laws and regulations, executive orders, and departmental policies. Additional data, beyond the minimum required, are also gathered and reported as part of the Laboratory’s efforts to ensure public safety and to monitor environmental quality at andmore » near the Laboratory. Chapter 1 provides an overview of the Laboratory’s major environmental programs and explains the risks and the actions taken to reduce risks at the Laboratory from environmental legacies and waste management operations. Chapter 2 reports the Laboratory’s compliance status for 2007. Chapter 3 provides a summary of the maximum radiological dose the public and biota populations could have potentially received from Laboratory operations and discusses chemical exposures. The environmental surveillance and monitoring data are organized by environmental media (Chapter 4, air; Chapters 5 and 6, water and sediments; Chapter 7, soils; and Chapter 8, foodstuffs and biota) in a format to meet the needs of a general and scientific audience. Chapter 9 provides a summary of the status of environmental restoration work around LANL. A glossary and a list of acronyms and abbreviations are in the back of the report. Appendix A explains the standards for environmental contaminants, Appendix B explains the units of measurements used in this report, Appendix C describes the Laboratory’s technical areas and their associated programs, and Appendix D provides web links to more information.« less

Menu Labeling as a Potential Strategy for Combating the Obesity Epidemic: A Health Impact Assessment

PubMed Central

Jarosz, Christopher J.; Simon, Paul; Fielding, Jonathan E.

2009-01-01

Objectives. We conducted a health impact assessment to quantify the potential impact of a state menu-labeling law on population weight gain in Los Angeles County, California. Methods. We utilized published and unpublished data to model consumer response to point-of-purchase calorie postings at large chain restaurants in Los Angeles County. We conducted sensitivity analyses to account for uncertainty in consumer response and in the total annual revenue, market share, and average meal price of large chain restaurants in the county. Results. Assuming that 10% of the restaurant patrons would order reduced-calorie meals in response to calorie postings, resulting in an average reduction of 100 calories per meal, we estimated that menu labeling would avert 40.6% of the 6.75 million pound average annual weight gain in the county population aged 5 years and older. Substantially larger impacts would be realized if higher percentages of patrons ordered reduced-calorie meals or if average per-meal calorie reductions increased. Conclusions. Our findings suggest that mandated menu labeling could have a sizable salutary impact on the obesity epidemic, even with only modest changes in consumer behavior. PMID:19608944

Still Growing Strong: UCLA Library.

ERIC Educational Resources Information Center

McClung, Patricia

1983-01-01

This description of the development of an academic research library in Los Angeles includes a brief history of the University of California, and discusses university librarians, library buildings, special collections, automation, and cooperative programs. (EJS)

KSC-2012-5454

NASA Image and Video Library

2012-09-19

CAPE CANAVERAL, Fla. – Space shuttle Endeavour, mounted atop NASA's Shuttle Carrier Aircraft or SCA, taxis down the runway at the Shuttle Landing Facility at NASA's Kennedy Space Center in Florida. The SCA, a modified 747 jetliner, will fly Endeavour to Los Angeles where it will be placed on public display at the California Science Center. This is the final ferry flight scheduled in the Space Shuttle Program era. For more information on the shuttles' transition and retirement, visit http://www.nasa.gov/transition. Photo credit: NASA/Rusty Backer The SCA, a modified 747 jetliner, will fly Endeavour to Los Angeles where it will be placed on public display at the California Science Center. This is the final ferry flight scheduled in the Space Shuttle Program era. For more information on the shuttles' transition and retirement, visit http://www.nasa.gov/transition. Photo credit: NASA/Jim Grossmann

Cooperative Threat Reduction: Cooperation Threat Reduction Program Liquid Propellant Disposition Project

NASA Astrophysics Data System (ADS)

2002-09-01

This audit is one in a series of audits the Deputy Secretary of Defense requested. As part of the Cooperative Threat Reduction (CTR) Program, DoD agreed to assist the Russian Federation in disposing of its liquid rocket propellant. Public Law 102-228 (section 2551 NOTE, title 22, United States Code), the Soviet Nuclear Threat Reduction Act of 1991 designates DoD as the executive agent for the CTR Program. Specific objectives of the act are to destroy chemical, nuclear, and other weapons; transport, store, disable, and safeguard weapons in connection with their destruction; and establish verifiable safeguards against proliferation of weapons of mass destruction. The Office of the Assistant Secretary of Defense (International Security Policy), under the Office of the Under Secretary of Defense for Policy, develops, coordinates, and oversees implementation of policy for the CTR Program. The CTR Directorate, Defense Threat Reduction Agency operates the program.

Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews

PubMed Central

Damery, Sarah; Flanagan, Sarah; Combes, Gill

2016-01-01

Objective To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity. Design Umbrella review of systematic reviews and meta-analyses. Setting Interventions must have delivered care crossing the boundary between at least two health and/or social care settings. Participants Adult patients with one or more chronic diseases. Data sources MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database, DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references. Outcome measures Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs. Results 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15–50%); 11/24 showed significant reductions in all-cause (10–30%) or condition-specific (15–50%) readmissions; 9/16 reported LoS reductions of 1–7 days and 4/9 showed significantly lower A&E use (30–40%). 10/25 reviews reported significant cost reductions but provided little robust evidence. Effective interventions included discharge management with postdischarge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients’ homes. Conclusions Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity. Trial registration number CRD42015016458. PMID:27872113

Safety of Next Day Discharge Following Lobectomy: Have We Broken the Speed Limit?

PubMed

Greer, Stephen; Miller, Ashley D; Smith, Jeremiah S; Holcombe, Jenny M; Headrick, James R

2018-06-13

Utilizing our standardized approach to air leak reduction (STAR) protocol has led to a continual decrease in the need for inpatient recovery following lobectomy. Although next day discharges do occur, the current literature hasn't addressed their safety. We analyzed our STAR dataset to study this group and their outcomes. A retrospective review of prospectively collected data from the STAR dataset was performed. Characteristics were compared between patients discharged on postoperative day (POD) 1 and those with longer admissions. Outcome data was analyzed. From June 2010 through June 2017, 390 patients underwent lobectomy and met study criteria. Of these, 150 (38%) were discharged on POD 1 versus 240 (62%) who were discharged later (mean LOS 3.9 days). There was no increase in morbidity, mortality or 30-day readmission between the two groups. Distinguishing characteristics of the POD 1 group included more non-smokers, use of a minimally invasive technique, and a lower incidence of prolonged air leak. FEV1 and DLCO data were also favorable in the POD 1 group. The percentage of patients sent home POD 1 increased from an average of 23% over the first three years of the study to 63% over the last three years. Appropriately identified patients can safely go home on POD 1 following lobectomy without an increase in 30-day readmission, morbidity or mortality. A continued focus on lobectomy LOS reduction has the capacity to increase patient satisfaction and lead to reduction in healthcare costs. Copyright © 2018. Published by Elsevier Inc.

Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance.

PubMed

Sinreich, David; Jabali, Ola

2007-09-01

Starting from the last decade of the twentieth century, most hospital Emergency Department (ED) budgets did not keep up with the demand for ED services made by growing populations and aging societies. Since labor consumes over 50% of the total monies invested in EDs and other healthcare systems, any downsizing, streamlining and reorganization plan needs to first address staffing issues such as determining the correct size of the workforce and its work shift scheduling. In this context, it is very important to remember that downsizing certainly does not mean a general cut-across-the-board. This study shows that a selective downsizing process in which each resource is treated separately (increasing the work capacity of some resources is also possible), based on its unique contribution to the overall ED operational performance, can approximately maintain current ED operational measures in terms patient length of stay (LOS) despite an overall reduction in staff hours. A linear optimization model (S-model) and a heuristic iterative simulation based algorithm (SWSSA) are used in this study for scheduling the resources' work shifts, one resource at a time. The algorithm was tested using data that was gathered from five general hospital EDs. By leveling the workload of the different resources in the ED, SWSSA was able to achieve LOS values within -19 to 4% of the original values despite a reduction of 8-17.5% in physicians' work hours and a reduction of 13-47% in the nurses' work hours.

Field Hearings on the Youth Service Corps and H.R. 717. Hearings before the Subcommittee on Employment Opportunities of the Committee on Education and Labor. House of Representatives, One Hundred First Congress, First Session (San Francisco, April 28, 1989; Los Angeles, June 23, 1989).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. House Committee on Education and Labor.

This document reports on Congressional hearings on issues relating to the 1989 youth services bill to create a nationwide Youth Service Corps. The hearings focused on the successes of local youth programs. Testimony includes statements and prepared statements, letters, and supplemental materials from the mayors of San Francisco and Los Angeles,…

The Role of English Pre-Service Teachers' Beliefs about Teaching in Teacher Education Programs (El papel de las creencias de los profesores de inglés en formación sobre la enseñanza en los programas de formación docente)

ERIC Educational Resources Information Center

Castellanos Jaimes, Judith

2013-01-01

This paper presents a review of studies on pre-service teachers' beliefs about teaching. The purpose of the article is to show teacher educators the relevance of exploring such issue in the classroom. Preservice teachers come into the teaching profession with beliefs about teaching; sometimes they are aware of them, other times they are not. The…

SABRINA - An interactive geometry modeler for MCNP (Monte Carlo Neutron Photon)

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

West, J.T.; Murphy, J.

SABRINA is an interactive three-dimensional geometry modeler developed to produce complicated models for the Los Alamos Monte Carlo Neutron Photon program MCNP. SABRINA produces line drawings and color-shaded drawings for a wide variety of interactive graphics terminals. It is used as a geometry preprocessor in model development and as a Monte Carlo particle-track postprocessor in the visualization of complicated particle transport problem. SABRINA is written in Fortran 77 and is based on the Los Alamos Common Graphics System, CGS. 5 refs., 2 figs.

Deflagration-to-Detonation Transition in Heteorogeneous Solids: A Bibliography.

DTIC Science & Technology

1980-11-01

and Rockets, Vol. 9. No. 6, 1972, pp. 415-419. 1.4 Francois, D., and L. Joly; " La Rupture des Metaux; Ecole d’ete de la Colle sur Loup ," Masson et Cie...Computer Program for Multifield Fluid Flows," Los Alamos Scientific Laboratory, LA -5680, 1974. 5.3, 9 Nnderssen, K. E. B.; "Pressure Drop in Ideal...5.6, 6, 9 Forest, C. A.: "Burning and Detonation," Los Alamos Scientific Laboratory, LA -7245, July 1978. 2, 3, 4 Fox, J.; "Flow Regimes in

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

Wiser, Ryan; Barbose, Galen; Heeter, Jenny

This analysis is the first-ever comprehensive assessment of the benefits and impacts of state renewable portfolio standards (RPSs). This joint National Renewable Energy Laboratory-Lawrence Berkeley National Laboratory project provides a retrospective analysis of RPS program benefits and impacts, including greenhouse gas emissions reductions, air pollution emission reductions, water use reductions, gross jobs and economic development impacts, wholesale electricity price reduction impacts, and natural gas price reduction impacts. Wherever possible, benefits and impacts are quantified in monetary terms. The paper will inform state policymakers, RPS program administrators, industry, and others about the costs and benefits of state RPS programs. In particular,more » the work seeks to inform decision-making surrounding ongoing legislative proposals to scale back, freeze, or expand existing RPS programs, as well as future discussions about increasing RPS targets or otherwise increasing renewable energy associated with Clean Power Plan compliance or other emission-reduction goals.« less

Retrospective Analysis of the Benefits and Impacts of U.S. Renewable Portfolio Standards

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

Wiser, Ryan; Barbose, Galen; Heeter, Jenny

This analysis is the first-ever comprehensive assessment of the benefits and impacts of state renewable portfolio standards (RPSs). This joint National Renewable Energy Laboratory-Lawrence Berkeley National Laboratory project provides a retrospective analysis of RPS program benefits and impacts, including greenhouse gas emissions reductions, air pollution emission reductions, water use reductions, gross jobs and economic development impacts, wholesale electricity price reduction impacts, and natural gas price reduction impacts. Wherever possible, benefits and impacts are quantified in monetary terms. The paper will inform state policymakers, RPS program administrators, industry, and others about the costs and benefits of state RPS programs. In particular,more » the work seeks to inform decision-making surrounding ongoing legislative proposals to scale back, freeze, or expand existing RPS programs, as well as future discussions about increasing RPS targets or otherwise increasing renewable energy associated with Clean Power Plan compliance or other emission-reduction goals.« less

Timing of discharge: a key to understanding the reason for readmission after colorectal surgery.

PubMed

Kelly, Kristin N; Iannuzzi, James C; Aquina, Christopher T; Probst, Christian P; Noyes, Katia; Monson, John R T; Fleming, Fergal J

2015-03-01

There is a growing interest in surgery regarding the balance between appropriate hospital length of stay (LOS) and prevention of unnecessary readmissions. This study examines the relationship between postoperative LOS and unplanned readmission after colorectal resection, exploring whether patients discharged earlier have different readmission risk profiles. Patients undergoing colorectal resection were selected by Common Procedural Terminology (CPT) code from the 2012 ACS National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified by LOS quartile. Kaplan-Meier analysis was used to examine characteristics associated with 30-day unplanned readmission. Factors with a p < 0.1 were included in the Cox proportional hazards model. Subsequently, chi-square analysis compared LOS, patient, and perioperative factors with the primary reason for readmission. Factors with a p < 0.2 were included in a multivariable logistic regression for each readmission reason. For 33,033 patients undergoing colorectal resection, the overall 30-day unplanned readmission rate was 11 %. After adjusting for patient and perioperative factors, a postoperative LOS ≥8 days was associated with a 55 % increase in the relative hazard of readmission. Patients with a ≤3-day LOS were more likely to be readmitted with ileus/obstruction (odds ratio (OR): 1.8, p = 0.001) and pain (OR: 2.2, p = 0.007). LOS was not significantly associated with readmission for intraabdominal infection or medical complications. Patients with longer LOS and complicated hospital courses continue to be high risk post-discharge, while straightforward early discharges have a different readmission risk profile. More targeted readmission prevention strategies are critical to focusing resource utilization for colorectal surgery patients.

The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis.

PubMed

Kwok, Chi Leung; Lee, Carmen Km; Lo, William Tl; Yip, Paul Sf

2016-08-17

Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012. A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors - population size and age-gender composition - and three service components - hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) - which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios. During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022. Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Sequenced Instructional Program in Physical Education for the Handicapped, Phase III. Producing and Disseminating Demonstration Packages. Final Report.

ERIC Educational Resources Information Center

Carr, Dorothy B.; Avance, Lyonel D.

Presented is a sequenced instructional program in physical education which constitutes the third of a three-phase, 4-year project, funded by Title III, for handicapped children, preschool through high school levels, in the Los Angeles Unified School District. Described are the project setting and the following accomplishments: a curriculum guide…

Connecting Neighborhood Councils and City Agencies--Evaluation of the Learning and Design Forums and Role of the University as a Mediating Institution

ERIC Educational Resources Information Center

Kathi, Pradeep Chandra

2012-01-01

The School of Planning Policy and Development at the University of Southern California brought together representatives of neighborhood councils and city agencies of the city of Los Angeles together in an action research program. This action research program called the Collaborative Learning Project developed a collaboration process called the…

A Qualitative Study of Early Childhood Educators' Beliefs about Key Preschool Classroom Experiences

ERIC Educational Resources Information Center

Lara-Cinisomo, Sandraluz; Fuligni, Allison Sidle; Daugherty, Lindsay; Howes, Carollee; Karoly, Lynn

2009-01-01

The aim of the study was to uncover early childhood educators' beliefs about how to best work with children getting ready for kindergarten. The study involved 11 focus groups with providers from three types of early education settings located in Los Angeles County: (1) public center-based programs, (2) private center-based programs, and (3) family…

DAP in the 'Hood: Perceptions of Child Care Practices by African American Child Care Directors Caring for Children of Color

ERIC Educational Resources Information Center

Sanders, Kay E.; Deihl, Amy; Kyler, Amy

2007-01-01

This paper presents a qualitative analysis concerning child care practices by six African American directors of subsidized child care centers located in a low-income, racial ethnic minority area of Los Angeles, California. These programs are traditionally African American programs that experienced an influx of Latino immigrant enrollment. Using…

Positive Youth Development in a School-Based Setting: A Study of the Los Angeles Police Academy Magnet School Program. PRGS Dissertation

ERIC Educational Resources Information Center

Maloney, Shannon

2014-01-01

Positive youth development (PYD) orients youth toward pro-social and forward-looking behavior through programs that emphasize youth empowerment and involvement, focus on skill development and character building, incorporate community collaboration at multiple levels, and include positive adult role models and mentors that interact with youth in…

Application of Matrix Outcome Mapping to Constructively Align Program Outcomes and Course Outcomes in Higher Education

ERIC Educational Resources Information Center

Mazouz, Abdelkader; Crane, Keenan

2013-01-01

Establishing a link between Course Learning Outcomes (LOs) and Program Outcomes (POs) while assessing the course contents and delivery are among the most challenging issues in Higher Education. In the present study two forms were generated based on specific Course Learning Outcomes identified in the syllabus at the beginning of the teaching term:…

[Is late-onset schizophrenia related to neurodegenerative processes? A review of literature].

PubMed

Lagodka, A; Robert, P

2009-09-01

Since 1943 when, for the first time, M. Bleuler used the term late-onset schizophrenia (LOS) to refer to diagnostic groups gathering some clinical features of schizophrenia, but with onset after the age of 40, opinions on this entity are divided. The main question is whether LOS and schizophrenia, with onset in early adulthood (early-onset schizophrenia EOS), have the same etiopathogeny. This discussion became more complex with the introduction, in 2000, of a new entity, the "very-late-onset schizophrenia-like psychosis" (VLOSP), which took the place of "late paraphrenia" and grouped together schizophrenia, delusional disorders and paranoid psychosis with age of onset after 60 years. Neuropathological processes underlying these entities have not beed determined. In particular, neurodegenerative processes could be explored. A literature review between 1 January 1995 and 30 April 2008, based on a research on PubMed with the terms "late-onset schizophrenia", "paraphrenia", "late paraphrenia", "VLOSP", and "late psychosis", takes stock of the various studies and hypotheses which have investigated the link between LOS/VLOSP and neurodegenerative processes. Clinical approach: there is no greater family history of dementia disorders in LOS/VLOSP than in the general population. Neuropsychological pattern between LOS and Alzheimer's disease (AD) seems different, with more impairment in delayed recall in AD, and in short-term memory in LOS. Some longitudinal studies, however, have argued that a part of patients with LOS would develop dementia at 10 years. These patients would have a later onset of disorders (> 60 years). Anatomopathological approach: anatomopathological studies show that LOS is not consecutive to AD, and might be related to a restricted limbic tauopathy. Neuroimaging approach: Magnetic Resonance Imaging (MRI) morphological neuroimaging studies show little differences between LOS and EOS. The thalamus volume was significantly smaller, and cortical atrophy was more important in LOS. MRI neuroimaging studies regarding white matter hyperintensities (WMH), which are considered as a macroscopic manifestation of cerebrovascular disease (CD), show inconsistent results. Positive results are observed with LOS subjects with later onset of disease. In addition, WMH were not located on cerebral tracts, which are implicated in EOS, but were periventricular. It is notable that the studies conducted do not differentiate between LOS and VLOSP, since these two groups of patients are generally mixed. Furthermore, an attempt to analyse the data has to take into account only the studies which have included subjects with strict criteria of schizophrenia, independently of the disorders' age of onset. In addition, we found no study comparing LOS and Lewy Bodies Dementia, which is however an important differential diagnosis. The two main hypotheses tested appear to be: (1): is LOS a prodrome of AD? (2): is LOS consecutive to CD? This review permits a partial answer to these questions. First, LOS as a prodrome of AD seems very unlikely, considering anatomopathological studies. However, it is possible that subjects with later age of onset of the disease develop dementia at 10 years. Second, CD seems not to be altered by the cerebral tracts which are implicated in EOS. A hypothesis could be that the tracts implicated in LOS and EOS differ. This might explain the differences found in clinical (less formal thought disorders and negative symptoms in LOS compared with EOS) and electroencephalographical studies (no reduction of P300's amplitude in LOS, which has however been proposed as trait marker of schizophrenia in EOS) between LOS and EOS. These tracts could be related to a limbic tauopathy found in anatomopathological studies. More vulnerable subjects would develop LOS with ageing. Other subjects would develop LOS secondary to CD. This could explain the later age of onset of the disease in these subjects.

National Earthquake Hazards Reduction Program; time to expand

USGS Publications Warehouse

Steinbrugge, K.V.

1990-01-01

All of us in earthquake engineering, seismology, and many related disciplines have been directly or indirectly affected by the National Earthquake Hazards Reduction Program (NEHRP). This program was the result of the Earthquake Hazards Reduction Act of 1977 (Public Law 95-124). With well over a decade of experience, should this expression of public policy now take a different or expanded role? 

Mind magic: a pilot study of preventive mind-body-based stress reduction in behaviorally inhibited and activated children.

PubMed

Jellesma, Francine C; Cornelis, Janine

2012-03-01

The aim of this pilot study was to examine a mind-body-based preventive intervention program and to determine relationships between children's behavioral inhibition system (BIS) and behavioral activation system, stress, and stress reduction after the program. Children participated in the program (n=30) or in a control condition (n=24). They filled out questionnaires before and after the program and reported their levels of stress before and after each of the five sessions. The program consisted of weekly sessions. Each session incorporated yoga postures, visualization, and social exercises. Breathing techniques were integrated. Stress reductions were only seen in the intervention group and mainly in children with high BIS--irrespective of their behavioral activation system. The results demonstrate that children with high BIS may benefit from a mind-body-based stress reduction program.

Impact of the University of California, Los Angeles/Charles R. Drew University Medical Education Program on medical students' intentions to practice in underserved areas.

PubMed

Ko, Michelle; Edelstein, Ronald A; Heslin, Kevin C; Rajagopalan, Shobita; Wilkerson, Luann; Colburn, Lois; Grumbach, Kevin

2005-09-01

To estimate the impact of a U.S. inner-city medical education program on medical school graduates' intentions to practice in underserved communities. The authors conducted an analysis of secondary data on 1,088 medical students who graduated from either the joint University of California, Los Angeles/Charles R. Drew University Medical Education Program (UCLA/Drew) or the UCLA School of Medicine between 1996 and 2002. Intention to practice in underserved communities was measured using students' responses to questionnaires administered at matriculation and graduation for program improvement by the Association of American Medical Colleges. Multivariate logistic regression analysis was used to compare the odds of intending to practice in underserved communities among UCLA/Drew students with those of their counterparts in the UCLA School of Medicine. Compared with students in the UCLA School of Medicine, UCLA/Drew students had greater adjusted odds of reporting intention to work in underserved communities at graduation, greater odds of maintaining or increasing such intentions between matriculation and graduation, and lower odds of decreased intention to work in underserved communities between matriculation and graduation. Training in the UCLA/Drew program was independently associated with intention to practice medicine in underserved communities, suggesting that a medical education program can have a positive effect on students' goals to practice in underserved areas.

Sustainability and scalability of the hospital elder life program at a community hospital.

PubMed

Rubin, Fred H; Neal, Kelly; Fenlon, Kerry; Hassan, Shuja; Inouye, Sharon K

2011-02-01

The Hospital Elder Life Program (HELP), an effective intervention to prevent delirium in older hospitalized adults, has been successfully replicated in a community teaching hospital as a quality improvement project. This article reports on successfully sustaining the program over 7 years and expanding its scale from one to six inpatient units at the same hospital. The program currently serves more than 7,000 older patients annually and is accepted as the standard of care throughout the hospital. Innovations that enhanced scalability and widespread implementation included ensuring dedicated staffing for the program, local adaptations to streamline protocols, continuous recruitment of volunteers, and more-efficient data collection. Outcomes include a lower rate of incident delirium; shorter length of stay (LOS); greater satisfaction of patients, families, and nursing staff; and significantly lower costs for the hospital. The financial return of the program, estimated at more than $7.3 million per year during 2008, comprises cost savings from delirium prevention and revenue generated from freeing up hospital beds (shorter LOS of HELP patients with and without delirium). Delirium poses a major challenge for hospital quality of care, patient safety, Medicare no-pay conditions, and costs of hospital care for older persons. Faced with rising numbers of elderly patients, hospitals can use HELP to improve the quality and cost-effectiveness of care. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Assessing the impact of harm reduction programs on law enforcement in Southeast Asia: a description of a regional research methodology.

PubMed

Thomson, Nick; Moore, Tim; Crofts, Nick

2012-07-09

For over 15 years the Australian Agency for International Development (AusAID) has been a leading donor for harm reduction projects in Southeast Asia. The recent AusAID-supported harm reduction projects of greatest significance have included the Asia Regional HIV/AIDS Project (AHRP), from 2002 until 2007,1 and the HIV/AIDS Asia Regional Program (HAARP), from 2007 until 2015.2 Both projects included in their design specific strategies for engaging with law enforcement agencies at country level. The main focus of these strategies has been to develop law enforcement harm reduction policy and curriculum, and the design and implementation of specific harm reduction training for law enforcement officers.In July 2008, the Australian Development Research Awards (ADRA) funded the Nossal Institute for Global Health at the University of Melbourne to establish a research project created to assess the influence of harm reduction programs on the policy and operational practices of law enforcement agencies in Southeast Asia, known as the LEHRN Project (Law Enforcement, Harm Reduction, Nossal Institute Project). The ADRA is a unique grant research mechanism that specifically funds development research to improve the understanding and informed decision making of the implementation of Australian aid effectiveness.While the need to engage law enforcement when establishing harm reduction programs was well documented, little was known about the impact or influence of harm reduction programs on policy and practices of law enforcement agencies. The LEHRN Project provided the opportunity to assess the impact of harm reduction programs on law enforcement in Southeast Asia, with a focus on Vietnam, Cambodia and Lao PDR.

Assessing the impact of harm reduction programs on law enforcement in Southeast Asia: a description of a regional research methodology

PubMed Central

2012-01-01

For over 15 years the Australian Agency for International Development (AusAID) has been a leading donor for harm reduction projects in Southeast Asia. The recent AusAID-supported harm reduction projects of greatest significance have included the Asia Regional HIV/AIDS Project (AHRP), from 2002 until 2007,1 and the HIV/AIDS Asia Regional Program (HAARP), from 2007 until 2015.2 Both projects included in their design specific strategies for engaging with law enforcement agencies at country level. The main focus of these strategies has been to develop law enforcement harm reduction policy and curriculum, and the design and implementation of specific harm reduction training for law enforcement officers. In July 2008, the Australian Development Research Awards (ADRA) funded the Nossal Institute for Global Health at the University of Melbourne to establish a research project created to assess the influence of harm reduction programs on the policy and operational practices of law enforcement agencies in Southeast Asia, known as the LEHRN Project (Law Enforcement, Harm Reduction, Nossal Institute Project). The ADRA is a unique grant research mechanism that specifically funds development research to improve the understanding and informed decision making of the implementation of Australian aid effectiveness. While the need to engage law enforcement when establishing harm reduction programs was well documented, little was known about the impact or influence of harm reduction programs on policy and practices of law enforcement agencies. The LEHRN Project provided the opportunity to assess the impact of harm reduction programs on law enforcement in Southeast Asia, with a focus on Vietnam, Cambodia and Lao PDR. PMID:22769050

Nuclear light bulb

NASA Technical Reports Server (NTRS)

Latham, Tom

1991-01-01

The nuclear light bulb engine is a closed cycle concept. The nuclear light bulb concept provides containment by keeping the nuclear fuel fluid mechanically suspended in a cylindrical geometry. Thermal heat passes through an internally cooled, fused-silica, transparent wall and heats hydrogen propellant. The seeded hydrogen propellant absorbs radiant energy and is expanded through a nozzle. Internal moderation was used in the configuration which resulted in a reduced critical density requirement. This result was supported by criticality experiments. A reference engine was designed that had seven cells and was sized to fit in what was then predicted to be the shuttle bay mass and volume limitations. There were studies done of nozzle throat cooling schemes to remove the radiant heat. Elements of the nuclear light bulb program included closed loop critical assembly tests done at Los Alamos with UF6 confined by argon buffer gas. It was shown that the fuel region could be seeded with constituents that would block UV radiation from the uranium plasma. A combination of calculations and experiments showed that internal moderation produced a critical mass reduction. Other aspects of the research are presented.

Nutriendo la Promesa: Materiales Para la Aplicacion de las Normas de Ejecucion del Programa Head Start. Guia Para la Utilizacion de los Materiales [y] Transparencias (Nurturing the Promise: Set of Training Materials on the Head Start Program Performance Standards. User's Guide [and] Set of Transparencies).

ERIC Educational Resources Information Center

Educational Services, Inc., Washington, DC.

Since 1975, the Head Start Program Performance Standards have defined the services that local programs are required to provide to enrolled children and families. With revisions effective in 1998, the Program Performance Standards translate the Head Start vision into quality practices implemented at the local level. This document is comprised of a…

Trend, Risk Factors, and Costs of Clostridium difficile Infections in Vascular Surgery.

PubMed

Egorova, Natalia N; Siracuse, Jeffrey J; McKinsey, James F; Nowygrod, Roman

2015-01-01

Starting in December 2013, the Hospital Inpatient Quality Reporting Program included Clostridium difficile infection (CDI) rates as a new publically reported quality measure. Our goal was to review the trend, hospital variability in CDI rates, and associated risk factors and costs in vascular surgery. The rates of CDI after major vascular procedures including aortic abdominal aneurysm (AAA) repair, carotid endarterectomy or stenting, lower extremity revascularization (LER), and LE amputation were identified using Nationwide Inpatient Sample database for 2000-2011. Risk factors associated with CDI were analyzed with hierarchical multivariate logistic regression. Extra costs, length of stay (LOS), and mortality were assessed for propensity-matched hospitalizations with and without CDI. During the study period, the rates of CDI after vascular procedures had increased by 74% from 0.6 in 2000 to 1.05% in 2011, whereas the case fatality rate was stable at 9-11%. In 2011, the highest rates were after ruptured aortic abdominal aneurysm (rAAA) repair (3.3%), followed by lower extremity amputations (2.3%) and elective open AAA (1.3%). The rates of CDI increased after all vascular procedures during the 12 years. The highest increase was after endovascular LER (151.8%) and open rAAA repair (135.7%). In 2011, patients who had experienced CDI had median LOS of 15 days (interquartile range, 9-25 days) compared with 8.3 days for matched patients without CDI, in-hospital mortality 9.1% (compared with 5.0%), and $13,471 extra cost per hospitalization. The estimated cost associated with CDI in vascular surgery in the United States was ∼$98 million in 2011. Hospital rates of CDI varied from 0 to 50% with 3.5% of hospitals having infection rates ≥5%. Factors associated with CDI included multiple chronic conditions, female gender, surgery type, emergent and weekend hospitalizations, hospital transfers, and urban locations. Despite potential reduction of infection rates as evidenced by the experience of hospitals with effective interventions, CDI is increasing among vascular surgery patients. It is associated with prolonged LOS, increased mortality, and higher costs. Copyright © 2015 Elsevier Inc. All rights reserved.

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 for' improved timeliness of hospital care in response to increasing acute demand. As such, the overall challenges in managing demand for acute and urgent care in New Zealand hospitals remain.

The Impact of Two Los Angeles County Teen Courts on Youth Recidivism: Comparing Two Informal Probation Programs

PubMed Central

Gase, Lauren N; Kuo, Tony; Lai, Elaine; Stoll, Michael A; Ponce, Ninez

2016-01-01

Objective This study sought to examine the impact of two Teen Courts operating in Los Angeles County, a juvenile justice system diversion program in which youth are judged by their peers and given restorative sentences to complete during a period of supervision. Methods A quasi-experimental design was used to compare youth who participated in Teen Court (n=112) to youth who participated in another diversion program administered by the Probation Department (the 654 Contract program) (n=194). Administrative data were abstracted from Probation records for all youth who participated in these programs between January 1, 2012 and June 20, 2014. Logistic and survival models were used to examine differences in recidivism - measured as whether the minor had any subsequent arrest or arrests for which the charge was filed. Results Comparison group participants had higher rates of recidivism than Teen Court participants, after controlling for age, gender, race/ethnicity, and risk level. While the magnitude of the program effects were fairly consistent across model specifications (odd ratios comparing Teen Court [referent] to school-based 654 Contract ranging from 1.95 to 3.07, hazard ratios ranging from 1.62 to 2.27), differences were not statistically significant in all scenarios. Conclusions While this study provides modest support for the positive impact of Teen Court, additional research is needed to better understand how juvenile diversion programs can improve youth outcomes. PMID:27547171

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

PubMed

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

2006-07-01

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

The IAEA neutron coincidence counting (INCC) and the DEMING least-squares fitting programs

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

Krick, M.S.; Harker, W.C.; Rinard, P.M.

1998-12-01

Two computer programs are described: (1) the INCC (IAEA or International Neutron Coincidence Counting) program and (2) the DEMING curve-fitting program. The INCC program is an IAEA version of the Los Alamos NCC (Neutron Coincidence Counting) code. The DEMING program is an upgrade of earlier Windows{reg_sign} and DOS codes with the same name. The versions described are INCC 3.00 and DEMING 1.11. The INCC and DEMING codes provide inspectors with the software support needed to perform calibration and verification measurements with all of the neutron coincidence counting systems used in IAEA inspections for the nondestructive assay of plutonium and uranium.

Poverty Reduction in Zambia: A Conceptual Analysis of the Zambian Poverty Reduction Strategy Paper

ERIC Educational Resources Information Center

Imboela, Bruce Lubinda

2005-01-01

Poverty reduction strategy papers (PRSPs) present a recipient country's program of intent for the utilization of World Bank loans and grants to alleviate debt under the bank's programs of action for poverty reduction in highly indebted poor countries (HIPCs). This article argues that structural transformation is a prerequisite for poverty…

Impact of a health maintenance organization hospitalist system in academic pediatrics.

PubMed

Landrigan, Christopher P; Srivastava, Rajendu; Muret-Wagstaff, Sharon; Soumerai, Stephen B; Ross-Degnan, Dennis; Graef, John W; Homer, Charles J; Goldmann, Donald A

2002-10-01

Hospitalist systems decrease length of stay (LOS) and cost for hospitalized adults. Whether hospitalist systems decrease LOS and cost for hospitalized children has not been conclusively established. We wanted to determine whether a health maintenance organization's (HMO's) implementation of a pediatric hospitalist system affected LOS, costs, mortality, readmission rate, follow-up rate, and parents' ratings of care. Interrupted time-series study of general pediatric patients admitted to a freestanding pediatric teaching hospital from 1993 to 1998. The intervention group consisted of all patients admitted to a staff model not-for-profit HMO that began using hospitalists in October 1996. Patients in other HMOs and traditional insurance groups were studied for comparison. The main outcomes were mean LOS and inflation-adjusted costs. Other outcomes included parents' ratings of care and mortality, readmission, and follow-up rates. Immediately after the introduction of the hospitalist system, mean LOS for staff model not-for-profit HMO fell 12% (0.3 days), and mean cost of hospitalization decreased 16% ($217) compared with prehospitalist levels. Parental ratings of care, initially somewhat low, improved substantially. Seven-day follow-up rates, mortality, and readmission rates did not change. Comparison groups experienced no concurrent improvements in LOS, cost, parental ratings, mortality, or readmission rates. A pediatric hospitalist system within a staff-model HMO significantly improved LOS, cost, and parental ratings of care without affecting rates of posthospitalization follow-up. Additional studies are needed both to measure broader aspects of quality and to assess the impact of such a program on patients being cared for through other types of delivery and insurance systems.

WASTE REDUCTION OF TECHNOLOGY EVALUATIONS OF THE U.S. EPA WRITE PROGRAM

EPA Science Inventory

The Waste Reduction Innovative Technology Evaluation (WRITE)Program was established in 1989 to provide objective, accurate performance and cost data about waste reducing technologies for a variety of industrial and commercial application. EPA's Risk Reduction Engineering Laborato...

Social networking technology, social network composition, and reductions in substance use among homeless adolescents.

PubMed

Rice, Eric; Milburn, Norweeta G; Monro, William

2011-03-01

Peer-based prevention programs for homeless youth are complicated by the potential for reinforcing high-risk behaviors among participants. The goal of this study is to understand how homeless youth could be linked to positive peers in prevention programming by understanding where in social and physical space positive peers for homeless youth are located, how these ties are associated with substance use, and the role of social networking technologies (e.g., internet and cell phones) in this process. Personal social network data were collected from 136 homeless adolescents in Los Angeles, CA. Respondents reported on composition of their social networks with respect to: home-based peers and parents (accessed via social networking technology; e.g., the internet, cell phone, texting), homeless peers and agency staff (accessed face-to-face) and whether or not network members were substance-using or non-substance-using. Associations between respondent's lifetime cocaine, heroin, and methamphetamine use and recent (previous 30 days) alcohol and marijuana use were assessed by the number of non-substance-using versus substance-using ties in multivariate linear regression models. 43% of adolescents reported a non-substance-using home-based tie. More of these ties were associated with less recent alcohol use. 62% of adolescents reported a substance-using homeless tie. More of these ties were associated with more recent marijuana use as well as more lifetime heroin and methamphetamine use. For homeless youth, who are physically disconnected from positive peers, social networking technologies can be used to facilitate the sorts of positive social ties that effective peer-based prevention programs require.

Feasibility of rapid discharge after transoral robotic surgery of the oropharynx.

PubMed

Richmon, Jeremy D; Feng, Allen L; Yang, Wuyang; Starmer, Heather; Quon, Harry; Gourin, Christine G

2014-11-01

To investigate the use of an algorithm for rapid discharge after transoral robotic surgery (TORS) and its effect on postoperative complications. Retrospective cohort study. A retrospective analysis of TORS cases from September 2009 to February 2013 was conducted. The effect of patient and tumor characteristics on postoperative length of stay (LOS) and complications were analyzed. A total of 91 patients were included; 79 underwent TORS for malignancy and 12 for a benign process. The mean LOS was 1.51 days (range, 1-5 days) with a median of 1 day. The mean time to initiation of oral diet was 1.26 days (range, 1-7 days) with a median of 1 day. Eleven (12%) patients experienced one or more complications during their postoperative course. Multivariate analysis demonstrated a significant association between patient and procedure variables and postoperative complications. TORS base of tongue reduction for obstructive sleep apnea (OSA) was associated with a significantly greater mean incremental time to initiation of oral diet (1.0 days, 95% confidence interval [CI]: 0.4 to 1.7, P < .001). A significantly greater mean incremental LOS was observed for patients with advanced comorbidity and a delay in initiation of oral diet beyond 24 hours. Rapid initiation of oral diet and rapid discharge home is feasible and not associated with postoperative complications. Similarly, the performance of a concurrent neck dissection does not contribute to LOS or the development of postoperative complications. Patients undergoing TORS for OSA are at greater risk of delay in initiation of oral diet and increased LOS. 4 © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Improving Tracheostomy Care Delivery: Instituting Clinical Care Pathways and Nursing Education to Improve Patient Outcomes.

PubMed

Colandrea, Maria; Eckardt, Patricia

2016-01-01

The complication rates for tracheostomy patients could be serious and life threatening. As a result, length of stay (LOS) increases and patient outcomes can be negatively impacted. Examples of complications include accidental decannulation, bleeding and total occlusion. Studies suggest there is an inconsistency in tracheostomy care among providers and institutions. Other studies suggest stronger patient outcomes can result from improved staff training and appropriate protocols. The purpose of this study was to develop and test a clinical care pathway (CCP) and nursing education program to improve tracheostomy patient outcomes. The use of a CCP and nursing education program at a tertiary VA Medical Center will: decrease length of stay (LOS). decrease 30 day tracheostomy readmissions. increase patient's readiness for discharge. increase nurses' comfort level with performing tracheostomy care. increase nurses' overall competence with performing tracheostomy care. A quasi-experimental pilot study examining the effect of a CCP compared LOS and complication rates of tracheostomy patients from admission to discharge. The population included veterans from a mid-Atlantic VA Medical Center. This study involved three phases. Phase 1: Administer the Readiness for Hospital Discharge Scale (RHDS) to tracheostomy patients' preintervention. Phase 2: Provide nurses with an educational program pre and post test assessment. Phase 3: Implement the CCP and evaluate patients' readiness for discharge. Comparing the pre-intervention sample of veterans (n = 10) to the post-intervention sample (n = 6), there was an increase in LOS by 1 day. There was a 15 point increase in RHDS from 165 (SD 25.8) to 180 (SD 14.42). This pilot was underpowered with an n = 6, so there was no significant difference in LOS and 30 day readmission rates. Bootstrapping of sample resulted in RHDS p = . 039 and readmission p = .007. A paired-samples t-test was conducted to assess nurses' competence in performing tracheostomy care and nursing comfort level in regards to providing tracheostomy care and discharge education. There was a significant increase in the post-test scores, nursing comfort level providing tracheostomy care and nurses' comfort level providing patient tracheostomy discharge education. The significance of this project improved overall tracheostomy care offered at a mid-Atlantic VA Medical Center. Standardizing tracheostomy care and properly educating nurses and patients, increased patients readiness for hospital discharge and decreased their readmission rates related to tracheostomies.

Technical assistance for hazardous-waste reduction

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

Thompson, F.M.; McComas, C.A.

1987-12-01

Minnesota's Waste Management Board has established, developed, and funded the Minnesota Technical Assistance Program (MnTAP). The MnTAP programs offers technical assistance to generators of hazardous waste by offering telephone and onsite consultation, a waste reduction resource bank, information dissemination, a student intern program, and research awards for waste reduction projects. The program has completed three years of successful operation. The increasing interest in and use of MnTAP's services by hazardous-waste generators has justified the belief that state technical assistance programs have an important role to play in helping generators to reduce their waste production.

Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units.

PubMed

Angel, Clay; Brooks, Kristen; Fourie, Julie

2016-01-01

Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units. A pilot from September 2010 to July 2012 included 920 unique patients, of whom 470 were seen by the delirium management team. A delirium management team included a redesigned role for consulting psychiatrists and a new clinical nurse specialist role; the team provided assistance with diagnosis and recommendations for nonpharmacologic and pharmacologic management of delirium. Multidisciplinary education focused on delirium identification and management and nurses' use of appropriate assessment tools. Electronic health record functions supported accurate problem list coding, referrals to the team, and standardized documentation. Length of stay. During the study period, average LOS in the target population decreased from 8.5 days to 6.5 days (p = 0.001); average LOS for the Medical Center remained stable. Compared with patients whose delirium was diagnosed during the baseline period, patients who received a delirium diagnosis during the pilot period had a higher illness burden and were likelier to have a history of delirium and diagnosed dementia. Program implementation was associated with reduced LOS among older inpatients with delirium. The delirium team is an effective model that can be quickly implemented with few additional resources.

1988 Winners of the Cost Reduction Incentive Awards.

ERIC Educational Resources Information Center

National Association of College and University Business Officers, Washington, DC.

Outstanding cost-reduction programs implemented at colleges and universities during calendar year 1987 are recognized. Each of the 54 award-winning ideas is described in a paragraph-length program summary. Although some aspects of programs may be unique to a particular institution, creative administrators are challenged to tailor the programs to…

[Development of the German diagnosis-related groups (G-DRG) for ophthalmology from 2004 to 2012].

PubMed

Schargus, M; Gass, P; Neubauer, A; Kotas, M

2014-04-01

In 2003 the German diagnosis-related groups (G-DRG) were introduced for reimbursement of inpatient treatment. The aim of this study was to analyze the development of G-DRGs in ophthalmology in Germany (MDC02) from 2004 to 2012 by means of data from the Institute for the Reimbursement System in Hospitals (InEK). The data regarding costs, cost weighting and mean length of stay (LOS) from the G-DRG reports of the InEK from 2004 to 2012 in 9 representative surgical and non-surgical ophthalmological treatment case groups were analyzed. Differences in the coding system as well as alterations between the G-DRGs over the course of time were taken into consideration. The cost weightings were calculated taking the year 2004 as the baseline and are presented in the form of graphs. The selected cases cover 54% of all G-DRG cases used by the InEK for G-DRG calculations. For 6 out of the 9 case groups there was a cost/reimbursement reduction by nearly one third of the calculated costs by InEK from 2004 to 2012. Only one case group showed an increase in costs by 23% which can be explained by alterations in graft costs in this case group. The mean LOS decreased over the time period in the 9 groups investigated by up to 40% and on average by -22.3%. The annually calculated costs of the InEK directly influence the calculation of the cost weightings and reimbursement and are therefore important for every hospital. During the time period analyzed a high reduction in costs and LOS in the majority of the analyzed case groups were found.

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.

Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County

PubMed Central

Brandt, Sylvia; Perez, Laura; Künzli, Nino; Lurmann, Fred; Wilson, John; Pastor, Manuel; McConnell, Rob

2014-01-01

Background Emerging evidence suggests that near-roadway air pollution (NRP) exposure causes childhood asthma. Associated costs are not well documented. Objective We estimated the cost of childhood asthma attributable to residential NRP exposure and regional ozone (O3) and nitrogen dioxide (NO2) in Los Angeles County. We developed a novel approach to apportion the costs between these exposures under different pollution scenarios. Methods We integrated results from a study of willingness to pay to reduce the burden of asthma with studies of health care utilization and charges to estimate the costs of an asthma case and exacerbation. We applied those costs to the number of asthma cases and exacerbations due to regional pollution in 2007 and to hypothetical scenarios of a 20% reduction in regional pollution in combination with a 20% reduction or increase in the proportion of the total population living within 75m of a major roadway. Results Cost of air pollution-related asthma in Los Angeles County in 2007 was $441 million for O3 and $202 million for NO2 in 2010 dollars. Cost of routine care (care in absence of exacerbation) accounted for 18% of the combined NRP and O3 cost and 39% of the combined NRP and NO2 cost—costs not recognized in previous analyses. NRP-attributable asthma accounted for 43% (O3) to 51% (NO2) of the total annual cost of exacerbations and routine care associated with pollution. Hypothetical scenarios showed that costs from increased NRP exposure may offset savings from reduced regional pollution. Conclusions Our model disaggregates the costs of regional pollution and NRP exposure and illustrates how they might vary under alternative exposure scenarios. The cost of air pollution is a substantial burden on families and an economic loss for society. PMID:25439228

Status of Environmental Management Initiatives to Accelerate the Reduction of Environmental Risks and Challenges Posed by the Legacy of the Cold War

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

None

2009-01-01

Fifty years of nuclear weapons production and energy research in the United States during the Cold War generated large amounts of radioactive wastes, spent nuclear fuel (SNF), excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. During most of that half century, the Nation did not have the environmental regulatory structure or nuclear waste cleanup technologies that exist today. The result was a legacy of nuclear waste that was stored and disposed of in ways now considered unacceptable. Cleaning up and ultimately disposing of these wastes is the responsibility of the U.S. Department of Energy (DOE).more » In 1989, DOE established the Office of Environmental Management (EM) to solve the large scale and technically challenging risks posed by the world's largest nuclear cleanup. This required EM to build a new nuclear cleanup infrastructure, assemble and train a technically specialized workforce, and develop the technologies and tools required to safely decontaminate, disassemble, stabilize, disposition, and remediate unique radiation hazards. The sites where nuclear activities produced legacy waste and contamination include the original Manhattan Project sites--Los Alamos, New Mexico; Hanford, Washington; and Oak Ridge, Tennessee--as well as major Cold War sites, such as Savannah River Site, South Carolina; the Idaho National Laboratory, Idaho; Rocky Flats Plant, Colorado; and Fernald, Ohio. Today EM has responsibility for nuclear cleanup activities at 21 sites covering more than two million acres in 13 states, and employs more than 30,000 Federal and contractor employees, including scientists, engineers and hazardous waste technicians. This cleanup poses unique, technically complex problems, which must be solved under the most hazardous of conditions, and which will require billions of dollars a year for several more decades. The EM program focus during its first 10 years was on managing the most urgent risks and maintaining safety at each site while negotiating state and Federal environmental compliance agreements. The program also concentrated on characterizing waste and nuclear materials and assessing the magnitude and extent of environmental contamination. By the late 1990s, EM had made significant progress in identifying and characterizing the extent of contamination and cleanup required and began transitioning from primarily a characterization and stabilization program to an active cleanup and closure program. During that time, EM formulated multi-year cleanup and closure plans, which contributed to cleanup progress; however, reducing the overall environmental risk associated with the cleanup program remained a challenge. In response, the Secretary of Energy directed a review of the EM program be undertaken. The resulting 'Top-to Bottom Review' re-directed the program focus from managing risks to accelerating the reduction of these risks.« less

Supplement Analysis for the Site-Wide Environmental Impact Statement for Continued Operation of Los Alamos National Laboratory -- Recovery and Storage of Strontium-90 Fueled Radioisotope Thermal Electric Generators at Los Alamos National Laboratory

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

N /A

2004-01-22

This Supplement Analysis (SA) has been prepared to determine if the Site-Wide Environmental Impact Statement for Continued Operations of Los Alamos National Laboratory (SWEIS) (DOE/EIS-0238) adequately addresses the environmental effects of recovery and storage for disposal of six strontium-90 (Sr-90) fueled radioisotope thermal electric generators (RTGs) at the Los Alamos National Laboratory (LANL) Technical Area (TA)-54, Area G, or if the SWEIS needs to be supplemented. DOE's National Nuclear Security Administration (NNSA) proposed to recover and store six Sr-90 RTGs from the commercial sector as part of its Offsite-Source Recovery Project (OSRP). The OSRP focuses on the proactive recovery andmore » storage of unwanted radioactive sealed sources exceeding the US Nuclear Regulatory Commission (NRC) limits for Class C low-level waste (also known as Greater than Class C waste, or GTCC). In response to the events of September 11, 2001, NRC conducted a risk-based evaluation of potential vulnerabilities to terrorist threats involving NRC-licensed nuclear facilities and materials. NRC's evaluation concluded that possession of unwanted radioactive sealed sources with no disposal outlet presents a potential vulnerability (NRC 2002). In a November 25, 2003 letter to the manager of the NNSA's Los Alamos Site Office, the NRC Office of Nuclear Security and Incident Response identified recovery of several Sr-90 RTGs as the highest priority and requested that DOE take whatever actions necessary to recovery these sources as soon as possible. This SA specifically compares key impact assessment parameters of this proposal to the offsite source recovery program evaluated in the SWEIS and a subsequent SA that evaluated a change to the approach of a portion of the recovery program. It also provides an explanation of any differences between the Proposed Action and activities described in the previous SWEIS and SA analyses.« less

When could a stigma program to address mental illness in the workplace break even?

PubMed

Dewa, Carolyn S; Hoch, Jeffrey S

2014-10-01

To explore basic requirements for a stigma program to produce sufficient savings to pay for itself (that is, break even). A simple economic model was developed to compare reductions in total short-term disability (SDIS) cost relative to a stigma program's costs. A 2-way sensitivity analysis is used to illustrate conditions under which this break-even scenario occurs. Using estimates from the literature for the SDIS costs, this analysis shows that a stigma program can provide value added even if there is no reduction in the length of an SDIS leave. To break even, a stigma program with no reduction in the length of an SDIS leave would need to prevent at least 2.5 SDIS claims in an organization of 1000 workers. Similarly, a stigma program can break even with no reduction in the number of SDIS claims if it is able to reduce SDIS episodes by at least 7 days in an organization of 1000 employees. Modelling results, such as those presented in our paper, provide information to help occupational health payers become prudent buyers in the mental health market place. While in most cases, the required reductions seem modest, the real test of both the model and the program occurs once a stigma program is piloted and evaluated in a real-world setting.

Evaluation of potential surface rupture and review of current seismic hazards program at the Los Alamos National Laboratory. Final report

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

Not Available

1991-12-09

This report summarizes the authors review and evaluation of the existing seismic hazards program at Los Alamos National Laboratory (LANL). The report recommends that the original program be augmented with a probabilistic analysis of seismic hazards involving assignment of weighted probabilities of occurrence to all potential sources. This approach yields a more realistic evaluation of the likelihood of large earthquake occurrence particularly in regions where seismic sources may have recurrent intervals of several thousand years or more. The report reviews the locations and geomorphic expressions of identified fault lines along with the known displacements of these faults and last knowmore » occurrence of seismic activity. Faults are mapped and categorized into by their potential for actual movement. Based on geologic site characterization, recommendations are made for increased seismic monitoring; age-dating studies of faults and geomorphic features; increased use of remote sensing and aerial photography for surface mapping of faults; the development of a landslide susceptibility map; and to develop seismic design standards for all existing and proposed facilities at LANL.« less

LANL Environmental ALARA Program Status Report for CY 2016

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

Whicker, Jeffrey Jay; Mcnaughton, Michael; Ruedig, Elizabeth

2017-02-24

Los Alamos National Laboratory (LANL) ensures that radiation exposures to members of the public and the environment from LANL operations, past and present, are below regulatory thresholds and are as low as reasonably achievable (ALARA) through compliance with DOE Order 458.1 Radiation Protection for the Public and the Environment, and LANL Policy 412 Environmental Radiation Protection (LANL2016a). In 2007, a finding (RL.2-F-1) and observation (RL.2-0-1) in the NNSA/ LASO report, September 2007, Release of Property (Land) Containing Residual Radioactive Material Self-Assessment Report, indicated that LANL had no policy or documented process in place for the release of property containing residualmore » radioactive material. In response, LANL developed PD410, Los Alamos National Laboratory Environmental ALARA Program. The most recent version of this document became effective in 2014 (LANL 2014a). The document provides program authorities, responsibilities, descriptions, processes, and thresholds for conducting qualitative and quantitative ALARA analyses for prospective and actual radiation exposures to the public and t o the environment resulting from DOE activities conducted on the LANL site.« less

LANL Environmental ALARA Program Status Report for CY 2015

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

Whicker, Jeffrey Jay; Mcnaughton, Michael; Gillis, Jessica Mcdonnel

2016-03-29

Los Alamos National Laboratory (LANL) ensures that radiation exposures to members of the public and the environment from LANL operations, past and present, are below regulatory thresholds and are as low as reasonably achievable (ALARA) through compliance with DOE Order 458.1 Radiation Protection for the Public and the Environment, and LANL Policy 412 Environmental Radiation Protection. In 2007, a finding (RL.2-F-1) and observation (RL.2-0-1) in the NNSA/ LASO report, September 2007, Release of Property (Land) Containing Residual Radioactive Material Self-Assessment Report, indicated that LANL had no policy or documented process in place for the release of property containing residual radioactivemore » material. In response, LANL developed PD410, Los Alamos National Laboratory Environmental ALARA Program. The most recent version of this document became effective on September 28, 2011. The document provides program authorities, responsibilities, descriptions, processes, and thresholds for conducting qualitative and quantitative ALARA analyses for prospective and actual radiation exposures to the public and t o the environment resulting from DOE activities conducted on the LANL site.« less

Nuclear Forensics at Los Alamos National Laboratory

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

Kinman, William Scott; Steiner, Robert Ernest; Lamont, Stephen Philip

Nuclear forensics assists in responding to any event where nuclear material is found outside of regulatory control; a response plan is presented and a nuclear forensics program is undergoing further development so that smugglers are sufficiently deterred.

Mindfulness meditation-based stress reduction: experience with a bilingual inner-city program.

PubMed

Roth, B; Creaser, T

1997-03-01

This article describes a bilingual mindfulness meditation-based stress reduction program in an inner-city setting. Mindfulness meditation is defined, and the practices of breathing meditation, eating meditation, walking meditation, and mindful yoga are described. Data analysis examined compliance, medical and psychologic symptom reduction, and changes in self-esteem, of English- and Spanish-speaking patients who completed the 8-week Stress Reduction and Relaxation Program at the Community Health Center in Meriden, Conn. Statistically significant decreases in medical and psychologic symptoms and improvement in self-esteem were found. Many program completers reported dramatic changes in attitudes, beliefs, habits, and behaviors. Despite the limitations of the research design, these findings suggest that a mindfulness meditation course can be an effective health care intervention when utilized by English- and Spanish-speaking patients in an inner-city community health center. The article includes a discussion of factors to be considered when establishing a mindfulness meditation-based stress reduction program in a health care setting.

A Tale of Two Cities: Financing Two Voucher Programs for Substance Abusers Through Community Donations

PubMed Central

Amass, Leslie; Kamien, Jonathan

2005-01-01

Voucher-based reinforcement therapy (VBRT) is an effective drug abuse treatment, but the cost of VBRT rewards has limited its dissemination. Obtaining VBRT incentives through donations may be one way to overcome this barrier. Two direct mail campaigns solicited donations for use in VBRT for pregnant, postpartum, and parenting drug users in Toronto, Ontario, Canada, and in Los Angeles, California. In Toronto, 19% of those contacted over 2 months donated $8,000 ($4,000/month) of goods and services. In Los Angeles, nearly 26% of those contacted over 34 months donated $161,000 ($4,472/month) of goods and services. Maintaining voucher programs by soliciting donations is feasible and sustainable. The methods in this article can serve as a guide for successful donation solicitation campaigns. Donations offer an alternative for obtaining VBRT rewards for substance abuse treatment and may increase its dissemination. PMID:15122959

Resolving Controversies Concerning the Kinetic Structure of Multi-Ion Plasma Shocks

NASA Astrophysics Data System (ADS)

Keenan, Brett; Simakov, Andrei; Chacon, Luis; Taitano, William

2017-10-01

Strong collisional shocks in multi-ion plasmas are featured in several high-energy-density environments, including Inertial Confinement Fusion (ICF) implosions. Yet, basic structural features of these shocks remain poorly understood (e.g., the shock width's dependence on the Mach number and the plasma ion composition, and temperature decoupling between ion species), causing controversies in the literature; even for stationary shocks in planar geometry [cf., Ref. and Ref.]. Using a LANL-developed, high-fidelity, 1D-2V Vlasov-Fokker-Planck code (iFP), as well as direct comparisons to multi-ion hydrodynamic simulations and semi-analytic predictions, we critically examine steady-state, planar shocks in two-ion species plasmas and put forward resolutions to these controversies. This work was supported by the Los Alamos National Laboratory LDRD Program, Metropolis Postdoctoral Fellowship for W.T.T., and used resources provided by the Los Alamos National Laboratory Institutional Computing Program.

Linking Air Quality and Human Health Effects Models: An Application to the Los Angeles Air Basin.

PubMed

Stewart, Devoun R; Saunders, Emily; Perea, Roberto A; Fitzgerald, Rosa; Campbell, David E; Stockwell, William R

2017-01-01

Proposed emission control strategies for reducing ozone and particulate matter are evaluated better when air quality and health effects models are used together. The Community Multiscale Air Quality (CMAQ) model is the US Environmental Protection Agency's model for determining public policy and forecasting air quality. CMAQ was used to forecast air quality changes due to several emission control strategies that could be implemented between 2008 and 2030 for the South Coast Air Basin that includes Los Angeles. The Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) was used to estimate health and economic impacts of the different emission control strategies based on CMAQ simulations. BenMAP-CE is a computer program based on epidemiologic studies that link human health and air quality. This modeling approach is better for determining optimum public policy than approaches that only examine concentration changes.

The Organizational Structure of the Instructional Program of a Community College: An Evaluation With Recommendations for Change.

ERIC Educational Resources Information Center

Smith, Jack E.

A study was undertaken in the Spring of 1974 to evaluate the effectiveness of the administrative structure of the instructional program of East Los Angeles College (ELAC) and to make recommendations for change. Since ELAC was founded 29 years ago each new discipline has been established as a separate department; at the time of the study 27 such…

Master Plan: The Introduction of Computer Science and Computer Related Instructional Programs, 1982-1985. Office of Instruction Publication Report No. 82-07.

ERIC Educational Resources Information Center

Veley, Victor F.; And Others

This report presents a master plan for the development of computer science and computer-related programs at Los Angeles Trade-Technical College for 1982 through 1985. Introductory material outlines the main elements of the plan: to analyze existing computer courses, to create new courses in Laser Technology, Genetic Engineering, and Robotics; and…

Laboratory directed research and development. FY 1995 progress report

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

Vigil, J.; Prono, J.

1996-03-01

This document presents an overview of Laboratory Directed Research and Development Programs at Los Alamos. The nine technical disciplines in which research is described include materials, engineering and base technologies, plasma, fluids, and particle beams, chemistry, mathematics and computational science, atmic and molecular physics, geoscience, space science, and astrophysics, nuclear and particle physics, and biosciences. Brief descriptions are provided in the above programs.

Program Level Feedback from Former Occupational Education Students: Report 1 of 2, Summary Findings of Respondents District-Wide. Research Brief.

ERIC Educational Resources Information Center

Glyer-Culver, Betty

In fall 2000, the staff of Los Rios Community College District Office of Institutional Research collaborated with occupational education deans, academic area deans, and faculty to develop a series of program-specific followup surveys to be administered in spring 2001. These surveys were designed to determine how well courses met the employment and…

Parents and Schools: Success through Partnership. A Presentation Guide for School Administration & Teachers = Arriba los padres y las escuelas: una asociacion critica. Guia para padres hispanos.

ERIC Educational Resources Information Center

Baron, Augustine, Jr.; Vasquez, Melba J. T.

These two documents pertain to the "Parents and Schools: Success through Partnership" program. The presentation guide for school administrators and Teachers" is intended to help school personnel present the program and its associated video, which addresses common culturally-based causes of misunderstandings between Hispanic American parents and…

Low Boom Flight Demonstrator Briefing

NASA Image and Video Library

2018-04-03

Dr. Ed Waggoner, program director, Integrated Aviation Systems Program, NASA, speaks at a briefing on the Low Boom Flight Demonstrator, Tuesday, April 3, 2018 at NASA Headquarters in Washington. This new experimental aircraft will cut cross country travel times in half by flying faster than the speed of sound without creating a sonic boom, enabling travel from New York to Los Angeles in two hours. Photo Credit: (NASA/Aubrey Gemignani)

Safe, Disciplined, Drug-Free Schools. A Background Paper for the Goals 2000: Educate America Satellite Town Meeting July 20, 1993.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

What can be done to solve the problem of crime in schools? "Project Freedom," in Wichita, Kansas, is creating programs to help children learn about dangers that come with joining gangs and becoming involved in drugs. A community program in Los Angeles, Community Youth Gang Services," is a crisis intervention team working with…

Transit investments for greenhouse gas and energy reduction program : second assessment report.

DOT National Transportation Integrated Search

2014-08-01

This report is the second assessment of the U.S. Department of Transportation, Federal Transit Administrations Transit Investments for : Greenhouse Gas and Energy Reduction (TIGGER) Program. The TIGGER Program provides capital funds to transit age...

MCNP (Monte Carlo Neutron Photon) capabilities for nuclear well logging calculations

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

Forster, R.A.; Little, R.C.; Briesmeister, J.F.

The Los Alamos Radiation Transport Code System (LARTCS) consists of state-of-the-art Monte Carlo and discrete ordinates transport codes and data libraries. The general-purpose continuous-energy Monte Carlo code MCNP (Monte Carlo Neutron Photon), part of the LARTCS, provides a computational predictive capability for many applications of interest to the nuclear well logging community. The generalized three-dimensional geometry of MCNP is well suited for borehole-tool models. SABRINA, another component of the LARTCS, is a graphics code that can be used to interactively create a complex MCNP geometry. Users can define many source and tally characteristics with standard MCNP features. The time-dependent capabilitymore » of the code is essential when modeling pulsed sources. Problems with neutrons, photons, and electrons as either single particle or coupled particles can be calculated with MCNP. The physics of neutron and photon transport and interactions is modeled in detail using the latest available cross-section data. A rich collections of variance reduction features can greatly increase the efficiency of a calculation. MCNP is written in FORTRAN 77 and has been run on variety of computer systems from scientific workstations to supercomputers. The next production version of MCNP will include features such as continuous-energy electron transport and a multitasking option. Areas of ongoing research of interest to the well logging community include angle biasing, adaptive Monte Carlo, improved discrete ordinates capabilities, and discrete ordinates/Monte Carlo hybrid development. Los Alamos has requested approval by the Department of Energy to create a Radiation Transport Computational Facility under their User Facility Program to increase external interactions with industry, universities, and other government organizations. 21 refs.« less

Pancreaticoduodenectomy in Florida: do 20-year trends document the salutary benefits of centralization of care?

PubMed

Ryan, Carrie E; Wood, Thomas W; Ross, Sharona B; Smart, Amanda E; Sukharamwala, Prashant B; Rosemurgy, Alexander S

2015-09-01

Concentration of care has been promoted as fostering superior outcomes. This study was undertaken to determine if the concentration of care is occurring in Florida for a pancreaticoduodenectomy, and if so, is it having a salutary effect. The data for a pancreaticoduodenectomy were obtained from the Florida Agency for Health Care Administration for three 3-year periods:1992-1994, 2001-2003, 2010-2012; data were sorted by surgeon volume of pancreaticoduodenectomy during these periods and correlated with post-operative length of stay (LOS), in-hospital mortality and hospital charges (adjusted to 2012 dollars). Relative to 1992-1994, in 2010-2012 46% fewer surgeons performed 115% more pancreaticoduodenectomies with significant reductions in LOS and in-hospital mortality, and higher charges (P < 0.001 for each). From 1992-1994 to 2010-2012 there was an 18-fold increase in the number of pancreaticoduodenectomies by surgeons completing ≥ 12 per year (n = 45 to n = 806, respectively). During 2010-2012, the more frequently surgeons performed a pancreaticoduodenectomy, the shorter LOS, the lower in-hospital mortality, the greater the likelihood of discharge home and the lower the hospital charges (P < 0.03 for each). Over the last 20 years, the concentration of care has occurred in Florida with substantially fewer surgeons undertaking many more pancreaticoduodenectomies with dramatic improvements in LOS and in-hospital mortality, albeit with increased hospital charges. © 2015 International Hepato-Pancreato-Biliary Association.

PAUSED encodes the Arabidopsis exportin-t ortholog.

PubMed

Hunter, Christine A; Aukerman, Milo J; Sun, Hui; Fokina, Maria; Poethig, R Scott

2003-08-01

Los1p/exportin-t (XPOT) mediates the nuclear export of tRNAs in yeast and mammals. The requirements for this transport pathway are unclear, however, because los1 mutations do not affect yeast growth, and the phenotype of XPOT mutations in mammals is unknown. Here, we show that PAUSED (PSD) is the Arabidopsis ortholog of LOS1/XPOT and is capable of rescuing the tRNA export defect of los1 in Brewer's yeast (Saccharomyces cerevisiae), suggesting that its function has been conserved. Putative null alleles of PSD disrupt the initiation of the shoot apical meristem and delay leaf initiation after germination, the emergence of the radicle and lateral roots, and the transition to flowering. Plants doubly mutant for psd and hasty, the Arabidopsis ortholog of exportin 5, are viable but have a more severe phenotype than either single mutant. These results suggest that PSD plays a role in tRNA export in Arabidopsis, but that at least one-and perhaps several-additional tRNA export pathways also exist. The PSD transcript is broadly expressed during development and is alternatively spliced in the 3'-untranslated region. No temporal or spatial difference in the abundance of different splice forms was observed. We propose that the mutant phenotype of psd reflects defects in developmental events and cell/tissue types that require elevated levels of protein synthesis and are therefore acutely sensitive to a reduction in tRNA export.

Sexually Transmitted Infections Among Incarcerated Women: Findings From a Decade of Screening in a Los Angeles County Jail, 2002–2012

PubMed Central

Boudov, Melina; Anderson, Laura J.; Malek, Mark; Smith, Lisa V.; Chien, Michael; Guerry, Sarah

2014-01-01

Objectives. We describe and report findings from a screening program to identify sexually transmitted infections (STIs) and HIV among female inmates in Los Angeles County Jail. Methods. Chlamydia and gonorrhea screening was offered to entering female inmates. Women were eligible if they were (1) aged 30 years or younger, or (2) pregnant or possibly pregnant, or (3) booked on prostitution or sex-related charges. Voluntary syphilis and HIV testing was offered to all women between 2006 and 2009. This analysis reports on data collected from 2002 through 2012. Results. A total of 76 207 women participated in the program. Chlamydia prevalence was 11.4% and gonorrhea was 3.1%. Early syphilis was identified in 1.4% (141 of 9733) and the overall prevalence of HIV was 1.1% (83 of 7448). Treatment levels for early syphilis and HIV were high (99% and 100%, respectively), but only 56% of chlamydia and 58% of gonorrhea cases were treated. Conclusions. Screening incarcerated women in Los Angeles County revealed a high prevalence of STIs and HIV. These inmates represent a unique opportunity for the identification of STIs and HIV, although strategies to improve chlamydia and gonorrhea treatment rates are needed. PMID:25211762

Canada's Voluntary ARET Program: Limited Success Despite Industry Cosponsorship

ERIC Educational Resources Information Center

Antweiler, Werner; Harrison, Kathryn

2007-01-01

The Accelerated Reduction/Elimination of Toxins (ARET) Challenge was a voluntary program initiated in 1994 by the Government of Canada. Unlike the U.S. 33/50 Program, ARET involved industry partners in negotiation and cosponsorship of the program, with the intention that early involvement would yield stronger commitment to voluntary reductions. We…

Impact Of Care Coaching On Hospital Length Of Stay, Readmission Rates, Post-Discharge Phone Calls, and Patient Satisfaction Post-Bariatric Surgery

PubMed Central

Jalilvand, Anahita; Suzo, Andrew; Hornor, Melissa; Layton, Kristina; Abdel-Rasoul, Mahmoud; Macadam, Luke; Mikami, Dean; Needleman, Bradley; Noria, Sabrena

2016-01-01

BACKGROUND Bariatric surgery is well established as an effective means of treating obesity; however 30-day readmission rates remain high. The Bariatric Care Coaching Program was developed in response to a perceived need for better communication with patients upon discharge from hospital, and prior to being seen at their first post-op visit. The lack of communication was apparent from the number of patient phone calls to clinic and readmissions to hospital. OBJECTIVES The aim of this study was to evaluate the impact of the Care Coach Program on hospital length of stay (LOS), readmission rates, patient phone calls, and patient satisfaction. SETTING The study was conducted at The Ohio State University, Wexner Medical Center. METHODS A retrospective review was conducted on patients who had primary bariatric surgery from July 1, 2013 to June 30, 2015. The control group included patients who underwent surgery from July 1, 2013 – June 30, 2014, before development of the program, and the experimental group was comprised of patients who received care coaching from July 1, 2014 – June 30, 2015. Demographics, post-operative complications, LOS, clinic phone calls and hospital readmissions prior to the first post-operative visit were collected from medical records. Patient satisfaction scores were collected from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey [HCAHPS]. Univariate, bivariate co-efficient analysis, and a conditional logistic regression model were performed utilizing SAS software. RESULTS There were 261 and 264 patients in the care-coach and control groups, respectively. The care-coached group had fewer patients with intractable nausea/vomiting (11.11%; [p=0.0164]), and more patients with a shorter LOS (2.3 + 1.1 days; [p=0.032]), related to laparoscopic sleeve gastrectomy (2 + 0.9 days vs. 2.3 + 0.8 days; [p=0.002]). There was no difference in readmission rates [p=0.841] or phone calls to clinic [p=0.407]. HCAHPS scores demonstrated an improvement in patients’ perception of communication regarding medications (59th versus 27th percentile), discharge information (98th versus 93rd percentile), and likelihood of recommending the hospital (85th versus 74th percentile). CONCLUSION: The Bariatric Care Coach Program is an important new adjunct in the care of our bariatric inpatients. It has had the greatest impact on post-operative nausea/vomiting, LOS for sleeve gastrectomy, and patient satisfaction. Further studies are needed to evaluate how to use this program to reduce readmission rates and phone calls to clinic. PMID:27320222