Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

PubMed Central

Jenkins, Timothy C.; Knepper, Bryan C.; Shihadeh, Katherine; Haas, Michelle K.; Sabel, Allison L.; Steele, Andrew W.; Wilson, Michael L.; Price, Connie S.; Burman, William J.; Mehler, Philip S.

2016-01-01

Objective To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use Design Quasi-experimental, interrupted-time series study Setting 525-bed public safety-net hospital Intervention Implementation of a formal ASP in July 2008 Methods We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008 – September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005 – June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset C. difficile infection, and other patient-centered measures. Results During the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1000 PD, respectively), resulting in a slope change of 5.5 DOT/1000 PD per quarter for total antibacterial use (P = .10) and 3.3 DOT/100 PD per quarter for antipseudomonal use (P = .01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1000PD per quarter, p=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. Conclusion In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures; however, this study highlights limitations of commonly used stewardship outcome measures. PMID:25740560

Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility

PubMed Central

Kassett, Nina; Sham, Rosalind; Aleong, Rosanne; Yang, Daisy; Kirzner, Michael; Craft, Aidlee

2016-01-01

Background There is a paucity of literature describing the implementation of antimicrobial stewardship programs (ASPs) in long-term care (LTC) facilities. The current study evaluated the impact of an ASP that was implemented across a geriatric facility, which included an inpatient specialty hospital and an LTC facility. The program included prospective audits with feedback, multidisciplinary education, information technology interventions, and guideline development. Objective To investigate the impact of the ASP on physicians’ prescribing practices in this geriatric facility. Methods Utilization data for antibiotics commonly used to treat urinary tract infections were retrieved for the period September 1, 2011, to August 31, 2013. The study examined whether there were significant changes in overall antibiotic use, ciprofloxacin use, and physician prescribing behaviour after program implementation in September 2012. Results There was no significant change in the total number of antibiotic prescriptions for urinary tract infections in the hospital or the LTC facility after ASP implementation. Significant reductions were seen in the average days of therapy initially prescribed and the actual days of therapy after ASP implementation in the LTC facility but not the hospital. Across both facilities, significant reductions were seen in the number of ciprofloxacin prescriptions. Conclusions The current study showed that an ASP can affect physicians’ antibiotic prescribing behaviour and antibiotic usage in an LTC environment. PMID:28123192

Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use.

PubMed

Jenkins, Timothy C; Knepper, Bryan C; Shihadeh, Katherine; Haas, Michelle K; Sabel, Allison L; Steele, Andrew W; Wilson, Michael L; Price, Connie S; Burman, William J; Mehler, Philip S

2015-06-01

To evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use. Quasi-experimental, interrupted time-series study. Public safety net hospital with 525 beds. Implementation of a formal ASP in July 2008. We conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008-September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005-June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures. During the preintervention period, total antibacterial and antipseudomonal use were declining (-9.2 and -5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (-3.7 and -2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (-$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes. In a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.

Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings

PubMed Central

Anderson, Deverick J.; Cochran, Ronda L.; Hicks, Lauri A.; Srinivasan, Arjun; Dodds Ashley, Elizabeth S.

2017-01-01

Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development. PMID:27927866

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program

PubMed Central

Reed, Erica E.; Stevenson, Kurt B.; West, Jessica E.; Bauer, Karri A.; Goff, Debra A.

2013-01-01

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come. PMID:23154323

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program.

PubMed

Reed, Erica E; Stevenson, Kurt B; West, Jessica E; Bauer, Karri A; Goff, Debra A

2013-02-15

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come.

Use of computer decision support in an antimicrobial stewardship program (ASP).

PubMed

Evans, R S; Olson, J A; Stenehjem, E; Buckel, W R; Thorell, E A; Howe, S; Wu, X; Jones, P S; Lloyd, J F

2015-01-01

Document information needs, gaps within the current electronic applications and reports, and workflow interruptions requiring manual information searches that decreased the ability of our antimicrobial stewardship program (ASP) at Intermountain Healthcare (IH) to prospectively audit and provide feedback to clinicians to improve antimicrobial use. A framework was used to provide access to patient information contained in the electronic medical record, the enterprise-wide data warehouse, the data-driven alert file and the enterprise-wide encounter file to generate alerts and reports via pagers, emails and through the Centers for Diseases and Control's National Healthcare Surveillance Network. Four new applications were developed and used by ASPs at Intermountain Medical Center (IMC) and Primary Children's Hospital (PCH) based on the design and input from the pharmacists and infectious diseases physicians and the new Center for Diseases Control and Prevention/National Healthcare Safety Network (NHSN) antibiotic utilization specifications. Data from IMC and PCH now show a general decrease in the use of drugs initially targeted by the ASP at both facilities. To be effective, ASPs need an enormous amount of "timely" information. Members of the ASP at IH report these new applications help them improve antibiotic use by allowing efficient, timely review and effective prioritization of patients receiving antimicrobials in order to optimize patient care.

Education and Communication in an Interprofessional Antimicrobial Stewardship Program.

PubMed

Foral, Pamela A; Anthone, Jennifer M; Destache, Christopher J; Vivekanandan, Renuga; Preheim, Laurel C; Gorby, Gary L; Horne, John M; Dobronski, Leo A; Syed, Javeria J; Mindru, Cezarina; Ali, Mir A; Ali, Karim F; Neemann, Kari A; Bittner, Marvin J

2016-09-01

Interprofessional education/interprofessional practice (IPE/IPP) is an essential component in medical education and training. A collaborative interprofessional team environment ensures optimal patient-centered care. To describe the implementation of 2 interprofessional antimicrobial stewardship program (ASP) teams using IPE/IPP and to assess the acceptance rate by the primary medical and surgical teams of ASP recommendations for antimicrobial interventions. A business plan for the ASP was approved at 2 academic medical centers used for the present study. During a 3-year study period, 2 interprofessional ASP teams included an attending physician specializing in infectious disease (ID), an ID physician fellow, an ASP pharmacist, physician residents, medical students, pharmacy residents, and pharmacy students. Educational seminars were presented for all adult-admitting physicians to discuss the need for the ASP and the prospective audit and feedback process. Cases were presented for discussion during ASP/ID rounds and recommendations were agreed upon by the ASP team. A motivational interviewing face-to-face technique was frequently used to convey the ASP team recommendation to the primary medical or surgical team in a noncoercive and educational manner. The ASP team recommendations for ASP interventions were documented in the medical records. The overall acceptance rate of recommendations by the primary medical and surgical teams were greater than 90% (2051 of 2266). The most frequent interventions provided were streamline therapy (601), route of administration change (452), bug-drug mismatch (190), and discontinuation of therapy (179). Route of administration change was also the most frequently accepted intervention (96%). The motivational face-to-face communication technique was particularly useful in conveying ASP team member recommendations to the primary medical or surgical teams. Communicating recommendations as a multidisciplinary team in an educational manner seems to have resulted in to greater acceptance of recommendations.

Dramatic effects of a new antimicrobial stewardship program in a rural community hospital.

PubMed

Libertin, Claudia R; Watson, Stephanie H; Tillett, William L; Peterson, Joy H

2017-09-01

New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia. An educational grand rounds lecture series was provided before implementation of the ASP to all prescribers. After implementation, algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes based on local antibiograms were provided to prescribers to improve this selection. Rates of C difficile infections, total targeted antimicrobial costs, and drug utilization rates were calculated for 1 year pre-ASP implementation (2013) and 1 year post-ASP implementation (October 2014-December 2015). The patient safety metric of C difficile infections decreased from 3.35 cases per 1,000 occupied bed days (OBDs) in 2013 to 1.35 cases per 1,000 OBDs in 2015. Total targeted antimicrobial costs decreased 50% from $16.93 per patient day in 2013 to $8.44 per patient day in 2015. Overall antimicrobial use decreased 10% from before the ASP initiative to 1 year after it. Annualized savings were $280,000 in 1 year, based on drug savings only. Judicious use of antimicrobials and resources can improve a patient safety metric and decrease costs dramatically in rural institutions where the average hospital census is <100 patients per day. The savings would allow the institutions to spend better while improving the use of antimicrobials. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Antimicrobial Stewardship in Inpatient Settings in the Asia Pacific Region: A Systematic Review and Meta-analysis.

PubMed

Honda, Hitoshi; Ohmagari, Norio; Tokuda, Yasuharu; Mattar, Caline; Warren, David K

2017-05-15

An antimicrobial stewardship program (ASP) is one of the core elements needed to optimize antimicrobial use. Although collaboration at the national level to address the importance of ASPs and antimicrobial resistance has occurred in the Asia Pacific region, hospital-level ASP implementation in this region has not been comprehensively evaluated. We conducted a systematic review and meta-analysis to assess the efficacy of ASPs in inpatient settings in the Asia Pacific region from January 2005 through March 2016. The impact of ASPs on various outcomes, including patient clinical outcomes, antimicrobial prescription outcomes, microbiological outcomes, and expenditure were assessed. Forty-six studies were included for a systematic review and meta-analysis. The pooled risk ratio for mortality from ASP before-after trials and 2-group comparative studies were 1.03 (95% confidence interval [CI], .88-1.19) and 0.69 (95% CI, .56-.86), respectively. The pooled effect size for change in overall antimicrobial and carbapenem consumption (% difference) was -9.74% (95% CI, -18.93% to -.99%) and -10.56% (95% CI, -19.99% to -3.03%), respectively. Trends toward decreases in the incidence of multidrug-resistant organisms and antimicrobial expenditure (range, 9.7%-58.1% reduction in cost in the intervention period/arm) were also observed. ASPs in inpatient settings in the Asia Pacific region appear to be safe and effective to reduce antimicrobial consumption and improve outcomes. However, given the significant variations in assessing the efficacy of ASPs, high-quality studies using standardized surveillance methodology for antimicrobial consumption and similar metrics for outcome measurement are needed to further promote antimicrobial stewardship in this region. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Clinical and economic outcomes from a community hospital's antimicrobial stewardship program.

PubMed

Malani, Anurag N; Richards, Patrick G; Kapila, Shikha; Otto, Michael H; Czerwinski, Jennifer; Singal, Bonita

2013-02-01

Data from community antimicrobial stewardship programs (ASPs) are limited. We describe clinical and economic outcomes from the first year of our hospital's ASP. The ASP team comprised 2 infectious disease physicians and 3 intensive care unit pharmacists. The team prospectively audited the new starts and weekly use of 8 target antimicrobials: aztreonam, caspofungin, daptomycin, ertapenem, linezolid, meropenem, tigecycline, and voriconazole. Using administrative data, outcomes from the first year of the program, including death within 30 days of hospitalization, readmission within 30 days of discharge, and development of Clostridium difficile infection (CDI), were compared with outcomes from a similar period before institution of the program. A total of 510 antimicrobial orders were reviewed, of which 323 (63%) were appropriate, 94 (18%) prompted deescalation, 61 (12%) were denied, and 27 (5%) led to formal consultation with an infectious disease physician. On multivariate analysis, implementation of the ASP was associated with an approximate 50% reduction in the odds of developing CDI (odds ratio, 0.46; 95% confidence interval, 0.25-0.82). The ASP was not associated with decreased mortality at 30 days after discharge or readmission rate. The antimicrobial cost per patient-day decreased by 13.3%, from $10.16 to $8.81. The antimicrobial budget decreased by 15.2%, resulting in a total savings of $228,911. There was a 25.4% decrease in defined daily doses of the target antimicrobials. Implementation of the ASP was associated with significant reductions in CDI rate, antimicrobial use, and pharmacy costs. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Antimicrobial Therapy for Legionnaire's Disease: Antibiotic Stewardship Implications.

PubMed

Cunha, Cheston B; Cunha, Burke A

2017-03-01

Legionnaire's disease is a common cause of community-acquired pneumonia (CAP). Although no single clinical feature is diagnostic, if characteristic extrapulmonary findings are present a presumptive clinical syndromic diagnosis is possible. Depending on geographic location, season, and physician awareness, Legionnaire's disease may be included in the differential diagnosis of CAP. Some antibiotics effective against Legionella sp are also effective in treating the typical bacterial causes of CAP. From an antimicrobial stewardship program (ASP) perspective, monotherapy is preferred to double-drug therapy. From an ASP and pharmacoeconomic standpoint, monotherapy with doxycycline or a respiratory quinolone provides optimal cost effective therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

Impact of a Prospective Audit and Feedback Antimicrobial Stewardship Program at a Veterans Affairs Medical Center: A Six-Point Assessment

PubMed Central

Morrill, Haley J.; Caffrey, Aisling R.; Gaitanis, Melissa M.; LaPlante, Kerry L.

2016-01-01

Background Prospective audit and feedback is a core antimicrobial stewardship program (ASP) strategy; however its impact is difficult to measure. Methods Our quasi-experimental study measured the effect of an ASP on clinical outcomes, antimicrobial use, resistance, costs, patient safety (adverse drug events [ADE] and Clostridium difficile infection [CDI]), and process metrics pre- (9/10–10/11) and post-ASP (9/12–10/13) using propensity adjusted and matched Cox proportional-hazards regression models and interrupted time series (ITS) methods. Results Among our 2,696 patients, median length of stay was 1 day shorter post-ASP (5, interquartile range [IQR] 3–8 vs. 4, IQR 2–7 days, p<0.001). Mortality was similar in both periods. Mean broad-spectrum (-11.3%), fluoroquinolone (-27.0%), and anti-pseudomonal (-15.6%) use decreased significantly (p<0.05). ITS analyses demonstrated a significant increase in monthly carbapenem use post-ASP (trend: +1.5 days of therapy/1,000 patient days [1000PD] per month; 95% CI 0.1–3.0). Total antimicrobial costs decreased 14%. Resistance rates did not change in the one-year post-ASP period. Mean CDI rates/10,000PD were low pre- and post-ASP (14.2 ± 10.4 vs. 13.8 ± 10.0, p = 0.94). Fewer patients experienced ADEs post-ASP (6.0% vs. 4.4%, p = 0.06). Conclusions Prospective audit and feedback has the potential to improve antimicrobial use and outcomes, and contain bacterial resistance. Our program demonstrated a trend towards decreased length of stay, broad-spectrum antimicrobial use, antimicrobial costs, and adverse events. PMID:26978263

Antimicrobial stewardship program in a Malaysian district hospital: First year experience

PubMed Central

Sing, Diana Yap Fui; Boo, Yang Liang; Mukhlis, Roshalina; Chin, Pek Woon; Hoo, Fan Kee

2016-01-01

Backgrounds & Objective: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital. Methods: An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above. Results: Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004). Conclusion: ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures. PMID:27648056

Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

PubMed Central

Linkin, Darren R.; Fishman, Neil O.; Landis, J. Richard; Barton, Todd D.; Gluckman, Steven; Kostman, Jay; Metlay, Joshua P.

2011-01-01

Objective To determine the effect of inaccurate communication of patient data—from clinicians caring for inpatients to prior-approval antimicrobial stewardship programs (ASP) staff (practitioners)—on the incidence of inappropriate antimicrobial recommendations by ASP practitioners Design A retrospective cohort design was utilized. The accuracy of communicated patient data was evaluated against patients’ medical records for pre-determined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined when an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients’ medical records. Setting The setting was an academic medical center with a prior-approval ASP. Patients All inpatient subjects of ASP prior-approval calls were eligible for inclusion. Results The panel agreed on whether the antimicrobial recommendation was inappropriate or not in 163 (82%) of 200 ASP calls; the 163 calls were then the basis for further analyses. After controlling for confounders, inaccurate communications were associated with inappropriate antimicrobial recommendations with an odds ratio (OR) of 2.2 (p=0.03). In secondary analyses of specific data types, only inaccuracies of microbiological data were associated with the study outcome (OR 7.5, p=0.002). The most common reason given by panelists for an inappropriate rating was that antimicrobials were not indicated. Conclusions Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm critical communicated data prior to use in prescribing decisions. PMID:17994518

Feasibility and applicability of antimicrobial stewardship in immunocompromised patients.

PubMed

Robilotti, Elizabeth; Holubar, Marisa; Seo, Susan K; Deresinski, Stan

2017-08-01

Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients. Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction. Emerging literature suggests that several stewardship interventions can be adapted to immunocompromised hosts and improve antimicrobial utilization, but data supporting improved outcomes is very limited. The application of antimicrobial stewardship principles to immunocompromised patients is feasible, necessary, and urgent. As antimicrobial stewardship programs gain momentum across a diverse range of healthcare settings more immunocompromised patients will fall under their purview. It is imperative that centers applying antimicrobial stewardship principles share their experience and establish collaborative research efforts to advance our knowledge base in applying antimicrobial stewardship initiatives to immunocompromised host populations, both in terms of programmatic success and patient outcomes.

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit.

PubMed

Nzegwu, Nneka I; Rychalsky, Michelle R; Nallu, Loren A; Song, Xuemei; Deng, Yanhong; Natusch, Amber M; Baltimore, Robert S; Paci, George R; Bizzarro, Matthew J

2017-10-01

OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012. METHODS We convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance. RESULTS Antibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time. CONCLUSIONS Implementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices. Infect Control Hosp Epidemiol 2017;38:1137-1143.

A Pilot Study for Antimicrobial Stewardship Post-Discharge: Avoiding Pitfalls at the Transitions of Care.

PubMed

Jones, Justin M; Leedahl, Nathan D; Losing, Ashley; Carson, Paul J; Leedahl, David D

2018-04-01

Lack of patient follow-up is a major concern during care transitions, and the role of an antimicrobial stewardship program (ASP) in assessing antimicrobial regimens after hospital discharge is not well described. We implemented an expanded ASP to include patients recently discharged from the hospital and measured its impact on inappropriate antimicrobial therapy 72 hours after inpatient culture data were finalized. A prospective cohort study was conducted at a 583-bed tertiary care center in the Upper Midwest of America. All patients discharged from our facility on antimicrobial therapy with pending culture results between February 3, 2016, and March 2, 2016, were included for review. If a pathogen nonsusceptible to all prescribed antimicrobials was identified post-discharge, a recommendation for therapy modification was communicated to the prescriber. Thirty-eight patients discharged from our hospital on antimicrobial therapy with pending culture results were evaluated for intervention. When final culture susceptibilities were considered, 5 of 38 patients had been prescribed an inappropriate antimicrobial agent. An ASP pharmacist intervened on 4 of 5 patients, resulting in 3 of 5 patients transitioning to appropriate antimicrobial therapy. When compared to a historical cohort, our transitions-of-care ASP yielded a 3.6-fold increase in antimicrobial-related interventions among discharged patients while reducing inappropriate outpatient antimicrobial therapy by 39%. We believe this is the first pharmacist-driven ASP represented in the medical literature which evaluated all available inpatient culture data to serve patients discharged from the hospital. Antimicrobial stewardship for patients in care transitions may provide an opportunity to increase ASP interventions and reduce inappropriate antimicrobial therapy.

Considering a new domain for antimicrobial stewardship: Topical antibiotics in the open surgical wound.

PubMed

Edmiston, Charles E; Leaper, David; Spencer, Maureen; Truitt, Karen; Litz Fauerbach, Loretta; Graham, Denise; Johnson, Helen Boehm

2017-11-01

The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan.

PubMed

Lin, Yu-Shiuan; Lin, I-Fen; Yen, Yung-Feng; Lin, Pei-Ching; Shiu, Yu-Chih; Hu, Hsing-Yi; Yang, Ying-Pi

2013-11-01

Reports of antimicrobial stewardship programs (ASPs) in community hospitals are limited, with the major focus on specific agents, small settings, or short time periods. Here we present the outcomes of cost control, consumption restraint, and quality of care after a 3-year multidisciplinary ASP in a 415-bed community public teaching hospital. Three strategies for improving antimicrobial stewardship were implemented: education, clinical pharmacists-based intervention, and regular outcome announcement. The steering panel of the program was a committee composed of infection specialists, attending physicians, clinical pharmacists, nurses, and medical laboratorists. Semiannual data from July 2009 to June 2012 was analyzed. Antibiotic costs declined from $21,464 to $12,146 per 1,000 patient-days (-43.4%). Approximately $2.5 million was saved in 3 years, and estimated labor cost was $3,935 per month. Defined daily dose per 1,000 patient-days were diminished from 906.7 to 717.5 (-20.9%). Significant reductions were found in the consumption of aminoglycosides, first-generation cephalosporins, and aminopenicillins. However, through comprehensive auditing, increasing consumption of fourth-generation cephalosporins and fluoroquinolones was noticed. No significant difference in the quality of care (ie, length of stay, incidence of health care associated infections, and mortality) was observed. The multidisciplinary ASP was beneficial to reduce antibiotic cost and consumption. The strategies were practical and worthy to be recommended to community health care settings. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program.

PubMed

Nguyen-Ha, Phuong-Tan; Howrie, Denise; Crowley, Kelli; Vetterly, Carol G; McGhee, William; Berry, Donald; Ferguson, Elizabeth; Polischuk, Emily; Brooks, Maria Mori; Goff, Jeffrey; Stillwell, Terri; Darville, Toni; Thompson, Ann E; Levin, James E; Michaels, Marian G; Green, Michael

2016-05-01

Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model. The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time. Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change -12%) and use (-25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (-31%, P = .021) and a nonsignificant decline in drug starts (-21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively. This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants. Copyright © 2016 by the American Academy of Pediatrics.

Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study

PubMed Central

2014-01-01

Background Initial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN. Methods We conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk. Results A total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14–0.92). Conclusions Antimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting. PMID:24884397

Association between adherence to an antimicrobial stewardship program and mortality among hospitalised cancer patients with febrile neutropaenia: a prospective cohort study.

PubMed

Rosa, Regis G; Goldani, Luciano Z; dos Santos, Rodrigo P

2014-05-23

Initial management of chemotherapy-induced febrile neutropaenia (FN) comprises empirical therapy with a broad-spectrum antimicrobial. Currently, there is sufficient evidence to indicate which antibiotic regimen should be administered initially. However, no randomized trial has evaluated whether adherence to an antimicrobial stewardship program (ASP) results in lower rates of mortality in this setting. The present study sought to assess the association between adherence to an ASP and mortality among hospitalised cancer patients with FN. We conducted a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All adult patients who were admitted to the haematology ward with cancer and FN were followed up for 28 days. ASP adherence to the initial antimicrobial prescription was determined. The mortality rates of patients who were treated with antibiotics according to the ASP protocol were compared with those of patients treated with other antibiotic regimens. The multivariate Cox proportional hazards model and propensity score were used to estimate 28-day mortality risk. A total of 307 FN episodes in 169 subjects were evaluated. The rate of adherence to the ASP was 53%. In a Cox regression analysis, adjusted for propensity scores and other potential confounding factors, ASP adherence was independently associated with lower mortality (hazard ratio, 0.36; 95% confidence interval, 0.14-0.92). Antimicrobial selection is important for the initial management of patients with FN, and adherence to the ASP, which calls for the rational use of antibiotics, was associated with lower mortality rates in this setting.

Prevalence, Characteristics, and Perception of Nursery Antibiotic Stewardship Coverage in the United States.

PubMed

Cantey, Joseph B; Vora, Niraj; Sunkara, Mridula

2017-09-01

Prolonged or unnecessary antibiotic use is associated with adverse outcomes in infants. Antibiotic stewardship programs (ASPs) aim to prevent these adverse outcomes and optimize antibiotic prescribing. However, data evaluating ASP coverage of nurseries are limited. The objectives of this study were to describe the characteristics of nurseries with and without ASP coverage and to determine perceptions of and barriers to nursery ASP coverage. The 2014 American Hospital Association annual survey was used to randomly select a level III neonatal intensive care unit from all 50 states. A level I and level II nursery from the same city as the level III nursery were then randomly selected. Hospital, nursery, and ASP characteristics were collected. Nursery and ASP providers (pharmacists or infectious disease providers) were interviewed using a semistructured template. Transcribed interviews were analyzed for themes. One hundred forty-six centers responded; 104 (71%) provided nursery ASP coverage. In multivariate analysis, level of nursery, university affiliation, and number of full-time equivalent ASP staff were the main predictors of nursery ASP coverage. Several themes were identified from interviews: unwanted coverage, unnecessary coverage, jurisdiction issues, need for communication, and a focus on outcomes. Most providers had a favorable view of nursery ASP coverage. Larger, higher-acuity nurseries in university-affiliated hospitals are more likely to have ASP coverage. Low ASP staffing and a perceived lack of importance were frequently cited as barriers to nursery coverage. Most nursery ASP coverage is viewed favorably by providers, but nursery providers regard it as less important than ASP providers. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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

Incorporating pharmacy student activities into an antimicrobial stewardship program in a long-term acute care hospital.

PubMed

Benson, John M

2014-02-01

The impact on antimicrobial costs of an antimicrobial stewardship program (ASP) that integrated pharmacy students as integral members was evaluated. Demographic and discharge disposition data and antimicrobial acquisition cost data were retrospectively collected for all patients admitted to Promise Hospital of Salt Lake between June 1, 2009, and May 31, 2012. During this study, the primary role of pharmacy students in the ASP was to monitor all infection-related patient problems in the facility and meet daily with the infectious diseases pharmacist and clinical pharmacist to develop recommendations for optimizing antimicrobial use. The primary outcome measure was the mean antimicrobial acquisition cost per patient per day, calculated before ASP implementation (baseline period) and two years after ASP implementation (intervention period). The acquisition costs of antimicrobial agents per patient day were compared before and two years after implementation of the ASP involving pharmacy students. Statistical significance was determined using Student's t test for continuous data and the chi-square test for nominal data. The rate of patient discharge to skilled nursing facilities was significantly higher during the intervention period versus the baseline period (p = 0.016); no other significant comparisons were found. The mean ± S.D. antimicrobial costs per patient day were $75.37 ± $11.85 in the baseline period and $64.13 ± $13.78 in the intervention period (p = 0.022). This difference represents a cost savings of $261,630 during the two-year intervention period. Decreased antimicrobial costs were observed over a two-year period after implementation of an ASP that incorporated pharmacy students as integral members of the program.

Working at the intersection of context, culture, and technology: Provider perspectives on antimicrobial stewardship in the emergency department using electronic health record clinical decision support.

PubMed

Chung, Phillip; Scandlyn, Jean; Dayan, Peter S; Mistry, Rakesh D

2017-11-01

Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado. We reviewed and coded the data using constant comparative analysis and framework analysis until a final set of themes emerged. Two dominant perceptions shaped providers' perspectives on ASPs in the ED and EHR CDS: (1) maintaining workflow efficiency and (2) constrained decision-making autonomy. Clinicians identified structural barriers to ASPs, such as pace of the ED, and various beliefs that shaped patterns of practice, including accommodating the prescribing decisions of other providers and managing parental expectations. Recommendations to enhance uptake focused on designing a simple yet flexible user interface, providing clinicians with performance data, and on-boarding clinicians to enhance buy-in. Developing a successful ED-based ASP using EHR CDS should attend to technologic needs, the institutional context, and the cultural beliefs of practice associated with providers' antibiotic prescribing. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Evaluation of Antimicrobial Stewardship-Related Alerts Using a Clinical Decision Support System.

PubMed

Ghamrawi, Riane J; Kantorovich, Alexander; Bauer, Seth R; Pallotta, Andrea M; Sekeres, Jennifer K; Gordon, Steven M; Neuner, Elizabeth A

2017-11-01

Background: Information technology, including clinical decision support systems (CDSS), have an increasingly important and growing role in identifying opportunities for antimicrobial stewardship-related interventions. Objective: The aim of this study was to describe and compare types and outcomes of CDSS-built antimicrobial stewardship alerts. Methods: Fifteen alerts were evaluated in the initial antimicrobial stewardship program (ASP) review. Preimplementation, alerts were reviewed retrospectively. Postimplementation, alerts were reviewed in real-time. Data collection included total number of actionable alerts, recommendation acceptance rates, and time spent on each alert. Time to de-escalation to narrower spectrum agents was collected. Results: In total, 749 alerts were evaluated. Overall, 306 (41%) alerts were actionable (173 preimplementation, 133 postimplementation). Rates of actionable alerts were similar for custom-built and prebuilt alert types (39% [53 of 135] vs 41% [253 of 614], P = .68]. In the postimplementation group, an intervention was attempted in 97% of actionable alerts and 70% of interventions were accepted. The median time spent per alert was 7 minutes (interquartile range [IQR], 5-13 minutes; 15 [12-17] minutes for actionable alerts vs 6 [5-7] minutes for nonactionable alerts, P < .001). In cases where the antimicrobial was eventually de-escalated, the median time to de-escalation was 28.8 hours (95% confidence interval [CI], 10.0-69.1 hours) preimplementation vs 4.7 hours (95% CI, 2.4-22.1 hours) postimplementation, P < .001. Conclusions: CDSS have played an important role in ASPs to help identify opportunities to optimize antimicrobial use through prebuilt and custom-built alerts. As ASP roles continue to expand, focusing time on customizing institution specific alerts will be of vital importance to help redistribute time needed to manage other ASP tasks and opportunities.

Social media as a tool for antimicrobial stewardship.

PubMed

Pisano, Jennifer; Pettit, Natasha; Bartlett, Allison; Bhagat, Palak; Han, Zhe; Liao, Chuanhong; Landon, Emily

2016-11-01

To increase the reach of our antimicrobial stewardship program (ASP), social media platforms, Facebook and Twitter, were used to increase internal medicine residents' (IMRs') antibiotic (Abx) knowledge and awareness of ASP resources. Fifty-five of 110 (50%) IMRs consented to participate; 39 (71%) completed both pre- and postintervention surveys and followed our ASP on social media. Along with 20 basic Abx and infectious diseases (IDs) questions, this survey assessed IMR awareness of ASP initiatives, social media usage, and attitudes and beliefs surrounding Abx resistance. Over 6 months, IMRs received posts and Tweets of basic Abx/IDs trivia while promoting use of educational tools and clinical pathways on our ASP Web site. To compare pre- and postsurvey responses, McNemar test or Stuart-Maxwell test was used for categorical variables, and paired t test or Wilcoxon signed-rank test was used for continuous variables, as appropriate. Of the IMRs, 98% and 58% use Facebook and Twitter, respectively. To compare pre- and postintervention, median scores for Abx knowledge increased from 12 (interquartile range, 8-13) to 13 (interquartile range, 11-15; P = .048); IMRs knowing how to access the ASP Web site increased from 70% to 94%. More IMRs indicated that they used the clinical pathways "sometimes, frequently, or always" after the intervention (33% vs 61%, P = .004). Social media is a valuable tool to reinforce ASP initiatives while encouraging the use of ASP resources to promote antimicrobial mindfulness. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Point-of-care Beta-lactam Allergy Skin Testing by Antimicrobial Stewardship Programs: A Pragmatic Multicenter Prospective Evaluation.

PubMed

Leis, Jerome A; Palmay, Lesley; Ho, Grace; Raybardhan, Sumit; Gill, Suzanne; Kan, Tiffany; Campbell, Jackie; Kiss, Alex; McCready, Janine B; Das, Pavani; Minnema, Brian; Powis, Jeff E; Walker, Sandra A N; Ferguson, Heather; Wong, Benny; Weber, Elizabeth

2017-06-01

Beta-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point-of-care. We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at three hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving non-preferred beta-lactam therapy due to severity of their allergy. The primary outcome was the proportion of patients receiving the preferred beta-lactam therapy. Of 827 patients with reported beta-lactam allergy over 15-months, beta-lactam therapy was preferred among 632(76%). During baseline periods, 50% (124/246) received preferred beta-lactam therapy based on history, compared with 60% (232/386) during the intervention periods (p=0.02), which improved further to 81% (313/386) upon provision of BLAST (p<0.001) without any increase in incidence of adverse drug reactions (4% vs. 3%; p=0.4). After adjusting for patient variables and the correlation between hospitals, the intervention period was associated with a 4.5-fold greater odds of receiving preferred beta-lactam therapy (95% CI, 2.4-8.2; p<0.0001). The use of BLAST at the point-of-care across three hospital ASPs resulted in greater use of preferred beta-lactam therapy without increasing the risk of adverse drug reactions. Longer term studies are needed to better assess the safety and clinical impact of this ASP intervention. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Impact of Matrix-Assisted Laser Desorption and Ionization Time-of-Flight and Antimicrobial Stewardship Intervention on Treatment of Bloodstream Infections in Hospitalized Children.

PubMed

Malcolmson, Caroline; Ng, Karen; Hughes, Shevaun; Kissoon, Niranjan; Schina, Jillian; Tilley, Peter A; Roberts, Ashley

2017-06-01

Early definitive identification of infectious pathogens coupled with antimicrobial stewardship interventions allow for targeted and timely administration of antimicrobials. We investigated the combined impact of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology and an antimicrobial stewardship program (ASP) in pediatric patients with blood stream infections (BSIs). This is a single-center study comparing a control group of patients from October 2009 to July 2010 with BSIs to a cohort of patients postimplementation of MALDI-TOF and an ASP, from October 2013 to July 2014. Primary outcome was time to optimal therapy. Secondary outcomes included time to effective therapy, 30-day all-cause mortality, 30-day readmission rate, hospital length of stay, and intensive care admission. One hundred episodes of BSIs were identified in the preintervention period, and 121 episodes were identified in the postintervention period. Time from blood culture collection to organism identification was significantly reduced in the prospective cohort compared with historical controls (18.8 vs 43.7 hours, respectively). A total of 73 ASP interventions were made on the treatment of BSIs in the postintervention period. Combined use of MALDI-TOF and ASP significantly reduced time to optimal therapy (77.0 to 54.2 hours, P < .001). In the subgroup analysis of Gram-negative bacteremia, time to effective and optimal therapy were significantly reduced (2.0 vs 0.7 hours and 146.8 vs 48.0 hours, respectively). There were no significant differences in clinical outcomes. The combined use of MALDI-TOF and ASP allows early optimization of antimicrobial therapy in pediatric inpatients with BSIs. © The Author 2016. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The efficacy of the direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in the pediatric ward of a tertiary medical facility without a pediatric antimicrobial stewardship program.

PubMed

Hoshina, T; Yamamoto, N; Ogawa, M; Nakamoto, T; Kusuhara, K

2017-08-01

Antimicrobial stewardship programs (ASPs) have been introduced in most hospital complexes; however, they are not always useful for pediatric patients. The aim of this study is to investigate the efficacy of direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in a tertiary medical facility without pediatric ASP. This retrospective study included 1,821 patients who were hospitalized in the pediatric ward of a large metropolitan hospital from 2010 to 2015. The clinical course, the use of intravenous antimicrobial agents and the results of a microbiological analysis were compared between the period after the beginning of direct intervention by the specialist (post-intervention period) and the previous period (pre-intervention period). In the post-intervention period, the proportion of the patients who received intravenous antimicrobial agents, the number of antimicrobial agents used for each episode, and the proportion of episodes in which an antimicrobial agent was re-administrated were significantly lower (P = 0.006, P = 0.004, P = 0.036, respectively), and the duration of antimicrobial treatment was significantly shorter (P < 0.001). In addition, narrower spectrum antimicrobial agents were used, and the incidence of meropenem-sensitive Pseudomonas aeruginosa significantly increased (P = 0.037) in the post-intervention period. There was no change of mortality between the two periods. Direct clinical intervention by a pediatric infectious diseases specialist is useful for the treatment of infectious diseases in the pediatric ward of a tertiary medical facility without a pediatric ASP. The creation of a pediatric ASP is recommended in hospital complexes.

Longitudinal evaluation of a World Wide Web-based antimicrobial stewardship program: assessing factors associated with approval patterns and trends over time.

PubMed

Venugopal, Vidya; Lehmann, Christoph U; Diener-West, Marie; Agwu, Allison L

2014-02-01

The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP. We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval. The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P < .01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent. The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Implementation of an antimicrobial stewardship program targeting residents with urinary tract infections in three community long-term care facilities: a quasi-experimental study using time-series analysis.

PubMed

Doernberg, Sarah B; Dudas, Victoria; Trivedi, Kavita K

2015-01-01

Asymptomatic bacteriuria in the elderly commonly results in antibiotic administration and, in turn, contributes to antimicrobial resistance, adverse drug events, and increased costs. This is a major problem in the long-term care facility (LTCF) setting, where residents frequently transition to and from the acute-care setting, often transporting drug-resistant organisms across the continuum of care. The goal of this study was to assess the feasibility and efficacy of antimicrobial stewardship programs (ASPs) targeting urinary tract infections (UTIs) at community LTCFs. This was a quasi-experimental study targeting antibiotic prescriptions for UTI using time-series analysis with 6-month retrospective pre-intervention and 6-month intervention period at three community LTCFs. The ASP team (infectious diseases (ID) pharmacist and ID physician) performed weekly prospective audit and feedback of consecutive prescriptions for UTI. Loeb clinical consensus criteria were used to assess appropriateness of antibiotics; recommendations were communicated to the primary treating provider by the ID pharmacist. Resident outcomes were recorded at subsequent visits. Generalized estimating equations using segmented regression were used to evaluate the impact of the ASP intervention on rates of antibiotic prescribing and antibiotic resistance. One-hundred and four antibiotic prescriptions for UTI were evaluated during the intervention, and recommendations were made for change in therapy in 40 (38 %), out of which 10 (25 %) were implemented. Only eight (8 %) residents started on antibiotics for UTI met clinical criteria for antibiotic initiation. An immediate 26 % decrease in antibiotic prescriptions for UTI during the ASP was identified with a 6 % reduction continuing through the intervention period (95 % Confidence Interval ([CI)] for the difference: -8 to -3 %). Similarly, a 25 % immediate decrease in all antibiotic prescriptions was noted after introduction of the ASP with a 5 % reduction continuing throughout the intervention period (95 % CI: -8 to -2 %). No significant effect was noted on resistant organisms or Clostridium difficile. Weekly prospective audit and feedback ASP in three community LTCFs over 6 months resulted in antibiotic utilization decreases but many lost opportunities for intervention.

Introducing an antibiotic stewardship program in a pediatric center in China.

PubMed

Zhang, Zhi-Gang; Chen, Fei; Chen, Jian-Zhong

2018-06-01

This study aimed to investigate the effect of antibiotic stewardship programs (ASP) on reducing antimicrobial resistance rate, antibiotics consumption and multi-drug resistance bacterial infections in the pediatric patients. This study was carried out in the Pediatric Center of a tertiary hospital of Shandong Province, China. The study duration was separated into two periods according to introduction of ASP (began from April 2011). Before intervention: from April 2009 to March 2011; after intervention: from April 2012 to March 2014. The consumption of antibiotics, defined daily dose (DDD), isolation of multidrug-resistant organisms (MDRO) and resistance rate of antibiotics were analyzed and compared between the two study periods. Total antibiotics consumption (DDDs) reduced from 56,725 in 2011 to 31,380 in 2014; antibiotic use density (AUD) reduced from 93.8 to 43.5; mean (± SD) antibiotic costs per patient (per quarter) decreased from 637 (± 29) RMB to 462 (± 49) RMB; and the mean total drug consumption (g)/DDD (DDDs) for inpatients decreased from 90.4 (± 3.3) to 56.4 (± 9.5). Multidrug-resistant microorganisms isolation reduced significantly from 463 (20.0) to 216 (6.9%). Resistance rate of general spectrum antibiotics reduced remarkably after intervention. The proportion of patients colonized or infected with Carbapenems-resistant Acinetobacter baumannii was correlated with DDDs of carbapenem. Implementation of ASP leads to reduced medical expense, decrease of improper and abuse of antibiotics, and reduced antibiotics resistance rate and MDRO isolation. Continuous efforts to improve antibiotic use are required.

Antimicrobial Stewardship Among Hospitalized Patients with Influenza Respiratory Tract Infections

PubMed Central

Lindsay, Patrick; Taggart, Linda; Leung, Elizabeth; Havey, Thomas

2017-01-01

Abstract Background Overlap between Influenza and bacterial respiratory illnesses contributes to the inappropriate use of antibiotics. One major study from the United States suggests a significant number of patients are being treated with antibiotics inappropriately. This paper however, did not perform an intervention to evaluate whether an Antimicrobial Stewardship Program (ASP) is effective in decreasing inappropriate antibiotic use. Appropriate use of antibiotics in Influenza patients has not been formally assessed in Canadian healthcare systems. Given ASP’s have been shown to be effective in previous studies, an opportunity has arisen for implementation in the setting of antibiotics in patients with Influenza, which has not previously been studied Methods We retrospectively identified all adults admitted to hospital who tested positive for Influenza from January 2016 to January 2017. We assessed the appropriateness of antibiotic use during the patient’s admission, evaluating whether antibiotics have been used according to standard of care for community acquired pneumonia. Antibiotic use and length of duration pre and post Stewardship implementation will be analyzed. After data has been collected, the results of this retrospective cohort study will inform the implementation of an ASP Results Eighty-one patients recorded positive Influenza tests. Twenty-six were collected from ICU patients and were excluded. Mean time to diagnosis from swab collection and final diagnosis was 2.8 days. Of the 55 non-ICU patients, 13 (24%) patients were continued on antibiotics after the diagnosis of Influenza was confirmed, with an average of 4.7 days of antibiotic use. It was deemed that 9 of these patients were continued appropriately on antibiotics with 4 patients having CXR infiltrate, 4 patients immunocompromised and 1 blood culture positive with strep pneumonia. Four (8%) patients were treated inappropriately with antibiotics for >24 hours after positive Influenza test, with a mean duration of 2.5 days after positive result Conclusion There is an opportunity for improvements in the appropriate use of antibiotics. Implementation of an ASP whereby positive Influenza results are delivered directly to the Stewardship team, could be an effective strategy to improve judicious antibiotic therapy Disclosures All authors: No reported disclosures.

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey.

PubMed

Sartelli, Massimo; Labricciosa, Francesco M; Barbadoro, Pamela; Pagani, Leonardo; Ansaloni, Luca; Brink, Adrian J; Carlet, Jean; Khanna, Ashish; Chichom-Mefire, Alain; Coccolini, Federico; Di Saverio, Salomone; May, Addison K; Viale, Pierluigi; Watkins, Richard R; Scudeller, Luigia; Abbo, Lilian M; Abu-Zidan, Fikri M; Adesunkanmi, Abdulrashid K; Al-Dahir, Sara; Al-Hasan, Majdi N; Alis, Halil; Alves, Carlos; Araujo da Silva, André R; Augustin, Goran; Bala, Miklosh; Barie, Philip S; Beltrán, Marcelo A; Bhangu, Aneel; Bouchra, Belefquih; Brecher, Stephen M; Caínzos, Miguel A; Camacho-Ortiz, Adrian; Catani, Marco; Chandy, Sujith J; Jusoh, Asri Che; Cherry-Bukowiec, Jill R; Chiara, Osvaldo; Colak, Elif; Cornely, Oliver A; Cui, Yunfeng; Demetrashvili, Zaza; De Simone, Belinda; De Waele, Jan J; Dhingra, Sameer; Di Marzo, Francesco; Dogjani, Agron; Dorj, Gereltuya; Dortet, Laurent; Duane, Therese M; Elmangory, Mutasim M; Enani, Mushira A; Ferrada, Paula; Esteban Foianini, J; Gachabayov, Mahir; Gandhi, Chinmay; Ghnnam, Wagih Mommtaz; Giamarellou, Helen; Gkiokas, Georgios; Gomi, Harumi; Goranovic, Tatjana; Griffiths, Ewen A; Guerra Gronerth, Rosio I; Haidamus Monteiro, Julio C; Hardcastle, Timothy C; Hecker, Andreas; Hodonou, Adrien M; Ioannidis, Orestis; Isik, Arda; Iskandar, Katia A; Kafil, Hossein S; Kanj, Souha S; Kaplan, Lewis J; Kapoor, Garima; Karamarkovic, Aleksandar R; Kenig, Jakub; Kerschaever, Ivan; Khamis, Faryal; Khokha, Vladimir; Kiguba, Ronald; Kim, Hong B; Ko, Wen-Chien; Koike, Kaoru; Kozlovska, Iryna; Kumar, Anand; Lagunes, Leonel; Latifi, Rifat; Lee, Jae G; Lee, Young R; Leppäniemi, Ari; Li, Yousheng; Liang, Stephen Y; Lowman, Warren; Machain, Gustavo M; Maegele, Marc; Major, Piotr; Malama, Sydney; Manzano-Nunez, Ramiro; Marinis, Athanasios; Martinez Casas, Isidro; Marwah, Sanjay; Maseda, Emilio; McFarlane, Michael E; Memish, Ziad; Mertz, Dominik; Mesina, Cristian; Mishra, Shyam K; Moore, Ernest E; Munyika, Akutu; Mylonakis, Eleftherios; Napolitano, Lena; Negoi, Ionut; Nestorovic, Milica D; Nicolau, David P; Omari, Abdelkarim H; Ordonez, Carlos A; Paiva, José-Artur; Pant, Narayan D; Parreira, Jose G; Pędziwiatr, Michal; Pereira, Bruno M; Ponce-de-Leon, Alfredo; Poulakou, Garyphallia; Preller, Jacobus; Pulcini, Céline; Pupelis, Guntars; Quiodettis, Martha; Rawson, Timothy M; Reis, Tarcisio; Rems, Miran; Rizoli, Sandro; Roberts, Jason; Pereira, Nuno Rocha; Rodríguez-Baño, Jesús; Sakakushev, Boris; Sanders, James; Santos, Natalia; Sato, Norio; Sawyer, Robert G; Scarpelini, Sandro; Scoccia, Loredana; Shafiq, Nusrat; Shelat, Vishalkumar; Sifri, Costi D; Siribumrungwong, Boonying; Søreide, Kjetil; Soto, Rodolfo; de Souza, Hamilton P; Talving, Peep; Trung, Ngo Tat; Tessier, Jeffrey M; Tumbarello, Mario; Ulrych, Jan; Uranues, Selman; Van Goor, Harry; Vereczkei, Andras; Wagenlehner, Florian; Xiao, Yonghong; Yuan, Kuo-Ching; Wechsler-Fördös, Agnes; Zahar, Jean-Ralph; Zakrison, Tanya L; Zuckerbraun, Brian; Zuidema, Wietse P; Catena, Fausto

2017-01-01

Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p  < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.

Sustained reduction in antibiotic consumption in a South African public sector hospital; Four year outcomes from the Groote Schuur Hospital antibiotic stewardship program.

PubMed

Boyles, T H; Naicker, V; Rawoot, N; Raubenheimer, P J; Eick, B; Mendelson, M

2017-01-30

Overuse of antibiotics has driven global bacterial resistance to the extent that we have entered a post-antibiotic era, where infections that were once easily treatable are now becoming untreatable. Efforts to control consumption have focused on antibiotic stewardship programmes (ASPs), aimed at optimising use. To report antibiotic consumption and cost over 4 years from a public hospital ASP in South Africa (SA). A comprehensive ASP comprising online education, a dedicated antibiotic prescription chart and weekly dedicated ward rounds was introduced at Groote Schuur Hospital, Cape Town, in 2012. Electronic records were used to collect data on volume and cost of antibiotics and related laboratory tests, and to determine inpatient mortality and 30-day readmission rates. These data were compared with a control period before the intervention. Total antibiotic consumption fell from 1 046 defined daily doses/1 000 patient days in 2011 (control period) to 868 by 2013 and remained at similar levels for the next 2 years. This was driven by reductions in intravenous antibiotic use, particularly ceftriaxone. Inflation-adjusted cost savings on antibiotics were ZAR3.2 million over 4 years. Laboratory tests increased over the same period with a total increased cost of ZAR0.4 million. There was no significant change in mortality or 30-day readmission rates. The effects of a comprehensive ASP on medical inpatients at a public sector hospital in SA were durable over 4 years, leading to a reduction in total antibiotic consumption without adverse effect. When increased laboratory costs were offset there was a net cost saving of ZAR2.8 million.

The value of participatory development to support antimicrobial stewardship with a clinical decision support system.

PubMed

Beerlage-de Jong, Nienke; Wentzel, Jobke; Hendrix, Ron; van Gemert-Pijnen, Lisette

2017-04-01

Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily practice. Our aim was to demonstrate why and how participatory development (involving end-users and other stakeholders) can contribute to the success of CDSSs in ASPs. A mixed-methods approach was applied, combining scenario-based prototype evaluations (to support verbalization of work processes and out-of-the-box thinking) among 6 medical resident physicians with an online questionnaire (to cross-reference findings of the prototype evaluations) among 54 Dutch physicians. The prototype evaluations resulted in insight into the end-users and their way of working, as well as their needs and expectations. The online questionnaire that was distributed among a larger group of medical specialists, including lung and infection experts, complemented the findings of the prototype evaluations. It revealed a say/do problem concerning the unrecognized need of support for selecting diagnostic tests. Low-fidelity prototypes of a technology allow researchers to get to know the end-users, their way of working, and their work context. Involving experts allows technology developers to continuously check the fit between technology and clinical practice. The combination enables the participatory development of technology to successfully support ASPs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Appropriateness of Antibiotic Prescribing in U. S. Children’s Hospitals: A National Point Prevalence Survey

PubMed Central

Tribble, Alison; Lee, Brian; Handy, Lori; Gerber, Jeffrey S; Hersh, Adam L; Kronman, Matthew; Terrill, Cindy; Newland, Jason

2017-01-01

Abstract Background Multiple studies estimate that inappropriate antibiotic prescribing ranges from 30–50% in hospitalized patients, but few have included pediatric patients. Pediatric studies characterizing inappropriate prescribing are needed to target and improve antimicrobial stewardship program (ASP) efforts. Methods Cross-sectional analysis of antimicrobial prescribing at 30 U.S. children’s hospitals. Participating hospitals were academic, tertiary care hospitals in the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative. Subjects were children 0–17 years with an active antibiotic order at 0800 on a single day during three consecutive calendar quarters (Q3 2016 – Q1 2017). Each hospital’s ASP used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. Data were pooled from the three surveys. The primary outcome was the pooled estimate for the percentage of prescriptions classified as inappropriate. Secondary outcomes were pooled estimates for indication, reason for inappropriate use, and ASP review status for each antibiotic. Results Of 19,598 children hospitalized on survey days, 6,922 (35%) had ≥1 active antibiotic order. Median age of children receiving antibiotics was 3.7 years (0.5, 10.9). Figures 1 and 2 show the most common antibiotics and indications. Of all antibiotic orders, 1,514 (15%) were classified as inappropriate, and 19% of patients with antibiotic orders had at least one inappropriate order. The most common reasons for inappropriate use were bug-drug mismatch (26%), surgical prophylaxis > 24 hours (18%) and unnecessary duplicate therapy (12%). ASPs would not have routinely reviewed 50% of all inappropriate orders. An additional 22% of inappropriate orders were for antibiotics typically reviewed by ASPs, but were yet to be reviewed at the time of the survey. Conclusion Across 30 children’s hospitals, approximately 1 in 3 hospitalized children is receiving an antibiotic at any given time. Almost 20% of these children are receiving inappropriate therapy, and a substantial portion of inappropriate use is not captured by current ASP practices. Figures 1 and 2: Disclosures C. Terrill, Merck: Grant Investigator, Research grant; Allergan: Grant Investigator, Research grant; J. Newland, Merck: Grant Investigator, Research grant; Allergan: Grant Investigator, Research grant.

Specifying an implementation framework for Veterans Affairs antimicrobial stewardship programmes: using a factor analysis approach.

PubMed

Chou, Ann F; Graber, Christopher J; Zhang, Yue; Jones, Makoto; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Glassman, Peter A

2018-06-04

Inappropriate antibiotic use poses a serious threat to patient safety. Antimicrobial stewardship programmes (ASPs) may optimize antimicrobial use and improve patient outcomes, but their implementation remains an organizational challenge. Using the Promoting Action on Research Implementation in Health Services (PARiHS) framework, this study aimed to identify organizational factors that may facilitate ASP design, development and implementation. Among 130 Veterans Affairs facilities that offered acute care, we classified organizational variables supporting antimicrobial stewardship activities into three PARiHS domains: evidence to encompass sources of knowledge; contexts to translate evidence into practice; and facilitation to enhance the implementation process. We conducted a series of exploratory factor analyses to identify conceptually linked factor scales. Cronbach's alphas were calculated. Variables with large uniqueness values were left as single factors. We identified 32 factors, including six constructs derived from factor analyses under the three PARiHS domains. In the evidence domain, four factors described guidelines and clinical pathways. The context domain was broken into three main categories: (i) receptive context (15 factors describing resources, affiliations/networks, formalized policies/practices, decision-making, receptiveness to change); (ii) team functioning (1 factor); and (iii) evaluation/feedback (5 factors). Within facilitation, two factors described facilitator roles and tasks and five captured skills and training. We mapped survey data onto PARiHS domains to identify factors that may be adapted to facilitate ASP uptake. Our model encompasses mostly mutable factors whose relationships with performance outcomes may be explored to optimize antimicrobial use. Our framework also provides an analytical model for determining whether leveraging existing organizational processes can potentially optimize ASP performance.

Impact of antimicrobial stewardship programme on hospitalized patients at the intensive care unit: a prospective audit and feedback study.

PubMed

Khdour, Maher R; Hallak, Hussein O; Aldeyab, Mamoon A; Nasif, Mowaffaq A; Khalili, Aliaa M; Dallashi, Ahamad A; Khofash, Mohammad B; Scott, Michael G

2018-04-01

Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of antimicrobial stewardship programme (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. A prospective audit with intervention and feedback by ASP team within 48-72 h of antibiotic administration began in September 2015. Four months of pre-ASP data were compared with 4 months of post-ASP data. Data collected included clinical and demographic data; use of antimicrobials measured by defined daily doses, duration of therapy, length of stay, readmission and all-cause mortality. Overall, 176 interventions were made the ASP team with an average acceptance rate of 78.4%. The most accepted interventions were dose optimization (87.0%) followed by de-escalation based on culture results with an acceptance rate of 84.4%. ASP interventions significantly reduces antimicrobial use by 24.3% (87.3 defined daily doses/100 beds vs. 66.1 defined daily doses/100 beds P < 0.001). The median (interquartile range) of length of stay was significantly reduced post ASP [11 (3-21) vs. 7 (4-19) days; P < 0.01]. Also, the median (interquartile range) of duration of therapy was significantly reduced post-ASP [8 (5-12) days vs. 5 (3-9); P = 0.01]. There was no significant difference in overall 30-day mortality or readmission between the pre-ASP and post-ASP groups (26.9% vs. 23.9%; P = 0.1) and (26.1% vs. 24.6%; P = 0.54) respectively. Our prospective audit and feedback programme was associated with positive impact on antimicrobial use, duration of therapy and length of stay. © 2017 The British Pharmacological Society.

Antimicrobial Stewardship Program Using Plan-Do-Study-Act Cycles to Reduce Unjustified Antibiotic Prescribing in Children Admitted With an Asthma Exacerbation

PubMed Central

Dorzin, Sasha E.; Halaby, Claudia; Quintos, Maria Lyn; Noor, Asif

2017-01-01

OBJECTIVE Antimicrobial stewardship programs (ASPs) ensure appropriate antibiotic use, reduce health care costs, and minimize antibiotic resistance. National asthma guidelines do not recommend antibiotics during an exacerbation unless the child has an infection or comorbidities. The American Academy of Pediatrics (AAP) established a benchmark for unjustified antibiotic use at 6.6%.9 A retrospective study at our institution showed that 7.8% of antibiotics were prescribed without justification in children admitted for asthma. The purpose of this study was to reduce unjustified antibiotic use at our institution by 25% in children through an ASP directed toward asthma. METHODS The study period lasted from November 2015 to March 2016. Children 6 months to 17 years of age, admitted for an asthma exacerbation, were included while those with comorbidities were excluded. A multidisciplinary team from pediatric pharmacotherapy, pulmonology, emergency department (ED), infectious diseases, and quality improvement was formed to focus on process improvement. Interventions were executed in a series of Plan-Do-Study-Act cycles. In cycle 1, our asthma guidelines on appropriate antibiotic use were disseminated to pediatric house staff and posted in pediatric units. Cycle 2 encompassed presenting the ASP and guidelines to the pediatric ED staff. Cycle 3 consisted of a journal club with the pulmonary division to discuss the role of azithromycin in an asthma exacerbation. RESULTS In cycle 1, twenty-four patients were reviewed in November 2015. Antibiotics were prescribed in 8/24 (33%) children, with an unjustified rate of 2/24 (8.3%). In cycle 2, twenty-three patients were reviewed in December and January with 8/23 (35%) prescribed antibiotics and an unjustified rate of 2/23 (8.7%). For cycle 3, in February and March 2016, twenty-one children were reviewed. Antibiotics were prescribed in 6/21 (27%) children and all were justified. In total, 68 patients were included in our study and had an unjustified antibiotic prescribing rate of 4/68 (5.9%), a reduction of 25%. CONCLUSION Our ASP surpassed the benchmark set by AAP guidelines, by reducing the percentage of unjustified antibiotics in children with asthma to 5.9%. PMID:29290744

Research activities to improve the utilization of antibiotics in Africa.

PubMed

Massele, Amos; Tiroyakgosi, Celda; Matome, Matshediso; Desta, Abayneh; Muller, Arno; Paramadhas, Bene D Anand; Malone, Brighid; Kurusa, Gobuiwang; Didimalang, Thatayaone; Moyo, Mosana; Godman, Brian

2017-02-01

There is a need to improve the rational use of antibiotics across continents including Africa. This has resulted in initiatives in Botswana including treatment guidelines and the instigation of Antibiotic Stewardship Programs (ASPs). The next steps involve a greater understanding of current antibiotic utilization and resistance patterns (AMR). This resulted in a 2-day meeting involving key stakeholders principally from Botswana to discuss key issues including AMR rates as well as ASPs in both the public and private sectors. Following this, the findings will be used to plan future studies across Africa including point prevalence studies. The findings will be presented in July 2016 at the next Medicines Utilization Research in Africa meeting will ideally serve as a basis for planning future pertinent interventional studies to enhance the rational use of antibiotics in Botswana and wider.

Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong.

PubMed

Ng, C K; Wu, T C; Chan, W M J; Leung, Y S W; Li, C K P; Tsang, D N C; Leung, G M

2008-10-01

Inappropriate use of antibiotics is one of the important factors attributing to emergence of drug-resistant pathogens. Infection with multidrug-resistant pathogens adversely affects quality of medical care. Queen Elizabeth Hospital, an 1800-bed acute service hospital in Hong Kong. Antibiotics are commonly prescribed for treating acute infections. Reduce inappropriate prescription of broad-spectrum antibiotics and overall antibiotic prescription through implementation of a multidisciplinary antibiotics stewardship programme (ASP). A multidisciplinary programme involving policy and guideline formulation, education and feedback, monthly antibiotic consumption and cost monitoring, antimicrobial susceptibility pattern reporting and concurrent feedbacks for commonly prescribed broad-spectrum antibiotics was implemented in 2004. Predefined logistics to prescribe "restricted" antibiotics were formulated and implemented with collaborative efforts from clinical and non-clinical departments. The programme was supported by management at department and hospital levels. Broad-spectrum antibiotics were prescribed inappropriately in 28.9% (n = 192) clinical scenarios. The ASP reduced the restricted and total antibiotic consumption as well as the antibiotics-related costs. Predefined clinical outcomes were not adversely affected. Economic analysis suggested that the extra human cost in running ASP could be offset by savings from antibiotic expenditure. It is cost-effective to implement a multidisciplinary ASP in acute service hospitals as the programme reduces antibiotic consumption and results in overall cost savings. The quality of medical care is not jeopardized as the important clinical outcomes are not adversely affected. The generalisability and sustainability of ASPs in other clinical contexts warrant further studies to ensure the continuous success of this programme.

β-Lactam Therapy for Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins.

PubMed

Li, Julius; Echevarria, Kelly L; Traugott, Kristi A

2017-03-01

Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Traditionally, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. Vancomycin has been demonstrated to have poorer outcomes in several studies and is only recommended for patients with severe penicillin allergies. Although cefazolin is considered as an alternative to the ASPs for patients with nonsevere penicillin allergies, cefazolin offers several pharmacologic advantages over ASPs, such as more convenient dosing regimens, and antimicrobial stewardship programs are increasingly using cefazolin as the preferential agent for MSSA infections as part of cost-saving initiatives. Concerns about susceptibility to hydrolysis by type A β-lactamases, particularly at high inocula seen in deep-seated infections such as endocarditis; selective pressures from unnecessary gram-negative coverage; and lack of comparative clinical data have precluded recommending cefazolin as a first-line therapy for MSSA bacteremia. Recent clinical studies, however, have suggested similar clinical efficacy but better tolerability, with lower rates of discontinuation due to adverse drug reactions, of cefazolin compared with ASPs. Other variables, such as adequate source control (e.g., intravascular catheter removal, debridement, or drainage) and enhanced pharmacodynamics through aggressive cefazolin dosing, may mitigate the role of cefazolin inoculum effect and factor into determining improved clinical outcomes. In this review, we highlight the utility of cefazolin versus ASPs in the treatment of MSSA bacteremia with a focus on clinical efficacy and safety. © 2017 Pharmacotherapy Publications, Inc.

Administration of a survey to evaluate the attitudes of house staff physicians towards antimicrobial resistance and the antimicrobial stewardship programme at a community teaching hospital.

PubMed

Venugopalan, Veena; Trustman, Nathan; Manning, Nyla; Hashem, Nehal; Berkowitz, Leonard; Hidayat, Levita

2016-03-01

Antimicrobial stewardship programmes (ASPs) are used in numerous institutions in an effort to promote safe and effective antimicrobial use. The objectives of this study were to (i) assess physicians' perceptions, attitudes and knowledge about antimicrobial use, resistance and the ASP at The Brooklyn Hospital Center (TBHC) and (ii) measure physicians' beliefs and attitudes to the current system of prior authorisation of antimicrobials. A 75-item, anonymous, voluntary, traditional paper and pencil survey was distributed to resident physicians at TBHC. Multiple-choice, 5-point Likert scale and knowledge-based questions were utilised. Of the 261 residents, 129 (49%) completed the survey. The respondents significantly believed that antibiotics are overused more frequently nationally vs. locally [117/129 (91%) vs. 91/129 (71%); P=0.0001]. Although 49% (63/129) felt that other providers overprescribe antibiotics, only 26% (34/129) agreed that they themselves were contributing to the current problem (P=0.0003). Fifty-seven percent of respondents agreed that individual patient care is improved by having an antibiotic approval programme; however, 45% of respondents reported that the antibiotic approval programme limits their autonomy in choosing antibiotics. Compared with surgical residents, medical residents were more likely (33% vs. 13%; P=0.02) to feel that the antibiotic approval programme forced them to choose an inappropriate antibiotic. On the antibiotic knowledge assessment segment of the survey, there was no difference in score when stratified by specialty or years of postgraduate training. Based on the survey results, house staff are supportive of antimicrobial stewardship and feel that the ASP is valuable for patient care. Copyright © 2016 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use.

PubMed

Campbell, Tonya J; Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non-ICU settings.

ASP Strategies and Appropriate Antibiotic Use

PubMed Central

Lee, Brian R; Tribble, Alison; Handy, Lori; Gerber, Jeffrey S; Hersh, Adam L; Kronman, Matthew; Terrill, Cindy; Newland, Jason

2017-01-01

Abstract Background The Infectious Diseases Society of America (IDSA) recommends hospitals implement antimicrobial stewardship programs (ASP) in order to decrease inappropriate antibiotic use due to the rise in antibiotic-resistant infections. Data are limited on the extent to which different ASP strategies influence appropriate antibiotic use. Methods We conducted an online survey in 2016 of U.S. Children’s Hospitals to collect hospital-level information on dedicated ASP effort, ASP monitoring activities, use of audit-feedback, formulary restrictions, rapid diagnostics, etc. During the same period the ASP teams at these hospitals completed 3 point prevalence surveys that documented details on all admitted patients 0–17 years receiving any antibiotics, determined what ASP modifications could be made, and if the antibiotic was appropriate. We employed hierarchical, multivariable logit models to examine which ASP-related, hospital-level strategies were associated with appropriate antibiotic use. Results Thirty hospitals participated. A total of 6,921 patients were included, representing 10,068 total antibiotics. Of these orders, 8,554 (85.0%) were categorized as appropriate, though this varied across sites (range: 68-92%). Additionally, 78.2% of antibiotics did not have recommended modifications. Appropriate antibiotic use was significantly higher for hospitals that relied on rapid diagnostics (aOR: 1.6; P < 0.001) or monitored their days of therapy (DOT) rate (aOR: 1.4; P < 0.001), whereas the presence of either audit-feedback (aOR: 1.04; P = 0.75) or formulary restrictions (aOR: 0.83; P = 0.059) were not associated. Having annual education for all prescribers had increased likelihood of antibiotics having no modification recommendations (aOR: 1.45; P = 0.037). Total ASP FTE was not correlated with hospital-level percent appropriate use (corr: −0.05; P = 0.79) or antibiotic modification recommendations (corr: −0.08; P = 0.67). Conclusion Routine monitoring of DOT rates and utilization of rapid diagnostics were associated with appropriate antibiotic use. Additional analysis is needed to understand additional factors that can aid hospitals in developing and maintaining ASPs to reduce inappropriate antibiotic use. Disclosures B. R. Lee, Merck: Grant Investigator, Grant recipient. PCORI: Grant Investigator, Grant recipient. C. Terrill, Merck: Grant Investigator, Research grant Allergan: Grant Investigator, Research grant. J. Newland, Merck: Grant Investigator, Research grant. Allergan: Grant Investigator, Research grant

Nitrofurantoin safety and effectiveness in treating acute uncomplicated cystitis (AUC) in hospitalized adults with renal insufficiency: antibiotic stewardship implications.

PubMed

Cunha, B A; Cunha, C B; Lam, B; Giuga, J; Chin, J; Zafonte, V F; Gerson, S

2017-07-01

Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl < 60 ml/min) with nitrofurantoin. Excluded were complicated urinary tract infections. Urinary isolated susceptibility testing was done by micro broth dilution (MBD). Treatment duration was 5-7 days. Cure was defined as eradication of the uropathogen and failure was defined as minimal/no decrease in urine colony counts. Of 26 evaluable patients with renal insufficiency (CrCl < 60 ml/min), nitrofurantoin eradicated the uropathogen in 18/26 (69%) of patients, and failed in 8/26 (31%). Of the eight failures, five were due to intrinsically resistant uropathogens, e.g., Proteus sp., and one failure was related to an alkaline urine. Of the treatment failures, only two were due to renal insufficiency, i.e., CrCl < 30 ml/min. Since there are few oral antibiotics available to treat AUC due to MDR GNB uropathogens, these results have important ASP implications. Currently, nitfurantoin is not recommended if CrCl < 60 ml/min. In our experience, used appropriately against susceptible uropathogens, nitrofurantoin was highly effective in nearly all patients with CrCl = 30-60 ml/min., and only failed in two patients due to renal insufficiency (CrCl < 30 ml/ml).

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use

PubMed Central

Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

Background The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Methods Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Results Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. Conclusions ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non-ICU settings. PMID:28562638

Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units: A Systematic Review and Network Meta-analysis.

PubMed

Teerawattanapong, Nattawat; Kengkla, Kirati; Dilokthornsakul, Piyameth; Saokaew, Surasak; Apisarnthanarak, Anucha; Chaiyakunapruk, Nathorn

2017-05-15

This study evaluated the relative efficacy of strategies for the prevention of multidrug-resistant gram-negative bacteria (MDR-GNB) in adult intensive care units (ICUs). A systematic review and network meta-analysis was performed; searches of the Cochrane Library, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) included all randomized controlled trials and observational studies conducted in adult patients hospitalized in ICUs and evaluating standard care (STD), antimicrobial stewardship program (ASP), environmental cleaning (ENV), decolonization methods (DCL), or source control (SCT), simultaneously. The primary outcomes were MDR-GNB acquisition, colonization, and infection; secondary outcome was ICU mortality. Of 3805 publications retrieved, 42 met inclusion criteria (5 randomized controlled trials and 37 observational studies), involving 62068 patients (median age, 58.8 years; median APACHE [Acute Physiology and Chronic Health Evaluation] II score, 18.9). The majority of studies reported extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and MDR Acinetobacter baumannii. Compared with STD, a 4-component strategy composed of STD, ASP, ENV, and SCT was the most effective intervention (rate ratio [RR], 0.05 [95% confidence interval {CI}, .01-.38]). When ENV was added to STD+ASP or SCT was added to STD+ENV, there was a significant reduction in the acquisition of MDR A. baumannii (RR, 0.28 [95% CI, .18-.43] and 0.48 [95% CI, .35-.66], respectively). Strategies with ASP as a core component showed a statistically significant reduction the acquisition of ESBL-producing Enterobacteriaceae (RR, 0.28 [95% CI, .11-.69] for STD+ASP+ENV and 0.23 [95% CI, .07-.80] for STD+ASP+DCL). A 4-component strategy was the most effective intervention to prevent MDR-GNB acquisition. As some strategies were differential for certain bacteria, our study highlighted the need for further evaluation of the most effective prevention strategies. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Antimicrobial Stewardship Programs: Comparison of a Program with Infectious Diseases Pharmacist Support to a Program with a Geographic Pharmacist Staffing Model

PubMed Central

Ma, Andrew; Clegg, Daniel; Fugit, Randolph V.; Pepe, Anthony; Goetz, Matthew Bidwell; Graber, Christopher J.

2015-01-01

Background: Stewardship of antimicrobial agents is an essential function of hospital pharmacies. The ideal pharmacist staffing model for antimicrobial stewardship programs is not known. Objective: To inform staffing decisions for antimicrobial stewardship teams, we aimed to compare an antimicrobial stewardship program with a dedicated Infectious Diseases (ID) pharmacist (Dedicated ID Pharmacist Hospital) to a program relying on ward pharmacists for stewardship activities (Geographic Model Hospital). Methods: We reviewed a randomly selected sample of 290 cases of inpatient parenteral antibiotic use. The electronic medical record was reviewed for compliance with indicators of appropriate antimicrobial stewardship. Results: At the hospital staffed by a dedicated ID pharmacist, 96.8% of patients received initial antimicrobial therapy that adhered to local treatment guidelines compared to 87% of patients at the hospital that assigned antimicrobial stewardship duties to ward pharmacists (P < .002). Therapy was modified within 24 hours of availability of laboratory data in 86.7% of cases at the Dedicated ID Pharmacist Hospital versus 72.6% of cases at the Geographic Model Hospital (P < .03). When a patient’s illness was determined not to be caused by a bacterial infection, antibiotics were discontinued in 78.0% of cases at the Dedicated ID Pharmacist Hospital and in 33.3% of cases at the Geographic Model Hospital (P < .0002). Conclusion: An antimicrobial stewardship program with a dedicated ID pharmacist was associated with greater adherence to recommended antimicrobial therapy practices when compared to a stewardship program that relied on ward pharmacists. PMID:26405339

Report: Ongoing Management Improvements and Further Evaluation Vital to EPA Stewardship and Voluntary Programs

EPA Pesticide Factsheets

Report #2005-P-00007, February 17, 2005. We asked stakeholders to define stewardship, list motivators and obstacles to participating in stewardship programs, and outline key roles for EPA to play to foster participating in environmental stewardship.

Strategies to Minimize Antibiotic Resistance

PubMed Central

Lee, Chang-Ro; Cho, Ill Hwan; Jeong, Byeong Chul; Lee, Sang Hee

2013-01-01

Antibiotic resistance can be reduced by using antibiotics prudently based on guidelines of antimicrobial stewardship programs (ASPs) and various data such as pharmacokinetic (PK) and pharmacodynamic (PD) properties of antibiotics, diagnostic testing, antimicrobial susceptibility testing (AST), clinical response, and effects on the microbiota, as well as by new antibiotic developments. The controlled use of antibiotics in food animals is another cornerstone among efforts to reduce antibiotic resistance. All major resistance-control strategies recommend education for patients, children (e.g., through schools and day care), the public, and relevant healthcare professionals (e.g., primary-care physicians, pharmacists, and medical students) regarding unique features of bacterial infections and antibiotics, prudent antibiotic prescribing as a positive construct, and personal hygiene (e.g., handwashing). The problem of antibiotic resistance can be minimized only by concerted efforts of all members of society for ensuring the continued efficiency of antibiotics. PMID:24036486

Impact of real-time notification of Clostridium difficile test results and early initiation of effective antimicrobial therapy.

PubMed

Polen, Christian B; Judd, William R; Ratliff, Patrick D; King, Gregory S

2018-05-01

Clostridium difficile is a prominent nosocomial pathogen and is the most common causative organism of health care-associated diarrhea. To our knowledge, no studies have investigated the impact of real-time notification of culture results with rapid antimicrobial stewardship program (ASP) intervention in the setting of C difficile infection (CDI). The purpose of this study was to assess the impact of real-time notification of detection of toxigenic C difficile by DNA amplification results in patients with confirmed CDI. This is a single-center, retrospective cohort study at a 433-bed tertiary medical center in central Kentucky. The study consisted of 2 arms: patients treated for CDI prior to implementation of real-time provider notification and patients postimplementation. The primary outcome was time to initiation of effective antimicrobial therapy. The median time to initiation of effective antimicrobial therapy decreased from 5.75 hours in the preimplementation cohort to 2.05 hours in the postimplementation cohort (P = .001). ASP intervention also resulted in a shorter time from detection of CDI to order entry of effective antimicrobial therapy in the patient's electronic medical record (3.0 vs 0.6 hours; P = .001). The implementation of a real-time notification system to alert a pharmacist-led ASP of toxigenic CDI resulted in statistically significant shorter times to order entry and subsequent initiation of effective antimicrobial therapy and contact precautions. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome.

PubMed

Bedini, Andrea; De Maria, Nicola; Del Buono, Mariagrazia; Bianchini, Marcello; Mancini, Mauro; Binda, Cecilia; Brasacchio, Andrea; Orlando, Gabriella; Franceschini, Erica; Meschiari, Marianna; Sartini, Alessandro; Zona, Stefano; Paioli, Serena; Villa, Erica; Gyssens, Inge C; Mussini, Cristina

2016-10-01

A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A). During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate. ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality. Copyright © 2016 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

The Development of After-School Program Educators through University-Community Partnerships

ERIC Educational Resources Information Center

Mahoney, Joseph L.; Levine, Mark D.; Hinga, Briana

2010-01-01

Participation in after-school programs (ASPs) "can" positively affect the development of young people. However, "whether" ASPs are beneficial depends on program quality. Although many factors influence the quality of a program, the competencies of adult staff who lead ASPs are a critical determinant. Unfortunately, ASP staff…

Best Practices for Curriculum, Teaching, and Evaluation Components of Aquatic Stewardship Education.

ERIC Educational Resources Information Center

Siemer, William F.

This paper reviews the literature to outline principles and best practices for aquatic stewardship education. Stewardship education develops an internalized stewardship ethic and the skills needed for decision making and environmentally responsible actions. Successful stewardship education programs are designed to influence beliefs, values,…

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

PubMed Central

Schwartz, David N.; Weinstein, Robert A.

2016-01-01

SUMMARY Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. PMID:27974411

Advancing antimicrobial stewardship: Summary of the 2015 CIDSC Report.

PubMed

Khan, F; Arthur, J; Maidment, L; Blue, D

2016-11-03

Antimicrobial resistance (AMR) is recognized as an important global public health concern that has a cross-cutting impact on human health, animal health, food and agriculture and the environment. The Communicable and Infectious Disease Steering Committee (CIDSC) of the Pan-Canadian Public Health Network (PHN) created a Task Group on Antimicrobial Stewardship to look at this issue from a Canadian perspective. To summarize the key findings of the Task Group Report that identified core components of antimicrobial stewardship programs, best practices, key challenges, gaps and recommendations to advance stewardship across jurisdictions. Search strategies were developed to identify scientific literature, grey literature and relevant websites on antimicrobial stewardship. The information was reviewed and based on this evidence, expert opinion and consensus-building, the Task Group identified core components, best practices, key challenges and gaps and developed recommendations to advance stewardship in Canada. The four components of a promising antimicrobial stewardship initiative were: leadership, interventions, monitoring/evaluation and future research. Best practices include a multi-sectoral/multipronged approach involving a wide range of stakeholders at the national, provincial/territorial, local and health care organizational levels. Key challenges and gaps identified were: the success and sustainability of stewardship undertakings require appropriate and sustained resourcing and expertise; there is limited evidence about how to effectively implement treatment guidance; and there is a challenge in ensuring accessibility, standardization and consistency of use among professionals. ​: Recommendations to the CIDSC about how to advance stewardship across jurisdictions included the following: institute a national infrastructure; develop best practices to implement stewardship programs; develop education and promote awareness; establish consistent evidence-based guidance, resources, tools and training; mandate the incorporation of stewardship education; develop audit and feedback tools; establish benchmarks and performance targets for stewardship; and conduct timely evaluation of stewardship programs. Findings of this report will inform a more systematic approach to addressing antimicrobial stewardship Canada-wide.

A cost-effectiveness analysis of two different antimicrobial stewardship programs.

PubMed

Okumura, Lucas Miyake; Riveros, Bruno Salgado; Gomes-da-Silva, Monica Maria; Veroneze, Izelandia

2016-01-01

There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.

Pesticide Environmental Stewardship Program Member Handbook

EPA Pesticide Factsheets

This Pesticide Environmental Stewardship Program (PESP) handbook is a resource with information to help prospective members to learn about PESP, to understand how the program works, and to assist in applying for membership.

How can Multi-Professional Education Support Better Stewardship?

PubMed Central

Pereira, Nuno Rocha; Castro-Sanchez, Enrique; Nathwani, Dilip

2017-01-01

Antimicrobial stewardship is widely accepted as an efficient strategy to combat the growing threat of antimicrobial resistance. Education is one of the cornerstones of successful antimicrobial stewardship programs. There is also general agreement that antimicrobial stewardship is a team effort that must involve the whole continuum of healthcare workers. Providing adequate education for all different professionals although challenging is deemed crucial to achieve good results. This paper reviews the different strategies available to educate the multiple healthcare workers, discusses how education can improve antimicrobial stewardship programs and outlines some of the challenges faced and research gaps that need to be addressed in order to improve education in this field. PMID:28458801

Development of an antimicrobial stewardship-based infectious diseases elective that incorporates human patient simulation technology.

PubMed

Falcione, Bonnie A; Meyer, Susan M

2014-10-15

To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs.

Antimicrobial stewardship in long term care facilities: what is effective?

PubMed

Nicolle, Lindsay E

2014-02-12

Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection - limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection - were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.

7 CFR 1469.23 - Program payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM Contracts and Payments § 1469.23 Program payments. (a) Stewardship component of CSP payments. (1) The conservation stewardship plan... Agriculture Statistics Service (NASS) land rental data, and Conservation Reserve Program (CRP) rental rates...

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship.

PubMed

Morency-Potvin, Philippe; Schwartz, David N; Weinstein, Robert A

2017-01-01

Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs. Copyright © 2016 American Society for Microbiology.

2015 Stewardship Science Academic Programs Annual

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

Stone, Terri; Mischo, Millicent

The Stockpile Stewardship Academic Programs (SSAP) are essential to maintaining a pipeline of professionals to support the technical capabilities that reside at the National Nuclear Security Administration (NNSA) national laboratories, sites, and plants. Since 1992, the United States has observed the moratorium on nuclear testing while significantly decreasing the nuclear arsenal. To accomplish this without nuclear testing, NNSA and its laboratories developed a science-based Stockpile Stewardship Program to maintain and enhance the experimental and computational tools required to ensure the continued safety, security, and reliability of the stockpile. NNSA launched its academic program portfolio more than a decade ago tomore » engage students skilled in specific technical areas of relevance to stockpile stewardship. The success of this program is reflected by the large number of SSAP students choosing to begin their careers at NNSA national laboratories.« less

[Healthcare-Associated Infection Control with Awareness of Patient Safety].

PubMed

Murakami, Nobuo

2016-03-01

In order to provide safe and secure medical care for patients, health care-associated infections (HAI) must not occur. HAI should be considered as incidents, and countermeasures should be viewed as a patient safety management itself. Healthcare-associated infection control (HAIC) is practiced by the infection control team (ICT), which is based on multidisciplinary cooperation. Team members have to recognize that it is the most important to make use of the expertise of each discipline. In addition, all members must try to respond quickly, to help the clinic staff. Visualized rapid information provision and sharing, environmental improvement, outbreak factor analysis, hand hygiene compliance rate improvement, proper antibiotic use (Antimicrobial Stewardship Program: ASP), and regional cooperation & leadership comprise the role of the ICT in the flagship hospital. Regarding this role, we present our hospital's efforts and the outcomes. In conclusion, for medical practice quality improvement, healthcare-associated infection control should be conducted thoroughly along with an awareness of patient safety.

Fidelity in After-School Program Intervention Research: A Systematic Review

ERIC Educational Resources Information Center

Maynard, Brandy R.; Peters, Kristen E.; Vaughn, Michael G.; Sarteschi, Christine M.

2014-01-01

Over the past 2 decades, the number of after-school programs (ASP) and the number of students attending ASPs has markedly increased. Although several reviews and meta-analyses have examined the outcomes of ASPs, ASP intervention study reviews have not specifically examined intervention fidelity. Establishing intervention fidelity is critically…

Development of an Antimicrobial Stewardship-based Infectious Diseases Elective that Incorporates Human Patient Simulation Technology

PubMed Central

Meyer, Susan M.

2014-01-01

Objective. To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. Design. The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. Assessment. Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. Conclusion. A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs. PMID:25386016

Evaluating ecological monitoring of civic environmental stewardship in the Green-Duwamish watershed, Washington

Treesearch

Jacob C. Sheppard; Clare M. Ryan; Dale J. Blahna

2017-01-01

The ecological outcomes of civic environmental stewardship are poorly understood, especially at scales larger than individual sites. In this study we characterized civic environmental stewardship programs in the Green-Duwamish watershed in King County, WA, and evaluated the extent to which stewardship outcomes were monitored. We developed a four-step process based on...

Influence of financial incentive programs in sustaining wildlife values

Treesearch

Thomas J. Straka; Michael A. Kilgore; Michael G. Jacobson; John L. Greene; Steven E. Daniels

2007-01-01

Conservation incentive programs have substantial impacts on the nation’s forests and wildlife habitat. There are eight major conservation incentive programs. The Forest Stewardship Program (FSP) provides forest landowner assistance by focusing on resource management plans embodying multi-resource stewardship principles. The Forest Land Enhancement Program (FLEP) is the...

Watershed Stewardship Education Program--A Multidisciplinary Extension Education Program for Oregon's Watershed Councils.

ERIC Educational Resources Information Center

Conway, Flaxen D. L.; Godwin, Derek; Cloughesy, Mike; Nierenberg, Tara

2003-01-01

The Watershed Stewardship Education Program (WSEP) is a multidisciplinary Oregon Extension designed to help watershed councils, landowners, and others work effectively together on water management. Components include practical, easy-to-use educational materials, training in effective collaboration, a Master Watershed Stewards program, and advanced…

Effective antibiotic stewardship in spinal cord injury: Challenges and a way forward.

PubMed

Skelton, Felicia; Suda, Katie; Evans, Charlesnika; Trautner, Barbara

2018-01-11

Context Antibiotic stewardship, defined as a multidisciplinary program to reduce the misuse of antibiotics, and in turn, antibiotic resistance, is a high priority. Persons with spinal cord injury/disorder (SCI/D) are vulnerable to receiving multiple courses of antibiotics over their lifetime given frequent healthcare exposure, and have high rates of bacterial infection with multi-drug resistant organisms. Additional challenges to evaluating appropriate use of antibiotics in this population include bacterial colonization in the urine and the differences in the presenting signs and symptoms of infection. Therefore, Veterans Health Administration (VHA) facilities with SCI/D centers need effective antibiotic stewardship programs. Results We analyzed the results of a 2012 VHA-wide survey evaluating available antibiotic stewardship resources, and compared the resources present at facilities with SCI/D (n=23) versus non-SCI/D facilities (n=107). VHA facilities with SCI/D centers are more likely to have components of an antibiotic stewardship program that have led to reduced antibiotic use in previous studies. They are also more likely to have personnel with infectious diseases training. Conclusion VHA facilities with SCI/D centers have the resources needed for antibiotic stewardship. The next step will be to determine how to implement effective antibiotic stewardship tailored for this patient care setting.

"We Only Speak English Here": English Dominance in Language Diverse, Immigrant After-School Programs

ERIC Educational Resources Information Center

Gast, Melanie Jones; Okamoto, Dina G.; Feldman, Valerie

2017-01-01

Past research suggests that community after-school programs (ASPs) are crucial sites for culturally relevant programming for minority and immigrant youth; yet, we know little about how ASPs address language in their programming. Using an ethnographic fieldwork approach, we examine the goals and practices of ASP workers serving immigrant youth with…

What Difference Does an Hour Make? Examining the Effects of an After School Program

ERIC Educational Resources Information Center

Farmer-Hinton, Raquel L.; Sass, Daniel A.; Schroeder, Mark

2009-01-01

The use and scope of after-school programs (ASPs) have always varied with the local context. Historically, affluent families used ASPs to provide enrichment for their children. During the Civil Rights and Black Nationalist movements, African Americans used ASPs for cultural and educational activities. In recent times, ASPs have been used for…

Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals: an interrupted time series study.

PubMed

Charani, E; Gharbi, M; Moore, L S P; Castro-Sanchéz, E; Lawson, W; Gilchrist, M; Holmes, A H

2017-06-01

To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators, using data (2008-14) from a biannual point prevalence survey of medical and surgical wards. There were six data points pre-implementation and six data points post-implementation. There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in the two specialties of medicine (6.48%, 95% CI = -1.25 to 14.20) and surgery (6.63%, 95% CI = 0.15-13.10) in the implementation period, with a significant sudden change in level in surgery ( P  <   0.05). There was an increase, though not significant, in medicine (15.20%, 95% CI = -17.81 to 48.22) and surgery (35.97%, 95% CI = -3.72 to 75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (-16.25%, 95% CI = -42.52 to 10.01) and surgery (-14.62%, 95% CI = -42.88 to 13.63). Introducing the app into an existing ASP had a significant impact on the compliance with policy in surgery, and a positive, but not significant, effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may reflect a high level of compliance pre-intervention, due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform, e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.

Effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals: an interrupted time series study

PubMed Central

Gharbi, M.; Moore, L. S. P.; Castro-Sanchéz, E.; Lawson, W.; Gilchrist, M.; Holmes, A. H.

2017-01-01

Objectives: To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). Methods: In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators, using data (2008–14) from a biannual point prevalence survey of medical and surgical wards. There were six data points pre-implementation and six data points post-implementation. Results: There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in the two specialties of medicine (6.48%, 95% CI = −1.25 to 14.20) and surgery (6.63%, 95% CI = 0.15–13.10) in the implementation period, with a significant sudden change in level in surgery (P < 0.05). There was an increase, though not significant, in medicine (15.20%, 95% CI = −17.81 to 48.22) and surgery (35.97%, 95% CI = −3.72 to 75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (−16.25%, 95% CI = −42.52 to 10.01) and surgery (−14.62%, 95% CI = −42.88 to 13.63). Conclusions: Introducing the app into an existing ASP had a significant impact on the compliance with policy in surgery, and a positive, but not significant, effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may reflect a high level of compliance pre-intervention, due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform, e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions. PMID:28333297

Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant Staphylococcus aureus infections: a single institution experience

PubMed Central

Hirano, Ryuichi; Sakamoto, Yuichi; Kitazawa, Junichi; Yamamoto, Shoji; Tachibana, Naoki

2016-01-01

Background Vancomycin (VCM) requires dose adjustment based on therapeutic drug monitoring. At Aomori Prefectural Central Hospital, physicians carried out VCM therapeutic drug monitoring based on their experience, because pharmacists did not participate in the dose adjustment. We evaluated the impact of an Antimicrobial Stewardship Program (ASP) on attaining target VCM trough concentrations and pharmacokinetics (PK)/pharmacodynamics (PD) parameters in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. Materials and methods The ASP was introduced in April 2012. We implemented a prospective audit of prescribed VCM dosages and provided feedback based on measured VCM trough concentrations. In a retrospective pre- and postcomparison study from April 2007 to December 2011 (preimplementation) and from April 2012 to December 2014 (postimplementation), 79 patients were treated for MRSA infection with VCM, and trough concentrations were monitored (pre, n=28; post, n=51). In 65 patients (pre, n=15; post, n=50), 24-hour area under the concentration–time curve (AUC 0–24 h)/minimum inhibitory concentration (MIC) ratios were calculated. Results Pharmacist feedback, which included recommendations for changing dose or using alternative anti-MRSA antibiotics, was highly accepted during postimplementation (88%, 29/33). The number of patients with serum VCM concentrations within the therapeutic range (10–20 μg/mL) was significantly higher during postimplementation (84%, 43/51) than during preimplementation (39%, 11/28) (P<0.01). The percentage of patients who attained target PK/PD parameters (AUC 0–24 h/MIC >400) was significantly higher during postimplementation (84%, 42/50) than during preimplementation (53%, 8/15; P=0.013). There were no significant differences in nephrotoxicity or mortality rate. Conclusion Our ASP increased the percentage of patients that attained optimal VCM trough concentrations and PK/PD parameters, which contributed to the appropriate use of VCM in patients with MRSA infections. PMID:27789965

Use of PNA FISH for blood cultures growing Gram-positive cocci in chains without a concomitant antibiotic stewardship intervention does not improve time to appropriate antibiotic therapy.

PubMed

Cosgrove, Sara E; Li, David X; Tamma, Pranita D; Avdic, Edina; Hadhazy, Eric; Wakefield, Teresa; Gherna, Michael; Carroll, Karen C

2016-09-01

Peptide nucleic acid fluorescence in situ hybridization (PNA FISH) is a rapid diagnostic assay that can identify certain organisms growing in blood cultures 30-90 min from the time of positive Gram-stain. Existing studies have demonstrated a clinical utility with this assay when antibiotic stewardship programs assist clinicians with interpreting the results. However, the benefit of these rapid assays in the absence of concomitant antibiotic stewardship involvement is unclear. In this randomized study of 220 patients with enterococcal or streptococcal bacteremia, we found that PNA FISH, in the absence of concomitant input from an antibiotic stewardship program, had no impact on time to effective or optimal therapy, length of hospital stay, or in-hospital mortality. Our results suggest that in the absence of guidance from an antibiotic stewardship program, the clinical benefits of rapid diagnostic microbiological tools may be reduced. Copyright © 2016 Elsevier Inc. All rights reserved.

Antimicrobial stewardship programs: interventions and associated outcomes.

PubMed

Patel, Dimple; Lawson, Wendy; Guglielmo, B Joseph

2008-04-01

Guidelines regarding antimicrobial stewardship programs recommend an infectious diseases-trained physician and an infectious diseases-trained pharmacist as core members. Inclusion of clinical microbiologists, infection-control practitioners, information systems experts and hospital epidemiologists is considered optimal. Recommended stewardship interventions include prospective audit and intervention, formulary restriction, education, guideline development, clinical pathway development, antimicrobial order forms and the de-escalation of therapy. The primary outcome associated with these interventions has been the associated cost savings; however, few published investigations have taken into account the overall cost of the intervention. Over the past 5 years, there has been an increased focus upon interventions intended to decrease bacterial resistance or reduce superinfection, including infections associated with Clostridium difficile colitis. Few programs have been associated with a reduction in antimicrobial drug adverse events. Antimicrobial stewardship programs are becoming increasingly associated with clear benefits and will be integral in the in-patient healthcare setting.

A Report of the Efforts of the Veterans Health Administration National Antimicrobial Stewardship Initiative.

PubMed

Kelly, Allison A; Jones, Makoto M; Echevarria, Kelly L; Kralovic, Stephen M; Samore, Matthew H; Goetz, Matthew B; Madaras-Kelly, Karl J; Simbartl, Loretta A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A

2017-05-01

OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities. RESULTS Nationally developed stewardship resources were well utilized, and many stewardship practices significantly increased, including development of written stewardship policies at 92% of facilities by 2015 (P<.05). While the proportional distribution of antibiotics did not change, inpatient antibiotic use significantly decreased after VHA Antimicrobial Stewardship Initiative activities began (P<.0001). A 12% decrease in antibiotic use was noted overall. The VHA has also noted significantly declining use of antimicrobials prescribed for resistant Gram-negative organisms, including carbapenems, as well as declining hospital readmission and mortality rates. Concurrently, the VHA reported decreasing rates of Clostridium difficile infection. CONCLUSIONS The VHA National Antimicrobial Stewardship Initiative includes continuing education, disease-specific guidelines, and development of example policies in addition to other highly utilized resources. While no specific ideal level of antimicrobial utilization has been established, the VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and resources with local implementation of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2017;38:513-520.

Stockpile Stewardship's 20th Anniversary

ScienceCinema

Hecker, Siegfried; Gottemoeller, Rose; Reis, Victor H.; McMillan, Charles; Rohlfing, Joan; Hurricane, Omar; Hagengruber, Roger; Taylor, John

2018-06-22

A short oral history of the NNSA's Stockpile Stewardship Program, produced in association with the 20th anniversary of the program. It features Siegfried Hecker, Rose Gottemoeller, Victor Reis, Charles McMillan, Joan Rohlfing, Omar Hurricane, Roger Hagengruber, and John Taylor.

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs

ERIC Educational Resources Information Center

Weaver, Robert G.; Moore, Justin B.; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M. Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W.

2017-01-01

Background: The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. Aims: (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between…

What is urban environmental stewardship? Constructing a practitioner-derived framework

Treesearch

M. Romolini; W. Brinkley; K.L. Wolf

2012-01-01

Agencies and organizations deploy various strategies in response to environmental challenges, including the formulation of policy, programs, and regulations. Citizen-based environmental stewardship is increasingly seen as an innovative and important approach to improving and conserving landscape health. A new research focus on the stewardship of urban natural resources...

Branching Out: The North Carolina Forest Stewardship Activity Guide.

ERIC Educational Resources Information Center

Chesson, Gail

Stewardship is the responsibility of individuals to maintain and improve their natural resources and surroundings. The Forest Stewardship Program (FSP) in North Carolina aims at enhancing the management of all forest resources on private lands. This activity guide is designed to help youth appreciate and understand forests and natural…

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.

PFOA Stewardship Program Baseline Year Summary Report

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

Embedding Positive Behavior Intervention and Supports in Afterschool Programs

ERIC Educational Resources Information Center

Farrell, Anne F.; Collier-Meek, Melissa A.; Pons, Shelby R.

2013-01-01

There is growing recognition that after-school programs (ASPs) provide opportunities for positive youth development. Many ASPs focus on behavior and socio-emotional challenges, provide evidence-based interventions to improve homework completion and academic skills, and offer physical activities and nutritious foods. Generally speaking, ASPs offer…

Engaging Pharmacy Students, Residents, and Fellows in Antimicrobial Stewardship.

PubMed

Chahine, Elias B; El-Lababidi, Rania M; Sourial, Mariette

2015-12-01

Antimicrobial stewardship programs are mainly established by infectious diseases physicians and infectious diseases-trained clinical pharmacists with the goal of optimizing patients' outcomes while halting antimicrobial resistance, decreasing adverse events, and controlling health care cost. The role of the infectious diseases-trained clinical pharmacist in antimicrobial stewardship is well established; however, there are not enough formally trained pharmacists to assume the challenging responsibilities of the steward coordinator. The purpose of this article was to review the available literature and resources and propose a model to engage introductory pharmacy practice experience students, advanced pharmacy practice experience students, postgraduate year (PGY) 1 pharmacy residents, PGY2 infectious diseases pharmacy residents, and PGY2 or PGY3 infectious diseases pharmacy fellows in antimicrobial stewardship. Further studies are needed to assess and document the impact of pharmacy students and postgraduate trainees on antimicrobial stewardship programs. © The Author(s) 2013.

Antimicrobial stewardship

PubMed Central

Chung, Gladys W.; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-01-01

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs. PMID:23302793

Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes.

PubMed

Chung, Gladys W; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-02-15

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

Pharmacist-driven antimicrobial stewardship in intensive care units in East China: A multicenter prospective cohort study.

PubMed

Li, Zhongwang; Cheng, Baoli; Zhang, Kai; Xie, Guohao; Wang, Yan; Hou, Jinchao; Chu, Lihua; Zhao, Jialian; Xu, Zhijun; Lu, Zhongqiu; Sun, Huaqin; Zhang, Jian; Wang, Zhiyi; Wu, Haiya; Fang, Xiangming

2017-09-01

Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls. The primary outcome was all-cause hospital mortality. The pharmacist-driven antimicrobial stewardship program had a lower hospital mortality rate compared with the nonpharmacist program (19.3% vs 29.0%; P = .007). Furthermore, logistic regression analysis indicated that the pharmacist-driven program independently predicted hospital mortality (odds ratio, 0.57; 95% confidence interval, 0.36-0.91; P = .017) after adjustment. Meanwhile, this strategy had a lower rate of multidrug resistance (23.8% vs 31.7%; P = .037). Moreover, the strategy optimized antimicrobial use, such as having a shorter duration of empirical antimicrobial therapy (2.7 days; interquartile range [IQR], 1.7-4.6 vs 3.0; IQR, 1.9-6.2; P = .002) and accumulated duration of antimicrobial treatment (4.0; IQR, 2.0-7.0 vs 5.0; IQR, 3.0-9.5; P = .030). Pharmacist-driven antimicrobial stewardship in an intensive care unit decreased patient mortality and the emergence of multidrug resistance, and optimized antimicrobial agent use. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Compliance with the Healthy Eating Standards in YMCA afterschool programs

PubMed Central

Beets, Michael W.; Weaver, R. Glenn; Turner-McGrievy, Brie; Beighle, Aaron; Moore, Justin B.; Webster, Collin; Khan, Mahmud; Saunders, Ruth

2016-01-01

Objective In 2011, the YMCA of the USA adopted Healthy Eating (HE) Standards for all their afterschool programs (ASPs). The extent to which YMCA-ASPs comply with the standards is unknown. Methods Twenty ASPs from all YMCA-ASPs across SC (N=102) were invited to participate. Direct observation of the foods/beverages served and staff behaviors were collected on four non-consecutive days/ASP. Results One ASP did not serve a snack. Of the remaining, a total of 26% ASPs served a fruit/vegetable and 32% served water every day; 26% served sugar-sweetened beverages, 47% served sugar-added foods, and only 11% served whole grains, when grains were served. Staff were sitting with the children (65%) or verbally promoting healthy eating (15%) on at least one observation day. Staff where drinking non-approved drinks (25%) or foods (45%) on at least one observation day. No ASPs served snacks family-style every day. Conclusions/Implications Additional efforts are required to assist YMCA-operated ASPs in achieving these important nutrition standards. PMID:27372234

Answer Set Programming and Other Computing Paradigms

ERIC Educational Resources Information Center

Meng, Yunsong

2013-01-01

Answer Set Programming (ASP) is one of the most prominent and successful knowledge representation paradigms. The success of ASP is due to its expressive non-monotonic modeling language and its efficient computational methods originating from building propositional satisfiability solvers. The wide adoption of ASP has motivated several extensions to…

2010/2015 PFOA Stewardship Program - 2014 Annual Progress Reports

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

Effectiveness of landowner assistance activities: an examination of the USDA Forest Service's Forest Stewardship Program

Treesearch

Brett J. Butler; Marla Markowski-Lindsay; Stephanie Snyder; Paul Catanzaro; David B. Kittredge; Kyle Andrejczyk; Brenton J. Dickinson; Derya Eryilmaz; Jaketon H. Hewes; Paula Randler; Donna Tadle; Michael A. Kilgore

2014-01-01

The USDA Forest Service's Forest Stewardship Program (FSP) is the nation's most prominent private forestry assistance program. We examined the FSP using a multiple analytic approach: analysis of annual FSP accomplishments, survey of state FSP coordinators, analytic comparison of family forest owners receiving and not receiving forestry practice assistance,...

Highlights of the national evaluation of the Forest Stewardship Planning Program

Treesearch

R.J. Moulton; J.D. Esseks

2001-01-01

In 1998 and 1999, a nationwide random sample of 1238 nonindustrial private (NIPF) landowners with approved multiple resource Forest Stewardship Plans were interviewed to determine if this program is meeting its Congressional mandate of promoting sustainable management of forest resources on NIPF ownerships. It was found that two-thirds of program participants had never...

A Clostridium difficile infection (CDI) stewardship initiative improves adherence to practice guidelines for management of CDI.

PubMed

Jury, Lucy A; Tomas, Myreen; Kundrapu, Sirisha; Sitzlar, Brett; Donskey, Curtis J

2013-11-01

A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.

Defining Standards and Policies for Promoting Physical Activity in Afterschool Programs

ERIC Educational Resources Information Center

Beets, Michael W.; Wallner, Megan; Beighle, Aaron

2010-01-01

Background: National guidelines exist that define "quality" afterschool programs (3-6 pm, ASP). No widely adopted national standards/policies exist, however, for ASP providers for the promotion of physical activity (PA). To address this gap, state-level ASP organizations have developed or adopted standards/policies related to PA. The extent to…

Compliance With the Healthy Eating Standards in YMCA After-School Programs.

PubMed

Beets, Michael W; Weaver, R Glenn; Turner-McGrievy, Gabrielle; Beighle, Aaron; Moore, Justin B; Webster, Collin; Khan, Mahmud; Saunders, Ruth

2016-09-01

In 2011, the YMCA of the US adopted Healthy Eating standards for all of their after-school programs (ASPs). The extent to which YMCA ASPs comply with the standards is unknown. Twenty ASPs from all YMCA ASPs across South Carolina (N = 102) were invited to participate. Direct observation of the food and beverages served and staff behaviors were collected on 4 nonconsecutive days per ASP. One ASP did not serve a snack. Of the remaining ASPs, a total of 26% served a fruit or vegetable and 32% served water every day; 26% served sugar-sweetened beverages, 47% served sugar-added foods, and only 11% served whole grains when grains were served. Staff members sat with the children (65%) or verbally promoted healthy eating (15%) on at least 1 observation day. Staff drank non-approved drinks (25%) or foods (45%) on at least 1 observation day. No ASPs served snacks family-style every day. Additional efforts are required to assist YMCA-operated ASPs in achieving these important nutrition standards. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Salty or Sweet? Nutritional Quality, Consumption, and Cost of Snacks Served in Afterschool Programs

ERIC Educational Resources Information Center

Beets, Michael W.; Weaver, Robert G.; Tilley, Falon; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S.; Freedman, Darcy A.

2015-01-01

Background: Snacks served in afterschool programs (ASPs, 3-6?pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks…

Community Partnership to Address Snack Quality and Cost in After-School Programs

ERIC Educational Resources Information Center

Beets, Michael W.; Tilley, Falon; Turner-McGrievy, Gabrielle; Weaver, Robert G.; Jones, Sonya

2014-01-01

Background: Policies call on after-school programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community partnership between ASPs and local grocery stores. Methods: Four large-scale ASPs (serving ~500 children, aged 6-12?years,…

Enhancing and Promoting Recovery In Attentionally Impaired People Diagnosed With Schizophrenia: Results From A Randomized Controlled Trial Of Attention Shaping In A Partial Hospital Program.

PubMed

Silverstein, Steven M; Roché, Matthew W; Khan, Zaynab; Carson, Sarah J; Malinovsky, Igor; Newbill, William A; Menditto, Anthony A; Wilkniss, Sandra M

2014-01-01

The attentional impairments associated with schizophrenia are well-documented and profound. Psychopharmacological and most psychosocial interventions have been shown to have limited effect in improving attentional capacity. That said, one form of psychosocial treatment, attention shaping procedures (ASP), has been repeatedly demonstrated to produce significant and meaningful change in various aspects of participant attentiveness behaviors. To date, studies of ASP have been limited in that they have been conducted primarily with inpatients, have not assessed the generalizability of ASP's effects, and have not explored whether reinforcement is required to be contingent on performance of attentive behaviors. To address these limitations we conducted the first randomized clinical trial of ASP with people diagnosed with schizophrenia who are being treated in a partial hospital program. Our results indicate that ASP is effective in improving attention in people with schizophrenia in these types of programs, the effects of ASP generalize outside of the immediate treatment context to both other treatment groups and real world functioning, and contingent reinforcement is a critical ingredient of ASP. This project provides further evidence for the benefits of use of ASP in the recovery-oriented treatment of people diagnosed with schizophrenia who have significant attentional impairments.

Recommendations for Best Professional Practices in Fishing, Boating and Stewardship Education.

ERIC Educational Resources Information Center

Fedler, Anthony J.; Matthews, Bruce E.

2001-01-01

To implement its mission of increasing participation in fishing and boating and the stewardship of related resources, the Recreational Boating and Fishing Foundation solicited input from 11 experts in related fields. They identified 10 principles for education programs and recommended best practices in four educational areas: program planning,…

[Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program].

PubMed

Collado, Roberto; Losa, Juan Emilio; Álvaro, Elena Alba; Toro, Piedad; Moreno, Leonor; Pérez, Montserrat

2015-12-01

Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program. Comparative pre-post study of antimicrobial consumption with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment.

The Clinical Utility of Methicillin Resistant Staphylococcus aureus (MRSA) Nasal Screening to Rule Out MRSA Pneumonia: A Diagnostic Meta-analysis with Antimicrobial Stewardship Implications.

PubMed

Parente, Diane M; Cunha, Cheston B; Mylonakis, Eleftherios; Timbrook, Tristan T

2018-01-11

Recent literature has highlighted MRSA nasal screening as a possible antimicrobial stewardship program (ASP) tool for avoiding unnecessary empiric MRSA therapy for pneumonia, yet current guidelines recommend MRSA therapy based on risk factors. The objective of this meta-analysis was to evaluate the diagnostic value of MRSA nasal screening in MRSA pneumonia. Pubmed and EMBASE were searched from inception to November 2016 for English studies evaluating MRSA nasal screening and development of MRSA pneumonia. Data analysis was performed using a bivariate random-effects model to estimate pooled sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values. Twenty-two studies, comprising of 5,163 patients met our inclusion criteria. Pooled sensitivity and specificity of MRSA nares screen for all MRSA pneumonia types was 70.9% and 90.3%, respectively. With a 10% prevalence of potential MRSA pneumonia, the calculated PPV was 44.8% while the NPV was 96.5%. The pooled sensitivity and specificity for MRSA community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) were at 85% and 92.1%, respectively. For CAP and HCAP both the PPV and NPV increased to 56.8% and 98.1%, respectively. In comparison, for MRSA ventilated-associated pneumonia (VAP), the sensitivity, specificity, PPV, NPV was 40.3%, 93.7%, 35.7%, and 94.8%, respectively. Nares screening for MRSA had a high specificity and NPV for ruling out MRSA pneumonia, particularly in cases of CAP/HCAP. Based on the NPV, utilization of MRSA nares screening is a valuable tool for AMS to streamline empiric antibiotic therapy, especially among patients with pneu. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Development of Antimicrobial Competencies and Training for Staff Hospital Pharmacists

PubMed Central

Crader, Marsha F.

2014-01-01

Antimicrobial stewardship is an important component in health care outcomes of all patients. Many institutions are seeking the best methods to incorporate antimicrobial stewardship strategies into their hospitals including pharmacy services. Multiple factors should be considered when beginning or expanding an antimicrobial stewardship program. The purpose of this article is to discuss the development of basic antibiotic competencies and training for staff pharmacists in a community hospital. The article includes an assessment of pharmacists’ knowledge pre education and post education, perception of benefits from an antibiotic education program, and learning needs and preferences. PMID:24421561

Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

PubMed Central

Barlam, Tamar F.; Cosgrove, Sara E.; Abbo, Lilian M.; MacDougall, Conan; Schuetz, Audrey N.; Septimus, Edward J.; Srinivasan, Arjun; Dellit, Timothy H.; Falck-Ytter, Yngve T.; Fishman, Neil O.; Hamilton, Cindy W.; Jenkins, Timothy C.; Lipsett, Pamela A.; Malani, Preeti N.; May, Larissa S.; Moran, Gregory J.; Neuhauser, Melinda M.; Newland, Jason G.; Ohl, Christopher A.; Samore, Matthew H.; Seo, Susan K.; Trivedi, Kavita K.

2016-01-01

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics. PMID:27080992

Keepers of Our Digital Future: An Assessment of the National Digital Stewardship Residencies, 2013-2016

ERIC Educational Resources Information Center

Mink, Meridith Beck

2016-01-01

In September 2015, the Institute of Museum and Library Services (IMLS) awarded the Council on Library and Information Resources (CLIR) a grant to investigate the early impacts of the National Digital Stewardship Residency (NDSR) programs, in order to inform subsequent development of similar programs by others with a vested interest in building…

Teacher Candidates' Perceptions of the Emphasis on Stewardship in Their Initial Teacher Licensure Program

ERIC Educational Resources Information Center

Yontz, Brian David

2010-01-01

The stewardship of schools is central to the renewal and preservation of that which is precious in our nation's schools. This study examined perceptions of future teachers as to the degree to which their teacher preparation program emphasized the idea of stewarding schools. With a theoretical foundation that initial teacher preparation provides…

Evaluating the forest stewardship program through a national survey of participants

Treesearch

J.D. Esseks; R.J. Moulton

2000-01-01

This paper reports findings from a national survey of 1,231 participants in the Forest Stewardship Program (FSP) of USDA's Forest Service. Launched in 1991, the FSP provides technical assistance through state forestry agencies to help landowners develop management plans for their non-industrial forestland. The survey allowed us to address five main evaluative...

Stockpile Stewardship: How We Ensure the Nuclear Deterrent Without Testing

ScienceCinema

None

2018-01-16

In the 1990s, the U.S. nuclear weapons program shifted emphasis from developing new designs to dismantling thousands of existing weapons and maintaining a much smaller enduring stockpile. The United States ceased underground nuclear testing, and the Department of Energy created the Stockpile Stewardship Program to maintain the safety, security, and reliability of the U.S. nuclear deterrent without full-scale testing. This video gives a behind the scenes look at a set of unique capabilities at Lawrence Livermore that are indispensable to the Stockpile Stewardship Program: high performance computing, the Superblock category II nuclear facility, the JASPER a two stage gas gun, the High Explosive Applications Facility (HEAF), the National Ignition Facility (NIF), and the Site 300 contained firing facility.

Introduction of the ASP3D Computer Program for Unsteady Aerodynamic and Aeroelastic Analyses

NASA Technical Reports Server (NTRS)

Batina, John T.

2005-01-01

A new computer program has been developed called ASP3D (Advanced Small Perturbation 3D), which solves the small perturbation potential flow equation in an advanced form including mass-consistent surface and trailing wake boundary conditions, and entropy, vorticity, and viscous effects. The purpose of the program is for unsteady aerodynamic and aeroelastic analyses, especially in the nonlinear transonic flight regime. The program exploits the simplicity of stationary Cartesian meshes with the movement or deformation of the configuration under consideration incorporated into the solution algorithm through a planar surface boundary condition. The new ASP3D code is the result of a decade of developmental work on improvements to the small perturbation formulation, performed while the author was employed as a Senior Research Scientist in the Configuration Aerodynamics Branch at the NASA Langley Research Center. The ASP3D code is a significant improvement to the state-of-the-art for transonic aeroelastic analyses over the CAP-TSD code (Computational Aeroelasticity Program Transonic Small Disturbance), which was developed principally by the author in the mid-1980s. The author is in a unique position as the developer of both computer programs to compare, contrast, and ultimately make conclusions regarding the underlying formulations and utility of each code. The paper describes the salient features of the ASP3D code including the rationale for improvements in comparison with CAP-TSD. Numerous results are presented to demonstrate the ASP3D capability. The general conclusion is that the new ASP3D capability is superior to the older CAP-TSD code because of the myriad improvements developed and incorporated.

Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: results of a multicenter survey.

PubMed

Navarro-San Francisco, Carolina; Del Toro, M Dolores; Cobo, Javier; De Gea-García, José H; Vañó-Galván, Sergio; Moreno-Ramos, Francisco; Rodríguez-Baño, Jesús; Paño-Pardo, José Ramón

2013-04-01

Antibiotic resistance has been recognized as a worldwide problem. Our aim was to assess the perceptions of Spanish residents about antibiotic use and resistance. An online cross-sectional survey was conducted on all resident doctors in five teaching hospitals (September to November 2010). A link to the questionnaire was e-mailed to 844 doctors. The questionnaire collected demographical characteristics, residents' knowledge about microorganisms of known clinical relevance, their habits in the antibiotic prescription process, and their perceptions on the activities aimed to improve antibiotic use. We received 279 responses corresponding to 33.05% of all targeted residents. The response rate was higher among junior than among senior residents (39.95% vs. 26.12%; p<0.05). Residents of all hospitals, specialties and seniority mostly considered that antimicrobial resistance was a significant problem at national level (94.3%), at their institution (91.3%), and for their daily practice (83.8%). Residents considered their training regarding antibiotics insufficient, although up to 86.5% had prescribed antibiotics in the last month. They preferred the availability of local antibiotic guidelines (65%), specific teaching sessions, specific antimicrobial management teams or readily accessible advice from a group or an infectious diseases specialist, to improve antibiotic prescribing, rather than other restrictive interventions. Most residents at the hospitals surveyed believed that antibiotic resistance was a serious problem. The results of this survey provided very important information to optimize adherence to Antimicrobial Stewardship Programs (ASPs). Educational strategies and non-restrictive aids are the most valuable interventions, which ASPs should capitalize on to improve antimicrobial prescription. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Taimi Lynne Hoag Award for Environmental Stewardship

EPA Pesticide Factsheets

The Region 5 Tribal Operation Committee established this Award in the name of Taimi Hoag to recognize significant contributions in environmental management and/or environmental stewardship by a tribal government leader, program manager, or staff person.

Internationalized and research-oriented photonics education: Abbe School of Photonics

NASA Astrophysics Data System (ADS)

Helgert, Christian; Nolte, Stefan; Pertsch, Thomas

2015-10-01

The Abbe School of Photonics (ASP) provides and coordinates the optics and photonics education of graduate and doctoral students at the Friedrich Schiller University in Jena, Germany. The internationalized Master's degree program is the key activity in training students in the optical sciences. The program is designed to provide them with the skills necessary to fill challenging positions in industry and academia. Here, an essential factor is ASP's close collaboration with more than 20 German photonics companies. To sustain these partners' future economic development, the availability of highly qualified employees is constantly required. Accordingly, these industrial partners, the European Union, the local state and the federal German government are strongly involved in the sustainable development of ASP's curriculum by both conceptual and financial engagements. The main goal is to promote the students' academic careers and job experience in the photonics industry as well as in academia. To open up the program to students from all over the world, all ASP lectures and courses are taught in English. Since 2009, more than 250 graduate students from more than 40 different countries have been enrolled at the School. Almost 90% of them of non-German nationality, fulfilling the essential ASP philosophy to locally establish an international education program. ASP's qualification strategy is fully research-oriented and based on the principles of academic freedom, competitive research conditions and internationalization at all levels. The education program is complemented by a structured doctoral student support and a prestigious guest professorship program.

After-School Program Engagement: Links to Child Competence and Program Quality and Content

ERIC Educational Resources Information Center

Mahoney, Joseph L; Parente, Maria E.; Lord, Heather

2007-01-01

This 2-year study assessed program-level differences in after-school program (ASP) engagement in relation to child competencies (effectance motivation, social competence, school grades) and program quality and content. Participants were 141 children (M age = 8.4 years) who attended 9 ASPs in an urban, disadvantaged city in the United States.…

A survey to optimize the design of an antimicrobial stewardship smartphone app at an academic medical center.

PubMed

Markley, J Daniel; Pakyz, Amy; Bernard, Shaina; Lee, Kimberly; Appelbaum, Nital; Bearman, Gonzalo; Stevens, Michael P

2017-03-01

Mobile medical apps are commonly used by health care professionals and could be used by antimicrobial stewardship programs to enhance adherence to local recommendations. We conducted a survey of health care workers to inform the design of an antimicrobial stewardship smartphone app. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.

PubMed

Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J; Crnich, Christopher J; Moehring, Rebekah; Schmader, Kenneth E; Olds, Danielle; Higgins, Patricia A; Jump, Robin L P

2016-03-01

We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc.

The ASP: Programs to Inspire Educators

NASA Astrophysics Data System (ADS)

Hurst, Anna; Gurton, S.; Bennett, M.; Berendson, M.; Gibbs, M.

2006-12-01

The Astronomical Society of the Pacific (ASP) provides educators with new approaches to hands-on astronomy and space science. Through interactive educational programs, our goal is to help more people understand, appreciate, and enjoy astronomy and science. Over the past several years, the ASP has re-dedicated itself to achieving this mission through an ever-expanding portfolio of programs. Our astronomy and education programs target educators of all descriptions classroom teachers, informal science educators (in science museums, planetariums, nature centers, etc.), college astronomy teachers, and amateur astronomers providing them with materials and training to capture the attention of their students and audiences and to introduce them to science via an initial engagement in astronomy. In this poster we provide an overview of current programs that include partnerships with the National Optical Astronomy Observatory, the Association of Science-Technology Centers, TERC, the Astronomical League, NASA, and the SETI Institute to address this broad range of formal and informal educators. Additionally, the poster will provide a summary of recently conducted research by the ASP regarding the Project ASTRO program, done in cooperation with our national partners, to gauge whether the program, as perceived by the teachers participating in Project ASTRO, a) assists in correcting common misconceptions in astronomy or science and b) improve students' attitudes towards science. Additional information regarding the ASP's educational programs can be found at: www.astrosociety.org/education.html

What does it take to get family forest owners to enroll in a forest stewardship-type program?

Treesearch

Michael A. Kilgore; Stephanie A. Snyder; Joseph Schertz; Steven J. Taff

2008-01-01

We estimated the probability of enrollment and factors influencing participation in a forest stewardship-type program, Minnesota's Sustainable Forest Incentives Act, using data from a mail survey of over 1000 randomly-selected Minnesota family forest owners. Of the 15 variables tested, only five were significant predictors of a landowner's interest in...

Roadmap to MaRIE January 2015

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

Barnes, Cris William

After the decision to end nuclear testing and the inception of the Stockpile Stewardship program, the condition of the stockpile was the primary mission driver. During the first two decades of stewardship, the primary program goal could be described as underwriting the Stockpile-to-Target Sequence (STS), the military requirements on the conditions the nuclear warheads needed to survive and still operate.

Right Size Determining the Staff Necessary to Sustain Simulation and Computing Capabilities for Nuclear Security

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

Nikkel, Daniel J.; Meisner, Robert

The Advanced Simulation and Computing Campaign, herein referred to as the ASC Program, is a core element of the science-based Stockpile Stewardship Program (SSP), which enables assessment, certification, and maintenance of the safety, security, and reliability of the U.S. nuclear stockpile without the need to resume nuclear testing. The use of advanced parallel computing has transitioned from proof-of-principle to become a critical element for assessing and certifying the stockpile. As the initiative phase of the ASC Program came to an end in the mid-2000s, the National Nuclear Security Administration redirected resources to other urgent priorities, and resulting staff reductions inmore » ASC occurred without the benefit of analysis of the impact on modern stockpile stewardship that is dependent on these new simulation capabilities. Consequently, in mid-2008 the ASC Program management commissioned a study to estimate the essential size and balance needed to sustain advanced simulation as a core component of stockpile stewardship. The ASC Program requires a minimum base staff size of 930 (which includes the number of staff necessary to maintain critical technical disciplines as well as to execute required programmatic tasks) to sustain its essential ongoing role in stockpile stewardship.« less

Improving patient care through implementation of an antimicrobial stewardship program.

PubMed

Palmer, Hannah R; Weston, Jaye; Gentry, Layne; Salazar, Miguel; Putney, Kimberly; Frost, Craig; Tipton, Joyce A; Cottreau, Jessica; Tam, Vincent H; Garey, Kevin W

2011-11-15

The implementation of an antimicrobial stewardship program at a health system is described. In 2008, the Center for Antimicrobial Stewardship and Epidemiology (CASE) was formed at St. Luke's Episcopal Hospital (SLEH) to improve the quality of care for patients as it related to antimicrobial therapy. The charter of CASE contained specific aims for improving patient care, furthering clinical research, and training the next generation of clinical infectious diseases pharmacists. The CASE team consists of at least two infectious diseases pharmacists and one physician (the medical director) who provide direct oversight for antimicrobial utilization within the hospital. The CASE medical director, an infectious diseases physician, is responsible for overseeing the activities of the center. With the oversight of the CASE advisory board, the medical director develops and implements the antimicrobial stewardship and management policies for SLEH. Another key innovative feature of CASE is its extensive involvement in training new infectious diseases pharmacists and conducting research. CASE uses a model in which a clinical scenario or problem is identified, a research project is undertaken to further elucidate the problem, and policy changes are made to improve patient outcomes. The CASE team is supported by a CASE advisory board, a CASE research collaborative including university faculty, and a dedicated training program for pharmacy fellows, residents, and students. Implementation of an antimicrobial stewardship program at a health system helped decrease the inappropriate use of antibiotics, improve patient care and outcomes, further clinical research, and increase training opportunities for future clinical infectious diseases pharmacists.

From Cleanup to Stewardship. A companion report to Accelerating Cleanup: Paths to Closure and background information to support the scoping process required for the 1998 PEIS Settlement Study

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

None, None

1999-10-01

Long-term stewardship is expected to be needed at more than 100 DOE sites after DOE's Environmental Management program completes disposal, stabilization, and restoration operations to address waste and contamination resulting from nuclear research and nuclear weapons production conducted over the past 50 years. From Cleanup to stewardship provides background information on the Department of Energy (DOE) long-term stewardship obligations and activities. This document begins to examine the transition from cleanup to long-term stewardship, and it fulfills the Secretary's commitment to the President in the 1999 Performance Agreement to provide a companion report to the Department's Accelerating Cleanup: Paths to Closuremore » report. It also provides background information to support the scoping process required for a study on long-term stewardship required by a 1998 Settlement Agreement.« less

Stockpile Stewardship: How We Ensure the Nuclear Deterrent Without Testing

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

None

2014-09-04

In the 1990s, the U.S. nuclear weapons program shifted emphasis from developing new designs to dismantling thousands of existing weapons and maintaining a much smaller enduring stockpile. The United States ceased underground nuclear testing, and the Department of Energy created the Stockpile Stewardship Program to maintain the safety, security, and reliability of the U.S. nuclear deterrent without full-scale testing. This video gives a behind the scenes look at a set of unique capabilities at Lawrence Livermore that are indispensable to the Stockpile Stewardship Program: high performance computing, the Superblock category II nuclear facility, the JASPER a two stage gas gun,more » the High Explosive Applications Facility (HEAF), the National Ignition Facility (NIF), and the Site 300 contained firing facility.« less

Antibiotic stewardship through the EU project "ABS International".

PubMed

Allerberger, Franz; Frank, Annegret; Gareis, Roland

2008-01-01

The increasing problem of antimicrobial resistance requires implementation of antibiotic stewardship (ABS) programs. The project "ABS International--implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union" was started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (antibiotic list, guides for antibiotic treatment and surgical prophylaxis, antibiotic-related organization) and valid process measures, as well as quality indicators for antibiotic use were developed. Specific ABS tools are being implemented in up to five healthcare facilities in each country. Although ABS International clearly focuses on healthcare institutions, future antimicrobial stewardship programs must also cover public education and antibiotic prescribing in primary care.

CDC, TJC Urge Providers To Up Their Game on Antibiotic Stewardship.

PubMed

Srinivasan, Arjun; Vento, Todd

2017-03-01

With data showing continued increases in the use of antibiotics, even in cases in which such prescribing is unnecessary and ill-advised, both the CDC and TJC are pushing initiatives aimed at improving antibiotic stewardship. The initiatives stress the importance of patient and provider education, the tracking of antibiotic use and resistance, and the need for top-level support. Although smaller hospitals face challenges in meeting the new standards, some health systems are getting around the problem through the use of telemedicine. The CDC is pushing hospitals to implement seven core elements that the agency maintains are critical to an effective antibiotic stewardship program. TJC has established a new standard requiring all hospitals to create antibiotic stewardship programs that are steered by a multidisciplinary team. Intermountain Healthcare in Salt Lake City is helping smaller hospitals in its network meet these new TJC and CDC directives by supplying support and expertise via telemedicine. The telehealth program also enables both emergency and inpatient providers to access infectious disease expertise when patients present with issues of concern.

Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia.

PubMed

Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

2016-01-01

Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. A cross-sectional study was conducted among community pharmacists between March-April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship.

Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia

PubMed Central

Khan, Muhammad Umair; Hassali, Mohamed Azmi Ahmad; Ahmad, Akram; Elkalmi, Ramadan Mohamed; Zaidi, Syed Tabish Razi; Dhingra, Sameer

2016-01-01

Background Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. Methods A cross-sectional study was conducted among community pharmacists between March–April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. Results A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). Conclusion The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship. PMID:26901404

7 CFR 1470.22 - Conservation stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM Contracts... process as outlined in the National Planning Procedures Handbook to encourage participants to address... the participant's decisions that describes the schedule of conservation activities to be implemented...

Environmental Stewardship: A Conceptual Review and Analytical Framework.

PubMed

Bennett, Nathan J; Whitty, Tara S; Finkbeiner, Elena; Pittman, Jeremy; Bassett, Hannah; Gelcich, Stefan; Allison, Edward H

2018-04-01

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Environmental Stewardship: A Conceptual Review and Analytical Framework

NASA Astrophysics Data System (ADS)

Bennett, Nathan J.; Whitty, Tara S.; Finkbeiner, Elena; Pittman, Jeremy; Bassett, Hannah; Gelcich, Stefan; Allison, Edward H.

2018-04-01

There has been increasing attention to and investment in local environmental stewardship in conservation and environmental management policies and programs globally. Yet environmental stewardship has not received adequate conceptual attention. Establishing a clear definition and comprehensive analytical framework could strengthen our ability to understand the factors that lead to the success or failure of environmental stewardship in different contexts and how to most effectively support and enable local efforts. Here we propose such a definition and framework. First, we define local environmental stewardship as the actions taken by individuals, groups or networks of actors, with various motivations and levels of capacity, to protect, care for or responsibly use the environment in pursuit of environmental and/or social outcomes in diverse social-ecological contexts. Next, drawing from a review of the environmental stewardship, management and governance literatures, we unpack the elements of this definition to develop an analytical framework that can facilitate research on local environmental stewardship. Finally, we discuss potential interventions and leverage points for promoting or supporting local stewardship and future applications of the framework to guide descriptive, evaluative, prescriptive or systematic analysis of environmental stewardship. Further application of this framework in diverse environmental and social contexts is recommended to refine the elements and develop insights that will guide and improve the outcomes of environmental stewardship initiatives and investments. Ultimately, our aim is to raise the profile of environmental stewardship as a valuable and holistic concept for guiding productive and sustained relationships with the environment.

Impact of an Antimicrobial Stewardship Program on Antibiotic Use at a Nonfreestanding Children's Hospital.

PubMed

Turner, R Brigg; Valcarlos, Elena; Loeffler, Ann M; Gilbert, Michael; Chan, Dominic

2017-09-01

Pediatric stewardship programs have been successful at reducing unnecessary antibiotic use. Data from nonfreestanding children's hospitals are currently limited. This study is an analysis of antibiotic use after implementation of an antimicrobial stewardship program at a community nonfreestanding children's hospital. In April 2013, an antimicrobial stewardship program that consisted of physician-group engagement and pharmacist prospective auditing and feedback was initiated. We compared antibiotic use in the preintervention period (April 2012 to March 2013) with that in the postintervention period (April 2013 to March 2015) in all units except the neonatal intensive care unit and the emergency department. In addition, drug-acquisition costs, antibiotic-specific use, death, length of stay, and case-mix index were examined. Antibiotic use decreased by 16.8% (95% confidence interval, 18.0% to -9.2%; P < .001) in the postintervention period. Vancomycin use decreased by 38% (P = .001), whereas antipseudomonal β-lactam use was unaltered. Drug-acquisition cost savings were estimated to be $67 000/year over the 2-year postintervention period. Lengths of stay and mortality rates were unchanged in the postintervention period after adjusting for case-mix index. Implementation of a simple stewardship initiative with limited resources at a community nonfreestanding children's hospital effectively reduced antibiotic use without an overt negative impact on overall clinical outcomes. The results of this study suggest that nonfreestanding children's hospitals can achieve substantial reductions in antibiotic use despite limited resources. © The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

The scope and value of an anticoagulation stewardship program at a community teaching hospital.

PubMed

Wychowski, Maura K; Ruscio, Christina I; Kouides, Peter A; Sham, Ronald L

2017-04-01

To report the impact of an inpatient anticoagulation stewardship program at a community hospital to promote optimal anticoagulant use. The anticoagulation team (ACT) stewardship program consists of two clinical pharmacists and hematologists to provide oversight of anticoagulants, high cost reversal agents including prothrombin complex concentrate (PCC, Kcentra™), and heparin-induced thrombocytopenia (HIT) management. Intervention data and number of charts reviewed were collected. Average cost avoidance data was applied to ACT interventions to estimate cost savings. The PCC analysis was conducted via retrospective chart review during the pre-intervention period. Prospective monitoring continued in the post-intervention period to determine the percentage of PCC use within the institution's guidelines or approved by ACT or hematology. A total of 19,445 patient charts were reviewed, and 1930 (10%) contained stewardship opportunity. Of the interventions, 71% were provided to the medical service and 22% to surgical services with acceptance rates of 91 and 83%, respectively. Intervention cost-avoidance calculated to be $694,217. Regarding HIT interventions, 52% of interventions involved pharmacokinetic/pharmacodynamics optimization in 18 patients with suspected or confirmed HIT. Regarding PCC use, 55.8% of PCC orders were considered inappropriate in the pre-invention period versus 2.6% post-intervention. Appropriate PCC doses per month post-intervention were consistent with pre-intervention doses (7.67 vs. 6.73, respectively). The projected annual PCC cost savings is $385,473. The overall estimated financial impact of ACT is $799,690 saved. Implementation of an anticoagulation stewardship program reduced costs and improved clinical outcomes. It is also expected that anticoagulant optimization and provider education improved overall safety.

7 CFR 1469.7 - Benchmark condition inventory and conservation stewardship plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Benchmark condition inventory and conservation...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General Provisions § 1469.7 Benchmark condition inventory and conservation stewardship...

The Federal Forest Stewardship Program and its implications for sustainable forestry on private forest ownerships in the United States

Treesearch

Robert J. Moulton; J. Dixon Esseks

2002-01-01

A 72 percent response rate was achieved in 1998 and 1999 national survey of 1,238 participants in the USDA Forest Service's Forest Stewardship Program, under which 130,000 individual multiple resource plans encompassing 16.5 million acres (6.5 million ha) of privately owned forest lands in the United States had been completed. Objectives were to determine if the...

A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance.

PubMed

Lanbeck, Peter; Ragnarson Tennvall, Gunnel; Resman, Fredrik

2016-07-27

Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.

Stockpile Stewardship at Los Alamos(U)

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

Webster, Robert B.

2012-06-29

Stockpile stewardship is the retention of nuclear weapons in the stockpile beyond their original design life. These older weapons have potential changes inconsistent with the original design intent and military specifications. The Stockpile Stewardship Program requires us to develop high-fidelity, physics-based capabilities to predict, assess, certify and design nuclear weapons without conducting a nuclear test. Each year, the Lab Directors are required to provide an assessment of the safety, security, and reliability our stockpile to the President of the United States. This includes assessing whether a need to return to testing exists. This is a talk to provide an overviewmore » of Stockpile Stewardship's scientific requirements and how stewardship has changed in the absence of nuclear testing. The talk is adapted from an HQ talk to the War college, and historical unclassified talks on weapon's physics.« less

7 CFR 1470.22 - Conservation stewardship plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., and (iii) Documenting the participant's conservation objectives to reach and exceed stewardship thresholds; (2) A plan map delineating enrolled land with associated acreage amounts; (3) In the case where a... participant's transition to or participation in the National Organic Program; (4) In the case where a...

Physical Activity and Energy Expenditure during an After-School Running Club: Laps versus Game Play

ERIC Educational Resources Information Center

Kahan, David; McKenzie, Thomas L.

2018-01-01

Background: After-school programs (ASPs) have the potential to contribute to student physical activity (PA), but there is limited empirical evidence to guide program development and implementation. Methods: We used pedometry to assess the overall effectiveness of an elementary school ASP running program relative to national and state PA…

After-School Programs: A Potential Partner to Support Urban Youth

ERIC Educational Resources Information Center

Evans, Ashley; Leung, Brian P.

2012-01-01

After-school programs (ASPs) are learning centers that provide enrichment opportunities after regular school hours. This article examines the value these programs can add to a child's educational day, especially for urban youth who are vulnerable during after-school hours. Quality ASPs can be part of the solution to help mitigate the effects of…

Structure and Deviancy Training in After-School Programs

ERIC Educational Resources Information Center

Rorie, Melissa; Gottfredson, Denise C.; Cross, Amanda; Wilson, Denise; Connell, Nadine M.

2011-01-01

Evidence regarding the effectiveness of after-school programs (ASPs) for reducing problem behaviors is mixed. Unstructured ASPs may increase antisocial behavior by increasing "deviancy training" opportunities, when peers reinforce deviant attitudes and behaviors. This research analyses approximately 3000 five-minute intervals from 398 observations…

Antimicrobial Stewardship Program Implementation of a Quality Improvement Intervention Using Real-Time Feedback and an Electronic Order Set for the Management of Staphylococcus aureus Bacteremia.

PubMed

Rosa, Rossana; Zavala, Bruno; Cain, Natalie; Anjan, Shweta; Aragon, Laura; Abbo, Lilian M

2018-03-01

Antimicrobial stewardship programs can optimize the management of Staphylococcus aureus bacteremia by integrating information technology and microbiology laboratory resources. This study describes our experience implementing an intervention consisting of real-time feedback and the use of an electronic order set for the management of S. aureus bacteremia. Infect Control Hosp Epidemiol 2018;39:346-349.

Cultural Competence in Afterschool Programs

ERIC Educational Resources Information Center

Simpkins, Sandra D.; Riggs, Nathaniel R.

2014-01-01

Increasing ethnic diversity among American youth, in combination with funding priorities often targeting underserved populations, has increased the number of diverse youth attending afterschool programs (ASPs). At present, there is little guidance on how to best design ASPs and prepare staff to support the development of these diverse youth. The…

Making healthy eating and physical activity policy practice: the design and overview of a group randomized controlled trial in afterschool programs.

PubMed

Beets, Michael W; Glenn Weaver, R; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S; Freedman, Darcy A; Saunders, Ruth; Pate, Russell R; Beighle, Aaron; Hutto, Brent; Moore, Justin B

2014-07-01

National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6 pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1800 children (6-12 years) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs' daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children's accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness. Copyright © 2014 Elsevier Inc. All rights reserved.

6 CFR 27.235 - Alternative security program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... submit an ASP in lieu of a Security Vulnerability Assessment, Site Security Plan, or both. (2) Tier 1... Tier 3 facilities may not submit an ASP in lieu of a Security Vulnerability Assessment. (b) The... Security Vulnerability Assessment or using the procedure specified in § 27.245 if the ASP is intended to...

Application of the ASP3D Computer Program to Unsteady Aerodynamic and Aeroelastic Analyses

NASA Technical Reports Server (NTRS)

Batina, John T.

2006-01-01

A new computer program has been developed called ASP3D (Advanced Small Perturbation - 3D), which solves the small perturbation potential flow equation in an advanced form including mass-consistent surface and trailing wake boundary conditions, and entropy, vorticity, and viscous effects. The purpose of the program is for unsteady aerodynamic and aeroelastic analyses, especially in the nonlinear transonic flight regime. The program exploits the simplicity of stationary Cartesian meshes with the movement or deformation of the configuration under consideration incorporated into the solution algorithm through a planar surface boundary condition. The paper presents unsteady aerodynamic and aeroelastic applications of ASP3D to assess the time dependent capability and demonstrate various features of the code.

Defense Experimentation and Stockpile Stewardship

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

None

2014-10-28

A primary mission of the site is to help ensure that the nation's nuclear weapon stockpile remains safe, secure and reliable. The stockpile stewardship program, working with the national weapons laboratories conducts a wide range of experiments using advanced diagnostic technologies, many of which were developed right here at the NNSS.

Defense Experimentation and Stockpile Stewardship

ScienceCinema

None

2018-01-16

A primary mission of the site is to help ensure that the nation's nuclear weapon stockpile remains safe, secure and reliable. The stockpile stewardship program, working with the national weapons laboratories conducts a wide range of experiments using advanced diagnostic technologies, many of which were developed right here at the NNSS.

Eco-Visualization: Promoting Environmental Stewardship in the Museum

ERIC Educational Resources Information Center

Holmes, Tiffany

2007-01-01

Eco-visualizations are artworks that reinterpret environmental data with custom software to promote stewardship. Eco-visualization technology offers a new way to dynamically picture environmental data and make it meaningful to a museum population. The questions are: How might museums create new projects and programs around place-based information?…

Estimating Landholders’ Probability of Participating in a Stewardship Program, and the Implications for Spatial Conservation Priorities

PubMed Central

Adams, Vanessa M.; Pressey, Robert L.; Stoeckl, Natalie

2014-01-01

The need to integrate social and economic factors into conservation planning has become a focus of academic discussions and has important practical implications for the implementation of conservation areas, both private and public. We conducted a survey in the Daly Catchment, Northern Territory, to inform the design and implementation of a stewardship payment program. We used a choice model to estimate the likely level of participation in two legal arrangements - conservation covenants and management agreements - based on payment level and proportion of properties required to be managed. We then spatially predicted landholders’ probability of participating at the resolution of individual properties and incorporated these predictions into conservation planning software to examine the potential for the stewardship program to meet conservation objectives. We found that the properties that were least costly, per unit area, to manage were also the least likely to participate. This highlights a tension between planning for a cost-effective program and planning for a program that targets properties with the highest probability of participation. PMID:24892520

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

Muhlheim, M.D.; Belles, R.J.; Cletcher, J.W.

The Accident Sequence Precursor (ASP) Program involves the systematic review and evaluation of operational events that have occurred at light-water reactors to identify and categorize precursors to potential severe core damage accident sequences. The results of the ASP Program are published in an annual report. The most recent report, which contains the precursors for 1995, is NUREG/CR-4674, Volume 23, Precursors to Potential Severe Core Damage Accidents: 1995, A Status Report, published in April 1997. This article provides an overview of the ASP review and evaluation process and a summary of the results for 1995.

Open innovation at the Abbe School of Photonics

NASA Astrophysics Data System (ADS)

Helgert, Christian; Geiss, Reinhard; Nolte, Stefan; Eilenberger, Falk; Zakoth, David; Mauroner, Oliver; Pertsch, Thomas

2017-08-01

The Abbe School of Photonics (ASP) provides and coordinates the optics and photonics education of graduate and doctoral students at the Friedrich Schiller University in Jena, Germany. The internationalized Master's degree program is the key activity in training students in the optical sciences. The program is designed to provide them with the skills necessary to fill challenging positions in industry and academia. Here, an essential factor is ASP's close collaboration with more than 20 German photonics companies. To sustain these partners' future economic development, the availability of highly qualified employees is constantly required. Accordingly, these industrial partners, the European Union, the local state and the federal German government are strongly involved in the sustainable development of ASP's curriculum by both conceptual and financial engagements. The main goal is to promote the students' academic careers and job experience in the photonics industry as well as in academia. To open up the program to students from all over the world, all ASP lectures and courses are taught in English. ASP's qualification strategy is fully research-oriented and based on the principles of academic freedom, competitive research conditions and internationalization at all levels. The education program is complemented by a structured doctoral student support and a prestigious guest professorship program. Recently, ASP and partners have started a project to build an open photonics laboratory in order to foster innovative and co-creative processes. The idea follows well-established open innovation schemes e.g. in electronics. This Photon Garage (German: "Lichtwerkstatt") will bring together professionals and interested laymen from different backgrounds to approach pertinent challenges in photonics. Here, we will share our latest insights into the potentials and opportunities offered by this novel educative approach.

Intergenerational equity and long-term stewardship plans.

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

Hocking, E. K.

2002-02-05

For an untold number of contaminated sites throughout the world, stewardship will be inevitable. For many such sites, stewardship will be a reasonable approach because of the uncertainties associated with present and future site conditions and site contaminants, the limited performance of available technologies, the nonavailability of technologies, and the risk and cost associated with complete cleanup. Regardless of whether stewardship is a realistic approach to site situations or simply a convenient default, it could be required at most contaminated sites for multiple generations. Because the stewardship plan is required to protect the release of hazardous contaminants to the environment,more » some use restrictions will be put in place to provide that protection. These use restrictions will limit access to resources for as long as the protection is required. The intergenerational quality of long-term stewardship plans and their inherent limitations on resource use require that they be designed to achieve equity among the affected generations. Intergenerational equity, defined here as the fairness of access to resources across generations, could be achieved through a well-developed stewardship plan that provides future generations with the information they need to make wise decisions about resource use. Developing and implementing such a plan would take into account the failure mechanisms of the plan's components, feature short stewardship time blocks that would allow for periodic reassessments of the site and of the stewardship program's performance, and provide present and future generations with necessary site information.« less

Improving Science Literacy Though Engagement in Astronomy at the Astronomical Society of the Pacific

NASA Astrophysics Data System (ADS)

Manning, James; Gibbs, M.; Gurton, S.

2009-01-01

The Astronomical Society of the Pacific (ASP) increases the understanding and appreciation of astronomy by engaging scientists, educators, enthusiasts and the public to advance science and science literacy. The mission-based astronomy and space science education and public outreach programs provide hands-on resources for both formal and informal educators working with K-12 students and the general public. This poster both highlights the ASP's signature programs, such as Project ASTRO, the Night Sky Network, and Astronomy from the Ground Up, and provides updated information regarding the recent impact the programs are having throughout the United States. Information regarding the ASP can be located online at www.astrosociety.org.

1994 Accident sequence precursor program results

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

Belles, R.J.; Cletcher, J.W.; Copinger, D.A.

1996-01-01

The Accident Sequence Precursor (ASP) Program involves the systematic review and evaluation of operational events that have occurred at light-water reactors to identify and categorize precursors to potential severe core damage accident sequences. The results of the ASP Program are published in an annual report. The most recent report, which contains the analyses of the precursors for 1994, is NUREG/CR-4674, Vols. 21 and 22, Precursors to Potential Severe Core Damage Accidents: 1994, A Status Report, published in December 1995. This article provides an overview of the ASP review and evaluation process and a summary of the results for 1994. 12more » refs., 2 figs., 4 tabs.« less

7 CFR 662.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... These programs include: Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives Program, Conservation Innovation Grants, Agricultural Water Enhancement Program, Conservation of Private Grazing Land, Wildlife Habitat Incentive...

Antimicrobial resistance of Enterococcus isolates in Turkey: A meta-analysis of current studies.

PubMed

Kilbas, Imdat; Ciftci, Ihsan Hakki

2018-03-01

In this study, a meta-analysis of Enterococcus isolates collected in 2000-2015 in Turkey and their susceptibility/resistance to antibiotics, clinical indications for initial drug treatment, and identification of alternative treatments was conducted. The meta-analysis examined antibiotic susceptibility/resistance in Enterococcus spp. isolates. The study was planned and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Statements on antimicrobial resistance were grouped according to the antimicrobial stewardship programme (ASP). The mean resistance rates of Enterococcus faecalis to vancomycin (VAN) and linezolid (LNZ) were 1.0±2.2% and 1.9±2.6%, respectively, whereas the mean resistance rates of Enterococcus faecium to VAN and LNZ were 10.3±11.3% and 2.4±0%, respectively. This study is the first meta-analysis of the resistance of clinical Enterococcus isolates in Turkey to antimicrobial agents, which is a major problem stemming from the excessive usage of antibiotics. The development of antibiotic resistance in Turkey has changed over time. To support the practice of evidence-based medicine, more notifications about Enterococcus resistance status are needed, especially notifications following ASP rules. Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

After-School Program Implementation in Urban Environments: Increasing Engagement among Adolescent Youth

ERIC Educational Resources Information Center

Pelcher, Allison; Rajan, Sonali

2016-01-01

Background: After-school programs (ASPs) play a crucial role in supplementing the present school day. However, implementing ASPs in the urban environment and among adolescents (grades 6-12) poses unique challenges. The purpose of this study was to conduct a systematic literature review to identify evidence-based barriers and facilitators to…

Impact of Policy Environment Characteristics on Physical Activity and Sedentary Behaviors of Children Attending Afterschool Programs

ERIC Educational Resources Information Center

Beets, Michael W.; Huberty, Jennifer; Beighle, Aaron; Moore, Justin B.; Webster, Collin; Ajja, Rahma; Weaver, Glenn

2013-01-01

State and national organizations recently developed policies focused on increasing physical activity (PA) in afterschool programs (ASPs). These policies emphasize "activity friendly" environment characteristics that, when present, should lead to higher levels of PA and reduce the amount of time children spend sedentary during an ASP.…

Citizen monitoring and restoration: Volunteers and community involvement in wilderness stewardship

Treesearch

Laurie Yung

2007-01-01

Citizen monitoring and restoration is increasingly viewed as a means to involve local communities in wilderness stewardship. This paper examines research on volunteers participating in five monitoring and restoration programs in Western Montana. Volunteers reported that they gained valuable skills, felt more connected with local wilderness areas, and made an important...

Aspen's Global 100: Beyond Grey Pinstripes 2009-2010--Preparing MBAs for Social and Environmental Stewardship

ERIC Educational Resources Information Center

Aspen Institute, 2009

2009-01-01

Beyond Grey Pinstripes is a research survey and alternative ranking of business schools that spotlights innovative full-time MBA programs leading the way in integrating social and environmental stewardship into their curriculum and scholarly research. These schools are preparing today's students--tomorrow's leaders--for future market realities by…

The Astronomical Society of the Pacific - Education and Public Outreach in the International Year of Astronomy

NASA Astrophysics Data System (ADS)

Gibbs, Michael; Manning, J.; Gurton, S.; Fraknoi, A.; Berendsen, M.; Hurst, A.; White, V.

2008-05-01

At the forefront of sharing the excitement of our exploration of the universe for 120 years, the Astronomical Society of the Pacific (ASP) is poised to use its networks and services to implement education and outreach programs for the 2009 International Year of Astronomy (IYA). The ASP is working with NASA, the AAS, NOAO, ASTC, and several other astronomical and educational organizations on IYA projects. The ASP will develop and implement four key signature programs, pending funding, for the IYA: a) "IYA Cosmic Calendar: A Year of Outreach Resources” with astronomy activities primarily for amateur astronomy clubs; b) "In the Footsteps of Galileo: A Teacher Training Program,” designed primarily for in-service teachers; c) an expanded "Astronomy from the Ground Up” program in IYA to bring astronomy into smaller museums and nature centers; and d) "The Cosmic Clearing-House,” an online educational resource for the best astronomy outreach resources and activities. The overarching goal for these programs is to bring together scientists, educators, and amateurs astronomers to improve science education and literacy through astronomy. The Society welcomes additional partners who seek to cooperate on IYA programs or work with the networks of formal and informal educators and amateur astronomers the ASP continues to support.

The burden of healthcare-associated Clostridium difficile infection in a non-metropolitan setting.

PubMed

Bond, S E; Boutlis, C S; Yeo, W W; Pratt, W A B; Orr, M E; Miyakis, S

2017-04-01

Healthcare-associated Clostridium difficile infection (HCA-CDI) remains a major cause of morbidity and mortality in industrialized countries. However, few data exist on the burden of HCA-CDI in multi-site non-metropolitan settings. This study examined the introduction of an antimicrobial stewardship programme (ASP) in relation to HCA-CDI rates, and the effect of HCA-CDI on length of stay (LOS) and hospital costs. A comparative before-and-after intervention study of patients aged ≥16 years with HCA-CDI from December 2010 to April 2016 across the nine hospitals of a non-metropolitan health district in New South Wales, Australia was undertaken. The intervention comprised a multi-site ASP supported by a clinical decision support system, with subsequent introduction of email feedback of HCA-CDI cases to admitting medical officers. HCA-CDI rates, comparative LOS and hospital costs, prior use of antimicrobials and proton pump inhibitors, and appropriateness of CDI treatment. HCA-CDI rates rose from 3.07 to 4.60 cases per 10,000 occupied bed-days pre-intervention, and remained stable at 4 cases per 10,000 occupied bed-days post-intervention (P=0.24). Median LOS (17 vs six days; P<0.01) and hospital costs (AU$19,222 vs $7861; P<0.01) were significantly greater for HCA-CDI cases (N=91) than for matched controls (N=172). Half of the patients with severe HCA-CDI (4/8) did not receive initial appropriate treatment (oral vancomycin). HCA-CDI placed a significant burden on the regional and rural health service through increased LOS and hospital costs. Interventions targeting HCA-CDI could be employed to consolidate the effects of ASPs. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

F Reactor Inspection

ScienceCinema

Grindstaff, Keith; Hathaway, Boyd; Wilson, Mike

2018-01-16

Workers from Mission Support Alliance, LLC., removed the welds around the steel door of the F Reactor before stepping inside the reactor to complete its periodic inspection. This is the first time the Department of Energy (DOE) has had the reactor open since 2008. The F Reactor is one of nine reactors along the Columbia River at the Department's Hanford Site in southeastern Washington State, where environmental cleanup has been ongoing since 1989. As part of the Tri-Party Agreement, the Department completes surveillance and maintenance activities of cocooned reactors periodically to evaluate the structural integrity of the safe storage enclosure and to ensure confinement of any remaining hazardous materials. "This entry marks a transition of sorts because the Hanford Long-Term Stewardship Program, for the first time, was responsible for conducting the entry and surveillance and maintenance activities," said Keith Grindstaff, Energy Department Long-Term Stewardship Program Manager. "As the River Corridor cleanup work is completed and transitioned to long-term stewardship, our program will manage any on-going requirements."

F Reactor Inspection

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

Grindstaff, Keith; Hathaway, Boyd; Wilson, Mike

2014-10-29

Workers from Mission Support Alliance, LLC., removed the welds around the steel door of the F Reactor before stepping inside the reactor to complete its periodic inspection. This is the first time the Department of Energy (DOE) has had the reactor open since 2008. The F Reactor is one of nine reactors along the Columbia River at the Department's Hanford Site in southeastern Washington State, where environmental cleanup has been ongoing since 1989. As part of the Tri-Party Agreement, the Department completes surveillance and maintenance activities of cocooned reactors periodically to evaluate the structural integrity of the safe storage enclosuremore » and to ensure confinement of any remaining hazardous materials. "This entry marks a transition of sorts because the Hanford Long-Term Stewardship Program, for the first time, was responsible for conducting the entry and surveillance and maintenance activities," said Keith Grindstaff, Energy Department Long-Term Stewardship Program Manager. "As the River Corridor cleanup work is completed and transitioned to long-term stewardship, our program will manage any on-going requirements."« less

Physical and Social-Motivational Contextual Correlates of Youth Physical Activity in Underresourced Afterschool Programs

ERIC Educational Resources Information Center

Zarrett, Nicole; Sorensen, Carl; Cook, Brittany Skiles

2015-01-01

Afterschool programs (ASPs) have become increasingly recognized as a key context to support youth daily physical activity (PA) accrual. The purpose of the present study was to assess the physical and social-motivational climate characteristics of ASPs associated with youth PA, and variations in contextual correlates of PA by youth sex. Systematic…

Making Healthy Eating and Physical Activity Policy Practice: Process Evaluation of a Group Randomized Controlled Intervention in Afterschool Programs

ERIC Educational Resources Information Center

Weaver, R. Glenn; Beets, Michael W.; Hutto, Brent; Saunders, Ruth P.; Moore, Justin B.; Turner-McGrievy, Gabrielle; Huberty, Jennifer L.; Ward, Dianne S.; Pate, Russell R.; Beighle, Aaron; Freedman, Darcy

2015-01-01

This study describes the link between level of implementation and outcomes from an intervention to increase afterschool programs' (ASPs) achievement of healthy eating and physical activity (HE-PA) Standards. Ten intervention ASPs implemented the Strategies-To-Enhance-Practice (STEPs), a multi-component, adaptive intervention framework identifying…

Development of a Portfolio Management Approach with Case Study of the NASA Airspace Systems Program

NASA Technical Reports Server (NTRS)

Neitzke, Kurt W.; Hartman, Christopher L.

2012-01-01

A portfolio management approach was developed for the National Aeronautics and Space Administration s (NASA s) Airspace Systems Program (ASP). The purpose was to help inform ASP leadership regarding future investment decisions related to its existing portfolio of advanced technology concepts and capabilities (C/Cs) currently under development and to potentially identify new opportunities. The portfolio management approach is general in form and is extensible to other advanced technology development programs. It focuses on individual C/Cs and consists of three parts: 1) concept of operations (con-ops) development, 2) safety impact assessment, and 3) benefit-cost-risk (B-C-R) assessment. The first two parts are recommendations to ASP leaders and will be discussed only briefly, while the B-C-R part relates to the development of an assessment capability and will be discussed in greater detail. The B-C-R assessment capability enables estimation of the relative value of each C/C as compared with all other C/Cs in the ASP portfolio. Value is expressed in terms of a composite weighted utility function (WUF) rating, based on estimated benefits, costs, and risks. Benefit utility is estimated relative to achieving key NAS performance objectives, which are outlined in the ASP Strategic Plan.1 Risk utility focuses on C/C development and implementation risk, while cost utility focuses on the development and implementation portions of overall C/C life-cycle costs. Initial composite ratings of the ASP C/Cs were successfully generated; however, the limited availability of B-C-R information, which is used as inputs to the WUF model, reduced the meaningfulness of these initial investment ratings. Development of this approach, however, defined specific information-generation requirements for ASP C/C developers that will increase the meaningfulness of future B-C-R ratings.

Making Healthy Eating and Physical Activity Policy Practice: The Design and Overview of a Group Randomized Controlled Trial in Afterschool Programs

PubMed Central

Beets, Michael W.; Weaver, R. Glenn; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S.; Freedman, Darcy A.; Saunders, Ruth; Pate, Russell R.; Beighle, Aaron; Moore, Justin B.

2014-01-01

National and state organizations have developed policies calling upon afterschool programs (ASPs, 3-6pm) to serve a fruit or vegetable (FV) each day for snack, while eliminating foods and beverages high in added-sugars, and to ensure children accumulate a minimum of 30 min/d of moderate-to-vigorous physical activity (MVPA). Few efficacious and cost-effective strategies exist to assist ASP providers in achieving these important public health goals. This paper reports on the design and conceptual framework of Making Healthy Eating and Physical Activity (HEPA) Policy Practice in ASPs, a 3-year group randomized controlled trial testing the effectiveness of strategies designed to improve snacks served and increase MVPA in children attending community-based ASPs. Twenty ASPs, serving over 1,800 children (6-12yrs) will be enrolled and match-paired based on enrollment size, average daily min/d MVPA, and days/week FV served, with ASPs randomized after baseline data collection to immediate intervention or a 1-year delayed group. The framework employed, STEPs (Strategies To Enhance Practice), focuses on intentional programming of HEPA in each ASPs’ daily schedule, and includes a grocery store partnership to reduce price barriers to purchasing FV, professional development training to promote physical activity to develop core physical activity competencies, as well as ongoing technical support/assistance. Primary outcome measures include children’s accelerometry-derived MVPA and time spend sedentary while attending an ASP, direct observation of staff HEPA promoting and inhibiting behaviors, types of snacks served, and child consumption of snacks, as well as, cost of snacks via receipts and detailed accounting of intervention delivery costs to estimate cost-effectiveness. PMID:24893225

Ecological Forecasting Project Management with Examples

NASA Technical Reports Server (NTRS)

Skiles, J. W.; Schmidt, Cindy; Estes, Maury; Turner, Woody

2017-01-01

Once scientists publish results of their projects and studies, all too often they end up on the shelf and are not otherwise used. The NASA Earth Science Division established its Applied Sciences Program (ASP) to apply research findings to help solve and manage real-world problems and needs. ASP-funded projects generally produce decision support systems for operational applications which are expected to last beyond the end of the NASA funding. Because of NASAs unique perspective of looking down on the Earth from space, ASP studies involve the use of remotely sensed information consisting of satellite data and imagery as well as information from sub-orbital platforms. ASP regularly solicits Earth science proposals that address one or more focus areas; disasters mitigation, ecological forecasting, health and air quality, and water resources. Reporting requirements for ASP-funded projects are different from those typical for research grants from NASA and other granting agencies, requiring management approaches different from other programs. This presentation will address the foregoing in some detail and give examples of three ASP-funded ecological forecasting projects that include: 1) the detection and survey of chimpanzee habitat in Africa from space, 2) harmful algal blooms (HABs) in the California Current System affecting aquaculture facilities and marine mammal populations, and 3) a call for the public to identify North America wildlife in Wisconsin using trail camera photos. Contact information to propose to ASP solicitations for those PIs interested is also provided.

Salty or Sweet? Nutritional quality, consumption, and cost of snacks served in afterschool programs

PubMed Central

Beets, Michael W.; Weaver, R. Glenn; Tilley, Falon; Turner-McGrievy, Brie; Huberty, Jennifer; Ward, Dianne S.; Freedman, Darcy A.

2015-01-01

BACKGROUND Snacks served in afterschool programs (ASPs, 3–6pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially-flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks meet existing nutrition policies, whether children eat the snacks, and their cost. METHODS Direct observation of snacks served and consumed was collected in 20 ASPs serving over 1,700 elementary-age children. The number of days snacks were served/week was evaluated for compliance with nutrition policies. Costs of snacks were collected via receipts. RESULTS Programs served desserts and artificially-flavored salty-snacks on 2.7 and 2.1 days/week. Fruits and vegetables were served 0.6 and 0.1 days/wk, respectively. Sugar-sweetened-beverages were served 1.8 days/wk. Of the children (N=383) observed, 75–100% consumed the snack served, with 95% and 100% of served fruits/vegetables consumed. No ASP served fruit/vegetables daily, 18 served sugar-sweetened foods, 16 served artificially-flavored snacks, and 14 served sugar-sweetened-beverages. Desserts and salty-snacks cost $0.27–$0.32/snack vs. $0.38–$0.40/snack for vegetables/fruits. CONCLUSIONS The quality of snacks failed to meet nutrition policies and consists of predominately high-sugar and artificially-flavored options. Strategies to improve snack offerings in ASPs while addressing price barriers are required. PMID:25564980

Salty or sweet? Nutritional quality, consumption, and cost of snacks served in afterschool programs.

PubMed

Beets, Michael W; Weaver, Robert G; Tilley, Falon; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S; Freedman, Darcy A

2015-02-01

Snacks served in afterschool programs (ASPs, 3-6 pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks meet existing nutrition policies, whether children eat the snacks, and their cost. Direct observation of snacks served and consumed was collected in 20 ASPs serving over 1700 elementary age children. The number of days that snacks were served/week was evaluated for compliance with nutrition policies. Costs of snacks were collected via receipts. Programs served desserts and artificially flavored salty snacks on 2.7 and 2.1 days/week. Fruits and vegetables were served 0.6 and 0.1 days/week, respectively. Sugar-sweetened beverages were served 1.8 days/week. Of the children (N = 383) observed, 75% to 100% consumed the snack served, with 95% and 100% of served fruits/vegetables consumed. No ASP served fruit/vegetables daily, 18 served sugar-sweetened foods, 16 served artificially flavored snacks, and 14 served sugar-sweetened beverages. Desserts and salty snacks cost $0.27-$0.32/snack vs $0.38-$0.40/snack for vegetables/fruits. The quality of snacks failed to meet nutrition policies and consists of predominately high-sugar and artificially flavored options. Strategies to improve snack offerings in ASPs while addressing price barriers are required. © 2015, American School Health Association.

4-H and Forestry Afterschool Clubs: A Collaboration to Foster Stewardship Attitudes and Behaviors in Youth

ERIC Educational Resources Information Center

Gupta, Angela S.; Grant, Samantha; Strauss, Andrea Lorek

2012-01-01

The University of Minnesota Extension's 4-H and Forestry Afterschool program combined the 4-H structure and various forestry curricula to foster positive attitudes towards the environment and stewardship-related behaviors as these may serve as precursors to later choices that benefit the environment. Evaluation of third through fifth grade club…

Environmental stewardship footprint research: linking human agency and ecosystem health in the Puget Sound region

Treesearch

Kathleen L. Wolf; Dale J. Blahna; Weston Brinkley; Michele Romolini

2013-01-01

Urbanization processes challenge ecosystem health in many metropolitan areas. New policy and program approaches are needed to restore and sustain natural systems as public agencies and organizations face greater demands and declining budgets. Environmental stewardship is an often overlooked intervention strategy, and the full potential of civic engagement by citizens...

Organizational ethics in Catholic health care: honoring stewardship and the work environment.

PubMed

Magill, G

2001-04-01

Organizational ethics refers to the integration of values into decision making, policies, and behavior throughout the multi-disciplinary environment of a health care organization. Based upon Catholic social ethics, stewardship is at the heart of organizational ethics in health care in this sense: stewardship provides the hermeneutic filter that enables basic ethical principles to be realized practically, within the context of the Catholic theology of work, to concerns in health care. This general argument can shed light on the specific topic of non-executive compensation programs as an illustration of organizational ethics in health care.

Mapping educational opportunities for healthcare workers on antimicrobial resistance and stewardship around the world.

PubMed

Rogers Van Katwyk, Susan; Jones, Sara L; Hoffman, Steven J

2018-02-05

Antimicrobial resistance is an important global issue facing society. Healthcare workers need to be engaged in solving this problem, as advocates for rational antimicrobial use, stewards of sustainable effectiveness, and educators of their patients. To fulfill this role, healthcare workers need access to training and educational resources on antimicrobial resistance. To better understand the resources available to healthcare workers, we undertook a global environmental scan of educational programs and resources targeting healthcare workers on the topic of antimicrobial resistance and antimicrobial stewardship. Programs were identified through contact with key experts, web searching, and academic literature searching. We summarized programs in tabular form, including participating organizations, region, and intended audience. We developed a coding system to classify programs by program type and participating organization type, assigning multiple codes as necessary and creating summary charts for program types, organization types, and intended audience to illustrate the breadth of available resources. We identified 94 educational initiatives related to antimicrobial resistance and antimicrobial stewardship, which represent a diverse array of programs including courses, workshops, conferences, guidelines, public outreach materials, and online-resource websites. These resources were developed by a combination of government bodies, professional societies, universities, non-profit and community organizations, hospitals and healthcare centers, and insurance companies and industry. Most programs either targeted healthcare workers collectively or specifically targeted physicians. A smaller number of programs were aimed at other healthcare worker groups including pharmacists, nurses, midwives, and healthcare students. Our environmental scan shows that there are many organizations working to develop and share educational resources for healthcare workers on antimicrobial resistance and antimicrobial stewardship. Governments, hospitals, and professional societies appear to be driving action on this front, sometimes working with other types of organizations. A broad range of resources have been made freely available; however, we have noted several opportunities for action, including increased engagement with students, improvements to pre-service education, recognition of antimicrobial resistance courses as continuing medical education, and better platforms for resource-sharing online.

Nature connection, outdoor play, and environmental stewardship in residential environmental education

NASA Astrophysics Data System (ADS)

Andrejewski, Robert G.

A lack of exposure to the natural world has led to a generation of children disconnected from nature. This phenomenon has profound negative implications for the physical and psychological well being of today's youth. Residential environmental education provides one avenue to connect children to nature. One purpose of this study was to investigate the role of Outdoor School, a residential environmental education program, on ecological knowledge, children's connection to nature, school belonging, outdoor play attitude, environmental stewardship attitude, outdoor play behavior, and environmental stewardship behavior, as reported by participants. A quasi-experimental research design was utilized in the study. A total of 228 fifth grade students (156 treatment, 72 control) from central Pennsylvania participated. The results of the program evaluation indicated that Outdoor School was successful in achieving significant, positive gains in the areas of ecological knowledge, connection to nature, outdoor play behavior, and environmental stewardship behavior. No change was found from pretest to post-test in outdoor play attitudes, environmental stewardship attitudes, and school belonging. Additionally, the study addressed gaps in the literature regarding the relationship between connection to nature, environmental stewardship, and outdoor play using two different approaches. An adaptation of the Theory of Planned Behavior (TPB) was used to predict outdoor play behavior in children. In this model, favorable attitudes, subjective norms, and perceived behavioral control lead to intentions to perform a given behavior. Intention to perform the behavior is the best predictor for behavior performance. For this study, participants' feeling of connection to nature was added as an affective independent variable. This model explained 45% of the variance in outdoor play. The hypothesis that a connection to nature would be a significant predictor of both attitudes toward outdoor play was supported by testing of the model. Finally, nature connection was tested as a full mediator of the relationship between outdoor play and environmental stewardship. There is support for the idea that direct experience in the outdoors facilitates environmental behaviors, but more research is needed to understand this relationship. Testing of the model failed to demonstrate that nature connection fully mediated the relationship between outdoor play and environmental stewardship; however, a feeling of connectedness to nature augmented the influence that outdoor play behavior exerts on environmental stewardship behavior.

Remote Antimicrobial Stewardship in Community Hospitals

PubMed Central

Wood, Zachary H.; Nicolsen, Nicole C.; Allen, Nichole; Cook, Paul P.

2015-01-01

Antimicrobial stewardship has become standard practice at university medical centers, but the practice is more difficult to implement in remote community hospitals that lack infectious diseases trained practitioners. Starting in 2011, six community hospitals within the Vidant Health system began an antimicrobial stewardship program utilizing pharmacists who reviewed charts remotely from Vidant Medical Center. Pharmacists made recommendations within the electronic medical record (EMR) to streamline, discontinue, or switch antimicrobial agents. Totals of charts reviewed, recommendations made, recommendations accepted, and categories of intervention were recorded. Linear regression was utilized to measure changes in antimicrobial use over time. For the four larger hospitals, recommendations for changes were made in an average of 45 charts per month per hospital and physician acceptance of the pharmacists’ recommendations varied between 83% and 88%. There was no significant decrease in total antimicrobial use, but much of the use was outside of the stewardship program’s review. Quinolone use decreased by more than 50% in two of the four larger hospitals. Remote antimicrobial stewardship utilizing an EMR is feasible in community hospitals and is generally received favorably by physicians. As more community hospitals adopt EMRs, there is an opportunity to expand antimicrobial stewardship beyond the academic medical center. PMID:27025642

Promoting Physical Activity within Under-Resourced Afterschool Programs: A Qualitative Investigation of Staff Experiences and Motivational Strategies for Engaging Youth

ERIC Educational Resources Information Center

Zarrett, Nicole; Abraczinskas, Michelle; Skiles Cook, Brittany; Wilson, Dawn K.; Ragaban, Faten

2018-01-01

Afterschool programs (ASPs) have become increasingly recognized as a key context to support youth daily physical activity (PA) accrual. Using Self-Determination Theory (SDT) as a framework, this study examined staff perspectives on the strengths and barriers within under-resourced ASPs for establishing a social-motivational climate for encouraging…

Education and Public Outreach in the International Year of Astronomy at the Astronomical Society of the Pacific

NASA Astrophysics Data System (ADS)

Gibbs, M. G.; Manning, J. G.; Gurton, S.; Fraknoi, A.; Berendsen, M.; Hurst, A.; White, V.

2008-11-01

At the forefront of sharing the excitement of our exploration of the universe for 120 years, the Astronomical Society of the Pacific (ASP) is poised to use its networks and services to implement education and outreach programs for the 2009 International Year of Astronomy (IYA). The ASP is working with the National Aeronautics and Space Administration (NASA), the American Astronomical Society (AAS), National Optical Astronomy Observatory (NOAO), Association of Science---Technology Centers (ASTC), and several other astronomical and educational organizations on IYA projects. The ASP will develop and implement four key signature programs, pending funding, for the IYA: a) IYA 2009 Cosmic Companion, with astronomy activities primarily for amateur astronomy clubs; b) Galileo Teacher Training Program, designed primarily for in-service teachers; c) Expanding the Informal Universe, to bring astronomy into smaller museums and nature centers; and d) Cosmic Clearing-House, an online educational resource for the best astronomy outreach resources and activities. The overarching goal for these programs is to bring together scientists, educators, and amateurs astronomers to improve science education and literacy through astronomy. The Society welcomes additional partners who seek to cooperate on IYA programs or work with the networks of formal and informal educators and amateur astronomers the ASP continues to support.

75 FR 31609 - Conservation Stewardship Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

...Section 2301 of the Food, Conservation, and Energy Act of 2008 (2008 Act) amended the Food Security Act of 1985 to establish the Conservation Stewardship Program (CSP). On July 29, 2009, the Natural Resources Conservation Service (NRCS) published an interim final rule for CSP with a 60-day public comment period. On September 21, 2009, the public comment period was extended 30 days. NRCS is publishing a final rule that addresses the comments received on the interim final rule and makes other minor adjustments to improve clarity of the rule.

Informing rangeland stewardship with research: lessons learned from Yolo County, California

Treesearch

Vance Russell; Chris Rose; Miles DaPrato

2008-01-01

Approximately 70 percent of the contiguous United States is in private lands with half of this total in row crop or rangelands. Audubon California’s Landowner Stewardship Program engages with farmers and ranchers on conservation and restoration projects in a manner compatible with existing agricultural operations. To assess the success of these efforts, Audubon,...

76 FR 19683 - Conservation Program Recipient Reporting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

... regulation that has application or plan due dates after October 1, 2010. The Watershed Operations and Flood Prevention Program, Emergency Watersheds Protection Program, Healthy Forests Reserve Program, Agricultural Management Assistance Program, and the Conservation Stewardship Program have application or plan due dates...

Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry.

PubMed

Berrevoets, Marvin Ah; Ten Oever, Jaap; Sprong, Tom; van Hest, Reinier M; Groothuis, Ingeborg; van Heijl, Inger; Schouten, Jeroen A; Hulscher, Marlies E; Kullberg, Bart-Jan

2017-08-15

The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry. We performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015 RESULTS: All hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting. Five out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial stewardship programs in hospitals.

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

Improving Wellbeing and Environmental Stewardship Through Volunteering in Nature.

PubMed

Molsher, Robyn; Townsend, Mardie

2016-03-01

Environmental volunteering (EV) can provide a unique way to optimise the wellbeing of participants while fostering environmental stewardship. However, the potential of EV to create human health benefits remains an under-researched area. This study provides evidence for improved wellbeing and mood state for 32 participants from diverse backgrounds undertaking EV activities. Most participants also reported improved environmental stewardship with a greatly improved understanding of the environment and the need to conserve it. Other benefits included: 31% of those seeking work obtained it; and 50% joined a volunteer group at program completion. EV provides a unique mechanism to enhance the wellbeing of the participants, while conserving the environment.

Arizona's Application Service Provider.

ERIC Educational Resources Information Center

Jordan, Darla

2002-01-01

Describes the U.S.'s first statewide K-12 application service provider (ASP). The ASP, implemented by the Arizona School Facilities Board, provides access to productivity, communications, and education software programs from any Internet-enabled device, whether in the classroom or home. (EV)

Fact Sheet: 2010/2015 PFOA Stewardship Program

EPA Pesticide Factsheets

EPA's existing chemicals programs address pollution prevention, risk assessment, hazard and exposure assessment and/or characterization, and risk management for chemicals substances in commercial use.

A national survey of pediatric dentists on antibiotic use in children.

PubMed

Sivaraman, Sujatha S; Hassan, Mohamed; Pearson, Julie M

2013-01-01

The purposes of this study were to: (1) examine the antibiotic prescribing practices of pediatric dentists and adherence to professional guidelines; and (2) assess their knowledge of and attitudes toward antibiotic resistance. A cross-sectional survey regarding antibiotic use, resistance, and knowledge of antibiotic stewardship programs was emailed to 4,636 members of the American Academy of Pediatric Dentistry (AAPD). 987 surveys (21 percent) were completed; 984 were analyzed. Lack of adherence to AAPD antibiotic guidelines was noted. There was a trend toward overuse of antibiotics for the following conditions: irreversible pulpitis with (32 percent) and without vital pulp (42 percent); localized dentoalveolar abscess with (68 percent) and without draining fistula (39 percent); mitral valve relapse with regurgitation (43 percent); intrusion (15 percent); extrusion (13 percent); and rheumatoid arthritis (12 percent). Determinants of antibiotic use were: facial swelling (88 percent); pain relief (15 percent); unavailable appointment for several weeks (six percent); and parental satisfaction (four percent). Although 98 percent of respondents believed that antibiotic resistance is of growing concern, only 15 percent were aware of antibiotic stewardship programs. AAPD members overprescribe antibiotics. Educational programs to increase knowledge of antibiotic resistance and stewardship programs should be implemented to increase adherence to professional guidelines.

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

PubMed Central

Philmon, Carla L.; Johnson, Gregory D.; Ward, William S.; Rivers, LaToya L.; Williamson, Sharon A.; Goodman, Edward L.

2014-01-01

Background: Antibiotic stewardship has been proposed as an important way to reduce or prevent antibiotic resistance. In 2001, a community hospital implemented an antimicrobial management program. It was successful in reducing antimicrobial utilization and expenditure. In 2011, with the implementation of a data-mining tool, the program was expanded and its focus transitioned from control of antimicrobial use to guiding judicious antimicrobial prescribing. Objective: To test the hypothesis that adding a data-mining tool to an existing antimicrobial stewardship program will further increase appropriate use of antimicrobials. Design: Interventional study with historical comparison. Methods: Rules and alerts were built into the data-mining tool to aid in identifying inappropriate antibiotic utilization. Decentralized pharmacists acted on alerts for intravenous (IV) to oral conversion, perioperative antibiotic duration, and restricted antimicrobials. An Infectious Diseases (ID) Pharmacist and ID Physician/Hospital Epidemiologist focused on all other identified alert types such as antibiotic de-escalation, bug-drug mismatch, and double coverage. Electronic chart notes and phone calls to physicians were utilized to make recommendations. Results: During 2012, 2,003 antimicrobial interventions were made with a 90% acceptance rate. Targeted broad-spectrum antimicrobial use decreased by 15% in 2012 compared to 2010, which represented cost savings of $1,621,730. There were no statistically significant changes in antimicrobial resistance, and no adverse patient outcomes were noted. Conclusions: The addition of a data-mining tool to an antimicrobial stewardship program can further decrease inappropriate use of antimicrobials, provide a greater reduction in overall antimicrobial use, and provide increased cost savings without negatively affecting patient outcomes. PMID:25477615

Toward Better Pain Management: The Development of a "Pain Stewardship Program" in a Tertiary Children's Hospital.

PubMed

Brenn, B Randall; Choudhry, Dinesh K; Sacks, Karen; Como-Fluehr, Sandra; Strain, Robert

2016-09-01

Despite increased focus on pediatric pain, uncontrolled pain is still a problem for hospitalized pediatric inpatients. A program was designed to find patients with uncontrolled pain and develop a framework to oversee their pain management. This report details the development of a pain stewardship program with data from the first year of its activity. Hospitalized inpatients in a tertiary care pediatric center in the mid-Atlantic region were included in the study. Pain scores are recorded every 4 hours in the hospital electronic health record. A report was constructed to find all patients with an average pain score ≥7 in the preceding 12 hours. The charts of these patients were reviewed by our anesthesia pain service, and all patients were grouped into 1 of the following action categories: (1) no action required; (2) telephone call to the patient's attending physician; (3) one-time consultation; (4) consultation with ongoing management; or (5) patient was already on the anesthesia pain service. Demographic data, pain regimens, and outcomes were recorded in a prospectively collected database. There were 843 records on 441 unique patients. Only 22% required action to be taken by the anesthesia pain service. The pain stewardship database revealed that patients with sickle cell disease or abdominal pain required more frequent attention. An electronic health record-based pain stewardship program is an important step in identifying all children in the hospital with undermanaged pain, and it provides a warning system that may improve patient care, outcomes, and satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

A human-centered framework for innovation in conservation incentive programs.

PubMed

Sorice, Michael G; Donlan, C Josh

2015-12-01

The promise of environmental conservation incentive programs that provide direct payments in exchange for conservation outcomes is that they enhance the value of engaging in stewardship behaviors. An insidious but important concern is that a narrow focus on optimizing payment levels can ultimately suppress program participation and subvert participants' internal motivation to engage in long-term conservation behaviors. Increasing participation and engendering stewardship can be achieved by recognizing that participation is not simply a function of the payment; it is a function of the overall structure and administration of the program. Key to creating innovative and more sustainable programs is fitting them within the existing needs and values of target participants. By focusing on empathy for participants, co-designing program approaches, and learning from the rapid prototyping of program concepts, a human-centered approach to conservation incentive program design enhances the propensity for discovery of novel and innovative solutions to pressing conservation issues.

Evaluation of a statewide dissemination and implementation of physical activity intervention in afterschool programs: a nonrandomized trial.

PubMed

Beets, Michael W; Glenn Weaver, R; Turner-McGrievy, Gabrielle; Saunders, Ruth P; Webster, Collin A; Moore, Justin B; Brazendale, Keith; Chandler, Jessica

2017-12-01

In 2015, YMCA-operated afterschool programs (ASPs) across South Carolina pledged to achieve the national standard that calls for every child to accumulate 30 min/day of moderate-to-vigorous physical activity (MVPA) during program time. This study shares the first-year findings related to the dissemination, implementation, and outcomes associated with the statewide intervention to achieve the MVPA Standard. Twenty ASPs were sampled from all YMCA-operated ASPs (N = 97) and visited at baseline (spring 2015) and first-year follow-up (spring 2016). Programs were provided standardized professional development training to increase the MVPA children accumulated while attending ASPs. The training focused on extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Implementation was evaluated via direct observation. Intent-to-treat (ITT) and as-treated comparisons were conducted in summer 2016. Reach/adoption was variable, with attendance at trainings ranging from 0 to 100% across ASPs. Effectiveness of the intervention using ITT models indicated no changes from baseline in the percentage of programs meeting the MVPA standard for boys or girls. Implementation levels also varied and were related to increases in both boys' and girls' MVPA for moderate and high implementers. Findings indicate improvements in MVPA can be made from attending the trainings and implementing some or all of the training components. Additional work is necessary to identify ways to ensure staff attend trainings to implement strategies and to identify which specific factors contributed to increases in MVPA.

Listening to your audience: developing an educational tool to assist with recreation planning on private lands

Treesearch

J. Daniel van Dijk; Gary T. Green; Craig A. Miller

2009-01-01

The Georgia Forestry Commission in conjunction with the U.S. Forest Service instituted the Forest Stewardship Program (FSP) in 1991. A growing component of the FSP is recreation, which is the component least understood by stewardship planners. A survey was developed to better understand the needs of planners with regard to developing forest recreation plans, and the...

Framework for Springs Stewardship Program and proposed action development: Spring Mountains National Recreation Area, Humboldt-Toiyabe National Forest

Treesearch

Marc Coles-Ritchie; Stephen J. Solem; Abraham E. Springer; Burton Pendleton

2014-01-01

In the desert Southwest, springs are an important ecological feature and serve as a focal point for both biological and human interactions on the landscape. As a result, attention has been placed on the stewardship and protection of these important resources. Management has traditionally focused on the more accessible and heavily used eastern canyons within the Spring...

ASP Celebrates IYA, One Month at a Time

NASA Astrophysics Data System (ADS)

Gurton, Suzanne; Berendsen, M.; Hurst, A.; White, V.

2008-05-01

Serving three major networks of educators, the ASP, in coordination with NASA and NOAO and others, is building a comprehensive program to celebrate the International Year of Astronomy (IYA) by featuring a different astronomy theme during each month of 2009. We will provide a rich array of themed resources, such as activities, tele-conferences, and news stories, to the variety of educators served by the ASP: amateur astronomers, museum educators and teachers. This poster will present our program of monthly themes, along with associated services and resources, to support the diverse public outreach efforts of the members of the NASA Night Sky Network, participants in Astronomy From the Ground Up, and Project ASTRO partners.

Data governance and stewardship: designing data stewardship entities and advancing data access.

PubMed

Rosenbaum, Sara

2010-10-01

U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information-an inevitable step in an information age-is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research. © Health Research and Educational Trust.

Data Governance and Stewardship: Designing Data Stewardship Entities and Advancing Data Access

PubMed Central

Rosenbaum, Sara

2010-01-01

U.S. health policy is engaged in a struggle over access to health information, in particular, the conditions under which information should be accessible for research when appropriate privacy protections and security safeguards are in place. The expanded use of health information—an inevitable step in an information age—is widely considered be essential to health system reform. Models exist for the creation of data-sharing arrangements that promote proper use of information in a safe and secure environment and with attention to ethical standards. Data stewardship is a concept with deep roots in the science and practice of data collection, sharing, and analysis. Reflecting the values of fair information practice, data stewardship denotes an approach to the management of data, particularly data that can identify individuals. The concept of a data steward is intended to convey a fiduciary (or trust) level of responsibility toward the data. Data governance is the process by which responsibilities of stewardship are conceptualized and carried out. As the concept of health information data stewardship advances in a technology-enabled environment, the question is whether legal barriers to data access and use will begin to give way. One possible answer may lie in defining the public interest in certain data uses, tying provider participation in federal health programs to the release of all-payer data to recognized data stewardship entities for aggregation and management, and enabling such entities to foster and enable the creation of knowledge through research. PMID:21054365

Effects of After-School Programs on Attendance and Externalizing Behaviors with Primary and Secondary School Students: A Systematic Review and Meta-Analysis

ERIC Educational Resources Information Center

Maynard, Brandy R.; Kremer, Kristen P.; Polanin, Joshua R.; Vaughn, Michael G.; Sarteschi, Christine M.

2015-01-01

Over the past two decades, the number and types of after-school programs (ASPs) have increased substantially as a result of increased federal and private spending and because ASPs are perceived to provide wide-ranging and far-reaching benefits to students, families, schools and the public. The purpose of this systematic review and meta-analysis is…

From policy to practice: strategies to meet physical activity standards in YMCA afterschool programs.

PubMed

Beets, Michael W; Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Gabriel; Pate, Russell R; Webster, Collin; Beighle, Aaron

2014-03-01

In 2011, the U.S. Young Men's Christian Association (YMCA) adopted activity standards recommending that afterschool programs (ASPs) ensure all children engage in a minimum of 30 minutes of moderate to vigorous physical activity (MVPA) daily during the ASP. ASPs decide how to accomplish this standard, for which few effective strategies exist. To evaluate strategies designed to help ASPs meet the MVPA standard. Single group intervention with pretest and three follow-up measures repeated-cross-sectional design with a subsample cohort. Four large-scale YMCA ASPs, serving approximately 500 children each day. Community-based participatory development of strategies focused on modification of program schedules, professional development training, and weekly checklists to evaluate activity opportunities. Accelerometry-derived MVPA classified as meet or fail-to-meet the 30 minutes' MVPA/day standard collected over a minimum of 4 nonconsecutive days at baseline (fall 2011) and three follow-up assessments (spring 2012, fall 2012, spring 2013). Random intercept logistic regression models evaluated the probability of meeting the standard for boys and girls, separately (analyzed summer 2013). A total of 895 children (aged 5-12 years, 48.4% girls) representing 3654 daily measures were collected across the four assessments. The percentage of girls and boys meeting the MVPA standard at baseline was 13.3% and 28.0%, respectively. By spring 2013, this increased to 29.3% and 49.6%. These changes represented an increase in the odds of meeting the 30 minutes' MVPA/day standard by 1.5 (95% CI=1.1, 2.0) and 2.4 (95% CI=1.2, 4.8) for girls and boys, respectively. The strategies developed herein represent an effective approach to enhancing current practice within YMCA ASPs to achieve existing MVPA standards. Additional work is necessary to evaluate the scalability of the strategies in a larger sample of ASPs. © 2014 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

Associations between antimicrobial stewardship program elements and Clostridium difficile infection performance.

PubMed

Barlow, Giulia; Patterson, Julie; Stultz, Jeremy; Pakyz, Amy L

2017-12-01

Hospitals are categorized as better, no different, or worse at a national level based on their Clostridium difficile infection performance. Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown. We found that a higher proportion of hospitals with either a worse or no different rank used a postprescription audit and feedback strategy than hospitals with a better rank. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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

Garland, Sid; Brown, Sally; Sims, Lynn

Long-term stewardship is the set of activities necessary to return contaminated land to safe and beneficial use. The activities include physical and legal controls to prevent inappropriate exposure to contamination left in place at a site. It is the longest phase of the Department of Energy's Environmental Management Program and ensures the protection of human health and the environment for varied end uses. At the Department of Energy's Oak Ridge Reservation an automated program has been developed and implemented that tracks the multitude of long-term stewardship activities. The Oak Ridge Reservation is a large site that currently has over 50more » actions requiring long-term stewardship activities. The Oak Ridge Reservation consists primarily of three plant sites, and long-term stewardship will enable these sites to be leased to private entities (East Tennessee Technology Park), modernized for an evolving national security mission (Y-12 National Security Complex), and revitalized to continue multi-disciplinary research (Oak Ridge National Laboratory). The varied site end uses of the individual plant sites coupled with the multitude of controls required by leaving waste in place presents challenges. A single remedial action may include surveillance and maintenance activities, media monitoring, property record notices as well as physical controls such as fences and signs. Thus, the array of long-term stewardship activities is complex and intermingled (over 200 inspections each year at various frequencies are required currently) and requires an effective tracking program, termed the Land Use Manager. The Land Use Manager is a web-based data management application for use by personnel responsible for implementing, maintaining, and verifying engineering and land use controls on the Oak Ridge Reservation. The program is a data entry and tracking tool, as well as a notification tool. The status and performance of engineering and land use controls are checked annually for evaluation in the required Remediation Effectiveness Report, and the automated Land Use Manager collects, maintains, tracks, notifies, monitors, and manages the information necessary to perform this evaluation. Land Use Manager tracks site information including type of contamination, regulatory requirements, locates land use controls; provides information on inspections, certification, and reporting; and provides reports. Most data access features, e.g., view, print, query, and download, are available to all users; however, data input, updating, and editing are restricted to the personnel directly responsible for monitoring and inspection. The Land Use Manager application was developed for the Department of Energy Oak Ridge Office by URS - CH2M Oak Ridge LLC, Restoration Services Incorporated, and MIJARA Corporation to meet the specific needs of long-term stewardship tracking on the Oak Ridge Reservation. The successful implementation of long-term stewardship enables the future government and private activities being planned on the Oak Ridge Reservation to proceed. (authors)« less

Examining relational empowerment for elementary school students in a yPAR program.

PubMed

Langhout, Regina Day; Collins, Charles; Ellison, Erin Rose

2014-06-01

This paper joins relational empowerment, youth empowerment, and Bridging Multiple Worlds frameworks to examine forms of relational empowerment for children in two intermediary institutions-school and a youth participatory action research after-school program (yPAR ASP). Participants were twelve children, most of whom were Latina/o and from im/migrant families, enrolled in a yPAR ASP for 2 years. A mixed-method approach was utilized; we analyzed children's interviews, self-defined goals, and their social networks to examine their experiences of relational empowerment. We conclude that children experienced each of the five relational empowerment factors-collaborative competence, bridging social divisions, facilitating others' empowerment, mobilizing networks, and passing on a legacy-in the yPAR ASP setting, and some factors in school. These experiences, however, were more pronounced in the yPAR ASP setting. Additionally, social network analyses revealed that a small but meaningful percentage of actors bridged worlds, especially home and family, but by year 2, also school and the yPAR ASP. Finally, most helpers for school-based goals came from school, but a sizable number came from family, friends, and home worlds, and by year 2, also came from the yPAR ASP. Implications range from theoretical to methodological development, including the use of social network analysis as a tool to descriptively examine relational power in context.

Making healthy eating policy practice: A group randomized controlled trial on changes in snack quality, costs, and consumption in after school programs

PubMed Central

Beets, Michael W.; Weaver, R. Glenn; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S.; Freedman, Darcy; Hutto, Brent; Moore, Justin B.; Beighle, Aaron

2017-01-01

Purpose The aim of this study was to evaluate an intervention designed to assist after school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable (FV) be served daily, and sugar-sweetened beverages/foods and artificially flavored foods eliminated. Design One-year group randomized controlled trial Setting Afterschool programs operating in South Carolina, US. Subjects Twenty ASPs serving over 1,700 children were recruited, match-paired post-baseline on enrollment size and days FV were served/week (days/wk), and randomized to either an intervention (n=10) or control (n=10) groups. Intervention Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multi-step adaptive intervention framework, which assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost. Measures Direct observation of snacks served and consumed, and monthly snack expenditures via receipts. Analysis Nonparametric and mixed-model repeated-measures Results By post-assessment, intervention ASPs increased serving FV to 3.9±2.1 vs. 0.7±1.7days/wk and decreased serving sugar-sweetened beverages to 0.1±0.7 vs. 1.8±2.4days/wk and foods to 0.3±1.1 vs. 2.7±2.5days/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01/snack decrease in the control ($0.39 to $0.38). Across both assessments and groups 80–100% of children consumed FV. Conclusions The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost. PMID:26158679

When Antimicrobial Stewardship Isn′t Watching: The Educational Impact of Critical Care Prospective Audit and Feedback

PubMed Central

Fleming, Dimitra; Ali, Karim F.; Matelski, John; D'Sa, Ryan; Powis, Jeff

2016-01-01

Prospective audit and feedback (PAF) is an effective strategy to optimize antimicrobial use in the critical care setting, yet whether skills gained during PAF influence future antimicrobial prescribing is uncertain. This multisite study demonstrates that knowledge learned during PAF is translated and incorporated into the practice of critical care physicians even when not supported by an antimicrobial stewardship program. PMID:27382599

The Gateway Paper--stewardship and governance in the health sector in Pakistan.

PubMed

Nishtar, Sania

2006-12-01

As an opening for a dialogue on health reforms in the country, the Gateway Paper places emphasis on strengthening the stewardship function of mandated State agencies in Pakistan with particular attention to two key areas. Firstly, greater emphasis on a stewardship role for the Ministry and departments of health in the context of inter-sectoral scope of health and secondly, a stronger role for the State agencies as regulators of healthcare within the country. The Gateway Paper envisages that the role of State agencies will become more critical as new models of financing health and delivering services are structured given that these entail regulation of private sector providers, providing oversight for ensuring a system for ongoing education and implementation of frameworks for public-private partnerships. The Gateway Paper refers to stewardship with reference to analysis and overview of health policies within the country, their relationship with evidence, their follow-up into planning and finally their implementation. The Paper also provides an insight into policies from a process-related as well as content and program related perspectives. In doing so a number of questions relating to the evidence and policy disconnect; issues at strategic and operational levels of planning, and governance-related impediments to program implementation have been discussed and a viewpoint articulated on an approach to addressing these challenges.

Identifying Strategies Programs Adopt to Meet Healthy Eating and Physical Activity Standards in Afterschool Programs.

PubMed

Weaver, Robert G; Moore, Justin B; Turner-McGrievy, Brie; Saunders, Ruth; Beighle, Aaron; Khan, M Mahmud; Chandler, Jessica; Brazendale, Keith; Randell, Allison; Webster, Collin; Beets, Michael W

2017-08-01

The YMCA of USA has adopted Healthy Eating and Physical Activity (HEPA) Standards for its afterschool programs (ASPs). Little is known about strategies YMCA ASPs are implementing to achieve Standards and these strategies' effectiveness. (1) Identify strategies implemented in YMCA ASPs and (2) evaluate the relationship between strategy implementation and meeting Standards. HEPA was measured via accelerometer (moderate-to-vigorous-physical-activity [MVPA]) and direct observation (snacks served) in 20 ASPs. Strategies were identified and mapped onto a capacity building framework ( Strategies To Enhance Practice [STEPs]). Mixed-effects regression estimated increases in HEPA outcomes as implementation increased. Model-implied estimates were calculated for high (i.e., highest implementation score achieved), moderate (median implementation score across programs), and low (lowest implementation score achieved) implementation for both HEPA separately. Programs implemented a variety of strategies identified in STEPs. For every 1-point increase in implementation score 1.45% (95% confidence interval = 0.33% to 2.55%, p ≤ .001) more girls accumulated 30 min/day of MVPA and fruits and/or vegetables were served on 0.11 more days (95% confidence interval = 0.11-0.45, p ≤ .01). Relationships between implementation and other HEPA outcomes did not reach statistical significance. Still regression estimates indicated that desserts are served on 1.94 fewer days (i.e., 0.40 vs. 2.34) in the highest implementing program than the lowest implementing program and water is served 0.73 more days (i.e., 2.37 vs. 1.64). Adopting HEPA Standards at the national level does not lead to changes in routine practice in all programs. Practical strategies that programs could adopt to more fully comply with the HEPA Standards are identified.

Communicable Astronomy for IYA: Using the Networks of the Astronomical Society of the Pacific for Education and Outreach

NASA Astrophysics Data System (ADS)

Manning, J.; Gibbs, M.; Gurton, S.; Fraknoi, A.

2008-12-01

At the forefront of sharing the excitement of the exploration of the universe for 120 years, the Astronomical Society of the Pacific (ASP) is poised to use its networks and services to implement education and outreach programs for the 2009 International Year of Astronomy (IYA). The ASP is partnering with NASA, the International Astronomical Union (IAU), the American Astronomical Society (AAS) and other organizations on IYA projects, and is developing signature programs for implementation--with the overarching goal of employing its networks of scientists, educators and amateur astronomers in efforts to improve science education and science literacy. This presentation will describe the ASP's efforts to make astronomy and science "communicable" through these astronomy intermediaries--to reach the larger public, to link astronomy to other sciences, and to create legacy programs that will continue beyond 2009.

ASP Celebrates IYA, One Month at a Time

NASA Astrophysics Data System (ADS)

Gurton, S.; Berendsen, M.; Hurst, A.; White, V.

2008-11-01

Serving three major networks of educators, the ASP is working with NASA, NOAO, ASTC and others to build a comprehensive program to celebrate the International Year of Astronomy (IYA2009). By featuring a different astronomy theme during each month of 2009, we will provide a rich array of themed resources, such as demonstrations and activities, teleconferences, and news stories to the variety of educators served by the ASP. This poster will present our program of monthly themes, along with associated services and resources, to support the diverse public outreach efforts of the members of the NASA Night Sky Network, museum educators in Astronomy From the Ground Up, and teachers in grades K--12 including Project ASTRO National Network partners and subscribers to Universe in the Classroom.

Community Involvement Training Program

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

Meet our PESP Partners

EPA Pesticide Factsheets

The Pesticide Environmental Stewardship Program is a voluntary membership program that promotes the adoption of innovative, alternative pest control practices such as Integrated Pest Management. PESP has three membership tiers: Bronze, Silver, Gold.

IARC - Illinois Accelerator Research Center | Pilot Program

Science.gov Websites

Toggle navigation Pilot Program Agenda Directions Registration Illinois Accelerator Research Center National Laboratory present Accelerator Stewardship Test Facility Pilot Program Use accelerator technology , energy and environment. With this pilot program, the DOE Office of Science National Laboratories are

About PESP Membership

EPA Pesticide Factsheets

The Pesticide Environmental Stewardship Program (PESP) is a voluntary membership program that promotes the adoption of innovative, alternative pest control practices such as Integrated Pest Management (IPM). Learn about membership benefits and how to join.

78 FR 4844 - Defense Programs Advisory Committee

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-23

... Management Secretariat, General Services Administration, notice is hereby given that the Defense Programs... Deputy Administrator for Defense Programs on the stewardship and maintenance of the Nation's nuclear... DP management issues, including facility operations and fiscal matters. e. Where appropriate...

Evaluation of pharmacy generalists performing antimicrobial stewardship services.

PubMed

Carreno, Joseph J; Kenney, Rachel M; Bloome, Mary; McDonnell, Jane; Rodriguez, Jennifer; Weinmann, Allison; Kilgore, Paul E; Davis, Susan L

2015-08-01

Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported. A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated. Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p < 0.001). After adjusting for infection type, antimicrobial stewardship provided by an intervention-group pharmacist was associated with improved care bundle compliance (adjusted odds ratio, 2.70; p < 0.001). No significant differences in patient outcomes during intervention and control months were detected. Pharmacy generalists trained to comply with a systematic care bundle approach enhanced the quality of antimicrobial management. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Contacts in the Office of Pesticide Programs, Biopesticides and Pollution Prevention Division

EPA Pesticide Factsheets

Contact the Biopesticides and Pollution Prevention Division (BPPD) about regulatory activities associated with biologically-based pesticides, implementation of integrated pest management and the Pesticide Environmental Stewardship Program.

Scientific Data Stewardship in the 21'st Century

NASA Astrophysics Data System (ADS)

Mabie, J. J.; Redmon, R.; Bullett, T.; Kihn, E. A.; Conkright, R.; Manley, J.; Horan, K.

2008-12-01

The Ionosonde Program at the National Geophysical Data Center (NGDC) serves as a case study for how to approach data stewardship in the 21'st century. As the number and sophistication of scientific instruments increase, along with the volumes and complexity of data that need to be preserved for future generations, the old approach of simply storing data in a library, physical or electronic, is no longer sufficient to ensure the long term preservation of our important environmental data. To ensure the data can be accessed, understood, and used by future generations, the data stewards must be familiar with the observation process before the data reach the archive and the scientific applications to which the data may be called to serve. This familiarity is best obtained by active participation. In the NGDC Ionosonde Program team, we strive to have activity and expertise in ionosonde field operations and scientific data analysis in addition to our core mission of preservation and distribution of data and metadata. We believe this approach produces superior data quality, proper documentation and evaluation tools for data customers as part of the archive process. We are presenting the Ionosonde Program as an example of modern scientific data stewardship.

Gasoline toxicology: overview of regulatory and product stewardship programs.

PubMed

Swick, Derek; Jaques, Andrew; Walker, J C; Estreicher, Herb

2014-11-01

Significant efforts have been made to characterize the toxicological properties of gasoline. There have been both mandatory and voluntary toxicology testing programs to generate hazard characterization data for gasoline, the refinery process streams used to blend gasoline, and individual chemical constituents found in gasoline. The Clean Air Act (CAA) (Clean Air Act, 2012: § 7401, et seq.) is the primary tool for the U.S. Environmental Protection Agency (EPA) to regulate gasoline and this supplement presents the results of the Section 211(b) Alternative Tier 2 studies required for CAA Fuel and Fuel Additive registration. Gasoline blending streams have also been evaluated by EPA under the voluntary High Production Volume (HPV) Challenge Program through which the petroleum industry provide data on over 80 refinery streams used in gasoline. Product stewardship efforts by companies and associations such as the American Petroleum Institute (API), Conservation of Clean Air and Water Europe (CONCAWE), and the Petroleum Product Stewardship Council (PPSC) have contributed a significant amount of hazard characterization data on gasoline and related substances. The hazard of gasoline and anticipated exposure to gasoline vapor has been well characterized for risk assessment purposes. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Simultaneous determination of methocarbamol and aspirin by RP-HPLC using fluorescence detection with time programming: its application to pharmaceutical dosage form.

PubMed

El-Din, M Sharaf; Eid, M; Zeid, A M

2013-01-01

A new simple, rapid and sensitive reversed-phase liquid chromatographic method was developed and validated for the simultaneous determination of methocarbamol (MET) and aspirin (ASP) in their combined dosage form. The separation of these compounds was achieved within 6.0 min on a CLC Shim-pack C8 column (250 × 4.6 mm, 5 µm particle size) using isocratic mobile phase consisting of acetonitrile and 0.02 M dihydrogenphosphate buffer (30:70, v/v) at pH = 5.0. The analysis was performed at a flow rate of 1.0 mL/min with fluorescence detection at 277/313 nm for MET and 298/410 nm for ASP using real-time programming. The selectivity, linearity of calibration, accuracy, inter- and intra-day precision and recovery were examined as parts of the method validation. The concentration-response relationship was linear over concentration ranges of 0.02-0.20 and 0.02-0.40 µg/mL for MET and ASP, respectively, with a limit of detection of 6 and 32 ng/mL for MET and ASP, respectively. The proposed method was successfully applied for the analysis of both MET and ASP in prepared tablets with average recoveries of 99.88 ± 0.65% for MET and 100.44 ± 0.78% for ASP. The results were favourably compared to those obtained by a reference method. Copyright © 2012 John Wiley & Sons, Ltd.

Conditions for Effective Application of Analysis of Symmetrically-Predicted Endogenous Subgroups

ERIC Educational Resources Information Center

Peck, Laura R.

2015-01-01

Several analytic strategies exist for opening up the "black box" to reveal more about what drives policy and program impacts. This article focuses on one of these strategies: the Analysis of Symmetrically-Predicted Endogenous Subgroups (ASPES). ASPES uses exogenous baseline data to identify endogenously-defined subgroups, keeping the…

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

Hecker, Siegfried; Gottemoeller, Rose; Reis, Victor H.

A short oral history of the NNSA's Stockpile Stewardship Program, produced in association with the 20th anniversary of the program. It features Siegfried Hecker, Rose Gottemoeller, Victor Reis, Charles McMillan, Joan Rohlfing, Omar Hurricane, Roger Hagengruber, and John Taylor.

Staffing for infectious diseases, clinical microbiology and infection control in hospitals in 2015: results of an ESCMID member survey.

PubMed

Dickstein, Y; Nir-Paz, R; Pulcini, C; Cookson, B; Beović, B; Tacconelli, E; Nathwani, D; Vatcheva-Dobrevska, R; Rodríguez-Baño, J; Hell, M; Saenz, H; Leibovici, L; Paul, M

2016-09-01

We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Impact of an Antimicrobial Stewardship Care Bundle to Improve the Management of Patients with Suspected or Confirmed Urinary Tract Infection.

PubMed

Collins, Curtis D; Kabara, Jared J; Michienzi, Sarah M; Malani, Anurag N

2016-12-01

Implementation of an antimicrobial stewardship program bundle for urinary tract infections among 92 patients led to a higher rate of discontinuation of therapy for asymptomatic bacteriuria (52.4% vs 12.5%; P =.004), more appropriate durations of therapy (88.7% vs 63.6%; P =.001), and significantly higher overall bundle compliance (75% vs 38.2%; P < .001). Infect Control Hosp Epidemiol 2016;1499-1501.

Pesticide Environmental Stewardship Program (PESP)

EPA Pesticide Factsheets

PESP is an EPA partnership program that works with the nation's pesticide-user community to promote IPM practices. Pesticide users can reduce the risks from pests and pesticides. Members include organizations and companies in the pesticide-user community.

Embedding Data Stewardship in Geoscience Australia

NASA Astrophysics Data System (ADS)

Bastrakova, I.; Fyfe, S.

2013-12-01

Ten years of technological innovation now enable vast amounts of data to be collected, managed, processed and shared. At the same time, organisations have witnessed government legislative and policy requirements for open access to public sector data, and a demand for flexibility in access to data by both machine-to-machine and human consumption. Geoscience Australia (GA) has adopted Data Stewardship as an organisation-wide initiative to improve the way we manage and share our data. The benefits to GA including: - Consolidated understanding of GA's data assets and their value to the Agency; - Recognition of the significant role of data custodianship and data management; - Well-defined governance, policies, standards, practices and accountabilities that promote the accessibility, quality and interoperability of GA's data; - Integration of disparate data sets into cohesive information products available online in real time and equally accessible to researchers, government, industry and the public. Although the theory behind data stewardship is well-defined and accepted and the benefits are generally well-understood, practical implementation requires an organisation to prepare for a long-term commitment of resources, both financial and human. Fundamentally this involves: 1. Raising awareness in the organisation of the need for data stewardship and the challenges this entails; 2. Establishing a data stewardship framework including a data governance office to set policy and drive organisational change; and 3. Embedding the functions and a culture of data stewardship into business as usual operations. GA holds a vast amount of data ranging from petabytes of Big Data to significant quantities of relatively small ';long tail' geoscientific observations and measurements. Over the past four years, GA has undertaken strategic activities that prepare us for Data Stewardship: - Organisation-wide audits of GA's data holdings and identification of custodians for each dataset; - Developing guiding Principles on how the Agency undertakes Science, Data Management and Cataloguing; - Developing a Data Classification Schema that aligns scientific requirements and business workflows with data architecture; - Creating the Scientific Data Stewardship Steering Committee, comprising champions from across the Agency to guide development and support implementation of Data Stewardship in GA; - Forming Scientific Data Communities of Practice of leading scientific experts to identify tandards and practices across their domain, and integrate data stewardship practices into scientific workflows; - Establishing the Data Governance and Services Section to provide ongoing capacity for the development, communication, coordination and governance of data stewardship policies, strategies, standards and practices. GA is now moving towards Data Stewardship as an operational capability and culture within the Agency. The challenges we face into the future include: - Maintaining continuous and enthusiastic engagement from the Agency executive; - Implementing long term cultural change at all levels within the organisation; - Formal recognition that data stewardship is a continuous operational BAU activity; - Incorporation of data custodianship and management activities in work programs and budgets; and - Cultivation and support of the data stewardship champions.

A conceptual model for training after-school program staffers to promote physical activity and nutrition.

PubMed

Weaver, Robert Glenn; Beets, Michael W; Webster, Collin; Beighle, Aaron; Huberty, Jennifer

2012-04-01

After-school programs (ASPs, 3 pm to 6 pm) have been called upon to increase the amount of daily physical activity children accumulate and improve the nutritional quality of the snacks served. To this end, state and national physical activity and nutrition (PAaN) policies have been proposed. Frontline staff who directly interact with children on a daily basis are charged with the responsibility to meet policy goals. Without appropriate skills, staffers' ability to achieve such goals is limited. The gap between policies and improvements in PAaN must be bridged through professional development training. This article describes the development of an ASP staff professional development training program. A systematic review was performed to identify relevant theoretical perspectives, empirical evidence, and recommended best practices relating to promoting PAaN of children. A comprehensive professional development framework was developed that incorporated the key elements identified from the review. These elements were distilled into 5 primary categories and conceptually referred to as the 5 Ms: mission-clearly defined policy/standards for PAaN; motivate-providing choices, developmentally appropriate activities, feedback, and encouragement; manage-structuring and managing the environment for safety, routines, and discipline; monitor-ongoing evaluation of PAaN; and maximize-incorporating all former Ms. The application of this training framework should lead to improved implementation and eventual achievement of policy goals for PAaN in ASPs. These competencies need to be developed in all ASPs if widespread improvements in PAaN within the ASP setting are to be realized. © 2012, American School Health Association.

ASP Programs and IYA

NASA Astrophysics Data System (ADS)

Manning, James G.

2009-01-01

At the forefront of sharing the excitement of the exploration of the universe for 120 years, the Astronomical Society of the Pacific is poised to use its networks and services to implement education and outreach programs for the 2009 International Year of Astronomy (IYA2009). The ASP is partnering with NASA, the AAS and other astronomy and education organizations on IYA2009 projects, and is developing signature programs for implementation-with the overarching goal of bringing together scientists, educators and amateur astronomers in efforts to improve science education and science literacy through astronomy. The presentation will outline five major thrusts designed to serve the amateur astronomy community, formal educators, informal educators, the online community, and these communities in combination through IYA-related professional development, resources, and the facilitation of connections. The use of the proceedings of the IYA2009 Symposium in St. Louis in June, 2008 as an IYA2009 resource will be mentioned, and the ASP will encourage partners to work with the Society to help reach mutual goals and objectives for IYA2009 and beyond.

Stewplan: software for creating forest stewardship plans (Version 1.3)

Treesearch

Peter D. Knopp; Mark J. Twery

2003-01-01

Describes the purpose and function of the Stewplan computer program. Provides instructions for loading Stewplan, a tutorial for getting started, and instructions for use. A copy of the program is included. [User's manual; CD-ROM].

Scientific evidence and research in antimicrobial stewardship.

PubMed

Almirante, Benito; Garnacho-Montero, José; Pachón, Jerónimo; Pascual, Álvaro; Rodríguez-Baño, Jesús

2013-09-01

Evaluating the impact of antibiotic stewardship programs is challenging. There is evidence that they are effective in terms of reducing the consumption and cost of antibiotics, although establishing their impact on antimicrobial resistance (beyond restrictive policies in outbreaks caused by specific antimicrobial resistant organisms) and clinical outcomes is more difficult. Proper definitions of exposure and outcome variables, the use of advanced and appropriate statistical analyses and well-designed quasi-experimental studies would more accurately support the conclusions. Cluster randomized trials should be used whenever possible and appropriate, although the limitations of this approach should also be acknowledged. These issues are reviewed in this paper. We conclude that there are good research opportunities in the field of antibiotic stewardship. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Stockpile stewardship past, present, and future

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

Adams, Marvin L., E-mail: mladams@tamu.edu

2014-05-09

The U.S. National Academies released a report in 2012 on technical issues related to the Comprehensive Test Ban Treaty. One important question addressed therein is whether the U.S. could maintain a safe, secure, and reliable nuclear-weapons stockpile in the absence of nuclear-explosion testing. Here we discuss two main conclusions from the 2012 Academies report, which we paraphrase as follows: 1) Provided that sufficient resources and a national commitment to stockpile stewardship are in place, the U.S. has the technical capabilities to maintain a safe, secure, and reliable stockpile of nuclear weapons into the foreseeable future without nuclear-explosion testing. 2) Doingmore » this would require: a) a strong weapons science and engineering program that addresses gaps in understanding; b) an outstanding workforce that applies deep and broad weapons expertise to deliver solutions to stockpile problems; c) a vigorous, stable surveillance program that delivers the requisite data; d) production facilities that meet stewardship needs. We emphasize that these conclusions are independent of CTBT ratification-they apply provided only that the U.S. continues its nuclear-explosion moratorium.« less

Challenges for a Sustainable Financial Foundation for Antimicrobial Stewardship.

PubMed

Dik, Jan-Willem H; Sinha, Bhanu

2017-03-30

Antimicrobial resistance is a worldwide threat and a problem with large clinical and economic impact. Antimicrobial Stewardship Programs are a solution to curb resistance development. A problem of resistance is a separation of actions and consequences, financial and clinical. Such a separation makes it difficult to create support among stakeholders leading to a lack of sense of responsibility. To counteract the resistance development it is important to perform diagnostics and know how to interpret the results. One should see diagnostics, therapy and resistance as one single process. Within this process all involved stakeholders need to work together on a more institutional level. We suggest therefore a solution: combining diagnostics and therapy into one single financial product . Such a product should act as an incentive to perform correct diagnostics. It also makes it easier to cover the costs of an antimicrobial stewardship program, which is often overlooked. Finally, such a product involves all stakeholders in the process and does not lay the costs at one stakeholder and the benefits somewhere else, solving the misbalance that is present nowadays.

Metrics for the NASA Airspace Systems Program

NASA Technical Reports Server (NTRS)

Smith, Jeremy C.; Neitzke, Kurt W.

2009-01-01

This document defines an initial set of metrics for use by the NASA Airspace Systems Program (ASP). ASP consists of the NextGen-Airspace Project and the NextGen-Airportal Project. The work in each project is organized along multiple, discipline-level Research Focus Areas (RFAs). Each RFA is developing future concept elements in support of the Next Generation Air Transportation System (NextGen), as defined by the Joint Planning and Development Office (JPDO). In addition, a single, system-level RFA is responsible for integrating concept elements across RFAs in both projects and for assessing system-wide benefits. The primary purpose of this document is to define a common set of metrics for measuring National Airspace System (NAS) performance before and after the introduction of ASP-developed concepts for NextGen as the system handles increasing traffic. The metrics are directly traceable to NextGen goals and objectives as defined by the JPDO and hence will be used to measure the progress of ASP research toward reaching those goals. The scope of this document is focused on defining a common set of metrics for measuring NAS capacity, efficiency, robustness, and safety at the system-level and at the RFA-level. Use of common metrics will focus ASP research toward achieving system-level performance goals and objectives and enable the discipline-level RFAs to evaluate the impact of their concepts at the system level.

Effects of Daily Physical Education on Physical Fitness and Weight Status in Middle School Adolescents

ERIC Educational Resources Information Center

Erfle, Stephen E.; Gamble, Abigail

2014-01-01

Background: In 2009, the Pennsylvania Department of Health developed the Active Schools Program (ASP) which required 30?minutes of daily physical education (PE) in middle schools to reduce childhood obesity. This investigation evaluated the ASP effects on physical fitness and weight status in middle school adolescents throughout 1 academic year.…

Assessment and Evaluation of the Utah Master Naturalist Program: Implications for Targeting Audiences

ERIC Educational Resources Information Center

Larese-Casanova, Mark

2011-01-01

The Utah Master Naturalist Program trains citizens who provide education, outreach, and service to promote citizen stewardship of natural resources within their communities. In 2007-2008, the Watersheds module of the program was evaluated for program success, and participant knowledge was assessed. Assessment and evaluation results indicated that…

Effects of Fishing Education Programs on Antecedents of Responsible Environmental Behavior.

ERIC Educational Resources Information Center

Siemer, William F.; Knuth, Barbara A.

2001-01-01

Investigates fishing and aquatic stewardship outcomes associated with different levels of program exposure among n=619 participants in a national fishing education program (Hooked on Fishing-Not on Drugs) designed for youth in Grades 6-8. Supports the assumption that such programs are more likely to influence antecedents to environmentally…

Using Implementation and Program Theory to Examine Communication Strategies in National Wildlife Federation's Backyard Wildlife Habitat Program

ERIC Educational Resources Information Center

Palmer, Dain; Dann, Shari L.

2004-01-01

Our evaluative approach used implementation theory and program theory, adapted from Weiss (1998) to examine communication processes and results for a national wildlife habitat stewardship education program. Using a mail survey of 1427 participants certified in National Wildlife Federation's (NWF) Backyard Wildlife Habitat (BWH) program and a study…

Advanced Technology System Scheduling Governance Model

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

Ang, Jim; Carnes, Brian; Hoang, Thuc

In the fall of 2005, the Advanced Simulation and Computing (ASC) Program appointed a team to formulate a governance model for allocating resources and scheduling the stockpile stewardship workload on ASC capability systems. This update to the original document takes into account the new technical challenges and roles for advanced technology (AT) systems and the new ASC Program workload categories that must be supported. The goal of this updated model is to effectively allocate and schedule AT computing resources among all three National Nuclear Security Administration (NNSA) laboratories for weapons deliverables that merit priority on this class of resource. Themore » process outlined below describes how proposed work can be evaluated and approved for resource allocations while preserving high effective utilization of the systems. This approach will provide the broadest possible benefit to the Stockpile Stewardship Program (SSP).« less

Physical and Social-Motivational Contextual Correlates of Youth Physical Activity in Underresourced Afterschool Programs.

PubMed

Zarrett, Nicole; Sorensen, Carl; Cook, Brittany Skiles

2015-08-01

Afterschool programs (ASPs) have become increasingly recognized as a key context to support youth daily physical activity (PA) accrual. The purpose of the present study was to assess the physical and social-motivational climate characteristics of ASPs associated with youth PA, and variations in contextual correlates of PA by youth sex. Systematic observations of 7 ASPs serving underserved youth (minority, low income) was conducted using the System for Observing Play and Leisure Activity in Youth and a social-motivational climate observation tool founded on self-determination theory. For five program days at each site, teams of two coders conducted continuous observations of youth PA (sedentary, moderate, vigorous), five physical features (e.g., equipment availability), eight staff interactions (e.g., encourage PA), and seven motivational climate components (e.g., inclusive). Aligned with previous research, regressions controlling for variations by site indicated that organized PA, provision of portable equipment, and staff PA participation and supervision are key correlates of youth PA. Moreover, as the first study to systematically observe motivational-context characteristics of ASPs, we identified several key modifiable motivational features that are necessary to address in order to increase youth engagement in PA during the out-of-school hours. Among motivational features assessed, "relatedness" components (positive peer relations, inclusive/cooperative activities) were primary correlates of girls' PA. In contrast, all three motivational features specified by self-determination theory (support for autonomy, mastery/competence, and inclusion/relatedness) were correlated with boys' PA. Findings are discussed in terms of policy and practice for understanding strengths and needs of ASPs to effectively engage youth in PA. © 2015 Society for Public Health Education.

A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

PubMed

Agwu, Allison L; Lee, Carlton K K; Jain, Sanjay K; Murray, Kara L; Topolski, Jason; Miller, Robert E; Townsend, Timothy; Lehmann, Christoph U

2008-09-15

Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.

Framework for the design and delivery of organized physical activity sessions for children and adolescents: rationale and description of the 'SAAFE' teaching principles.

PubMed

Lubans, David R; Lonsdale, Chris; Cohen, Kristen; Eather, Narelle; Beauchamp, Mark R; Morgan, Philip J; Sylvester, Benjamin D; Smith, Jordan J

2017-02-23

The economic burden of inactivity is substantial, with conservative estimates suggesting the global cost to health care systems is more than US$50 billion. School-based programs, including physical education and school sport, have been recommended as important components of a multi-sector, multi-system approach to address physical inactivity. Additionally, community sporting clubs and after-school programs (ASPs) offer further opportunities for young people to be physically active outside of school. Despite demonstrating promise, current evidence suggests school-based physical activity programs, community sporting clubs and ASPs are not achieving their full potential. For example, physical activity levels in physical education (PE) and ASP sessions are typically much lower than recommended. For these sessions to have the strongest effects on young people's physical activity levels and their on-going physical literacy, they need to improve in quality and should be highly active and engaging. This paper presents the Supportive, Active, Autonomous, Fair, Enjoyable (SAAFE) principles, which represent an evidence-based framework designed to guide the planning, delivery and evaluation of organized physical activity sessions in school, community sport and ASPs. In this paper we provide a narrative and integrative review of the conceptual and empirical bases that underpin this framework and highlight implications for knowledge translation and application.

76 FR 56214 - 60-Day Notice of Intention To Request Clearance for Information Collection: Opportunity for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-12

... youth program participants. Since many of the YouthGo information collections ask similar questions to..., interviews, youth program observations, and pre-post youth program surveys. The information collections will... stewardship and the next generation of conservationists. By conducting focus groups, interviews, identical pre...

Making Healthy Eating Policy Practice: A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in After-School Programs.

PubMed

Beets, Michael W; Weaver, R Glenn; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S; Freedman, Darcy; Hutto, Brent; Moore, Justin B; Beighle, Aaron

2016-09-01

The aim of this study was to evaluate an intervention designed to assist after-school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable be served daily and sugar-sweetened beverages/foods and artificially flavored foods eliminated. The study used a 1-year group-randomized controlled trial. The study took place in ASPs operating in South Carolina, United States. Twenty ASPs serving over 1700 children were recruited, match-paired postbaseline on enrollment size and days fruits/vegetables were served per week, and randomized to either intervention (n = 10) or control (n = 10) groups. The study used Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multistep adaptive intervention framework that assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost. Direct observation of snacks served and consumed and monthly snack expenditures as determined by receipts were used. The study used nonparametric and mixed-model repeated measures. By postassessment, intervention ASPs increased serving of fruits/vegetables to 3.9 ± 2.1 vs. 0.7 ± 1.7 d/wk and decreased serving sugar-sweetened beverages to 0.1 ± 0.7 vs. 1.8 ± 2.4 d/wk and sugar-sweetened foods to 0.3 ± 1.1 vs. 2.7 ± 2.5 d/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01 per snack decrease in the control group ($0.39 to $0.38). Across both assessments and groups, 80% to 100% of children consumed FVs. The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost. © 2016 by American Journal of Health Promotion, Inc.

The volitional inhibition of anticipatory ocular pursuit using a stop signal.

PubMed

Jarrett, Christian Beresford; Barnes, Graham R

2003-10-01

Unlike limb movements, smooth pursuit eye movements cannot normally be performed in the absence of a target. However, when subjects have a high expectancy of an imminent target appearance, the situation changes, and anticipatory smooth pursuit (ASP) tends to precede target onset by several hundred milliseconds. The velocity of this ASP is scaled predictively according to expected target velocity. And when an upcoming target is unexpectedly altered, or fails to appear, ASP continues regardless for approximately 150-200 ms before modification by visual feedback begins [J. Neurophysiol., 84 (2000) 2340]. These and other observations led to the earlier suggestion that ASP might be ballistic, being pre-programmed from start to finish. Two experiments with different timing parameters were therefore performed to test this hypothesis using a version of Logan's [Psychol. Rev., 91 (1984) 295] stop signal task. The aim was to test whether ASP could be stopped at will, and if so, whether the time taken to stop varied as a function of the time since ASP onset. Results showed that in response to a stop signal, ASP can be inhibited at any point in its trajectory, and for the majority of subjects in experiment 1, and all the subjects in experiment 2, with a latency that does not change significantly with target speed or time since ASP onset. These results provide the first demonstration that anticipatory movements can be stopped volitionally in response to a stop signal. Possible cognitive and neurophysiological mechanisms underlying this process are discussed.

Choosing Wisely Canada Students and Trainees Advocating for Resource Stewardship (STARS) campaign: a descriptive evaluation

PubMed Central

Cardone, Franco; Cheung, Daphne; Han, Angela; Born, Karen B.; Alexander, Lisa; Levinson, Wendy; Wong, Brian M.

2017-01-01

Background: Resource stewardship is being increasingly recognized as an essential competency for physicians, but medical schools are just beginning to integrate this into education. We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. Methods: We evaluated the campaign 6 months after its launch, in November 2015. STARS students were administered a telephone survey eliciting a description of the initiatives that they had implemented or planned to implement at their schools to promote resource stewardship, and exploring their perceptions of facilitators of and barriers to successful implementation of their initiatives. We used a mixed-methods approach to analyze and summarize the data. Results: Twenty-seven (82%) of the 33 eligible students representing all 17 medical schools responded. In 14 schools (82%), students led various local activities (e.g., interest groups, campaign weeks) to raise awareness about resource stewardship among medical students and faculty. Students contributed to curriculum change (both planned and implemented) at 10 schools (59%). Thematic analysis revealed key program characteristics that facilitated success (e.g., pan-Canadian student network, local faculty champion) as well as barriers to implementing change (e.g., complex processes to change curriculum, hierarchical nature of medical school). Interpretation: This student-led campaign, with support from local faculty and Choosing Wisely Canada staff, led to awareness-building activities and early curricula change at medical schools across Canada. Future plans will build on the initial momentum created by the STARS campaign to sustain and spread local initiatives. PMID:29263153

The CORALS Connection

ERIC Educational Resources Information Center

Plankis, Brian; Klein, Carolyn

2010-01-01

The Ocean, Reefs, Aquariums, Literacy, and Stewardship (CORALS) research program helps students connect global environmental issues to local concerns and personal choices. During the 18-week program, students strengthen their understanding of coral reef decline through a classroom aquarium activity, communicate with science experts, and create…

SOUTHWEST REGIONAL GAP LAND COVER

EPA Science Inventory

The Gap Analysis Program is a national inter-agency program that maps the distribution

of plant communities and selected animal species and compares these distributions with land

stewardship to identify gaps in biodiversity protection. GAP uses remote satellite imag...

42 CFR 414.806 - Penalties associated with the failure to submit timely and accurate ASP data.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Penalties associated with the failure to submit timely and accurate ASP data. 414.806 Section 414.806 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES...

42 CFR 414.806 - Penalties associated with the failure to submit timely and accurate ASP data.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Penalties associated with the failure to submit timely and accurate ASP data. 414.806 Section 414.806 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES...

42 CFR 414.806 - Penalties associated with the failure to submit timely and accurate ASP data.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Penalties associated with the failure to submit timely and accurate ASP data. 414.806 Section 414.806 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Submission of...

42 CFR 414.806 - Penalties associated with the failure to submit timely and accurate ASP data.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Penalties associated with the failure to submit timely and accurate ASP data. 414.806 Section 414.806 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Submission of...

42 CFR 414.806 - Penalties associated with the failure to submit timely and accurate ASP data.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Penalties associated with the failure to submit timely and accurate ASP data. 414.806 Section 414.806 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES...

7 CFR 1470.31 - Appeals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM General Administration § 1470.31 Appeals. A participant may obtain administrative review of an adverse decision under this part...

7 CFR 1470.7 - Enhancements and conservation practices.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM General Provisions § 1470.7 Enhancements and conservation practices. (a) Participant decisions describing...

36 CFR 230.4 - State program administration.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false State program administration. 230.4 Section 230.4 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE... the State Forester, shall establish a State Forest Stewardship Coordinating Committee whose...

OVERVIEW OF VOLUNTARY STEWARDSHIP EFFORTS TO ADDRESS PHARMACEUTICAL DISPOSAL

EPA Science Inventory

This presentation will provide an overview of current federal regulatory guidance for pharmaceutical disposal, currently funded pilot programs for take-back pilot studies, and state programs. The EPA Office of Water's role is to protect our Nation's watersheds and drinking water ...

Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.

PubMed

Sloane, Philip D; Huslage, Kirk; Kistler, Christine E; Zimmerman, Sheryl

2016-01-01

Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Connecting NASA Airborne Scientists, Engineers, and Pilots to K-12 Classrooms

NASA Astrophysics Data System (ADS)

Schaller, E. L.

2015-12-01

The NASA Airborne Science Program (ASP) conducts Earth system science research missions with NASA aircraft all over the world. During ASP missions, NASA scientists, engineers and pilots are deployed to remote parts of the world such as Greenland, Antarctica, Chile, and Guam. These ASP mission personnel often have a strong desire to share the excitement of their mission with local classrooms near their deployment locations as well as classrooms back home in the United States. Here we discuss ongoing efforts to connect NASA scientists, engineers and pilots in the field directly with K-12 classrooms through both in-person interactions and remotely via live web-based chats.

Tapping into the Forest Management Assistance Programs

Treesearch

John L. Greene; Terry K. Haines

1998-01-01

Use of federal and state forest management assistance programs can enable nonindustial private forest owners to reduce their management expenses and practice better stewardship. This paper summarizes six federal and twelve state assistance programs available to owners in the North Central states. It also describes how to calculate the amount of a government...

Developing a Volunteer Program for Public Environmental Education.

ERIC Educational Resources Information Center

Meehan, Donald B.; Berta, Susan

Volunteers can serve as a means to educate the public about environmental issues and increase stewardship ethic. This booklet is designed to provide much of the key information about designing and managing environmental volunteer programs to educate the general public. The booklet is based on the experiences of a volunteer program called Island…

COPEing With Environmental Education Program Development and Infusion into the Global Studies Curricula of Rural Schools.

ERIC Educational Resources Information Center

Peters, Richard O.

An environmental education-oriented global studies program to promote attitudes of environmental stewardship can be implemented in K-12 rural school systems, as an integrated part of social studies instruction, without overburdening the curriculum, by using the Curriculum Organization and Program Evaluation (COPE) model. The model provides…

Goals and Objectives

EPA Pesticide Factsheets

The five goals related to the Border 2020 program: reducing air pollution, access to clean and safe water, promoting clean waste management, emergency preparedness and response, compliance assurance.and environmental stewardship

Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions.

PubMed

Wilkinson, Krista; Gravel, Denise; Taylor, Geoffrey; McGeer, Allison; Simor, Andrew; Suh, Kathryn; Moore, Dorothy; Kelly, Sharon; Boyd, David; Mulvey, Michael; Mounchili, Aboubakar; Miller, Mark

2011-04-01

Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities. A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005. Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program. Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

The Watershed Report Card.

ERIC Educational Resources Information Center

Kelly, Allyson

1996-01-01

Outlines the history and development of the Watershed Report Card, an integrated program that educates Ontario participants about the holistic nature of a watershed and fosters community stewardship of the local ecosystem. The program consists of the inventory level, assessment and monitoring level, and remediation level. Emphasizes partnerships…

Environmental practices for biomedical research facilities.

PubMed Central

Medlin, E L; Grupenhoff, J T

2000-01-01

As a result of the Leadership Conference on Biomedical Research and the Environment, the Facilities Committee focused its work on the development of best environmental practices at biomedical research facilities at the university and independent research facility level as well as consideration of potential involvement of for-profit companies and government agencies. The designation "facilities" includes all related buildings and grounds, "green auditing" of buildings and programs, purchasing of furnishings and sources, energy efficiency, and engineering services (lighting, heating, air conditioning), among other activities. The committee made a number of recommendations, including development of a national council for environmental stewardship in biomedical research, development of a system of green auditing of such research facilities, and creation of programs for sustainable building and use. In addition, the committee recommended extension of education and training programs for environmental stewardship, in cooperation with facilities managers, for all research administrators and researchers. These programs would focus especially on graduate fellows and other students, as well as on science labs at levels K--12. PMID:11121360

The Intersection Between Colonization Resistance, Antimicrobial Stewardship, and Clostridium difficile.

PubMed

Rosa, Rossana; Donskey, Curtis J; Munoz-Price, L Silvia

2018-06-07

Colonization resistance refers to the innate defense provided by the indigenous microbiota against colonization by pathogenic organisms. We aim to describe how this line of defense is deployed against Clostridium difficile and what the implications are for interventions directed by Antimicrobial Stewardship Programs. The indigenous microbiota provides colonization resistance through depletion of nutrients, prevention of access to adherence sites within the gut mucosa, production of inhibitory substances, and stimulation of the host's immune system. The ability to quantify colonization resistance could provide information regarding periods of maximal vulnerability to colonization with pathogens and also allow the identification of mechanisms of restoration of colonization resistance. Methods utilized to determine the composition of the gut microbiota include sequencing technologies and measurement of concentration of specific bacterial metabolites. Use of innovations in the quantification of colonization resistance can expand the role of Antimicrobial Stewardship from prevention of disruption of the indigenous microbiota to restoration of colonization resistance.

Antifungal stewardship considerations for adults and pediatrics.

PubMed

Hamdy, Rana F; Zaoutis, Theoklis E; Seo, Susan K

2017-08-18

Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via post-prescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

Science and technology in the stockpile stewardship program, S & TR reprints

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

Storm, E

This document reports on these topics: Computer Simulations in Support of National Security; Enhanced Surveillance of Aging Weapons; A New Precision Cutting Tool: The Femtosecond Laser; Superlasers as a Tool of Stockpile Stewardship; Nova Laser Experiments and Stockpile Stewardship; Transforming Explosive Art into Science; Better Flash Radiography Using the FXR; Preserving Nuclear Weapons Information; Site 300Õs New Contained Firing Facility; The Linear Electric Motor: Instability at 1,000 gÕs; A Powerful New Tool to Detect Clandestine Nuclear Tests; High Explosives in Stockpile Surveillance Indicate Constancy; Addressing a Cold War Legacy with a New Way to Produce TATB; JumpinÕ Jupiter! Metallic Hydrogen;more » Keeping the Nuclear Stockpile Safe, Secure, and Reliable; The Multibeam FabryÐPerot Velocimeter: Efficient Measurements of High Velocities; Theory and Modeling in Material Science; The Diamond Anvil Cell; Gamma-Ray Imaging Spectrometry; X-Ray Lasers and High-Density Plasma« less

PEYA Winners

EPA Pesticide Factsheets

The President's Environmental Youth Award is a recognition program for K-12 students who conduct an environmental stewardship and community service project. One winner or group is recognized from each of EPA's 10 regions.

New Chemicals Program Review of Alternatives for PFOA and Related Chemicals

EPA Pesticide Factsheets

In 2006, EPA and the eight major companies in the industry launched the 2010/15 PFOA Stewardship Program, in which companies committed to reduce global facility emissions and product content of PFOA and related chemicals by 95 percent by 2010, and to work

A review of antimicrobial stewardship training in medical education

PubMed Central

Silverberg, Sarah L.; Zannella, Vanessa E.; Countryman, Drew; Ayala, Ana Patricia; Lenton, Erica; Friesen, Farah

2017-01-01

Objectives We reviewed the published literature on antimicrobial stewardship training in undergraduate and postgraduate medical education to determine which interventions have been implemented, the extent to which they have been evaluated, and to understand which are most effective. Methods We searched Ovid MEDLINE and EMBASE from inception to December 2016. Four thousand three hundred eighty-five (4385) articles were identified and underwent title and abstract review. Only those articles that addressed antimicrobial stewardship interventions for medical trainees were included in the final review. We employed Kirkpatrick’s four levels of evaluation (reaction, learning, behaviour, results) to categorize intervention evaluations. Results Our review included 48 articles. The types of intervention varied widely amongst studies worldwide. Didactic teaching was used heavily in all settings, while student-specific feedback was used primarily in the postgraduate setting. The high-level evaluation was sparse, with 22.9% reporting a Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one article reported positive results from the intervention. No articles evaluated the impact of an intervention on undergraduate trainees’ prescribing behaviour after graduation. Conclusions This study enhances our understanding of the extent of antimicrobial stewardship in the context of medical education. While our study demonstrates that medical schools are implementing antimicrobial stewardship interventions, rigorous evaluation of programs to determine whether such efforts are effective is lacking. We encourage more robust evaluation to establish effective, evidence-based approaches to training prescribers in light of the global challenge of antimicrobial resistance.  PMID:29035872

Intercomparison of SOUP, ASP, LPSP, and MDI magnetograms

NASA Astrophysics Data System (ADS)

Berger, T.; Lites, B.; Martinez-Pillet, V.; Tarbell, T.; Title, A.

2001-05-01

We compare simultaneous magnetograms of a solar active region taken by the Advanced Stokes Polarimeter (ASP) and the Solar Optical Universal Polimeter (SOUP) in 1998. In addition we compare magnetograms taken by the La Palma Stokes Polarimeter (LPSP), the Michelson Doppler Imager (MDI) on SOHO, and the SOUP instrument in 2000. The SOUP instrument on the Swedish Vacuum Solar Telescope (SVST) attains the highest spatial resolution but has the least understood calibration; the ASP on the Dunn Solar Telescope (DST) at Sacramento Peak attains the highest magnetic field precision. The goal of the program is to better quantify the SOUP magnetograms and thereby study magnetic element dynamics in the photosphere with higher precision.

Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. I. Rationale for and avenues toward a green pharmacy.

PubMed Central

Daughton, Christian G

2003-01-01

Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. Although PPCPs typically have been identified in surface and ground waters, some are also undoubtedly associated with solid phases such as suspended particulates, sediments, and sewage sludges, despite their relatively high affinity for water. Often amenable to degradation, their continual introduction to waste-receiving waters results from their widespread, continuous, combined use by individuals and domestic animals, giving PPCPs a "pseudo-persistence" in the environment. Little is known about the environmental or human health hazards that might be posed by chronic, subtherapeutic levels of these bioactive substances or their transformation products. The continually growing, worldwide importance of freshwater resources, however, underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite the paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented to reduce or minimize the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment; additional, collateral benefits could automatically accrue, including reducing consumers' medication expenses and improving patient health and consumer safety. In this article, the first of a two-part mini-monograph describing the "green pharmacy," I focus initially on the background behind the imperative for an ecologically oriented stewardship program for PPCPs. I then present a broad spectrum of possible source control/reduction actions, controlled largely by the health care industry, that could minimize the disposition of PPCPs to the environment. This two-part mini-monograph attempts to capture cohesively for the first time the wide spectrum of actions available for minimizing the release of PPCPs to the environment. A major objective is to generate an active dialog or debate across the many disciplines that must become actively involved to design and implement a successful approach to life-cycle stewardship of PPCPs. PMID:12727606

Physical activity opportunities in afterschool programs.

PubMed

Weaver, R Glenn; Beets, Michael W; Huberty, Jennifer; Freedman, Darcy; Turner-Mcgrievy, Gabrielle; Ward, Diane

2015-05-01

Afterschool programs (ASPs) have potential to provide children moderate to vigorous physical activity (MVPA). The availability and types (e.g., free play or organized activities) of physical activity opportunities, their structure (e.g., presence of lines, elimination games), and staff behaviors (e.g., encouragement, engaged) can influence children's MVPA. This study explored these factors in 20 ASPs serving over 1,700 elementary-age children. The occurrence, types, and structure of physical activity opportunities, and staff behaviors were collected via the SOSPAN (System for Observing Staff Promotion of Physical Activity and Nutrition). A total of 4,660 SOSPAN scans were completed across 63 complete program days (1,733 during physical activity opportunities). Physical activity opportunities were observed on 60 program days across all 20 sites, with 73% of those opportunities classified as free play. ASPs scheduled an average of 66.3 minutes (range 15-150 minutes) of physical activity opportunities daily. Games played included basketball, tag, soccer, and football. Staff rarely engaged in physical activity promotion behaviors, and the structure of organized games discouraged MVPA. For example, staff verbally promoted physical activity in just 6.1% of scans, while organized games were more likely to involve lines and elimination. Professional development training may enhance staffs' physical activity promotion and the structure of activity opportunities. © 2015 Society for Public Health Education.

Physical activity opportunities in afterschool programs

PubMed Central

Weaver, R. Glenn; Beets, Michael W.; Huberty, Jennifer; Freedman, Darcy; Turner-Mcgrievy, Gabrielle; Ward, Diane

2015-01-01

Afterschool programs (ASPs) have potential to provide children moderate-to-vigorous physical activity (MVPA). The availability and types (e.g., free play or organized activities) of physical activity opportunities, their structure (e.g., presence of lines, elimination games), and staff behaviors (e.g., encouragement, engaged) can influence children’s MVPA. This study explored these factors in 20 ASPs serving over 1,700 elementary-age children. The occurrence, types and structure of physical activity opportunities, and staff behaviors were collected via the System for Observing Staff Promotion of Physical Activity and Nutrition (SOSPAN). A total of 4,660 SOSPAN scans were completed across 63 complete program days (1733 during physical activity opportunities). Physical activity opportunities were observed on 60 program days across all 20 sites, with 73% of those opportunities classified as free play. ASPs scheduled an average of 66.3 minutes (range 15-150min) of physical activity opportunities daily. Games played included basketball, tag, soccer and football. Staff rarely engaged in physical activity promotion behaviors, and the structure of organized games discouraged MVPA. For example, staff verbally promoted physical activity in just 6.1% of scans, while organized games were more likely to involve lines and elimination. Professional development training may enhance staffs’ physical activity promotion and the structure of activity opportunities. PMID:25586132

Accident sequence precursor events with age-related contributors

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

Murphy, G.A.; Kohn, W.E.

1995-12-31

The Accident Sequence Precursor (ASP) Program at ORNL analyzed about 14.000 Licensee Event Reports (LERs) filed by US nuclear power plants 1987--1993. There were 193 events identified as precursors to potential severe core accident sequences. These are reported in G/CR-4674. Volumes 7 through 20. Under the NRC Nuclear Plant Aging Research program, the authors evaluated these events to determine the extent to which component aging played a role. Events were selected that involved age-related equipment degradation that initiated an event or contributed to an event sequence. For the 7-year period, ORNL identified 36 events that involved aging degradation as amore » contributor to an ASP event. Except for 1992, the percentage of age-related events within the total number of ASP events over the 7-year period ({approximately}19%) appears fairly consistent up to 1991. No correlation between plant ape and number of precursor events was found. A summary list of the age-related events is presented in the report.« less

A functional nonsynonymous toll-like receptor 4 gene polymorphism is associated with metabolic syndrome, surrogates of insulin resistance, and syndromes of lipid accumulation.

PubMed

Steinhardt, Alberto Penas; Aranguren, Florencia; Tellechea, Mariana L; Gómez Rosso, Leonardo A; Brites, Fernando D; Martínez-Larrad, Maria T; Serrano-Ríos, Manuel; Frechtel, Gustavo D; Taverna, Mariano J

2010-05-01

Toll-like receptor 4 (TLR4) plays a key role in the activation of innate immune responses. Loss-of-function mutations in TLR4 prevent diet-induced obesity and insulin resistance (IR). We conducted a population cross-sectional study to evaluate whether Asp299Gly (rs4986790) TLR4 gene polymorphism is associated with metabolic syndrome (MS), surrogates of IR, and syndromes of lipid accumulation (SLAs) in Argentinean healthy male subjects. rs4986790 was genotyped in 621 healthy unrelated male blood donors. National Cholesterol Education Program/Adult Treatment Panel III-MS (NCEP/ATP III-MS); SLAs such as enlarged waist elevated triglyceride syndrome (EWET), hypertriglyceridemic waist (HW), and overweight-lipid syndrome (OLS); and surrogates of IR were assessed. The prevalence of MS, OLS, and EWET was significantly higher among Asp299Asp carriers (P < .05). These findings were confirmed using 32 000 bootstrap samples. Surrogate markers of IR were also significantly higher in Asp299Asp carriers (P < .05). Most findings were especially strengthened among individuals with C-reactive protein below the 95th percentile and/or total cholesterol to high-density lipoprotein cholesterol ratio >or=5. This is the first report to find, in Argentinean healthy male blood donors, associations between the Asp299Asp genotype of rs4986790 TLR4 gene polymorphism and high risk for NCEP/ATP III-MS, SLAs, and surrogates of IR. These findings are consistent with previous functional and observational studies showing that Asp299 allele, in comparison with Gly299, is associated with increased TLR4 activation, higher levels of inflammatory cytokines, acute-phase reactants and soluble adhesion molecules, and higher risk of atherosclerosis.

2009 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

2011 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

2006 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

2013 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

2007 Community Involvement Training Conference

EPA Pesticide Factsheets

A dynamic training conference that brings together more than 450 people from EPA and the Agency’s partners and stakeholders who plan and implement environmental community involvement, partnership, stewardship, outreach, and education programs.

Antimicrobial Stewardship in the Emergency Department and Guidelines for Development

PubMed Central

May, Larissa; Cosgrove, Sara; L’Archeveque, Michelle; Talan, David A.; Payne, Perry; Rothman, Richard E.

2013-01-01

Antimicrobial resistance is a mounting public health concern. Emergency departments (EDs) represent a particularly important setting for addressing inappropriate antimicrobial prescribing practices, given the frequent use of antibiotics in this setting that sits at the interface of the community and the hospital. This article outlines the importance of antimicrobial stewardship in the ED setting and provides practical recommendations drawn from existing evidence for the application of various strategies and tools that could be implemented in the ED including advancement of clinical guidelines, clinical decision support systems, rapid diagnostics, and expansion of ED pharmacist programs. PMID:23122955

Stewardship matters: Case studies in establishment success of urban trees

Treesearch

Lara A. Roman; Lindsey A. Walker; Catherine M. Martineau; David J. Muffly; Susan A. MacQueen; Winnie Harris

2015-01-01

Urban tree planting initiatives aim to provide ecosystem services that materialize decades after planting, therefore understanding tree survival and growth is essential to evaluating planting program performance. Tree mortality is relatively high during the establishment phase, the first few years after planting. Qualitative assessments of programs with particularly...

THE SOUTHWEST REGIONAL GAP PROJECT: A DATABASE MODEL FOR REGIONAL LANDSCAPE ASSESSMENT, RESOURCE PLANNING, AND VULNERABILITY ANALYSIS

EPA Science Inventory

The Gap Analysis Program (GAP) is a national interagency program that maps the distribution of plant communities and selected animal species and compares these distributions with land stewardship to identify biotic elements at potential risk of endangerment. Acquisition of primar...

Gardening with Children: My Summers at Beanstalk Children's Garden

ERIC Educational Resources Information Center

Stoecklin, Vicki L.

2009-01-01

There has been increased interest in recent years on gardening with children and a variety of programs have been started to support different types of programmatic goals. Goals of gardening programs include environmental stewardship, personal growth/social skills, an integrated learning environment, nutrition/health, science education, practical…

Wilderness education: The ultimate commitment to quality wilderness stewardship

Treesearch

Gregory F. Hansen; Tom Carlson

2007-01-01

The effective planning, implementation, and monitoring of a wilderness education program will ultimately produce measurable results that can be instrumental in achieving wilderness management goals and objectives. This paper will provide a simple step-by-step overview of how to develop and maintain a successful wilderness education program through planning,...

Keepers of the Seals.

ERIC Educational Resources Information Center

Momatiuk, Yva; Eastcott, John

1998-01-01

The Pribilof Islands Stewardship Program aims to preserve the rich species diversity of the islands and recover the sense of connectedness that once linked local Aleuts and their environment. The summer program draws on both science and traditional knowledge, offering Aleut youth the chance to assist scientists, protect the seals, and participate…

A Perspective on Carnegie Corporation's Program, 1983-1997.

ERIC Educational Resources Information Center

Hamburg, David A.

The Carnegie Corporation's mission is to continue Andrew Carnegie's philanthropic preoccupations with promoting education and world peace. In this essay, retiring Carnegie Corporation President David A. Hamburg provides a detailed accounting of his stewardship of the foundation since 1983, when he set forth new program directions in the context of…

QuikSCience: Effective Linkage of Competitive, Cooperative, and Service Learning in Science Education

ERIC Educational Resources Information Center

Lemus, Judith D.; Bishop, Kristina; Walters, Howard

2010-01-01

The QuikSCience Challenge science education program combines a cooperative team project emphasizing community service with an academic competition for middle and high school students. The program aims to develop leadership abilities, motivate interest in ocean sciences, engage students in community service and environmental stewardship, and…

NOS3 Glu298Asp genotype and blood pressure response to endurance training: the HERITAGE family study.

PubMed

Rankinen, T; Rice, T; Pérusse, L; Chagnon, Y C; Gagnon, J; Leon, A S; Skinner, J S; Wilmore, J H; Rao, D C; Bouchard, C

2000-11-01

Endothelium-dependent vasodilation is a mechanism that may affect blood pressure response to endurance training. Because NO plays a central role in this process, the endothelial NO synthase gene is a good candidate for the regulation of exercise blood pressure. We investigated the associations between an endothelial NO synthase gene polymorphism (Glu298Asp) and endurance training-induced changes in resting and submaximal exercise blood pressure in 471 white subjects of the HERITAGE Family Study. Two submaximal exercise tests at 50 W were conducted both before and after a 20-week endurance training program. Steady-state exercise blood pressure was measured twice in each test with an automated unit. The Glu298Asp polymorphism was typed with a PCR-based method and digestion with BAN:II. Both systolic and diastolic blood pressure at 50 W decreased in response to the training program, whereas resting blood pressure remained unchanged. The decrease in diastolic blood pressure at 50 W was greater (P=0.0005, adjusted for age, gender, baseline body mass index, and baseline diastolic blood pressure at 50 W) in the Glu/Glu homozygotes (4.4 [SEM 0.4] mm Hg, n=187) than in the heterozygotes (3.1 [0.4] mm Hg, n=213) and the Asp/Asp homozygotes (1.3 [0.7] mm Hg, n=71). The genotype accounted for 2.3% of the variance in diastolic blood pressure at 50 W training response. Both the Glu298 homozygotes and the heterozygotes had a greater (P=0.013) training-induced reduction in rate-pressure product at 50 W than the Asp298 homozygotes. These data suggest that DNA sequence variation in the endothelial NO synthase gene locus is associated with the endurance training-induced decreases in submaximal exercise diastolic blood pressure and rate-pressure product in sedentary normotensive white subjects.

The effectiveness of experiential environmental education: O'Neill Sea Odyssey program case study

NASA Astrophysics Data System (ADS)

Hanneman, Lauren E.

Environmental education programs aim to develop participant awareness, sensitivity, and understanding of their affective relationship to the natural environment through conceptual knowledge and personal experiences. Previous findings have suggested that participation in environmental education programs leads to short-term positive increases in environmental knowledge, pro-environmental attitudes, and intentions to act in environmentally responsible behaviors; however, few studies have included long-term, follow-up assessment. This research provided an analysis of the effectiveness of the O'Neill Sea Odyssey (OSO) education program in fostering a long-term awareness of personal responsibility about ocean pollution among student participants. A survey administered to 261 students from the greater San Francisco Bay Area in California was used to explore 7th through 10 th grade students' conceptions about the connection between ocean pollution and stewardship behaviors. The study revealed that 75% of 86 former OSO participants retained a high level of awareness of the connection between non-point source pollution and personal behaviors two to five years after the program, regardless of differences in sex, language, grade level, and community setting. These results indicate that OSO participants retained a long-term conceptual awareness about environmental stewardship behaviors taught during the OSO program.

76 FR 65121 - Community Forest and Open Space Conservation Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-20

... broad range of citizens in forest conservation, stewardship, and governance. Where situated near Federal... conservation of a tract but does not have the capacity to effectively oversee management and governance issues...

75 FR 34924 - Conservation Stewardship Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-21

... the words of ``issuance'' at the end of the preamble. DATES: Effective Date: The rule is effective...: Words of Issuance [Corrected] (1) On page 31653, in the second column, the Words of Issuance that read...

Development of Designer Diamond Technology for High Pressure High Temperature Experiments in Support of Stockpile Stewardship Program

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

Vohra, Yogesh, K.

The role of nitrogen in the fabrication of designer diamond was systematically investigated by adding controlled amount of nitrogen in hydrogen/methane/oxygen plasma. This has led to a successful recipe for reproducible fabrication of designer diamond anvils for high-pressure high-temperature research in support of stockpile stewardship program. In the three-year support period, several designer diamonds fabricated with this new growth chemistry were utilized in high-pressure experiments at UAB and Lawrence Livermore National Laboratory. The designer diamond anvils were utilized in high-pressure studies on heavy rare earth metals, high pressure melting studies on metals, and electrical resistance measurements on iron-based layered superconductorsmore » under high pressures. The growth chemistry developed under NNSA support can be adapted for commercial production of designer diamonds.« less

Intergenerational equity and environmental restoration cleanup levels.

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

Hocking, E. K.; Environmental Assessment

2001-01-01

The United States Department of Energy environmental restoration program faces difficult decisions about the levels of cleanup to be achieved at its many contaminated sites and has acknowledged the need for considering intergenerational equity in its decision making. Intergenerational equity refers to the fairness of access to resources across generations. Environmental restoration cleanup levels can have unintended and unfair consequences for future generations access to resources. The potentially higher costs associated with using low, non-risk-based cleanup levels for remediation may divert funding from other activities that could have a greater beneficial impact on future generations. Low, non-risk-based cleanup levels couldmore » also result in more damage to the nation's resources than would occur if a higher cleanup level were used. The loss or impairment of these resources could have an inequitable effect on future generations. However, intergenerational inequity could arise if sites are not completely restored and if access to and use of natural and cultural resources are unfairly limited as a result of residual contamination. In addition to concerns about creating possible intergenerational inequities related to selected cleanup levels, the tremendous uncertainties associated with sites and their restoration can lead site planners to rely on stewardship by default. An ill-conceived stewardship program can contribute to intergenerational inequity by limiting access to resources while passing on risks to future generations and not preparing them for those risks. This paper presents a basic model and process for designing stewardship programs that can achieve equity among generations.« less

Antibiotic Consumption During a 4-year Period in a Community Hospital with an Antimicrobial Stewardship Program

PubMed Central

Garcell, Humberto Guanche; Arias, Ariadna Villanueva; Fernandez, Eliezer Alemán; Guerrero, Yaquelín Batista; Serrano, Ramon N. Alfonso

2016-01-01

Objectives We sought to evaluate the trend of antibiotic consumption in patients admitted to a community hospital in Qatar with an antimicrobial stewardship program. Methods This observational study was carried out in a 75-bed facility in Western Qatar over a 4-year period (2012–2015). The monitoring of antimicrobial consumption from inpatient wards was performed from the pharmacy records and presented as defined daily dose (DDD) divided by the patient days and expressed as 100 bed-days (DBD). Results The consumption of antimicrobials in 2012 was 171.3 DBD, and increased to 252.7 DBD in 2013, 229.1 DBD in 2014, and 184.7 DBD in 2015. Cephalosporins use reduced from 98.2 DBD in 2013 to 51.5 DBD in 2015 while the consumption of penicillins increased during the beginning of 2014 with a slight decrease in 2015. Carbapenems consumption during 2014–2015 was lower than previous years, and vice-versa for aminoglycosides. Fluoroquinolones had a sustained increase with 37.1% increased consumption in 2015 compared to the two previous years. There was an increase in the use of intravenous (IV) (108.5%) and oral azithromycin (55.1%) and the use of oral (152.8%) and IV moxifloxacin (22.9%). Conclusions We observed a decrease in antibiotic use in patients admitted to a community hospital with an antimicrobial stewardship program, but the increase in fluoroquinolones consumption is a concern that requires focused strategies. PMID:27602189

An increase level of acylation stimulating protein is correlated with metabolic risk markers in North Indian obese women.

PubMed

Mishra, Supriya; Gupta, Vani; Mishra, Sameeksha; Gupta, Vandana; Mahdi, Abbas Ali; Sachan, Rekha

2017-12-01

The present study was to investigate the association between serum acylation stimulating protein (ASP) level with metabolic risk factors in North Indian obese women. This is a case control study, total n=322 women aged between 20 and 45 years (n=162 with metabolic syndrome & n=160 without metabolic syndrome) were recruited for the study according to National Cholesterol Education Program Treatment Panel (NCEPATP) guidelines. Serum ASP level were determined by enzyme linked immunosorbent assay. Results indicated that circulating ASP and other metabolic risk factors (waist circumference, triglycerides, fasting plasma glucose etc) were significantly higher in women with metabolic syndrome (WmetS) than in women without syndrome (WometS) (p<0.001). Furthermore circulating ASP was significantly higher possitively correlated with waist circumference (r=0.51, p<0.001), triglyceride (r=0.56, p<0.001), glucose (r=0.70, p<0.001), and negatively correlated with high density lipoprotein(r=-0.56, p<0.001) in women with metabolic syndrome. Conclusively circulating ASP was found to be significantly associated with hyperlipidemia, obesity and obesity related disorders in North Indian obese women. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Antimicrobial Stewardship: The Need to Cover All Bases

PubMed Central

Friedman, N. Deborah

2013-01-01

Increasing antimicrobial resistance has necessitated an approach to guide the use of antibiotics. The necessity to guide antimicrobial use via stewardship has never been more urgent. The decline in anti-infective innovation and the failure of currently available antimicrobials to treat some serious infections forces clinicians to change those behaviors that drive antimicrobial resistance. The majority of antimicrobial stewardship (AMS) programs function in acute-care hospitals, however, hospitals are only one setting where antibiotics are prescribed. Antimicrobial use is also high in residential aged care facilities and in the community. Prescribing in aged care is influenced by the fact that elderly residents have lowered immunity, are susceptible to infection and are frequently colonized with multi-resistant organisms. While in the community, prescribers are faced with public misconceptions about the effectiveness of antibiotics for many upper respiratory tract illnesses. AMS programs in all of these locations must be sustainable over a long period of time in order to be effective. A future with effective antimicrobials to treat bacterial infection will depend on AMS covering all of these bases. This review discusses AMS in acute care hospitals, aged care and the community and emphasizes that AMS is critical to patient safety and relies on government, clinician and community engagement. PMID:27029310

[The interplay of diagnostic and antimicrobial stewardship for the management of septic patients: the Tuscan model.

PubMed

Forni, Silvia; Toccafondi, Giulio; Viaggi, Bruno; Grazzini, Maddalena; D'Arienzo, Sara; Gemmi, Fabrizio; Vannucci, Andrea; Tulli, Giorgio

2018-02-01

Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies. This may result in important advancement in time-critical care pathways for septic patients. Nevertheless, RDTM are costly and if not rationally positioned may consume resources and hinder the efficacy of AS programs. In this regard, Tuscany Region is engaged in designing, through a systemic approach, an effective high-quality clinical microbiological service grid. In order to develop a sustainable and equitable model for integrating diagnostic and antimicrobial stewardship we conducted a survey in the regional network of 14 microbiological laboratories. The results shows that in order to develop a sustainable service we need to improve the communication at the interface between laboratories and care unit, harmonize the time windows for processing samples and to devise a robust score for stratifying patient with suspected sepsis.

Antimicrobial Stewardship in the Emergency Department: Challenges, Opportunities, and a Call to Action for Pharmacists.

PubMed

Bishop, Bryan M

2016-12-01

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance. © The Author(s) 2015.

Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions.

PubMed Central

Daughton, Christian G

2003-01-01

Since the 1980s, the occurrence of pharmaceuticals and personal care products (PPCPs) as trace environmental pollutants, originating primarily from consumer use and actions rather than manufacturer effluents, continues to become more firmly established. The growing, worldwide importance of freshwater resources underscores the need for ensuring that any aggregate or cumulative impacts on (or from) water supplies are minimized. Despite a paucity of effects data from long-term, simultaneous exposure at low doses to multiple xenobiotics (particularly non-target-organism exposure to PPCPs), a wide range of proactive actions could be implemented for reducing or minimizing the introduction of PPCPs to the environment. Most of these actions fall under what could be envisioned as a holistic stewardship program--overseen by the health care industry and consumers alike. Significantly, such a stewardship program would benefit not just the environment--additional, collateral benefits could automatically accrue, including the lessening of medication expense for the consumer and improving patient health and consumer safety. In this article (the second of two parts describing the "green pharmacy") I focus on those actions and activities tied more closely to the end user (e.g., the patient) and issues associated with drug disposal/recycling that could prove useful in minimizing the environmental disposition of PPCPs. I also outline some recommendations and suggestions for further research and pose some considerations regarding the future. In this mini-monograph I attempt to capture cohesively for the first time the wide spectrum of actions available for minimizing the release of PPCPs to the environment. A major objective is to generate an active dialog or debate across the many disciplines that must become actively involved to design and implement a successful approach to life-cycle stewardship of PPCPs. PMID:12727607

76 FR 21325 - Notice of Funds Availability: Inviting Applications for the Market Access Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... for the 2012 Market Access Program (MAP). The intended effect of this notice is to solicit... INFORMATION CONTACT: Entities wishing to apply for funding assistance should contact the Program Operations....gov/mos/programs/map.asp . SUPPLEMENTARY INFORMATION: I. Funding Opportunity Description Authority...

Putting The "Yee-Hah!" In Astronomy Outreach: Professional Development Through The ASP "Sky Rangers" Project

NASA Astrophysics Data System (ADS)

Manning, Jim; Gurton, S.; Hurst, A.

2010-05-01

The Astronomical Society of the Pacific is conducting a NASA-funded professional development program to help increase astronomy education and outreach capacity at national parks, nature centers, and other outdoor and environmental centers--venues that still have a dark night sky as a natural resource and a yen to interpret it for their visitors. Through online workshops and on-site workshops at national parks, the ASP staff, working in conjunction with partners from the National Park Service, National Association for Interpretation, and the Association of Science and Technology Centers, provides materials and training focusing on the sky. Participants become part of ASP's "Astronomy from the Ground Up" informational education community of practice, with ongoing options to hone their new skills. The presenter will report on early progress and lessons learned, as well as future plans, as the ASP and its partners work to help wilderness and nature interpreters put a little more "yee-hah!" in their visitor presentations aimed at the sky.

Influence of a 5-year serial infection control and antibiotic stewardship intervention on cardiac surgical site infections.

PubMed

Frenette, Charles; Sperlea, David; Tesolin, Joey; Patterson, Connie; Thirion, Daniel J G

2016-09-01

Surgical site infections (SSIs) complicate surgery, resulting in higher morbidity and mortality. Infection control bundles and antibiotic stewardship can be effective at reducing SSIs. The influence of long-term serial interventions is unclear. The goal of this retrospective quasiexperimental study was to assess the influence of a 5-year serial infection control and antibiotic stewardship intervention on SSIs. The multidisciplinary program actively implemented pre-, intra-, and postoperative strategies over a 5-year period from 2009-2014 for all patients undergoing coronary artery bypass graft (CABG), valve replacement, or both at a tertiary care public institution. Outcomes are compared with a 2-year preinterventions period (2007-2009) and 1-year postinterventions period (2014-2015). A total of 6,518 procedures were included. After interventions, the overall combined infection rate for CABG, CABG and valve, and valve procedures decreased by 66.3%, from 11.9%-4.0% (odds ratio, 0.34; 95% confidence interval, 0.23-0.49; P < .001). A significant decrease of >50% (P < .001) relative rate was observed in overall, sternum, leg, CABG, and combined CABG and valve infection rates when comparing pre- and postinterventions groups. The antibiotic stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 46.8%, from 39.8%-86.6% (95% confidence interval, 41.0-52.4; P < .001). Long-term, serial comprehensive infection control and antibiotic stewardship interventions decrease overall SSIs in patients undergoing CABG and valve replacement procedures. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The Networks and Services of the Astronomical Society of the Pacific

NASA Astrophysics Data System (ADS)

Manning, J. G.; Fraknoi, A.; Gibbs, M. G.; Gurton, S.; Hurst, A.; Berendesen, M.; Deans, P.; White, V.

2008-11-01

Founded in 1889, the Astronomical Society of the Pacific (ASP) is an international organization dedicated to advancing science literacy through engagement in astronomy. Its programs, many with sponsorship from the National Science Foundation, NASA, and astronomical institutions around the world, are particularly designed to assist those who work to improve the public understanding of science. In recent years, the ASP has been expanding the impact of its diverse projects through a variety of networks and services.

Planning for Multiagent Using ASP-Prolog

NASA Astrophysics Data System (ADS)

Son, Tran Cao; Pontelli, Enrico; Nguyen, Ngoc-Hieu

This paper presents an Answer Set Programming based approach to multiagent planning. The proposed methodology extends the action language \\cal B in [12] to represent and reason about plans with cooperative actions of an individual agent operating in a multiagent environment. This language is used to formalize multiagent planning problems and the notion of a joint plan for multiagent in the presence of cooperative actions. Finally, the paper presents a system for computing joint plans based on the ASP-Prolog system.

Community partnership to address snack quality and cost in after-school programs.

PubMed

Beets, Michael W; Tilley, Falon; Turner-McGrievy, Gabrielle; Weaver, Robert G; Jones, Sonya

2014-08-01

Policies call on after-school programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community partnership between ASPs and local grocery stores. Four large-scale ASPs (serving ˜500 children, aged 6-12 years, each day) and a single local grocery store chain participated in this study. The nutritional quality of snacks served was recorded preintervention (18 weeks spring/fall 2011) and postintervention (7 weeks spring 2012) via direct observation, along with cost/child/snack/day. Preintervention snacks were low-nutrient-density salty snacks (eg, chips, 3.0 servings/week), sugar-sweetened beverages (eg, powdered-lemonade, 1.9 servings/week), and desserts (eg, cookies, 2.1 servings/week), with only 0.4 servings/week of fruits and no vegetables. By postintervention, fruits (3.5 servings/week) and vegetables (1.2 servings/week) were increased, whereas sugar-sweetened beverages and desserts were eliminated. Snack expenditures were $0.26 versus $0.24 from preintervention to postintervention. Partnership savings versus purchasing snacks at full retail cost was 24.5% or $0.25/serving versus $0.34/serving. This innovative partnership can serve as a model in communities where ASPs seek to identify low-cost alternatives to providing nutritious snacks. © 2014, American School Health Association.

Community Partnership to Address Snack Quality and Cost in Afterschool Programs

PubMed Central

Tilley, Falon; Turner-McGrievy, Gabrielle; Weaver, Robert Glenn; Jones, Sonya

2014-01-01

Background Policies call on afterschool programs (ASPs) to serve more nutritious snacks. A major barrier for improving snack quality is cost. This study describes the impact on snack quality and expenditures from a community-partnership between ASPs and local grocery stores. Methods Four large-scale ASPs (serving ∼500 children aged 6-12 years each day) and a single local grocery store chain participated in the study. The nutritional quality of snacks served was recorded pre-intervention (18 weeks spring/fall 2011) and post-intervention (7 weeks spring 2012) via direct observation, along with cost/child/snack/day. Results Pre-intervention snacks were low-nutrient-density salty snacks (eg, chips, 3.0 servings/week), sugar-sweetened beverages (eg, powdered-lemonade, 1.9 servings/week), and desserts (eg, cookies, 2.1servings/week), with only 0.4 servings/week of fruits and no vegetables. By post-intervention, fruits (3.5 servings/week) and vegetables (1.2 servings/week) increased, while sugar-sweetened beverages and desserts were eliminated. Snack expenditures were $0.26 versus $0.24 from pre-intervention to post-intervention. Partnership savings versus purchasing snacks at full retail cost was 24.5% or $0.25/serving versus $0.34/serving. Conclusions This innovative partnership can serve as a model in communities where ASPs seek to identify low-cost alternatives to providing nutritious snacks. PMID:25040123

ACHP | News | ACHP Considers Program Comment for Select GSA Repairs and

Science.gov Websites

) legislation has provided GSA with significant stewardship opportunities for its historic public buildings . However, the rigid spending deadline associated with the legislation has prompted the need for this

7 CFR 1470.24 - Payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... associated waste transport or transfer devices for animal feeding operations; or (3) Conservation activities... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM Contracts and Payments... additional conservation activities, and improving, maintaining, and managing existing conservation activities...

7 CFR 1470.24 - Payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... associated waste transport or transfer devices for animal feeding operations; or (3) Conservation activities... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM Contracts and Payments... additional conservation activities, and improving, maintaining, and managing existing conservation activities...

7 CFR 1470.24 - Payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... associated waste transport or transfer devices for animal feeding operations; or (3) Conservation activities... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM Contracts and Payments... additional conservation activities, and improving, maintaining, and managing existing conservation activities...

7 CFR 1470.24 - Payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... associated waste transport or transfer devices for animal feeding operations; or (3) Conservation activities... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION STEWARDSHIP PROGRAM Contracts and Payments... additional conservation activities, and improving, maintaining, and managing existing conservation activities...

Science-based stockpile stewardship at Los Alamos National Laboratory

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

Immele, J.

1995-10-01

I would like to start by working from Vic Reis`s total quality management diagram in which he began with the strategy and then worked through the customer requirements-what the Department of Defense (DoD) is hoping for from the science-based stockpile stewardship program. Maybe our customer`s requirements will help guide some of the issues that we should be working on. ONe quick answer to {open_quotes}why have we adopted a science-based strategy{close_quotes} is that nuclear weapons are a 50-year responsibility, not just a 5-year responsibility, and stewardship without testing is a grand challenge. While we can do engineering maintenance and turn overmore » and remake a few things on the short time scale, without nuclear testing, without new weapons development, and without much of the manufacturing base that we had in the past, we need to learn better just how these weapons are actually working.« less

Penicillin skin testing: potential implications for antimicrobial stewardship.

PubMed

Unger, Nathan R; Gauthier, Timothy P; Cheung, Linda W

2013-08-01

As the progression of multidrug-resistant organisms and lack of novel antibiotics move us closer toward a potential postantibiotic era, it is paramount to preserve the longevity of current therapeutic agents. Moreover, novel interventions for antimicrobial stewardship programs are integral to combating antimicrobial resistance worldwide. One unique method that may decrease the use of second-line antibiotics (e.g., fluoroquinolones, vancomycin) while facilitating access to a preferred β-lactam regimen in numerous health care settings is a penicillin skin test. Provided that up to 10% of patients have a reported penicillin allergy, of whom ~10% have true IgE-mediated hypersensitivity, significant potential exists to utilize a penicillin skin test to safely identify those who may receive penicillin or a β-lactam antibiotic. In this article, we provide information on the background, associated costs, currently available literature, pharmacists' role, antimicrobial stewardship implications, potential barriers, and misconceptions, as well as future directions associated with the penicillin skin test. © 2013 Pharmacotherapy Publications, Inc.

The Development of NOAA Education Common Outcome Performance Measures (Invited)

NASA Astrophysics Data System (ADS)

Baek, J.

2013-12-01

The National Oceanic and Atmospheric Administration (NOAA) Education Council has embarked on an ambitious Monitoring and Evaluation (M&E) project that will allow it to assess education program outcomes and impacts across the agency, line offices, and programs. The purpose of this internal effort is to link outcome measures to program efforts and to evaluate the success of the agency's education programs in meeting the strategic goals. Using an outcome-based evaluation approach, the NOAA Education Council is developing two sets of common outcome performance measures, environmental stewardship and professional development. This presentation will examine the benefits and tradeoffs of common outcome performance measures that collect program results across a portfolio of education programs focused on common outcomes. Common outcome performance measures have a few benefits to our agency and to the climate education field at large. The primary benefit is shared understanding, which comes from our process for writing common outcome performance measures. Without a shared and agreed upon set of definitions for the measure of an outcome, the reported results may not be measuring the same things and would incorrectly indicate levels of performance. Therefore, our writing process relies on a commitment to developing a shared set of definitions based on consensus. We hope that by taking the time to debate and coming to agreement across a diverse set of programs, the strength of our common measures can indicate real progress towards outcomes we care about. An additional benefit is that these common measures can be adopted and adapted by other agencies and organizations that share similar theories of change. The measures are not without their drawbacks, and we do make tradeoffs as part of our process in order to continue making progress. We know that any measure is necessarily a narrow slice of performance. A slice that may not best represent the unique and remarkable contribution of an individual program, but does reflect a variety of contributions along a single dimension across a large portfolio of programs. The process has ended up pushing our working group to call for even more measures, to capture an increasing number of dimensions that reflect the nature of the portfolio of programs. This past year we have been working on developing two sets of common outcome performance measures for professional development (PD) and stewardship education programs. The outcome we chose for PD programs was the use of what was learned in the educator's practice. The outcome we chose for stewardship programs was the stewardship behaviors that participants learn and practice. The measurement of these outcomes will inform whether our strategies are having their intended impact. By knowing how and how much these outcomes are occurring as a result of our program, we can improve program performance over time. The common outcome performance measures help demonstrate how these programs engage audiences in supporting NOAA's mission. As AGU climate literacy community continues to grow, it is important to consider an approach to demonstrate the community's contribution to the Nation's climate literacy. Development of common outcome performance measures is one approach that could help focus the community in meeting its goals.

LONG-TERM STEWARDSHIP AT DOE HANFORD SITE - 12575

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

MOREN RJ; GRINDSTAFF KD

2012-01-11

The U.S. Department of Energy's (DOE) Hanford Site is located in southeast Washington and consists of 1,518 square kilometers (586 square miles) of land. Established in 1943 as part of the Manhattan Project, Hanford workers produced plutonium for our nation's nuclear defense program until the mid 1980's. Since then, the site has been in cleanup mode that is being accomplished in phases. As we achieve remedial objectives and complete active cleanup, DOE will manage Hanford land under the Long-Term Stewardship (LTS) Program until completion of cleanup and the site becomes ready for transfer to the post cleanup landlord - currentlymore » planned for DOE's Office of Legacy Management (LM). We define Hanford's LTS Program in the ''Hanford Long-Term Stewardship Program Plan,'' (DOE/RL-201 0-35)[1], which describes the scope including the relationship between the cleanup projects and the LTS Program. DOE designed the LTS Program to manage and provide surveillance and maintenance (S&M) of institutional controls and associated monitoring of closed waste sites to ensure the protection of human health and the environment. DOE's Richland Operations Office (DOE-RL) and Hanford cleanup and operations contractors collaboratively developed this program over several years. The program's scope also includes 15 key activities that are identified in the DOE Program Plan (DOE/RL-2010-35). The LTS Program will transition 14 land segments through 2016. The combined land mass is approximately 570 square kilometers (220 square miles), with over 1,300 active and inactive waste sites and 3,363 wells. Land segments vary from buffer zone property with no known contamination to cocooned reactor buildings, demolished support facilities, and remediated cribs and trenches. DOE-RL will transition land management responsibilities from cleanup contractors to the Mission Support Contract (MSC), who will then administer the LTS Program for DOE-RL. This process requires an environment of cooperation between the contractors and DOE-RL. Information Management (IM) is a key part of the LTS program. The IM Program identifies, locates, stores, protects and makes accessible Hanford LTS records and data to support the transfer of property ultimately to LM. As such, DOE-RL manages the Hanford LTS Program in a manner consistent with LM's goals, policies, and procedures.« less

Simulating Aerosol Optical Properties With the Aerosol Simulation Program (ASP): Closure Studies Using ARCTAS Data

NASA Astrophysics Data System (ADS)

Alvarado, M. J.; Macintyre, H. L.; Bian, H.; Chin, M.; Wang, C.

2012-12-01

The scattering and absorption of ultraviolet and visible radiation by aerosols can significantly alter actinic fluxes and photolysis rates. Accurate modeling of aerosol optical properties is thus essential to simulating atmospheric chemistry, air quality, and climate. Here we evaluate the aerosol optical property predictions of the Aerosol Simulation Program (ASP) with in situ data on aerosol scattering and absorption gathered during the Arctic Research of the Composition of the Troposphere from Aircraft and Satellites (ARCTAS) campaign. The model simulations are initialized with in situ data on the aerosol size distribution and composition. We perform a set of sensitivity studies (e.g., internal vs. external mixture, core-in-shell versus Maxwell-Garnett, fraction of the organic carbon mass that is light-absorbing "brown carbon," etc.) to determine the model framework and parameters most consistent with the observations. We compare the ASP results to the aerosol optical property lookup tables in FAST-JX and suggest improvements that will better enable FAST-JX to simulate the impact of aerosols on photolysis rates and atmospheric chemistry.

From policy to practice: Addressing snack quality, consumption, and price in afterschool programs

PubMed Central

Beets, Michael W.; Tilley, Falon; Weaver, Robert G.; Turner-McGrievy, Brie; Moore, Justin B.; Webster, Collin

2013-01-01

Objective To evaluate a community partnership between afterschool programs (ASPs) and grocery store to provide discounted pricing on snacks to meet the National Afterschool Association Healthy Eating Standards that call for serving a fruit/vegetable (FV) daily, while eliminating sugar-based foods/beverages. Methods A single-group, pre- with multiple post-test design (Spring 2011–2013) in four large-scale ASPs serving 500 children/day was used along with direct observation of snacks served, consumed, and cost. Results At baseline FV, sugar-sweetened beverages (SSB), and desserts were served 0.1±0.5, 1.7±2.0, and 2.0±1.4 days/wk. By Spring 2013, FV increased to 5.0±0.0 days/wk, while SSB and desserts were eliminated. Eighty-four percent of children consumed the fruit; 59% consumed the vegetables. Cost associated with purchasing snacks resulted in a $2,000–$3,000 savings over a standard 180day school year. Conclusions and Implications This partnership can serve as a model for successfully meeting nutrition policies established for ASP snacks. PMID:24268299

75 FR 43199 - Notice of Public Meeting; Central Montana Resource Advisory Council

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-23

... sage grouse study project; A presentation about the Undaunted Stewardship Program; A field visit to an... details (next meeting date, location, travel vouchers, etc.). All RAC meetings are open to the public. The...

Y-12 Site Sustainability Plan

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

Spencer, Charles G

2012-12-01

The accomplishments to date and the long-range planning of the Y-12 Energy Management and Sustainability and Stewardship programs support the U.S. Department of Energy (DOE) and the National Nuclear Security Administration (NNSA) vision for a commitment to energy effi ciency and sustainability and to achievement of the Guiding Principles. Specifi cally, the Y-12 vision is to support the Environment, Safety and Health Policy and the DOE Strategic Sustainability Performance Plan, while promoting overall sustainability and reduction of greenhouse gas emissions. The mission of the Y-12 Energy Management program is to incorporate energy-effi cient technologies site-wide and to position Y-12 tomore » meet NNSA energy requirement needs through 2025 and beyond. The plan addresses greenhouse gases, buildings, fleet management, water use, pollution prevention, waste reduction, sustainable acquisition, electronic stewardship and data centers, site innovation and government-wide support.« less

AN INTER-AGENCY APPROACH FOR DETERMINING REGIONAL LAND COVER AND SPECIES HABITAT CONSERVATION STATUS IN THE AMERICAN SOUTHWEST: THE SOUTHWEST REGIONAL GAP ANALYSIS PROJECT

EPA Science Inventory

The Gap Analysis Program (GAP) is a national inter-agency program that maps the distribution of plant communities and selected animal species and compares these distributions with land stewardship to identify biotic elements at potential risk of endangerment. GAP uses remote sens...

What Difference Does It Make? Assessing Outcomes from Participation in a Residential Environmental Education Program

ERIC Educational Resources Information Center

Stern, Marc J.; Powell, Robert B.; Ardoin, Nicole M.

2008-01-01

The authors explored the influences of 3- and 5-day residential environmental education programs at the Great Smoky Mountains Institute at Tremont (TN) on participants' connections with nature, environmental stewardship, interest in learning and discovery, and awareness of the Great Smoky Mountains National Park and biodiversity. The authors found…

77 FR 24169 - Notice of Funds Availability: Inviting Applications for the Market Access Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-23

... for the 2013 Market Access Program (MAP). The intended effect of this notice is to solicit... not be considered. FOR FURTHER INFORMATION CONTACT: Entities wishing to apply for funding assistance... at http://www.fas.usda.gov/mos/programs/map.asp . SUPPLEMENTARY INFORMATION: I. Funding Opportunity...

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship.

PubMed

Messacar, Kevin; Parker, Sarah K; Todd, James K; Dominguez, Samuel R

2017-03-01

New rapid molecular diagnostic technologies for infectious diseases enable expedited accurate microbiological diagnoses. However, diagnostic stewardship and antimicrobial stewardship are necessary to ensure that these technologies conserve, rather than consume, additional health care resources and optimally affect patient care. Diagnostic stewardship is needed to implement appropriate tests for the clinical setting and to direct testing toward appropriate patients. Antimicrobial stewardship is needed to ensure prompt appropriate clinical action to translate faster diagnostic test results in the laboratory into improved outcomes at the bedside. This minireview outlines the roles of diagnostic stewardship and antimicrobial stewardship in the implementation of rapid molecular infectious disease diagnostics. Copyright © 2017 American Society for Microbiology.

Making WaterSense in Charlottesville

EPA Pesticide Factsheets

From a 5K race to $100 toilet rebates to an “Imagine a Day without Water” campaign, the City of Charlottesville, Virginia, is a leader in working with EPA’s WaterSense program to promote water conservation and resource stewardship.

7 CFR 1469.5 - Eligibility requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General...) Land must meet the definition of eligible land; and (3) The application must meet the conservation...-up. Producers who are participants in an existing conservation stewardship contract are not eligible...

7 CFR 1469.5 - Eligibility requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General...) Land must meet the definition of eligible land; and (3) The application must meet the conservation...-up. Producers who are participants in an existing conservation stewardship contract are not eligible...

7 CFR 1469.5 - Eligibility requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM General...) Land must meet the definition of eligible land; and (3) The application must meet the conservation...-up. Producers who are participants in an existing conservation stewardship contract are not eligible...

Alaska Department of Natural Resources

Science.gov Websites

and Commissions Board of Agriculture Board of Forestry Community Forest Council Forest Stewardship Development Advisory Board Media Releases Public Notices Divisions/Offices Divisions Agriculture Forestry Programs and Services Agriculture Forestry Geological & Geophysical Surveys Mining, Land & Water

Alaska Department of Natural Resources

Science.gov Websites

Commissions Board of Agriculture Board of Forestry Community Forest Council Forest Stewardship Coordinating Development Advisory Board Media Releases Public Notices Divisions/Offices Divisions Agriculture Forestry divisions reflect its major programs: Agriculture, Forestry, Geological & Geophysical Surveys, Mining

Alaska Department of Natural Resources

Science.gov Websites

Commissions Board of Agriculture Board of Forestry Community Forest Council Forest Stewardship Coordinating Development Advisory Board Media Releases Public Notices Divisions/Offices Divisions Agriculture Forestry major programs: Agriculture, Forestry, Geological & Geophysical Surveys, Mining, Land & Water

THE POTENTIAL ROLE OF REMOTE SENSING IN TRANSGENIC CROP MONITORING PROGRAMS

EPA Science Inventory

Sustainable agriculture combines efficient production with wise stewardship of the earth's resources. Development of environmentally benign production techniques is one focus of sustainable agriculture. The new transgenic crops producing toxic proteins that target specific crop p...

Development of a resource planning index for Washington's February 2010 scenic and recreational highways.

DOT National Transportation Integrated Search

2010-02-01

Washington State Department of Transportation Local Programs Division requested the creation of a : Resource Planning Index (or Index) for use in benchmarking and tracking the stewardship : performance of investments associated with Washington...

Science Matters.

ERIC Educational Resources Information Center

Blanchard, Pam

2000-01-01

Describes Louisiana Sea Grant's most recent marine education program, the coastal Ecosystem Stewardship project. Its purpose is to provide students with background information on wetlands management issues; training in basic water quality monitoring methods, data collection, and manipulation; and opportunities to participate in a restoration…

NIF Operations Management Plan, August 2011

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

Van Wonterghem, Bruno M.

Lawrence Livermore National Laboratory’s (LLNL) National Ignition Facility (NIF) is a key component of the National Nuclear Security Administration’s (NNSA) Stockpile Stewardship Program, whose purpose is to maintain the safety, reliability, and effectiveness of our nation’s nuclear stockpile without underground nuclear testing. The NIF is crucial to the Stockpile Stewardship Program because it is the only facility that can create the conditions of extreme temperature and pressure—conditions that exist only in stars or in exploding nuclear weapons—that are relevant to understanding how our modern nuclear weapons operate. As such, the NIF’s primary mission is to attain fusion ignition in themore » laboratory. Fusion ignition not only supports Stockpile Stewardship needs, but also provides the basis for future decisions about fusion’s potential as a long-term energy source. Additionally, NIF provides scientists with access to high-energy-density regimes that can yield new insight and understanding in the areas of astrophysics, hydrodynamics, material properties, plasma physics, and radiative properties. The use of the NIF to support the Stockpile Stewardship Program and the advancement of basic high-energy-density science understanding is planned and managed through program-level execution plans and NIF directorate-level management teams. An example of a plan is the National Ignition Campaign Execution Plan. The NIF Operations Management Plan provides an overview of the NIF Operations organization and describes how the NIF is supported by the LLNL infrastructure and how it is safely and responsibly managed and operated. Detailed information on NIF management of the organization is found in a series of supporting plans, policies, and procedures. A list of related acronyms can be found in Appendix A of this document. The purpose of this document is to provide a roadmap of how the NIF Operations organization functions. It provides a guide to understanding the requirements, document flow down, organizational vision and mission, performance metrics, and interrelationship of the NIF Operations organization with other directorate and laboratory organizations. This document also provides a listing of roles and responsibilities, core processes, procedures, authority matrices, change control boards, and other information necessary for successfully functioning in the NIF Operations organization. This document, the NIF Shot Operations Plan, and the NIF Maintenance Plan together represent the primary documents satisfying our Conduct of Operations compliance requirement.« less

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

Nelson, Jody K.

Land stewardship is one of nine sustainability programs in the U.S. Department of Energy's Environmental Management System. Land stewardship includes maintaining and improving ecosystem health. At the Rocky Flats Site near Westminster, Colorado, land stewardship is an integral component of the Office of Legacy Management's post-closure monitoring and management at the site. Nearly 263 hectares (650 acres) were disturbed and re-vegetated during site cleanup and closure operations. Proactive management of revegetation areas is critical to the successful reestablishment of native grasslands, wetlands, and riparian communities. The undisturbed native plant communities that occur at the site also require active management tomore » maintain the high-quality wetlands and other habitats that are home to numerous species of birds and other wildlife such as elk and deer, rare plant communities, and the federally listed threatened Preble's meadow jumping mouse. Over the past several decades, an increase of Noxious weeds has impacted much of Colorado's Front Range. As a result, weed control is a key component of the land stewardship program at Rocky Flats. Thirty-three species of state-listed Noxious weeds are known to occur in the Central and Peripheral Operable Units at Rocky Flats, along with another five species that are considered invasive at the site. Early detection and rapid response to control new invasive species is crucial to the program. An integrated weed control/vegetation management approach is key to maintaining healthy, sustainable plant communities that are able to resist Noxious weed invasions. Weed mapping, field surveys, and field-staff training sessions (to learn how to identify new potential problem species) are conducted to help detect and prevent new weed problems. The integrated approach at Rocky Flats includes administrative and cultural techniques (prevention), mechanical controls, biological controls, and chemical controls. Several species of biocontrol insects have been released to assist with control of different target weed species. Monitoring is conducted to evaluate the effectiveness of control efforts and to provide information for future control efforts. The effective implementation of this integrated approach has reduced the infestation levels of many species and has kept several newly discovered invasive species from spreading and becoming larger problems at the site. (authors)« less

Effects of Participation in after-School Programs for Middle School Students: A Randomized Trial

ERIC Educational Resources Information Center

Gottfredson, Denise; Cross, Amanda Brown; Wilson, Denise; Rorie, Melissa; Connell, Nadine

2010-01-01

This study assessed the effects of attending an after-school program (ASP) on a range of outcomes for middle school youths. The program operated for 9 hr per week for 30 weeks and included attendance monitoring and reinforcement, academic assistance, a prevention curriculum, and recreational programming. Participants were 447 students randomly…

Filamentous fungal-specific septin AspE is phosphorylated in vivo and interacts with actin, tubulin and other septins in the human pathogen Aspergillus fumigatus

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

Juvvadi, Praveen Rao; Belina, Detti; Soderblom, Erik J.

2013-02-15

Highlights: ► In vivo interactions of the novel septin AspE were identified by GFP-Trap® affinity purification. ► Septins AspA, AspB, AspC and AspD interacted with AspE in vivo. ► Actin and tubulin interacted with AspE in vivo. ► AspE is phosphorylated at six serine residues in vivo. -- Abstract: We previously analyzed the differential localization patterns of five septins (AspA–E), including a filamentous fungal-specific septin, AspE, in the human pathogen Aspergillus fumigatus. Here we utilized the A. fumigatus strain expressing an AspE–EGFP fusion protein and show that this novel septin with a tubular localization pattern in hyphae is phosphorylated inmore » vivo and interacts with the other septins, AspA, AspB, AspC and AspD. The other major proteins interacting with AspE included the cytoskeletal proteins, actin and tubulin, which may be involved in the organization and transport of the septins. This is the first report analyzing the phosphorylation of AspE and localizing the sites of phosphorylation, and opens opportunities for further analysis on the role of post-translational modifications in the assembly and organization of A. fumigatus septins. This study also describes the previously unknown interaction of AspE with the actin-microtubule network. Furthermore, the novel GFP-Trap® affinity purification method used here complements widely-used GFP localization studies in fungal systems.« less

2016 Annual Progress Report: DOE Hydrogen and Fuel Cells Program

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

Satyapal, Sunita

In the past year, the DOE Hydrogen Program (the Program) made substantial progress toward its goals and objectives. The Program has conducted comprehensive and focused efforts to enable the widespread commercialization of hydrogen and fuel cell technologies in diverse sectors of the economy. With emphasis on applications that will effectively strengthen our nation's energy security and improve our stewardship of the environment, the Program engages in research, development, and demonstration of critical improvements in the technologies. Highlights of the Program's accomplishments can be found in the sub-program chapters of this report.

2010 Annual Progress Report: DOE Hydrogen Program

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

Not Available

In the past year, the DOE Hydrogen Program (the Program) made substantial progress toward its goals and objectives. The Program has conducted comprehensive and focused efforts to enable the widespread commercialization of hydrogen and fuel cell technologies in diverse sectors of the economy. With emphasis on applications that will effectively strengthen our nation's energy security and improve our stewardship of the environment, the Program engages in research, development, and demonstration of critical improvements in the technologies. Highlights of the Program's accomplishments can be found in the sub-program chapters of this report.

2015 Annual Progress Report: DOE Hydrogen and Fuel Cells Program

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

Popovich, Neil

In the past year, the DOE Hydrogen Program (the Program) made substantial progress toward its goals and objectives. The Program has conducted comprehensive and focused efforts to enable the widespread commercialization of hydrogen and fuel cell technologies in diverse sectors of the economy. With emphasis on applications that will effectively strengthen our nation's energy security and improve our stewardship of the environment, the Program engages in research, development, and demonstration of critical improvements in the technologies. Highlights of the Program's accomplishments can be found in the sub-program chapters of this report.

2012 Annual Progress Report: DOE Hydrogen and Fuel Cells Program

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

Not Available

In the past year, the DOE Hydrogen Program (the Program) made substantial progress toward its goals and objectives. The Program has conducted comprehensive and focused efforts to enable the widespread commercialization of hydrogen and fuel cell technologies in diverse sectors of the economy. With emphasis on applications that will effectively strengthen our nation's energy security and improve our stewardship of the environment, the Program engages in research, development, and demonstration of critical improvements in the technologies. Highlights of the Program's accomplishments can be found in the sub-program chapters of this report.

The Relationships among Group Size, Participation, and Performance of Programming Language Learning Supported with Online Forums

ERIC Educational Resources Information Center

Shaw, Ruey-Shiang

2013-01-01

This study examined the relationships among group size, participation, and learning performance factors when learning a programming language in a computer-supported collaborative learning (CSCL) context. An online forum was used as the CSCL environment for learning the Microsoft ASP.NET programming language. The collaborative-learning experiment…

Aquatic Species Program Review: Proceedings of the March 1983 Principal Investigators Meeting

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

Not Available

1983-06-01

The Aquatic Species Program (ASP) addresses the utilization of plant biomass that naturally occurs in wetland or submerged areas. Processes are being developed through this program to make use of such aquatic species, capitalizing on their inherent capacity for rapid growth as well as their extraordinary chemical compositions.

Endangered Species and Human Survival.

ERIC Educational Resources Information Center

Regenstein, Lewis

1984-01-01

In wiping out the natural heritage over which we were given dominion and stewardship responsibilities, we are sowing the seeds of our own destruction. With the advent of the Reagan administration, the government's endangered species program has all but ceased to function. (RM)

Effectiveness of the forest stewardship program in conserving natural resources on private lands in Indiana

Treesearch

Andriy V. Zhalnin; Shorna R. Broussard; Richard L. Farnsworth

2008-01-01

Forest ecosystems are a dominant component of the nation's landscape but are a challenge to manage because of diverse ownership and policy objectives. Privately owned, nonindustrial lands comprise nearly half of all forests in the United States (42 percent); nearly 10.3 million citizens own 393 million acres. A number of landowner assistance programs are designed...

Forestry in U.S. Climate Change Action Plans: From the Arch to Kyoto

Treesearch

Robert J. Moulton

1998-01-01

The international community has played a major role in prompting actions to address global climate change. The 1989 Summit of the Arch in Paris resulted in President Bush's announcement in his 1990 State of the Union message of the America the Beautiful (ATB) program, which greatly expanded federal funding for urban forestry and for forest stewardship programs...

Which Factors Contribute to Environmental Behaviour of Landowners in Southwestern Ontario, Canada?

PubMed

Nebel, Silke; Brick, Jeff; Lantz, Van A; Trenholm, Ryan

2017-09-01

Loss of natural heritage is a problem that is particularly prevalent in areas of high population density. We used a survey to understand the factors that drive environmental behavior of landowners in southwestern Ontario, Canada. The survey, which contained questions about environmental attitude, pro-environmental behavior and demographics, was mailed to 18,090 rural route addresses, and we received 3256 completed surveys (18% response rate). Two types of environmental behavior, namely voluntarily increasing the area of land set aside for conservation, and enrollment in a conservation stewardship program, were significantly correlated with a positive attitude towards conservation. Financial considerations also played a role. We showed that the biggest motivator to enroll in a wetland enhancement program was access to 'more information on how the decline in wetland area affects them personally', while 'public recognition' was the least motivating factor. We suggest that enrollment in voluntary land stewardship programs might be increased by providing information about the effects of ecosystem loss, and by providing financial incentives for participation. In a larger social context, outreach programs by government agencies could focus on improving pro-environmental attitudes, which in turn is likely to result in more pro-environmental behavior of landowners.

Which Factors Contribute to Environmental Behaviour of Landowners in Southwestern Ontario, Canada?

NASA Astrophysics Data System (ADS)

Nebel, Silke; Brick, Jeff; Lantz, Van A.; Trenholm, Ryan

2017-09-01

Loss of natural heritage is a problem that is particularly prevalent in areas of high population density. We used a survey to understand the factors that drive environmental behavior of landowners in southwestern Ontario, Canada. The survey, which contained questions about environmental attitude, pro-environmental behavior and demographics, was mailed to 18,090 rural route addresses, and we received 3256 completed surveys (18% response rate). Two types of environmental behavior, namely voluntarily increasing the area of land set aside for conservation, and enrollment in a conservation stewardship program, were significantly correlated with a positive attitude towards conservation. Financial considerations also played a role. We showed that the biggest motivator to enroll in a wetland enhancement program was access to `more information on how the decline in wetland area affects them personally', while `public recognition' was the least motivating factor. We suggest that enrollment in voluntary land stewardship programs might be increased by providing information about the effects of ecosystem loss, and by providing financial incentives for participation. In a larger social context, outreach programs by government agencies could focus on improving pro-environmental attitudes, which in turn is likely to result in more pro-environmental behavior of landowners.

ASP: Gearing Up for the Next 120

NASA Astrophysics Data System (ADS)

Manning, J. G.

2010-08-01

In 2009, the Astronomical Society of the Pacific celebrates 120 years of serving the cause of astronomy, with a membership of professional and amateur astronomers, educators, and interested public; professional and popular publications; and increasingly, a variety of education and professional development programs and dissemination networks serving our various constituencies. As the Society begins a new strategic planning phase and looks forward to the next 120 years of service, with a re-articulated mission ("Advancing science literacy through engagement in astronomy") and a continuing commitment to science, education and outreach, in which direction(s) shall it head? The presenter will offer a few thoughts and conference participants will be surveyed for theirs in their role as continuing or newly minted ASP members. Outcomes: The audience will gain insight into ASP's future planning and will be surveyed for their input in the process.

Assessing Environmental Stewardship Motivation

ERIC Educational Resources Information Center

Bramston, Paul; Pretty, Grace; Zammit, Charlie

2011-01-01

Environmental stewardship networks flourish across Australia. Although the environment benefits, this article looks to identify what volunteers draw from their stewardship. The authors adapted 16 questions that purportedly tap environmental stewardship motivation and administered them to a convenience sample of 318 university students and then to…

77 FR 18879 - Meeting of the Regional Resource Stewardship Council

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... TENNESSEE VALLEY AUTHORITY Meeting of the Regional Resource Stewardship Council AGENCY: Tennessee Valley Authority (TVA). ACTION: Notice of meeting. SUMMARY: The TVA Regional Resource Stewardship Council... Stewardship Council, Tennessee Valley Authority, 400 West Summit Hill Drive, WT-11 B, Knoxville, Tennessee...

The Role of NOAA's National Data Centers in the Earth and Space Science Infrastructure

NASA Astrophysics Data System (ADS)

Fox, C. G.

2008-12-01

NOAA's National Data Centers (NNDC) provide access to long-term archives of environmental data from NOAA and other sources. The NNDCs face significant challenges in the volume and complexity of modern data sets. Data volume challenges are being addressed using more capable data archive systems such as the Comprehensive Large Array-Data Stewardship System (CLASS). Challenges in assuring data quality and stewardship are in many ways more challenging. In the past, scientists at the Data Centers could provide reasonable stewardship of data sets in their area of expertise. As staff levels have decreased and data complexity has increased, Data Centers depend on their data providers and user communities to provide high-quality metadata, feedback on data problems and improvements. This relationship requires strong partnerships between the NNDCs and academic, commercial, and international partners, as well as advanced data management and access tools that conform to established international standards when available. The NNDCs are looking to geospatial databases, interactive mapping, web services, and other Application Program Interface approaches to help preserve NNDC data and information and to make it easily available to the scientific community.

National Aeronautics and Space Administration: 1998 Accountability Report

NASA Technical Reports Server (NTRS)

1999-01-01

This Accountability Report summarizes NASA's program accomplishments and its stewardship over budget and financial resources. The report is the culmination of NASA's management process, which begins with mission definition and program planning, continues with formulation and justification of NASA's budgets for the President and Congress, and ends with NASA scientific and engineering program accomplishments. This report covers NASA's activities from October 1, 1997, through September 30, 1998, with discussion of some subsequent events.

Post-Closure Strategy for Use-Restricted Sites on the Nevada National Security Site, Nevada Test and Training Range, and Tonopah Test Range, Nevada

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

Silvas, A. J.

The purpose of this Post-Closure Strategy is to provide a consistent methodology for continual evaluation of post-closure requirements for use-restricted areas on the Nevada National Security Site (NNSS), Nevada Test and Training Range (NTTR), and Tonopah Test Range (TTR) to consolidate, modify, or streamline the program. In addition, this document stipulates the creation of a single consolidated Post-Closure Plan that will detail the current post-closure requirements for all active use restrictions (URs) and outlines its implementation and subsequent revision. This strategy will ensure effective management and control of the post-closure sites. There are currently over 200 URs located on themore » NNSS, NTTR, and TTR. Post-closure requirements were initially established in the Closure Report for each site. In some cases, changes to the post-closure requirements have been implemented through addenda, errata sheets, records of technical change, or letters. Post-closure requirements have been collected from these multiple sources and consolidated into several formats, such as summaries and databases. This structure increases the possibility of inconsistencies and uncertainty. As more URs are established and the post-closure program is expanded, the need for a comprehensive approach for managing the program will increase. Not only should the current requirements be obtainable from a single source that supersedes all previous requirements, but the strategy for modifying the requirements should be standardized. This will enable more effective management of the program into the future. This strategy document and the subsequent comprehensive plan are to be implemented under the assumption that the NNSS and outlying sites will be under the purview of the U.S. Department of Energy, National Nuclear Security Administration for the foreseeable future. This strategy was also developed assuming that regulatory control of the sites remains static. The comprehensive plan is not intended to be a permanent long-term stewardship plan. However, it is intended to clarify requirements and identify components to effectively manage the sites until regulatory requirements are met or management of the site changes. The Environmental Management Program is required to manage these sites until the NNSS Environmental Restoration program is completed, currently planned for 2030. Prior to completion of the Environmental Restoration program, additional planning will be conducted to ensure that long-term stewardship of the sites is maintained. A comprehensive post-closure plan can be transitioned effectively into any future site-wide long-term stewardship program that may be developed. Therefore, the post-closure plan will include current aspects of the post-closure program that are also important aspects of long-term stewardship, including the following: • Management of physical and engineering controls such as fences, signs, and soil covers • Management of institutional and administrative controls such as use restrictions and real estate systems • Management of monitoring and maintenance programs • Management of information related to the sites such as geographic information system data and related documentation The strategy will also allow for periodic review and modification of any aspect of the program to ensure continued effectiveness.« less

Setting Your Sites

ERIC Educational Resources Information Center

Benz, Stephen

2006-01-01

Schools and universities recognize that many of the people and neighborhoods they serve expect education institutions to embrace environmental stewardship and sustainable design. Standards such as the LEED-registered facility program, managed by the U.S. Green Building Council, are receiving more attention. Schools can demonstrate their commitment…

MULTI-FACETED SUSTAINABILITY ON ITHACA COLLEGE NATURAL LANDS

EPA Science Inventory

This student-generated proposal presents a multi-faceted program for sustainable stewardship of the natural areas south of the built campus of Ithaca College. Our challenge is to use student research and class projects to enhance biodiversity, support education and research, and...

U1A Complex

ScienceCinema

None

2018-01-16

Some of the most sophisticated experiments in the stockpile stewardship program are conducted in an environmentally safe manner, nearly 1000 feet below the ground at the site. The U1a complex a sprawling underground laboratory and tunnel complex is home to a number of unique capabilities.

From policy to practice: addressing snack quality, consumption, and price in after-school programs.

PubMed

Beets, Michael W; Tilley, Falon; Weaver, Robert G; Turner-McGrievy, Gabrielle; Moore, Justin B; Webster, Collin

2014-01-01

To evaluate a community partnership between after-school programs (ASPs) and grocery stores to provide discounted pricing on snacks to meet the National Afterschool Association Healthy Eating Standards that call for serving a fruit or vegetable (FV) daily while eliminating sugar-based foods and beverages. A single-group, pretest with multiple posttest design (spring, 2011-2013) in 4 large-scale ASPs serving 500 children/d was used, along with direct observation of snacks served, consumed, and cost. At baseline, FV, sugar-sweetened beverages, and desserts were served 0.1 ± 0.5, 1.7 ± 2.0, and 2.0 ± 1.4 d/wk. By spring, 2013, FV increased to 5.0 ± 0.0 d/wk, whereas sugar-sweetened beverages and desserts were eliminated. A total of 84% of children consumed the fruit; 59% consumed the vegetables. Cost associated with purchasing snacks resulted in a $2,000-$3,000 savings over a standard 180-day school year. This partnership can serve as a model for successfully meeting nutrition policies established for ASP snacks. Copyright © 2014 Society for Nutrition Education and Behavior. All rights reserved.

The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program.

PubMed

Slayton, Rachel B; Scott, R Douglas; Baggs, James; Lessa, Fernanda C; McDonald, L Clifford; Jernigan, John A

2015-06-01

To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals Markov model with a 5-year time horizon Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old. CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012. Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials. RESULTS In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion). The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.

Impact of computerized pre-authorization of broad spectrum antibiotics in Pseudomonas aeruginosa at a children's hospital in Japan.

PubMed

Horikoshi, Yuho; Higuchi, Hiroshi; Suwa, Junichi; Isogai, Mihoko; Shoji, Takayo; Ito, Kenta

2016-08-01

The spread of antimicrobial-resistant organisms is a global concern. To stem this tide, an antimicrobial stewardship program at hospitals is essential to optimize the prescription of broad spectrum antibiotics. In this study we examined the impact of computerized pre-authorization for broad spectrum antibiotics for Pseudomonas aeruginosa at a children's hospital. An antimicrobial stewardship program at Tokyo Metropolitan Children's Medical Center was assessed between March 2010 and March 2015. A paper-based post-prescription audit was switched to computerized pre-authorization for broad antipseudomonal agents in October 2011. The prescriber was required to obtain approval from physicians in the pediatric infectious diseases division before prescribing restricted antimicrobial agents. Approved prescriptions were processed and logged electronically. We evaluated days of therapy per 1000 patient-days, the cost of antibiotics, and the susceptibility of P. aeruginosa to piperacillin, ceftazidime, cefepime, piperacillin/tazobactam, carbapenems, and ciprofloxacin. Also, the average length of admission and infection-related mortality at 30 days were compared pre- and post-intervention. Administration of carbapenems, piperacillin/tazobactam, and ceftazidime decreased significantly after the introduction of computerized pre-authorization. Antibiotic costs were reduced by JPY2.86 million (USD 26,000) annually. None of the antipseudomonal agents showed decreased sensitivity. The average length of admission was shorter in post-intervention. Infection-related mortality at 30 days showed no difference between the pre- and post-intervention periods. An antimicrobial stewardship program using computerized pre-authorization decreased the use and cost of broad spectrum antibiotics without significant difference in infection-related mortality at 30 days, although our study did not improve susceptibilities of P. aeruginosa. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

77 FR 33239 - Prairie Stewardship Plan/Environmental Impact Statement, San Juan Island National Historical Park

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... Stewardship Plan/Environmental Impact Statement, San Juan Island National Historical Park AGENCY: National... Prairie Stewardship Plan, San Juan Island National Historical Park, Washington. SUMMARY: Pursuant to the... initiating the preparation of an Environmental Impact Statement (EIS) for a Prairie Stewardship Plan, as...

Effects of Annotations and Homework on Learning Achievement: An Empirical Study of Scratch Programming Pedagogy

ERIC Educational Resources Information Center

Su, Addison Y. S.; Huang, Chester S. J.; Yang, Stephen J. H.; Ding, T. J.; Hsieh, Y. Z.

2015-01-01

In Taiwan elementary schools, Scratch programming has been taught for more than four years. Previous studies have shown that personal annotations is a useful learning method that improve learning performance. An annotation-based Scratch programming (ASP) system provides for the creation, share, and review of annotations and homework solutions in…

Seed Balls and the Circle of Courage: A Decolonization Model of Youth Development in an Environmental Stewardship Program

ERIC Educational Resources Information Center

Wenger-Schulman, A. R. S.; Hoffman, Lauren

2018-01-01

Middle School 88 in Brooklyn, New York serves a community of students often considered at high risk for dropping out of high school and other socially undesirable behaviors. In this high-need setting, the authors designed and implemented an environmental education program designed to meet the needs of urban youth of color. The approach they used,…

Evaluating environmental education, citizen science, and stewardship through naturalist programs.

PubMed

Merenlender, Adina M; Crall, Alycia W; Drill, Sabrina; Prysby, Michelle; Ballard, Heidi

2016-12-01

Amateur naturalists have played an important role in the study and conservation of nature since the 17th century. Today, naturalist groups make important contributions to bridge the gap between conservation science and practice around the world. We examined data from 2 regional naturalist programs to understand participant motivations, barriers, and perspectives as well as the actions they take to advance science, stewardship, and community engagement. These programs provide certification-based natural history and conservation science training for adults that is followed by volunteer service in citizen science, education, and stewardship. Studies in California and Virginia include quantitative and qualitative evaluation data collected through pre- and postcourse surveys, interviews, and long-term tracking of volunteer hours. Motivations of participants focused on learning about the local environment and plants and animals, connecting with nature, becoming certified, and spending time with people who have similar interests. Over half the participants surveyed were over 50 years old, two-thirds were women, and a majority reported household incomes of over $50,000 (60% in California, 85% in Virginia), and <20% of those surveyed in both states described themselves as nonwhite. Thus, these programs need to improve participation by a wider spectrum of the public. We interviewed younger and underrepresented adults to examine barriers to participation in citizen science. The primary barrier was lack of time due to the need to work and focus on career advancement. Survey data revealed that participants' ecological knowledge, scientific skills, and belief in their ability to address environmental issues increased after training. Documented conservation actions taken by the participants include invasive plant management, habitat restoration, and cleanups of natural areas and streams. Long-term data from Virginia on volunteer hours dedicated to environmental citizen science show an increase from 14% in 2007 to 32% in 2014. In general, participants in the naturalist programs we examined increased their content knowledge about ecosystems, had greater confidence in conserving them, and continued to engage as citizen scientists after completing the program. © 2016 Society for Conservation Biology.

Using Lagrangian Chemical Transport Modeling to Assess the Impact of Biomass Burning on Ozone and PM2.5

NASA Astrophysics Data System (ADS)

Alvarado, M. J.; Lonsdale, C. R.; Brodowski, C. M.

2017-12-01

One of the challenges of using in situ measurements to study the air quality and climate impacts of biomass burning is correctly determining the contribution of biomass burning sources to the measured ambient concentrations. This is especially important for policy purposes, as the ozone (O3) and fine particulate matter (PM2.5) from natural wildfires should not be confused with that from controllable anthropogenic sources. We have developed a Lagrangian chemical transport model called STILT-ASP that is able to quantify the impact of wildfire events on O3 and PM2.5 measurements made at surface monitoring sites, by mobile laboratories, or by aircraft. STILT-ASP is built by coupling the Stochastic Time Inverted Lagrangian Transport (STILT) model with AER's Aerosol Simulation Program (ASP), which has been used in many studies of the gas and aerosol chemistry of biomass burning smoke. Here we present recent revisions made in STILT-ASP v2.0, including the use of more detailed chemical speciation of fire emissions and biogenic emissions calculated using the MEGAN model with meteorological inputs consistent with those used to drive STILT. We will present the results of an evaluation of the performance of STILT-ASP v2.0 using surface, mobile lab, and aircraft data from the 2013 Houston DISCOVER-AQ campaign. STILT-ASP v2.0 showed good average performance for O3 during the peak of the high O3 episodes on Sept. 25-26, 2013, with a mean bias of -4 ppbv. We will also demonstrate the use of STILT-ASP to evaluate the impact of biomass burning on O3 and PM2.5 in urban areas and to assess the impact of remote fires on the boundary conditions used in Eulerian chemical transport models like CAMx.

7 CFR 1470.23 - Conservation activity operation and maintenance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Conservation activity operation and maintenance. 1470... STEWARDSHIP PROGRAM Contracts and Payments § 1470.23 Conservation activity operation and maintenance. The participant will maintain and manage existing conservation activities on the agricultural operation to at...

7 CFR 1470.23 - Conservation activity operation and maintenance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Conservation activity operation and maintenance. 1470... STEWARDSHIP PROGRAM Contracts and Payments § 1470.23 Conservation activity operation and maintenance. The participant will operate and maintain existing conservation activities on the agricultural operation to at...

Connecticut: New Haven City Government (A Former EPA CARE Project)

EPA Pesticide Factsheets

The City of New Haven is the recipient of a citywide Level II CARE cooperative agreement. The City of New Haven will use CARE funding to expand the existing air toxics initiative into a more comprehensive air, water and land stewardship program.

75 FR 18567 - Agency Information Collection; Activity Under OMB Review; Omnibus Household Survey Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-12

...'s strategic goals (safety, reduced congestion, global connectivity, environmental stewardship and..., as well as other governmental agencies, to survey the public about current transportation issues, and... transit (subway, streetcar, or light rail) Commuter rail Water transportation (taxis, ferries, ships...

Reaching for the Top

ERIC Educational Resources Information Center

Harvey, Elizabeth

2009-01-01

Principal gifts are very large donations that take years to cultivate and potentially can have a major impact on an institution. Venerable private research universities have sought principal gifts for decades with well-staffed, systematic cultivation and stewardship programs. Until recently, however, principal gifts were not necessarily considered…

A database application for wilderness character monitoring

Treesearch

Ashley Adams; Peter Landres; Simon Kingston

2012-01-01

The National Park Service (NPS) Wilderness Stewardship Division, in collaboration with the Aldo Leopold Wilderness Research Institute and the NPS Inventory and Monitoring Program, developed a database application to facilitate tracking and trend reporting in wilderness character. The Wilderness Character Monitoring Database allows consistent, scientifically based...

The Nature of Scatter at the DARHT Facility and Suggestions for Improved Modeling of DARHT Facility

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

Morneau, Rachel Anne

This report describes the US Stockpile Stewardship Program which is meant to sustain and evaluate nuclear weapon stockpile with no underground nuclear tests. This research will focus on DARHT, the Dual Axis Radiographic Hydrodynamic Test facility.

Blind inlets: Conservation practices to reduce herbicide losses from closed depressional areas

USDA-ARS?s Scientific Manuscript database

Pesticides are designed to benefit agricultural production and may inadvertently affect water quality if environmental stewardship programs are not implemented. Closed depressional areas (potholes) are typical in the US Midwest and are usually drained with tile risers, however sediment and contamina...

The intersection of antimicrobial stewardship and microbiology: educating the next generation of health care professionals.

PubMed

O'Donnell, Lauren A; Guarascio, Anthony J

2017-01-01

With the alarming rise of antibiotic resistance, clinical professionals are called upon to manage antibiotic therapies using the most relevant and recent clinical and laboratory data. To this end, antimicrobial stewardship (AMS) programs aim to reduce unnecessary or suboptimal use of antibiotics while maximizing outcomes for the patient. For AMS programs to succeed, the active participation of clinical professionals at all levels of patient care is required. Although programs exist to train established clinicians in AMS, there is a paucity of literature on how and when to integrate AMS concepts and skills in pre-clinical and clinical coursework. Here, we discuss the crucial microbiology concepts and proficiencies that are necessary for building and supporting an AMS program. We provide recommendations for key points to include in clinical curricula in order to develop the necessary microbiology interpretation skills to participate in AMS. The influence of AMS programs on local organism susceptibility patterns is emphasized. The importance of antibiograms, rapid diagnostic testing and the practical interpretations of microbiology laboratory reporting are discussed in regard to prioritization in clinical curricula. We also review the current literature on instructional strategies for introducing AMS into clinical programs, and propose concepts that should be included in didactic coursework in order to provide a foundation for AMS education. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

Erhart, Steven C.; Spencer, Charles G.

The accomplishments to date and the long-range planning of the Y-12 Energy Management and Sustainability and Stewardship programs support the U.S. Department of Energy (DOE) and the National Nuclear Security Administration (NNSA) vision for a commitment to energy effi ciency and sustainability and to achievement of the Guiding Principles. Specifi cally, the Y-12 vision is to support the Environment, Safety and Health Policy and the DOE Strategic Sustainability Performance Plan (SSPP), while promoting overall sustainability and reduction of greenhouse gas (GHG) emissions. The mission of the Y-12 Energy Management program is to incorporate energy-efficient technologies site-wide and to position Y-12more » to meet NNSA energy requirement needs through 2025 and beyond. This plan addresses: Greenhouse Gas Reduction and Comprehensive Greenhouse Gas Inventory; Buildings, ESPC Initiative Schedule, and Regional and Local Planning; Fleet Management; Water Use Efficiency and Management; Pollution Prevention and Waste Reduction; Sustainable Acquisition; Electronic Stewardship and Data Centers; Renewable Energy; Climate Change; and Budget and Funding.« less

A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department.

PubMed

Losier, Mia; Ramsey, Tasha D; Wilby, Kyle John; Black, Emily K

2017-09-01

To improve antimicrobial utilization, development and implementation of antimicrobial stewardship programs in the emergency department (ED) has been recommended. The primary objective of this review was to characterize antimicrobial stewardship (AMS) in the ED and to identify interventions that improve patient outcomes or process of care and/or reduce consequences of antimicrobial use. This study was completed as a systematic review. The following databases were searched from inception through November, 2016: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Web of Science. Randomized controlled trials, nonrandomized controlled trials, controlled and uncontrolled before-and-after studies, interrupted time series studies, and repeated-measures studies evaluating AMS interventions in the ED were included in the review. Studies published in languages other than English were excluded. A total of 43 studies meeting inclusion criteria were identified from our search. Patient or provider education and guideline or clinical pathway implementation were the most commonly reported interventions. Few studies reported on audit and feedback, and no study evaluated preauthorization. Impact of interventions showed variable results. Where identified, benefits of AMS interventions primarily included improvement in delivery of care or a decrease in antimicrobial utilization; however, most studies were rated as having unclear or high risk of bias. AMS interventions in the ED may improve patient care. However, the optimal combination of interventions is unclear. Additional studies with more rigorous design evaluating core components of AMS programs, including prospective audit and feedback are needed.

Understanding social influences on wilderness fire stewardship decisions

Treesearch

Katie Knotek

2006-01-01

Federal land managers and the public engage in many decisions about stewardship of wilderness in the United States, including decisions about stewardship of fire. To date, social science research lacks a holistic examination of the decision-making context of managers and the public about stewardship of fire inside wilderness and across its boundaries. A conceptual...

The organisational structure of urban environmental stewardship

Treesearch

Dana R. Fisher; Lindsay Campbell; Erika S. Svendsen

2012-01-01

How is the organisational structure of urban environmental stewardship groups related to the diverse ways that civic stewardship is taking place in urban settings? The findings of the limited number of studies that have explored the organisational structure of civic environmentalism are combined with the research on civic stewardship to answer this question. By...

Serendipity and Stewardship: Teaching with the Spirit in a Secular Classroom

ERIC Educational Resources Information Center

Hall, Bradford J.

2009-01-01

Can one appropriately teach with the spirit in a secular classroom? This chapter addresses the question by exploring how the concepts of serendipity and stewardship encourage a form of spirituality that is inclusive and appropriate for the university setting. Serendipity and stewardship work hand in hand. Stewardship resists the temptation of…

2011 Annual Progress Report: DOE Hydrogen and Fuel Cells Program (Book)

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

Not Available

In the past year, the DOE Hydrogen and Fuel Cells Program (the Program) made substantial progress toward its goals and objectives. The Program has conducted comprehensive and focused efforts to enable the widespread commercialization of hydrogen and fuel cell technologies in diverse sectors of the economy. With emphasis on applications that will effectively strengthen our nation's energy security and improve our stewardship of the environment, the Program engages in research, development, and demonstration of critical improvements in the technologies. Highlights of the Program's accomplishments can be found in the sub-program chapters of this report.

A Status Report on the AAS Astronomy Ambassadors Program

NASA Astrophysics Data System (ADS)

Fienberg, Richard Tresch; Fraknoi, Andrew; Gurton, Suzanne; Hurst, Anna; Schatz, Dennis L.

2014-06-01

The American Astronomical Society, in partnership with the Astronomical Society of the Pacific (ASP), has launched a series of professional-development workshops and a community of practice designed to improve early-career astronomers’ ability to communicate effectively with students and the public. Called AAS Astronomy Ambassadors, the program provides training and mentoring for young astronomers, from advanced undergraduates to beginning faculty; it also provides them access to resources and a network of contacts within the astronomy education and public outreach (EPO) community. Ambassadors are provided with a library of outreach activities and resource materials suitable for a range of venues and audiences. For much of this library we are using resources developed by organizations such as the ASP, the Pacific Science Center, and the Center for Astronomy Education for other outreach programs, though some resources have been created by one of us (AF) specifically for this program. After a period of evaluation and revision, the program’s “Menu of Outreach Opportunities for Science Education” (MOOSE) is now posted on the AAS website at http://aas.org/outreach/moose-menu-outreach-opportunities-science-education.The first two Astronomy Ambassadors workshops were held at AAS meetings in January 2013 and January 2014; each served 30 young astronomers chosen from about twice that many applicants. Web-based follow-up activities are being provided through a website at the ASP designed to keep cohorts of educators trained in their programs in touch with one another. The AAS is exploring ways to fund additional workshops at future winter meetings; suggestions are most welcome. Meanwhile, the Astronomy Ambassadors trained to date have logged more than 150 outreach events, reaching many thousands of children and adults across the U.S. and Canada.

Physical Activity and Psychological Correlates during an After-School Running Club

ERIC Educational Resources Information Center

Kahan, David; McKenzie, Thomas L.

2018-01-01

Background: After-school programs (ASPs) have the potential to contribute to moderate-to-vigorous physical activity (MVPA), but there is limited empirical evidence to guide their development and implementation. Purpose: This study assessed the replication of an elementary school running program and identified psychological correlates of children's…

FY 2017 Stockpile Stewardship and Management Plan - Biennial Plan Summary

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

None, None

2016-03-01

This year’s summary report updates the Fiscal Year 2016 Stockpile Stewardship and Management Plan (FY 2016 SSMP), the 25-year strategic program of record that captures the plans developed across numerous NNSA programs and organizations to maintain and modernize the scientific tools, capabilities, and infrastructure necessary to ensure the success of NNSA’s nuclear weapons mission. The SSMP is a companion to the Prevent, Counter, and Respond: A Strategic Plan to Reduce Global Nuclear Threats (FY 2017-2021) report, the planning document for NNSA’s nuclear threat reduction mission. New versions of both reports are published each year in response to new requirements andmore » challenges. Much was accomplished in FY 2015 as part of the program of record described in this year’s SSMP. The science-based Stockpile Stewardship Program allowed the Secretaries of Energy and Defense to certify for the twentieth time that the stockpile remains safe, secure, and effective without the need for underground nuclear explosive testing. The talented scientists, engineers, and technicians at the three national security laboratories, the four nuclear weapons production plants, and the national security site are primarily responsible for this continued success. Research, development, test, and evaluation programs have advanced NNSA’s understanding of weapons physics, component aging, and material properties through first-of-a-kind shock physics experiments, along with numerous other critical experiments conducted throughout the nuclear security enterprise. The multiple life extension programs (LEPs) that are under way made progress toward their first production unit dates. The W76-1 LEP is past the halfway point in total production, and the B61-12 completed three development flight tests. Critical to this success is the budget. The Administration’s budget request for NNSA’s Weapons Activities has increased for all but one of the past seven years, resulting in a total increase of approximately 45 percent since 2010. If adopted by Congress, the FY 2017 budget request will increase funding by $396 million (about 4.5 percent) from the enacted FY 2016 level. A significant portion of the increase would fund the research for multiple life extension programs, support the programs in Directed Stockpile Work, and modernize the physical infrastructure of the nuclear security enterprise.« less

Organizing urban ecosystem services through environmental stewardship governance in New York City

Treesearch

James J. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

2013-01-01

How do stewardship groups contribute to the management of urban ecosystem services? In this paper, we integrate the research on environmental stewardship with the social-ecological systems literature to explain how stewardship groups serve as bridge organizations between public agencies and civic organizations, working across scales and sectors to build the flexible...

UBIQUITOUS POLLUTION FROM HEALTH AND COSMETIC CARE: SIGNIFICANCE, CONCERN, SOLUTIONS, STEWARDSHIP

EPA Science Inventory

Those chemical pollutants that are regulated under various international, federal, and state programs represent but a small fraction of the universe of chemicals that occur in the environment as a result of both natural processses and human influence. Although this galaxy of ta...

Big Explosives Experimental Facility - BEEF

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

None

The Big Explosives Experimental Facility or BEEF is a ten acre fenced high explosive testing facility that provides data to support stockpile stewardship and other national security programs. At BEEF conventional high explosives experiments are safely conducted providing sophisticated diagnostics such as high speed optics and x-ray radiography.

Big Explosives Experimental Facility - BEEF

ScienceCinema

None

2018-01-16

The Big Explosives Experimental Facility or BEEF is a ten acre fenced high explosive testing facility that provides data to support stockpile stewardship and other national security programs. At BEEF conventional high explosives experiments are safely conducted providing sophisticated diagnostics such as high speed optics and x-ray radiography.

US Policy approaches for assessing soil health

USDA-ARS?s Scientific Manuscript database

There is worldwide recognition for a more holistic vision of soil health and tools to guide soil conservation policy, management and restoration. To meet this need, U.S. conservation programs in the US Food, Conservation, and Energy Act of 2008 (the farm bill), including the Conservation Stewardship...

FY 2014 Annual Progress Report - Advanced Combustion Engine Research and Development (Book)

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

Not Available

In the past year, the DOE Hydrogen Program (the Program) made substantial progress toward its goals and objectives. The Program has conducted comprehensive and focused efforts to enable the widespread commercialization of hydrogen and fuel cell technologies in diverse sectors of the economy. With emphasis on applications that will effectively strengthen our nation's energy security and improve our stewardship of the environment, the Program engages in research, development, and demonstration of critical improvements in the technologies. Highlights of the Program's accomplishments can be found in the sub-program chapters of this report.

Modeling the Complex Photochemistry of Biomass Burning Plumes in Plume-Scale, Regional, and Global Air Quality Models

NASA Astrophysics Data System (ADS)

Alvarado, M. J.; Lonsdale, C. R.; Yokelson, R. J.; Travis, K.; Fischer, E. V.; Lin, J. C.

2014-12-01

Forecasting the impacts of biomass burning (BB) plumes on air quality is difficult due to the complex photochemistry that takes place in the concentrated young BB plumes. The spatial grid of global and regional scale Eulerian models is generally too large to resolve BB photochemistry, which can lead to errors in predicting the formation of secondary organic aerosol (SOA) and O3, as well as the partitioning of NOyspecies. AER's Aerosol Simulation Program (ASP v2.1) can be used within plume-scale Lagrangian models to simulate this complex photochemistry. We will present results of validation studies of the ASP model against aircraft observations of young BB smoke plumes. We will also present initial results from the coupling of ASP v2.1 into the Lagrangian particle dispersion model STILT-Chem in order to better examine the interactions between BB plume chemistry and dispersion. In addition, we have used ASP to develop a sub-grid scale parameterization of the near-source chemistry of BB plumes for use in regional and global air quality models. The parameterization takes inputs from the host model, such as solar zenith angle, temperature, and fire fuel type, and calculates enhancement ratios of O3, NOx, PAN, aerosol nitrate, and other NOy species, as well as organic aerosol (OA). We will present results from the ASP-based BB parameterization as well as its implementation into the global atmospheric composition model GEOS-Chem for the SEAC4RS campaign.

Antimicrobial Stewardship Barriers and Goals in Pediatric Oncology and Bone Marrow Transplantation: A Survey of Antimicrobial Stewardship Practitioners.

PubMed

Wolf, Joshua; Sun, Yilun; Tang, Li; Newland, Jason G; Gerber, Jeffrey S; Van Dyke, Christie J; Hymes, Saul R; Yu, Diana; Carias, Delia C; Bryant, Penelope A

2016-03-01

We undertook a cross-sectional survey of antimicrobial stewardship clinicians in North America and Australasia regarding practices, goals, and barriers to implementation of stewardship for pediatric oncology patients. Goals and barriers were similar regardless of clinician or institutional characteristics and geographic location. Strategies addressing these factors could help optimize antimicrobial use.

NASA FY 2000 Accountability Report

NASA Technical Reports Server (NTRS)

2000-01-01

This Accountability Report consolidates reports required by various statutes and summarizes NASA's program accomplishments and its stewardship over budget and financial resources. It is a culmination of NASA's management process, which begins with mission definition and program planning, continues with the formulation and justification of budgets for the President and Congress, and ends with scientific and engineering program accomplishments. The report covers activities from October 1, 1999, through September 30, 2000. Achievements are highlighted in the Statement of the Administrator and summarized in the Report.

Implementation of a pharmacist-led antimicrobial management team in a community teaching hospital: use of pharmacy residents and pharmacy students in a prospective audit and feedback approach.

PubMed

Laible, Brad R; Nazir, Jawad; Assimacopoulos, Aris P; Schut, Jennifer

2010-12-01

Antimicrobial stewardship is an important process proven to combat antimicrobial resistance, improve patient outcomes, and reduce costs. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have provided guidelines for the provision of antimicrobial stewardship. According to these recommendations, antimicrobial stewardship teams should be multidisciplinary in nature, with core members consisting of an infectious disease physician and an infectious disease-trained clinical pharmacist. Due to limited resources, our institution chose to implement a pharmacist-led antimicrobial stewardship service on 1 medical/surgical ward, with the existing clinical pharmacist and 3 infectious disease physicians as core members. This clinical pharmacist was not trained in infectious disease specialty, and stewardship activities were only one part of his daily activities. Pharmacy residents and students were extensively utilized to assist in the stewardship process. Approximately two thirds of stewardship recommendations were accepted using primarily a prospective audit and feedback approach.

Academic Support Program in the Faculty of Agricultural and Forestry Engineering of the University of Cordoba (Spain)

NASA Astrophysics Data System (ADS)

Castro, Sergio; Navarro, Rafael M.; Camacho, Emilio; Gallardo, Rosa; García-Ferrer, Alfonso; Pérez-Marín, M. Dolores; Peña, Adolfo; Taguas, Encarnación V.

2014-05-01

The incorporation of new students to undergraduate degrees is performed in different stages through a long, sequential enrollment process. The student integration to the new context of higher education including group work and new teaching methodologies lead to notable adaptation difficulties to this new educational environment. In fact, the highest rate of student failure in the Bachelor degree usually happens during the first courses. The Unit of Quality Evaluation/Monitoring of School of Agricultural and Forest Engineering (ETSIAM) has detected that these failure rates at first and second degree course may be reduced through the involvement of students in a support learning process, by increasing their skills and motivation as well as the contact with the University environment in the context of their future professional horizon. In order to establish a program of this type, it has been launched an Academic Support Program (ASP) at the ETSIAM. This program aims to achieve and reinforce the basic academic and personal skills/competences require by the Bologna's process (BC) and specific competences of the engineers on the area of Agriculture and Forestry in the European context. The ASP includes diferent bloks of seminars, lectures, collaborative work and discussion groups among students, professionals, professors and researchers and it has been designed based on these competences and tranversal contents in both degrees. These activities are planned in a common time for both degrees, out of teaching classes. In addition, a virtual space in Moodle has been created for discussion forums and preparation activities. Additional information about schedules, speakers and companies, presentations and other material are also provided. In the preliminary implementation of the ASP, we will present the results corresponding to the first year of this academic support program. We have conducted a survey among the students in order to have a first feedback about the impact of the ASP on their integration to University. As a general opinion, the students considered that the seminars were useful and interesting. Moreover, they appreciated that activities were open and attendance was not required. Student proposed new topics related with their professional development. This type of activities not only allows improving the satisfaction of the students but also connecting professors of different subjects and areas of knowledge with student and professional sector.

Brains Rule!: a model program for developing professional stewardship among neuroscientists.

PubMed

Zardetto-Smith, Andrea M; Mu, Keli; Carruth, Laura L; Frantz, Kyle J

2006-01-01

Brains Rule! Neuroscience Expositions, funded through a National Institute on Drug Abuse Science Education Drug Abuse Partnership Award, has developed a successful model for informal neuroscience education. Each Exposition is a "reverse science fair" in which neuroscientists present short neuroscience teaching modules to students. This study focuses on results of assessments conducted with neuroscientist presenters during Expositions at two sites, Atlanta, Georgia and Corpus Christi, Texas. The effects of participating in the Expositions on presenters' perceptions of their own presentation and communication skills were evaluated, as was the potential for increased active participation by neuroscientists in future outreach programs. In four of the five Expositions studied, pre- versus post-event surveys demonstrated significant changes in presenters' perceptions of their own abilities to explain neuroscience concepts to children. Over the course of an Exposition, presenters learned to fit their approaches to conveying neuroscience concepts to fifth through eighth graders and learned to link information they presented about the brain and nervous system to children's past experiences to improve comprehension. The present data suggest that Brains Rule! Neuroscience Expositions are effective in improving communication and teaching skills among neuroscience professionals and contribute to professional stewardship by increasing motivation to participate in future informal education programs.

Airspace Systems Program: Next Generation Air Transportation System, NextGen Systems Analysis, Integration and Evaluation Project. Version 1.0; Project Plan

NASA Technical Reports Server (NTRS)

Quon, Leighton

2010-01-01

The key objectives of the NASA ASP are to: Improve mobility, capacity efficiency and access of the airspace system. Improve collaboration, predictability, and flexibility for the airspace users. Enable accurate modeling and simulation of air transportation systems. Accommodate operations of all classes of aircraft. Maintain system safety and environmental protection. In support of these program objectives, the major goal of the NextGen-SAIE Project is to enable the transition of key capacity and efficiency improvements to the NAS. Since many aspects of the NAS are unique to specific airport or airspace environments, demand on various parts of the NAS is not expected to increase equally as system demand grows. SAIE will provide systems level analysis of the NAS characteristics, constraints, and demands such that a suite of capacity-increasing concepts and technologies for system solutions are enabled and facilitated. The technical objectives in support of this goal are the following: Integration, evaluation, and transition of more mature concepts and technologies in an environment that faithfully emulates real-world complexities. Interoperability research and analysis of ASP technologies across ATM functions is performed to facilitate integration and take ASP concepts and technologies to higher Technology Readiness Level (TRL). Analyses are conducted on the program s concepts to identify the system benefits or impacts. System level analysis is conducted to increase understanding of the characteristics and constraints of airspace system and its domains.

Product stewardship in the composites industry

NASA Technical Reports Server (NTRS)

Aldrich, Donald C.; Merriman, Edmund A.

1994-01-01

The definition and purpose of Product Stewardship is discussed. Its' impact in the composites industry is stated. The report also outlines 12 ways that Product Stewardship can be utilized by consumers.

Empowering Youth

ERIC Educational Resources Information Center

Miner, Jennifer; Elshof, Leo; Redden, Anna; Terry, John

2004-01-01

The Gulf of Maine Institute (GOMI) is striving to empower youth to take on stewardship roles in their communities. Through its Community Based Initiative (CBI) program, GOMI addresses environmental degradation by working with teams of students, teachers, and community members from around the Gulf of Maine to inspire youth to be stewards of the…

Energy Service Companies as a Component of a Comprehensive University Sustainability Strategy

ERIC Educational Resources Information Center

Pearce, Joshua M.; Miller, Laura L.

2006-01-01

Purpose: This paper aims to quantify and critically analyze the best practices of a comprehensive environmental stewardship strategy (ESS), which included a guaranteed energy savings program (GESP) that utilized an energy service company (ESCO). Design/methodology/approach: The environmental and economic benefits and limitations of an approach…

Socially Responsible Investing: It's Time for Schools to Get on Board

ERIC Educational Resources Information Center

Armoza, Natalia

2011-01-01

Whether it is in their professional development programs, admissions materials, or curricula, independent schools have a lot to say about environmental stewardship, equity, community service, and justice. When they send their students to rebuild post-Katrina New Orleans or construct LEED-certified structures, the schools and their constituents…

Making a Difference College Guide. Third Edition.

ERIC Educational Resources Information Center

Weinstein, Miriam

This book profiles those unique institutions or departments that are committed to public service, social change and environmental stewardship. Colleges in this guide engage in the major issues of today, especially environmental, women's, peace and ethnic studies. The programs are varied, such as marine biology, social work, outdoor education,…

36 CFR 230.1 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Purpose and scope. 230.1 Section 230.1 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND... by which the Stewardship Incentive Program will be administered by the Forest Service to establish...

36 CFR 230.1 - Purpose and scope.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 2 2011-07-01 2011-07-01 false Purpose and scope. 230.1 Section 230.1 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE STATE AND... by which the Stewardship Incentive Program will be administered by the Forest Service to establish...

THE NEVADA GEOSPATIAL DATA BROWSER: A SPATIAL DATA ARCHIVE FOR THE SOUTHWEST REGIONAL GAP ANALYSIS PROJECT

EPA Science Inventory

The Southwest Regional Gap Analysis project (SWReGAP) is a 5-state (Arizona, Colorado, Nevada, New Mexico, and Utah) inter-agency program that maps the distribution of plant communities and selected animal species and compares these distributions with land stewardship to identify...

Roadmap to MaRIE May 2015

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

Barnes, Cris William

Los Alamos National Laboratory (LANL) hosted the Stewardship Science Academic Programs Symposium, which is designed to foster relationships among young scientists, sponsors and the National Nuclear Security Administration national laboratories. The event highlights much of the work done by prominent scientists and allows attendees to view the multiple on site facilities at LANL.

Economics/Environment/Educational Outcomes of Site Planning.

ERIC Educational Resources Information Center

Grube, Karl W.; Bewley, Mary

Few school leaders and school architects have recognized or comprehended the potential symbiosis between school site resources and the enrichment of the instructional program, the urgency of repairing and improving the biosphere, the broadening of community life onto school sites, and the recognition of the responsibility role of stewardship of…

The Role of the Environment in Adventure and Outdoor Education.

ERIC Educational Resources Information Center

Miner, Todd

2003-01-01

Decreasing emphasis on the environment in outdoor and adventure education is resulting in ecologically less knowledgeable participants. It is critical that the environment continue to be part of these programs for three reasons: citizenship and stewardship; empathy and counterbalancing a narcissistic focus on thrills; and opportunities to get in…

77 FR 15933 - Conservation Loan Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-19

... ``Conservation Practice'' to coincide with the definition in NRCS regulations. FSA will add a definition of... though forestry practices are included in 7 CFR 762.121 and 764.231 as an authorized loan purpose or use... conservation practice included in the Forest Stewardship Management Plan will be an eligible use of CL funds...

Successfully Applying Team Teaching with Adult Learners

ERIC Educational Resources Information Center

Laughlin, Kevin; Nelson, Peggy; Donaldson, Susan

2011-01-01

Team teaching is a great strategy to convey systems thinking to students, families, and communities and to help learners gain multiple perspectives. Learners benefit from the professional interaction among skilled instructors. This article uses a program of land stewardship to demonstrate the advantages of team teaching. Both the advantages and…

Brains Rule!: A Model Program for Developing Professional Stewardship among Neuroscientists

ERIC Educational Resources Information Center

Zardetto-Smith, Andrea M.; Mu, Keli; Carruth, Laura L.; Frantz, Kyle J.

2006-01-01

Brains Rule! Neuroscience Expositions, funded through a National Institute on Drug Abuse Science Education Drug Abuse Partnership Award, has developed a successful model for informal neuroscience education. Each Exposition is a "reverse science fair" in which neuroscientists present short neuroscience teaching modules to students. This…

Ecosystem Matters: Activity and Resource Guide for Environmental Educators.

ERIC Educational Resources Information Center

Adams, Mary; And Others

An ecological approach involved making conscious decisions which result in actions that responsibly contribute to the long-term stewardship of natural resources. This activity and resource guide was designed for use by both educators and resource managers to supplement existing courses and programs concerning ecological matters. These…

A National Strategic Plan for Natural Resources and Environmental Management Education.

ERIC Educational Resources Information Center

Fridgen, Cynthia

1995-01-01

The Natural Resources and Environmental Management Program is designed to help people understand their relationship to the environment, practice stewardship, make informed decisions, and appreciate biodiversity. Areas of emphasis include air, land, and water quality; citizen responsibility; conflict management; approaches to land use and species…

Seven Steps for Implementing Afterschool Programs: Strategies for Physical Educators

ERIC Educational Resources Information Center

Price-Shingles, June N.; Place, Greg

2016-01-01

After-school programs (ASP) are a long-standing activity historically facilitated by organizations such as the YMCA, Boys and Girls Club, social service/community centers and, in the past decade, an increasing number of municipal park districts. Staffing usually consist of recreation professionals, social and youth workers, and volunteers. In…

Afterschool Program Participation and the Development of Child Obesity and Peer Acceptance

ERIC Educational Resources Information Center

Mahoney, Joseph L.; Lord, Heather; Carryl, Erica

2005-01-01

This longitudinal study assessed the role of afterschool program (ASP) participation in the development of child obesity and peer acceptance in a sample of 439 children. Most participants lived in poverty and were Hispanic or African American. Measurements of height and weight determined obesity status and peer acceptance was assessed through…

76 FR 45221 - Notice of Funding Availability: Inviting Applications for the Food for Progress Program

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

...://www.fas.usda.gov/excredits/FoodAid/FFP/FrameworkGuidance.asp . VI. Proposal Review Criteria A. Review... beneficiaries realistic for the proposed activities? (f) Are the beneficiaries and criteria for selection... Applications for the Food for Progress Program Announcement Type: New. Catalog of Federal Domestic Assistance...

Prediction of binding modes between protein L-isoaspartyl (D-aspartyl) O-methyltransferase and peptide substrates including isomerized aspartic acid residues using in silico analytic methods for the substrate screening.

PubMed

Oda, Akifumi; Noji, Ikuhiko; Fukuyoshi, Shuichi; Takahashi, Ohgi

2015-12-10

Because the aspartic acid (Asp) residues in proteins are occasionally isomerized in the human body, not only l-α-Asp but also l-β-Asp, D-α-Asp and D-β-Asp are found in human proteins. In these isomerized aspartic acids, the proportion of D-β-Asp is the largest and the proportions of l-β-Asp and D-α-Asp found in human proteins are comparatively small. To explain the proportions of aspartic acid isomers, the possibility of an enzyme able to repair l-β-Asp and D-α-Asp is frequently considered. The protein L-isoaspartyl (D-aspartyl) O-methyltransferase (PIMT) is considered one of the possible repair enzymes for l-β-Asp and D-α-Asp. Human PIMT is an enzyme that recognizes both l-β-Asp and D-α-Asp, and catalyzes the methylation of their side chains. In this study, the binding modes between PIMT and peptide substrates containing l-β-Asp or D-α-Asp residues were investigated using computational protein-ligand docking and molecular dynamics simulations. The results indicate that carboxyl groups of both l-β-Asp and D-α-Asp were recognized in similar modes by PIMT and that the C-terminal regions of substrate peptides were located in similar positions on PIMT for both the l-β-Asp and D-α-Asp peptides. In contrast, for peptides containing l-α-Asp or D-β-Asp residues, which are not substrates of PIMT, the computationally constructed binding modes between PIMT and peptides greatly differed from those between PIMT and substrates. In the nonsubstrate peptides, not inter- but intra-molecular hydrogen bonds were observed, and the conformations of peptides were more rigid than those of substrates. Thus, the in silico analytical methods were able to distinguish substrates from nonsubstrates and the computational methods are expected to complement experimental analytical methods. Copyright © 2015 Elsevier B.V. All rights reserved.

Predicting Opportunities for Greening and Patterns of Vegetation on Private Urban Lands

NASA Astrophysics Data System (ADS)

Troy, Austin R.; Grove, J. Morgan; O'Neil-Dunne, Jarlath P. M.; Pickett, Steward T. A.; Cadenasso, Mary L.

2007-09-01

This paper examines predictors of vegetative cover on private lands in Baltimore, Maryland. Using high-resolution spatial data, we generated two measures: “possible stewardship,” which is the proportion of private land that does not have built structures on it and hence has the possibility of supporting vegetation, and “realized stewardship,” which is the proportion of possible stewardship land upon which vegetation is growing. These measures were calculated at the parcel level and averaged by US Census block group. Realized stewardship was further defined by proportion of tree canopy and grass. Expenditures on yard supplies and services, available by block group, were used to help understand where vegetation condition appears to be the result of current activity, past legacies, or abandonment. PRIZM™ market segmentation data were tested as categorical predictors of possible and realized stewardship and yard expenditures. PRIZM™ segmentations are hierarchically clustered into 5, 15, and 62 categories, which correspond to population density, social stratification (income and education), and lifestyle clusters, respectively. We found that PRIZM 15 best predicted variation in possible stewardship and PRIZM 62 best predicted variation in realized stewardship. These results were further analyzed by regressing each dependent variable against a set of continuous variables reflective of each of the three PRIZM groupings. Housing age, vacancy, and population density were found to be critical determinants of both stewardship metrics. A number of lifestyle factors, such as average family size, marriage rates, and percentage of single-family detached homes, were strongly related to realized stewardship. The percentage of African Americans by block group was positively related to realized stewardship but negatively related to yard expenditures.

75 FR 48742 - Renewal of the Regional Resource Stewardship Council Charter

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-11

... its natural resource stewardship activities through a balanced and broad range of diverse views and... for public input regarding stewardship issues. Dated: July 26, 2010. Anda A. Ray, Senior Vice...

Service-Learning in the Environmental Sciences for Teaching Sustainability Science

NASA Astrophysics Data System (ADS)

Truebe, S.; Strong, A. L.

2016-12-01

Understanding and developing effective strategies for the use of community-engaged learning (service-learning) approaches in the environmental geosciences is an important research need in curricular and pedagogical innovation for sustainability. In 2015, we designed and implemented a new community-engaged learning practicum course through the Earth Systems Program in the School of Earth, Energy and Environmental Sciences at Stanford University focused on regional open space management and land stewardship. Undergraduate and graduate students partnered with three different regional land trust and environmental stewardship organizations to conduct quarter-long research projects ranging from remote sensing studies of historical land use, to fire ecology, to ranchland management, to volunteer retention strategies. Throughout the course, students reflected on the decision-making processes and stewardship actions of the organizations. Two iterations of the course were run in Winter and Fall 2015. Using coded and analyzed pre- and post-course student surveys from the two course iterations, we evaluate undergraduate and graduate student learning outcomes and changes in perceptions and understanding of sustainability science. We find that engagement with community partners to conduct research projects on a wide variety of aspects of open space management, land management, and environmental stewardship (1) increased an understanding of trade-offs inherent in sustainability and resource management and (2) altered student perceptions of the role of scientific information and research in environmental management and decision-making. Furthermore, students initially conceived of open space as purely ecological/biophysical, but by the end of the course, (3) their understanding was of open space as a coupled human/ecological system. This shift is crucial for student development as sustainability scientists.

US DOE Perspectives on Advisory Board Effectiveness - 13539

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

Adler, David

2013-07-01

Federal missions on the Oak Ridge Reservation began with the Manhattan Project, and continues today with major facilities supporting the Nation's Science and National Security missions. While most of the land area on the Oak Ridge Reservation is free of environmental impacts from these activities, significant legacy contamination is associated with specific facilities and past waste management areas. In 1989, the Oak Ridge Reservation (ORR) was placed on National Priorities List, and DOE established its Office of Environmental Management that same year. Three years later, in 1992, the Federal Facility Agreement for the reservation was signed. Three years afterward, themore » Oak Ridge Site Specific Advisory Board was established to augment ongoing public involvement activities related to Oak Ridge Reservation cleanup activities. One of the early and most impactful decisions the board made was to organize the End Use Working Group. This broad-based group of board members, DOE representatives, and members of the public was formed in 1997 to study future uses for contaminated areas of the reservation. The group was instrumental in building consensus in the Oak Ridge community regarding the long-term end state of reservation lands. The group's recommendations were a fundamental input into Record's of Decision subsequently developed to establish cleanup requirements across the ORR, and they continue to influence decisions being made today. In developing its recommendations on end states, the End Use Working Group came to the realization that long-term stewardship of contaminated areas of the reservation would be necessary, in some cases in perpetuity. It was from this concept that the Oak Ridge SSAB's 15-year involvement in stewardship would begin. A stewardship committee formed by the End Use Working Group wrote Volume 1 of the Stakeholder Report on Stewardship. This document-and its companion Volume 2, which was written a year later-form a crucial foundation for stewardship planning in Oak Ridge and have been referenced around the DOE complex as other sites consider stewardship planning. From these two broad-based initiatives, the board's focus has evolved to increasingly hone in on more specific, project-based recommendations and initiatives. The Oak Ridge Reservation Site Specific Advisory Board has been a highly effective forum for soliciting community input on Oak Ridge Reservation cleanup. Experience in Oak Ridge indicates that the utility of Board recommendations is far higher when the Board is asked to focus on broad programmatic issues, and less useful when the Board attempts to provide advice and recommendations on matters related to technical or project management issues. In Oak Ridge the Board has helped shape the program on many levels including definition of end-state cleanup objectives, budget development, program sequencing, waste management, and decisions concerning preservation of history related to missions implemented on the Oak Ridge Reservation. (authors)« less

Stewardship mapping and assessment project: a framework for understanding community-based environmental stewardship

Treesearch

Erika S. Svendsen; Lindsay K. Campbell; Dana R. Fisher; James J.T. Connolly; Michelle L. Johnson; Nancy Falxa Sonti; Dexter H. Locke; Lynne M. Westphal; Cherie LeBlanc Fisher; Morgan Grove; Michele Romolini; Dale J. Blahna; Kathleen L. Wolf

2016-01-01

The Stewardship Mapping and Assessment Project (STEW-MAP) is designed to answer who, where, why and how environmental stewardship groups are caring for our urbanized landscapes. This report is intended to be a guide for those who wish to start STEW-MAP in their own city. It contains step-by-step directions for how to plan and implement a STEW-MAP project. STEW-MAP is...

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage

PubMed Central

Pakyz, Amy L.; Moczygemba, Leticia R.; Wang, Hui; Stevens, Michael P.; Edmond, Michael B.

2015-01-01

Objectives To determine whether an antimicrobial stewardship ‘intensity’ score predicts hospital antimicrobial usage. Methods An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy programmes, de-escalation of therapy, antimicrobial order forms and dose optimization). Multiple regression analyses were used to assess whether the composite score and also the categories were associated with either total or antimicrobial stewardship programme-target antimicrobial use as measured in days of therapy. Results The mean antimicrobial stewardship programme score was 55 (SD 21); the total composite score was not significantly associated with total or target antimicrobial use [estimate –0.49 (95% CI –2.30 to 0.89)], while the category strategies was significantly and negatively associated with target antimicrobial use [–5.91 (95% CI –9.51 to –2.31)]. Conclusions The strategy component of a score developed to measure the intensity of antimicrobial stewardship was associated with the amount of antimicrobials used. Thus, the number and types of strategies employed by antimicrobial stewardship programmes may be of particular importance in programme effectiveness. PMID:25614043

Evaluation of Ga-DOTA-(D-Asp)n as bone imaging agents: D-aspartic acid peptides as carriers to bone.

PubMed

Ogawa, Kazuma; Ishizaki, Atsushi; Takai, Kenichiro; Kitamura, Yoji; Makino, Akira; Kozaka, Takashi; Kiyono, Yasushi; Shiba, Kazuhiro; Odani, Akira

2017-10-25

67 Ga-DOTA-(L-Asp) 11 and 67 Ga-DOTA-(L-Asp) 14 , which have been developed as bone imaging agents, showed a high accumulation in bone and a rapid blood clearance in mice. However, peptides composed of D-amino acids are more stable in vivo than those composed of their L-equivalents. In this study, 67 Ga-DOTA-(D-Asp) n (n = 2, 5, 8, 11, or 14) were synthesized using the Fmoc-based solid-phase methodology and evaluated. In hydroxyapatite binding assay, binding of 67 Ga-DOTA-(D-Asp) n tended to increase with increasing length of the amino acid chain. 67 Ga-DOTA-(D-Asp) 11 and 67 Ga-DOTA-(D-Asp) 14 caused a high accumulation of radioactivity in the bones of the mice. However, the results for 67 Ga-DOTA-(D-Asp) n and 67 Ga-DOTA-(L-Asp) n were comparable. In urine analyses, the proportion of intact complex after injection of 67 Ga-DOTA-(D-Asp) 14 was significantly higher than that of 67 Ga-DOTA-(L-Asp) 14 . Although 67 Ga-DOTA-(D-Asp) 14 was more stable than 67 Ga-DOTA-(L-Asp) 14 , the properties of 67 Ga-DOTA-(D-Asp) n and 67 Ga-DOTA-(L-Asp) n as bone imaging agents may be comparable.

Quantitative determination of free D-Asp, L-Asp and N-methyl-D-aspartate in mouse brain tissues by chiral separation and Multiple Reaction Monitoring tandem mass spectrometry.

PubMed

Fontanarosa, Carolina; Pane, Francesca; Sepe, Nunzio; Pinto, Gabriella; Trifuoggi, Marco; Squillace, Marta; Errico, Francesco; Usiello, Alessandro; Pucci, Piero; Amoresano, Angela

2017-01-01

Several studies have suggested that free d-Asp has a crucial role in N-methyl d-Asp receptor-mediated neurotransmission playing very important functions in physiological and pathological processes. This paper describes the development of an analytical procedure for the direct and simultaneous determination of free d-Asp, l-Asp and N-methyl d-Asp in specimens of different mouse brain tissues using chiral LC-MS/MS in Multiple Reaction Monitoring scan mode. After comparing three procedures and different buffers and extraction solvents, a simple preparation procedure was selected the analytes of extraction. The method was validated by analyzing l-Asp, d-Asp and N-methyl d-Asp recovery at different spiked concentrations (50, 100 and 200 pg/μl) yielding satisfactory recoveries (75-110%), and good repeatability. Limits of detection (LOD) resulted to be 0.52 pg/μl for d-Asp, 0.46 pg/μl for l-Asp and 0.54 pg/μl for NMDA, respectively. Limits of quantification (LOQ) were 1.57 pg/μl for d-Asp, 1.41 pg/μl for l-Asp and 1.64 pg/μl for NMDA, respectively. Different concentration levels were used for constructing the calibration curves which showed good linearity. The validated method was then successfully applied to the simultaneous detection of d-Asp, l-Asp and NMDA in mouse brain tissues. The concurrent, sensitive, fast, and reproducible measurement of these metabolites in brain tissues will be useful to correlate the amount of free d-Asp with relevant neurological processes, making the LC-MS/MS MRM method well suited, not only for research work but also for clinical analyses.

Associations between XPD Asp312Asn Polymorphism and Risk of Head and Neck Cancer: A Meta-Analysis Based on 7,122 Subjects

PubMed Central

Hu, Yuan Yuan; Yuan, Hua; Jiang, Guang Bing; Chen, Ning; Wen, Li; Leng, Wei Dong; Zeng, Xian Tao; Niu, Yu Ming

2012-01-01

Background To investigate the association between XPD Asp312Asn polymorphism and head and neck cancer risk through this meta-analysis. Methods We performed a meta-analysis of 9 published case-control studies including 2,670 patients with head and neck cancer and 4,452 controls. An odds ratio (OR) with a 95% confidence interval (CI) was applied to assess the association between XPD Asp312Asn polymorphism and head and neck cancer risk. Results Overall, no significant association between XPD Asp312Asn polymorphism and head and neck cancer risk was found in this meta-analysis (Asn/Asn vs. Asp/Asp: OR = 0.95, 95%CI = 0.80–1.13, P = 0.550, P heterogeneity = 0.126; Asp/Asn vs. Asp/Asp: OR = 1.11, 95%CI = 0.99–1.24, P = 0.065, P heterogeneity = 0.663; Asn/Asn+Asp/Asn vs. Asp/Asp: OR = 1.07, 95%CI = 0.97–1.19, P = 0.189, P heterogeneity = 0.627; Asn/Asn vs. Asp/Asp+Asp/Asn: OR = 0.87, 95%CI = 0.68–1.10, P = 0.243, P heterogeneity = 0.089). In the subgroup analysis by HWE, ethnicity, and study design, there was still no significant association detected in all genetic models. Conclusions This meta-analysis demonstrates that XPD Asp312Asn polymorphism may not be a risk factor for developing head and neck cancer. PMID:22536360

Lauroyl-L-aspartate decreased food intake and body temperature in neonatal chicks.

PubMed

Erwan, E; Chowdhury, V S; Ito, K; Furuse, M

2013-11-15

We hypothesized that the effects of L- and D-amino acids might be influenced when conjugated with fatty acid. Thus, the effects of oral administration of lauroyl-L-aspartate (Lau-L-Asp) as well as lauroyl-D-aspartate (Lau-D-Asp) were examined. In Experiment 1, oral administration of both Lau-L-Asp and Lau-D-Asp decreased food intake while L- or D-Asp did not influence food intake. Interestingly, only Lau-L-Asp decreased body temperature. Experiment 2 was conducted to determine whether non-conjugated mixture of L-Asp plus lauric acid has same effects under ad libitum feeding conditions. Lau-L-Asp decreased food intake and body temperature, but L-Asp plus lauric acid did not show any effect studied. In Experiment 3, we found that Lau-L-Asp declined food intake as well as time-dependently suppressed the body temperature in fasted chicks. However, L-Asp plus lauric acid did not show any effect. These results suggest that Lau-L-Asp may exert anorexigenic and hypothermic actions in chicks. © 2013.

Web-based UMLS concept retrieval by automatic text scanning: a comparison of two methods.

PubMed

Brandt, C; Nadkarni, P

2001-01-01

The Web is increasingly the medium of choice for multi-user application program delivery. Yet selection of an appropriate programming environment for rapid prototyping, code portability, and maintainability remain issues. We summarize our experience on the conversion of a LISP Web application, Search/SR to a new, functionally identical application, Search/SR-ASP using a relational database and active server pages (ASP) technology. Our results indicate that provision of easy access to database engines and external objects is almost essential for a development environment to be considered viable for rapid and robust application delivery. While LISP itself is a robust language, its use in Web applications may be hard to justify given that current vendor implementations do not provide such functionality. Alternative, currently available scripting environments for Web development appear to have most of LISP's advantages and few of its disadvantages.

The effects of acylation stimulating protein supplementation VS antibody neutralization on energy expenditure in wildtype mice.

PubMed

Paglialunga, Sabina; Fisette, Alexandre; Munkonda, Mercedes; Gao, Ying; Richard, Denis; Cianflone, Katherine

2010-04-23

Acylation stimulating protein (ASP) is an adipogenic hormone that stimulates triglyceride (TG) synthesis and glucose transport in adipocytes. Previous studies have shown that ASP-deficient C3 knockout mice are hyperphagic yet lean, as they display increased oxygen consumption and fatty acid oxidation compared to wildtype mice. In the present study, antibodies against ASP (Anti-ASP) and human recombinant ASP (rASP) were tested in vitro and in vivo. Continuous administration for 4 weeks via osmotic mini-pump of Anti-ASP or rASP was evaluated in wildtype mice on a high-fat diet (HFD) to examine their effects on body weight, food intake and energy expenditure. In mature murine adipocytes, rASP significantly stimulated fatty acid uptake (+243% vs PBS, P < 0.05) while Anti-ASP neutralized the rASP response. Mice treated with Anti-ASP showed elevated energy expenditure (P < 0.0001), increased skeletal muscle glucose oxidation (+141%, P < 0.001), reduced liver glycogen (-34%, P < 0.05) and glucose-6-phosphate content (-64%, P = 0.08) compared to control mice. There was no change in body weight, food intake, fasting insulin, adiponectin, CRP or TG levels compared to controls. Interestingly, HFD mice treated with rASP showed the opposite phenotype with reduced energy expenditure (P < 0.0001) and increased body weight (P < 0.05), cumulative food intake (P < 0.0001) and liver glycogen content (+59%, P < 0.05). Again, there was no change in circulating insulin, adiponectin, CRP or TG levels, however, plasma free fatty acids were reduced (-48%, P < 0.05). In vitro, Anti-ASP effectively neutralized ASP stimulated fatty acid uptake. In vivo, Anti-ASP treatment increased whole body energy utilization while rASP increased energy storage. Therefore, ASP is a potent anabolic hormone that may also be a mediator of energy expenditure.

Measuring the Efficacy of an Energy and Environmental Awareness Campaign to Effectively Reduce Water Consumption

ERIC Educational Resources Information Center

Miller, Laura Little

2010-01-01

Increased energy costs and a move toward environmental stewardship are driving many organizations, including universities, to engage in awareness efforts to reduce both energy consumption and their carbon footprint. The purpose of this paper is to determine whether organizational programs aimed at energy and environmental awareness have a…

Environmental Impact from Outdoor/Environmental Education Programs: Effects of Frequent Stream Classes on Aquatic Macroinvertebrates

ERIC Educational Resources Information Center

Bossley, Jon P.

2016-01-01

Environmental stewardship is an underlying theme in outdoor education (OE) and environmental education (EE), but maintaining natural areas in a sustainable balance between conservation and preservation requires knowledge about how natural areas respond to anthropogenic disturbance. My five-part study investigated the effects of disturbance on…

AN APPROACH FOR DETERMINING REGIONAL LAND COVER AND SPECIES HABITAT CONSERVATION STATUS IN THE AMERICAN SOUTHWEST: THE SOUTHWEST REGIONAL GAP ANALYSIS PROJECT

EPA Science Inventory

The Gap Analysis Program (GAP) is a national interagency progranl that maps the distribution of plant communities and selected animal species and compares these distributions with land stewardship to identify biotic elements at potential risk of endangerment. GAP uses remote sens...

Fermilab | Illinois Accelerator Research Center | Illinois Accelerator

Science.gov Websites

Department of Commerce and Economic Opportunity and the U.S. Department of Energy. Construction Progress as Research Center IARC Illinois Accelerator Research Center Fermilab U.S. Department of Energy Stewardship Pilot Program Contact IARC Funded By Illinois Department of Commerce and Economic Opportunity U.S

De-escalating Antibiotic Use in the Inpatient Setting: Strategies, Controversies, and Challenges.

PubMed

Daniel Markley, J; Bernard, Shaina; Bearman, Gonzalo; Stevens, Michael P

2017-04-01

Antibiotic de-escalation (ADE) is widely accepted as an integral strategy to curtail the global antibiotic resistance crisis. However, there is significant uncertainty regarding the ideal ADE strategy and its true impact on antibiotic resistance. Rapid diagnostic testing has the potential to enhance ADE strategies. Herein, we aim to discuss the current strategies, controversies, and challenges of ADE in the inpatient setting. A consensus definition of ADE remains elusive at this time. Preliminary studies utilizing rapid diagnostic tests including matrix-assisted laser desorption/ionization time of flight (MALDI-TOF), procalcitonin, and other molecular techniques have demonstrated the potential to support ADE strategies. In the absence of evidence-based, highly specific ADE protocols, the likelihood that individual providers will make consistent, often challenging, decisions to de-escalate antibiotic therapy is low. Antimicrobial stewardship programs should support local physicians with ADE and develop innovative ways to integrate ADE into the broader construct of antimicrobial stewardship programs. The evolving field of rapid diagnostics has significant potential to improve ADE strategies, but more research is needed to fully realize this goal.

[Impact of rational use of antibiotics in a third level clinic in Colombia].

PubMed

Pallares, Christian J; Cataño, Juan C

2017-06-01

The increasing resistance of bacteria to antibiotics threatens the survival of patients and health costs. To determine the impact of an antimicrobial stewardship program in bacterial resistance and antibiotic consumption. Quasi experimental study in a third level clinic in the city of Medellin, that evaluate in two time periods (pre-intervention between October 2012 and September 2013 and post intervention between October 2013 and September 2014) the impact of an antimicrobial stewardship program in terms of antibiotic consumption and bacterial ecology. Adherence to institutional guidelines for management of infections in the post-intervention period was 82%. Antibiotic consumption of meropenem, ceftriaxone, vancomycin and colistin decreased, and imipenem, daptomycin and linezolid was increased. A significant decrease in antibiotic resistance in Pseudomonas aeruginosa was observed, including carbapenems. An increase of extended spectrum beta lactamase production (ESBL) in Enterobacteriaceae (especially E. coli) and piperacillin/tazobactam resistance was observed. The construction and implementation of a strategy in hospitals with guidelines for managing infectious diseases, restrictions in antibiotic use, a permanent monitoring system for the formulation of antibiotics, achieved a positive impact on reducing antibiotic use and bacterial resistance.

75 FR 20991 - NACEPT Subcommittee on Promoting Environmental Stewardship

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9141-2] NACEPT Subcommittee on Promoting Environmental Stewardship AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of meeting. SUMMARY: Under the... (NACEPT) is to advise the U.S. Environmental Protection Agency on how to promote environmental stewardship...

Data principles for the U.S. Global Change Research Program

NASA Technical Reports Server (NTRS)

Ludwig, George H.; Shaffer, Lisa R.

1991-01-01

The U.S. Interagency Working Group on Data Management for Global Change has developed a set of data management and access principles. The overall purpose of these statements of principle is to stimulate responsible stewardship for data and related information and to facilitate full and open access to them. These statements have been accepted by the U.S. Agencies responsible for the Global Change Research Program. The statements of principle are presented and discussed.

[The health system of Bolivia].

PubMed

Ledo, Carmen; Soria, René

2011-01-01

This paper describes the Bolivian health system, including its structure and organization, its financing sources, its health expenditure, its physical, material and humans resources, its stewardship activities and the its health research institutions. It also discusses the most recent policy innovations developed in Bolivia: the Maternal and Child Universal Insurance, the Program for the Extension of Coverage to Rural Areas, the Family, Community and Inter-Cultural Health Model and the cash-transfer program Juana Azurduy intended to strengthen maternal and child care.

Achieving environmental excellence through a multidisciplinary grassroots movement.

PubMed

Herechuk, Bryan; Gosse, Carolyn; Woods, John N

2010-01-01

St. Joseph's Healthcare Hamilton (SJHH) supports a grassroots green team, called Environmental Vision and Action (EVA). Since the creation of EVA, a healthy balance between corporate projects led by corporate leaders and grassroots initiatives led by informal leaders has resulted in many successful environmental initiatives. Over a relatively short period of time, environmental successes at SJHH have included waste diversion programs, energy efficiency and reduction initiatives, alternative commuting programs, green purchasing practices, clinical and pharmacy greening and increased staff engagement and awareness. Knowledge of social movements theory helped EVA leaders to understand the internal processes of a grassroots movement and helped to guide it. Social movements theory may also have broader applicability in health care by understanding the passionate engagement that people bring to a common cause and how to evolve sources of opposition into engines for positive change. After early successes, as the limitations of a grassroots movement began to surface, the EVA team revived the concept of evolving the grassroots green program into a corporate program for environmental stewardship. It is hard to quantify the importance of allowing our staff, physicians, volunteers and patients to engage in changes that they feel passionately about. However, at SJHH, the transformation of a group of people unsatisfied with the organization's environmental performance into an 'engine for change' has led to a rapid improvement in environmental stewardship at SJHH that is now regarded as a success.

Dansylated octapeptide Dns-Glu-Asp-Asp-Ser-Asp-Glu-Glu-Asn inhibits the proliferation rate of HL-60 cells.

PubMed

Marsili, V; Nardicchi, V; Lupidi, G; Brozzetti, A; Gianfranceschi, G L

1996-12-01

Small acidic phosphorylated chromatin peptides show regulatory activity on gene expression. The peptide pyroGlu-Asp-Asp-Ser-Asp-Glu-Glu-Asn, synthesized on the basis of structural and biochemical studies, shows functional properties in vitro (phosphorylation by casein kinase II, control of DNA transcription by RNA polymerase II, inhibition of proliferation and promotion of differentiation in some cell lines) very similar to those of native chromatin peptides. In this report we show that the dansylated octapeptide Dns-Glu-Asp-Asp-Ser-Asp-Glu-Glu-Asn remarkably inhibits cell growth of the HL-60 cell line. The biological effect of the peptide seems to be considerably higher than that shown by the nondansylated peptide, and it cannot be attributed to a toxic effect of the Dns group. The measurement of uptake of 3H-labelled Glu-Asp-Asp-Ser-Asp-Glu-Glu-Asn demonstrates that it is unable to pass through the HL-60 cell membrane. It is our considered opinion that the addition of hydrophobic groups to the peptide N-terminus should increase the biological activity by improving its transport through the cellular membrane.

Cleavage of the actin-capping protein alpha -adducin at Asp-Asp-Ser-Asp633-Ala by caspase-3 is preceded by its phosphorylation on serine 726 in cisplatin-induced apoptosis of renal epithelial cells.

PubMed

van de Water, B; Tijdens, I B; Verbrugge, A; Huigsloot, M; Dihal, A A; Stevens, J L; Jaken, S; Mulder, G J

2000-08-18

Decreased phosphorylation of focal adhesion kinase and paxillin is associated with loss of focal adhesions and stress fibers and precedes the onset of apoptosis (van de Water, B., Nagelkerke, J. F., and Stevens, J. L. (1999) J. Biol. Chem. 274, 13328-13337). The cortical actin cytoskeletal network is also lost during apoptosis, yet little is known about the temporal relationship between altered phosphorylation of proteins that are critical in the regulation of this network and their potential cleavage by caspases during apoptosis. Adducins are central in the cortical actin network organization. Cisplatin caused apoptosis of renal proximal tubular epithelial cells, which was associated with the cleavage of alpha-adducin into a 74-kDa fragment; this was blocked by a general caspase inhibitor benzyloxycarbonyl-Val-Ala-Asp-fluoromethyl ketone (z-VAD-fmk). Hemagglutinin-tagged human alpha-adducin was cleaved into a similar 74-kDa fragment by caspase-3 in vitro but not by caspase-6 or -7. Asp-Arg-Val-Asp(29)-Glu, Asp-Ile-Val-Asp(208)-Arg, and Asp-Asp-Ser-Asp(633)-Ala were identified as the principal caspase-3 cleavage sites; Asp-Asp-Ser-Asp(633)-Ala was key in the formation of the 74-kDa fragment. Cisplatin also caused an increased phosphorylation of alpha-adducin and gamma-adducin in the MARCKS domain that preceded alpha-adducin cleavage and was associated with loss of adducins from adherens junctions; this was not affected by z-VAD-fmk. In conclusion, the data support a model in which increased phosphorylation of alpha-adducin due to cisplatin leads to dissociation from the cytoskeleton, a situation rendered irreversible by caspase-3-mediated cleavage of alpha-adducin at Asp-Asp-Ser-Asp(633)-Ala.

Glu298Asp eNOS gene polymorphism causes attenuation in nonexercising muscle vasodilatation.

PubMed

Dias, Rodrigo G; Alves, Maria-Janieire N N; Pereira, Alexandre C; Rondon, Maria Urbana P B; Dos Santos, Marcelo R; Krieger, José E; Krieger, Marta H; Negrão, Carlos E

2009-04-10

The influence of Glu298Asp endothelial nitric oxide synthase (eNOS) polymorphism in exercise-induced reflex muscle vasodilatation is unknown. We hypothesized that nonexercising forearm blood flow (FBF) responses during handgrip isometric exercise would be attenuated in individuals carrying the Asp298 allele. In addition, these responses would be mediated by reduced eNOS function and NO-mediated vasodilatation or sympathetic vasoconstriction. From 287 volunteers previously genotyped, we selected 33 healthy individuals to represent three genotypes: Glu/Glu [n = 15, age 43 +/- 3 yr, body mass index (BMI) 22.9 +/- 0.3 kg/m(2)], Glu/Asp (n = 9, age 41 +/- 3 yr, BMI 23.7 +/- 1.0 kg/m(2)), and Asp/Asp (n = 9, age 40 +/- 4 yr, BMI 23.5 +/- 0.9 kg/m(2)). Heart rate (HR), mean blood pressure (MBP), and FBF (plethysmography) were recorded for 3 min at baseline and 3 min during isometric handgrip exercise. Baseline HR, MBP, FBF, and forearm vascular conductance (FVC) were similar among genotypes. FVC responses to exercise were significantly lower in Asp/Asp when compared with Glu/Asp and Glu/Glu (Delta = 0.07 +/- 0.14 vs. 0.64 +/- 0.20 and 0.57 +/- 0.09 units, respectively; P = 0.002). Further studies showed that intra-arterial infusion of NG-monomethyl-L-arginine (L-NMMA) did not change FVC responses to exercise in Asp/Asp, but significantly reduced FVC in Glu/Glu (Delta = 0.79 +/- 0.14 vs. 0.14 +/- 0.09 units). Thus the differences between Glu/Glu and Asp/Asp were no longer observed (P = 0.62). l-NMMA + phentolamine increased similarly FVC responses to exercise in Glu/Glu and Asp/Asp (P = 0.43). MBP and muscle sympathetic nerve activity increased significant and similarly throughout experimental protocols in Glu/Glu and Asp/Asp. Individuals who are homozygous for the Asp298 allele of the eNOS enzyme have attenuated nonexercising muscle vasodilatation in response to exercise. This genotype difference is due to reduced eNOS function and NO-mediated vasodilatation, but not sympathetic vasoconstriction.

TREATMENT INTENSIFICATION WITH INSULIN DEGLUDEC/INSULIN ASPART TWICE DAILY: RANDOMIZED STUDY TO COMPARE SIMPLE AND STEP-WISE TITRATION ALGORITHMS.

PubMed

Gerety, Gregg; Bebakar, Wan Mohamad Wan; Chaykin, Louis; Ozkaya, Mesut; Macura, Stanislava; Hersløv, Malene Lundgren; Behnke, Thomas

2016-05-01

This 26-week, multicenter, randomized, open-label, parallel-group, treat-to-target trial in adults with type 2 diabetes compared the efficacy and safety of treatment intensification algorithms with twice-daily (BID) insulin degludec/insulin aspart (IDegAsp). Patients randomized 1:1 to IDegAsp BID used either a 'Simple' algorithm (twice-weekly dose adjustments based on a single prebreakfast and pre-evening meal self-monitored plasma glucose [SMPG] measurement; IDegAsp[BIDSimple], n = 136) or a 'Stepwise' algorithm (once-weekly dose adjustments based on the lowest of 3 pre-breakfast and 3 pre-evening meal SMPG values; IDegAsp[BIDStep-wise], n = 136). After 26 weeks, mean change from baseline in glycated hemoglobin (HbA1c) with IDegAsp[BIDSimple] was noninferior to IDegAsp[BIDStep-wise] (-15 mmol/mol versus -14 mmol/mol; 95% confidence interval [CI] upper limit, <4 mmol/mol) (baseline HbA1c: 66.3 mmol/mol IDegAsp[BIDSimple] and 66.6 mmol/mol IDegAsp[BIDStep-wise]). The proportion of patients who achieved HbA1c <7.0% (<53 mmol/mol) at the end of the trial was 66.9% with IDegAsp[BIDSimple] and 62.5% with IDegAsp[BIDStep-wise]. Fasting plasma glucose levels were reduced with each titration algorithm (-1.51 mmol/L IDegAsp[BIDSimple] versus -1.95 mmol/L IDegAsp[BIDStep-wise]). Weight gain was 3.8 kg IDegAsp[BIDSimple] versus 2.6 kg IDegAsp[BIDStep-wise], and rates of overall confirmed hypoglycemia (5.16 episodes per patient-year of exposure [PYE] versus 8.93 PYE) and nocturnal confirmed hypoglycemia (0.78 PYE versus 1.33 PYE) were significantly lower with IDegAsp[BIDStep-wise] versus IDegAsp[BIDSimple]. There were no significant differences in insulin dose increments between groups. Treatment intensification with IDegAsp[BIDSimple] was noninferior to IDegAsp[BIDStep-wise]. Both titration algorithms were well tolerated; however, the more conservative step-wise algorithm led to less weight gain and fewer hypoglycemic episodes. Clinicaltrials.gov: NCT01680341.

Nuclear materials stewardship: Our enduring mission

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

Isaacs, T.H.

1998-12-31

The US Department of Energy (DOE) and its predecessors have handled a remarkably wide variety of nuclear materials over the past 50 yr. Two fundamental changes have occurred that shape the current landscape regarding nuclear materials. If one recognizes the implications and opportunities, one sees that the stewardship of nuclear materials will be a fundamental and important job of the DOE for the foreseeable future. The first change--the breakup of the Soviet Union and the resulting end to the nuclear arms race--altered US objectives. Previously, the focus was on materials production, weapon design, nuclear testing, and stockpile enhancements. Now themore » attention is on dismantlement of weapons, excess special nuclear material inventories, accompanying increased concern over the protection afforded to such materials; new arms control measures; and importantly, maintenance of the safety and reliability of the remaining arsenal without testing. The second change was the raised consciousness and sense of responsibility for dealing with the environmental legacies of past nuclear arms programs. Recognition of the need to clean up radioactive contamination, manage the wastes, conduct current operations responsibly, and restore the environment have led to the establishment of what is now the largest program in the DOE. Two additional features add to the challenge and drive the need for recognition of nuclear materials stewardship as a fundamental, enduring, and compelling mission of the DOE. The first is the extraordinary time frames. No matter what the future of nuclear weapons and no matter what the future of nuclear power, the DOE will be responsible for most of the country`s nuclear materials and wastes for generations. Even if the Yucca Mountain program is successful and on schedule, it will last more than 100 yr. Second, the use, management, and disposition of nuclear materials and wastes affect a variety of nationally important and diverse objectives, from national security to the future of nuclear power in this country and abroad, to the care of the environment. Sometimes these objectives are in concert, but often they are seen as competing or being in conflict. By recognizing the corporate responsibility for these materials and the accompanying programs, national decision making will be improved.« less

Overview of antimicrobial options for Mycoplasma pneumoniae pneumonia: focus on macrolide resistance.

PubMed

Cao, Bin; Qu, Jiu-Xin; Yin, Yu-Dong; Eldere, Johan Van

2017-07-01

Community-acquired pneumonia (CAP) is a common infectious disease affecting children and adults of any age. Mycoplasma pneumoniae has emerged as leading causative agent of CAP in some region, and the abrupt increasing resistance to macrolide that widely used for management of M. pneumoniae has reached to the level that it often leads to treatment failures. We aim to discuss the drivers for development of macrolide-resistant M. pneumoniae, antimicrobial stewardship and also the potential treatment options for patients infected with macrolide-resistant M. pneumonia. The articles in English and Chinese published in Pubmed and in Asian medical journals were selected for the review. M. pneumoniae can develop macrolide resistance by point mutations in the 23S rRNA gene. Inappropriate and overuse of macrolides for respiratory tract infections may induce the resistance rapidly. A number of countries have introduced the stewardship program for restricting the use of macrolide. Tetracyclines and fluoroquinolones are highly effective for macrolide-resistant strains, which may be the substitute in the region of high prevalence of macrolide-resistant M. pneumoniae. The problem of macrolide resistant M. pneumonia is emerging. Antibiotic stewardship is needed to inhibit the inappropriate use of macrolide and new antibiotics with a more acceptable safety profile for all ages need to be explored. © 2015 John Wiley & Sons Ltd.

Cultivating Positive Youth Development, Critical Consciousness, and Authentic Care in Urban Environmental Education.

PubMed

Delia, Jesse; Krasny, Marianne E

2017-01-01

This paper addresses the issue of how to provide affordances for youth development in the context of environmental stewardship in cities. Urban environmental education encompasses place-based and action-oriented stewardship practices, including community gardening and vegetable production, often with the dual goals of developing youth and community assets. Yet in-depth understanding of how these goals are achieved is lacking. Using narrative inquiry, we explored participant experiences in a multi-year agriculture internship program conducted by the food justice organization East New York Farms! (ENYF) in Brooklyn, NY. Emerging from our conversations with youth were five themes defining their intern experience: ENYF as somewhere to belong, to be pushed, to grapple with complexity, to practice leadership, and to become yourself. We propose a theory of change that emphasizes politicized notions of caring as a foundation for cultivating developmental assets, including competence, contribution, and critical consciousness, among youth who participate in ENYF programs multiple years. This paper extends the literature on socio-environmental affordances to encompass urban environmental education programs, which incorporate physical and social features that act as affordances. Further, this paper describes a feedback loop in which youth afforded opportunities to develop assets through contributing to their community in turn create affordances for additional youth and adults.

Cultivating Positive Youth Development, Critical Consciousness, and Authentic Care in Urban Environmental Education

PubMed Central

Delia, Jesse; Krasny, Marianne E.

2018-01-01

This paper addresses the issue of how to provide affordances for youth development in the context of environmental stewardship in cities. Urban environmental education encompasses place-based and action-oriented stewardship practices, including community gardening and vegetable production, often with the dual goals of developing youth and community assets. Yet in-depth understanding of how these goals are achieved is lacking. Using narrative inquiry, we explored participant experiences in a multi-year agriculture internship program conducted by the food justice organization East New York Farms! (ENYF) in Brooklyn, NY. Emerging from our conversations with youth were five themes defining their intern experience: ENYF as somewhere to belong, to be pushed, to grapple with complexity, to practice leadership, and to become yourself. We propose a theory of change that emphasizes politicized notions of caring as a foundation for cultivating developmental assets, including competence, contribution, and critical consciousness, among youth who participate in ENYF programs multiple years. This paper extends the literature on socio-environmental affordances to encompass urban environmental education programs, which incorporate physical and social features that act as affordances. Further, this paper describes a feedback loop in which youth afforded opportunities to develop assets through contributing to their community in turn create affordances for additional youth and adults. PMID:29379456

Reducing co-administration of proton pump inhibitors and antibiotics using a computerized order entry alert and prospective audit and feedback.

PubMed

Kandel, Christopher E; Gill, Suzanne; McCready, Janine; Matelski, John; Powis, Jeff E

2016-07-22

Antibiotics and proton pump inhibitors (PPIs) are associated with Clostridium difficile infection (CDI). Both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and PPIs among hospitalized patients. Consecutive patients admitted to two General Internal Medicine wards from October 1, 2010 until March 31, 2013 at a teaching hospital in Toronto, Ontario, Canada were evaluated. The baseline observation period was followed by the first phase, which involved the creation of a computerized order entry alert that was triggered when either a PPI or an antibiotic was ordered in the presence of the other. The second phase consisted of the introduction of an antibiotic stewardship-initiated prospective audit and feedback strategy. The primary outcome was the co-administration of antibiotics and PPIs during each phase. This alert led to a significant reduction in the co-administration of antibiotics and PPIs adjusted for month and secular trends, expressed as days of therapy per 100 patient days (4.99 vs. 3.14, p < 0.001) The subsequent introduction of the antibiotic stewardship program further reduced the co-administration (3.14 vs. 1.80, p <0.001). No change was observed in adjusted monthly CDI rates per 100 patient care days between the baseline and alert cohorts (0.12 vs. 0.12, p = 0.99) or the baseline and antibiotic stewardship phases (0.12 vs. 0.13, p = 0.97). Decreasing the co-administration of PPIs and antibiotics can be achieved using a simple automatic alert followed by prospective audit and feedback.

Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections.

PubMed

Frenette, Charles; Sperlea, David; Leharova, Yveta; Thirion, Daniel J G

2016-12-01

OBJECTIVE The goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs). METHODS This study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation were included. Outcomes were compared between a preintervention group (2010-2011) and a postintervention group (2012-2014). RESULTS A total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4-3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4-3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4-24.9). CONCLUSIONS A long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas-kidney transplantation. Infect Control Hosp Epidemiol 2016;1468-1474.

The Aspergillus fumigatus septins play pleiotropic roles in septation, conidiation, and cell wall stress, but are dispensable for virulence.

PubMed

Vargas-Muñiz, José M; Renshaw, Hilary; Richards, Amber D; Lamoth, Frédéric; Soderblom, Erik J; Moseley, M Arthur; Juvvadi, Praveen R; Steinbach, William J

2015-08-01

Septins are a conserved family of GTPases that regulate important cellular processes such as cell wall integrity, and septation in fungi. The requirement of septins for virulence has been demonstrated in the human pathogenic yeasts Candida albicans and Cryptococcus neoformans, as well as the plant pathogen Magnaporthe oryzae. Aspergillus spp. contains five genes encoding for septins (aspA-E). While the importance of septins AspA, AspB, AspC, and AspE for growth and conidiation has been elucidated in the filamentous fungal model Aspergillus nidulans, nothing is known on the role of septins in growth and virulence in the human pathogen Aspergillus fumigatus. Here we deleted all five A. fumigatus septins, and generated certain double and triple septin deletion strains. Phenotypic analyses revealed that while all the septins are dispensable in normal growth conditions, AspA, AspB, AspC and AspE are required for regular septation. Furthermore, deletion of only the core septin genes significantly reduced conidiation. Concomitant with the absence of an electron-dense outer conidial wall, the ΔaspB strain was also sensitive to anti-cell wall agents. Infection with the ΔaspB strain in a Galleria mellonella model of invasive aspergillosis showed hypervirulence, but no virulence difference was noted when compared to the wild-type strain in a murine model of invasive aspergillosis. Although the deletion of aspB resulted in increased release of TNF-α from the macrophages, no significant inflammation differences in lung histology was noted between the ΔaspB strain and the wild-type strain. Taken together, these results point to the importance of septins in A. fumigatus growth, but not virulence in a murine model. Copyright © 2015 Elsevier Inc. All rights reserved.

An Ecological Analysis of After-School Program Participation and the Development of Academic Performance and Motivational Attributes for Disadvantaged Children

ERIC Educational Resources Information Center

Mahoney, Joseph L.; Lord, Heather; Carryl, Erica

2005-01-01

This longitudinal study evaluated after-school program (ASP) participation and the development of academic performance (school grades, reading achievement) and teacher-rated motivational attributes (expectancy of success, effectance motivation) over a school year. Participants were 599 boys and girls (6.3 to 10.6 years) from an urban,…

Bodily Play in the After-School Program: Fulfillment of Intentionality in Interaction between Body and Place

ERIC Educational Resources Information Center

Londal, Knut

2011-01-01

This article investigates the relationship between children in an after-school program (ASP) and the places where they play. It focuses on the kind of bodily play the children themselves choose and control. The author applies a life-world approach to this study, and his theoretical perspective is based on phenomenological philosophy. The…

Influence of a Science-Focused After-School Program on Underrepresented High-School Students' Science Attitudes and Trajectory: A Survey Validation Study

ERIC Educational Resources Information Center

Puvirajah, Anton; Verma, Geeta; Li, Hongli; Martin-Hansen, Lisa

2015-01-01

As engagement with science, technology, engineering, and mathematics (STEM) increases in after-school programs (ASPs), it is important to examine the impact of this engagement on students' academic achievement, STEM participation, and affinity toward STEM. Results of these examinations can offer insights into both best practices that could be…

A Conceptual Model for Training After-School Program Staffers to Promote Physical Activity and Nutrition

ERIC Educational Resources Information Center

Weaver, Robert Glenn; Beets, Michael W.; Webster, Collin; Beighle, Aaron; Huberty, Jennifer

2012-01-01

Background: After-school programs (ASPs, 3 pm to 6 pm) have been called upon to increase the amount of daily physical activity children accumulate and improve the nutritional quality of the snacks served. To this end, state and national physical activity and nutrition (PAaN) policies have been proposed. Frontline staff who directly interact with…

77 FR 38267 - Information Collection; Role of Communities in Stewardship Contracting Projects

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

...) Nature of roles played by the entities involved in developing agreement or contract plans, (c) Benefits... Collection; Role of Communities in Stewardship Contracting Projects AGENCY: Forest Service, USDA. ACTION... revision of a currently approved information collection, Role of Communities in Stewardship Contracting...

Preserving Open Space via Community Stewardship.

ERIC Educational Resources Information Center

Lopez, Stephen

1983-01-01

When community groups assume stewardship of underused properties and turn them into recreational spaces, park agencies can save money on overhead and construction. Three stewardship projects in New York State, involving a playing field, gardening areas, and a historical restoration, are described. Criteria for successful projects are included. (PP)

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

Colantonio, Patrizia; Leboffe, Loris; Bolli, Alessandro

Caspase-3 is responsible for the cleavage of several proteins including the nuclear enzyme poly(ADP-ribose) polymerase (PARP). Designed on the cleavage site of PARP, Ac-Asp-Glu-Val-Asp-H has been reported as a highly specific inhibitor. To overcome the susceptibility to proteolysis, the intrinsic instability, and the scarce membrane permeability of tetra-peptidyl aldehydes, di- and tri-peptidyl caspase-3 inhibitors have been synthesized. Here, the synthesis and the inhibition properties of peptidyl aldehydes Z-tLeu-Asp-H, Z-tLeu-Val-Asp-H, and Z-Val-tLeu-Asp-H are reported. Z-tLeu-Asp-H, Z-tLeu-Val-Asp-H, and Z-Val-tLeu-Asp-H inhibit competitively human caspase-3 activity in vitro with K{sub i}{sup 0} = 3.6 nM, 18.2 nM, and 109 nM, respectively (pH 7.4 andmore » 25 deg. C). Moreover, Z-tLeu-Asp-H impairs apoptosis in human DLD-1 colon adenocarcinoma cells without affecting caspase-8. Therefore, Ac-Asp-Glu-Val-Asp-H can be truncated to Z-tLeu-Asp-H retaining nanomolar inhibitory activity in vitro and displaying action in whole cells, these properties reflect the unprecedented introduction of the bulky and lipophilic tLeu residue at the P{sub 2} position.« less

In vitro activity of almond skin polyphenols for scavenging free radicals and inducing quinone reductase.

PubMed

Chen, C-Y Oliver; Blumberg, Jeffrey B

2008-06-25

Observational studies and clinical trials suggest nut intake, including almonds, is associated with an enhancement in antioxidant defense and a reduction in the risk of cancer and cardiovascular disease. Almond skins are rich in polyphenols (ASP) that may contribute to these putative benefits. To assess their potential mechanisms of action, we tested the in vitro effect of ASP extracted with methanol (M) or a gastrointestinal juice mimic (GI) alone or in combination with vitamins C (VC) or E (VE) (1-10 micromol/L) on scavenging free radicals and inducing quinone reductase (QR). Flavonoid profiles from ASP-M and -GI extracts were different from one another. ASP-GI was more potent in scavenging HOCl and ONOO (-) radicals than ASP-M. In contrast, ASP-M increased and ASP-GI decreased QR activity in Hepa1c1c7 cells. Adding VC or VE to ASP produced a combination- and dose-dependent action on radical scavenging and QR induction. In comparison to their independent actions, ASP-M plus VC were less potent in scavenging DPPH, HOCl, ONOO (-), and O 2 (-) (*). However, the interaction between ASP-GI plus VC promoted their radical scavenging activity. Combining ASP-M plus VC resulted in a synergistic interaction, inducing QR activity, but ASP-GI plus VC had an antagonistic effect. On the basis of their total phenolic content, the measures of total antioxidant activity of ASP-M and -GI were comparable. Thus, in vitro, ASP act as antioxidants and induce QR activity, but these actions are dependent upon their dose, method of extraction, and interaction with antioxidant vitamins.

Appropriateness of gram-negative agent use at a tertiary care hospital in the setting of significant antimicrobial resistance.

PubMed

Vora, Neil M; Kubin, Christine J; Furuya, E Yoko

2015-01-01

Background.  Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods.  We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ(2) or Fischer's exact test for categorical variables and Student t test or Mann-Whitney U test for continuous variables. Results.  A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29-.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28-.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09-.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35-5.16) was associated with suboptimal use. Conclusions.  Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

Training should be the first step toward an antifungal stewardship program.

PubMed

Valerio, Maricela; Muñoz, Patricia; Rodríguez-González, Carmen; Sanjurjo, María; Guinea, Jesús; Bouza, Emilio

2015-04-01

The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA). The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16±1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Making Interdisciplinary Connections to Your School Gardening Program. Education in Blossom: The School Garden-Community Partnership.

ERIC Educational Resources Information Center

Eames-Sheavly, Marcia

1998-01-01

Proposes that it is critical for children to understand and appreciate plants, and that gardening can be integrated into the regular school curriculum. Gives examples of "pizza garden" and flower garden projects related to math, science, language arts, creative arts, nutrition and health, physical education, Earth stewardship, music, social…

Good Ideas at Work for Education. Take Pride in America Program.

ERIC Educational Resources Information Center

Federal Interagency Committee on Education, Washington, DC.

Take Pride in America (TPIA) is a national campaign and partnership between public and private organizations and individuals who are committed to: (1) increasing awareness of the importance of the wise use of our natural and cultural resources; (2) encouraging an attitude of stewardship and responsibility toward our public and private resources;…

The Nature Conservancy's Student Stewardship Program, Student Workbook.

ERIC Educational Resources Information Center

Roberts, Mary, Ed.

Five schools in northeastern Ohio were chosen to participate in this environmental education project. Students were assigned a natural area in their community to study in detail. This workbook is designed for recording data collected during the year long project. The topics to be studied are organized according to the month that they will be done,…

Fostering "Connectedness to Nature" through U.S. Fish and Wildlife Service Education and Outreach Programming: A Qualitative Evaluation

ERIC Educational Resources Information Center

Theimer, Stefan; Ernst, Julie

2012-01-01

Despite a recent increased emphasis on emotional connections to nature and their relationship to stewardship and health outcomes in the environmental education and other literature, there is a lack of understanding of what qualities of nature experiences actually influence emotional connections to nature, otherwise known as environmental…

The Fact of the Matter

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

Kippen, Karen Elizabeth; Montoya, Donald Raymond

For more than 20 years the science and engineering capabilities of the nation’s Stockpile Stewardship Program have allowed the United States to sustain a safe, secure, and effective nuclear deterrent. Most of the problems identifi ed within the nuclear stockpile are related to its aging materials. MaRIE will advance this record of excellence in addressing such materials problems.

The Six Principles of Facilities Stewardship

ERIC Educational Resources Information Center

Kaiser, Harvey H.; Klein, Eva

2010-01-01

Facilities stewardship means high-level and pervasive commitment to optimize capital investments, in order to achieve a high-functioning and attractive campus. It includes a major commitment to capital asset preservation and quality. Stewardship is about the long view of an institution's past and future. It ultimately forms the backdrop for…

After the Bell: Developing an Awareness of Pet Stewardship

ERIC Educational Resources Information Center

Farenga, Stephen J.; Ness, Daniel; Hutchinson, Michael

2008-01-01

Given the commonness of pets in communities throughout the United States, Canada, and Australia, among other countries, pet stewardship should be a natural topic of study for the integration of science, mathematics, and technology. Therefore, the term "stewardship" will be examined by applying observation and research to shape our…

Becoming Rooted in the Stewardship Way of Life.

ERIC Educational Resources Information Center

Voboril, Bob

2003-01-01

Criticizes how Catholic schools have been forced to survive by adopting a purchase mentality. The solution is to embrace the stewardship way of life. Points out that stewardship takes a while to take effect, but once it does it will create a counter cultural attitude toward one's income and assets. (MZ)

Antibiotic Stewardship: New Frontier, Familiar Journey.

PubMed

Martin, Caren McHenry

2017-05-01

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Planning the Transition to Long-Term Stewardship for the River Corridor

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

Cearlock, C.S.; Lerch, J.A.; Sands, J.P.

2007-07-01

Long-term stewardship refers to all activities necessary to ensure protection of human health and the environment following completion of remediation, disposal, or stabilization of a site or a portion of a site. Efforts to establish the proposed approach and criteria to be met for long-term stewardship in the river corridor of the Hanford Site in Richland, Washington, are currently being established and a draft plan is expected to be completed in mid-2007 to facilitate planning for a smooth and seamless transition to long-term stewardship. Once the initial criteria have been established, supporting information will be gathered as the work proceeds.more » Near the end of cleanup actions under the River Corridor Closure Contract, these criteria will be finalized in a long-term stewardship plan that documents how the criteria have been met. In addition, the final long-term stewardship plan will also contain a proposed Finding of Suitability to Transfer in accordance with Comprehensive Environmental Response, Compensation, and Liability Act of 1980 Section 120(h) [1]. This final long-term stewardship plan will provide the foundation for post-River Corridor Closure Contract and management activities in the river corridor pending actual property transfer from the U.S. Department of Energy. (authors)« less

Conformational Change in the Active Site of Streptococcal Unsaturated Glucuronyl Hydrolase Through Site-Directed Mutagenesis at Asp-115.

PubMed

Nakamichi, Yusuke; Oiki, Sayoko; Mikami, Bunzo; Murata, Kousaku; Hashimoto, Wataru

2016-08-01

Bacterial unsaturated glucuronyl hydrolase (UGL) degrades unsaturated disaccharides generated from mammalian extracellular matrices, glycosaminoglycans, by polysaccharide lyases. Two Asp residues, Asp-115 and Asp-175 of Streptococcus agalactiae UGL (SagUGL), are completely conserved in other bacterial UGLs, one of which (Asp-175 of SagUGL) acts as a general acid and base catalyst. The other Asp (Asp-115 of SagUGL) also affects the enzyme activity, although its role in the enzyme reaction has not been well understood. Here, we show substitution of Asp-115 in SagUGL with Asn caused a conformational change in the active site. Tertiary structures of SagUGL mutants D115N and D115N/K370S with negligible enzyme activity were determined at 2.00 and 1.79 Å resolution, respectively, by X-ray crystallography. The side chain of Asn-115 is drastically shifted in both mutants owing to the interaction with several residues, including Asp-175, by formation of hydrogen bonds. This interaction between Asn-115 and Asp-175 probably prevents the mutants from triggering the enzyme reaction using Asp-175 as an acid catalyst.