Changes in Polish law related to the implementation of COUNCIL DIRECTIVE 2013/59/EURATOM of 5 December 2013

NASA Astrophysics Data System (ADS)

Wołoszczuk, Katarzyna; Skubacz, Krystian; Podgórska, Zuzanna

2018-01-01

Radon is an invisible, naturally occurring radioactive noble gas. According to the WHO report, it is the most important cause of lung cancer after smoking [1]. Recent epidemiological studies show that a statistically significant increase in the risk of lung cancer already occurs as a result of prolonged exposure to radon inside rooms where the concentration is at 100 Bq/m3 and increases by 16% per 100 Bq/m3 increase (considering a prolonged exposure period). For this reason, the Council Directive 2013/59/Euratom (BSS) [2] establishing the basic safety standards for the protection against the hazards related to ionizing radiation, that was passed in 2013, pays particular attention to issues related to radon exposure. BSS reduce radon concentration limits in workplaces to 300 Bq/m3. According to the regulations in force, the BSS must be implemented in the Polish Atomic Law no later than 6th February 2018.

Protection from radon exposure at home and at work in the directive 2013/59/Euratom.

PubMed

Bochicchio, F

2014-07-01

In recent years, international organisations involved in radiation protection and public health have produced new guidance, recommendations and requirements aiming better protection from radon exposure. These organisations have often worked in close collaboration in order to facilitate the establishment of harmonised standards. This paper deals with such standards and specifically with the new European Council Directive of 5 December 2013 on basic safety standards for protection against the dangers arising from exposure to ionising radiation (2013/59/Euratom). This new Directive has established a harmonised framework for the protection against ionising radiations, including protection from radon exposure. Requirements for radon in workplace are much more tightening than in previous Directive, and exposures to radon in dwellings are regulated for the first time in a Directive. Radon-related articles of this Directive are presented and discussed in this paper, along with some comparisons with other relevant international standards. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Radiation protection in orthopaedics: implications for clinical practice of the new regulations governing roentgen ray irradiation and radioprotection].

PubMed

Nestle, U; Berlich, J

2006-05-01

In 2001 or 2002, the legislator made substantial alterations to the "Röntgenverordnung" [regulations governing use of roentgen ray radiation] and "Strahlenschutzverordnung" [regulations governing radiation protection]. This was done to bring German law in line with EU Directives 96/29/Euratom (basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionizing radiation) and 97/43/Euratom (health protection of individuals against the dangers of ionizing radiation in relation to medical exposure). Proper use of radiation in medicine requires that those involved in its application are aware of the biological effects of radiation. When staff and others are protected good organization and appropriate technology at the workplace can achieve a great deal. In the new directives, the radiation protection for the patient is quantified and the responsibility of the physician is clearly pointed out. The most important aim is uniform quality throughout Europe in radiological diagnosis and radiation protection.

[Radiation protection. Implications for clinical practice on the new regulations governing roentgen ray irradiation and radioprotection].

PubMed

Nestle, U; Berlich, J

2006-08-01

In 2001 or 2002, the legislator made substantial alterations to the "Röntgenverordnung" [regulations governing use of roentgen ray radiation] and "Strahlenschutzverordnung" [regulations governing radiation protection]. This was done to bring German law in line with EU Directives 96/29/Euratom (basic safety standards for the protection of the health of workers and the general public against the dangers arising from ionizing radiation) and 97/43/Euratom (health protection of individuals against the dangers of ionizing radiation in relation to medical exposure). Proper use of radiation in medicine requires that those involved in its application are aware of the biological effect of radiation. When staff and others are protected good organization and appropriate technology at the workplace can achieve a great deal. In the new directives, the radiation protection for the patient is quantified and the responsibility of the physician is clearly pointed out. The most important aim is uniform quality throughout Europe in radiological diagnosis and radiation protection.

76 FR 17406 - Proposed Subsequent Arrangement

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

... the Peaceful Uses of Nuclear Energy Between the European Atomic Energy Community (EURATOM) and the... America and the Government of Norway Concerning Peaceful Uses of Nuclear Energy. DATES: This subsequent... Peaceful Uses of Nuclear Energy. In accordance with section 131a. of the Atomic Energy Act of 1954, as...

Evaluation of antimicrobial susceptibilities and virulence factors of Staphylococcus aureus strains isolated from community-acquired and health-care associated pediatric infections.

PubMed

Karbuz, Adem; Karahan, Zeynep Ceren; Aldemir-Kocabaş, Bilge; Tekeli, Alper; Özdemir, Halil; Güriz, Haluk; Gökdemir, Refik; İnce, Erdal; Çiftçi, Ergin

2017-01-01

Karbuz A, Karahan ZC, Aldemir-Kocabaş B, Tekeli A, Özdemir H, Güriz H, Gökdemir R, İnce E, Çiftçi E. Evaluation of antimicrobial susceptibilities and virulence factors of Staphylococcus aureus strains isolated from community-acquired and health-care associated pediatric infections. Turk J Pediatr 2017; 59: 395-403. The aim of this study was to investigate the enterotoxins and Panton-Valentine leukocidin (PVL) gene as virulence factor, identification if antimicrobial sensitivity patterns, agr (accessory gene regulator) types and sequence types and in resistant cases to obtain SCCmec (staphylococcal cassette chromosome mec) gene types which will be helpful to decide empirical therapy and future health politics for S. aureus species. Total of 150 isolates of S. aureus were isolated from the cultures of the child patients in January 2011 and December 2012. In this study, the penicillin resistance was observed as 93.8%. PVL and mecA was detected positive in 8.7% and in 6% of all S. aureus strains, respectively. Two MRSA (methicillin resistant S.aureus) strains were detected as SCCmec type III and SCCmec type V and five MRSA strains were detected as SCCmec type IV. SET-I and SET-G were the most common detected enterotoxins. In both community-associated and healthcare-associated MRSA strains, agr type 1 was detected most commonly. The most common sequence types were ST737 in 13 patients than ST22 in eight patients and ST121 in six patients. This study highlights a necessity to review the cause of small changes in the structural genes in order to determine whether it is a cause or outcome; community-acquired and healthcare associated strains overlap.

15 CFR 740.11 - Governments, international organizations, international inspections under the Chemical Weapons...

Code of Federal Regulations, 2014 CFR

2014-01-01

..., including Additional Protocols, designed to ensure that special nuclear materials and other related nuclear... headquarters in Luxembourg. Euratom establishes and administers safeguards designed to ensure that special... the aggregation exceeds the APP parameter set forth in ECCN 4A003.b. (v) “600 series” items may not be...

The Terminological Problems Facing Euratom's Nuclear Documentation Service.

ERIC Educational Resources Information Center

Detant, Marcel

In order to carry out its project for a mechanized documentation service based on a system of keyword coordination, European Atomic Energy Community's Centre for Information and Documentation was led to draw up an inventory of terminology in the nuclear field and maintain a tight control over it. A basic thesaurus of 1230 keywords was drawn up and…

The cosmopolitan maternal heritage of the Thoroughbred racehorse breed shows a significant contribution from British and Irish native mares.

PubMed

Bower, M A; Campana, M G; Whitten, M; Edwards, C J; Jones, H; Barrett, E; Cassidy, R; Nisbet, R E R; Hill, E W; Howe, C J; Binns, M

2011-04-23

The paternal origins of Thoroughbred racehorses trace back to a handful of Middle Eastern stallions, imported to the British Isles during the seventeenth century. Yet, few details of the foundation mares were recorded, in many cases not even their names (several different maternal lineages trace back to 'A Royal Mare'). This has fuelled intense speculation over their origins. We examined mitochondrial DNA from 1929 horses to determine the origin of Thoroughbred foundation mares. There is no evidence to support exclusive Arab maternal origins as some historical records have suggested, or a significant importation of Oriental mares (the term used in historic records to refer to Middle East and western Asian breeds including Arab, Akhal-Teke, Barb and Caspian). Instead, we show that Thoroughbred foundation mares had a cosmopolitan European heritage with a far greater contribution from British and Irish Native mares than previously recognized.

CITYZER - Services for effective decision making and environmental resilience

NASA Astrophysics Data System (ADS)

Harri, Ari-Matti; Turtiainen, Heikki; Turpeinen, Jani; Viitala, Erkki; Janka, Kauko; Palonen, Henry; Rönkkö, Topi; Laiho, Tiina; Laitinen, Teija; Haukka, Harri; Schmidt, Walter; Nousiainen, Timo

2016-04-01

The CITYZER project develops new digital services and products to support decision making processes related to weather and air quality in cities. This includes, e.g., early warnings and forecasts (0-24 h), which allow for avoiding weather-related accidents, mitigate human distress and costs from weather-related damage and bad air quality, and generally improve the resilience and safety of the society. The project takes advantage of the latest scientific know-how and directly exploits the expertise obtained from, e.g., Tekes-funded (MMEA [1], RAVAKE) and EU-funded (HAREN, EDHIT [2]) projects. Central to the project is the Observation Network Manager NM10 [3] developed by Vaisala Oyj within the Tekes/MMEA project, on which CITYZER defines and builds new commercial services and connects new sensor networks (e.g., air quality). The target groups of the services and products (e.g., public sector, real estate and energy companies, and distributors) and related business models will be analyzed and developed in collaboration with local player (e.g., Asia, South America) taking advantage of the pre-existing contacts by the Haaga-Helia, Vaisala Oyj and CLIC Innovation. Service models are designed to account for and adapt to the special needs of different areas and customers. The developed services will be scalable (most common platforms) and responsive. CITYZER project partners include Vaisala Oyj (observation instrumentation, systems and products), Sasken Ltd (mobile products), Emtele Ltd (Portable IoT ICT Service Operation Center/Environment and remote intelligent cabinet for sensor network-GW and connections), HSY (urban services), Haaga-Helia University of Applied Sciences (service business models including digital services), Finnish Meteorological Institute (implementation of and scientific research on meteorological & air quality products), and the Tampere University of Technology (definition of and scientific research on air quality products), Pegasor Ltd (support for air quality instrumentation and products), INNO-W Ltd (providing business services support), as well as the CLIC Innovation Ltd as a subcontractor for arranging cooperation with international partners and project information dissemination, as well as composing the consortium agreement and other legal issues. Additional project partners are welcomed to join the project and current consortium encourage all potential partners to contact project management for further details. The business impact of this project to existing markets is estimated to be substantial and it will also create totally new markets especially for weather information related services. The existing whole target market size at this point is estimated to be several billion USD and the size of the market is growing steadily. The key CITYZER outcomes are the piloted services and products with envisaged great commercial and export potential. Development of the services will be managed by Sasken, Emtele, Pegasor and Vaisala and supported by INNO-W. The user profiling and market assessment, including the most potential market area either from Asia or South America, will be led by Haaga-Helia and supported by industrial partners. FMI, Vaisala and Pegasor will use their expertise and current business relations to those foreign markets to speed up and guide the user and market evaluation. Essential potential players are local actors in e.g. Brazil, China and India that will be subcontracted to bring in local expertise in the user profiling and market assessment processes. This three year project is scheduled such that, overall, the first two years focus on implementing the technical basis as well as customer and market analyses. Throughout the course of the project a CityzerDemo test bed environment will be developed in the Helsinki metropolitan area, demonstrating the observational and modeling system and services built on them. In addition, the services and business models will be evaluated. Acknowledgements The project has received funding from TEKES, the Finnish Funding Agency for Innovation. References [1] http://mmea.fi/ [2] http://edhit.eu/ [3] http://www.vaisala.com/en/products/metdatamanagementsystems/Pages/NM10.aspx

CITYZER - Services for effective decision making and environmental resilience

NASA Astrophysics Data System (ADS)

Haukka, Harri; Turtiainen, Heikki; Janka, Kauko; Palonen, Henry; Turpeinen, Jani; Viitala, Erkki; Rönkkö, Topi; Laiho, Tiina; Laitinen, Teija; Harri, Ari-Matti; Schmidt, Walter; Nousiainen, Timo; Niemi, Jarkko

2017-04-01

The CITYZER project develops new digital services and products to support decision making processes related to weather and air quality in cities. This includes, e.g., early warnings and forecasts (0-24 h), which allow for avoiding weather-related accidents, mitigate human distress and costs from weather-related damage and bad air quality, and generally improve the resilience and safety of the society. The project takes advantage of the latest scientific know-how and directly exploits the expertise obtained from, e.g., Tekes-funded (MMEA [1], RAVAKE) and EU-funded (HAREN, EDHIT [2]) projects. Central to the project is the Observation Network Manager NM10 [3] developed by Vaisala within the Tekes/MMEA project, on which CITYZER defines and builds new commercial services and connects new sensor networks (e.g., air quality). The target groups of the services and products (e.g., public sector, real estate and energy companies, and distributors) and related business models will be analyzed and developed in collaboration with local players (e.g., India, South America, China) taking advantage of the pre-existing contacts by the Haaga-Helia, Vaisala Ltd and CLIC Innovation. Service models are designed to account for and adapt to the special needs of different areas and customers. The developed services will be scalable (most common platforms) and responsive. CITYZER project partners include Vaisala Ltd (weather observation instrumentation and products), Sasken Ltd (mobile products), Emtele Ltd (Portable IoT ICT Service Operation Center/Environment and remote intelligent cabinet for sensor network-GW and connections), HSY (urban services), Haaga-Helia University of Applied Sciences (service business models including digital services), Finnish Meteorological Institute (implementation of and scientific research on meteorological & air quality products), and the Tampere University of Technology (definition of and scientific research on air quality products), Pegasor Ltd (support for air quality instrumentation and products), INNO-W Ltd (business services support), as well as the CLIC Innovation Ltd as a subcontractor for arranging cooperation with international partners and project information dissemination, as well as composing the consortium agreement and other legal issues. The business impact of this project to existing markets is estimated to be substantial and it will also create totally new markets especially for weather information related services. The existing whole target market size at this point is estimated to be several billion USD and the size of the market is growing steadily. The key CITYZER outcomes are the piloted services and products with envisaged great commercial and export potential. Development of the services will be managed by INNO-W supported by Sasken, Emtele, Pegasor and Vaisala. The user profiling and market assessment, including Asia and South America, will be led by Haaga-Helia supported by INNO-W and Sasken. FMI, Vaisala and Pegasor will use their expertise and current business relations to those foreign markets to speed up and guide the user and market evaluation. Essential potential players are local business school teams in Brazil and India that will be subcontracted to bring in local expertise in the user profiling and market assessment processes. This three year project is scheduled such that, overall, the first two years focus on implementing the technical basis as well as customer and market analyses. Throughout the course of the project a CityzerDemo environment will be developed in the Helsinki metropolitan area, demonstrating the observational and modeling system and services built on them. In addition, the services and business models will be evaluated. Acknowledgements The project has received funding from TEKES, the Finnish Funding Agency for Innovation. References [1] http://mmea.fi/ [2] http://edhit.eu/ [3] http://www.vaisala.com/en/products/metdatamanagementsystems/Pages/NM10.aspx

Tamper-indicating seals : practices, problems, and standards

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

Johnston, R. G.

2003-01-01

Tamper-indicating seals have been used by customs officials for over 7,000 years. Today, seals are widely used to help counter theft, smuggling, sabotage, vandalism, terrorism, and espionage. Despite their antiquity and modern widespread use, however, there remains considerable confusion about seals, as well as a lot of misconceptions, wishful thinking, sloppy terminology, and poor practice. The absence of meaningful norms and standards, together with the surprisingly limited amount of research and development (R&D) in the field of tamper detection, has also hindered the effective use of seals. The Vulnerability Assessment Team (VAT) at Los Alamos National Laboratory has intensively studiedmore » tamper-indicating seals for the last 12 years. We have engaged in vulnerability assessments, R&D, consulting, and training for over two dozen United States government agencies and private companies, as well as for the International Atomic Energy Agency (IAEA) and Euratom. The VAT has also analyzed over 200 different types of seals in detail. This paper summarizes some of our conclusions, recommendations, and warnings regarding seals and tamper detection.« less

LIEKKI -- Combustion and gasification research in Finland 1988--1998

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

Hupa, M.; Matinlinna, J.

1996-12-31

The objective of the Combustion and Gasification Research Program LIEKKI is to develop environmentally sound energy production techniques that are based on combustion and/or gasification. The research supports equipment manufacturers in Finland as they develop and improve their top export products, such as the fluidized bed boilers, black liquor recovery boilers, and heavy diesel power plants. The research is also heavily focused on new techniques not yet on the market, ones with higher efficiency of electricity production and, simultaneously, significantly simpler emission control systems. The most important concepts here include combustors or gasifiers based on fluidized bed technology at elevatedmore » pressures. At present the LIEKKI program includes 49 research projects and it connects some 150 scientists and research engineers in the universities and research centers of Finland. The overall annual budget of the program has been around 10 Mill. USD, co-funded by the industry and the government agency TEKES (Technology Development Centre) in Finland. The program is coordinated by Aabo Akademi University in Turku, Finland.« less

Biomass Direct Liquefaction Options. TechnoEconomic and Life Cycle Assessment

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

Tews, Iva J.; Zhu, Yunhua; Drennan, Corinne

The purpose of this work was to assess the competitiveness of two biomass to transportation fuel processing routes, which were under development in Finland, the U.S. and elsewhere. Concepts included fast pyrolysis (FP), and hydrothermal liquefaction (HTL), both followed by hydrodeoxygenation, and final product refining. This work was carried out as a collaboration between VTT (Finland), and PNNL (USA). The public funding agents for the work were Tekes in Finland and the Bioenergy Technologies Office of the U.S. Department of Energy. The effort was proposed as an update of the earlier comparative technoeconomic assessment performed by the IEA Bioenergy Directmore » Biomass Liquefaction Task in the 1980s. New developments in HTL and the upgrading of the HTL biocrude product triggered the interest in reinvestigating this comparison of these biomass liquefaction processes. In addition, developments in FP bio-oil upgrading had provided additional definition of this process option, which could provide an interesting comparison.« less

Machine vision 1992-1996: technology program to promote research and its utilization in industry

NASA Astrophysics Data System (ADS)

Soini, Antti J.

1994-10-01

Machine vision technology has got a strong interest in Finnish research organizations, which is resulting in many innovative products to industry. Despite this end users were very skeptical towards machine vision and its robustness for harsh industrial environments. Therefore Technology Development Centre, TEKES, who funds technology related research and development projects in universities and individual companies, decided to start a national technology program, Machine Vision 1992 - 1996. Led by industry the program boosts research in machine vision technology and seeks to put the research results to work in practical industrial applications. The emphasis is in nationally important, demanding applications. The program will create new industry and business for machine vision producers and encourage the process and manufacturing industry to take advantage of this new technology. So far 60 companies and all major universities and research centers are working on our forty different projects. The key themes that we have are process control, robot vision and quality control.

Indoor radon survey in Visegrad countries.

PubMed

Műllerová, Monika; Kozak, Krzysztof; Kovács, Tibor; Smetanová, Iveta; Csordás, Anita; Grzadziel, Dominik; Holý, Karol; Mazur, Jadwiga; Moravcsík, Attila; Neznal, Martin; Neznal, Matej

2016-04-01

The indoor radon measurements were carried out in 123 residential buildings and 33 schools in Visegrad countries (Slovakia, Hungary and Poland). In 13.2% of rooms radon concentration exceeded 300Bqm(-3), the reference value recommended in the Council Directive 2013/59/EURATOM. Indoor radon in houses shows the typical radon behavior, with a minimum in the summer and a maximum in the winter season, whereas in 32% of schools the maximum indoor radon was reached in the summer months. Copyright © 2016 Elsevier Ltd. All rights reserved.

CONFERENCE DESCRIPTION Theory of Fusion Plasmas: Varenna-Lausanne International Workshop

NASA Astrophysics Data System (ADS)

Garbet, X.; Sauter, O.

2010-12-01

The Joint Varenna-Lausanne international workshop on Theory of Fusion Plasmas takes place every other year in a place particularly favourable for informal and in-depth discussions. Invited and contributed papers present state-of-the-art research in theoretical plasma physics, covering all domains relevant to fusion plasmas. This workshop always welcomes a fruitful mix of experienced researchers and students, to allow a better understanding of the key theoretical physics models and applications. Theoretical issues related to burning plasmas Anomalous Transport (Turbulence, Coherent Structures, Microinstabilities) RF Heating and Current Drive Macroinstabilities Plasma-Edge Physics and Divertors Fast particles instabilities Further details: http://Varenna-Lausanne.epfl.ch The conference is organized by: Centre de Recherches en Physique des Plasmas, Ecole Polytechnique Fédérale de Lausanne, Association EURATOM - Confédération Suisse 'Piero Caldirola' International Centre for the Promotion of Science and International School of Plasma Physics Istituto di Fisica del Plasma del CNR, Milano Editors: X Garbet (CEA, Cadarache, France) and O Sauter (CRPP-EPFL, Lausanne, Switzerland)

The impact of council directive 2011/70/EURATOM and IAEA joint convention review meetings on the ongoing establishment of the Portuguese regulatory framework and on the future of national radioactive waste

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

Paiva, Isabel; Trindade, Romao B.

Council Directive 2011/70/EURATOM of 19 July 2011, establishing a Community framework for the responsible and safe management of spent fuel and radioactive waste will enter in force August 2013 in all EU Member States. Portugal has already started preparing its legislative framework to accommodate the new legislative piece. However, the first report of Portugal to the Joint Convention on the Safety of Spent Fuel Management and on the Safety of Radioactive Waste Management of the IAEA, in Vienna, 2012, has shown that Portugal still has many steps to overcome to establish a successful and effective basic regulatory framework. The existencemore » of many competent authorities related to the radiological protection area and a newly independent commission that is still looking on how to fulfill its regulator role in other areas such as the radioactive waste management makes quite challenging the full application of the new directive as well as compliance that Portugal will have to show in the next Joint Convention review meeting in order to meet the obligations of the Convention. In this paper, the reality of the regulatory Portuguese framework on radiological protection, nuclear safety and radioactive waste management is presented. Discussion of the future impact of the new legislation and its consequences such as the need to setup the national program on radioactive waste management is critical discussed. (authors)« less

European Federation of Organisations for Medical Physics (EFOMP) policy statement 12.1: Recommendations on medical physics education and training in Europe 2014.

PubMed

Caruana, C J; Christofides, S; Hartmann, G H

2014-09-01

In 2010, EFOMP issued Policy Statement No. 12: "The present status of Medical Physics Education and Training in Europe. New perspectives and EFOMP recommendations" to be applied to education and training in Medical Physics within the context of the developments in the European Higher Education Area arising from the Bologna Declaration and with a view to facilitate the free movement of Medical Physics professionals within Europe. Concurrently, new recommendations regarding qualifications frameworks were published by the European Parliament and Council which introduced new terminology and a new qualifications framework - the European Qualifications Framework (EQF) for lifelong learning. In addition, a new European directive involving the medical use of ionizing radiations and set to replace previous directives in this area was in the process of development. This has now been realized as Council Directive 2013/59/Euratom of 5 December 2013 which has repealed directive 97/43/Euratom. In this regard, a new document was developed in the context of the EC financed project "European Guidelines on the Medical Physics Expert" and published as RP174. Among other items, these guidelines refer to the mission statement, key activities, qualification framework and curricula for the specialty areas of Medical Physics relating to radiological devices and protection from ionizing radiation. These developments have made necessary an update of PS12; this policy statement provides the necessary update. Copyright © 2014. Published by Elsevier Ltd.

Boron-Coated Straw Collar for Uranium Neutron Coincidence Collar Replacement

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

Hu, Jianwei; Croft, Stephen; McElroy, Robert Dennis

The objective of this project was to design and optimize, in simulation space, an active neutron coincidence counter (or collar) using boron-coated straws (BCSs) as a non- 3He replacement to the Uranium Neutron Coincidence Collar (UNCL). UNCL has been used by the International Atomic Energy Agency (IAEA) and European Atomic Energy Community (Euratom) since the 1980s to verify the 235U content in fresh light water reactor fuel assemblies for safeguards purposes. This report documents the design and optimization of the BCS collar.

Overview of physics goals for OP1.2a on Wendelstein 7-X

NASA Astrophysics Data System (ADS)

Pedersen, Thomas Sunn; W7-X Team

2017-10-01

Wendelstein 7-X achieved, and in many cases exceeded, the pre-defined goals for its first operation phase, OP1.1. Results include core values of Te = 8 keV, Ti = 2 keV and ne>3*1019 m-3 and confinement times of 100-150 ms. The next operation phase, OP1.2a, scheduled to start in fall 2017, features a much more elaborate set of plasma-facing components. 10 inertially cooled graphite test divertor units (TDU) have been installed, as have graphite tiles on all the heat shields and baffles. Upgrades have also been made to heating systems, diagnostics, and particle fueling systems. This will allow for significantly increased pulse lengths, heating power and plasma performance, in particular, higher plasma density, and higher ion temperatures, thereby enabling a much more detailed investigation of the W7-X optimization and significantly higher triple products than achieved in OP1.1. The robustness of the TDU allows for an aggressive exploration of divertor operation scenarios in this phase. The main goals and plans, and, if available, first results of OP1.2a will be presented. This work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014-2018 under Grant agreement No 633053.

Radiation dose optimisation for conventional imaging in infants and newborns using automatic dose management software: an application of the new 2013/59 EURATOM directive.

PubMed

Alejo, L; Corredoira, E; Sánchez-Muñoz, F; Huerga, C; Aza, Z; Plaza-Núñez, R; Serrada, A; Bret-Zurita, M; Parrón, M; Prieto-Areyano, C; Garzón-Moll, G; Madero, R; Guibelalde, E

2018-04-09

Objective: The new 2013/59 EURATOM Directive (ED) demands dosimetric optimisation procedures without undue delay. The aim of this study was to optimise paediatric conventional radiology examinations applying the ED without compromising the clinical diagnosis. Automatic dose management software (ADMS) was used to analyse 2678 studies of children from birth to 5 years of age, obtaining local diagnostic reference levels (DRLs) in terms of entrance surface air kerma. Given local DRL for infants and chest examinations exceeded the European Commission (EC) DRL, an optimisation was performed decreasing the kVp and applying the automatic control exposure. To assess the image quality, an analysis of high-contrast resolution (HCSR), signal-to-noise ratio (SNR) and figure of merit (FOM) was performed, as well as a blind test based on the generalised estimating equations method. For newborns and chest examinations, the local DRL exceeded the EC DRL by 113%. After the optimisation, a reduction of 54% was obtained. No significant differences were found in the image quality blind test. A decrease in SNR (-37%) and HCSR (-68%), and an increase in FOM (42%), was observed. ADMS allows the fast calculation of local DRLs and the performance of optimisation procedures in babies without delay. However, physical and clinical analyses of image quality remain to be needed to ensure the diagnostic integrity after the optimisation process. Advances in knowledge: ADMS are useful to detect radiation protection problems and to perform optimisation procedures in paediatric conventional imaging without undue delay, as ED requires.

Development of an integrated, unattended assay system for LWR-MOX fuel pellet trays

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

Stewart, J.E.; Hatcher, C.R.; Pollat, L.L.

1994-08-01

Four identical unattended plutonium assay systems have been developed for use at the new light-water-reactor mixed oxide (LWR-MOX) fuel fabrication facility at Hanau, Germany. The systems provide quantitative plutonium verification for all MOX pellet trays entering or leaving a large, intermediate store. Pellet-tray transport and storage systems are highly automated. Data from the ``I-Point`` (information point) assay systems will be shared by the Euratom and International Atomic Energy Agency (IAEA) Inspectorates. The I-Point system integrates, for the first time, passive neutron coincidence counting (NCC) with electro-mechanical sensing (EMS) in unattended mode. Also, provisions have been made for adding high-resolution gammamore » spectroscopy. The system accumulates data for every tray entering or leaving the store between inspector visits. During an inspection, data are analyzed and compared with operator declarations for the previous inspection period, nominally one month. Specification of the I-point system resulted from a collaboration between the IAEA, Euratom, Siemens, and Los Alamos. Hardware was developed by Siemens and Los Alamos through a bilateral agreement between the German Federal Ministry of Research and Technology (BMFT) and the US DOE. Siemens also provided the EMS subsystem, including software. Through the USSupport Program to the IAEA, Los Alamos developed the NCC software (NCC COLLECT) and also the software for merging and reviewing the EMS and NCC data (MERGE/REVIEW). This paper describes the overall I-Point system, but emphasizes the NCC subsystem, along with the NCC COLLECT and MERGE/REVIEW codes. We also summarize comprehensive testing results that define the quality of assay performance.« less

Emergency Medical Service (EMS) Utilization by Syrian Refugees Residing in Ankara, Turkey.

PubMed

Altıner, Ali Osman; Yeşil, Sıdıka Tekeli

2018-04-01

Introduction Many Syrians have left their country and migrated to other countries since March 2011, due to the civil war. As of March 2016, a total of 2,747,946 Syrian refugees had immigrated to Turkey. Some Syrian refugees have been living in camps, while 2,475,134 have been living in metropolitan areas, such as Ankara. Study Objective This study investigated Emergency Medical Service (EMS) utilization among Syrian refugees residing in Ankara. This study was a descriptive, cross-sectional database analysis using data obtained from the Department of EMS of the Ankara Provincial Health Directorate. Five stations in the Altındağ region of Ankara responded to 42% of all calls from Syrian refugees. Prehospital EMS in Ankara have been used mostly by Syrian refugees younger than 18-years-old. Study findings also suggest that medical staff in regions where Syrian refugees are likely to be treated should be supported and provided with the ability to overcome language barriers and cultural differences. Altıner AO , Tekeli Yeşil S . Emergency Medical Service (EMS) utilization by Syrian refugees residing in Ankara, Turkey. Prehosp Disaster Med. 2018;33(2):160-164.

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

Henzlova, Daniela; Kouzes, R.; McElroy, R.

International safeguards inspectorates (e.g., International Atomic Energy Agency {IAEA}, or Euratom) rely heavily on neutron assay techniques, and in particular, on coincidence counters for the verification of declared nuclear materials under safeguards and for monitoring purposes. While 3He was readily available, the reliability, safety, ease of use, gamma-ray insensitivity, and high intrinsic thermal neutron detection efficiency of 3He-based detectors obviated the need for alternative detector technologies. However, the recent decline of the 3He gas supply has triggered international efforts to develop and field neutron detectors that make use of alternative materials. In response to this global effort, the U.S. Departmentmore » of Energy’s (DOE) National Nuclear Security Administration (NNSA) and Euratom launched a joint effort aimed at bringing together international experts, technology users and developers in the field of nuclear safeguards to discuss and evaluate the proposed 3He alternative materials and technologies. The effort involved a series of two workshops focused on detailed overviews and viability assessments of various 3He alternative technologies for use in nuclear safeguards applications. The key objective was to provide a platform for collaborative discussions and technical presentations organized in a compact, workshop-like format to stimulate interactions among the participants. The meetings culminated in a benchmark exercise providing a unique opportunity for the first inter-comparison of several available alternative technologies. This report provides an overview of the alternative technology efforts presented during the two workshops along with a summary of the benchmarking activities and results. The workshop recommendations and key consensus observations are discussed in the report, and used to outline a proposed path forward and future needs foreseeable in the area of 3He-alternative technologies.« less

The Euratom Seventh Framework Programme FP7 (2007-2011)

NASA Astrophysics Data System (ADS)

Garbil, R.

2010-10-01

The objective of the Seventh Euratom Framework Program in the area of nuclear fission and radiation protection is to establish a sound scientific and technical basis to accelerate practical developments of nuclear energy related to resource efficiency, enhancing safety performance, cost-effectiveness and safer management of long-lived radioactive waste. Key cross-cutting topics such as the nuclear fuel cycle, actinide chemistry, risk analysis, safety assessment, even societal and governance issues are linked to the individual technical areas. Research need to explore new scientific and techno- logical opportunities and to respond in a flexible way to new policy needs that arise. The following activities are to be pursued. (a) Management of radioactive waste, research on partitioning and transmutation and/or other concepts aimed at reducing the amount and/or hazard of the waste for disposal; (b) Reactor systems research to underpin the con- tinued safe operation of all relevant types of existing reactor systems (including fuel cycle facilities), life-time extension, development of new advanced safety assessment methodologies and waste-management aspects of future reactor systems; (c) Radiation protection research in particular on the risks from low doses on medical uses and on the management of accidents; (d) Infrastructures and support given to the availability of, and cooperation between, research infrastructures necessary to maintain high standards of technical achievement, innovation and safety in the European nuclear sector and Research Area. (e) Human resources, mobility and training support to be provided for the retention and further development of scientific competence, human capacity through joint training activities in order to guarantee the availability of suitably qualified researchers, engineers and employees in the nuclear sector over the longer term.

An Illustrative Guide to the Minerva Framework

NASA Astrophysics Data System (ADS)

Flom, Erik; Leonard, Patrick; Hoeffel, Udo; Kwak, Sehyun; Pavone, Andrea; Svensson, Jakob; Krychowiak, Maciej; Wendelstein 7-X Team Collaboration

2017-10-01

Modern phsyics experiments require tracking and modelling data and their associated uncertainties on a large scale, as well as the combined implementation of multiple independent data streams for sophisticated modelling and analysis. The Minerva Framework offers a centralized, user-friendly method of large-scale physics modelling and scientific inference. Currently used by teams at multiple large-scale fusion experiments including the Joint European Torus (JET) and Wendelstein 7-X (W7-X), the Minerva framework provides a forward-model friendly architecture for developing and implementing models for large-scale experiments. One aspect of the framework involves so-called data sources, which are nodes in the graphical model. These nodes are supplied with engineering and physics parameters. When end-user level code calls a node, it is checked network-wide against its dependent nodes for changes since its last implementation and returns version-specific data. Here, a filterscope data node is used as an illustrative example of the Minerva Framework's data management structure and its further application to Bayesian modelling of complex systems. This work has been carried out within the framework of the EUROfusion Consortium and has received funding from the Euratom research and training programme 2014-2018 under Grant Agreement No. 633053.

The development of internationally managed information systems and their prospects.

PubMed

East, H

1978-12-01

This paper reviews a selection of international collaborative efforts in the production of information services and attempts to characterize modes of cooperation. Information systems specifically discussed include: international nuclear information system (INIS); Nuclear Science Abstract (NSA); EURATOM; AGRIS; AGRINDEX; Information Retrieval Limited (IRL); IFIS (International Food Information Service); Chemical Abstracts Service (CAS); MEDLARS; and TITUS. 3 methods of international information transfer are discussed: commercial transactions; negotiated (bilateral) barter arrangements; and contribution to internationally managed systems. Technical, economic, and professional objectives support the rationale for international cooperation. It is argued that economic and political considerations, as much as improved technology or information transfer, will determine the nature of collaboration in the future.

Modelling structural and plasma facing materials for fusion power plants: Recent advances and outstanding issues in the EURATOM fusion materials programme

NASA Astrophysics Data System (ADS)

Boutard, Jean-Louis; Dudarev, Sergei; Rieth, Michael

2011-10-01

EFDA Fusion Materials Topical Group was established at the end of 2007 to coordinate the EU effort on the development of structural and protection materials able to withstand the very demanding operating conditions of a future DEMO power plant. Focusing on a selection of well identified materials issues, including the behaviour of Reduced Activation Ferritic-Martensitic steels, and W-alloys under the foreseen operation conditions in a future DEMO, this paper describes recent advances in physical modelling and experimental validation, contributing to the definition of chemical composition and microstructure of materials with improved in-service stability at high temperature, high neutron flux and intense ion bombardment.

EC Project 'GUIDELINES ON MPE': proposed qualification and curriculum frameworks and the MPE in nuclear medicine

NASA Astrophysics Data System (ADS)

Caruana, C. J.

2011-09-01

The objectives of EC project 'Guidelines on Medical Physics Expert' are to provide for improved implementation of the provisions relating to the Medical Physics Expert within Council Directive 97/43/EURATOM and the proposed recast Basic Safety Standards directive. This includes harmonisation of the mission statement for Medical Physics Services as well as the education and training of the MPE. It also includes detailed knowledge-skills-competence inventories for the Medical Physics Expert in each of Diagnostic and Interventional Radiology, Nuclear Medicine and Radiotherapy. This paper presents the proposed Qualification and Curriculum Frameworks and their application to the Medical Physics Expert in Nuclear Medicine.

Lung deposited surface area concentrations in a street canyon

NASA Astrophysics Data System (ADS)

Kuuluvainen, Heino; Hietikko, Riina; Järvinen, Anssi; Saukko, Erkka; Irjala, Matti; Niemi, Jarkko V.; Timonen, Hilkka; Keskinen, Jorma; Rönkkö, Topi

2017-04-01

Street canyons are interesting environments with respect to the dispersion of traffic emissions and human exposure. Pedestrians may be exposed to relatively high concentrations of fine particles and the vertical dispersion affects the human exposure above the ground level in buildings. Previously, particle concentrations have been measured in street canyons at a few different heights (Marini et al., 2015). The information on the lung deposited surface area (LDSA) concentration, which is a relevant metric for the negative health effects, is very limited even at the ground level of street canyons (Kuuluvainen et al., 2016). More information especially on the vertical dispersion and the ground level concentrations is needed, for instance, for the use of urban planning and the design of ventilation systems in buildings. Measurements were carried out in a busy street canyon in Helsinki, Finland, at an urban super-site measurement station (Mäkelänkatu 50). The data included vertical concentration profiles measured in an intensive measurement campaign with a Partector (Naneos GmbH) installed into a drone, long-term measurements with an AQ Urban particle sensor (Pegasor Ltd.), and an extensive comparison measurement in the field with different devices measuring the LDSA. These devices were an AQ Urban, Partector, DiSCmini (Testo AG), NSAM (TSI Inc.), and an ELPI+ (Dekati Ltd.). In addition, continuous measurements of gas phase components, particle size distributions, and meteorology were run at the supersite. The vertical profile measurements were con-ducted in November 2016 during two days. In the measurements, the drone was flown from the ground level to an altitude of 50 or 100 m, which is clearly above the roof level of the buildings. Altogether, 48 up-and-down flights were conducted during the two days. The vertical profiles were supported by continuous measurements at the ground level on both sides of the street canyon. The long-term measurements were conducted during the year 2016. A short period of data was also analysed with respect to the emissions of individual vehicles by using a recorded video of the traffic fleet. As an example of the vertical profiles, Figure 1 shows the LDSA concentration as a function of the altitude. The data measured with a time resolution of one second is seen along with the values averaged for different altitude intervals. The effect of wind conditions and changes in the traffic fleet on the concentration profiles could be analysed. In addition to the vertical profiles, we were able to analyse the LDSA concentrations on the ground level with respect to long-term averages and rapid changes caused by different individual vehicles. This work was conducted in two different research projects. The INKA-ILMA/EAKR project was funded by Tekes, European Union, Finnish companies, Helsinki Region Environmental Authority (HSY), and cities of Tampere and Kuopio. The CITYZER project was funded by Tekes and Finnish companies. References: Marini, S., Buonanno, G., Stabile, L., Avino, P. (2015). Environ. Sci. Pollut. Res., 22 (3), 2051-2063. Kuuluvainen, H., Rönkkö, T., Järvinen, A., Saari, S., Karjalainen, P., Lähde, T., Pirjola, L., Niemi, J. V., Hillamo, R., Keskinen, J. (2016). Atmos. Environ., 136, 105-113.

Nuclear Forensics International Technical Working Group (ITWG): a collaboration of scientists, law enforcement officials, and regulators working to combat nuclear terrorism and proliferation

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

Schwantes, Jon M.

Founded in 1996 upon the initiative of the “Group of 8” governments (G8), the Nuclear Forensics International Technical Working Group (ITWG) is an ad hoc organization of official Nuclear Forensics practitioners (scientists, law enforcement, and regulators) that can be called upon to provide technical assistance to the global community in the event of a seizure of nuclear or radiological materials. The ITWG is supported by and is affiliated with nearly 40 countries and international partner organizations including the International Atomic Energy Agency (IAEA), EURATOM, INTERPOL, EUROPOL, and the United Nations Interregional Crime and Justice Research Institute (UNICRI) (Figure 1). Besidesmore » providing a network of nuclear forensics laboratories that are able to assist the global community during a nuclear smuggling event, the ITWG is also committed to the advancement of the science of nuclear forensic analysis, largely through participation in periodic table top and Collaborative Materials Exercises (CMXs). Exercise scenarios use “real world” samples with realistic forensics investigation time constraints and reporting requirements. These exercises are designed to promote best practices in the field and test, evaluate, and improve new technical capabilities, methods and techniques in order to advance the science of nuclear forensics. Past efforts to advance nuclear forensic science have also included scenarios that asked laboratories to adapt conventional forensics methods (e.g. DNA, fingerprints, tool marks, and document comparisons) for collecting and preserving evidence comingled with radioactive materials.« less

Will X-ray Safety Glasses Become Mandatory for Radiological Vascular Interventions?

PubMed

Thomas, Rohit Philip; Grau, Mathias; Eldergash, Osama; Kowald, Tobias; Schnabel, Johannes; Szczechowicz, Marcin; Chavan, Ajay

2018-07-01

The annual permissible radiation ocular lens dose has been reduced to 20 millisieverts (mSv) in the current European directive 2013/59/Euratom. The aim of this study was to evaluate the personal radiation dose for vascular interventions with special focus on ocular lens dose. From May 2016 to October 2016, the personal radiation doses of two interventionists and four technicians were prospectively recorded during 206 vascular interventions. The position of personnel, intervention type and fluoroscopy time were recorded. Parameters evaluated were total body dose measured by film dosimeter, hand dose measured by ring thermoluminescent dosimeter (TLD) and ocular lens dose measured by TLD placed in front of the safety glasses. Linear regression analysis was used to estimate the dose at 2 and 5 years. The ocular lens dose, hand and total body dose of the two interventionists were 11/5, 56/47 and 0.6 mSv each, respectively. The estimated 5-year ocular dose was 113.08 mSv (95% CI 38.2-187.97)/40.95 (95% CI 16.9-64.7). Similarly, hand dose was 608.4 mSv (95% CI 442.78-774.38)/514.47 (95% CI 329.83-699.10) and body dose 6.07 mSv (95% CI 4.70-8.22)/5.12 (95% CI 3.65-6.59), respectively. Amongst four technicians, only the first assistant showed recordings of 0.3 mSv body dose, 2 mSv ocular lens dose and 5 mSv hand dose. The yearly ocular lens dose, particularly for interventionists dealing with complex interventions, could cross the permitted yearly limit set by the new Euratom directive. Therefore, X-ray safety glasses would become mandatory for complex radiological vascular interventions. Level III, non-randomized controlled cohort/follow-up study.

Development of an Assessment Method for Building Materials Under Euratom Scope.

PubMed

de With, Govert

2017-11-01

In 2013, the European Commission published its basic safety standards for protection against the dangers arising from exposure to ionizing radiation (Council Directive 2013/59/Euratom)-also known as EU-BSS. As a result, the use of raw materials with potentially elevated activity concentrations such as fly ash, phosphogypsum, and slags will now fall under EU-BSS scope when applied in building materials. In light of this new policy, a variety of tools are available to assess compliance with the 1-mSv y reference level for building materials. At the heart of these tools is a gamma-spectrometric determination of the naturally occurring radionuclides Ra, Th, and K in the material of concern. As a large number of construction products contain a certain amount of the raw material that falls under the scope of the EU regulation, this policy will lead to substantial measurement of building materials that pose little radiation risk. For this reason, a method is developed to enable assessment against the 1-mSv value not on the basis of gamma-spectrometric analysis but rather based on the product's material composition. The proposed method prescribes a maximum permitted content of raw materials with potentially elevated activity concentrations in terms of a weight percentage of the end product, where the raw materials of concern are defined as those listed in Annex XIII of the EU-BSS. The permitted content is a function of the product's surface density. Therefore, a product with a low surface density of up to 25 kg m can consist of nearly 100% raw materials with potentially elevated activity concentrations, and this percentage drops to around 15% for products with a surface density of around 500 kg m. Building materials that comply with these requirements on product composition are exempt from testing, while products that do not comply must perform regular gamma-spectrometric analysis. A full validation and testing of the method is provided. In addition, the paper discusses issues relevant for regulatory implementation.

Secure Video Surveillance System (SVSS) for unannounced safeguards inspections.

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

Galdoz, Erwin G.; Pinkalla, Mark

2010-09-01

The Secure Video Surveillance System (SVSS) is a collaborative effort between the U.S. Department of Energy (DOE), Sandia National Laboratories (SNL), and the Brazilian-Argentine Agency for Accounting and Control of Nuclear Materials (ABACC). The joint project addresses specific requirements of redundant surveillance systems installed in two South American nuclear facilities as a tool to support unannounced inspections conducted by ABACC and the International Atomic Energy Agency (IAEA). The surveillance covers the critical time (as much as a few hours) between the notification of an inspection and the access of inspectors to the location in facility where surveillance equipment is installed.more » ABACC and the IAEA currently use the EURATOM Multiple Optical Surveillance System (EMOSS). This outdated system is no longer available or supported by the manufacturer. The current EMOSS system has met the project objective; however, the lack of available replacement parts and system support has made this system unsustainable and has increased the risk of an inoperable system. A new system that utilizes current technology and is maintainable is required to replace the aging EMOSS system. ABACC intends to replace one of the existing ABACC EMOSS systems by the Secure Video Surveillance System. SVSS utilizes commercial off-the shelf (COTS) technologies for all individual components. Sandia National Laboratories supported the system design for SVSS to meet Safeguards requirements, i.e. tamper indication, data authentication, etc. The SVSS consists of two video surveillance cameras linked securely to a data collection unit. The collection unit is capable of retaining historical surveillance data for at least three hours with picture intervals as short as 1sec. Images in .jpg format are available to inspectors using various software review tools. SNL has delivered two SVSS systems for test and evaluation at the ABACC Safeguards Laboratory. An additional 'proto-type' system remains at SNL for software and hardware testing. This paper will describe the capabilities of the new surveillance system, application and requirements, and the design approach.« less

Experimental Measurements of the Lower Hybrid Electric Field and Induced Neutral Flow in Tore Supra by Optical Emission Spectroscopy

NASA Astrophysics Data System (ADS)

Martin, E. H.; Klepper, C. C.; Isler, R. C.; Goniche, M.; Caughman, J. B. O.

2014-10-01

Recently, the RF electric field vector (ELH) in front of a lower hybrid (LH) launcher, operating at 3.7 GHz, at the low field side of the Tore Supra tokamak was determined by spectroscopic analysis of passive Dβ spectral emission from the near-antenna plasma. The ELH was determined by globally minimizing the χ associated with the experimental and theoretical spectral line profile. The theoretical profile is calculated from a non-perturbative solution to the Schrödinger equation, which includes the magnetic and dynamic electric field vectors. The magnitude, the direction, and the scaling with LH power of the measured ELH were fairly consistent with those calculated from a full-wave LH model. In addition to ELH the inboard and an outboard neutral flow was determined from the Doppler shifts associated with the Dα and Dβ spectral profiles. It was found that excitation of the LH wave induced both an inboard and outboard co-current neutral flow, which is linearly dependent on injected power; preliminary results indicate ICRH decreases the LH wave-induced co-current neutral flow. Neutral flow velocities are consistent with measurements of ion flow velocities obtained by charge exchange recombination spectroscopy. Work supported by the US DOE under Contract No. DE-AC05-00OR22725 with UT-Battelle, LLC., and by the European Communities under the contract of Assoc. EURATOM-CEA and within the framework of the EFDA.

Occupational exposure to natural radioactivity in a zircon sand milling plant.

PubMed

Ballesteros, Luisa; Zarza, Isidoro; Ortiz, Josefina; Serradell, Vicente

2008-10-01

Raw zirconium sand is one of the substances (naturally occurring radioactive material, NORM) which is widely used in the ceramic industry. This sand contains varying concentrations of natural radionuclides: mostly U-238 but also Th-232 and U-235, together with their daughters, and therefore may need to be regulated by Directive 96/29/EURATOM. This paper describes the method used to perform the radiological study on a zircon sand milling plant and presents the results obtained. Internal and external doses were evaluated using radioactivity readings from sand, airborne dust, intermediate materials and end products. The results on total effective dose show the need for this type of industry to be carefully controlled, since values near to 1 mSv were obtained.

Radionuclides in drinking water: the recent legislative requirements of the European Union.

PubMed

Grande, Sveva; Risica, Serena

2015-03-01

In November 2013, a new EURATOM Directive was issued on the protection of public health from the radionuclide content in drinking water. After introducing the contents of the Directive, the paper analyses the hypotheses about drinking water ingestion adopted in documents of international and national organizations and the data obtained from national/regional surveys. Starting from the Directive's parametric value for the Indicative Dose, some examples of derived activity concentrations of radionuclides in drinking water are reported for some age classes and three exposure situations, namely, (i) artificial radionuclides due to routine water release from nuclear power facilities, (ii) artificial radionuclides from nuclear medicine procedures, and (iii) naturally occurring radionuclides in drinking water or resulting from existing or past NORM industrial activities.

Radon in Irish Show Caves—Personal Monitoring Data From 2001-2006

NASA Astrophysics Data System (ADS)

Currivan, L.; Murray, M.; O'Colmain, M.; Pollard, D.

2008-08-01

The European Directive 96/29/EURATOM and its transposition into national legislation demands the application of radiation protection measures if the presence of radon and radon decay products leads to significant increase in exposures of workers. Irish legislation further demands that laboratories carrying out radon measurements operate a high level quality assurance programme. As a result of a reconnaissance survey regular measurements of show cave guides have been made in order to assess exposure to radon in such workplaces and to ascertain that the limits set for radon are not exceeded. In 2000, an action level of 400 Bqm-3, was established. Doses in the range 0.3-12.0 mSv have been estimated for workers for the period 2001-2006.

Low-Severity Hydroprocessing to Stabilize Bio-oil: TechnoEconomic Assessment

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

Tews, Iva J.; Elliott, Douglas C.

The impetus for this study was the suggestion that recent developments in fast pyrolysis (FP) bio-oil production had indicated instability of the bio-oil in storage which might lead to unacceptable viscosity increases. Commercial operation of FP in Finland began in 2014 and the distribution of the bio-oil to isolated users has been proposed as the long-term plan. Stability of the shipped bio-oil therefore became a concern. Experimental results at PNNL with low-severity hydroprocessing of bio-oil for stabilization has validated a process in which the stability of the bio-oil could be improved, as measured by viscosity increase following storage of themore » product at 80 °C for 24h. In the work reported here the assessed process configuration consists of fast pyrolysis followed by low temperature and pressure hydroprocessing to produce a stable fuel oil product. The product could then be stored for an extended period of time without significant viscosity increase. This work was carried out as part of a collaborative project between Technical Research Centre of Finland (VTT) and Pacific Northwest National Laboratory (PNNL). The public funding agents for the work were Tekes in Finland and the Bioenergy Technologies Office of the U.S. Department of Energy. The effort was proposed as an evaluation of the process developed in earlier collaboration and jointly invented by VTT and PNNL researchers.« less

MO-DE-BRA-05: EUTEMPE-RX: Combining E-Learning and Face-To-Face Training to Build Expert Knowledge, Skills and Competences for Medical Physicists in Diagnostic and Interventional Radiology

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

Bosmans, H; Van Peteghem, N; Creten, S

Purpose: In 2013, the EURATOM authorities of the European Commission decided to support the Horizon2020 project submission ‘EUTEMPE-RX’ that aimed for a new set of course modules to train medical physicists in diagnostic and interventional radiology to expert level with small group deep learning. Each module would consist of 2 phases: an e-learning and a face-to-face phase, each phase requiring typically 40h of participant time. Methods: The European Federation (EFOMP) and 13 European partners, all of them selected for their excellent scientific and/or educational skills, led the 12 course modules. A quality manual ensured the quality of course content andmore » organization. Educational workshops familiarized the teachers with e-learning techniques and methods for assessment. Content was set in accordance with the EC document RP174 that lists learning outcomes in terms of knowledge, skills and competences (KSCs) for different specialties and levels of medical physics. Surveys for stake holder satisfaction were prepared. Results: Today the course modules are being realized. The modules cover most of the KSCs in RP174 document. Teachers have challenged the participants with unique tasks: case studies in medical physics leadership, Monte Carlo simulation of a complete x-ray imaging chain, development of a task specific QA protocol, compilation of optimization plans, simulation tasks with anthropomorphic breast models, etc. Participants undertook practical sessions in modern hospitals and visited a synchrotron facility, a calibration lab, screening organizations, etc. Feedback form quality surveys was very positive and constructive. A sustainability plan has been worked out. Conclusion: The modules have enabled the participants to develop their KSCs and cope with challenges in medical physics. The sustainability plan will be implemented to continue the unique combined e-learning and face to face training at high level training in diagnostic and interventional radiology also beyond Europe. The EUTEMPE-RX project is funded by the Horizon2020 - EURATOM program of the European Commission.« less

Natural radioactivity in building material in the European Union: robustness of the activity concentration index I and comparison with a room model.

PubMed

Nuccetelli, C; Risica, S; D'Alessandro, M; Trevisi, R

2012-09-01

Using a wide database collected in the last 10 years, the authors have calculated the activity concentration index I for many building materials in the European Union. Suggested by a European technical guidance document, the index I has recently been adopted as a screening tool in the proposal for the new Euratom basic safety standards directive. The paper analyses the possible implications of the choice of different parameters for the computation of index I, i.e. background to be subtracted, dose criteria, etc. With the collected data an independent assessment of gamma doses was also made with an ISS room model, choosing reasonable hypotheses on the use of materials. The results of the two approaches, i.e. index I and a room model, were compared.

Justification of CT scans using referral guidelines for imaging.

PubMed

Stanescu, G; Rosca-Fartat, G; Stanescu, D

2015-07-01

This study analyses the efficiency of the justification of individual computed tomography (CT) procedures using the good practice guide. The conformity of the CT scans with guide's recommendations was retrospectively analysed in a paediatric emergency hospital in Romania. The involved patient doses were estimated. The results show that around one-third of the examinations were not prescribed in conformity with the guide's recommendations, but these results are affected by unclear guide provisions, discussed here. The implications of the provisions of the revised International Atomic Energy Agency's Basic Safety Standards and of the Council Directive 2013/59/EURATOM were analysed. The education and training courses for medical doctors disseminating the provisions of the good practice guide should be considered as the main support for the justification of the CT scans at the individual level. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

National radon programmes and policies: the RADPAR recommendations.

PubMed

Bochicchio, F; Hulka, J; Ringer, W; Rovenská, K; Fojtikova, I; Venoso, G; Bradley, E J; Fenton, D; Gruson, M; Arvela, H; Holmgren, O; Quindos, L; McLaughlin, J; Collignan, B; Gray, A; Grosche, B; Jiranek, M; Kalimeri, K; Kephalopoulos, S; Kreuzer, M; Schlesinger, D; Zeeb, H; Bartzis, J

2014-07-01

Results from epidemiological studies on lung cancer and radon exposure in dwellings and mines led to a significant revision of recommendations and regulations of international organisations, such as WHO, IAEA, Nordic Countries, European Commission. Within the European project RADPAR, scientists from 18 institutions of 14 European countries worked together for 3 y (2009-12). Among other reports, a comprehensive booklet of recommendations was produced with the aim that they should be useful both for countries with a well-developed radon programme and for countries with little experience on radon issues. In this paper, the main RADPAR recommendations on radon programmes and policies are described and discussed. These recommendations should be very useful in preparing a national action plan, required by the recent Council Directive 2013/59/Euratom. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Natural radioactivity in building materials in the European Union: a database and an estimate of radiological significance.

PubMed

Trevisi, R; Risica, S; D'Alessandro, M; Paradiso, D; Nuccetelli, C

2012-02-01

The authors set up a database of activity concentration measurements of natural radionuclides (²²⁶Ra, ²³²Th and ⁴⁰K) in building material. It contains about 10,000 samples of both bulk material (bricks, concrete, cement, natural- and phosphogypsum, sedimentary and igneous bulk stones) and superficial material (igneous and metamorphic stones) used in the construction industry in most European Union Member States. The database allowed the authors to calculate the activity concentration index I--suggested by a European technical guidance document and recently used as a basis for elaborating the draft Euratom Basic Safety Standards Directive--for bricks, concrete and phosphogypsum used in the European Union. Moreover, the percentage could be assessed of materials possibly subject to restrictions, if either of the two dose criteria proposed by the technical guidance were to be adopted. Copyright © 2011 Elsevier Ltd. All rights reserved.

Sustainability and integration of radioecology-position paper.

PubMed

Muikku, M; Beresford, N A; Garnier-Laplace, J; Real, A; Sirkka, L; Thorne, M; Vandenhove, H; Willrodt, C

2018-03-01

This position paper gives an overview of how the COMET project (COordination and iMplementation of a pan-European instrumenT for radioecology, a combined Collaborative Project and Coordination and Support Action under the EC/Euratom 7th Framework Programme) contributed to the integration and sustainability of radioecology in Europe via its support to and interaction with the European Radioecology ALLIANCE. COMET built upon the foundations laid by the FP7 project STAR (Strategic Network for Integrating Radioecology) Network of Excellence in radioecology. In close association with the ALLIANCE, and based on the Strategic Research Agenda (SRA), COMET developed innovative mechanisms for joint programming and implementation of radioecological research. To facilitate and foster future integration under a common federating structure, research activities developed within COMET were targeted at radioecological research needs identified in the SRA. Furthermore, COMET maintained and developed strong mechanisms for knowledge exchange, dissemination and training to enhance and maintain European capacity, competence and skills in radioecology. In the short term the work to promote radioecology will continue under the H2020 project EJP-CONCERT (European Joint Programme for the Integration of Radiation Protection Research). The EJP-CONCERT project (2015-2020) aims to develop a sustainable structure for promoting and administering joint programming and open research calls in the field of radiation protection research for Europe. In the longer term, radioecological research will be facilitated by the ALLIANCE. External funding is, however, required in order to be able to answer emerging research needs.

The Euratom-Rosatom ERCOSAM-SAMARA projects on containment thermal-hydraulics of current and future LWRs for severe accident management

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

Paladino, D.; Guentay, S.; Andreani, M.

2012-07-01

During a postulated severe accident with core degradation, hydrogen would form in the reactor pressure vessel mainly due to high temperatures zirconium-steam reaction and flow together with steam into the containment where it will mix with the containment atmosphere (steam-air). The hydrogen transport into the containment is a safety concern because it can lead to explosive mixtures through the associated phenomena of condensation, mixing and stratification. The ERCOSAM and SAMARA projects, co-financed by the European Union and the Russia, include various experiments addressing accident scenarios scaled down from existing plant calculations to different thermal-hydraulics facilities (TOSQAN, MISTRA, PANDA, SPOT). Themore » tests sequences aim to investigate hydrogen concentration build-up and stratification during a postulated accident and the effect of the activation of Severe Accident Management systems (SAMs), e.g. sprays, coolers and Passive Auto-catalytic Recombiners (PARs). Analytical activities, performed by the project participants, are an essential component of the projects, as they aim to improve and validate various computational methods. They accompany the projects in the various phases; plant calculations, scaling to generic containment and to the different facilities, planning pre-test and post-test simulations are performed. Code benchmark activities on the basis of conceptual near full scale HYMIX facility will finally provide a further opportunity to evaluate the applicability of the various methods to the study of scaling issues. (authors)« less

European Technological Effort in Preparation of ITER Construction

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

Andreani, Roberto

2005-04-15

Europe has started since the '80s with the preparatory work done on NET, the Next European Torus, the successor of JET, to prepare for the construction of the next generation experiment on the road to the fusion reactor. In 2000 the European Fusion Development Agreement (EFDA) has been signed by sixteen countries, including Switzerland, not a member of the Union. Now the signatory countries have increased to twenty-five. A vigorous programme of design and R and D in support of ITER construction has been conducted by EFDA through the coordinated effort of the national institutes and laboratories supported financially, inmore » the framework of the VI European Framework Research Programme (2002-2006), by contracts of association with EURATOM. In the last three years, with the expenditure of 160 M[Euro], the accent has been particularly put on the preparation of the industrial manufacturing activities of components and systems for ITER. Prototypes and manufacturing methods have been developed in all the main critical areas of machine construction with the objective of providing sound and effective solutions: vacuum vessel, toroidal field coils, poloidal field coils, remote handling equipment, plasma facing components and divertor components, electrical power supplies, generators and power supplies for the Heating and Current Drive Systems and other minor subsystems.Europe feels to be ready to host the ITER site and to provide adequate support and guidance for the success of construction to our partners in the ITER collaboration, wherever needed.« less

Model-based minimization algorithm of a supercritical helium loop consumption subject to operational constraints

NASA Astrophysics Data System (ADS)

Bonne, F.; Bonnay, P.; Girard, A.; Hoa, C.; Lacroix, B.; Le Coz, Q.; Nicollet, S.; Poncet, J.-M.; Zani, L.

2017-12-01

Supercritical helium loops at 4.2 K are the baseline cooling strategy of tokamaks superconducting magnets (JT-60SA, ITER, DEMO, etc.). This loops work with cryogenic circulators that force a supercritical helium flow through the superconducting magnets in order that the temperature stay below the working range all along their length. This paper shows that a supercritical helium loop associated with a saturated liquid helium bath can satisfy temperature constraints in different ways (playing on bath temperature and on the supercritical flow), but that only one is optimal from an energy point of view (every Watt consumed at 4.2 K consumes at least 220 W of electrical power). To find the optimal operational conditions, an algorithm capable of minimizing an objective function (energy consumption at 5 bar, 5 K) subject to constraints has been written. This algorithm works with a supercritical loop model realized with the Simcryogenics [2] library. This article describes the model used and the results of constrained optimization. It will be possible to see that the changes in operating point on the temperature of the magnet (e.g. in case of a change in the plasma configuration) involves large changes on the cryodistribution optimal operating point. Recommendations will be made to ensure that the energetic consumption is kept as low as possible despite the changing operating point. This work is partially supported by EUROfusion Consortium through the Euratom Research and Training Program 20142018 under Grant 633053.

pp iii Morphological response to Quaternary deformation at an intermontane basin piedmont, the northern Tien Shan, Kyrghyzstan

NASA Astrophysics Data System (ADS)

Bowman, Dan; Korjenkov, Andrey; Porat, Naomi; Czassny, Birka

2004-11-01

The Tien Shan is a most active intracontinental mountain-building range with abundant Quaternary fault-related folding. In order to improve our understanding of Quaternary intermontane basin deformation, we investigated the intermontane Issyk-Kul Lake area, an anticline that was up-warped through the piedmont cover, causing partitioning of the alluvial fan veneer. To follow the morphological scenario during the warping process, we relied on surface-exposed and trenched structures and on alluvial fans and bajadas as reference surfaces. We used air photos and satellite images to analyze the spatial-temporal morphological record and determined the age of near surface sediments by luminescence dating. We demonstrate that the up-warped Ak-Teke hills are a thrust-generated subdued anticline with strong morphological asymmetry which results from the coupling of the competing processes of up-warp and erosional feedback. The active creeks across the up-warped anticline indicate that the antecedent drainage system kept pace with the rate of uplift. The rivers which once sourced the piedmont, like the Toru-Aygyr, Kultor and the Dyuresu, became deeply entrenched and gradually transformed the study area into an abandoned morphological surface. The up-warp caused local lateral drainage diversion in front of the northern backlimb and triggered the formation of a dendritic drainage pattern upfan. Luminescence dating suggest that the period of up-warp and antecedent entrenchment started after 157 ka. The morphologically mature study area demonstrates the response of fluvial systems to growing folds on piedmont areas, induced by a propagating frontal fold at a thrust belt edge, following shortening.

Best Practices for NPT Transit Matching

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

Gilligan, Kimberly V.; Whitaker, J. Michael; Oakberg, John A.

2016-09-01

Transit matching is the process for relating or matching reports of shipments and receipts submitted to the International Atomic Energy Agency (IAEA). Transit matching is a component used by the IAEA in drawing safeguards conclusions and performing investigative analysis. Transit matching is part of IAEA safeguards activities and the State evaluation process, and it is included in the annual Safeguards Implementation Report (SIR). Annually, the IAEA currently receives reports of ~900,000 nuclear material transactions, of which ~500,000 are for domestic and foreign transfers. Of these the IAEA software can automatically match (i.e., machine match) about 95% of the domestic transfersmore » and 25% of the foreign transfers. Given the increasing demands upon IAEA resources, it is highly desirable for the machine-matching process to match as many transfers as possible. Researchers at Oak Ridge National Laboratory (ORNL) have conducted an investigation funded by the National Nuclear Security Administration through the Next Generation Safeguards Initiative to identify opportunities to strengthen IAEA transit matching. Successful matching, and more specifically machine matching, is contingent on quality data from the reporting States. In February 2016, ORNL hosted representatives from three States, the IAEA, and Euratom to share results from past studies and to discuss the processes, policies, and procedures associated with State reporting for transit matching. Drawing on each entity's experience and knowledge, ORNL developed a best practices document to be shared with the international safeguards community to strengthen transit matching. This paper shares the recommendations that resulted from this strategic meeting and the next steps being taken to strengthen transit matching.« less

Testing Bonner sphere spectrometers in the JRC-IRMM mono-energetic neutron beams

NASA Astrophysics Data System (ADS)

Bedogni, R.; Domingo, C.; Esposito, A.; Chiti, M.; García-Fusté, M. J.; Lovestam, G.

2010-08-01

Within the framework of the Euratom Transnational Access programme, a specific sub-programme, called NUDAME (neutron data measurements at IRMM), was dedicated to support neutron measurement experiments at the accelerator-based facilities of the JRC-IRMM Geel, Belgium. In this context, the INFN-LNF and UAB groups undertook two separate experiments at the 7 MV Van de Graaff facility, aimed at testing their Bonner sphere spectrometers (BSS) with mono-energetic neutron beams. Both research groups routinely employ the BSS in neutron spectra measurements for radiation protection dosimetry purposes, where accurate knowledge of the BSS response is a mandatory condition for correct dose evaluations. This paper presents the results obtained by both groups, focusing on: (1) the comparison between the value of neutron fluence provided as reference data and that obtained by applying the FRUIT unfolding code to the measured BSS data and (2) the experimental validation of the response matrices of the BSSs, previously derived with Monte Carlo simulations.

The Austrian radon activities on the way to the national radon action plan.

PubMed

Gruber, V; Ringer, W; Wurm, G; Haider, W

2014-07-01

Based on the new Euratom Basic Safety Standards (BSS), all EU member states will be obliged to design a strategy to address long-term risks from radon exposure, which is laid down in the 'national radon action plan'. In Austria, the National Radon Centre is responsible for the development of the action plan. This paper presents the current and planned radon protection activities on the way to establish the radon action plan--like the national radon database, the definition of radon risk areas by improving the existing radon map, as well as strategies and activities to increase the radon awareness of the public and decision-makers and to involve the building sector. The impact of and the need for actions caused by the BSS requirements on the Austrian radon legislation, strategy and programme are discussed. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Human capital needs - teaching, training and coordination for nuclear fuel cycle

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

Retegan, T.; Ekberg, C.; John, J.

Human capital is the accumulation of competencies, knowledge, social and creativity skills and personality attributes, which are necessary to perform work so as to produce economic value. In the frame of the nuclear fuel cycle, this is of paramount importance that the right human capital exists and in Europe this is fostered by a series of integrated or directed projects. The teaching, training and coordination will be discussed in the frame of University curricula with examples from several programs, like e.g. the Master of Nuclear Engineering at Chalmers University, Sweden and two FP7 EURATOM Projects: CINCH - a project formore » cooperation in nuclear chemistry - and ASGARD - a research project on advanced or novel nuclear fuels and their reprocessing issues for generation IV reactors. The integration of the university curricula in the market needs but also the anchoring in the research and future fuel cycles will be also discussed, with examples from the ASGARD project. (authors)« less

The European Federation of Organisations for Medical Physics Policy Statement No. 6.1: Recommended Guidelines on National Registration Schemes for Medical Physicists.

PubMed

Christofides, Stelios; Isidoro, Jorge; Pesznyak, Csilla; Bumbure, Lada; Cremers, Florian; Schmidt, Werner F O

2016-01-01

This EFOMP Policy Statement is an update of Policy Statement No. 6 first published in 1994. The present version takes into account the European Union Parliament and Council Directive 2013/55/EU that amends Directive 2005/36/EU on the recognition of professional qualifications and the European Union Council Directive 2013/59/EURATOM laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation. The European Commission Radiation Protection Report No. 174, Guidelines on Medical Physics Expert and the EFOMP Policy Statement No. 12.1, Recommendations on Medical Physics Education and Training in Europe 2014, are also taken into consideration. The EFOMP National Member Organisations are encouraged to update their Medical Physics registration schemes where these exist or to develop registration schemes taking into account the present version of this EFOMP Policy Statement (Policy Statement No. 6.1"Recommended Guidelines on National Registration Schemes for Medical Physicists"). Copyright © 2016. Published by Elsevier Ltd.

Revised Stratigraphy of The Nallıhan-Dudaş (Beypazarı) Area and Significance of the Campanian-Maastrichtian Reef Occurrences Based on the Foraminiferal and Rudist Data

NASA Astrophysics Data System (ADS)

Görmüş, Muhittin; Sami Us, Muhammed; Özer, Sacit; Tekin, Erdoǧan; Akpınar, Serap; Kabakcı, Büşra

2016-04-01

Transgressive to regressive succession of the Cretaceous Period and Cretaceous Paleogene boundary from the Nallıhan-Beypazarı area have significant data to interpret the past geological history of northwestern Turkey. In the literature, main scientific differences are seen on the formation/lithodem names, their ages, contact relations and environmental interpretations. In the study, a revision has been made for a proper stratigraphy of the area. For the revised stratigraphy, the obtained results from our field and laboratory works and the literature information were used. The following stratigraphy were established from basement to top: the Permo-Triassic aged Sekli metamorphics, Jurassic to lower Cretaceous Soǧukçam formation, Campanian to Maastrichtian aged Dereköy Group-Haremiköy conglomerates, Çeǧiköy reefs, Nardin formation (Seben formation), Taraklı formation; the Paleogene aged Kızılçay group including Kızılbayır formation, Karaköy volcanoclastics, Selvipınar limestone, the Miocene-Pliocene terrestrial sediments, Çoraklar formation, Hırka formation, Akpınar formation, Çayırhan formation, Teke volkanics, Bozbelen formation, Kirmir formation. The main unconformities are between Jura and Campanian, Maastrichtian and Paleogene, Eocene and Miocene times. Among the geological units, the Çeǧiköy reefs having rich rudist fauna overlie the Haremiköy conglomerates in both sides at the north-Yeşilyurt village and at the south-Gökçeöz village. Another outcrop, Emincik is between two mentioned villages. Biohermal reefs mainly includes very rich rudists up to 40 centimetres in size around the Yeşilköy such as: Pironaea polystyla, Vaccinites loftusi, Hippurites sublaevis. Larger foraminifera Orbitoides medius, O. apiculatus, Siderolites calcitrapoides, Pseodosiderolites vidali are also common in the fore reef areas. Around the Gökçeöz at the south part, the identified rudists are as follows: Vaccinites sp., Hippurites aff. sublaevis, Pironaea polystyla Joufia cf. reticulata, Hippuritella variabilis. In this location, smaller rudists are at the bottom, larger ones are at the top of the biostromal limestones. The first reefal occurrences are interpreted as local fringing type reefs. The reefs around the Emincik are the second occurrences of reefs. This was interpreted as patch reefs. Rudist fauna are less than the other locations and it occurs above the orbitoid rich siliciclastics. Extinction of rudists is at the end of middle Maastrichtian due to paleoenvironmental changes and open marine conditions. Transgressive succession continuous with regressive succession. The Taraklı Formation siliciclastics including rich Orbitoides apiculatus and O. gruenbachensis. The location is also important for the mass larger foraminifera-Orbitoides extinction on the Cretaceous/Paleogene boundary. Terrestrial siliciclastics overlies the very shallow marine Maastrichtian siliciclastics. ACKNOWLADGEMENT: The authors thanks to Ankara University Scientific Research Projects Coordination Unit (BAP) for the financial support on the project 13B4343014.

State of practice and emerging application of analytical techniques of nuclear forensic analysis: highlights from the 4th Collaborative Materials Exercise of the Nuclear Forensics International Technical Working Group (ITWG)

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

Schwantes, Jon M.; Marsden, Oliva; Pellegrini, Kristi L.

Founded in 1996 upon the initiative of the “Group of 8” governments (G8), the Nuclear Forensics International Technical Working Group (ITWG) is an ad hoc organization of official nuclear forensics practitioners (scientists, law enforcement, and regulators) that can be called upon to provide technical assistance to the global community in the event of a seizure of nuclear or radiological materials. The ITWG is supported by and is affiliated with roughly 40 countries and international partner organizations including the International Atomic Energy Agency (IAEA), EURATOM, INTERPOL, EUROPOL, and the United Nations Interregional Crime and Justice Research Institute (UNICRI). Besides providing amore » network of nuclear forensics laboratories that are able to assist law enforcement during a nuclear smuggling event, the ITWG is also committed to the advancement of the science of nuclear forensic analysis, largely through participation in periodic table top and Collaborative Materials Exercises (CMXs). Exercise scenarios use “real world” samples with realistic forensics investigation time constraints and reporting requirements. These exercises are designed to promote best practices in the field and test, evaluate, and improve new technical capabilities, methods and techniques in order to advance the science of nuclear forensics. The ITWG recently completed its fourth CMX in the 20 year history of the organization. This was also the largest materials exercise to date, with participating laboratories from 16 countries or organizations. Three samples of low enriched uranium were shipped to these laboratories as part of an illicit trafficking scenario, for which each laboratory was asked to conduct nuclear forensic analyses in support of a fictitious criminal investigation. An objective review of the State Of Practice and Art of international nuclear forensic analysis based upon the outcome of this most recent exercise is provided.« less

Advancing the Fork detector for quantitative spent nuclear fuel verification

DOE PAGES

Vaccaro, S.; Gauld, I. C.; Hu, J.; ...

2018-01-31

The Fork detector is widely used by the safeguards inspectorate of the European Atomic Energy Community (EURATOM) and the International Atomic Energy Agency (IAEA) to verify spent nuclear fuel. Fork measurements are routinely performed for safeguards prior to dry storage cask loading. Additionally, spent fuel verification will be required at the facilities where encapsulation is performed for acceptance in the final repositories planned in Sweden and Finland. The use of the Fork detector as a quantitative instrument has not been prevalent due to the complexity of correlating the measured neutron and gamma ray signals with fuel inventories and operator declarations.more » A spent fuel data analysis module based on the ORIGEN burnup code was recently implemented to provide automated real-time analysis of Fork detector data. This module allows quantitative predictions of expected neutron count rates and gamma units as measured by the Fork detectors using safeguards declarations and available reactor operating data. This study describes field testing of the Fork data analysis module using data acquired from 339 assemblies measured during routine dry cask loading inspection campaigns in Europe. Assemblies include both uranium oxide and mixed-oxide fuel assemblies. More recent measurements of 50 spent fuel assemblies at the Swedish Central Interim Storage Facility for Spent Nuclear Fuel are also analyzed. An evaluation of uncertainties in the Fork measurement data is performed to quantify the ability of the data analysis module to verify operator declarations and to develop quantitative go/no-go criteria for safeguards verification measurements during cask loading or encapsulation operations. The goal of this approach is to provide safeguards inspectors with reliable real-time data analysis tools to rapidly identify discrepancies in operator declarations and to detect potential partial defects in spent fuel assemblies with improved reliability and minimal false positive alarms. Finally, the results are summarized, and sources and magnitudes of uncertainties are identified, and the impact of analysis uncertainties on the ability to confirm operator declarations is quantified.« less

Advancing the Fork detector for quantitative spent nuclear fuel verification

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

Vaccaro, S.; Gauld, I. C.; Hu, J.

The Fork detector is widely used by the safeguards inspectorate of the European Atomic Energy Community (EURATOM) and the International Atomic Energy Agency (IAEA) to verify spent nuclear fuel. Fork measurements are routinely performed for safeguards prior to dry storage cask loading. Additionally, spent fuel verification will be required at the facilities where encapsulation is performed for acceptance in the final repositories planned in Sweden and Finland. The use of the Fork detector as a quantitative instrument has not been prevalent due to the complexity of correlating the measured neutron and gamma ray signals with fuel inventories and operator declarations.more » A spent fuel data analysis module based on the ORIGEN burnup code was recently implemented to provide automated real-time analysis of Fork detector data. This module allows quantitative predictions of expected neutron count rates and gamma units as measured by the Fork detectors using safeguards declarations and available reactor operating data. This study describes field testing of the Fork data analysis module using data acquired from 339 assemblies measured during routine dry cask loading inspection campaigns in Europe. Assemblies include both uranium oxide and mixed-oxide fuel assemblies. More recent measurements of 50 spent fuel assemblies at the Swedish Central Interim Storage Facility for Spent Nuclear Fuel are also analyzed. An evaluation of uncertainties in the Fork measurement data is performed to quantify the ability of the data analysis module to verify operator declarations and to develop quantitative go/no-go criteria for safeguards verification measurements during cask loading or encapsulation operations. The goal of this approach is to provide safeguards inspectors with reliable real-time data analysis tools to rapidly identify discrepancies in operator declarations and to detect potential partial defects in spent fuel assemblies with improved reliability and minimal false positive alarms. Finally, the results are summarized, and sources and magnitudes of uncertainties are identified, and the impact of analysis uncertainties on the ability to confirm operator declarations is quantified.« less

Advancing the Fork detector for quantitative spent nuclear fuel verification

NASA Astrophysics Data System (ADS)

Vaccaro, S.; Gauld, I. C.; Hu, J.; De Baere, P.; Peterson, J.; Schwalbach, P.; Smejkal, A.; Tomanin, A.; Sjöland, A.; Tobin, S.; Wiarda, D.

2018-04-01

The Fork detector is widely used by the safeguards inspectorate of the European Atomic Energy Community (EURATOM) and the International Atomic Energy Agency (IAEA) to verify spent nuclear fuel. Fork measurements are routinely performed for safeguards prior to dry storage cask loading. Additionally, spent fuel verification will be required at the facilities where encapsulation is performed for acceptance in the final repositories planned in Sweden and Finland. The use of the Fork detector as a quantitative instrument has not been prevalent due to the complexity of correlating the measured neutron and gamma ray signals with fuel inventories and operator declarations. A spent fuel data analysis module based on the ORIGEN burnup code was recently implemented to provide automated real-time analysis of Fork detector data. This module allows quantitative predictions of expected neutron count rates and gamma units as measured by the Fork detectors using safeguards declarations and available reactor operating data. This paper describes field testing of the Fork data analysis module using data acquired from 339 assemblies measured during routine dry cask loading inspection campaigns in Europe. Assemblies include both uranium oxide and mixed-oxide fuel assemblies. More recent measurements of 50 spent fuel assemblies at the Swedish Central Interim Storage Facility for Spent Nuclear Fuel are also analyzed. An evaluation of uncertainties in the Fork measurement data is performed to quantify the ability of the data analysis module to verify operator declarations and to develop quantitative go/no-go criteria for safeguards verification measurements during cask loading or encapsulation operations. The goal of this approach is to provide safeguards inspectors with reliable real-time data analysis tools to rapidly identify discrepancies in operator declarations and to detect potential partial defects in spent fuel assemblies with improved reliability and minimal false positive alarms. The results are summarized, and sources and magnitudes of uncertainties are identified, and the impact of analysis uncertainties on the ability to confirm operator declarations is quantified.

78 FR 48904 - United States v. Chiropractic Associates, Ltd. of South Dakota; Public Comment and Response on...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-12

... DEPARTMENT OF JUSTICE Antitrust Division United States v. Chiropractic Associates, Ltd. of South... proposed Final Judgment in United States v. Chiropractic Associates, Ltd. of South Dakota., Civil Action No... SOUTH DAKOTA SOUTHERN DIVISION UNITED STATES OF AMERICA, Plaintiff, v. CHIROPRACTIC ASSOCIATES, LTD. OF...

The importance of unitization for familiarity-based learning.

PubMed

Parks, Colleen M; Yonelinas, Andrew P

2015-05-01

It is often assumed that recollection is necessary to support memory for novel associations, whereas familiarity supports memory for single items. However, the levels of unitization framework assumes that familiarity can support associative memory under conditions in which the components of an association are unitized (i.e., treated as a single coherent item). In the current study we tested two critical assumptions of this framework. First, does unitization reflect a specialized form of learning or is it simply a form of semantic or elaborative encoding, and, second, can the beneficial effects of unitization on familiarity be observed for across-domain associations or are they limited to creating new associations between items that are from the same stimulus domains? Unitization was found to increase associative recognition but not item recognition. It affected familiarity more than recollection, increased associative but not item priming, and was dissociable from levels of processing effects. Moreover, unitization effects were found to be particularly effective in supporting face-word and fractal-sound pairs. The current results indicate that unitization reflects a specialized form of learning that supports associative familiarity of within- and across-domain associations. (c) 2015 APA, all rights reserved).

The importance of unitization for familiarity-based learning

PubMed Central

Parks, Colleen M.; Yonelinas, Andrew P.

2014-01-01

It is often assumed that recollection is necessary to support memory for novel associations, whereas familiarity supports memory for single items. However, the levels of unitization (LOU) framework assumes that familiarity can support associative memory under conditions in which the components of an association are unitized (i.e., treated as a single coherent item). In the current study we test two critical assumptions of this framework. First, does unitization reflect a specialized form of learning or is it simply a form of semantic or elaborative encoding, and, second, can the beneficial effects of unitization on familiarity be observed for across-domain associations or are they limited to creating new associations between items that are from the same stimulus domains? Unitization was found to increase associative recognition but not item recognition, it affected familiarity more so than recollection, it increased associative but not item priming, and it was dissociable from levels of processing effects. Moreover, unitization effects were found to be particularly effective in supporting face-word and fractal-sound pairs. The current results indicate that unitization reflects a specialized form of learning that supports associative familiarity of within- and across-domain associations. PMID:25329077

Limiter heat loads during the first operation of the W7-X stellarator

NASA Astrophysics Data System (ADS)

Wurden, Glen; Niemann, Holger; Jakubowski, Marcin; Bozhenkov, Sergey; Biedermann, Christoph; Marsen, Stefan; Effenberg, Florian; Stephey, Laurie; Schmitz, Oliver; W7-X Team

2016-10-01

During the first operational phase (OP1.1) of the new W7-X stellarator, five poloidal graphite limiters served as the main boundary for the plasma. There was a dedicated set of diagnostics to observe the performance of the temporary poloidal limiters and infer basic transport behavior of the 3-D helical SOL plasma. We describe IR imaging of the limiters, which resulted in observations of 1) heat flux determination as a function of time and space, 2) total energy into the limiters, 3) high-frequency helical patterns of energy bursts onto the limiters, 4) changes in surface emissivity, and 5) detection of UFO's (small-to-large dusts). These measurements were made in 2 magnetic configuration discharges (differing iota), and in ones where the power loads to the limiters were systematically modified by the use of trim coils. Observed power fractions on the limiters ranged from 40% to 20% of the 0.6 to 4 MW ECRH input powers. Acknowledgement: Funded under DOE LANS Contract DE-AC5026NA25396 and DE-SC0014210, and within the EUROfusion Consortium under Euratom Grant 633053.

Predicting thermo-mechanical behaviour of high minor actinide content composite oxide fuel in a dedicated transmutation facility

NASA Astrophysics Data System (ADS)

Lemehov, S. E.; Sobolev, V. P.; Verwerft, M.

2011-09-01

The European Facility for Industrial Transmutation (EFIT) of the minor actinides (MA), from LWR spent fuel is being developed in the integrated project EUROTRANS within the 6th Framework Program of EURATOM. Two composite uranium-free fuel systems, containing a large fraction of MA, are proposed as the main candidates: a CERCER with magnesia matrix hosting (Pu,MA)O 2-x particles, and a CERMET with metallic molybdenum matrix. The long-term thermal and mechanical behaviour of the fuel under the expected EFIT operating conditions is one of the critical issues in the core design. To make a reliable prediction of long-term thermo-mechanical behaviour of the hottest fuel rods in the lead-cooled version of EFIT with thermal power of 400 MW, different fuel performance codes have been used. This study describes the main results of modelling the thermo-mechanical behaviour of the hottest CERCER fuel rods with the fuel performance code MACROS which indicate that the CERCER fuel residence time can safely reach at least 4-5 effective full power years.

The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists.

PubMed

Christofides, Stelios; Isidoro, Jorge; Pesznyak, Csilla; Cremers, Florian; Figueira, Rita; van Swol, Christiaan; Evans, Stephen; Torresin, Alberto

2016-01-01

Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) and the International Basic Safety Standards (BSS). It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time. This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD. Copyright © 2016. Published by Elsevier Ltd.

Modelling of Divertor Detachment in MAST Upgrade

NASA Astrophysics Data System (ADS)

Moulton, David; Carr, Matthew; Harrison, James; Meakins, Alex

2017-10-01

MAST Upgrade will have extensive capabilities to explore the benefits of alternative divertor configurations such as the conventional, Super-X, x divertor, snowflake and variants in a single device with closed divertors. Initial experiments will concentrate on exploring the Super-X and conventional configurations, in terms of power and particle loads to divertor surfaces, access to detachment and its control. Simulations have been carried out with the SOLPS5.0 code validated against MAST experiments. The simulations predict that the Super-X configuration has significant advantages over the conventional, such as lower detachment threshold (2-3x lower in terms of upstream density and 4x higher in terms of PSOL). Synthetic spectroscopy diagnostics from these simulations have been created using the Raysect ray tracing code to produce synthetic filtered camera images, spectra and foil bolometer data. Forward modelling of the current set of divertor diagnostics will be presented, together with a discussion of future diagnostics and analysis to improve estimates of the plasma conditions. Work supported by the RCUK Energy Programme [Grant Number EP/P012450/1] and EURATOM.

MAST Upgrade Status and Future Enhancements

NASA Astrophysics Data System (ADS)

Harrison, James; MAST Upgrade Team Team

2017-10-01

The MAST Upgrade spherical tokamak has unique capabilities to address some of the key issues facing the development of fusion energy. Its main objectives are: 1) development of novel exhaust concepts, 2) contribution to the knowledge base for ITER and 3) to explore potential routes to smaller/cheaper fusion reactors. To fulfil these aims, it is equipped with 19 new poloidal field coils and closed divertors with Super-X capability. BT has been increased by 50% and the pulse length and Ip have increased to 5s and 2MA respectively. Auxiliary heating is provided by on and off axis NBI. The gas fuelling system allows for injection from 10 poloidal locations. The divertors are diagnosed with probes, bolometers, Thomson scattering, IR, visible imaging and spectroscopy. Fast ion physics studies are enhanced with a new fast ion loss detector. Following the construction phase, further enhancements are underway including new diagnostics, a cryoplant to serve the cryopumps and 2 additional neutral beams to increase the heating power from 5 to 10MW. Work supported by the RCUK Energy Programme [Grant Number EP/P012450/1] and EURATOM.

The European Federation of Organisations for Medical Physics. Policy Statement No. 7.1: The roles, responsibilities and status of the medical physicist including the criteria for the staffing levels in a Medical Physics Department approved by EFOMP Council on 5th February 2016.

PubMed

Evans, Stephen; Christofides, Stelios; Brambilla, Marco

2016-04-01

This EFOMP Policy Statement is an amalgamation and an update of the EFOMP Policy Statements No. 2, 4 and 7. It presents guidelines for the roles, responsibilities and status of the medical physicist together with recommended minimum staffing levels. These recommendations take into account the ever-increasing demands for competence, patient safety, specialisation and cost effectiveness of modern healthcare services, the requirements of the European Union Council Directive 2013/59/Euratom laying down the basic safety standards for protection against the dangers arising from exposure to ionising radiation, the European Commission's Radiation Protection Report No. 174: "Guidelines on medical physics expert", as well as the relevant publications of the International Atomic Energy Agency. The provided recommendations on minimum staffing levels are in very good agreement with those provided by both the European Commission and the International Atomic Energy Agency. Copyright © 2016. Published by Elsevier Ltd.

Basis for standards: ICRP activities.

PubMed

Vano, E

2015-07-01

The purpose of this chapter is to describe work achieved recently by the International Commission on Radiological Protection (ICRP) and especially by Committee 3 (Protection in Medicine) and its use for standards. In March 1960, the Board of Governors of the International Atomic Energy Agency approved the Agency's 'Health and Safety Measures', stating that the Agency's 'Basic Safety Standards' (BSS) would be based, to the extent possible, on the recommendations of the ICRP. In a similar way, the Council of the European Union took into account the new recommendations of the ICRP when adopting the new Directive 2013/59/EURATOM that laid down BSS for protection against the dangers arising from exposure to ionising radiation. The new limit for the lens of the eyes for occupational exposures has been incorporated into these international standards and several articles dealing with medical exposures: justification, optimisation, recording patient doses, the use of diagnostic reference levels, training, accidental and unintended exposures, etc. have also been included in agreement with the ICRP recommendations. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Developmental differences in relations between parent-reported executive function and unitized and non-unitized memory representations during childhood

PubMed Central

Blankenship, Sarah L.; Riggins, Tracy

2015-01-01

Previous research has documented an association between executive functioning (EF) and memory for bound details. However, it is unknown if this relation varies as a function of the type of bound information (i.e., unitized versus non-unitized) and whether this association changes as a function of age during childhood, when both EF and memory undergo rapid development. The current study sought to address these gaps by examining whether relations between parent-reported EF differed for unitized versus non-unitized memory representations and if these relations differed between children who were 4, 6, or 8 years of age. Results revealed that EF was selectively associated with non-unitized associative memory in 8-year-old children; no significant relations between EF and either memory condition were evident in 4- or 6-year-olds. These results suggest relations between EF and memory may be specific to non-unitized representations and that this association may emerge across childhood as both EF and memory abilities develop. PMID:26347683

Device for monitoring cell voltage

DOEpatents

Doepke, Matthias [Garbsen, DE; Eisermann, Henning [Edermissen, DE

2012-08-21

A device for monitoring a rechargeable battery having a number of electrically connected cells includes at least one current interruption switch for interrupting current flowing through at least one associated cell and a plurality of monitoring units for detecting cell voltage. Each monitoring unit is associated with a single cell and includes a reference voltage unit for producing a defined reference threshold voltage and a voltage comparison unit for comparing the reference threshold voltage with a partial cell voltage of the associated cell. The reference voltage unit is electrically supplied from the cell voltage of the associated cell. The voltage comparison unit is coupled to the at least one current interruption switch for interrupting the current of at least the current flowing through the associated cell, with a defined minimum difference between the reference threshold voltage and the partial cell voltage.

Associative memory in aging: the effect of unitization on source memory.

PubMed

Bastin, Christine; Diana, Rachel A; Simon, Jessica; Collette, Fabienne; Yonelinas, Andrew P; Salmon, Eric

2013-03-01

In normal aging, memory for associations declines more than memory for individual items. Unitization is an encoding process defined by creation of a new single entity to represent a new arbitrary association. The current study tested the hypothesis that age-related differences in associative memory can be reduced by encoding instructions that promote unitization. In two experiments, groups of 20 young and 20 older participants learned new associations between a word and a background color under two conditions. In the item detail condition, they had to imagine that the item is the same color as the background-an instruction promoting unitization of the associations. In the context detail condition, which did not promote unitization, they had to imagine that the item interacted with another colored object. At test, they had to retrieve the color that was associated with each word (source memory). In both experiments, the results showed an age-related decrement in source memory performance in the context detail but not in the item detail condition. Moreover, Experiment 2 examined receiver operating characteristics in older participants and indicated that familiarity contributed more to source memory performance in the item detail than in the context detail condition. These findings suggest that unitization of new associations can overcome the associative memory deficit observed in aging, at least for item-color associations.

Radon-222 in groundwater and effective dose due to ingestion and inhalation in the city of Ibadan, Nigeria.

PubMed

Ademola, Janet Ayobami; Oyeleke, Oyebode Akanni

2017-03-20

Radon concentration in groundwater collected from the eleven Local Government Areas (LGAs) of Ibadan, Nigeria, was analyzed. Annual effective doses due to ingestion and inhalation of radon from the consumption of the water were determined. The arithmetic means (AMs) of radon concentration for the 11 LGAs varied from 2.18 to 76.75 Bq l -1 with a standard deviation of 1.57 and 70.64 Bq l -1 , respectively. The geometric means (GMs) varied from 1.67 to 49.47 Bq l -1 with geometric standard deviation of 2.22 and 3.04, respectively. About 58% of the 84 water samples examined had a higher concentration of radon than the 11.1 Bq l -1 recommended by United States Environmental Protection Agency (USEPA); the AMs of six LGAs and GMs of three LGAs were higher than the recommended value. However the AMs and GMs of all the LGAs with about 93% of the water sampled were lower than the 100 Bq l -1 recommended by the World Health Organization and EURATOM drinking water directive. The concentration of radon varied with the geological formation of the area. The AMs of the annual effective dose due to ingestion of radon in water ranged from 0.036 to 1.261 mSv y -1 , 0.071 to 2.521 mSv y -1 and 0.042 to 1.471 mSv y -1 for adult, child and infant, respectively and the GMs in the range of 0.026 to 0.813, 0.055 to 1.625 and 0.032 to 0.948 mSv y -1 , respectively. The AMs of 10 LGAs and GMs of 7 LGAs were higher than the recommended reference dose level of 0.1 mSv y -1 from the consumption of water for the duration of one year for all the three categories of people. The AMs and GMs of the annual effective dose due to inhalation of radon in drinking water ranged from 0.533 to 18.82 μSv y -1 and 0.411 to 12.13 μSv y -1 , respectively, contributing less to the overall dose.

Behavior and Release of Nitrogen at Mines and Quarries in Nordic Conditions

NASA Astrophysics Data System (ADS)

Karlsson, Teemu; Neitola, Raisa; Jermakka, Johannes; Merta, Elina; Mroueh, Ulla-Maija

2015-04-01

The increased extraction of mineral resources and mining activities creates added pressure on the environmental issues and a proper water management in mining areas in Finland. Among others, nitrogen compounds released from explosives or from mining processes can have a detrimental effect on the environment. Thus, this project aimed at comprehensive understanding on the nitrogen issue in the extractive industry. The project collected essential data on nitrogen compounds present in the environments of mines and quarries, and generated better understanding of the discharge and behaviour of nitrogen compounds in mining areas. The sources and balances of explosives-originated nitrogen compounds at mines and quarries of different sizes were investigated and compared. Additionally, the focus was in 'nitrogen smudging' problem of waste rocks and the intensity, as well as evolution and chemical characteristics of their nitrogen contamination. According to the results, the total load of potential nitrogen to the environment depends on the scale and type of the activity as well as the type of explosives used. The main emission sources of nitrogen are process and dewatering waters. A lysimeter study showed that the explosives originated nitrogen content of left over stones from natural stone quarrying is relatively low and ca. half of the nitrogen is leached within the first weeks after detonation. The "nitrogen smudging" of natural stone quarrying left over stones is relatively low to begin with and enhanced by the rapid flushing by rainwater, thus the residues of explosives should not be considered to prevent the utilization of otherwise mineralogically inert waste rocks of good technical quality. The overall nitrogen management should take into account the background concentrations and sensitivity of the local ecosystem. The research project "Solution for Control of Nitrogen Discharges at Mines and Quarries, (MINIMAN)" was realized during years 2012-2014 as a cooperative project with GTK, VTT and TTY together with several industrial and international partners and financed by Tekes Green Mining Programme.

The Importance of Unitization for Familiarity-Based Learning

ERIC Educational Resources Information Center

Parks, Colleen M.; Yonelinas, Andrew P.

2015-01-01

It is often assumed that recollection is necessary to support memory for novel associations, whereas familiarity supports memory for single items. However, the levels of unitization framework assumes that familiarity can support associative memory under conditions in which the components of an association are unitized (i.e., treated as a single…

78 FR 22901 - United States v. Chiropractic Associates, Ltd. of South Dakota Proposed Final Judgment and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-17

... DEPARTMENT OF JUSTICE Antitrust Division United States v. Chiropractic Associates, Ltd. of South... District of South Dakota in United States of America v. Chiropractic Associates Ltd, of South Dakota, (CASD... terms for chiropractic services. Copies of the Complaint, proposed Final Judgment, and Competitive...

Resource Conservation and Recovery Act (RCRA) Part B Permit Application for Production Associated Units at the Oak Ridge Y-12 Plant

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

Not Available

This is the RCRA required permit application for Radioactive and Hazardous Waste Management at the Oak Ridge Y-12 Plant for the following units: Building 9206 Container Storage Unit; Building 9212 Container Storage Unit; Building 9720-12 Container Storage Unit; Cyanide Treatment Unit. All four of these units are associated with the recovery of enriched uranium and other metals from wastes generated during the processing of nuclear materials.

An Exploration of the Perspectives of Associate Nurse Unit Managers Regarding the Implementation of Smoke-free Policies in Adult Mental Health Inpatient Units.

PubMed

Dean, Tania D; Cross, Wendy; Munro, Ian

2018-04-01

In Adult Mental Health Inpatient Units, it is not unexpected that leadership of Associate Nurse Unit Managers contributes to successful implementation of smoke-free policies. In light of challenges facing mental health nursing, and limited research describing their leadership and the role it plays in addressing smoke-free policy implementation, the aim of this study is to explore Associate Nurse Unit Managers perspectives' regarding the implementation of smoke-free policies, which were introduced on 1 July, 2015. Individual in-depth semi-structured interviews were undertaken six months post the implementation of smoke-free policies. In this qualitative descriptive study, six Associate Nurse Unit Managers working in a Victorian public Adult Mental Health Inpatient Unit, were asked eight questions which targeted leadership and the implementation and enforcement of smoke-free policies. Associate Nurse Unit Managers provide leadership and role modeling for staff and they are responsible for setting the standards that govern the behavior of nurses within their team. All participants interviewed believed that they were leaders in the workplace. Education and consistency were identified as crucial for smoke-free policies to be successful. Participants acknowledged that the availability of therapeutic interventions, staff resources and the accessibility of nicotine replacement therapy were crucial to assist consumers to remain smoke-free while on the unit. The findings from this research may help to improve the understanding of the practical challenges that Associate Nurse Unit Manager's face in the implementation of smoke-free policies with implications for policies, nursing practice, education and research.

The missing link? Testing a schema account of unitization.

PubMed

Tibon, Roni; Greve, Andrea; Henson, Richard

2018-05-09

Unitization refers to the creation of a new unit from previously distinct items. The concept of unitization has been used to explain how novel pairings between items can be remembered without requiring recollection, by virtue of new, item-like representations that enable familiarity-based retrieval. We tested an alternative account of unitization - a schema account - which suggests that associations between items can be rapidly assimilated into a schema. We used a common operationalization of "unitization" as the difference between two unrelated words being linked by a definition, relative to two words being linked by a sentence, during an initial study phase. During the following relearning phase, a studied word was re-paired with a new word, either related or unrelated to the original associate from study. In a final test phase, memory for the relearned associations was tested. We hypothesized that, if unitized representations act like schemas, then we would observe some generalization to related words, such that memory would be better in the definition than sentence condition for related words, but not for unrelated words. Contrary to the schema hypothesis, evidence favored the null hypothesis of no difference between definition and sentence conditions for related words (Experiment 1), even when each cue was associated with multiple associates, indicating that the associations can be generalized (Experiment 2), or when the schematic information was explicitly re-activated during Relearning (Experiment 3). These results suggest that unitized associations do not generalize to accommodate new information, and therefore provide evidence against the schema account.

Relationship Between Labor and Delivery Unit Management Practices and Maternal Outcomes.

PubMed

Plough, Avery C; Galvin, Grace; Li, Zhonghe; Lipsitz, Stuart R; Alidina, Shehnaz; Henrich, Natalie J; Hirschhorn, Lisa R; Berry, William R; Gawande, Atul A; Peter, Doris; McDonald, Rory; Caldwell, Donna L; Muri, Janet H; Bingham, Debra; Caughey, Aaron B; Declercq, Eugene R; Shah, Neel T

2017-08-01

To define, measure, and characterize key competencies of managing labor and delivery units in the United States and assess the associations between unit management and maternal outcomes. We developed and administered a management measurement instrument using structured telephone interviews with both the primary nurse and physician managers at 53 diverse hospitals across the United States. A trained interviewer scored the managers' interview responses based on management practices that ranged from most reactive (lowest scores) to most proactive (highest scores). We established instrument validity by conducting site visits among a subsample of 11 hospitals and established reliability using interrater comparison. Using a factor analysis, we identified three themes of management competencies: management of unit culture, patient flow, and nursing. We constructed patient-level regressions to assess the independent association between these management themes and maternal outcomes. Proactive management of unit culture and nursing was associated with a significantly higher risk of primary cesarean delivery in low-risk patients (relative risk [RR] 1.30, 95% CI 1.02-1.66 and RR 1.47, 95% CI 1.13-1.92, respectively). Proactive management of unit culture was also associated with a significantly higher risk of prolonged length of stay (RR 4.13, 95% CI 1.98-8.64), postpartum hemorrhage (RR 2.57, 95% CI 1.58-4.18), and blood transfusion (RR 1.87, 95% CI 1.12-3.13). Proactive management of patient flow and nursing was associated with a significantly lower risk of prolonged length of stay (RR 0.23, 95% CI 0.12-0.46 and RR 0.27, 95% CI 0.11-0.62, respectively). Labor and delivery unit management varies dramatically across and within hospitals in the United States. Some proactive management practices may be associated with increased risk of primary cesarean delivery and maternal morbidity. Other proactive management practices may be associated with decreased risk of prolonged length of stay, indicating a potential opportunity to safely improve labor and delivery unit efficiency.

Outcome of the European initiative for radiation protection research and future perspectives.

PubMed

Repussard, J

2018-01-01

In 2009, the European Commission published the report of the high-level expert group that had been mandated to consider the scientific challenges posed by the issues of low dose effects of ionising radiation, and to formulate proposals for research policy evolution in this field at European level. This report formulated a first draft of a strategic research agenda. International scientific cooperation and an integrated approach are essential for the further development and enhancement of the international framework of radiation protection. This paper reflects on the results which have been gained through this integration approach: strategic research agendas have been established, policies and action plans have been developed for infrastructures and training education, several ambitious research projects have been launched, and a first draft of a European 'joint road map' for radiation protection research will be published. Reflecting on the challenges that lie ahead, this paper also presents the initiatives that the five European research platforms (MELODI: low dose research; ALLIANCE: radioecology; EURADOS: dosimetry; NERIS: emergency preparedness; EURAMED: radiation protection in medical applications) have jointly presented to the European Commission and Euratom member states to further enhance radiation protection research.

Spanish experience on the design of radon surveys based on the use of geogenic information.

PubMed

Sainz Fernández, C; Quindós Poncela, L S; Fernández Villar, A; Fuente Merino, I; Gutierrez-Villanueva, J L; Celaya González, S; Quindós López, L; Quindós López, J; Fernández, E; Remondo Tejerina, J; Martín Matarranz, J L; García Talavera, M

2017-01-01

One of the requirements of the recently approved EU-BSS (European Basic Safety Standards Directive, EURATOM, 2013) is the design and implementation of national radon action plans in the member states (Annex XVIII). Such plans require radon surveys. The analysis of indoor radon data is supported by the existing knowledge about geogenic radiation. With this aim, we used the terrestrial gamma dose rate data from the MARNA project. In addition, we considered other criterion regarding the surface of Spain, population, permeability of rocks, uranium and radium contain in soils because currently no data are available related to soil radon gas concentration and permeability in Spain. Given that, a Spanish radon map was produced which will be part of the European Indoor Radon Map and a component of the European Atlas of Natural Radiation. The map indicates geographical areas with high probability of finding high indoor radon concentrations. This information will support legislation regarding prevention of radon entry both in dwellings and workplaces. In addition, the map will serve as a tool for the development of strategies at all levels: individual dwellings, local, regional and national administration. Copyright © 2016 Elsevier Ltd. All rights reserved.

Measurements and Modeling of Radiation Exposure Due to Solar Particle Events

NASA Astrophysics Data System (ADS)

Beck, P.; Conrad Wp6-Sgb Team

Dose assessment procedures of cosmic radiation to aircraft crew are introduced in most of the European countries according the corresponding European directive and national regulations 96 29 Euratom However the radiation exposure due to solar particle events is still a matter of scientific research Several in-flight measurements were performed during solar storm conditions First models to estimate the exposure due to solar particle events were discussed previously Recently EURADOS European Radiation Dosimetry Group http www eurados org started to coordinate research activities in model improvements for dose assessment of solar particle events The coordinated research is a work package of the European research project CONRAD Coordinated Network for Radiation Dosimetry on complex mixed radiation fields at workplaces Major aim of sub group B of that work package is the validation of models for dose assessment of solar particle events using data from neutron ground level monitors in-flight measurement results obtained during a solar particle event and proton satellite data The paper describes the current status of obtainable solar storm measurements and gives an overview of the existing models for dose assessment of solar particle events in flight altitudes

Will fusion be ready to meet the energy challenge for the 21st century?

NASA Astrophysics Data System (ADS)

Bréchet, Yves; Massard, Thierry

2016-05-01

Finite amount of fossil fuel, global warming, increasing demand of energies in emerging countries tend to promote new sources of energies to meet the needs of the coming centuries. Despite their attractiveness, renewable energies will not be sufficient both because of intermittency but also because of the pressure they would put on conventional materials. Thus nuclear energy with both fission and fusion reactors remain the main potential source of clean energy for the coming centuries. France has made a strong commitment to fusion reactor through ITER program. But following and sharing Euratom vision on fusion, France supports the academic program on Inertial Fusion Confinement with direct drive and especially the shock ignition scheme which is heavily studied among the French academic community. LMJ a defense facility for nuclear deterrence is also open to academic community along with a unique PW class laser PETAL. Research on fusion at LMJ-PETAL is one of the designated topics for experiments on the facility. Pairing with other smaller European facilities such as Orion, PALS or LULI2000, LMJ-PETAL will bring new and exciting results and contribution in fusion science in the coming years.

Ultralow Dose MSCT Imaging in Dental Implantology

PubMed Central

Widmann, Gerlig; Al-Ekrish, Asma'a A.

2018-01-01

Introduction: The Council Directive 2013/59 Euratom has a clear commitment for keeping medical radiation exposure as low as reasonably achievable and demands a regular review and use of diagnostic reference levels. Methods: In dental implantology, the range of effective doses for cone beam computed tomography (CBCT) shows a broad overlap with multislice computed tomography (MSCT). More recently, ultralow dose imaging with new generations of MSCT scanners may impart radiation doses equal to or lower than CBCT. Dose reductions in MSCT have been further facilitated by the introduction of iterative image reconstruction technology (IRT), which provides substantial noise reduction over the current standard of filtered backward projection (FBP). Aim: The aim of this article is to review the available literature on ultralow dose CT imaging and IRTs in dental implantology imaging and to summarize their influence on spatial and contrast resolution, image noise, tissue density measurements, and validity of linear measurements of the jaws. Conclusion: Application of ultralow dose MSCT with IRT technology in dental implantology offers the potential for very large dose reductions compared with standard dose imaging. Yet, evaluation of various diagnostic tasks related to dental implantology is still needed to confirm the results obtained with various IRTs and ultra-low doses so far. PMID:29492174

77 FR 20551 - Connect America Fund; A National Broadband Plan for Our Future; Establishing Just and Reasonable...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

..., and the Petition for Reconsideration of United States Telecom Association is dismissed in part. DATES... reconsideration filed by the United States Telecom Association (USTelecom), which, among other things, asked the... Reconsideration of United States Telecom Association is dismissed in part. 19. It is further ordered, that the...

CLOSEUP VIEW OF A GENERATOR UNIT WITH ITS ASSOCIATED INSTRUMENTATION ...

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

CLOSE-UP VIEW OF A GENERATOR UNIT WITH ITS ASSOCIATED INSTRUMENTATION AND CONTROL PANEL. - Wilson Dam & Hydroelectric Plant, Turbine & Generator Unit, Spanning Tennessee River at Wilson Dam Road (Route 133), Muscle Shoals, Colbert County, AL

The moderating effect of employee hostility on the association of long-term elderly care unit's negative resident characteristics to employee stress and well-being.

PubMed

Heponiemi, Tarja; Elovainio, Marko; Pekkarinen, Laura; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo

2006-04-01

This study examined the moderating effect of employee hostility on the association of unit-level resident characteristics (depression and behavioral problems) to individual-level employee's resident-related stress and psychological well-being during 1-year follow-up study among 501 employees in elderly care. Our results showed that employee hostility was associated with decreased psychological well-being. In addition, hostility moderated the association between unit-level proportion of depressive residents and resident-related stress experienced by the individual employees. Hostile employees reported increased resident-related stress irrespective of the proportion of depressed residents in the unit. Instead, nonhostile employees were sensitive to the depression in the unit. They reported low levels of stress when depression levels in the unit were low and increased stress when depression levels were high. (c) 2006 APA, all rights reserved.

Organizational Factors Associated With Perceived Quality of Patient Care in Closed Intensive Care Units.

PubMed

McIntosh, Nathalie; Oppel, Eva; Mohr, David; Meterko, Mark

2017-09-01

Improving patient care quality in intensive care units is increasingly important as intensive care unit services account for a growing proportion of hospital services. Organizational factors associated with quality of patient care in such units have been identified; however, most were examined in isolation, making it difficult to assess the relative importance of each. Furthermore, though most intensive care units now use a closed model, little research has been done in this specific context. To examine the relative importance of organizational factors associated with patient care quality in closed intensive care units. In a national exploratory, cross-sectional study focused on intensive care units at US Veterans Health Administration acute care hospitals, unit directors were surveyed about nurse and physician staffing, work resources and training, patient care coordination, rounding, and perceptions of patient care quality. Administrative records yielded data on patient volume and facility teaching status. Descriptive statistics, bivariate analyses, and regression modeling were used for data analysis. Sixty-nine completed surveys from directors of closed intensive care units were returned. Regression model results showed that better patient care coordination (β = 0.43; P = .01) and having adequate work resources (β = 0.26; P = .02) were significantly associated with higher levels of patient care quality in such units ( R 2 = 0.22). Augmenting work resources and/or focusing limited hospital resources on improving patient care coordination may be the most productive ways to improve patient care quality in closed intensive care units. ©2017 American Association of Critical-Care Nurses.

Factors associated with low unit cohesion in Australian Defence Force members who deployed to the Middle East (2001–2009)

PubMed Central

Kanesarajah, Jeeva; Waller, M; Zheng, W Y; Dobson, A J

2016-01-01

Introduction Unit cohesion has been shown to bolster the mental health of military personnel; hence, it is important to identify the characteristics that are associated with low unit cohesion, so that interventions to improve unit cohesion can be targeted and implemented. Little is known about the factors associated with low unit cohesion. This research aims to identify demographic, military service and deployment factors associated with low unit cohesion. Methods Data from a self-reported cross-sectional study of 11 411 current or ex-serving Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009 were used. Multivariable logistic regression was used to investigate the research aims. Results Being female (adjusted OR (aOR) (95% CI) 1.35 (1.21 to 1.51)), non-commissioned officer (aOR (95% CI) 1.50 (1.39 to 1.62)), lower ranked (aOR (95% CI) 1.74 (1.51 to 2.01)) or having left military service (aOR (95% CI) 1.71 (1.46 to 2.02)) was associated with reporting low unit cohesion. Potentially modifiable factors such as performing logistic roles on deployment (aOR (95% CI) 1.13 (1.01 to 1.27)), dissatisfaction with work experience on deployment such as working with colleagues who did not do what was expected of them (aOR (95% CI) 4.09 (3.61 to 4.64)), and major problems at home while deployed (aOR (95% CI) 1.50 (1.38 to 1.63)) were also associated with reporting low unit cohesion. Conclusions This is the first study to identify demographic, military service and deployment factors associated with low unit cohesion. The modifiable nature of unit cohesion means that military leaders could use this information to identify subgroups for targeted resilience interventions that may reduce vulnerabilities to mental health problems and improve the job satisfaction, preparedness and deployment experiences of serving members. PMID:26567321

Associative list processing unit

DOEpatents

Hemmert, Karl Scott; Underwood, Keith D.

2013-01-29

An associative list processing unit and method comprising employing a plurality of prioritized cell blocks and permitting inserts to occur in a single clock cycle if all of the cell blocks are not full. Also, an associative list processing unit and method comprising employing a plurality of prioritized cell blocks and using a tree of prioritized multiplexers descending from the plurality of cell blocks.

Situational and dispositional influences on nurses' workplace well-being: the role of empowering unit leadership.

PubMed

Spence Laschinger, Heather K; Finegan, Joan; Wilk, Piotr

2011-01-01

Unit-level leadership and structural empowerment play key roles in creating healthy work environments, yet few researchers have examined these contextual effects on nurses' well-being. The aim of this study was to test a multilevel model of structural empowerment examining the effect of nursing unit leadership quality and structural empowerment on nurses' experiences of burnout and job satisfaction and to examine the effect of a personal dispositional variable, core self-evaluation, on these nurse experiences. Nurses (n = 3,156) from 217 hospital units returned surveys that included measures of leader-member exchange, structural empowerment, burnout, core self-evaluation, and job satisfaction. Multilevel structural equation modeling was used to test the model. Nurses' shared perceptions of leader-member exchange quality on their units positively influenced their shared perceptions of unit structural empowerment (Level 2), which resulted in significantly higher levels of individual nurse job satisfaction (Level 1). Unit-level leader-member exchange quality also directly influenced individual nurse job satisfaction. Unit leader-member exchange quality and structural empowerment influenced emotional exhaustion and cynicism differentially. Higher unit-level leader-member exchange quality was associated with lower cynicism; higher unit-level structural empowerment was associated with lower emotional exhaustion. At Level 1, higher core self-evaluation was associated with lower levels of both emotional exhaustion and cynicism, both of which were associated with lower job satisfaction. This study provides a theoretical understanding of how unit leadership affects both unit- and individual-level outcomes.

Associations between adherence to the Danish Food-Based Dietary Guidelines and cardiometabolic risk factors in a Danish adult population: the DIPI study.

PubMed

Arentoft, Johanne L; Hoppe, Camilla; Andersen, Elisabeth W; Overvad, Kim; Tetens, Inge

2018-03-01

Diet is recognised as one modifiable lifestyle factor for ischaemic heart disease (IHD). We aimed at investigating the associations between adherence to the Danish Food-Based Dietary Guidelines (FBDG) indicated by a Dietary Quality Index (DQI) and selected cardiometabolic risk factors in a cross-sectional study with 219 Danish adult participants (59 %women; age 31-65years) with a minimum of one self-rated risk marker of IHD. Information regarding diet was obtained using web-based dietary assessment software and adherence to the Danish FBDG was expressed by a DQI calculated from 5 food and nutrient indicators (whole grain, fish, fruit and vegetables, energy from saturated fat and from added sugar). Background information, blood samples and anthropometrics were collected and blood pressure was measured. Linear regression analyses were used to evaluate the association between DQI and cardiometabolic risk factors. DQI was inversely associated with LDL:HDL ratio and TAG (-0·089 per unit; 95 % CI -0·177, -0·002 and -5 % per unit; 95 % CI -9, 0, respectively) and positively associated with HDL-cholesterol (0·047 mmol/l per unit; 95 % CI 0·007, 0·088). For men, DQI was inversely associated with BMI (-3 %per unit; 95 % CI -5, -1), trunk fat (-1 % per unit; 95 % CI -2, -1), high-sensitivity C-reactive protein (-30 % per unit; 95 % CI -41, -16 %), HbA1c (-0·09 % per unit; 95 % CI -0·14, -0·04), insulin (-13 % per unit; 95 % CI -19, -7) and homoeostatic model assessment-insulin resistance (-14 % per unit; 95 % CI -21, -7). In women, DQI was positively associated with systolic blood pressure (2·6 mmHg per unit; 95 % CI 0·6, 4·6). In conclusion, higher adherence to the current Danish FBDG was associated with a more beneficial cardiometabolic risk profile in a Danish adult population with a minimum of one self-rated risk factor for IHD.

Electrophysiological Correlates of Familiarity and Recollection in Associative Recognition: Contributions of Perceptual and Conceptual Processing to Unitization

PubMed Central

Li, Bingcan; Mao, Xinrui; Wang, Yujuan; Guo, Chunyan

2017-01-01

It is generally accepted that associative recognition memory is supported by recollection. In addition, recent research indicates that familiarity can support associative memory, especially when two items are unitized into a single item. Both perceptual and conceptual manipulations can be used to unitize items, but few studies have compared these two methods of unitization directly. In the present study, we investigated the effects of familiarity and recollection on successful retrieval of items that were unitized perceptually or conceptually. Participants were instructed to remember either a Chinese two-character compound or unrelated word-pairs, which were presented simultaneously or sequentially. Participants were then asked to recognize whether word-pairs were intact or rearranged. Event-related potential (ERP) recordings were performed during the recognition phase of the study. Two-character compounds were better discriminated than unrelated word-pairs and simultaneous presentation was found to elicit better discrimination than sequential presentation for unrelated word-pairs only. ERP recordings indicated that the early intact/rearranged effects (FN400), typically associated with familiarity, were elicited in compound word-pairs with both simultaneous and sequential presentation, and in simultaneously presented unrelated word-pairs, but not in sequentially presented unrelated word-pairs. In contrast, the late positive complex (LPC) effects associated with recollection were elicited in all four conditions. Together, these results indicate that while the engagement of familiarity in associative recognition is affected by both perceptual and conceptual unitization, conceptual unitization promotes a higher level of unitization (LOU). In addition, the engagement of recollection was not affected by unitized manipulations. It should be noted, however, that due to experimental design, the effects presented here may be due to semantic rather than episodic memory and future studies should take this into consideration when manipulating rearranged pairs. PMID:28400723

Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians.

PubMed

Ramos, João Gabriel Rosa; Passos, Rogerio da Hora; Baptista, Paulo Benigno Pena; Forte, Daniel Neves

2017-01-01

To evaluate the factors potentially associated with the decision of admission to the intensive care unit in Brazil. An electronic survey of Brazilian physicians working in intensive care units. Fourteen variables that were potentially associated with the decision of admission to the intensive care unit were rated as important (from 1 to 5) by the respondents and were later grouped as "patient-related," "scarcity-related" and "administrative-related" factors. The workplace and physician characteristics were evaluated for correlation with the factor ratings. During the study period, 125 physicians completed the survey. The scores on patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors, with a mean ± SD of 3.42 ± 0.7, 2.75 ± 0.7 and 2.87 ± 0.7, respectively (p < 0.001). The patient's underlying illness prognosis was rated by 64.5% of the physicians as always or frequently affecting decisions, followed by acute illness prognosis (57%), number of intensive care unit beds available (56%) and patient's wishes (53%). After controlling for confounders, receiving specific training on intensive care unit triage was associated with higher ratings of the patient-related factors and scarcity-related factors, while working in a public intensive care unit (as opposed to a private intensive care unit) was associated with higher ratings of the scarcity-related factors. Patient-related factors were more frequently rated as potentially affecting intensive care unit admission decisions than scarcity-related or administrative-related factors. Physician and workplace characteristics were associated with different factor ratings.

Factors potentially associated with the decision of admission to the intensive care unit in a middle-income country: a survey of Brazilian physicians

PubMed Central

Ramos, João Gabriel Rosa; Passos, Rogerio da Hora; Baptista, Paulo Benigno Pena; Forte, Daniel Neves

2017-01-01

Objective To evaluate the factors potentially associated with the decision of admission to the intensive care unit in Brazil. Methods An electronic survey of Brazilian physicians working in intensive care units. Fourteen variables that were potentially associated with the decision of admission to the intensive care unit were rated as important (from 1 to 5) by the respondents and were later grouped as "patient-related," "scarcity-related" and "administrative-related" factors. The workplace and physician characteristics were evaluated for correlation with the factor ratings. Results During the study period, 125 physicians completed the survey. The scores on patient-related factors were rated higher on their potential to affect decisions than scarcity-related or administrative-related factors, with a mean ± SD of 3.42 ± 0.7, 2.75 ± 0.7 and 2.87 ± 0.7, respectively (p < 0.001). The patient's underlying illness prognosis was rated by 64.5% of the physicians as always or frequently affecting decisions, followed by acute illness prognosis (57%), number of intensive care unit beds available (56%) and patient's wishes (53%). After controlling for confounders, receiving specific training on intensive care unit triage was associated with higher ratings of the patient-related factors and scarcity-related factors, while working in a public intensive care unit (as opposed to a private intensive care unit) was associated with higher ratings of the scarcity-related factors. Conclusions Patient-related factors were more frequently rated as potentially affecting intensive care unit admission decisions than scarcity-related or administrative-related factors. Physician and workplace characteristics were associated with different factor ratings. PMID:28977256

The Association of Workplace Social Capital With Work Engagement of Employees in Health Care Settings: A Multilevel Cross-Sectional Analysis.

PubMed

Fujita, Sumiko; Kawakami, Norito; Ando, Emiko; Inoue, Akiomi; Tsuno, Kanami; Kurioka, Sumiko; Kawachi, Ichiro

2016-03-01

The aim of the study was to examine the cross-sectional multilevel association between unit-level workplace social capital and individual-level work engagement among employees in health care settings. The data were collected from employees of a Japanese health care corporation using a questionnaire. The analyses were limited to 440 respondents from 35 units comprising five or more respondents per unit. Unit-level workplace social capital was calculated as an average score of the Workplace Social Capital Scale for each unit. Multilevel regression analysis with a random intercept model was conducted. After adjusting for demographic variables, unit-level workplace social capital was significantly and positively associated with respondents' work engagement (P < 0.001). The association remained significant after additionally adjusting for individual-level perceptions of workplace social capital (P < 0.001). Workplace social capital might exert a positive contextual effect on work engagement of employees in health care settings.

Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives

PubMed Central

Meddings, Jennifer; Reichert, Heidi; Greene, M Todd; Safdar, Nasia; Krein, Sarah L; Olmsted, Russell N; Watson, Sam R; Edson, Barbara; Albert Lesher, Mariana; Saint, Sanjay

2017-01-01

Background The Agency for Healthcare Research and Quality (AHRQ) has funded national collaboratives using the Comprehensive Unit-based Safety Program to reduce rates of two catheter-associated infections—central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI), using evidence-based intervention bundles to improve technical aspects of care and socioadaptive approaches to foster a culture of safety. Objective Examine the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates. Methods We analysed data from two prospective cohort studies from acute-care intensive care units (ICUs) and non-ICUs participating in the AHRQ CLABSI and CAUTI collaboratives. National Healthcare Safety Network catheter-associated infections per 1000 catheter-days were collected at baseline and quarterly postimplementation. The HSOPS was collected at baseline and again 1 year later. Infection rates were modelled using multilevel negative binomial models as a function of HSOPS components over time, adjusted for hospital-level characteristics. Results 1821 units from 1079 hospitals (CLABSI) and 1576 units from 949 hospitals (CAUTI) were included. Among responding units, infection rates declined over the project periods (by 47% for CLABSI, by 23% for CAUTI, unadjusted). No significant associations were found between CLABSI or CAUTI rates and HSOPS measures at baseline or over time. Conclusions We found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of CLABSI and CAUTI. These results suggest that it may be possible to improve CLABSI and CAUTI rates without making significant changes in safety culture, particularly as measured by instruments like HSOPS. PMID:27222593

Urinary NGAL in patients with and without acute kidney injury in a cardiology intensive care unit

PubMed Central

Watanabe, Mirian; Silva, Gabriela Fulan e; da Fonseca, Cassiane Dezoti; Vattimo, Maria de Fatima Fernandes

2014-01-01

Objective To assess the diagnostic and prognostic efficacy of urine neutrophil gelatinase-associated lipocalin in patients admitted to an intensive care unit. Methods Longitudinal, prospective cohort study conducted in a cardiology intensive care unit. The participants were divided into groups with and without acute kidney injury and were followed from admission to the intensive care unit until hospital discharge or death. Serum creatinine, urine output and urine neutrophil gelatinase-associated lipocalin were measured 24 and 48 hours after admission. Results A total of 83 patients admitted to the intensive care unit for clinical reasons were assessed, most being male (57.8%). The participants were divided into groups without acute kidney injury (N=18), with acute kidney injury (N=28) and with severe acute kidney injury (N=37). Chronic diseases, mechanical ventilation and renal replacement therapy were more common in the groups with acute kidney injury and severe acute kidney injury, and those groups exhibited longer intensive care unit stay and hospital stay and higher mortality. Serum creatinine did not change significantly in the group with acute kidney injury within the first 24 hours of admission to the intensive care unit, although, urine neutrophil gelatinase-associated lipocalin was high in the groups with acute kidney injury and severe acute kidney injury (p<0.001). Increased urine neutrophil gelatinase-associated lipocalin was associated with death. Conclusion An increase in urine neutrophil gelatinase-associated lipocalin precedes variations in serum creatinine in patients with acute kidney injury and may be associated with death. PMID:25607262

Within-unit relationship quality mediates the association between military sexual trauma and posttraumatic stress symptoms in veterans separating from military service.

PubMed

Laws, Holly; Mazure, Carolyn M; McKee, Sherry A; Park, Crystal L; Hoff, Rani

2016-09-01

Few studies have examined the impact of military sexual trauma (MST) on social functioning during deployment. Yet consideration of unit relationships during deployment may be important, given that military unit cohesion and support can provide protective effects against the stress of combat, and reduce the likelihood of developing posttraumatic stress disorder. Although prior research has posited that depleted social resources are one pathway through which MST is associated with posttraumatic stress symptoms (PTSS), no studies have statistically tested this theory. This study examined the association of MST and PTSS and evaluated the potential mediating role of decreased unit relationship quality. Mediational analyses were conducted on a sample of veterans following discharge from military service (N = 818; 328 women, 490 men). Women were significantly more likely to experience MST than men. As hypothesized, experiences of MST during deployment were associated with higher PTSS. MST experiences were associated with less trust in and support from one's military unit, which partially mediated the association between MST and PTSS. The indirect effect of MST on PTSS through lower unit relationship quality accounted for 20.4% of the total effect of MST on PTSS. While the retrospective study design precludes tests of causality, mediational findings provided statistical evidence that lower unit relationship quality partially explains the association between MST and PTSS. This finding is consistent with interpersonal theories of trauma response suggesting that the deleterious effects of MST may be in part due to its erosion of social resources during deployment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Improving associative memory in older adults with unitization.

PubMed

Ahmad, Fahad N; Fernandes, Myra; Hockley, William E

2015-01-01

We examined if unitization inherent preexperimentally could reduce the associative deficit in older adults. In Experiment 1, younger and older adults studied compound word (CW; e.g., store keeper) and noncompound word (NCW; e.g., needle birth) pairs. We found a reduction in the age-related associative deficit such that older but not younger adults showed a discrimination advantage for CW relative to NCW pairs on a yes-no associative recognition test. These results suggest that CW compared to NCW word pairs provide schematic support that older adults can use to improve their memory. In Experiment 2, reducing study time in younger adults decreased associative recognition performance, but did not produce a discrimination advantage for CW pairs. In Experiment 3, both older and younger adults showed a discrimination advantage for CW pairs on a two-alternative forced-choice recognition test, which encourages greater use of familiarity. These results suggest that test format influenced young adults' use of familiarity during associative recognition of unitized pairs, and that older adults rely more on familiarity than recollection for associative recognition. Unitization of preexperimental associations, as in CW pairs, can alleviate age-related associative deficits.

The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units.

PubMed

Baernholdt, Marianne; Mark, Barbara A

2009-12-01

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

Factors associated with low unit cohesion in Australian Defence Force members who deployed to the Middle East (2001-2009).

PubMed

Kanesarajah, Jeeva; Waller, M; Zheng, W Y; Dobson, A J

2016-10-01

Unit cohesion has been shown to bolster the mental health of military personnel; hence, it is important to identify the characteristics that are associated with low unit cohesion, so that interventions to improve unit cohesion can be targeted and implemented. Little is known about the factors associated with low unit cohesion. This research aims to identify demographic, military service and deployment factors associated with low unit cohesion. Data from a self-reported cross-sectional study of 11 411 current or ex-serving Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009 were used. Multivariable logistic regression was used to investigate the research aims. Being female (adjusted OR (aOR) (95% CI) 1.35 (1.21 to 1.51)), non-commissioned officer (aOR (95% CI) 1.50 (1.39 to 1.62)), lower ranked (aOR (95% CI) 1.74 (1.51 to 2.01)) or having left military service (aOR (95% CI) 1.71 (1.46 to 2.02)) was associated with reporting low unit cohesion. Potentially modifiable factors such as performing logistic roles on deployment (aOR (95% CI) 1.13 (1.01 to 1.27)), dissatisfaction with work experience on deployment such as working with colleagues who did not do what was expected of them (aOR (95% CI) 4.09 (3.61 to 4.64)), and major problems at home while deployed (aOR (95% CI) 1.50 (1.38 to 1.63)) were also associated with reporting low unit cohesion. This is the first study to identify demographic, military service and deployment factors associated with low unit cohesion. The modifiable nature of unit cohesion means that military leaders could use this information to identify subgroups for targeted resilience interventions that may reduce vulnerabilities to mental health problems and improve the job satisfaction, preparedness and deployment experiences of serving members. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Pre-Intensive Care Unit Cognitive Status, Subsequent Disability, and New Nursing Home Admission among Critically Ill Older Adults.

PubMed

Ferrante, Lauren E; Murphy, Terrence E; Gahbauer, Evelyne A; Leo-Summers, Linda S; Pisani, Margaret A; Gill, Thomas M

2018-05-01

Cognitive impairment is common among older adults, yet little is known about the association of pre-intensive care unit cognitive status with outcomes relevant to older adults maintaining independence after a critical illness. To evaluate whether pre-intensive care unit cognitive status is associated with post-intensive care unit disability, new nursing home admission, and mortality after a critical illness among older adults. In this prospective cohort study, 754 persons aged 70 years or more were monitored from March 1998 to December 2013 with monthly assessments of disability. Cognitive status was assessed every 18 months, using the Mini-Mental State Examination (range, 0-30), with scores classified as 28 or higher (cognitively intact), 24-27 (minimal impairment), and less than 24 (moderate impairment). The primary outcome was disability count (range, 0-13), assessed monthly over 6 months after an intensive care unit stay. The secondary outcomes were incident nursing home admission and time to death after intensive care unit admission. The analytic sample included 391 intensive care unit admissions. The mean age was 83.5 years. The prevalence of moderate impairment, minimal impairment, and intact cognition (the comparison group) was 17.3, 46.2, and 36.5%, respectively. In the multivariable analysis, moderate impairment was associated with nearly a 20% increase in disability over the 6-month follow-up period (adjusted relative risk, 1.19; 95% confidence interval, 1.04-1.36), and minimal impairment was associated with a 16% increase in post-intensive care unit disability (adjusted relative risk, 1.16; 95% confidence interval, 1.02-1.32). Moderate impairment was associated with more than double the likelihood of a new nursing home admission (adjusted odds ratio, 2.37; 95% confidence interval, 1.01-5.55). Survival differed significantly across the three cognitive groups (log-rank P = 0.002), but neither moderate impairment (adjusted hazard ratio, 1.19; 95% confidence interval, 0.65-2.19) nor minimal impairment (adjusted hazard ratio, 1.00; 95% confidence interval, 0.61-1.62) was significantly associated with mortality in the multivariable analysis. Among older adults, any impairment (even minimal) in pre-intensive care unit cognitive status was associated with an increase in post-intensive care unit disability over the 6 months after a critical illness; moderate cognitive impairment doubled the likelihood of a new nursing home admission. Pre-intensive care unit cognitive impairment was not associated with mortality from intensive care unit admission through 6 months of follow-up. Pre-intensive care unit cognitive status may provide prognostic information about the likelihood of older adults maintaining independence after a critical illness.

Severe and fatal obstetric injury claims in relation to labor unit volume.

PubMed

Milland, Maria; Mikkelsen, Kim L; Christoffersen, Jens K; Hedegaard, Morten

2015-05-01

To assess possible association between the incidence of approved claims for severe and fatal obstetric injuries and delivery volume in Denmark. A nationwide panel study of labor units. Claimants seeking financial compensation due to injuries occurring in labor units in 1995-2012. Exposure information regarding the annual number of deliveries per labor unit was retrieved from the Danish National Birth Register. Outcome information was retrieved from the Danish Patient Compensation Association. Exposure was categorized in delivery volume quintiles as annual volume per labor unit: (10-1377), (1378-2016), (2017-2801), (2802-3861), (3862-6659). Five primary measures of outcome were used. Incidence rate ratios of (A) Submitted claims, (B) Approved claims, (C) Approved severe injury claims (120% degree of disability), (D) Approved fatal injury claims, and (C+D) Combined. 1 151 734 deliveries in 51 labor units and 1872 submitted claims were included. The incidence rate ratios of approved claims overall, of approved fatal injury claims, and of approved severe and fatal injuries combined increased significantly with decreasing annual delivery volume. Face value incidence rate ratios of approved severe injuries increased with decreasing labor unit volume, but the association did not reach statistical significance. High volume labor units appear associated with fewer approved and fewer fatal injury claims compared with units with less volume. The findings support the development towards consolidation of units in Denmark. A suggested option would be to tailor obstetric patient safety initiatives according to the delivery volume of individual labor units. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Rapanos v. United States & Carabell v. United States

EPA Pesticide Factsheets

Documents associated with guidance for implementing the definition of waters of the United States under the Clean Water Act following the Rapanos v. United States, and Carabell v. United States Supreme Court decision.

Prevalence and factors associated with breast milk donation in banks that receive human milk in primary health care units.

PubMed

Meneses, Tatiana Mota Xavier de; Oliveira, Maria Inês Couto de; Boccolini, Cristiano Siqueira

To estimate the prevalence and to analyze factors associated with breast milk donation at primary health care units in order to increase the human milk bank reserves. Cross-sectional study carried out in 2013 in Rio de Janeiro, Brazil. A representative sample of 695 mothers of children younger than 1 year attended to at the nine primary health care units with human milk donation services were interviewed. A hierarchical approach was used to obtain adjusted prevalence ratios (APR) by Poisson regression with robust variance. The final model included the variables associated with breast milk donation (p≤0.05). 7.3% of the mothers had donated breast milk. Having been encouraged to donate breast milk by healthcare professionals, relatives, or friends (APR=7.06), receiving information on breast milk expression by the primary health care unit (APR=3.65), and receiving help from the unit professionals to breastfeed (APR=2.24) were associated with a higher prevalence of donation. Admission of the newborn to the neonatal unit was associated with a lower prevalence of donation (APR=0.09). Encouragement to breast milk donation, and information and help provided by primary health care unit professionals to breastfeeding were shown to be important for the practice of human milk donation. Copyright © 2017. Published by Elsevier Editora Ltda.

Is acculturation always adverse to Korean immigrant health in the United States?

PubMed

Ra, Chaelin Karen; Cho, Youngtae; Hummer, Robert A

2013-06-01

This study examined the association between individuals' proportion of life spent in the United States and the health status and health behaviors among Korean immigrants aged 25 and above. The analysis is stratified by level of education to test whether a higher proportion of time spent in the United States is associated with poorer health among both less educated and highly educated Korean immigrants. California health interview survey data from 2005 to 2007 were used to estimate logistic regression models of health and health behaviour among Korean immigrants, stratified by educational attainment. The health and health behaviour of less educated Korean immigrants tended to be worse among those with a higher proportion of residence in the United States. However, more highly educated Korean immigrants tended to exhibit lower odds of being unhealthy and lower odds of poor health behavior with a higher proportion of life spent in the United States. Acculturation is not always associated with poorer immigrant health outcomes. A higher proportion of life spent in the United States tends to be associated with more favorable health and health behavior among highly educated Korean immigrants.

A longitudinal analysis of nursing specialty certification by Magnet® status and patient unit type.

PubMed

Boyle, Diane K; Gajewski, Byron J; Miller, Peggy A

2012-12-01

The objective of this study was to examine nursing specialty certification trends by Magnet® status and unit type. Research exploring organizational and unit attributes associated with higher specialty certification rates is timely given the beginning evidence that certification is associated with lower patient adverse events. The sample included 6047 units in 1249 National Database of Nursing Quality Indicators hospitals. Hierarchical linear modeling was used to predict growth in percentage of specialty-certified RNs within each unit type and Magnet status. Data (Bayesian Information Criteria = 224 583.30) demonstrated significant growth in specialty certification rates over time (P < .0001). Magnet-designated organizations had significantly different starting certification rates (P = .0002) and rates of change (P = .0002). Unit types also had significantly different starting certification rates (P < .0001) and different rates of change (P < .0001). Magnet recognition is associated with increases in specialty certification rates. Certification rates have risen faster in unit types such as pediatric critical care than in unit types such as adult step-down and adult surgical.

Specialized stroke services: a meta-analysis comparing three models of care.

PubMed

Foley, Norine; Salter, Katherine; Teasell, Robert

2007-01-01

Using previously published data, the purpose of this study was to identify and discriminate between three different forms of inpatient stroke care based on timing and duration of treatment and to compare the results of clinically important outcomes. Randomized controlled trials, including a recent review of inpatient stroke unit/rehabilitation care, were identified and grouped into three models of care as follows: (a) acute stroke unit care (patients admitted within 36 h of stroke onset and remaining for up to 2 weeks; n = 5), (b) units combining acute and rehabilitative care (combined; n = 4), and (c) rehabilitation units where patients were transferred onto the service approximately 2 weeks following stroke (post-acute; n = 5). Pooled analyses for the outcomes of mortality, combined death and dependency and length of hospital stay were calculated for each model of care, compared to conventional care. All three models of care were associated with significant reductions in the odds of combined death and dependency; however, acute stroke units were not associated with significant reductions in mortality when this outcome was analyzed separately (OR 0.80; 95% CI: 0.61-1.03). Post-acute stroke units were associated with the greatest reduction in the odds of mortality (OR 0.60; 95% CI: 0.44-0.81). Significant reductions in length of hospital stay were associated with combined stroke units only (weighted mean difference -14 days; 95% CI: -27 to -2). Overall, specialized stroke services were associated with significant reductions in mortality, death and dependency and length of hospital stay although not every model of care was associated with equal benefit.

Individual and work-unit measures of psychological demands and decision latitude and the use of antihypertensive medication.

PubMed

Daugaard, S; Andersen, J H; Grynderup, M B; Stokholm, Z A; Rugulies, R; Hansen, Å M; Kærgaard, A; Mikkelsen, S; Bonde, J P; Thomsen, J F; Christensen, K L; Kolstad, H A

2015-04-01

To analyse whether psychological demands and decision latitude measured on individual and work-unit level were related to prescription of antihypertensive medication. A total of 3,421 women and 897 men within 388 small work units completed a questionnaire concerning psychological working conditions according to the job strain model. Mean levels of psychological demands and decision latitude were computed for each work unit to obtain exposure measures that were less influenced by reporting bias. Dispensed antihypertensive medication prescriptions were identified in The Danish National Prescription Registry. Odds ratios (OR) comparing the highest and lowest third of the population at individual and work-unit level, respectively, were estimated by multilevel logistic regression adjusted for confounders. Psychological demands and decision latitude were tested for interaction. Supplementary analyses of 21 months follow-up were conducted. Among women, increasing psychological demands at individual (adjusted OR 1.54; 95 % CI 1.02-2.33) and work-unit level (adjusted OR 1.41; 95 % CI 1.04-1.90) was significantly associated with purchase of antihypertensive medication. No significant association was found for decision latitude. Follow-up results supported an association with psychological demands but they were not significant. All results for men showed no association. Psychological demands and decision latitude did not interact. High psychological work demands were associated with the purchase of prescribed antihypertensive medication among women. This effect was present on both the work-unit and the individual level. Among men there were no associations. The lack of interaction between psychological demands and decision latitude did not support the job strain model.

Babies born before arrival to hospital and maternity unit closures in Queensland and Australia.

PubMed

Kildea, Sue; McGhie, Alexandra C; Gao, Yu; Rumbold, Alice; Rolfe, Margaret

2015-09-01

Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively correlated with the number of maternity units in Australia, r=-0.804, n=19 years, p<0.001 and Queensland, r=-0.906, n=19 years, p<0.001. The closure of maternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance.

PubMed

Wolfe, Jonathan D; Domenico, Henry J; Hickson, Gerald B; Wang, Deede; Dubree, Marilyn; Feistritzer, Nancye; Wells, Nancy; Talbot, Thomas R

2018-04-20

Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics. Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model. In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant. Uptake of an HH program was associated with factors related to a unit's safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.

Association between Pseudomonas aeruginosa positive water samples and healthcare-associated cases: nine-year study at one university hospital.

PubMed

Lefebvre, A; Bertrand, X; Quantin, C; Vanhems, P; Lucet, J-C; Nuemi, G; Astruc, K; Chavanet, P; Aho-Glélé, L S

2017-07-01

To study the association between the results of water samples and Pseudomonas aeruginosa healthcare-associated cases in a French university hospital. Generalized Estimating Equations were used on complete case and imputed datasets. The spatial unit was the building and the time unit was the quarter. For the period 2004-2013, 2932 water samples were studied; 17% were positive for P. aeruginosa. A higher incidence of P. aeruginosa cases was associated with a higher proportion of positive water samples (P=0.056 in complete case analysis and P=0.031 with the imputed dataset). The association was no longer observed when haematology and intensive care units were excluded, but was significant in analyses of data concerning intensive care units alone (P<0.001). This study suggests that water outlet contamination in hospitals can lead to an increase in healthcare-associated P. aeruginosa cases in wards dealing with susceptible patients, but does not play a significant role in other wards. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

FIRST EURADOS INTERCOMPARISON EXERCISE OF EYE LENS DOSEMETERS FOR MEDICAL APPLICATIONS.

PubMed

Clairand, I; Ginjaume, M; Vanhavere, F; Carinou, E; Daures, J; Denoziere, M; Silva, E H; Roig, M; Principi, S; Van Rycheghem, L

2016-09-01

In the context of the decrease in the eye lens dose limit for occupational exposure to 20 mSv per year stated by the recent revision of the European Basic Safety Standards Directive 2013/59/EURATOM, the European Radiation Dosimetry Group (EURADOS) has organised in 2014, for the first time, an intercomparison exercise for eye lens dosemeters. The main objective was to assess the capabilities of the passive eye lens dosemeters currently in use in Europe for occupational monitoring in medical fields. A total of 20 European individual monitoring services from 15 different countries have participated. The dosemeters provided by the participants were all composed of thermoluminescent detectors, of various types and designs. The irradiations were carried out with several photon fields chosen to cover the energy and angle ranges encountered in medical workplace. Participants were asked to report the doses in terms of Hp(3) using their routine protocol. The results provided by each participant were compared with the reference delivered doses. All the results were anonymously analysed. Results are globally satisfactory since, among the 20 participants, 17 were able to provide 90 % of their response in accordance with the ISO 14146 standard requirements. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Extracting physical quantities from BES data

NASA Astrophysics Data System (ADS)

Fox, Michael; Field, Anthony; Schekochihin, Alexander; van Wyk, Ferdinand; MAST Team

2015-11-01

We propose a method to extract the underlying physical properties of turbulence from measurements, thereby facilitating quantitative comparisons between theory and experiment. Beam Emission Spectroscopy (BES) diagnostics record fluctuating intensity time series, which are related to the density field in the plasma through Point-Spread Functions (PSFs). Assuming a suitable form for the correlation function of the underlying turbulence, analytical expressions are derived that relate the correlation parameters of the intensity field: the radial and poloidal correlation lengths and wavenumbers, the correlation time and the fluctuation amplitude, to the equivalent correlation properties of the density field. In many cases, the modification caused by the PSFs is substantial enough to change conclusions about physics. Our method is tested by applying PSFs to the ``real'' density field, generated by non-linear gyrokinetic simulations of MAST, to create synthetic turbulence data, from which the method successfully recovers the correlation function of the ``real'' density field. This method is applied to BES data from MAST to determine the scaling of the 2D structure of the ion-scale turbulence with equilibrium parameters, including the ExB flow shear. Work funded by the Euratom research and training programme 2014-2018 under grant agreement No 633053 and from the RCUK Energy Programme [grant number EP/I501045].

Design of a phase contrast imaging diagnostic for the Wendelstein 7-X stellarator

NASA Astrophysics Data System (ADS)

Edlund, E. M.; Porkolab, M.; Grulke, O.; Böttger, L.-G.; Sehren, C.

2016-10-01

The Wendelstein 7-X stellarator at IPP Greifswald commenced operation in 2015, and while its design has been aimed at minimizing neoclassical transport, turbulent transport is expected to be strongly affected by the magnetic geometry. With this in mind, MIT and IPP-Greifswald scientists have undertaken a project to design and implement a phase contrast imaging (PCI) diagnostic to measure turbulence in W7-X in the OP1.2 operating phase starting in 2017. The principle and design aspects of the PCI method have been described in numerous past publications. In W7-X the PCI system will have two imaging systems differing only in the angle of the spatial mask that selects for magnetic pitch angle, and will produce measurements of poloidal and radial correlations. A series of remotely controllable optics will allow the beam size and image magnification to be adjustable. We expect sensitivity to fluctuations in the range of 2 kHz to approximately 2 MHz and wavenumbers in the range of 1 cm-1 to 30 cm-1 which should allow us to detect ITG, TEM and possibly ETG turbulence. The MIT portion of this project is supported by the US DOE under Grant DE-SC0014229, and the IPP part is funded under Euratom Grant agreement No 633053.

Synthetic reconstruction of recycling on the limiter during startup phase of W7-X based on EMC3-EIRENE simulations

NASA Astrophysics Data System (ADS)

Frerichs, Heinke; Effenberg, Florian; Schmitz, Oliver; Stephey, Laurie; W7-X Team

2016-10-01

Interpretation of spectroscopic measurements in the edge region of high-temperature plasmas can be a challenge due to line of sight integration effects. The EMC3-EIRENE code - a 3D fluid edge plasma and kinetic neutral gas transport code - is a suitable tool for full 3D reconstruction of such signals. A versatile synthetic diagnostic module has been developed recently which allows the realistic three dimensional setup of various plasma edge diagnostics to be captured. We present an analysis of recycling on the inboard limiter of W7-X during its startup phase in terms of a synthetic camera for Hα light observations and reconstruct the particle flux from these synthetic images based on ionization per photon coefficients (S/XB). We find that line of sight integration effects can lead to misinterpretation of data (redistribution of particle flux due to neutral gas diffusion), and that local plasma effects are important for the correct treatment of photon emissions. This work was supported by the U.S. Department of Energy (DOE) under Grant DE-SC0014210, by startup funds of the Department of Engineering Physics at the University of Wisconsin - Madison, and by the EUROfusion Consortium under Euratom Grant No 633053.

New PANDA Tests to Investigate Effects of Light Gases on Passive Safety Systems

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

Paladino, D.; Auban, O.; Candreia, P.

The large- scale thermal-hydraulic PANDA facility (located at PSI in Switzerland), has been used over the last few years for investigating different passive decay- heat removal systems and containment phenomena for the next generation of light water reactors (Simplified Boiling Water Reactor: SBWR; European Simplified Boiling Water Reactor: ESBWR; Siedewasserreaktor: SWR-1000). Currently, as part of the European Commission 5. EURATOM Framework Programme project 'Testing and Enhanced Modelling of Passive Evolutionary Systems Technology for Containment Cooling' (TEMPEST), a new series of tests is being planned in the PANDA facility to experimentally investigate the distribution of non-condensable gases inside the containment andmore » their effect on the performance of the 'Passive Containment Cooling System' (PCCS). Hydrogen release caused by the metal-water reaction in the case of a postulated severe accident will be simulated in PANDA by injecting helium into the reactor pressure vessel. In order to provide suitable data for Computational Fluid Dynamic (CFD) code assessment and improvement, the instrumentation in PANDA has been upgraded for the new tests. In the present paper, a detailed discussion is given of the new PANDA tests to be performed to investigate the effects of light gas on passive safety systems. The tests are scheduled for the first half of the year 2002. (authors)« less

IFMIF: overview of the validation activities

NASA Astrophysics Data System (ADS)

Knaster, J.; Arbeiter, F.; Cara, P.; Favuzza, P.; Furukawa, T.; Groeschel, F.; Heidinger, R.; Ibarra, A.; Matsumoto, H.; Mosnier, A.; Serizawa, H.; Sugimoto, M.; Suzuki, H.; Wakai, E.

2013-11-01

The Engineering Validation and Engineering Design Activities (EVEDA) for the International Fusion Materials Irradiation Facility (IFMIF), an international collaboration under the Broader Approach Agreement between Japan Government and EURATOM, aims at allowing a rapid construction phase of IFMIF in due time with an understanding of the cost involved. The three main facilities of IFMIF (1) the Accelerator Facility, (2) the Target Facility and (3) the Test Facility are the subject of validation activities that include the construction of either full scale prototypes or smartly devised scaled down facilities that will allow a straightforward extrapolation to IFMIF needs. By July 2013, the engineering design activities of IFMIF matured with the delivery of an Intermediate IFMIF Engineering Design Report (IIEDR) supported by experimental results. The installation of a Linac of 1.125 MW (125 mA and 9 MeV) of deuterons started in March 2013 in Rokkasho (Japan). The world's largest liquid Li test loop is running in Oarai (Japan) with an ambitious experimental programme for the years ahead. A full scale high flux test module that will house ∼1000 small specimens developed jointly in Europe and Japan for the Fusion programme has been constructed by KIT (Karlsruhe) together with its He gas cooling loop. A full scale medium flux test module to carry out on-line creep measurement has been validated by CRPP (Villigen).

Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France.

PubMed

Pilkington, Hugo; Blondel, Béatrice; Drewniak, Nicolas; Zeitlin, Jennifer

2014-12-01

The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001-08 by distance from mother's municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5-45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

Ventilator-associated pneumonia improvement program.

PubMed

Murray, Theresa; Goodyear-Bruch, Caryl

2007-01-01

Ventilator-associated pneumonia (VAP) is a significant clinical problem associated with increased intensive care unit and hospital length of stay and substantial increases in delivery cost and associated morbidity and mortality. With system changes and management of the environment of care, the incidence of VAP was reduced in seven of our intensive care units across the system. Steps necessary to reduce VAP were identified and put into place in all the intensive care units. Patient positioning, oral care, nutrition, and management of comfort drugs are a few of the processes addressed to reduce VAP. Standardization of these essential care practices can reduce the incidence of this nosocomial infection and its associated increases in the cost of care delivery and mortality.

The Association between Exposure to "Tips" and Smoking-Related Outcomes among Adolescents in the United States

ERIC Educational Resources Information Center

Zhao, Xiaoquan; Cai, Xiaomei

2016-01-01

The Tips From Former Smokers ("Tips") campaign in the United States primarily targets adult smokers, but considers adolescents an important secondary audience. This study examines the association between exposure to Tips and smoking outcomes in the adolescent population in the United States. We analyzed data from the 2013 National Youth…

Associative list processing unit

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

Hemmert, Karl Scott; Underwood, Keith D

2014-04-01

An associative list processing unit and method comprising employing a plurality of prioritized cell blocks and permitting inserts to occur in a single clock cycle if all of the cell blocks are not full.

Associations between motor unit action potential parameters and surface EMG features.

PubMed

Del Vecchio, Alessandro; Negro, Francesco; Felici, Francesco; Farina, Dario

2017-10-01

The surface interference EMG signal provides some information on the neural drive to muscles. However, the association between neural drive to muscle and muscle activation has long been debated with controversial indications due to the unavailability of motor unit population data. In this study, we clarify the potential and limitations of interference EMG analysis to infer motor unit recruitment strategies with an experimental investigation of several concurrently active motor units and of the associated features of the surface EMG. For this purpose, we recorded high-density surface EMG signals during linearly increasing force contractions of the tibialis anterior muscle, up to 70% of maximal force. The recruitment threshold (RT), conduction velocity (MUCV), median frequency (MDF MU ), and amplitude (RMS MU ) of action potentials of 587 motor units from 13 individuals were assessed and associated with features of the interference EMG. MUCV was positively associated with RT ( R 2 = 0.64 ± 0.14), whereas MDF MU and RMS MU showed a weaker relation with RT ( R 2 = 0.11 ± 0.11 and 0.39 ± 0.24, respectively). Moreover, the changes in average conduction velocity estimated from the interference EMG predicted well the changes in MUCV ( R 2 = 0.71), with a strong association to ankle dorsiflexion force ( R 2 = 0.81 ± 0.12). Conversely, both the average EMG MDF and RMS were poorly associated with motor unit recruitment. These results clarify the limitations of EMG spectral and amplitude analysis in inferring the neural strategies of muscle control and indicate that, conversely, the average conduction velocity could provide relevant information on these strategies. NEW & NOTEWORTHY The surface EMG provides information on the neural drive to muscles. However, the associations between EMG features and neural drive have been long debated due to unavailability of motor unit population data. Here, by using novel highly accurate decomposition of the EMG, we related motor unit population behavior to a wide range of voluntary forces. The results fully clarify the potential and limitation of the surface EMG to provide estimates of the neural drive to muscles. Copyright © 2017 the American Physiological Society.

The Sexual Harassment-Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders.

PubMed

Griffith, James

2017-10-03

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group- or unit-level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company-sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one-third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross-leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed. © 2017 The American Association of Suicidology.

Central venous catheter-associated bloodstream infections in a pediatric intensive care unit: effect of the location of catheter insertion.

PubMed

Krishnaiah, Anil; Soothill, James; Wade, Angie; Mok, Quen Q; Ramnarayan, Padmanabhan

2012-05-01

To compare the rate of central venous catheter-associated bloodstream infections between pediatric intensive care unit admissions where central venous catheters were inserted within the same hospital (internal central venous catheters) and those where central venous catheters were inserted before transfer from other hospitals (external central venous catheters). Retrospective analysis of prospectively collected data. A tertiary care pediatric intensive care unit in London, UK. Consecutive pediatric intensive care unit admissions between May 2007 and March 2009. None. Catheter-associated bloodstream infections were identified using a widely accepted surveillance definition. The rate and time to occurrence of catheter-associated bloodstream infection were compared between internal and external nontunneled central venous catheters. A multilevel Cox-regression model was used to study the association between location of central venous catheter insertion and time to catheter-associated bloodstream infection. In total, 382 central venous catheters were studied (245 internal; 137 external) accounting for a total of 1,737 central venous catheter days. There was a higher catheter-associated bloodstream infection incidence density among external central venous catheters (23.1 [95% confidence interval 11.0-35.2] vs. 9.7 [95% confidence interval 3.9-15.5] per 1,000 catheter-days). Multivariable analyses demonstrated higher infection risk with external central venous catheters (hazard ratio 2.65 [95% confidence interval 1.18-5.96]) despite adjustment for confounding variables. The rate of catheter-associated bloodstream infections in the pediatric intensive care unit is significantly affected by external insertion of the central venous catheter. Future interventions to reduce nosocomial infections on pediatric intensive care units will need to be specifically targeted at this high-risk patient group.

Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions.

PubMed

Taylor, Jennifer A; Dominici, Francesca; Agnew, Jacqueline; Gerwin, Daniel; Morlock, Laura; Miller, Marlene R

2012-02-01

Safety climate and nurses' working conditions may have an impact on both patient outcomes and nurse occupational health, but these outcomes have rarely been examined concurrently. To examine the association of unit-level safety climate and specific nurse working conditions with injury outcomes for both nurses and patients in a single hospital. A cross-sectional study was conducted using nursing-unit level and individual-level data at an urban, level-one trauma centre in the USA. Multilevel logistic regressions were used to examine associations among injury outcomes, safety climate and working conditions on 29 nursing units, including a total of 723 nurses and 28 876 discharges. Safety climate was measured in 2004 using the Safety Attitudes Questionnaire (SAQ). Working conditions included registered nursing hours per patient day (RNHPPD) and unit turnover. Patient injuries included 290 falls, 167 pulmonary embolism/deep vein thrombosis (PE/DVT), and 105 decubitus ulcers. Nurse injury was defined as a reported needle-stick, splash, slip, trip, or fall (n=78). Working conditions and outcomes were measured in 2005. The study found a negative association between two SAQ domains, Safety and Teamwork, with the odds of both decubitus ulcers and nurse injury. RNHPPD showed a negative association with patient falls and decubitus ulcers. Unit turnover was positively associated with nurse injury and PE/DVT, but negatively associated with falls and decubitus ulcers. Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries.

Asthma in Adults Fact Sheet

MedlinePlus

... American Lung Association Epidemiology and Statistics Unit using SPSS software. Center for Disease Control and Prevention. Behavioral ... American Lung Association Epidemiology and Statistics Unit using SPSS software. Centers for Disease Control and Prevention. National ...

Associations of forest bird species richness with housing and landscape pattern across the United States

Treesearch

A. M. Pidgeon; V. C. Radeloff; C. H. Flather; C. A. Lepczyk; M. K. Clayton; T. J. Hawbaker; R. B. Hammer

2007-01-01

In the United States, housing density has substantially increased in and adjacent to forests. Our goal in this study was to identify how housing density and human populations are associated with avian diversity. We compared these associations to those between landscape pattern and avian diversity, and we examined how these associations vary across the conterminous...

Effect of Geography on the Analysis of Coccidioidomycosis-Associated Deaths, United States.

PubMed

Noble, Jason A; Nelson, Robert G; Fufaa, Gudeta D; Kang, Paul; Shafir, Shira Chani; Galgiani, John N

2016-10-01

Because coccidioidomycosis death rates vary by region, we reanalyzed coccidioidomycosis-associated mortality in the United States by race/ethnicity, then limited analysis to Arizona and California. Coccidioidomycosis-associated deaths were shown to increase among African-Americans but decrease among Native Americans and Hispanics. Separately, in a Native American cohort, diabetes co-varied with coccidioidomycosis-associated death.

Decreasing Catheter-Associated Urinary Tract Infections in the Neurological Intensive Care Unit: One Unit's Success.

PubMed

Richards, Brenda; Sebastian, Bindhu; Sullivan, Hillary; Reyes, Rosemarie; D'Agostino, John F; Hagerty, Thomas

2017-06-01

Catheter-associated urinary tract infections are preventable adverse outcomes that increase hospital morbidity, mortality, and costs. These infections are particularly prevalent in intensive care units. To describe the success of an 18-bed neurological intensive care unit in using several nurse-implemented strategies that reduced the number of catheter-associated urinary tract infections. A prospective, interventional design with application of evidence-based practices to reduce catheter-associated urinary tract infections was used. Before implementation of the strategies, 40 catheter-associated urinary tract infections were reported for 2012 and 38 for 2013. The standardized infection ratio was 2.04 for 2012 (95% CI, 1.456-2.775) and 2.34 (95% CI, 1.522-3.312) for 2013. After implementation of the strategies, significantly fewer catheter-associated urinary tract infections were reported. In 2014, a total of 15 infections were reported, and the standardized infection ratio was less than 1.0 (95% CI, 0.685-1.900). Application of current evidence-based practices resulted in a substantial decrease in the number of catheter-associated urinary tract infections and a lower standardized infection ratio. These findings support current recommendations for "bundling" to maximize outcomes. ©2017 American Association of Critical-Care Nurses.

The perplexing links between contraceptive sterilization and (dis)advantage in ten low-fertility countries.

PubMed

Eeckhaut, Mieke C W; Sweeney, Megan M

2016-01-01

This study investigated the association between contraceptive sterilization and socio-economic status (measured by educational attainment) in ten countries, using data from the 2006-10 National Survey of Family Growth and the 2004-10 Generations and Gender Surveys. The findings confirm that a long-standing association between socio-economic status and sterilization persists in the contemporary United States: female sterilization is associated with economic disadvantage, whereas male sterilization is associated with economic advantage. The latter association is found to be unique to the United States, but female sterilization is associated with disadvantage in most of the other countries studied. While basic demographic background factors such as early childbearing and parity can explain the observed associations in most of the countries, a strong gendered association between sterilization and socio-economic status remains in the United States and Belgium even after adjusting for these factors.

Associations of Special Care Units and Outcomes of Residents with Dementia: 2004 National Nursing Home Survey

ERIC Educational Resources Information Center

Luo, Huabin; Fang, Xiangming; Liao, Youlian; Elliott, Amanda; Zhang, Xinzhi

2010-01-01

Purpose: We compared the rates of specialized care for residents with Alzheimer's disease or dementia in special care units (SCUs) and other nursing home (NH) units and examined the associations of SCU residence with process of care and resident outcomes. Design and Methods: Data came from the 2004 National Nursing Home Survey. The indicators of…

Editor's Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function.

PubMed

Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni; De Maria, Elia; Fitzsimons, Donna; Halvorsen, Sigrun; Hassager, Christian; Iakobishvili, Zaza; Magdy, Ahmed; Marandi, Toomas; Mimoso, Jorge; Parkhomenko, Alexander; Price, Susana; Rokyta, Richard; Roubille, Francois; Serpytis, Pranas; Shimony, Avi; Stepinska, Janina; Tint, Diana; Trendafilova, Elina; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zima, Endre; Zukermann, Robert; Lettino, Maddalena

2018-02-01

Acute cardiovascular care has progressed considerably since the last position paper was published 10 years ago. It is now a well-defined, complex field with demanding multidisciplinary teamworking. The Acute Cardiovascular Care Association has provided this update of the 2005 position paper on acute cardiovascular care organisation, using a multinational working group. The patient population has changed, and intensive cardiovascular care units now manage a large range of conditions from those simply requiring specialised monitoring, to critical cardiovascular diseases with associated multi-organ failure. To describe better intensive cardiovascular care units case mix, acuity of care has been divided into three levels, and then defining intensive cardiovascular care unit functional organisation. For each level of intensive cardiovascular care unit, this document presents the aims of the units, the recommended management structure, the optimal number of staff, the need for specially trained cardiologists and cardiovascular nurses, the desired equipment and architecture, and the interaction with other departments in the hospital and other intensive cardiovascular care units in the region/area. This update emphasises cardiologist training, referring to the recently updated Acute Cardiovascular Care Association core curriculum on acute cardiovascular care. The training of nurses in acute cardiovascular care is additionally addressed. Intensive cardiovascular care unit expertise is not limited to within the unit's geographical boundaries, extending to different specialties and subspecialties of cardiology and other specialties in order to optimally manage the wide scope of acute cardiovascular conditions in frequently highly complex patients. This position paper therefore addresses the need for the inclusion of acute cardiac care and intensive cardiovascular care units within a hospital network, linking university medical centres, large community hospitals, and smaller hospitals with more limited capabilities.

Unit cohesion, traumatic exposure and mental health of military personnel.

PubMed

Kanesarajah, J; Waller, M; Zheng, W Y; Dobson, A J

2016-06-01

The benefit of military unit cohesion to morale and psychological resilience is well established. But it remains unclear whether unit cohesion modifies the association between deployment-related traumatic exposure and mental health problems. To examine the association between unit cohesion, traumatic exposure and poor mental health [symptoms of post-traumatic stress disorder (PTSD), psychological distress and alcohol dependency] and assess whether the relationship between traumatic exposure and poor mental health differs by level of unit cohesion. A self-reported cross-sectional survey of Australian military personnel deployed to Iraq or Afghanistan between 2001 and 2009. Among 11411 participants, those with low levels of unit cohesion had higher odds of PTSD symptoms [aOR (95% CI): 2.54 (1.88, 3.42)], very high psychological distress [aOR (95% CI): 4.28 (3.04, 6.02)] and a high level of alcohol problems [aOR (95% CI): 1.71 (1.32, 2.22)] compared with those reporting high unit cohesion on deployment. Higher exposure to traumatic events on deployment was associated with greater risk of PTSD symptoms, very high levels of psychological distress and high levels of alcohol problems in this cohort. However, there was no evidence of a statistically significant interaction between unit cohesion and traumatic exposures in influencing poor mental health. Our findings suggest that both unit cohesion and traumatic exposure are independently associated with poor mental health. Efforts to improve military unit cohesion may help to improve the mental health resilience of military personnel, regardless of their level of traumatic exposure. © The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study.

PubMed

Luckraz, Heyman; Manga, Na'ngono; Senanayake, Eshan L; Abdelaziz, Mahmoud; Gopal, Shameer; Charman, Susan C; Giri, Ramesh; Oppong, Raymond; Andronis, Lazaros

2018-05-01

Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.

Spatial Character Analysis of Streets as Public Spaces: The Case of Izmit Hurriyet and Cumhuriyet Street, Turkey

NASA Astrophysics Data System (ADS)

Özbayraktar, Mehtap; Pekdemir, Merve; Mırzaliyeva, Gumru

2017-10-01

The word “public” was first used to refer to the theatre audience in France in the mid-17th century. In the 18th century, it turned into the meaning of “public space incorporating a large variety of people and composed of acquaintances and strangers”. The concepts of publicity, public space, and public realm have been studied and described by many researchers in the course of time. These descriptions show the development of public space as well. In the very general sense, public spaces are areas of personal and social happiness; collective living spaces of the society; areas of expression of natural and cultural variety; and key elements providing a ground for the establishment of an identity. In the United Nations’ report on public spaces, public space is addressed under six groups: 1. The spaces we intensely used in our daily life; 2. Green open public spaces; 3. Public activity spaces which users can go in without any difficulty, are open to public, and are under protection; 4. Public sector realm (social agreements in which the people are represented, contribute to collective goods, and trust in the administrators elected); 5. City as a public space; 6. Cyberspace. As cities grow, public spaces transform and diversify. Attempts are made to meet the changing needs through types of space developed. However, the character of the existing public spaces, the distribution of open spaces and parks and their inadequacy, the destruction of public space, and the things that are required to be done stand as important issues to be addressed. One of the public spaces going through transformation are streets which we intensely use in our daily life. In general, streets are defined as roads with buildings on both sides in settlements such as provinces and districts whose boundaries are determined by neighbouring buildings. Some researchers have defined streets based on their social functions. According to them, streets are meeting spaces; spaces to deal with strangers; the house of the society; the main elements of urban existence; spaces as changeable as life; symbolic models of urban problems; and symbols of free city. However, the role of streets, which are so important in our daily life, has only been reduced to pass. They have been divided into two between pedestrians and vehicles and lost many social functions of theirs. Accordingly, the present study aims to answer the question of whether the abovementioned features and characters of streets as public spaces are still maintained with special reference to a street, which is one of the main streets of Izmit, Turkey. The street, which was called İmre Tökeli Avenue, Hamidiye Street (1908), and Demiryolu Tekeli Street (1948) in the course of time, is currently called Hürriyet and Cumhuriyet Street. The people also call it “walking road”. According to the sources, the history of this street is the history of Izmit as well. The past and present spatial character of the study area will be revealed through archive reviews, city development plants, face-to-face interviews, and surveys. Problems will be determined, and recommendations will be developed.

Distribution Grid Integration Unit Cost Database | Solar Research | NREL

Science.gov Websites

Unit Cost Database Distribution Grid Integration Unit Cost Database NREL's Distribution Grid Integration Unit Cost Database contains unit cost information for different components that may be used to associated with PV. It includes information from the California utility unit cost guides on traditional

Complex Social Structure of an Endangered Population of Bottlenose Dolphins (Tursiops truncatus) in the Aeolian Archipelago (Italy)

PubMed Central

Blasi, Monica F.; Boitani, Luigi

2014-01-01

We investigated social structure and association patterns for a small population of Mediterranean bottlenose dolphins, Tursiops truncatus, inhabiting the Aeolian Archipelago (southern Italy). Specifically we evaluate the role of sex and age composition, residency patterns and interaction with trammel nets on this social organization. Association data for 23 regularly sighted individuals were obtained from summer photoidentification surveys collected from 2005–2012. Using a combined cluster and social network analysis approach, we found associations between dolphins were hierarchically structured, where two mixed-sex social units were subdivided into smaller temporarily dynamic groups. We found non-random and long-term preferred associations in the population; however, the degree of social cohesion, residence pattern and interaction with trammel nets differed considerably between the two social units. Six of eight females occurred in the more resident social unit-1; in addition, social unit-1 individuals had significantly stronger associations, higher preferred associates, lived in larger groups and occurred less frequently with trammel nets. Nine of eleven males were clustered in social unit-2 and five of these males, interacting with trammel nets, formed small groups and preferred associations. We propose that female and male groups associate in the study area during the breeding season and that some males choose to interact with reproductive females forming a distinct but interrelated social unit. Other males may be associating in a larger fission-fusion network, which consists of dolphins that appear to temporarily join the network from the coastal population. We cannot exclude that some males specialized in trammel net foraging, suggesting that this foraging technique may favor a solitary lifestyle. Large group sizes and high degree of social cohesion for females could be an indication of greater protection and more efficiency in detecting, deterring or repelling anthropogenic pressures. Most likely dolphins' social organization depends on a combination of socio-ecological, demographic and anthropogenic factors. PMID:25494331

Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis: the CRIC study

PubMed Central

Bansal, Nisha; McCulloch, Charles E.; Rahman, Mahboob; Kusek, John W.; Anderson, Amanda H.; Xie, Dawei; Townsend, Raymond R.; Lora, Claudia M.; Wright, Jackson; Go, Alan S.; Ojo, Akinlolu; Alper, Arnold; Lustigova, Eva; Cuevas, Magda; Kallem, Radhakrishna; Hsu, Chi-yuan

2014-01-01

Studies of hemodialysis patients have shown a U-shaped association between systolic blood pressure (SBP) and mortality. These studies have largely relied on dialysis-unit SBP measures and have not evaluated whether this U-shape also exists in advanced chronic kidney disease (CKD), prior to starting hemodialysis. We determined the association between SBP and mortality at advanced CKD and again after initiation of hemodialysis. This was a prospective study of Chronic Renal Insufficiency Cohort (CRIC) participants with advanced CKD followed through initiation of hemodialysis. We studied the association between SBP and mortality when participants: 1) had an estimated glomerular filtration rate <30 ml/min/1.73m2 (N=1,705); 2) initiated hemodialysis and had dialysis-unit SBP measures (N=403) and; 3) initiated hemodialysis and had out-of-dialysis-unit SBP measured at a CRIC study visit (N=326). Cox models adjusted for demographics, cardiovascular risk factors and dialysis parameters. A quadratic term for SBP was included to test for a U-shaped association. At advanced CKD, there was no association between SBP and mortality (HR 1.02 [95% CI: 0.98–1.07] per every 10 mm Hg increase). Among participants who started hemodialysis, a U-shaped association between dialysis-unit SBP and mortality was observed. In contrast, there was a linear association between out-of-dialysis-unit SBP and mortality (HR 1.26 [95% CI: 1.14–1.40] per every 10 mm Hg increase). In conclusion, more efforts should be made to obtain out-of-dialysis-unit SBP which may merit more consideration as a target for clinical management and in interventional trials. PMID:25287404

Multiresistant Enterobacter cloacae outbreak in an intensive care unit associated with therapeutic beds

PubMed Central

van der Mee-Marquet, Nathalie; Girard, Sophie; Lagarrigue, François; Leroux, Isabelle; Voyer, Isabelle; Bloc, Daniel; Besnier, Jean-Marc; Quentin, Roland

2006-01-01

We report a multiresistant Enterobacter cloacae outbreak in an intensive care unit, associated with mattresses and with antibacterial-treated and vapour-permeable polyurethane synthetic mattress covers of therapeutic beds. PMID:16542475

Characterizing episodic memory retrieval: electrophysiological evidence for diminished familiarity following unitization.

PubMed

Pilgrim, Lea K; Murray, Jamie G; Donaldson, David I

2012-08-01

Episodic memory relies on both recollection and familiarity; why these processes are differentially engaged during retrieval remains unclear. Traditionally, recollection has been considered necessary for tasks requiring associative retrieval, whereas familiarity supports recognition of items. Recently, however, familiarity has been shown to contribute to associative recognition if stimuli are "unitized" at encoding (a single representation is created from multiple elements)-the "benefit" of unitization. Here, we ask if there is also a "cost" of unitization; are the elements of unitized representations less accessible via familiarity? We manipulated unitization during encoding and used ERPs to index familiarity and recollection at retrieval. The data revealed a selective reduction in the neural correlate of familiarity for individual words originally encoded in unitized compared with nonunitized word pairs. This finding reveals a measurable cost of unitization, suggesting that the nature of to-be-remembered stimuli is critical in determining whether familiarity contributes to episodic memory.

Association of Nursing Overtime, Nurse Staffing, and Unit Occupancy with Health Care-Associated Infections in the NICU.

PubMed

Beltempo, Marc; Blais, Régis; Lacroix, Guy; Cabot, Michèle; Piedboeuf, Bruno

2017-08-01

Objective  This study aims to assess the association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections (HCAIs) in the neonatal intensive care unit (NICU). Study Design  A 2-year retrospective cohort study was conducted for 2,236 infants admitted in a Canadian tertiary care, 51-bed NICU. Daily administrative data were obtained from the database "Logibec" and combined to the patient outcomes database. Median values for the nursing overtime hours/total hours worked ratio, the available to recommended nurse staffing ratio, and the unit occupancy rate over 3-day periods before HCAI were compared with days that did not precede infections. Adjusted odds ratios (aOR) that control for the latter factors and unit risk factors were also computed. Results  A total of 122 (5%) infants developed a HCAI. The odds of having HCAI were higher on days that were preceded by a high nursing overtime ratio (aOR, 1.70; 95% confidence interval [95% CI], 1.05-2.75, quartile [Q]4 vs. Q1). High unit occupancy rates were not associated with increased odds of infection (aOR, 0.85; 95% CI, 0.47-1.51, Q4 vs. Q1) nor were higher available/recommended nurse ratios (aOR, 1.16; 95% CI, 0.67-1.99, Q4 vs. Q1). Conclusion  Nursing overtime is associated with higher odds of HCAI in the NICU. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Directory of Book Trade and Related Organizations. Books Trade Associations, United States and Canada; International and Foreign Book Trade Associations; National Information Standards Organization (NISO) Standards; Calendar, 2003-2012; Acronyms; Index of Organizations; Subject Index.

ERIC Educational Resources Information Center

Bowker Annual Library and Book Trade Almanac, 2003

2003-01-01

Includes two lists: one of book trade associations in the United States and Canada, and one of international and foreign book trade associations. Concludes with National Information Standards Organization (NISO) standards; calendar, 2003-2012; acronyms; index of organizations; and subject index. (LRW)

Effectiveness of a Mobile Mammography Program.

PubMed

Stanley, Elizabeth; Lewis, Madelene C; Irshad, Abid; Ackerman, Susan; Collins, Heather; Pavic, Dag; Leddy, Rebecca J

2017-12-01

Mobile mammography units have increasingly been used to address patient health care disparities; however, there are limited data comparing mobile units to stationary sites. This study aims to evaluate the characteristics of women who underwent mammography screening in a mobile unit versus those who underwent mammography screening at a cancer center. In this retrospective study, we analyzed all screening mammography examinations performed in a mobile unit in 2014 (n = 1433 examinations). For comparison, we randomized and reviewed an equivalent number of screening mammography examinations performed at our cancer center in 2014 (n = 1434 examinations). BI-RADS assessment, adherence to follow-up, biopsies performed, cancer detection rate, and sociodemographic variables were recorded. An independent-samples t test was conducted to identify potential differences in age between cancer center patients and mobile unit patients. Chi-square analyses were used to test for associations between location and factors such as health insurance, race, marital status, geographic area, adherence to screening guidelines, recall rate, adherence to follow-up, and cancer detection rates. Patients visiting our cancer center (mean = 57.74 years; SD = 10.55) were significantly older than those visiting the mobile unit (mean = 52.58 years; SD = 8.19; p < 0.001). There was a significant association between location and health insurance status (χ 2 = 610.92; p < 0.001) with more uninsured patients undergoing screening in the mobile van (cancer center = 3.70%, mobile unit = 38.73%). There was a significant association between screening location and patient race (χ 2 = 118.75, p < 0.001), with more white patients being screened at the cancer center (cancer center = 47.28%, mobile unit = 33.30%), more black patients being screened in the mobile van (cancer center = 49.30%, mobile unit = 54.15%), and more Hispanic patients being screened in the mobile van (cancer center = 1.05%, mobile unit = 6.77%). There was a significant association between location and patient marital status (χ 2 = 135.61, p < 0.001), with more married patients screened at the cancer center (cancer center = 49.16%, mobile unit = 38.31%), more single patients screened in the mobile van (cancer center = 25.17%, mobile unit = 34.47%), and more widowed patients being screened at the cancer center (cancer center = 8.09%, mobile unit = 4.47%). There was a significant association between location and geographic area (χ 2 = 33.33, p < 0.001), with both locations reaching more urban than rural patients (cancer center = 79.99%, mobile unit = 70.62%). There was a significant association between location and adherence to screening guidelines (χ 2 = 179.60, p < 0.001), with patients screened at the cancer center being more compliant (cancer center = 56.90%, mobile unit = 34.47%). Finally, there was a significant association between location and recall rate (χ 2 = 4.06, p < 0.001). The cancer center had a lower recall rate (13.32%) than the mobile van (15.98%). Of those patients with BI-RADS 0, there was a significant association between location and adherence to follow-up (χ 2 = 22.75, p < 0.001) with patients using the mobile unit less likely to return for additional imaging (cancer center = 2.65%, mobile unit = 17.03%). Significant differences were found among patients visiting the cancer center versus the mobile mammography van. The cancer center's population is older and more adherent to guidelines, whereas the mobile mammography population exhibited greater racial and marital diversity, higher recall rate, and lack of adherence to follow-up recommendations. By identifying these characteristics, we can develop programs and materials that meet these populations' needs and behaviors, ultimately increasing mammography screening and follow-up rates among underserved populations.

The Methodist Hospital CCU: a Beacon unit of excellence.

PubMed

Lewis, Tricia; Abanobi, Beatrice; Alleman, Paula; Ballinas, Eva; Botbyl, Brenda; Bries, Girlie; Clark, Liz; Clarkson, Terri; Cooper, Bridgette; Cooper, Jason; Cox, Shelly; Cude, Rebecca; Davis, Juanita; Delosreyes, Arlene; Durst, Kimberly; East, Ana; Edwards, Erving; Ellison, Rose; Eparwa, Perlita; Forjuoh, Harriet; Foster, Donald; Foytik, Lisa; Gordon, Maria; Grace, Jean; Green, Lisa; Harrison, Cassandra; Herrera, Rubin; Horn, Mary; Hunsinger, Cheryce; Issac, Annamma; Jackson, Valerie; Johnson, Athie; Kitayama, Susanna; Karaan, Juliet; Kezmarski, Mary; Kleinrock, Richard; Latson, Maria; Lee, Valerie; Long, Robin; Macapagal, Fred; Magsino, Diana; Manojkumar, Saleena; Martin, Denise; Matura, Lea Ann; McCarthy, Cynthia; McClellan, Emma; McDaniel, Christy; Mengo, Pam; Meurer, Judy; Muttathottil, Liz; Osayande, Esther; Osei-Frimpong, Diana; Phillips, Betty; Pittman, James; Pratt, Craig; Putney, David; Refuerzo, Laarni; Rendon, Lavinia; Richter, Russ; Simms, Sylvia; Sitoy, Diana; Small-Nelson, Judith; Sosa, Tomas; Stuckey, Denise; Tacquard, Natalie; Talbott, Sarah; Talladen, Aleine; Taylor, Shani; Thomas, Lini; Thompson, Pam; Walters, Gordon; West, Rachel

2005-06-01

This article features the Coronary Care Unit of The Methodist Hospital of Houston, Texas. This unit was one of the first Beacon Critical Care Units recognized by the American Association of Critical Care Nurses. This article focuses on how to achieve this award. The Coronary Care Unit nursing infrastructure is described, and specific unit examples are included.

12 CFR 561.53 - United States Treasury General Account.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 6 2012-01-01 2012-01-01 false United States Treasury General Account. 561.53... REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 561.53 United States Treasury General Account. The term United States Treasury General Account means an account maintained in the name of the United States...

12 CFR 161.53 - United States Treasury General Account.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false United States Treasury General Account. 161.53... REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 161.53 United States Treasury General Account. The term United States Treasury General Account means an account maintained in the name of the United States...

12 CFR 561.53 - United States Treasury General Account.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false United States Treasury General Account. 561.53... REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 561.53 United States Treasury General Account. The term United States Treasury General Account means an account maintained in the name of the United States...

Healthcare resource utilization and epidemiology of pediatric burn-associated hospitalizations, United States, 2000.

PubMed

Shields, Brenda J; Comstock, R Dawn; Fernandez, Soledad A; Xiang, Huiyun; Smith, Gary A

2007-01-01

The objective of this study was to describe the epidemiology and financial burden of burn-associated hospitalizations for children younger than 18 years in the United States. Retrospective data analysis of pediatric burn-associated hospitalizations was done using the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2000. An estimated 10,000 children younger than 18 years were hospitalized for burn-associated injuries in the United States in 2000. These children spent an estimated 66,200 days in the hospital with associated hospital charges equal to USD 211,772,700. Total charges and length of stay for pediatric burn-associated hospitalizations in the United States during 2000 were associated with degree of burn, percentage of total body surface area burned, child's age, region of the United States, hospital location, and hospital type. Children 2 years old or younger were more likely to be nonwhite, be hospitalized for burns, and burn their hands/wrists, compared with children 3 to 17 years of age. Male children in both age groups were more likely to be hospitalized for burns than female children. Children 2 years old or younger were more likely to be burned by hot liquids/vapors and contact with hot substances/objects, while children 3 to 17 years were more likely to be burned by fire/flames. This study is the first national study on healthcare resource utilization for pediatric burn-associated hospitalizations to utilize the KID database. Burns are a major source of pediatric morbidity and are associated with significant national healthcare resource utilization annually. Future burn prevention efforts should emphasize implementing passive injury prevention strategies, especially for young children who are nonwhite and live in low-income communities.

The relationship between safety climate and recent accidents: behavioral learning and cognitive attributions.

PubMed

Desai, Vinit M; Roberts, Karlene H; Ciavarelli, Anthony P

2006-01-01

The association between accidents and subsequent work unit safety perceptions was assessed to address cognitive and behavioral changes following accidents. Many studies attempt to predict accident rates using measures of work unit safety, but effects vary considerably. Conversely, this study examined whether recent accidents may be positively associated with work unit safety perceptions, as suggested by behavioral learning mechanisms (increases in safety investments following accidents) or cognitive mechanisms (defensive attributions regarding accident causality). Lagged squadron-level accident experience was correlated with work unit safety perceptions obtained through a 61-question safety climate survey administered to 6,361 individuals in U.S. Navy flight squadrons. Positive associations between minor or intermediately severe accidents and future safety climate scores were found, although no effect was found for major accidents. We suggest that accident history should be considered when examining work unit safety perceptions because recent accidents may be associated with higher safety climate scores. We did not find that this varies systematically with accident severity, and longitudinal research on additional samples is needed to further test this possibility. This research may be used to refine measurement of work unit safety and to examine impacts of accidents or safety violations on workers' cognitive processes and group behavioral changes.

[Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

PubMed

Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

2015-01-01

Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Terrestrial Carbon Sequestration in National Parks: Values for the Conterminous United States

USGS Publications Warehouse

Richardson, Leslie A.; Huber, Christopher; Zhu, Zhi-Liang; Koontz, Lynne

2015-01-01

Lands managed by the National Park Service (NPS) provide a wide range of beneficial services to the American public. This study quantifies the ecosystem service value of carbon sequestration in terrestrial ecosystems within NPS units in the conterminous United States for which data were available. Combining annual net carbon balance data with spatially explicit NPS land unit boundaries and social cost of carbon estimates, this study calculates the net metric tons of carbon dioxide sequestered annually by park unit under baseline conditions, as well as the associated economic value to society. Results show that, in aggregate, NPS lands in the conterminous United States are a net carbon sink, sequestering more than 14.8 million metric tons of carbon dioxide annually. The associated societal value of this service is estimated at approximately $582.5 million per year. While this analysis provides a broad overview of the annual value of carbon sequestration on NPS lands averaged over a five year baseline period, it should be noted that carbon fluxes fluctuate from year to year, and there can be considerable variation in net carbon balance and its associated value within a given park unit. Future research could look in-depth at the spatial heterogeneity of carbon flux within specific NPS land units.

Social and Spatial Networks: Kinship Distance and Dwelling Unit Proximity in Rural Thailand

PubMed Central

Verdery, Ashton M.; Entwisle, Barbara; Faust, Katherine; Rindfuss, Ronald R.

2013-01-01

We address a long hypothesized relationship between the proximity of individuals' dwelling units and their kinship association. Better understanding this relationship is important because of its implications for contact and association among members of a society. In this paper, we use a unique dataset from Nang Rong, Thailand which contains dwelling unit locations (GPS) and saturated kinship networks of all individuals living in 51 agricultural villages. After presenting arguments for a relationship between individuals’ dwelling unit locations and their kinship relations as well as the particulars of our case study, we introduce the data and describe our analytic approach. We analyze how kinship - considered as both a system linking collections of individuals in an extended kinship network and as dyadic links between pairs of individuals -patterns the proximity of dwelling units in rural villages. The results show that in general, extended kin live closer to one another than do unrelated individuals. Further, the degree of relatedness between kin correlates with the distance between their dwelling units. Close kin are more likely to co-reside, a fact which drives much of the relationship between kinship relatedness and dwelling unit proximity within villages. There is nevertheless suggestive evidence of a relationship between kinship association and dwelling unit proximity among kin who do not live together. PMID:23956489

78 FR 24147 - Petition for Reconsideration of Action in a Rulemaking Proceeding

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-24

... United States Telecom Association. DATES: Oppositions to the Petition must be filed on or before May 9... the United States Telecom Association, published at 78 FR 13936, March 1, 2013 in WC Docket No. 02-60...

Meteorological conditions associated with increased incidence of West Nile virus disease in the United States, 2004-2012.

PubMed

Hahn, Micah B; Monaghan, Andrew J; Hayden, Mary H; Eisen, Rebecca J; Delorey, Mark J; Lindsey, Nicole P; Nasci, Roger S; Fischer, Marc

2015-05-01

West Nile virus (WNV) is a leading cause of mosquito-borne disease in the United States. Annual seasonal outbreaks vary in size and location. Predicting where and when higher than normal WNV transmission will occur can help direct limited public health resources. We developed models for the contiguous United States to identify meteorological anomalies associated with above average incidence of WNV neuroinvasive disease from 2004 to 2012. We used county-level WNV data reported to ArboNET and meteorological data from the North American Land Data Assimilation System. As a result of geographic differences in WNV transmission, we divided the United States into East and West, and 10 climate regions. Above average annual temperature was associated with increased likelihood of higher than normal WNV disease incidence, nationally and in most regions. Lower than average annual total precipitation was associated with higher disease incidence in the eastern United States, but the opposite was true in most western regions. Although multiple factors influence WNV transmission, these findings show that anomalies in temperature and precipitation are associated with above average WNV disease incidence. Readily accessible meteorological data may be used to develop predictive models to forecast geographic areas with elevated WNV disease risk before the coming season. © The American Society of Tropical Medicine and Hygiene.

The influence of time units on the flexibility of the spatial numerical association of response codes effect.

PubMed

Zhao, Tingting; He, Xianyou; Zhao, Xueru; Huang, Jianrui; Zhang, Wei; Wu, Shuang; Chen, Qi

2018-05-01

The Spatial Numerical/Temporal Association of Response Codes (SNARC/STEARC) effects are considered evidence of the association between number or time and space, respectively. As the SNARC effect was proposed by Dehaene, Bossini, and Giraux in 1993, several studies have suggested that different tasks and cultural factors can affect the flexibility of the SNARC effect. This study explored the influence of time units on the flexibility of the SNARC effect via materials with Arabic numbers, which were suffixed with time units and subjected to magnitude comparison tasks. Experiment 1 replicated the SNARC effect for numbers and the STEARC effect for time units. Experiment 2 explored the flexibility of the SNARC effect when numbers were attached to time units, which either conflicted with the numerical magnitude or in which the time units were the same or different. Experiment 3 explored whether the SNARC effect of numbers was stable when numbers were near the transition of two adjacent time units. The results indicate that the SNARC effect was flexible when the numbers were suffixed with time units: Time units influenced the direction of the SNARC effect in a way which could not be accounted for by the mathematical differences between the time units and numbers. This suggests that the SNARC effect is not obligatory and can be easily adapted or inhibited based on the current context. © 2017 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

A population-based study of the association of medical manpower with county trauma death rates in the United States.

PubMed Central

Rutledge, R; Fakhry, S M; Baker, C C; Weaver, N; Ramenofsky, M; Sheldon, G F; Meyer, A A

1994-01-01

OBJECTIVE: To determine the association between measures of medical manpower available to treat trauma patients and county trauma death rates in the United States. The primary hypothesis was that greater availability of medical manpower to treat trauma injury would be associated with lower trauma death rates. SUMMARY BACKGROUND DATA: When viewed from the standpoint of the number of productive years of life lost, trauma has a greater effect on health care and lost productivity in the United States than any disease. Allocation of health care manpower to treat injuries seems logical, but studies have not been done to determine its efficacy. The effect of medical manpower and hospital resource allocation on the outcome of injury in the United States has not been fully explored or adequately evaluated. METHODS: Data on trauma deaths in the United States were obtained from the National Center for Health Statistics. Data on the number of surgeons and emergency medicine physicians were obtained from the American Hospital Association and the American Medical Association. Data on physicians who have participated in the American College of Surgeons (ACS) Advanced Trauma Life Support Course (ATLS) were obtained from the ACS. Membership information for the American Association for Surgery of Trauma (AAST) was obtained from that organization. Demographic data were obtained from the United States Census Bureau. Multivariate stepwise linear regression and cluster analysis were used to model the county trauma death rates in the United States. The Statistical Analysis System (Cary, NC) for statistical analysis was used. RESULTS: Bivariate and multivariate analyses showed that a variety of medical manpower measures and demographic factors were associated with county trauma death rates in the United States. As in other studies, measures of low population density and high levels of poverty were found to be strongly associated with increased trauma death rates. After accounting for these variables, using multivariate analysis and cluster analysis, an increase in the following medical manpower measures were associated with decreased county trauma death rates: number of board-certified general surgeons, number of board-certified emergency medicine physicians, number of AAST members, and number of ATLS-trained physicians. CONCLUSIONS: This study confirms previous work that showed a strong relation among measures of poverty, rural setting, and increased county trauma death rates. It also found that counties with more board-certified surgeons per capita and with more surgeons with an increased interest (AAST membership) or increased training (ATLS) in trauma care have lower per-capita trauma death rates.(ABSTRACT TRUNCATED AT 400 WORDS) Images Figure 1. PMID:8185404

Analysis of tandem repeat units of the promoter of capsanthin/capsorubin synthase (Ccs) gene in pepper fruit.

PubMed

Tian, Shi-Lin; Li, Zheng; Li, Li; Shah, S N M; Gong, Zhen-Hui

2017-07-01

Capsanthin/capsorubin synthase ( Ccs ) gene is a key gene that regulates the synthesis of capsanthin and the development of red coloration in pepper fruits. There are three tandem repeat units in the promoter region of Ccs , but the potential effects of the number of repetitive units on the transcriptional regulation of Ccs has been unclear. In the present study, expression vectors carrying different numbers of repeat units of the Ccs promoter were constructed, and the transient expression of the β-glucuronidase ( GUS ) gene was used to detect differences in expression levels associated with the promoter fragments. These repeat fragments and the plant expression vector PBI121 containing the 35s CaMV promoter were ligated to form recombinant vectors that were transfected into Agrobacterium tumefaciens GV3101. A fluorescence spectrophotometer was used to analyze the expression associated with the various repeat units. It was concluded that the constructs containing at least one repeat were associated with GUS expression, though they did not differ from one another. This repeating unit likely plays a role in transcription and regulation of Ccs expression.

Voluntary Associations and the American Political Process, Student Book. The Lavinia and Charles P. Schwartz Citizenship Project.

ERIC Educational Resources Information Center

Sheehy, Maureen S.

This curriculum unit on citizenship education examines some voluntary associations which Americans join to accomplish certain objectives. The purposes of the unit are to show students how associations take positions on certain issues, such as reforming Congress or amnesty, and how they work to effect governmental policies. It is hoped that…

Poultry: the most common food in outbreaks with known pathogens, United States, 1998-2012.

PubMed

Chai, S J; Cole, D; Nisler, A; Mahon, B E

2017-01-01

As poultry consumption continues to increase worldwide, and as the United States accounts for about one-third of all poultry exports globally, understanding factors leading to poultry-associated foodborne outbreaks in the United States has important implications for food safety. We analysed outbreaks reported to the United States' Foodborne Disease Outbreak Surveillance System from 1998 to 2012 in which the implicated food or ingredient could be assigned to one food category. Of 1114 outbreaks, poultry was associated with 279 (25%), accounting for the highest number of outbreaks, illnesses, and hospitalizations, and the second highest number of deaths. Of the 149 poultry-associated outbreaks caused by a confirmed pathogen, Salmonella enterica (43%) and Clostridium perfringens (26%) were the most common pathogens. Restaurants were the most commonly reported location of food preparation (37% of poultry-associated outbreaks), followed by private homes (25%), and catering facilities (13%). The most commonly reported factors contributing to poultry-associated outbreaks were food-handling errors (64%) and inadequate cooking (53%). Effective measures to reduce poultry contamination, promote safe food-handling practices, and ensure food handlers do not work while ill could reduce poultry-associated outbreaks and illnesses.

Mycobacterium chimaera in Heater-Cooler Units in Denmark Related to Isolates from the United States and United Kingdom.

PubMed

Svensson, Erik; Jensen, Elsebeth Tvenstrup; Rasmussen, Erik Michael; Folkvardsen, Dorte Bek; Norman, Anders; Lillebaek, Troels

2017-03-01

Mycobacterium chimaera was present at high rates (>80%) in heater-cooler units (HCUs) from all 5 thoracic surgery departments in Denmark. Isolates were clonal to HCU-associated isolates from the United States (including some from patients) and United Kingdom. However, M. chimaera from 2 brands of HCU were genetically distinct.

12 CFR 390.314 - United States Treasury General Account.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 5 2012-01-01 2012-01-01 false United States Treasury General Account. 390.314... Affecting All State Savings Associations § 390.314 United States Treasury General Account. The term United States Treasury General Account means an account maintained in the name of the United States Treasury the...

12 CFR 390.314 - United States Treasury General Account.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 5 2014-01-01 2014-01-01 false United States Treasury General Account. 390.314... Affecting All State Savings Associations § 390.314 United States Treasury General Account. The term United States Treasury General Account means an account maintained in the name of the United States Treasury the...

12 CFR 390.314 - United States Treasury General Account.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 5 2013-01-01 2013-01-01 false United States Treasury General Account. 390.314... Affecting All State Savings Associations § 390.314 United States Treasury General Account. The term United States Treasury General Account means an account maintained in the name of the United States Treasury the...

7 CFR 400.767 - Requester obligations.

Code of Federal Regulations, 2011 CFR

2011-01-01

....gov; or (iv) By overnight delivery to the Associate Administrator, Risk Management Agency, United... subpart must: (1) Be submitted: (i) In writing by certified mail, to the Associate Administrator, Risk Management Agency, United States Department of Agriculture, Stop Code 0801, 1400 Independence Avenue, SW...

7 CFR 400.767 - Requester obligations.

Code of Federal Regulations, 2010 CFR

2010-01-01

....gov; or (iv) By overnight delivery to the Associate Administrator, Risk Management Agency, United... subpart must: (1) Be submitted: (i) In writing by certified mail, to the Associate Administrator, Risk Management Agency, United States Department of Agriculture, Stop Code 0801, 1400 Independence Avenue, SW...

United Nations Day, 24 October.

ERIC Educational Resources Information Center

Osborne, Ken, Ed.

1993-01-01

Serving as the journal of the Manitoba Social Science Teachers' Association, this issue commemorates United Nations Day with the editorial, "Teaching about the United Nations" (Ken Osborne). Another article devoted to the international organization is "The United Nations and International Peace and Security" (Ken Osborne). The…

Impact of Noise on Nurses in Pediatric Intensive Care Units.

PubMed

Watson, J'ai; Kinstler, Angela; Vidonish, William P; Wagner, Michael; Lin, Li; Davis, Kermit G; Kotowski, Susan E; Daraiseh, Nancy M

2015-09-01

Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing. To measure noise levels and noise duration on specialty pediatric intensive care units to explore sources of noise and its effects on the health of registered nurses. In a cross-sectional pilot study, levels and sources of noise in 3 different specialty pediatric intensive care units were assessed. Fifteen nurses were observed for 4-hour sessions during a 24-hour period. Sound pressure levels (noise) and heart rate were measured continuously, and stress ratings were recorded. Descriptive statistics were calculated for noise (level, source, location, and activity), heart rate, and stress. The Pearson correlation coefficient was calculated to analyze the relationship between heart rate and noise. Mean noise level was 71.9 (SD, 9.2) dBA. Mean heart rate was 85.2/min (SD, 15.8/min) and was significantly associated with noise, unit, within-unit location, nurse sources, and noise activities. The most frequent sources of noise were patients' rooms, care activities, and staff communications. Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes. ©2015 American Association of Critical-Care Nurses.

Infection Prevention Practices in Japan, Thailand, and the United States: Results From National Surveys.

PubMed

Krein, Sarah L; Greene, M Todd; Apisarnthanarak, Anucha; Sakamoto, Fumie; Tokuda, Yasuharu; Sakihama, Tomoko; Fowler, Karen E; Ratz, David; Saint, Sanjay

2017-05-15

Numerous evidence-based practices for preventing device-associated infections are available, yet the extent to which these practices are regularly used in acute care hospitals across different countries has not been compared, to our knowledge. Data from hospital surveys conducted in Japan, the United States, and Thailand in 2012, 2013, and 2014, respectively, were evaluated to determine the use of recommended practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). The outcomes were the percentage of hospitals reporting regular use (a score of 4 or 5 on a scale from 1 [never use] to 5 [always use]) of each practice across countries and identified hospital characteristics associated with the use of selected practices in each country. Survey response rates were 71% in Japan and the United States and 87% in Thailand. A majority of hospitals in Japan (76.6%), Thailand (63.2%), and the United States (97.8%) used maximum barrier precautions for preventing CLABSI and semirecumbent positioning to prevent VAP (66.2% for Japan, 86.7% for Thailand, and 98.7% for the United States). Nearly all hospitals (>90%) in Thailand and the United States reported monitoring CLABSI, VAP, and CAUTI rates, whereas in Japan only CLABSI rates were monitored by a majority of hospitals. Regular use of CAUTI prevention practices was variable across the 3 countries, with only a few practices adopted by >50% of hospitals. A majority of hospitals in Japan, Thailand, and the United States have adopted certain practices to prevent CLABSI and VAP. Opportunities for targeting prevention activities and reducing device-associated infection risk in hospitals exist across all 3 countries. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Age of red blood cells and outcome in acute kidney injury

PubMed Central

2013-01-01

Introduction Transfusion of red blood cells (RBCs) and, in particular, older RBCs has been associated with increased short-term mortality in critically ill patients. We evaluated the association between age of transfused RBCs and acute kidney injury (AKI), hospital, and 90-day mortality in critically ill patients. Methods We conducted a prospective, observational, predefined sub-study within the FINNish Acute Kidney Injury (FINNAKI) study. This study included all elective ICU admissions with expected ICU stay of more than 24 hours and all emergency admissions from September to November 2011. To study the age of RBCs, we classified transfused patients into quartiles according to the age of oldest transfused RBC unit in the ICU. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Results Out of 1798 patients, 652 received at least one RBC unit. The median [interquartile range] age of the oldest RBC unit transfused was 12 [11-13] days in the freshest quartile and 21 [17-27] days in the quartiles 2 to 4. On logistic regression, RBC age was not associated with the development of KDIGO stage 3 AKI. Patients in the quartile of freshest RBCs had lower crude hospital and 90-day mortality rates compared to those in the quartiles of older blood. After adjustments, older RBC age was associated with significantly increased risk for hospital mortality. Age, Simplified Acute Physiology Score II (SAPS II)-score without age points, maximum Sequental Organ Failure Assessment (SOFA) score and the total number of transfused RBC units were independently associated with 90-day mortality. Conclusions The age of transfused RBC units was independently associated with hospital mortality but not with 90-day mortality or KDIGO stage 3 AKI. The number of transfused RBC units was an independent risk factor for 90-day mortality. PMID:24093554

Associations of prenatal and early life dietary inflammatory potential with childhood adiposity and cardiometabolic risk in Project Viva.

PubMed

Sen, S; Rifas-Shiman, S L; Shivappa, N; Wirth, M D; Hebert, J R; Gold, D R; Gillman, M W; Oken, E

2018-05-01

Limited information exists regarding the association between early-life diet and cardiometabolic risk. Examine associations of dietary inflammatory index (DII) in pregnancy and early childhood (3-5 years) with adiposity, blood pressure and metabolic markers in mid-childhood (6-10 years). Among 992 mother-child pairs from Project Viva, a pre-birth cohort, we examined associations of DII scores with outcomes using multivariable linear regression adjusted for child age and sex and maternal age, BMI, education, parity, smoking, race and income. Mean (SD) maternal DII in pregnancy was -2.6(1.4) units and in child DII in early childhood was 0.3(0.7). Mean mid-childhood BMI z-score was 0.40(0.98) units. In boys only, DII in early childhood was associated with higher BMIz (adjusted β = 0.16 units per unit DII, 95%CI 0.02, 0.29), waist circumference (0.93 cm; -0.07, 1.92) and skin fold thicknesses (1.12 mm; 0.01, 2.23). Dietary inflammatory index in the highest quartiles during both pregnancy and in early childhood, compared to the lowest quartiles, was associated with higher waist circumference (2.4 cm; 0.14, 4.6) in all children, and BMIz in boys (0.78 units; 0.34, 1.22). Associations with BP and metabolic markers were null. A pro-inflammatory diet in pregnancy and early childhood may promote the development of adiposity. © 2017 World Obesity Federation.

Alloimmunization is associated with older age of transfused red blood cells in sickle cell disease.

PubMed

Desai, Payal C; Deal, Allison M; Pfaff, Emily R; Qaqish, Bahjat; Hebden, Leyna M; Park, Yara A; Ataga, Kenneth I

2015-08-01

Red blood cell (RBC) alloimmunization is a significant clinical complication of sickle cell disease (SCD). It can lead to difficulty with cross-matching for future transfusions and may sometimes trigger life-threatening delayed hemolytic transfusion reactions. We conducted a retrospective study to explore the association of clinical complications and age of RBC with alloimmunization in patients with SCD followed at a single institution from 2005 to 2012. One hundred and sixty six patients with a total of 488 RBC transfusions were evaluated. Nineteen patients (11%) developed new alloantibodies following blood transfusions during the period of review. The median age of RBC units was 20 days (interquartile range: 14-27 days). RBC antibody formation was significantly associated with the age of RBC units (P = 0.002), with a hazard ratio of 3.5 (95% CI: 1.71-7.11) for a RBC unit that was 7 days old and 9.8 (95% CI: 2.66-35.97) for a unit that was 35 days old, 28 days after the blood transfusion. No association was observed between RBC alloimmunization and acute vaso-occlusive complications. Although increased echocardiography-derived tricuspid regurgitant jet velocity (TRV) was associated with the presence of RBC alloantibodies (P = 0.02), TRV was not significantly associated with alloimmunization when adjusted for patient age and number of transfused RBC units. Our study suggests that RBC antibody formation is significantly associated with older age of RBCs at the time of transfusion. Prospective studies in patients with SCD are required to confirm this finding. © 2015 Wiley Periodicals, Inc.

Discrimination of lithologic units using geobotanical and LANDSAT TM spectral data

NASA Technical Reports Server (NTRS)

Birnie, R. W.; Defeo, N. J.

1986-01-01

Thematic Mapper (TM) spectral data were correlated with lithologic units, geobotanical forest associations, and geomorphic site parameters in the Ridge and Valley Province of Pennsylvania. Both the TM and forest association data can be divided into four groups based on their lithology (sandstone or shale) and geomorphic aspect (north or south facing). In this clastic sedimentary terrane, geobotanical associations are useful indicators of lithology and these different geobotanical associations are detectable in LANDSAT TM data.

Associations Between Parenting Styles and Perceived Child Effortful Control Within Chinese Families in the United States, the United Kingdom, and Taiwan

PubMed Central

Huang, Ching-Yu; Cheah, Charissa S. L.; Lamb, Michael E.; Zhou, Nan

2017-01-01

The current study examined the associations between parentally perceived child effortful control (EC) and the parenting styles of 122 Chinese mothers (36 first-generation Chinese immigrants in the United Kingdom, 40 first-generation Chinese immigrants in the United States, and 46 Taiwanese mothers) of 5- to 7-year-old (M age = 5.82 years, SD = .805; 68 boys and 54 girls) children. The findings showed significant cultural group differences in mothers’ reported authoritarian parenting style. Significant associations also emerged between mothers’ reports of their children’s EC and some parenting dimensions, although there were no cultural group differences in perceived child EC. Different patterns of associations between perceived child EC and parenting styles in these three groups also demonstrated heterogeneity within the Chinese population, and highlighted the need to consider differences between original and receiving societies when seeking to understand parenting and child development in different immigrant groups. PMID:29276309

Associations Between Parenting Styles and Perceived Child Effortful Control Within Chinese Families in the United States, the United Kingdom, and Taiwan.

PubMed

Huang, Ching-Yu; Cheah, Charissa S L; Lamb, Michael E; Zhou, Nan

2017-07-01

The current study examined the associations between parentally perceived child effortful control (EC) and the parenting styles of 122 Chinese mothers (36 first-generation Chinese immigrants in the United Kingdom, 40 first-generation Chinese immigrants in the United States, and 46 Taiwanese mothers) of 5- to 7-year-old ( M age = 5.82 years, SD = .805; 68 boys and 54 girls) children. The findings showed significant cultural group differences in mothers' reported authoritarian parenting style. Significant associations also emerged between mothers' reports of their children's EC and some parenting dimensions, although there were no cultural group differences in perceived child EC. Different patterns of associations between perceived child EC and parenting styles in these three groups also demonstrated heterogeneity within the Chinese population, and highlighted the need to consider differences between original and receiving societies when seeking to understand parenting and child development in different immigrant groups.

Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related?

PubMed

Muroi, Maki; Shen, Jay J; Angosta, Alona

2017-02-01

Registered nurses (RNs) play an important role in safe medication administration and patient safety. This study examined a total of 1276 medication error (ME) incident reports made by RNs in hospital inpatient settings in the southwestern region of the United States. The most common drug class associated with MEs was cardiovascular drugs (24.7%). Among this class, anticoagulants had the most errors (11.3%). The antimicrobials was the second most common drug class associated with errors (19.1%) and vancomycin was the most common antimicrobial that caused errors in this category (6.1%). MEs occurred more frequently in the medical-surgical and intensive care units than any other hospital units. Ten percent of MEs reached the patients with harm and 11% reached the patients with increased monitoring. Understanding the contributing factors related to MEs, addressing and eliminating risk of errors across hospital units, and providing education and resources for nurses may help reduce MEs. Copyright © 2016 Elsevier Inc. All rights reserved.

Educational inequalities in parental care time: Cross-national evidence from Belgium, Denmark, Spain, and the United Kingdom.

PubMed

Gracia, Pablo; Ghysels, Joris

2017-03-01

This study uses time-diary data for dual-earner couples from Belgium, Denmark, Spain, and the United Kingdom to analyze educational inequalities in parental care time in different national contexts. For mothers, education is significantly associated with parenting involvement only in Spain and the United Kingdom. In Spain these differences are largely explained by inequalities in mothers' time and monetary resources, but not in the United Kingdom, where less-educated mothers disproportionally work in short part-time jobs. For fathers, education is associated with parenting time in Denmark, and particularly in Spain, while the wife's resources substantially drive these associations. On weekends, the educational gradient in parental care time applies only to Spain and the United Kingdom, two countries with particularly large inequalities in parents' opportunities to engage in parenting. The study shows country variations in educational inequalities in parenting, suggesting that socioeconomic resources, especially from mothers, shape important variations in parenting involvement. Copyright © 2016. Published by Elsevier Inc.

Is Spending More Time Associated With Less Missed Care?: A Comparison of Time Use and Missed Care Across 15 Nursing Units at 2 Hospitals.

PubMed

McNair, Norma; Baird, Jennifer; Grogan, Tristan R; Walsh, Catherine M; Liang, Li-Jung; Worobel-Luk, Pamela; Needleman, Jack; Nuckols, Teryl K

2016-09-01

The aim of this study is to examine the relationship between nursing time use and perceptions of missed care. Recent literature has highlighted the problem of missed nursing care, but little is known about how nurses' time use patterns are associated with reports of missed care. In 15 nursing units at 2 hospitals, we assessed registered nurse (RN) perceptions of missed care, observed time use by RNs, and examined the relationship between time spent and degree of missed care at the nursing unit level. Patterns of time use were similar across hospitals, with 25% of time spent on documentation. For 6 different categories of nursing tasks, no association was detected between time use, including time spent on documentation, and the degree of missed care at the nursing unit level. Nursing time use cannot fully explain variation in missed care across nursing units. Further work is needed to account for patterns of missed care.

Cross (Unit)-Level Effects of Cohesion on Relationships of Suicide Thoughts to Combat Exposure, Postdeployment Stressors, and Postdeployment Social Support.

PubMed

Griffith, James

2015-01-01

A behavioral health concern for the US military has been suicide, largely due to its increased prevalence in the last several years during US involvement in the Iraq and Afghanistan wars. Using hierarchical linear modeling (HLM), the present study examined relationships among combat exposure, postdeployment stressors, social support, and unit cohesion. Survey data were obtained from 4,567 soldiers who were members of 50 company-sized units. At the individual level, combat exposure and postdeployment stressors were associated with suicidal thoughts. Postdeployment social support was associated with fewer suicidal thoughts. There was no evidence of the stress-buffering effect of social support. At the group level, reduced risk for suicidal thoughts was associated with units having higher than average cohesion. Reduced risk for suicidal thoughts in conjunction with combat experiences was observed in units having higher than average cohesion, though not reaching a traditional level of statistical significance.

Agreement between the Board of Trustees of the California State Universtiy and the California Faculty Association. Unit 3--Faculty. August 16, 1983-June 30, 1986.

ERIC Educational Resources Information Center

California Faculty Association.

The collective bargaining agreement between the Board of Trustees of the California State University and the California Faculty Association chapter (18,000 members) of the National Education Association (NEA) covering the period August 16, 1983-June 30, 1986 is presented. Items covered in the agreement include: unit recognition; definitions;…

Nurse work environment and quality of care by unit types: A cross-sectional study.

PubMed

Ma, Chenjuan; Olds, Danielle M; Dunton, Nancy E

2015-10-01

Nursing unit is the micro-organization in the hospital health care system in which integrated patient care is provided. Nursing units of different types serve patients with distinct care goals, clinical tasks, and social structures and norms. However, empirical evidence is sparse on unit type differences in quality of care and its relation with nurse work environment. Nurse work environment has been found as an important nursing factor predicting nurse and patient outcomes. To examine the unit type differences in nurse-reported quality of care, and to identify the association between unit work environment and quality of care by unit types. This is a cross-sectional study using nurse survey data (2012) from US hospitals nationwide. The nurse survey collected data on quality of care, nurse work environment, and other work related information from staff nurses working in units of various types. Unit types were systematically classified across hospitals. The unit of analysis was the nursing unit, and the final sample included 7677 units of 14 unit types from 577 hospitals in 49 states in the US. Multilevel regressions were used to assess the relationship between nurse work environment and quality of care across and by unit types. On average, units had 58% of the nurses reporting excellent quality of care and 40% of the nurses reporting improved quality of care over the past year. Unit quality of care varied by unit types, from 43% of the nurses in adult medical units to 73% of the nurses in interventional units rating overall quality of care on unit as excellent, and from 35% of the nurses in adult critical care units to 44% of the nurses in adult medical units and medical-surgical combined units reporting improved quality of care. Estimates from regressions indicated that better unit work environments were associated with higher quality of care when controlling various hospital and unit covariates; and this association persisted among units of different types. Unit type differences exist in the overall quality of care as well as achievement in improving quality of care. The low rates of nurses reporting improvement in the quality of nursing care to patients suggest that further interventions focusing at the unit-level are needed for achieving high care quality. Findings from our study also suggest that improving nurse work environments can be an effective strategy to improve quality of care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Neonatal Intensive Care Unit Nurses Working in an Open Ward: Stress and Work Satisfaction.

PubMed

Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie

2016-01-01

There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.

40 CFR 63.1101 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... operation. A unit operation may have more than one batch emission episode per batch cycle. For example, a... shutdowns and during periods not associated with a shutdown. Examples of activities that can generate... management units such as an air flotation unit, clarifier, or biological treatment unit. Examples of an oil...

40 CFR 63.1101 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operation. A unit operation may have more than one batch emission episode per batch cycle. For example, a... shutdowns and during periods not associated with a shutdown. Examples of activities that can generate... management units such as an air flotation unit, clarifier, or biological treatment unit. Examples of an oil...

40 CFR 63.1101 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... operation. A unit operation may have more than one batch emission episode per batch cycle. For example, a... shutdowns and during periods not associated with a shutdown. Examples of activities that can generate... management units such as an air flotation unit, clarifier, or biological treatment unit. Examples of an oil...

40 CFR 63.1101 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... operation. A unit operation may have more than one batch emission episode per batch cycle. For example, a... shutdowns and during periods not associated with a shutdown. Examples of activities that can generate... management units such as an air flotation unit, clarifier, or biological treatment unit. Examples of an oil...

40 CFR 63.1101 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operation. A unit operation may have more than one batch emission episode per batch cycle. For example, a... shutdowns and during periods not associated with a shutdown. Examples of activities that can generate... management units such as an air flotation unit, clarifier, or biological treatment unit. Examples of an oil...

Cost Savings Associated with the LV 100-5 Tank Engine

DTIC Science & Technology

2002-03-01

34 F. UNDER ARMOR AUXILLARY POWER UNIT...................................... 35 viii G. SUMMARY...48 E. UNDER ARMOR AUXILLARY POWER UNIT...................................... 49 F. SUMMARY...the gunner and commander thermal sights. An under armor auxiliary power unit, new computer mass memory unit, color maps and displays are included

Rapid deployable global sensing hazard alert system

DOEpatents

Cordaro, Joseph V; Tibrea, Steven L; Shull, Davis J; Coleman, Jerry T; Shuler, James M

2015-04-28

A rapid deployable global sensing hazard alert system and associated methods of operation are provided. An exemplary system includes a central command, a wireless backhaul network, and a remote monitoring unit. The remote monitoring unit can include a positioning system configured to determine a position of the remote monitoring unit based on one or more signals received from one or more satellites located in Low Earth Orbit. The wireless backhaul network can provide bidirectional communication capability independent of cellular telecommunication networks and the Internet. An exemplary method includes instructing at least one of a plurality of remote monitoring units to provide an alert based at least in part on a location of a hazard and a plurality of positions respectively associated with the plurality of remote monitoring units.

Association between environmental quality and lung cancer survival in the United States, 2000-2005.

EPA Science Inventory

Background/Aims Lung cancer remains one of the most prevalent and lethal cancers in the United States. Individual environmental exposures have been associated with lung cancer incidence. However, the impact of cumulative environmental exposures on survival is not well understood ...

Status of the European Atlas of Natural Radiation.

PubMed

Bossew, P; Tollefsen, T; Cinelli, G; Gruber, V; De Cort, M

2015-11-01

According to the EURATOM (European Atomic Energy Community) Treaty, one of the missions of the Joint Research Centre (JRC) of the European Commission (EC) is to collect, process, evaluate and present data on environmental radioactivity. In 2006, the JRC started the 'European Atlas of Natural Radiation' project, in order to give an overview of the geographic distribution of sources of, and exposures to, natural radiation. As a first task, a map of indoor radon concentration was created, because in most cases this is the most important contribution to exposure, and since it could be expected that data collection would take quite some time, because radon (Rn) surveys are very differently advanced between European countries. The authors show the latest status of this map. A technically more ambitious map proved the one of the geogenic Rn potential (RP), due to heterogeneity of data sources across Europe and the need to develop models to estimate a harmonised quantity which adequately measures or classifies the RP. Further maps currently in the making include those of secondary cosmic radiation, of terrestrial gamma radiation and of the concentrations of the elements U, Th and K that are its source. In this article, the authors show the progress of some of these maps. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Analysis of filament statistics in fast camera data on MAST

NASA Astrophysics Data System (ADS)

Farley, Tom; Militello, Fulvio; Walkden, Nick; Harrison, James; Silburn, Scott; Bradley, James

2017-10-01

Coherent filamentary structures have been shown to play a dominant role in turbulent cross-field particle transport [D'Ippolito 2011]. An improved understanding of filaments is vital in order to control scrape off layer (SOL) density profiles and thus control first wall erosion, impurity flushing and coupling of radio frequency heating in future devices. The Elzar code [T. Farley, 2017 in prep.] is applied to MAST data. The code uses information about the magnetic equilibrium to calculate the intensity of light emission along field lines as seen in the camera images, as a function of the field lines' radial and toroidal locations at the mid-plane. In this way a `pseudo-inversion' of the intensity profiles in the camera images is achieved from which filaments can be identified and measured. In this work, a statistical analysis of the intensity fluctuations along field lines in the camera field of view is performed using techniques similar to those typically applied in standard Langmuir probe analyses. These filament statistics are interpreted in terms of the theoretical ergodic framework presented by F. Militello & J.T. Omotani, 2016, in order to better understand how time averaged filament dynamics produce the more familiar SOL density profiles. This work has received funding from the RCUK Energy programme (Grant Number EP/P012450/1), from Euratom (Grant Agreement No. 633053) and from the EUROfusion consortium.

Standards, documents of relevance and directives in individual monitoring: is European individual monitoring in compliance with standards?

PubMed

Fantuzzi, E

2007-01-01

Individual monitoring services (IMS) in Europe do not comply with the same legal or approval requirements. Anyway, a degree of harmonisation existing in individual monitoring practices in Europe has been achieved mainly thanks to documents as standards or international recommendations, which with different weight represent invaluable vehicles of condensed information transfer. However, implementation of standards is not straightforward and harmonisation is not directly a consequence. Somehow, 'harmony' is needed also in standards: IEC and ISO standards, on performance requirements for dosemeters sometimes have different approaches (i.e. performance criteria). Moreover, standards do not all refer to reliability, and therefore being in compliance with standards does not by itself assure that dose results are reliable. Standards are not the only reference documents for an IMS. EURADOS working group on 'Harmonisation of Individual Monitoring in Europe', who has been active in the years 2001-2004, suggested a classification of publication on individual monitoring, distinguishing between standards and documents of relevance, which can be both national and international. None of the two categories are mandatory unless specified in legislation. The Council Directive 96/29/EURATOM and its implementation in each EU Member States has fostered harmonisation of the approach (i.e. approval of dosimetric services) and of the reference quantities for individual monitoring within EU, but national legislation still allow substantial differences in individual monitoring from country to country.

Microinstabilities in the pedestal region

NASA Astrophysics Data System (ADS)

Dickinson, David; Dudson, Benjamin; Wilson, Howard; Roach, Colin

2014-10-01

The regulation of transport at the pedestal top is important for the inter-ELM pedestal dynamics. Linear gyrokinetic analysis of the pedestal region during an ELM cycle on MAST has shown kinetic ballooning modes to be unstable at the knee of the pressure profile and in the steep pedestal region whilst microtearing modes (MTMs) dominate in the shallow gradient region inboard of the pedestal top. The transition between these instabilities at the pedestal knee has been observed in low and high collisionality MAST pedestals, and is likely to play an important role in the broadening of the pedestal. Nonlinear simulations are needed in this region to understand the microturbulence, the corresponding transport fluxes, and to gain further insight into the processes underlying the pedestal evolution. Such gyrokinetic simulations are numerically challenging and recent upgrades to the GS2 gyrokinetic code help improve their feasibility. We are also exploring reduced models that capture the relevant physics using the plasma simulation framework BOUT + + . An electromagnetic gyrofluid model has recently been implemented with BOUT + + that has significantly reduced computational cost compared to the gyrokinetic simulations against which it will be benchmarked. This work was funded by the RCUK Energy programme, EURATOM and a EUROFusion fellowship WP14-FRF-CCFE/Dickinson and was carried out using: HELIOS at IFERC, Japan; ARCHER (EPSRC Grant No. EP/L000237/1); HECToR (EPSRC Grant No. EP/H002081/1).

Impact of radiation protection means on the dose to the lens of the eye while handling radionuclides in nuclear medicine.

PubMed

Bruchmann, Iris; Szermerski, Bastian; Behrens, Rolf; Geworski, Lilli

2016-12-01

The human eye lens appears to be more radiosensitive than previously assumed. The reduction of the limit for the dose to the lens of the eye to 20 mSv per year has been passed in the current Euratom Directives (2013). Therefore, in this work the impact of laboratory glasses and X-ray protective goggles was investigated and reciprocal attenuation factors (i.e. transmission factors) for different nuclides (Tc-99m, I-131, Y-90, F-18 and Ga-68) were determined. The radionuclides in typical geometry (syringe, applicator) were positioned at a distance of 50 cm to the eyes of four Alderson-Head-Phantoms. Different dosemeters measuring H p (3) respective H p (0.07) were fixed to the eyes of the phantoms, either behind the glasses or without any protection means, respectively. The mean reciprocal attenuation factors were determined to be between unity for F-18 and I-131 using laboratory glasses (no attenuation effect) and < 0.01 for Y-90 using X-ray protective goggles. All other results were between these extremes. It has been shown, that prospective doses to the lens of the eye can be reduced significantly by using appropriate radiation protection means, especially for those dose-relevant beta radiation emitting nuclides such as Y-90. Copyright © 2015. Published by Elsevier GmbH.

Proceedings of the Toronto TEAM/ACES workshop

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

Turner, L.R.

The third TEAM Workshop of the third round was held at Ontario Hydro in Toronto 25--26 October 1990, immediately following the Conference on Electromagnetic Field Computation. This was the first Joint Workshop with ACES (Applied Computational Electromagnetics Society), whose goals are similar to TEAM, but who tend to work at higher frequencies (Antennas, Propagation, and Scattering). A fusion problem, the eddy current heating of the case of the Euratom Large Coil Project Coil, was adapted as Problem 14 at the Oxford Workshop, and a solution to that problem was presented at Toronto by Oskar Biro of the Graz (Austria) Universitymore » of Technology. Individual solutions were also presented for Problems 8 (Flaw in a Plate) and 9 (Moving Coil inside a Pipe). Five new solutions were presented to Problem 13 (DC Coil in a Ferromagnetic Yoke), and Koji Fujiwara of Okayama University summarized these solutions along with the similar number presented at Oxford. The solutions agreed well in the air but disagreed in the steel. Codes with a formulation in magnetic field strength or scalar potential underestimated the flux density in the steel, and codes based on flux density or vector potential overestimated it. Codes with edge elements appeared to do better than codes with nodal elements. These results stimulated considerable discussions; in my view that was the most valuable result of the workshop.« less

Modelling ion cyclotron emission from KSTAR tokamak and LHD helical device plasmas

NASA Astrophysics Data System (ADS)

Dendy, Richard; Chapman, Ben; Reman, Bernard; Chapman, Sandra; Akiyama, Tsuyoshi; Yun, Gunsu

2017-10-01

New high quality measurements of ion cyclotron emission (ICE) from KSTAR and LHD greatly extend the scope and diversity of plasma conditions under which ICE is observed. Variables include the origin (fusion reactions or neutral beam injection) and energy (sub- or super-Alfvénic) of the minority energetic ions that drive ICE; the composition of the bulk plasma (hydrogen or deuterium) which supports the modes excited; plasma density in the emitting region, and the timescale on which it changes; and toroidal magnetic field geometry (tokamak or helical device). Future exploitation of ICE as a diagnostic for energetic ion populations in JET D-T plasmas and in ITER rests on quantitative understanding of the physics of the emission. This is tested and extended by current KSTAR and LHD measurements of ICE. We report progress on direct numerical simulation using full orbit ion kinetic codes that solve the Maxwell-Lorentz equations for hundreds of millions of particles. In the saturated regime, these simulations yield excited field spectra that correspond directly to the measured ICE spectra under diverse KSTAR and LHD regimes. At early times, comparison of simulation outputs with linear analytical theory confirms the magnetoacoustic cyclotron instability as the basic driver of ICE. Supported by RCUK Energy Programme Grant EP/P012450/1, NRF Korea Grant 2014M1A7A1A03029881, NIFS budget ULHH029 and Euratom.

The association between spiritual well-being and burnout in intensive care unit nurses: A descriptive study.

PubMed

Kim, Hyun Sook; Yeom, Hye-Ah

2018-06-01

To describe the spiritual well-being and burnout of intensive care unit nurses and examine the relationship between these factors. This was a cross-sectional descriptive study. The participants were 318 intensive care unit recruited from three university hospitals in South Korea. The survey questionnaire included demographic information, work-related characteristics and end-of-life care experience, along with the Spiritual Well-Being Scale and Burnout Questionnaire. The data were analysed using descriptive statistics, t-tests, ANOVA with Scheffé test and a multiple regression analysis. The burnout level among intensive care unit nurses was 3.15 out of 5. A higher level of burnout was significantly associated with younger age, lower education level, single marital status, having no religion, less work experience and previous end-of-life care experience. Higher levels of spiritual well-being were associated with lower levels of burnout, even after controlling for the general characteristics in the regression model. Intensive care unit nurses experience a high level of burnout in general. Increased spiritual well-being might reduce burnout among intensive care unit nurses. Younger and less experienced nurses should receive more attention as a vulnerable group with lower spirituality and greater burnout in intensive care unit settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units.

PubMed

Rashid, Mahbub; Khan, Nayma; Jones, Belinda

2016-01-01

This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed.

Public policies on healthcare-associated infections: a Brazil and UK case study.

PubMed

Padoveze, Maria Clara; Melo, Sara; Bishop, Simon; Poveda, Vanessa de Brito; Fortaleza, Carlos Magno Castelo Branco

2017-12-11

To summarize the historical events and drivers underlying public policy for the prevention and control of healthcare-associated infections in Brazil and in the United Kingdom. In doing so, the article aims to identify lessons and recommendations for future development of public policy. The analysis is based on a historical overview of national healthcare-associated infections programs taken from previously published sources. Findings highlight how the development of healthcare-associated infections prevention and control policies followed similar trajectories in Brazil and the United Kingdom. This can be conceptualized around four sequential phases: Formation, Consolidation, Standardization, and Monitoring and Evaluation. However, while we identified similar phases of development in Brazil and the United Kingdom, it can be seen that the former entered each stage around 20 years after the latter.

Chassis unit insert tightening-extract device

NASA Technical Reports Server (NTRS)

Haerther, L. W.; Zimmerman, P. A. (Inventor)

1964-01-01

The invention relates to the insertion and extraction of rack mounted electronic units and in particular to a screw thread insert tightening and extract device, for chassis units having a collar which may be rotatably positioned manually for the insert tightening or extraction of various associated chassis units, as desired.

Insights from a national survey into why substance abuse treatment units add prevention and outreach services

PubMed Central

Wells, Rebecca; Lemak, Christy Harris; D'Aunno, Thomas A

2006-01-01

Background Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. Results A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Conclusion Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and outreach. The effects of supervisor graduate education on likelihood of adding new prevention and outreach programs suggests that leaders' education can affect organizational strategy. Foundation and government officials may encourage prevention and outreach by funding curricular enhancements to graduate degree programs demonstrating the importance of public goods. Overall, these findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention. PMID:16887037

Insights from a national survey into why substance abuse treatment units add prevention and outreach services.

PubMed

Wells, Rebecca; Lemak, Christy Harris; D'Aunno, Thomas A

2006-08-03

Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and outreach. The effects of supervisor graduate education on likelihood of adding new prevention and outreach programs suggests that leaders' education can affect organizational strategy. Foundation and government officials may encourage prevention and outreach by funding curricular enhancements to graduate degree programs demonstrating the importance of public goods. Overall, these findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention.

Registered Nurse (Associate Degree).

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Center on Education and Training for Employment.

This document, which is designed for use in developing a tech prep competency profile for the occupation of registered nurse (with an associate degree), lists technical competencies and competency builders for 19 units pertinent to the health technologies cluster in general and 5 units specific to the occupation of registered nurse. The following…

AGRICULTURAL AMMONIA EMISSIONS AND AMMONIUM CONCENTRATIONS ASSOCIATED WITH AEROSOLS AND PRECIPITATION IN THE SOUTHEAST UNITED STATES

EPA Science Inventory

Temporal and spatial variations in ammonia (NH3) emissions and ammonium (NH4+) concentrations associated with aerosols and volume-weighted NH4+ concentration in precipitation are investigated over the period 1990-1998 in the southeast United States (Alabama, Florida, Georgia, Ken...

PREFACE: 4th International Workshop & Summer School on Plasma Physics 2010

NASA Astrophysics Data System (ADS)

2014-06-01

Fourth International Workshop & Summer School on Plasma Physics 2010 The Fourth International Workshop & Summer School on Plasma Physics (IWSSPP'10) is organized by St. Kliment Ohridsky University of Sofia, with co-organizers TCPA Foundation, Association EURATOM/IRNRE, The Union of the Physicists in Bulgaria, and the Bulgarian Academy of Sciences. It was held in Kiten, Bulgaria, at the Black Sea Coast, from July 5 to July 10, 2010. The scientific programme covers the topics Fusion Plasma and Materials; Plasma Modeling and Fundamentals; Plasma Sources, Diagnostics and Technology. As the previous issues of this scientific meeting (IWSSPP'05, J. Phys.: Conf. Series 44 (2006) and IWSSPP'06, J. Phys.: Conf. Series 63 (2007), IWSSPP'08, J. Phys.: Conf. Series 207 (2010), its aim was to stimulate the creation and support of a new generation of young scientists for further development of plasma physics fundamentals and applications, as well as to ensure an interdisciplinary exchange of views and initiate possible collaborations by bringing together scientists from various branches of plasma physics. This volume of Journal of Physics: Conference Series includes 34 papers (invited lectures, contributed talks and posters) devoted to various branches of plasma physics, among them fusion plasma and materials, dc and microwave discharge modelling, transport phenomena in gas discharge plasmas, plasma diagnostics, cross sections and rate constants of elementary processes, material processing, plasma-chemistry and technology. Some of them have been presented by internationally known and recognized specialists in their fields; others are MSc or PhD students' first steps in science. In both cases, we believe they will raise readers' interest. We would like to thank the members of both the International Advisory Committee and the Local Organizing Committee, the participants who sent their manuscripts and passed through the (sometimes heavy and troublesome) refereeing and editing procedure and our referees for their patience and considerable effort to improve the manuscripts. We would like to express our gratitude to the invited lecturers who were willing to pay the participation fee. In this way, in addition to the intellectual support they provided by means of their excellent lectures, they also supported the school financially. E. Benova

The influence of an ITER-like wall on disruptions at JET

NASA Astrophysics Data System (ADS)

de Vries, Peter

2013-10-01

Disruptions are a key issue for tokamaks such as ITER because the fast release of the high thermal and magnetic energies will result in large forces and heat loads. Hence, finding methods to avoid them or mitigate their impact is vital. The recent replacement of carbon tiles with a metallic ITER-like wall (ILW) has greatly increased the significance of disruptions for JET operations. This paper summarizes how the metallic wall influenced the disruption physics itself and its influence on the causes of disruptions. Tolerable heat loads on the ILW are reduced compared to the carbon wall because of the potential for melting. This is exacerbated by the fact that with the ILW, significantly less energy is radiated during the disruption and thus more energy is conducted to the wall. The lower radiation and thus higher temperatures also slow down the current decay, yielding larger vessel forces. Mitigation by massive gas injection had to be applied routinely in order to safely operate JET with the new wall. The start of operations with the ILW showed a marked rise in the average disruption rate from 3.4% to 10%, although in the last 2 weeks, H-mode operations with only 3.3% disruptions was achieved. The increased disruption rate can be attributed to the influence of the new wall on plasma operation and control, requiring adjustments of the established carbon-wall scenarios. A detailed survey of disruption causes will be presented, showing the improvements made to avoid various disruption classes, but also indicating those disruption types responsible for the enhanced disruption rate. The latter can be mainly attributed to disruptions due to too high core radiation but also due to density control issues and error field locked modes. Detailed technical and physics understanding of disruption causes is essential for devising optimum strategies to avoid or mitigate these events. This research was funded partly by the European Communities under the contract of Association between EURATOM and FOM, and was carried out within the framework of EFDA. The views and opinions expressed herein do not necessarily reflect those of the Europe.

Preliminary Stratigraphic Basis for Geologic Mapping of Venus

NASA Technical Reports Server (NTRS)

Basilevsky, A. T.; Head, J. W.

1993-01-01

The age relations between geologic formations have been studied at 36 1000x1000 km areas centered at the dark paraboloid craters. The geologic setting in all these sites could be characterized using only 16 types of features and terrains (units). These units form a basic stratigraphic sequence (from older to younger: (1) Tessera (Tt); (2-3) Densely fractured terrains associated with coronae (COdf) and in the form of remnants among plains (Pdf); (4) Fractured and ridged plains (Pfr); (5) Plains with wrinkle ridges (Pwr); (6-7) Smooth and lobate plains (Ps/Pl); and (8) Rift-associated fractures (Fra). The stratigraphic position of the other units is determined by their relation with the units of the basic sequence: (9) Ridge bells (RB), contemporary with Pfr; (10-11) Ridges of coronae and arachnoids annuli (COar/Aar), contemporary with wrinkle ridges of Pwr; (12) Fractures of coronae annuli (COaf) disrupt Pwr and Ps/Pl; (13) Fractures (F) disrupt Pwr or younger units; (14) Craters with associated dark paraboloids (Cdp), which are on top of all volcanic and tectonic units except the youngest episodes of rift-associated fracturing and volcanism; (15-16) Surficial streaks (Ss) and surficial patches (Sp) are approximately contemporary with Cdp. These units may be used as a tentative basis for the geologic mapping of Venus including VMAP. This mapping should test the stratigraphy and answer the question of whether this stratigraphic sequence corresponds to geologic events which were generally synchronous all around the planet or whether the sequence is simply a typical sequence of events which occurred in different places at diffferent times.

Dementia care worker stress associations with unit type, resident, and work environment characteristics: a cross-sectional secondary data analysis of the Swiss Nursing Homes Human Resources Project (SHURP).

PubMed

Vogel, Barbara; De Geest, Sabina; Fierz, Katharina; Beckmann, Sonja; Zúñiga, Franziska

2017-03-01

Although caring for residents with dementia in nursing homes is associated with various stressors for care workers, the role of the unit type, and particularly the proportion of residents with dementia, remains unclear. This study aimed to explore associations between unit type and care worker stress, taking into account additional potential stressors. This cross-sectional study was a secondary data analysis in the Swiss Nursing Homes Human Resources Project, which included data from 3,922 care workers from 156 Swiss nursing homes. Care workers' stress was measured with a shortened version of the Health Professions Stress Inventory. Generalized estimating equation models were used to assess care worker stress and its relationships with three unit types (special care units and others with high or low proportions of residents with dementia), work environment factors, and aggressive resident behavior. After including all potential stressors in the models, no significant differences between the three unit types regarding care worker stress were found. However, increased care worker stress levels were significantly related to lower ratings of staffing and resources adequacy, the experience of verbal aggression, and the observation of verbal or physical aggression among residents. Although the unit type plays only a minor role regarding care worker stress, this study confirms that work environment and aggressive behavior of residents are important factors associated with work-related stress. To prevent increases of care worker stress, interventions to improve the work environment and strengthen care workers' ability to cope with aggressive behavior are suggested.

A Cross-Cultural Comparison of Knowledge and Stigma Associated with Autism Spectrum Disorder among College Students in Lebanon and the United States

ERIC Educational Resources Information Center

Obeid, Rita; Daou, Nidal; DeNigris, Danielle; Shane-Simpson, Christina; Brooks, Patricia J.; Gillespie-Lynch, Kristen

2015-01-01

Although misconceptions associated with ASD are apparent worldwide, they may differ across cultures. This study compares knowledge and stigma associated with ASD in a country with limited autism resources, Lebanon, and a country with substantial autism resources, the United States (US). College students in the US (N = 346) and Lebanon (N = 329)…

Water Quality Management Studies. Postimpoundment Study of R.E. ’Bob’ Woodruff Lake, Alabama River, Alabama.

DTIC Science & Technology

1984-08-01

8 3. Water-quality, sediment, and biological parameters, associated units, EPA STORET codes, container type, 0 preservative and methods used for...Section III.B). Water samples were collected and preserved according to * _ approved EPA (1974) or American Public Health Association (APHA) (1975...procedures. Water-quality parameters tested, associated units, EPA STORET codes, test procedures, and preservation tech- niques used throughout the

Water characteristics associated with the occurrence of Legionella pneumophila in dental units.

PubMed

Zanetti, F; Stampi, S; De Luca, G; Fateh-Moghadam, P; Antonietta, M; Sabattini, B; Checchi, L

2000-02-01

This study evaluated the incidence of Legionella pneumophila in dental unit water samples and investigated how the occurrence of these bacteria may be related to some physical, chemical and bacteriological characteristics of the water. The samples were taken from the incoming tap water, oral rinsing cup, air-water syringe, ultrasonic scaler, and the turbine of 23 dental units of private and public institutions. Apart from L. pneumophila (serogroup 1 and 3) isolated in 22 out of the 101 (21.8%) water samples tested, two other species were found: L. bozemanii and L. dumoffii. The highest densities and frequency of L. pneumophila were observed in the water coming into the units and in the dental units of public institutions. A negative association between L. pneumophila and 36 degrees C and 22 degrees C heterotrophic total plate counts and other gram-negative bacteria was found. An inverse association between the concentration of L. pneumophila and water temperature was also observed. The values of pH and total hardness did not show any significant difference in the L. pneumophila-positive and -negative dental unit waters. Finally, the chemical oxygen demand (COD) and residual chlorine were found to correlate positively with L. pneumophila.

Associations between perinatal interventions and hospital stillbirth rates and neonatal mortality.

PubMed

Joyce, R; Webb, R; Peacock, J L

2004-01-01

Previous studies suggest that high risk and low birthweight babies have better outcomes if born in hospitals with level III neonatal intensive care units. Relations between obstetric care, particularly intrapartum interventions and perinatal outcomes, are less well understood, however. To investigate effects of obstetric, paediatric, and demographic factors on rates of hospital stillbirths and neonatal mortality. Cross sectional data on all 65 maternity units in all Thames Regions, 1994-1996, covering 540 834 live births and stillbirths. Hospital level analyses investigated associations between staffing rates (consultant/junior paediatricians, consultant/junior obstetricians, midwives), facilities (consultant obstetrician/anaesthetist sessions, delivery beds, special care baby unit, neonatal intensive care unit cots, etc), interventions (vaginal births, caesarean sections, forceps, epidurals, inductions, general anaesthetic), parental data (parity, maternal age, social class, deprivation, multiple births), and birthweight standardised stillbirth rates and neonatal mortality. Unifactorial analyses showed consistent negative associations between measures of obstetric intervention and stillbirth rates. Some measures of staffing, facilities, and parental data also showed significant associations. Scores for interventional, organisational, and parental variables were derived for multifactorial analysis to overcome the statistical problems caused by high intercorrelations between variables. A higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates. Organisational and parental factors were not significant after adjustment. Only Townsend deprivation score was significantly associated with neonatal mortality (positive correlation). Birthweight adjusted stillbirth rates were significantly lower in units that took a more interventionalist approach and in those with higher levels of consultant obstetric staffing. There were no apparent associations between neonatal death rates and the hospital factors measured here.

Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA

PubMed Central

Herzer, Kurt R; Niessen, Louis; Constenla, Dagna O; Ward, William J; Pronovost, Peter J

2014-01-01

Objective To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. Design Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. Setting USA. Population Adult patients in the intensive care unit. Costs Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. Main outcome measures Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. Results Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections’ economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. Conclusions This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections. PMID:25256190

A closer look at associations between hospital leadership walkrounds and patient safety climate and risk reduction: a cross-sectional study.

PubMed

Schwendimann, René; Milne, Judy; Frush, Karen; Ausserhofer, Dietmar; Frankel, Allan; Sexton, J Bryan

2013-01-01

Leadership walkrounds (WRs) are widely used in health care organizations to improve patient safety. This retrospective, cross-sectional study evaluated the association between WRs and caregiver assessments of patient safety climate and patient safety risk reduction across 49 hospitals in a nonprofit health care system. Linear regression analyses using units' participation in WRs were conducted. Survey results from 706 hospital units revealed that units with ≥ 60% of caregivers reporting exposure to at least 1 WR had a significantly higher safety climate, greater patient safety risk reduction, and a higher proportion of feedback on actions taken as a result of WRs compared with those units with <60% of caregivers reporting exposure to WRs. WR participation at the unit level reflects a frequency effect as a function of units with none/low, medium, and high leadership WR exposure.

Characteristics of the Nursing Practice Environment Associated With Lower Unit-Level RN Turnover.

PubMed

Nelson-Brantley, Heather V; Park, Shin Hye; Bergquist-Beringer, Sandra

2018-01-01

The aim of this study is to examine characteristics of the nursing practice environment associated with lower RN turnover. Identifying characteristics of the practice environment that contribute to lower RN turnover is important for meeting the national quality strategy priority of reducing healthcare costs. Data from 1002 adult care units in 162 National Database of Nursing Quality Indicators participating hospitals were analyzed using multivariate linear regression. The Practice Environment Scale of the Nursing Work Index was used to measure practice environment characteristics. RN turnover was measured at the unit level. Nursing units with higher overall ratings of the nursing practice environment had lower rates of RN turnover. Units with higher RN perceived staffing and resource adequacy experienced significantly lower RN turnover. Unit managers and hospital administrators should consider RN perception of staffing and resource adequacy and the overall practice environment when developing targeted strategies for decreasing RN turnover.

Harassing under the influence: the prevalence of male heavy drinking, the embeddedness of permissive workplace drinking norms, and the gender harassment of female coworkers.

PubMed

Bacharach, Samuel B; Bamberger, Peter A; McKinney, Valerie M

2007-07-01

Drawing from the literature linking alcohol consumption and aggressive behavior, the authors examine the degree to which the risk of gender harassment toward female workers may be associated with the drinking behaviors and perceived workplace drinking norms of their male coworkers. Using multilevel analyses to examine data from 1,301 workers (including 262 women employed in 58 work units in the manufacturing, service and construction sectors), our findings indicate that, even when controlling for a variety of other demographic and unit-level factors, there is a significant association between the proportion of males in a work unit identified as being heavy or "at-risk" drinkers and the probability of gender harassment toward unit females. Our findings further indicate that this association is amplified as a function of the embeddedness of permissive workplace drinking norms among males' referent others. Copyright 2007 APA

Stroke-Associated Pneumonia Risk Score: Validity in a French Stroke Unit.

PubMed

Cugy, Emmanuelle; Sibon, Igor

2017-01-01

Stroke-associated pneumonia is a leading cause of in-hospital death and post-stroke outcome. Screening patients at high risk is one of the main challenges in acute stroke units. Several screening tests have been developed, but their feasibility and validity still remain unclear. The aim of our study was to evaluate the validity of four risk scores (Pneumonia score, A2DS2, ISAN score, and AIS-APS) in a population of ischemic stroke patients admitted in a French stroke unit. Consecutive ischemic stroke patients admitted to a stroke unit were retrospectively analyzed. Data that allowed to retrospectively calculate the different pneumonia risk scores were recorded. Sensitivity and specificity of each score were assessed for in-hospital stroke-associated pneumonia and mortality. The qualitative and quantitative accuracy and utility of each diagnostic screening test were assessed by measuring the Youden Index and the Clinical Utility Index. Complete data were available for only 1960 patients. Pneumonia was observed in 8.6% of patients. Sensitivity and specificity were, respectively, .583 and .907 for Pneumonia score, .744 and .796 for A2DS2, and .696 and .812 for ISAN score. Data were insufficient to test AIS-APS. Stroke-associated pneumonia risk scores had an excellent negative Clinical Utility Index (.77-.87) to screen for in-hospital risk of pneumonia after acute ischemic stroke. All scores might be useful and applied to screen stroke-associated pneumonia in stroke patients treated in French comprehensive stroke units. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Nosocomial infection in a pediatric intensive care unit in a developing country.

PubMed

Abramczyk, Marcelo L; Carvalho, Werther B; Carvalho, Eduardo S; Medeiros, Eduardo A S

2003-12-01

Determine the rate and outcome of nosocomial infection (NI) in pediatric intensive care unit patients in a developing country. Prospective cohort study using the Centers for Disease Control and Prevention definitions to diagnose nosocomial infection and NNISS (National Nosocomial Infection Surveillance System) methodology. São Paulo Hospital - Universidade Federal de São Paulo - Brazil, a 700-bed teaching hospital with an 8-bed pediatric intensive care unit. All 515 children consecutively admitted to the pediatric intensive care unit from April 1996 to October 1997. The NI incidence was 18.3% and the mean infection rate per 1,000 patient days was 46.1; the ventilator-associated pneumonia rate was 18.7 per 1,000 ventilator days; the central line-associated bloodstream infection rate was 10.2 per 1,000 central line days; and the urinary tract catheter-associated infection rate was 1.8 per 1,000 catheter days. Pneumonia was the most common NI (31.6%), followed by bloodstream infections (17.3%), and surgical site infection (17.3%). Gram-negative bacterias were the most common pathogens identified in the NIs (54.8%), followed by Gram-positive bacterias (23.8%), and yeasts. Pneumonia was the most common type of NI. A high incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was found, whereas the urinary tract catheter-associated infection rate was low. Gram-negative bacterias were the most common etiologic agents identified in the unit, and yeasts were frequently found. Pediatric patients have characteristics of their own, with major differences when compared to the adult population.

Motor unit recruitment patterns 2: the influence of myoelectric intensity and muscle fascicle strain rate.

PubMed

Hodson-Tole, Emma F; Wakeling, James M

2008-06-01

To effectively meet the force requirements of a given movement an appropriate number and combination of motor units must be recruited between and within muscles. Orderly recruitment of motor units has been shown to occur in a wide range of skeletal muscles, however, alternative strategies do occur. Faster motor units are better suited to developing force rapidly, and produce higher mechanical power with greater efficiency at faster shortening strain rates than slower motor units. As the frequency content of the myoelectric signal is related to the fibre type of the active motor units, we hypothesised that, in addition to an association between myoelectric frequency and intensity, there would be a significant association between muscle fascicle shortening strain rate and myoelectric frequency content. Myoelectric and sonomicrometric data were collected from the three ankle extensor muscles of the rat hind limb during walking and running. Myoelectric signals were analysed using wavelet transformation and principal component analysis to give a measure of the signal frequency content. Sonomicrometric signals were analysed to give measures of muscle fascicle strain and strain rate. The relationship between myoelectric frequency and both intensity and muscle fascicle strain rate was found to change across the time course of a stride, with differences also occurring in the strength of the associations between and within muscles. In addition to the orderly recruitment of motor units, a mechanical strategy of motor unit recruitment was therefore identified. Motor unit recruitment is therefore a multifactorial phenomenon, which is more complex than typically thought.

Neonatal Intensive Care Unit Census Influences Discharge of Moderately Preterm Infants

PubMed Central

Profit, Jochen; McCormick, Marie C.; Escobar, Gabriel J.; Richardson, Douglas K.; Zheng, Zheng; Coleman-Phox, Kim; Roberts, Rebecca; Zupancic, John A. F.

2011-01-01

Objective The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants. Design/Methods In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge. Results There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates. Conclusions Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions. PMID:17272621

Information Literacy in Postsecondary Education in the United Kingdom, the United States, Australia, and New Zealand

ERIC Educational Resources Information Center

Folk, Amanda L.

2016-01-01

This comparison seeks to determine if the three documents addressing information literacy skills and competence developed by professional library associations for postsecondary education in four predominantly English-speaking countries--the United Kingdom, the United States, Australia, and New Zealand--have similar or varying conceptions of…

Why and How We Made a Problem Oriented AV Teaching Unit for Chemistry Students.

ERIC Educational Resources Information Center

Mulder, T. H. M.; Verdonk, A. H.

1984-01-01

Describes an audiovisual teaching unit on the chemical laboratory technique of recrystallization which was developed along problem-solving lines and based on observation of student laboratory behavior. Discussion includes usual procedures for developing such units, how this unit solves problems typically associated with teaching, and its general…

Safety organizing, emotional exhaustion, and turnover in hospital nursing units.

PubMed

Vogus, Timothy J; Cooil, Bruce; Sitterding, Mary; Everett, Linda Q

2014-10-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on how engaging in safety organizing affects caregivers. While we know that organizational processes can have divergent effects on organizational and employee outcomes, little research exists on the effects of pursuing highly reliable performance through safety organizing on caregivers. Specifically, we examined whether, and the conditions under which, safety organizing affects RN emotional exhaustion and nursing unit turnover rates. Subjects included 1352 RNs in 50 intensive care, internal medicine, labor, and surgery nursing units in 3 Midwestern acute-care hospitals who completed questionnaires between August and December 2011 and 50 Nurse Managers from the units who completed questionnaires in December 2012. Cross-sectional analyses of RN emotional exhaustion linked to survey data on safety organizing and hospital incident reporting system data on adverse event rates for the year before survey administration. Cross-sectional analysis of unit-level RN turnover rates for the year following the administration of the survey linked to survey data on safety organizing. Multilevel regression analysis indicated that safety organizing was negatively associated with RN emotional exhaustion on units with higher rates of adverse events and positively associated with RN emotional exhaustion with lower rates of adverse events. Tobit regression analyses indicated that safety organizing was associated with lower unit level of turnover rates over time. Safety organizing is beneficial to caregivers in multiple ways, especially on nursing units with high levels of adverse events and over time.

Temporal and bi-directional associations between sleep duration and physical activity/sedentary time in children: An international comparison.

PubMed

Lin, Yingyi; Tremblay, Mark S; Katzmarzyk, Peter T; Fogelholm, Mikael; Hu, Gang; Lambert, Estelle V; Maher, Carol; Maia, Jose; Olds, Timothy; Sarmiento, Olga L; Standage, Martyn; Tudor-Locke, Catrine; Chaput, Jean-Philippe

2018-06-01

The purpose of this multinational and cross-sectional study was to investigate whether nighttime sleep duration was associated with physical activity (PA) and sedentary time (SED) the following day, whether daytime PA/SED were associated with sleep duration the subsequent night, and whether the associations were modified by sex and study sites. Data from 5779 children aged 9-11years were analyzed. A waist-worn Actigraph GT3X+ accelerometer was used to assess children's 24-h movement behaviours for 7days, i.e. sleep duration, total SED, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA). Multilevel linear regression models were used to account for the repeated measures nested within participants (there were up to 7 sleep→PA/SED and PA/SED→sleep pairings per participant) and schools, and adjusted for covariates. To facilitate interpretation, all sleep and PA/SED variables were standardized. Results showed that the relationship between sleep and PA/SED is bi-directional in this international sample of children. Specifically, for each one standard deviation (SD) unit increase in sleep duration, SED the following day decreased by 0.04 SD units, while LPA and MVPA increased by 0.04 and 0.02 SD units, respectively. Sleep duration decreased by 0.02 SD units and increased by 0.04 SD units for each one SD unit increase in SED and MVPA, respectively. Sleep duration was not affected by changes in LPA. These associations differed across sex and study sites in both directions. However, since the observed effect sizes are subtle, public health initiatives should consider the clinical and practical relevance of these findings. Copyright © 2017 Elsevier Inc. All rights reserved.

The socio-genetics of a complex society: female gelada relatedness patterns mirror association patterns in a multilevel society.

PubMed

Snyder-Mackler, Noah; Alberts, Susan C; Bergman, Thore J

2014-12-01

Multilevel societies with fission-fusion dynamics--arguably the most complex animal societies--are defined by two or more nested levels of organization. The core of these societies are modular social units that regularly fission and fuse with one another. Despite convergent evolution in disparate taxa, we know strikingly little about how such societies form and how fitness benefits operate. Understanding the kinship structure of complex societies could inform us about the origins of the social structure as well as about the potential for individuals in these societies to accrue indirect fitness benefits. Here, we combined genetic and behavioural data on geladas (Theropithecus gelada), an Old World Monkey, to complete the most comprehensive socio-genetic analysis of a multilevel society to date. In geladas, individuals in the core social 'units', associate at different frequencies to form 'teams', 'bands' and, the largest aggregations, 'communities'. Units were composed of closely related females, and females remained with their close kin during permanent fissions of units. Interestingly, female-female relatedness also significantly predicted between-unit, between-team and between-band association patterns, while male-male relatedness did not. Thus, it is likely that the socio-genetic structure of gelada society results from females maintaining associations with their female relatives during successive unit fissions--possibly in an attempt to balance the direct and indirect fitness benefits of group living. Overall, the persistence of associations among related females across generations appears to drive the formation of higher levels of gelada society, suggesting that females seek kin for inclusive fitness benefits at multiple levels of gelada society. © 2014 John Wiley & Sons Ltd.

Ideas for Studying About the United States in Europe.

ERIC Educational Resources Information Center

Wright, David

1986-01-01

Suggests six activities for teaching United Kingdom students about the United States and vice versa. Ideas include word associations, map and globe work to discover climate and habitation patterns, exchange of student projects, and relevant textbook passages. (JDH)

Multiple ways to the prior occurrence of an event: an electrophysiological dissociation of experimental and conceptually driven familiarity in recognition memory.

PubMed

Wiegand, Iris; Bader, Regine; Mecklinger, Axel

2010-11-11

Recent research has shown that familiarity contributes to associative memory when the to-be-associated stimuli are unitized during encoding. However, the specific processes underlying familiarity-based recognition of unitized representations are still indefinite. In this study, we present electrophysiologically dissociable early old/new effects, presumably related to two different kinds of familiarity inherent in associative recognition tasks. In a study-test associative recognition memory paradigm, we employed encoding conditions that established unitized representations of two pre-experimentally unrelated words, e.g. vegetable-bible. We compared event-related potentials (ERP) during the retrieval of these unitized word pairs using different retrieval cues. Word pairs presented in the same order as during unitization at encoding elicited a parietally distributed early old/new effect which we interpret as reflecting conceptually driven familiarity for newly formed concepts. Conversely, word pairs presented in reversed order only elicited a topographically dissociable early effect, i.e. the mid-frontal old/new effect, the putative correlate of experimental familiarity. The late parietal old/new effect, the putative ERP correlate of recollection, was obtained irrespective of word order, though it was larger for words presented in same order. These results indicate that familiarity may not be a unitary process and that different task demands can promote the assessment of conceptually driven familiarity for novel unitized concepts or experimentally-induced increments of experimental familiarity, respectively. Copyright © 2010 Elsevier B.V. All rights reserved.

Functional Roles and Social Roles: Adolescents' Significant Others in the United States and Japan.

ERIC Educational Resources Information Center

Darling, Nancy; And Others

This study examined the quality of relations characterizing adolescents' social environments and related variations in the quality of relations to associates' social roles and to the gender and culture of both associates and subjects. It investigated whether adolescents from Japan and from the United States described their relationships with…

75 FR 62140 - Notice of Receipt of Complaint; Solicitation of Comments Relating to the Public Interest

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-07

... Certain Mobile Devices, Associated Software, and Components Thereof, DN 2757; the Commission is soliciting... into the United States, the sale for importation, and the sale within the United States after importation of certain mobile devices, associated software, and components thereof. The complaint names as...

A Practical Clinical Approach to the Treatment of Nicotine Dependence in Adolescents

ERIC Educational Resources Information Center

Upadhyaya, Himanshu; Deas, Deborah; Brady, Kathleen

2005-01-01

Cigarette smoking in the United States is predominantly a pediatric disorder and causes significant morbidity and mortality; tobacco is related to more than 400,000 deaths in the United States annually. Psychiatric comorbidity is associated with smoking, and early-onset smoking (before age 13) is robustly associated with psychopathology later in…

Do factors related to combustion-based sources explain heterogeneity in PM-mortality associations across the United States?

EPA Science Inventory

Introduction: Spatial heterogeneity of effect estimates in associations between PM2.5 and total non-accidental mortality (TNA) in the United States (US), is an issue in epidemiology. This study uses rate ratios generated from the Multi-City/Multi-Pollutant study (1999-2005) for 3...

Inspection of fecal contamination on strawberries using line-scan led-induced fluorescence imaging techniques

USDA-ARS?s Scientific Manuscript database

In the United States, fecal contamination of produce is a food safety issue because illnesses caused by associated pathogens such as Escherichia coli and Salmonella. Outbreaks of foodborne illnesses associated with consuming raw fruits and vegetables in the United States continue to be a public heal...

Birds of the Southeastern United States: A Historical Perspective

Treesearch

James G. Dickson

1997-01-01

Historic freshwater aquatic and wetland ecosystems of the Southeastern United States were predominantly rivers and streams and associated natural bottomland forests. These systems have been drastically altered through the creation of reservoirs via damming, through other alterations of water courses and their associated forests, and through conversion to other uses. In...

A Phloem Sandwich Unit for Observing Bark Beetles, Associated Predators, and Parasites

Treesearch

Donald N. Kim; Mitchel C. Miller

1981-01-01

This paper describes a phloem sandwich that allows observation of parent beetles, their brood, and associates within the inner bark, and permits observation of predator and parasite behavior on the bark surface. The construction of the unit permits the introduction of multiple pairs of beetles into a single sandwich.

Visibility of Diversity within Association of Research Libraries Websites

ERIC Educational Resources Information Center

Mestre, Lori S.

2011-01-01

Libraries in the United States have worked towards developing more inclusive environments and programs. This inclusiveness should also extend to the online library presence. This article provides results of a web page scan of all Association of Research Libraries (ARL) in the United States to document the visibility of diversity on their pages. A…

Dynamics of population densities and vegetation associations of Anopheles albimanus larvae in a coastal area of southern Chiapas, Mexico.

PubMed

Rodríguez, A D; Rodríguez, M H; Meza, R A; Hernández, J E; Rejmankova, E; Savage, H M; Roberts, D R; Pope, K O; Legters, L

1993-03-01

Spatial and seasonal variations on Anopheles albimanus larval densities and their plant associations were investigated in larval habitats in southern Mexico between April 1989 and May 1990. Thirty-four plant groups were dominant in larval habitats. Dense larval populations were associated with 3 genera of plants, Cynodon, Echinocloa and Fimbristylis and no larvae were found in habitats with Salvinia and Rhizophora. Low significant positive or negative associations were documented with the other 12 plant genera. Larval habitats were classified according to the morphology of their dominant plants. Higher larval densities were observed in the groups characterized by relatively short emergent vegetation. The distribution of habitat-types within 5 identified vegetation units showed a significantly dependent relationship. For the entire study period, highest larval densities were detected in flooded pasture/grassland vegetation units. For all vegetation units, higher larval densities were found when the dominant plant type covered between 25-50% of the breeding site. The integration of data from habitat-types into vegetation units did not result in loss of information.

Sedimentology of the lower Karoo Supergroup fluvial strata in the Tuli Basin, South Africa

NASA Astrophysics Data System (ADS)

Bordy, Emese M.; Catuneanu, Octavian

2002-11-01

The Karoo Supergroup in the Tuli Basin (South Africa) consists of a sedimentary sequence (˜450-500 m) composed of four stratigraphic units, namely the informal Basal, Middle and Upper Units, and the formal Clarens Formation. The units were deposited in continental settings from approximately Late Carboniferous to Middle Jurassic. This paper focuses on the ˜60-m-thick Basal Unit, which was examined in terms of sedimentary facies and palaeo-environments based on evidence provided by primary sedimentary structures, palaeo-flow measurements, palaeontological findings, borehole data (59 core descriptions) and stratigraphic relations. Three main facies associations have been identified: (i) gravelstone (breccias and conglomerate-breccias), (ii) sandstone and (iii) fine-grained sedimentary rocks. The coarser facies are interpreted as colluvial fan deposits, possibly associated with glaciogenic diamictites. The sandstone facies association is mainly attributed to channel fills of low sinuosity, braided fluvial systems. The coal-bearing finer-grained facies are interpreted as overbank and thaw-lake deposits, and represent the lower energy correlatives of the sandy channel fills. Sediment aggradation in this fluvio-lacustrine system took place under cold climatic conditions, with floating lake ice likely associated with lacustrine environments. Palaeo-current indicators suggest that the highly weathered, quartz-vein-rich metamorphic rock source of the Basal Unit was situated east-northeast of the study area. The accumulation of the Basal Unit took place within the back-bulge depozone of the Karoo foreland system. In addition to flexural subsidence, the amount of accommodation in this tectonic setting was also possibly modified by extensional tectonism in the later stages of the basin development. Based on sedimentological and biostratigraphic evidence, the coal-bearing fine-grained facies association displays strong similarities with the Vryheid Formation of the main Karoo Basin to the south. The lowermost non-fossiliferous breccias have been correlated before with the Dwyka Group in the main Karoo, and hence the Basal Unit may be regarded as the distal equivalent of the Dwyka and Ecca groups to the south.

Haemodialysis dose and serum bicarbonate (chapter 7).

PubMed

Tomson, Charlie; Thomas, David; Rao, Raman; van Schalkwyk, Dirk; Ansell, David

2007-08-01

Data from 21 renal units was insufficient to allow analyses of the dose of dialysis in those units. Amongst the remainder, there is evidence of a progressive increase in the proportion of patients meeting the Renal Association audit standard for urea reduction ratio (URR). In the UK as a whole, 81% of prevalent haemodialysis patients met the standard for URR in 2005. Greater achievement of the standard in a given unit is associated with a higher median URR in that unit, although there is some evidence that some units have been able to narrow the distribution of achieved URR values. Achievement of the standard remains, as in previous years' Reports, less common amongst patients recently established on haemodialysis compared with those established on haemodialysis for longer. Correction of acidosis, as measured by serum bicarbonate concentration remains highly variable, although there is continued uncertainty about the interpretation of routine measurements of venous serum bicarbonate concentration in haemodialysis patients. Overall, approximately 64% of UK haemodialysis patients, and 50% of peritoneal dialysis patients met the Renal Association standard for serum bicarbonate in 2005.

Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men.

PubMed

Jensen, Tina Kold; Gottschau, Mads; Madsen, Jens Otto Broby; Andersson, Anne-Maria; Lassen, Tina Harmer; Skakkebæk, Niels E; Swan, Shanna H; Priskorn, Lærke; Juul, Anders; Jørgensen, Niels

2014-10-02

Study associations between three measures of alcohol consumption (recent, typical/habitual, binging), semen quality and serum reproductive hormones. Cross-sectional population based study. 1221 young Danish men, aged 18-28 years were recruited when they attended a compulsory medical examination to determine their fitness for military service from 2008 to 2012. Total alcohol consumption: (1) in the week preceding (habitual/typical) the visit (recent alcohol intake), (2) in a typical week and (3) frequency of 'binge drinking' (consuming more than 5 units/day)) in the past 30 days was estimated. Semen quality (volume, sperm concentration, total sperm count, and percentages of motile and morphologically normal spermatozoa) and serum concentration of reproductive hormones (follicle-stimulating hormone, luteinising hormone, testosterone, sex hormone binding globulin, oestradiol, free testosterone and inhibin B). Sperm concentration, total sperm count and percentage of spermatozoa with normal morphology were negatively associated with increasing habitual alcohol intake. This association was observed in men reporting at least 5 units in a typical week but was most pronounced for men with a typical intake of more than 25 units/week. Men with a typical weekly intake above 40 units had a 33% (95% CI 11% to 59%) reduction in sperm concentration compared to men with an intake of 1-5 units/week. A significant increase in serum free testosterone with increasing alcohol consumption the week preceding the visit was found. Binging was not independently associated with semen quality. Our study suggests that even modest habitual alcohol consumption of more than 5 units per week had adverse effects on semen quality although most pronounced associations were seen in men who consumed more than 25 units per week. Alcohol consumption was also linked to changes in testosterone and SHBG levels. Young men should be advised to avoid habitual alcohol intake. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Microbial communities associated with wet flue gas desulfurization systems

PubMed Central

Brown, Bryan P.; Brown, Shannon R.; Senko, John M.

2012-01-01

Flue gas desulfurization (FGD) systems are employed to remove SOx gasses that are produced by the combustion of coal for electric power generation, and consequently limit acid rain associated with these activities. Wet FGDs represent a physicochemically extreme environment due to the high operating temperatures and total dissolved solids (TDS) of fluids in the interior of the FGD units. Despite the potential importance of microbial activities in the performance and operation of FGD systems, the microbial communities associated with them have not been evaluated. Microbial communities associated with distinct process points of FGD systems at several coal-fired electricity generation facilities were evaluated using culture-dependent and -independent approaches. Due to the high solute concentrations and temperatures in the FGD absorber units, culturable halothermophilic/tolerant bacteria were more abundant in samples collected from within the absorber units than in samples collected from the makeup waters that are used to replenish fluids inside the absorber units. Evaluation of bacterial 16S rRNA genes recovered from scale deposits on the walls of absorber units revealed that the microbial communities associated with these deposits are primarily composed of thermophilic bacterial lineages. These findings suggest that unique microbial communities develop in FGD systems in response to physicochemical characteristics of the different process points within the systems. The activities of the thermophilic microbial communities that develop within scale deposits could play a role in the corrosion of steel structures in FGD systems. PMID:23226147

The impact of social support, unit cohesion, and trait resilience on PTSD in treatment-seeking military personnel with PTSD: The role of posttraumatic cognitions.

PubMed

Zang, Yinyin; Gallagher, Thea; McLean, Carmen P; Tannahill, Hallie S; Yarvis, Jeffrey S; Foa, Edna B

2017-03-01

The personal resources of social support, unit cohesion, and trait resilience have been found to be associated with posttraumatic stress disorder (PTSD) severity among military personnel. However, the underlying mechanisms of these relationships are unclear. We hypothesized that negative posttraumatic cognitions, which are associated with PTSD, mediate the relationships between these personal resources and PTSD. The relationship between PTSD symptom severity and a latent factor comprised of social support, unit cohesion, and trait resilience was evaluated using cross-sectional data from 366 treatment-seeking active duty military personnel with PTSD following deployments to or near Iraq or Afghanistan. Structural equation modeling (SEM) was used to test whether posttraumatic cognitions mediated this relationship. The SEM model indicated that (1) a robust latent variable named personal resources (indicated by social support, unit cohesion, and trait resilience) was negatively associated with PTSD severity; (2) personal resources were negatively associated with negative posttraumatic cognitions; (3) negative posttraumatic cognitions fully mediated the association between personal resources and PTSD severity. The final SEM mediation model showed a highly satisfactory fit [χ 2 (22) = 16.344, p = 0.798; χ 2 /df = 0.743; CFI = 1; RMSEA = 0.000]. These findings suggest that among active duty military personnel seeking treatment for PTSD, personal resources (social support, unit cohesion, and trait resilience) may mitigate PTSD severity by reducing negative posttraumatic cognitions. Copyright © 2016 Elsevier Ltd. All rights reserved.

A cross-national study of prescription nonadherence due to cost: data from the Joint Canada-United States Survey of Health.

PubMed

Kennedy, Jae; Morgan, Steve

2006-08-01

In Canada and the United States, patients who have difficulty paying for prescribed medications are less likely to obtain them and may experience increased risks for morbidity and mortality and/or increased health care costs due to nonadherence. As prescription drug costs have risen, the ability to pay for medications has emerged as a critical public health issue. The objectives of this study were to estimate the rates of cost-associated nonadherence in Canada and the United States, and to identify factors that predict cost-associated nonadherence in both countries. This original analysis used data from the 2002/2003 Joint Canada-US Survey of Health, a household phone survey jointly conducted by Statistics Canada (Ottawa, Ontario, Canada) and the US National Center for Health Statistics (Hyattsville, Maryland). The sample included 3505 adults in Canada and 5183 adults in the United States. Weighted group comparisons and logistic regression analyses were used to identify population factors predictive of cost-associated prescription nonadherence. Residents of Canada were much less likely than residents of the United States to report cost-associated nonadherence (5.1% vs 9.9%; P < 0.001). Americans without health insurance (28.2%) and Americans and Canadians without prescription-drug coverage (16.2%) were significantly more likely than those with insurance (6.2%) to report cost-associated nonadherence (P < 0.001). In addition to country of residence and insurance coverage, significant risk factors predictive of nonadherence were young age, poor health, chronic pain, and low household income. The results of this analysis suggest that people with low incomes and inadequate insurance, as well as those with poor health and/or chronic symptoms, are more likely to report failing to fill a prescription due to cost. The overall rate of cost-associated nonadherence was significantly higher in the United States than in Canada, even when other person-level factors were controlled for, including health insurance and prescription-drug coverage.

Climate Change Impacts on Freshwater Recreational Fishing in the United States

EPA Science Inventory

Using a geographic information system, a spatially explicit modeling framework was developed consisting grid cells organized into 2,099 eight-digit hydrologic unit code (HUC-8) polygons for the coterminous United States. Projected temperature and precipitation changes associated...

Transnational Environmental Problems--The United States, Canada, Mexico.

ERIC Educational Resources Information Center

Wilcher, Marshall E.

1983-01-01

Examines problems associated with transboundary environmental pollution, focusing on problems arising between the United States and Mexico and between the United States and Canada. Also discusses new organizational forms developed to bring transboundary issues to a higher policy-making level. (JN)

Nursing job satisfaction, certification and healthcare-associated infections in critical care.

PubMed

Boev, Christine; Xue, Ying; Ingersoll, Gail L

2015-10-01

The purpose of this study was to examine the relationship between nursing job satisfaction and healthcare-associated infections (HAIs) in adult critical care. Multilevel modelling was used to examine the relationship between nursing job satisfaction and two HAIs, ventilator-associated pneumonia (VAP) and central-line associated bloodstream infections (CLABSI). Units with nurses that reported satisfaction with organisational policies were associated with a 6.08 decrease in VAP (p=0.013) and units with nurses reporting favourable perception of task requirements were associated with a 7.02 decrease in VAP (.014). Positive perception of organisational policies was associated with lower rates of CLABSI (p=0.002). Unexpected findings include a positive relationship between perception of pay and autonomy and CLABSI as well as perception of interactions and VAP. Units with a higher proportion of Critical Care Registered Nurse (CCRN) certified nurses were associated with lower rates of both CLABSI (p<0.001) and VAP (p=0.037). This study provides preliminary evidence to support the relationship between nursing job satisfaction and HAIs in critical care, although some relationships were counterintuitive. A secondary finding included significant relationships between CCRN certified nurses and HAIs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Choice in maternity care: associations with unit supply, geographic accessibility and user characteristics

PubMed Central

2012-01-01

Background Despite national policies to promote user choice for health services in many European countries, current trends in maternity unit closures create a context in which user choice may be reduced, not expanded. Little attention has been paid to the potential impact of closures on pregnant women’s choice of maternity unit. We study here how pregnant women’s choices interact with the distance they must travel to give birth, individual socioeconomic characteristics and the supply of maternity units in France in 2003. Results Overall, about one-third of women chose their maternity units based on proximity. This proportion increased steeply as supply was constrained. Greater distances between the first and second closest maternity unit were strongly associated with increasing preferences for proximity; when these distances were ≥ 30 km, over 85% of women selected the closest unit (revealed preference) and over 70% reported that proximity was the reason for their choice (expressed preference). Women living at a short distance to the closest maternity unit appeared to be more sensitive to increases in distance between their first and second closest available maternity units. The preference for proximity, expressed and revealed, was related to demographic and social characteristics: women from households in the manual worker class chose a maternity unit based on its proximity more often and also went to the nearest unit when compared with women from professional and managerial households. These sociodemographic associations held true after adjusting for supply factors, maternal age and socioeconomic status. Conclusions Choice seems to be arbitrated in both absolute and relative terms. Taking changes in supply into consideration and how these affect choice is an important element for assessing the real impact of maternity unit closures on pregnant women’s experiences. An indicator measuring the proportion of women for whom the distance between the first and second maternity unit is greater than 30 km can provide a simple measure of choice to complement indicators of geographic accessibility in evaluations of the impact of maternity unit closures. PMID:22905951

Clinical indicators associated with HIV acquisition in the United States Air Force

DTIC Science & Technology

2016-12-09

59 MDW/SGYU SUBJECT: Profess ional Presentation Approval 30 NOV 20 16 I. Your journal, entitled Clinica l indicators associated w ith HIV ...presentation. a new 5g MOW Form 303g must be submitted for review and approval.) Epidemiology and Risk Factors for HIV Infection in U.S. Air Force...Service Members, 1996-20 11 6. TITLE OF MATERIAL TO BE PUBLISHED OR PRESENTED: Clinical indicators associated with HIV acquisition in the United States

Delineation, peer review, and refinement of subregions of the conterminous United States

Treesearch

J.E. Keys; D.T. Cleland; W.H. McNab

2007-01-01

This paper briefly describes the background of the U.S. Department of Agriculture (USDA) Forest Service National Hierarchical Framework of Ecological Units and the methods used for delineating map units at the subregion planning and analysis scale. The process for scientific review and continuous refinement of ecological units and associated data of subregions is also...

76 FR 39134 - ZIONSOLUTIONS, LLC; Zion Nuclear Power Station, Units 1 and 2 Exemption From Recordkeeping...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

...; Zion Nuclear Power Station, Units 1 and 2 Exemption From Recordkeeping Requirements 1.0 Background Zion Nuclear Power Station (ZNPS or Zion), Unit 1, is a Westinghouse 3250 MWt Pressurized Water Reactor which... previously applicable to the nuclear power units and associated systems, structures, and components (SSC) are...

Visual integration enhances associative memory equally for young and older adults without reducing hippocampal encoding activation.

PubMed

Memel, Molly; Ryan, Lee

2017-06-01

The ability to remember associations between previously unrelated pieces of information is often impaired in older adults (Naveh-Benjamin, 2000). Unitization, the process of creating a perceptually or semantically integrated representation that includes both items in an associative pair, attenuates age-related associative deficits (Bastin et al., 2013; Ahmad et al., 2015; Zheng et al., 2015). Compared to non-unitized pairs, unitized pairs may rely less on hippocampally-mediated binding associated with recollection, and more on familiarity-based processes mediated by perirhinal cortex (PRC) and parahippocampal cortex (PHC). While unitization of verbal materials improves associative memory in older adults, less is known about the impact of visual integration. The present study determined whether visual integration improves associative memory in older adults by minimizing the need for hippocampal (HC) recruitment and shifting encoding to non-hippocampal medial temporal structures, such as the PRC and PHC. Young and older adults were presented with a series of objects paired with naturalistic scenes while undergoing fMRI scanning, and were later given an associative memory test. Visual integration was varied by presenting the object either next to the scene (Separated condition) or visually integrated within the scene (Combined condition). Visual integration improved associative memory among young and older adults to a similar degree by increasing the hit rate for intact pairs, but without increasing false alarms for recombined pairs, suggesting enhanced recollection rather than increased reliance on familiarity. Also contrary to expectations, visual integration resulted in increased hippocampal activation in both age groups, along with increases in PRC and PHC activation. Activation in all three MTL regions predicted discrimination performance during the Separated condition in young adults, while only a marginal relationship between PRC activation and performance was observed during the Combined condition. Older adults showed less overall activation in MTL regions compared to young adults, and associative memory performance was most strongly predicted by prefrontal, rather than MTL, activation. We suggest that visual integration benefits both young and older adults similarly, and provides a special case of unitization that may be mediated by recollective, rather than familiarity-based encoding processes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Communication skills in ICU and adult hospitalisation unit nursing staff.

PubMed

Ayuso-Murillo, D; Colomer-Sánchez, A; Herrera-Peco, I

In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: Intensive Care Units, ICU, and Hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n=29) and those from Hospitalisation units (n=40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5,6 (A+), 5,2 (C-), 6,2 (O+), 5,1 (H-), 5,3 (Q1-), and emotional control: 6,1 (B+), 5,9 (N+). Meanwhile the data doesn't adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills. Copyright © 2016 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA.

PubMed

Herzer, Kurt R; Niessen, Louis; Constenla, Dagna O; Ward, William J; Pronovost, Peter J

2014-09-25

To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. USA. Adult patients in the intensive care unit. Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections' economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Predictors of heavy episodic drinking and weekly drunkenness among immigrant Latinos in North Carolina

PubMed Central

Daniel-Ulloa, J.; Reboussin, B.A.; Gilbert, P.A.; Mann, L.; Alonzo, J.; Downs, M.; Rhodes, S.D.

2014-01-01

Few studies have examined correlates of heavy drinking among rural immigrant Latino men. This analysis identified correlates of typical week drunkenness and past 30-day heavy episodic drinking, within a sample of immigrant Latino men in rural North Carolina (n = 258). In the bivariate analyses, Mexican birth, entering the United States as an adult, and year-round employment were associated with increased odds of typical week drunkenness, and higher acculturation and affiliation with a religion with strict prohibitions against drinking alcohol were associated with lower odds of typical week drunkenness. Being older, Mexican birth, and entering the United States as an adult were associated with increased odds of heavy episodic drinking, and affiliation with a religion with strict prohibitions against drinking alcohol was associated with decreased odds of heavy episodic drinking. In multivariable modeling, only religious affiliation was associated with typical week drunkenness. Mexican birth, entering the United States as an adult and were associated with increased odds of heavy episodic drinking, and affiliation with a religion with strict prohibitions against drinking alcohol and completing high school was associated with lower odds of heavy episodic drinking. The health of minority men in the United States has been neglected, and immigrant Latino men comprise a particularly vulnerable population. This analysis provides initial data on some factors associated with heavy drinking within a population about whom little is known. Future studies should examine moderating or mediating factors between age, acculturation, religiosity, and heavy drinking that might be targets for behavioral interventions. PMID:24457467

United States National Student Association. Report of the Officers.

ERIC Educational Resources Information Center

Kelly, Kathy

Each year the officers of the United States National Student Association are required to report on their activities. The report is for the year 1974-75 and discusses activities in the administration of the national office including a brief overview of the finances and operation of the national office. On-going administrative programs including the…

Factors relating to windblown dust in associations between PM2.5 and mortality across the United States

EPA Science Inventory

Introduction: In effect estimates of city-specific PM2.5-mortality associations across United States (US), there exists a substantial amount of spatial heterogeneity. Some of this heterogeneity may be due to mass distribution of PM; areas where PM2.5 is likely to be dominated by ...

Diversity and antifungal activity of the endophytic fungi associated with the native medicinal cactus Opuntia humifusa (Cactaceae) from the United States

USDA-ARS?s Scientific Manuscript database

The endophytic fungal community associated with the native cactus Opuntia humifusa in the United States was investigated and its potential for providing antifungal compounds. A total of 108 endophytic fungal isolates were obtained and identified by molecular methods into 17 different taxa of the gen...

Energy in Our Society.

ERIC Educational Resources Information Center

Philadelphia Electric Co., PA. Energy Education Advisory Council.

This publication is a series of 13 original classroom instructional packets and an additional 4 units adapted from National Science Teachers Association units. Each packet is designed to supplement specific existing subject curricula. Units have been designed for physics, chemistry, English, mathematics, general science and studies. Packets…

Evidence for a Lithic Unit Within the North Polar Layered Deposits

NASA Astrophysics Data System (ADS)

Horgan, B.; Smith, I.; Seelos, F.

2016-09-01

Orbital spectra suggest that sediments on Planum Boreum are pyroxene-bearing, and the source unit for these "veneers" may be associated with a radar reflection within the PLD. A lithic unit within the PLD may have influenced their thermal stability.

Pre-hospital National Early Warning Score (NEWS) is associated with in-hospital mortality and critical care unit admission: A cohort study.

PubMed

Abbott, Tom E F; Cron, Nicholas; Vaid, Nidhi; Ip, Dorothy; Torrance, Hew D T; Emmanuel, Julian

2018-03-01

National Early Warning Score (NEWS) is increasingly used in UK hospitals. However, there is only limited evidence to support the use of pre-hospital early warning scores. We hypothesised that pre-hospital NEWS was associated with death or critical care escalation within the first 48 h of hospital stay. Planned secondary analysis of a prospective cohort study at a single UK teaching hospital. Consecutive medical ward admissions over a 20-day period were included in the study. Data were collected from ambulance report forms, medical notes and electronic patient records. Pre-hospital NEWS was calculated retrospectively. The primary outcome was a composite of death or critical care unit escalation within 48 h of hospital admission. The secondary outcome was length of hospital stay. 189 patients were included in the analysis. The median pre-hospital NEWS was 3 (IQR 1-5). 13 patients (6.9%) died or were escalated to the critical care unit within 48 h of hospital admission. Pre-hospital NEWS was associated with death or critical care unit escalation (OR, 1.25; 95% CI, 1.04-1.51; p = 0.02), but NEWS on admission to hospital was more strongly associated with this outcome (OR, 1.52; 95% CI, 1.18-1.97, p < 0.01). Neither was associated with hospital length of stay. Pre-hospital NEWS was associated with death or critical care unit escalation within 48 h of hospital admission. NEWS could be used by ambulance crews to assist in the early triage of patients requiring hospital treatment or rapid transport. Further cohort studies or trials in large samples are required before implementation.

Prediction and Outcome of Intensive Care Unit-Acquired Paresis.

PubMed

Peñuelas, Oscar; Muriel, Alfonso; Frutos-Vivar, Fernando; Fan, Eddy; Raymondos, Konstantinos; Rios, Fernando; Nin, Nicolás; Thille, Arnaud W; González, Marco; Villagomez, Asisclo J; Davies, Andrew R; Du, Bin; Maggiore, Salvatore M; Matamis, Dimitrios; Abroug, Fekri; Moreno, Rui P; Kuiper, Michael A; Anzueto, Antonio; Ferguson, Niall D; Esteban, Andrés

2018-01-01

Intensive care unit-acquired paresis (ICUAP) is associated with poor outcomes. Our objective was to evaluate predictors for ICUAP and the short-term outcomes associated with this condition. A secondary analysis of a prospective study including 4157 mechanically ventilated adults in 494 intensive care units from 39 countries. After sedative interruption, patients were screened for ICUAP daily, which was defined as the presence of symmetric and flaccid quadriparesis associated with decreased or absent deep tendon reflexes. A multinomial logistic regression was used to create a predictive model for ICUAP. Propensity score matching was used to estimate the relationship between ICUAP and short-term outcomes (ie, weaning failure and intensive care unit [ICU] mortality). Overall, 114 (3%) patients had ICUAP. Variables associated with ICUAP were duration of mechanical ventilation (relative risk ratio [RRR] per day, 1.10; 95% confidence interval [CI] 1.08-1.12), steroid therapy (RRR 1.8; 95% CI, 1.2-2.8), insulin therapy (RRR 1.8; 95% CI 1.2-2.7), sepsis (RRR 1.9; 95% CI: 1.2 to 2.9), acute renal failure (RRR 2.2; 95% CI 1.5-3.3), and hematological failure (RRR 1.9; 95% CI: 1.2-2.9). Coefficients were used to generate a weighted scoring system to predict ICUAP. ICUAP was significantly associated with both weaning failure (paired rate difference of 22.1%; 95% CI 9.8-31.6%) and ICU mortality (paired rate difference 10.5%; 95% CI 0.1-24.0%). Intensive care unit-acquired paresis is relatively uncommon but is significantly associated with weaning failure and ICU mortality. We constructed a weighted scoring system, with good discrimination, to predict ICUAP in mechanically ventilated patients at the time of awakening.

Comprehensive stroke units: a review of comparative evidence and experience.

PubMed

Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris

2013-06-01

Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common. To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units. Cochrane Library and Medline (1980 to December 2010) review of English language articles comparing stroke units to alternative forms of stroke care delivery, different types of stroke unit models, and differences in processes of care within different stroke unit models. Different levels of comparative evidence of comprehensive stroke units to other models of stroke units are collected. There are no randomized controlled trials directly comparing comprehensive stroke units to other stroke unit models (either acute or rehabilitation). Comprehensive stroke units are associated with reduced length of stay and greatest reduction in combined death and dependency in a meta-analysis study when compared to other stroke unit models. Comprehensive stroke units also have better length of stay and functional outcome when compared to acute or rehabilitation stroke unit models in a cross-sectional study, and better length of stay in a 'before-and-after' comparative study. Components of stroke unit care that improve outcome are multifactorial and most probably include early mobilization. A comprehensive stroke unit model has been successfully implemented in metropolitan and rural hospital settings. Comprehensive stroke units are associated with reductions in length of stay and combined death and dependency and improved functional outcomes compared to other stroke unit models. A comprehensive stroke unit model is worth considering as the preferred model of stroke unit care in the planning and delivery of metropolitan and rural stroke services. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Factors influencing a mother's choice of feeding after discharge of her baby from a neonatal unit.

PubMed

Hallbauer, U; Grobler, J M; Niemand, I

2002-08-01

To assess feeding methods chosen by mothers of babies who spent time in a neonatal unit. Factors influencing this decision were investigated. Descriptive study. Mothers were interviewed on the day they took their babies home. Basic demographic data on mother and baby were collected from the hospital records. The neonatal unit, Pelonomi Hospital, Bloemfontein from May 1996 to May 1998. Eighty-one mothers of babies admitted to the neonatal unit. At discharge 60% of mothers intended to breast-feed their babies exclusively the next day. The mother's decision to breast-feed her baby at home was significantly associated with her decision before delivery (P = 0.0050). Other factors positively associated with the decision to breast-feed exclusively at home were a significantly higher birth weight of the baby (P < 0.0008) and gestational age of the baby (P < 0.0005). The only hospital practice positively associated with this decision was the frequency with which mothers saw their babies during their stay in the unit (P = 0.0153). Mothers' knowledge of how to increase breast-milk supply was very poor. Infants with a lower weight and gestational age, who stayed in the unit longer, were less likely to be breast-fed after discharge from the neonatal unit. The mothers' experience in the unit did not seem to alter their choice of feeding method decided upon before delivery. This suggests that efforts to promote breast-feeding in the neonatal unit were either ineffectual or inadequate. In order to remedy this situation it is necessary to keep the mother-infant pair together (lodger mothers) and to promote breast-feeding before and after delivery. It would also be necessary to train staff in the management of lactation problems.

Recruitment of faster motor units is associated with greater rates of fascicle strain and rapid changes in muscle force during locomotion

PubMed Central

Lee, Sabrina S. M.; de Boef Miara, Maria; Arnold, Allison S.; Biewener, Andrew A.; Wakeling, James M.

2013-01-01

SUMMARY Animals modulate the power output needed for different locomotor tasks by changing muscle forces and fascicle strain rates. To generate the necessary forces, appropriate motor units must be recruited. Faster motor units have faster activation–deactivation rates than slower motor units, and they contract at higher strain rates; therefore, recruitment of faster motor units may be advantageous for tasks that involve rapid movements or high rates of work. This study identified motor unit recruitment patterns in the gastrocnemii muscles of goats and examined whether faster motor units are recruited when locomotor speed is increased. The study also examined whether locomotor tasks that elicit faster (or slower) motor units are associated with increased (or decreased) in vivo tendon forces, force rise and relaxation rates, fascicle strains and/or strain rates. Electromyography (EMG), sonomicrometry and muscle-tendon force data were collected from the lateral and medial gastrocnemius muscles of goats during level walking, trotting and galloping and during inclined walking and trotting. EMG signals were analyzed using wavelet and principal component analyses to quantify changes in the EMG frequency spectra across the different locomotor conditions. Fascicle strain and strain rate were calculated from the sonomicrometric data, and force rise and relaxation rates were determined from the tendon force data. The results of this study showed that faster motor units were recruited as goats increased their locomotor speeds from level walking to galloping. Slow inclined walking elicited EMG intensities similar to those of fast level galloping but different EMG frequency spectra, indicating that recruitment of the different motor unit types depended, in part, on characteristics of the task. For the locomotor tasks and muscles analyzed here, recruitment patterns were generally associated with in vivo fascicle strain rates, EMG intensity and tendon force. Together, these data provide new evidence that changes in motor unit recruitment have an underlying mechanical basis, at least for certain locomotor tasks. PMID:22972893

Recruitment of faster motor units is associated with greater rates of fascicle strain and rapid changes in muscle force during locomotion.

PubMed

Lee, Sabrina S M; de Boef Miara, Maria; Arnold, Allison S; Biewener, Andrew A; Wakeling, James M

2013-01-15

Animals modulate the power output needed for different locomotor tasks by changing muscle forces and fascicle strain rates. To generate the necessary forces, appropriate motor units must be recruited. Faster motor units have faster activation-deactivation rates than slower motor units, and they contract at higher strain rates; therefore, recruitment of faster motor units may be advantageous for tasks that involve rapid movements or high rates of work. This study identified motor unit recruitment patterns in the gastrocnemii muscles of goats and examined whether faster motor units are recruited when locomotor speed is increased. The study also examined whether locomotor tasks that elicit faster (or slower) motor units are associated with increased (or decreased) in vivo tendon forces, force rise and relaxation rates, fascicle strains and/or strain rates. Electromyography (EMG), sonomicrometry and muscle-tendon force data were collected from the lateral and medial gastrocnemius muscles of goats during level walking, trotting and galloping and during inclined walking and trotting. EMG signals were analyzed using wavelet and principal component analyses to quantify changes in the EMG frequency spectra across the different locomotor conditions. Fascicle strain and strain rate were calculated from the sonomicrometric data, and force rise and relaxation rates were determined from the tendon force data. The results of this study showed that faster motor units were recruited as goats increased their locomotor speeds from level walking to galloping. Slow inclined walking elicited EMG intensities similar to those of fast level galloping but different EMG frequency spectra, indicating that recruitment of the different motor unit types depended, in part, on characteristics of the task. For the locomotor tasks and muscles analyzed here, recruitment patterns were generally associated with in vivo fascicle strain rates, EMG intensity and tendon force. Together, these data provide new evidence that changes in motor unit recruitment have an underlying mechanical basis, at least for certain locomotor tasks.

Towards a framework of nuclear competencies

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

Ghitescu, P.

For the countries considering the introduction of a nuclear energy program, the management of human resources should be a part of the wider integrated management system in order to ensure long term safe and reliable operation. Nuclear energy strategy and approaches to human resources development should take into consideration such fundamental aspects as: development and implementation of a workforce plan, required competencies and qualifications, prerequisites for staffing a nuclear energy program, needed training programs and training facilities, qualification and training requirements. Development of common instruments that respond to the above needs and vision has lead to a new concept ofmore » European Credit System for Vocational Education and Training. The European Credit System for Vocational Education and Training (ECVET) is based on definition of 'learning outcomes ' in terms of knowledge, skills and competence, and on identification of portfolios of learning outcomes that allow an individual to prove competencies in a coherent manner. ECVET proposes a common understanding of basic definitions of education and training as well as of the new proposed concepts and it should be recognized by all employers in the EU. In this context, a number of 'Euratom Fission Training Schemes' (EFTS) have been launched in specific areas where a shortage of skilled professionals has been identified. In these schemes the competence building is the result of traditional education plus life-long learning, non-traditional learning, and other forms of educational experiences, relying, in particular, on border-less mobility to get acquainted with various sectors. Each particular Training Scheme should follow a similar path for the achievement of the designed learning outcomes (knowledge, skills, and attitudes). This path to the Training Scheme consists of different activities regarding: definition of training scheme learning outcomes and modules, assessment of prerequisites and student selection, student interview for development of individual training plan, start of the training activities under a specific training scheme. The introduction and recognition of ECVET will lead to a common taxonomy of competencies, and will provide also information about qualifications and units in numerical form, enabling mutual recognition of a training scheme. The description of the learning outcomes to be achieved for qualifying to a specific job profile may follow the analysis phase of the systematic approach to training (SAT). This would ensure a common tool, already used by all trainers. All these steps contribute to establishing of a framework of nuclear competencies recognized and accepted throughout member states. (authors)« less

Organizational effects on patient satisfaction in hospital medical-surgical units.

PubMed

Bacon, Cynthia Thornton; Mark, Barbara

2009-05-01

The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients' satisfaction with nursing care in hospitals. Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited. The data source for this study was the Outcomes Research in Nursing Administration Project, a multisite organizational study conducted to investigate relationships among nurse staffing, organizational context and structure, and patient outcomes. The sample for this study was 2,720 patients and 3,718 RNs in 286 medical-surgical units in 146 hospitals. Greater availability of nursing unit support services and higher levels of work engagement were associated with higher levels of patient satisfaction. Older age, better health status, and better symptom management were also associated with higher levels of patient satisfaction. Organizational factors in hospitals and nursing units, particularly support services on the nursing unit and mechanisms that foster nurses' work engagement and effective symptom management, are important influences on patient satisfaction.

Predictors of Homonegativity in the United States and the Netherlands Using the Fifth Wave of the World Values Survey.

PubMed

Haney, Jolynn L

2016-10-01

Using data from the fifth wave of the World Values Survey (WVS), I investigated negative attitude toward homosexual individuals in two countries-the United States and the Netherlands-to determine how factors associated with homonegativity in the United States compare with factors associated with homonegativity in the Netherlands. Logistic regression of survey responses from 2,299 participants from the United States (n = 1,249) and the Netherlands (n = 1,050) supported findings from previous research suggesting that homonegativity is more likely to occur in the United States than in the Netherlands, and that negative attitudes toward persons with AIDS and immigrants predicted homonegativity in both countries. Predictors of homonegativity in the United States included being male and being unemployed; in the Netherlands, being unhappy predicted homonegativity. How these findings inform social work policy and practice related to the lesbian, gay, bisexual, and transgender (LGBT) population, as well as suggestions for future research, are discussed.

Different contexts, different effects? Work time and mental health in the United States and Germany.

PubMed

Kleiner, Sibyl; Schunck, Reinhard; Schömann, Klaus

2015-03-01

This paper takes a comparative approach to the topic of work time and health, asking whether weekly work hours matter for mental health. We hypothesize that these relationships differ within the United States and Germany, given the more regulated work time environments within Germany and the greater incentives to work long hours in the United States. We further hypothesize that German women will experience greatest penalties to long hours. We use data from the German Socioeconomic Panel and the National Longitudinal Survey of Youth to examine hours effects on mental health score at midlife. The results support our initial hypothesis. In Germany, longer work time is associated with worse mental health, while in the United States, as seen in previous research, the associations are more complex. Our results do not show greater mental health penalties for German women and suggest instead a selection effect into work hours operating by gender. © American Sociological Association 2015.

Superfund record of decision (EPA Region 5): Feed Materials Production Center, (USDOE), Operable Unit 4, Fernald, Hamilton County, OH, December 7, 1995

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

NONE

This decision document presents the selected remedial action for Operable Unit 4 of the Fernald Site in Fernald, Ohio. The materials within Operable Unit 4 exhibit a wide range of properties. Most notable would be the elevated direct radiation associated with the K-65 residues versus the much lower direct radiation associated with cold metal oxides in Silo 3. Even more significant would be the much lower levels of contamination associated with the soils and building materials, like concrete, within the Operable Unit 4 Study Area. On the basis of the evaluation of final alternatives, the selected remedy addressing Operable Unitmore » 4 at the FEMP is a combination of Alternatives 3A.1/Vit - Removal, Vitrification, and Off-site Disposal - Nevada Test Site (NTS); 3B.1/Vit - Removal, Vitrification, and Off-site Disposal - NTS; and 2C - Demolition, Removal and On-Property Disposal.« less

Substance use disorder comorbidity with schizophrenia in families of Mexican and Central American Ancestry

PubMed Central

Jiménez-Castro, Lorena; Hare, Elizabeth; Medina, Rolando; Raventos, Henriette; Nicolini, Humberto; Mendoza, Ricardo; Ontiveros, Alfonso; Jerez, Alvaro; Muñoz, Rodrigo; Dassori, Albana; Escamilla, Michael

2010-01-01

Objectives The aims of this study were to estimate the frequency and course of substances use disorders in Latino patients with schizophrenia and to ascertain risk factors associated with substance use disorders in this population. Method We studied 518 subjects with schizophrenia recruited for a genetic study from the Southwest United States, Mexico, and Central America (Costa Rica and Guatemala). Subjects were assessed using structured interviews and a best estimate consensus process. Logistic regression, χ2, t- test, Fisher’s exact test, and Yates’ correction, as appropriate, were performed to assess the sociodemographic variables associated with dual diagnosis. We defined substance use disorder as either alcohol or substance abuse or dependence. Results Out of 518 patients with schizophrenia, 121 (23.4%) had substance use disorders. Comorbid substance use disorders were associated with male gender, residence in the United States, immigration of Mexican men to the United State, history of depressive syndrome or episode, and being unemployed. The most frequent substance use disorder was alcohol abuse/dependence, followed by marijuana abuse/dependence, and solvent abuse/dependence. Conclusion This study provides data suggesting that depressive episode or syndrome, unemployment, male gender, and immigration of Mexican men to the United States were factors associated with substance use disorder comorbidity in schizophrenia. Binary logistic regression showed that country of residence was associated with substance use disorder in schizophrenic patients. The percentage of subjects with comorbid substance use disorders was higher in the Latinos living in the United States compared with subjects living in Central America and Mexico. PMID:20303714

ERP correlates of source memory: unitized source information increases familiarity-based retrieval.

PubMed

Diana, Rachel A; Van den Boom, Wijnand; Yonelinas, Andrew P; Ranganath, Charan

2011-01-07

Source memory tests typically require subjects to make decisions about the context in which an item was encoded and are thought to depend on recollection of details from the study episode. Although it is generally believed that familiarity does not contribute to source memory, recent behavioral studies have suggested that familiarity may also support source recognition when item and source information are integrated, or "unitized," during study (Diana, Yonelinas, and Ranganath, 2008). However, an alternative explanation of these behavioral findings is that unitization affects the manner in which recollection contributes to performance, rather than increasing familiarity-based source memory. To discriminate between these possibilities, we conducted an event-related potential (ERP) study testing the hypothesis that unitization increases the contribution of familiarity to source recognition. Participants studied associations between words and background colors using tasks that either encouraged or discouraged unitization. ERPs were recorded during a source memory test for background color. The results revealed two distinct neural correlates of source recognition: a frontally distributed positivity that was associated with familiarity-based source memory in the high-unitization condition only and a parietally distributed positivity that was associated with recollection-based source memory in both the high- and low-unitization conditions. The ERP and behavioral findings provide converging evidence for the idea that familiarity can contribute to source recognition, particularly when source information is encoded as an item detail. Copyright © 2010 Elsevier B.V. All rights reserved.

Design of the environment of care for safety of patients and personnel: does form follow function or vice versa in the intensive care unit?

PubMed

Bartley, Judene; Streifel, Andrew J

2010-08-01

We review the context of the environment of care in the intensive care unit setting in relation to patient safety and quality, specifically addressing healthcare-associated infection issues and solutions involving interdisciplinary teams. Issues addressed include current and future architectural design and layout trends, construction trends affecting intensive care units, and prevention of construction-associated healthcare-associated infections related to airborne and waterborne risks and design solutions. Specific elements include single-occupancy, acuity-scalable intensive care unit rooms; environmental aspects of hand hygiene, such as water risks, sink design/location, human waste management, surface selection (floor covering, countertops, furniture, and equipment) and cleaning, antimicrobial-treated or similar materials, ultraviolet germicidal irradiation, specialized rooms (airborne infection isolation and protective environments), and water system design and strategies for safe use of potable water and mitigation of water intrusion. Effective design and operational use of the intensive care unit environment of care must engage critical care personnel from initial planning and design through occupancy of the new/renovated intensive care unit as part of the infection control risk assessment team. The interdisciplinary infection control risk assessment team can address key environment of care design features to enhance the safety of intensive care unit patients, personnel, and visitors. This perspective will ensure the environment of care supports human factors and behavioral aspects of the interaction between the environment of care and its occupants.

Hospital Magnet Status, Unit Work Environment, and Pressure Ulcers.

PubMed

Ma, Chenjuan; Park, Shin Hye

2015-11-01

To identify how organizational nursing factors at different structural levels (i.e., unit-level work environment and hospital Magnet status) are associated with hospital-acquired pressure ulcers (HAPUs) in U.S. acute care hospitals. A cross-sectional observational study used data from the National Database of Nursing Quality Indicators®. Responses from 33,845 registered nurses (RNs) were used to measure unit work environments. The unit of analysis was the nursing unit, and there were 1,381 units in 373 hospitals in the United States. Unit work environment was measured by the Practice Environment Scale of Nurse Working Index (PES-NWI). Multilevel logistic regressions were used to estimate the effects of unit work environment and hospital Magnet status on HAPUs. All models were controlled for hospital and unit characteristics when considering clustering of units within hospitals. Magnet hospital units had 21% lower odds of having an HAPU than non-Magnet hospital units (95% confidence interval [CI], 0.64-0.98). With one unit increase of the PES-NWI score, units had 29% lower odds of having an HAPU (95% CI, 0.55-0.91). When including both hospital Magnet status and unit work environment in the model, hospital Magnet status no longer had a significant effect on HAPUs (odds ratio [OR] = 0.82; 95% CI, 0.66-1.02), whereas the significant effect of unit work environment persisted (OR = 0.73; 95% CI, 0.56-0.93). Both hospital and unit environments were significantly associated with HAPUs, and the unit-level work environment can be more influential in reducing HAPUs. Investment in the nurse work environments at both the hospital level and unit level has the potential to reduce HAPUs; and additional to hospital-level initiatives (e.g., Magnet recognition program), efforts targeting on-unit work environments deserve more attention. © 2015 Sigma Theta Tau International.

Changes in patient safety culture after restructuring of intensive care units: Two cross-sectional studies.

PubMed

Vifladt, Anne; Simonsen, Bjoerg O; Lydersen, Stian; Farup, Per G

2016-02-01

Compare changes in registered nurses' perception of the patient safety culture in restructured and not restructured intensive care units during a four-year period. Two cross-sectional surveys were performed, in 2008/2009 (time 1) and 2012/2013 (time 2). During a period of 0-3 years after time 1, three of six hospitals merged their general and medical intensive care units (restructured). The other hospitals maintained their structure of the intensive care units (not restructured). Intensive care units in hospitals at one Norwegian hospital trust. The safety culture was measured with Hospital Survey on Patient Safety Culture. At times 1 and 2, 217/302 (72%) and 145/289 (50%) registered nurses participated. Restructuring was negatively associated with change in the safety culture, in particular, the dimensions of the safety culture within the unit level. The dimensions most vulnerable for restructuring were manager expectations and actions promoting safety, teamwork within hospital units and staffing. In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting safety, teamwork within hospital units and staffing. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Relationships among Alcohol Outlet Density, Alcohol Use, and Intimate Partner Violence Victimization among Young Women in the United States

ERIC Educational Resources Information Center

Waller, Martha W.; Iritani, Bonita J.; Christ, Sharon L.; Clark, Heddy Kovach; Moracco, Kathryn E.; Halpern, Carolyn Tucker; Flewelling, Robert L.

2012-01-01

Greater access to alcohol has been widely found to be associated with many negative outcomes including violence perpetration. This study examines the relationship between alcohol outlet density, alcohol use, and intimate partner violence (IPV) victimization among young women in the United States. A direct association between alcohol outlet density…

Amicus Curiae Brief for the United States Supreme Court on Mental Health Issues Associated with "Physician-Assisted Suicide"

ERIC Educational Resources Information Center

Werth, James L., Jr.; Gordon, Judith R.

2002-01-01

After providing background material related to the Supreme Court cases on "physician-assisted suicide" (Washington v. Glucksberg, 1997, and Vacco v. Quill, 1997), this article presents the amicus curiae brief that was submitted to the United States Supreme Court by 2 national mental health organizations, a state psychological association, and an…

United States Catholic Elementary and Secondary Schools 1993-1994. Annual Statistical Report on Schools, Enrollment and Staffing.

ERIC Educational Resources Information Center

Brigham, Frederick H., Jr.

Since 1969-70, the National Catholic Educational Association has published a statistical report on Catholic elementary and secondary schools in the United States. This year's report contains the core school enrollment and staffing data from the Association's database and includes data on Chapter 1 services, extended care programs, school boards of…

A Survey of Local Member Units of the National Association for Retarded Citizens.

ERIC Educational Resources Information Center

National Association for Retarded Citizens, Arlington, TX. Research and Demonstration Inst.

The booklet describes findings of a 1976 survey of 883 local Association for Retarded Citizens (ARC) units which revealed great diversity in size, scope of operation, and sophistication. The majority of ARCs had 100 or fewer members, no staff, and were located in areas of 50,000 or fewer people. Other majority characteristics included use of…

Tree shelters and other methods for reducing deer damage to hardwood regeneration in the eastern United States

Treesearch

Gary W. Miller

1998-01-01

This report summarizes the basic silvicultural problems associated with regenerating commercial hardwood (broadleaf) species in the eastern United States and includes a review of current methods used to reduce the impact of deer browsing. The following topics are discussed: 1) the biological requirements and regeneration mechanism associated with several important tree...

California Groundwater Units

USGS Publications Warehouse

Johnson, Tyler D.; Belitz, Kenneth

2014-01-01

The California Groundwater Units dataset classifies and delineates areas within the State of California into one of three groundwater-based polygon units: (1) those areas previously defined as alluvial groundwater basins or subbasins, (2) highland areas that are adjacent to and topographically upgradient of groundwater basins, and (3) highland areas not associated with a groundwater basin, only a hydrogeologic province. In total, 938 Groundwater Units are represented. The Groundwater Units dataset relates existing groundwater basins with their newly delineated highland areas which can be used in subsequent hydrologic studies. The methods used to delineate groundwater-basin-associated highland areas are similar to those used to delineate a contributing area (such as for a lake or water body); the difference is that highland areas are constrained to the immediately surrounding upslope (upstream) area. Upslope basins have their own delineated highland. A geoprocessing tool was created to facilitate delineation of highland areas for groundwater basins and subbasins and is available for download.

Dynamically limiting energy consumed by cooling apparatus

DOEpatents

Chainer, Timothy J.; David, Milnes P.; Iyengar, Madhusudan K.; Parida, Pritish R.; Schmidt, Roger R.; Schultz, Mark D.

2015-05-26

Cooling apparatuses and methods are provided which include one or more coolant-cooled structures associated with an electronics rack, a coolant loop coupled in fluid communication with one or more passages of the coolant-cooled structure(s), one or more heat exchange units coupled to facilitate heat transfer from coolant within the coolant loop, and N controllable components associated with the coolant loop or the heat exchange unit(s), wherein N.gtoreq.1. The N controllable components facilitate circulation of coolant through the coolant loop or transfer of heat from the coolant via the heat exchange unit(s). A controller is coupled to the N controllable components, and dynamically adjusts operation of the N controllable components, based on Z input parameters and one or more specified constraints, to provide a specified cooling to the coolant-cooled structure(s), while limiting energy consumed by the N controllable components, wherein Z.gtoreq.1.

Dynamically limiting energy consumed by cooling apparatus

DOEpatents

Chainer, Timothy J.; David, Milnes P.; Iyengar, Madhusudan K.; Parida, Pritish R.; Schmidt, Roger R.; Schultz, Mark D.

2015-06-09

Cooling methods are provided which include providing: one or more coolant-cooled structures associated with an electronics rack, a coolant loop coupled in fluid communication with one or more passages of the coolant-cooled structure(s), one or more heat exchange units coupled to facilitate heat transfer from coolant within the coolant loop, and N controllable components associated with the coolant loop or the heat exchange unit(s), wherein N.gtoreq.1. The N controllable components facilitate circulation of coolant through the coolant loop or transfer of heat from the coolant via the heat exchange unit(s). A controller is also provided to dynamically adjust operation of the N controllable components, based on Z input parameters and one or more specified constraints, and provide a specified cooling to the coolant-cooled structure(s), while limiting energy consumed by the N controllable components, wherein Z.gtoreq.1.

Internode data communications in a parallel computer

DOEpatents

Archer, Charles J.; Blocksome, Michael A.; Miller, Douglas R.; Parker, Jeffrey J.; Ratterman, Joseph D.; Smith, Brian E.

2013-09-03

Internode data communications in a parallel computer that includes compute nodes that each include main memory and a messaging unit, the messaging unit including computer memory and coupling compute nodes for data communications, in which, for each compute node at compute node boot time: a messaging unit allocates, in the messaging unit's computer memory, a predefined number of message buffers, each message buffer associated with a process to be initialized on the compute node; receives, prior to initialization of a particular process on the compute node, a data communications message intended for the particular process; and stores the data communications message in the message buffer associated with the particular process. Upon initialization of the particular process, the process establishes a messaging buffer in main memory of the compute node and copies the data communications message from the message buffer of the messaging unit into the message buffer of main memory.

Internode data communications in a parallel computer

DOEpatents

Archer, Charles J; Blocksome, Michael A; Miller, Douglas R; Parker, Jeffrey J; Ratterman, Joseph D; Smith, Brian E

2014-02-11

Internode data communications in a parallel computer that includes compute nodes that each include main memory and a messaging unit, the messaging unit including computer memory and coupling compute nodes for data communications, in which, for each compute node at compute node boot time: a messaging unit allocates, in the messaging unit's computer memory, a predefined number of message buffers, each message buffer associated with a process to be initialized on the compute node; receives, prior to initialization of a particular process on the compute node, a data communications message intended for the particular process; and stores the data communications message in the message buffer associated with the particular process. Upon initialization of the particular process, the process establishes a messaging buffer in main memory of the compute node and copies the data communications message from the message buffer of the messaging unit into the message buffer of main memory.

Linking hospital workers' organisational work environment to depressive symptoms: A mediating effect of effort-reward imbalance? The ORSOSA study.

PubMed

Jolivet, Anne; Caroly, Sandrine; Ehlinger, Virgine; Kelly-Irving, Michelle; Delpierre, Cyrille; Balducci, Franck; Sobaszek, Annie; De Gaudemaris, Régis; Lang, Thierry

2010-08-01

Few studies have analysed the association between the organisational work environment and depression in hospital workers and we still have little understanding of how processes in the practice environment are related to depressive disorders. However, individual perception of an imbalance between efforts made and expected rewards has been associated with incident depression. The main goal of this study was to test the hypothesis that some organisational constraints at the work-unit level may be related to depressive symptoms in hospital workers, either directly or through individual perceptions of effort-reward imbalance (ERI). In 2006, 3316 female registered nurses and nursing aids working in 190 work units in seven French university hospitals, recruited from the baseline screening of an epidemiological cohort study (the ORSOSA study), responded in 2006 to valid self-report questionnaires (CES-D, ERI). The organisational work environment was assessed with the self-rated Nursing Work Index - Extended Organisation (NWI-EO) aggregated at the work unit level. Multilevel models were used. We found that poor relations between workers within work units were associated with higher CES-D score, independently of perceived ERI. Low level of communication between workers in the unit was associated with individual perceptions of ERI and indirectly associated with depressive symptoms. Understaffing and non-respect of planned days off and vacations were associated with perceived ERI but these organisational constraints were not associated with depressive symptoms. Our study allowed us to identify and quantify organisational factors that have a direct effect on hospital workers' depressive symptoms, or an indirect effect through perceived ERI. Better understanding of the effect of organisational factors on health through perceived ERI would provide targets for successful interventions. Organisational approaches may be more effective in improving mental health at work and may also have a longer-lasting impact than individual approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

NACUBO's Guide to Unitizing Investment Pools. Second Edition

ERIC Educational Resources Information Center

Wheeler, Mary S.

2011-01-01

The National Association of College and University Business Officers' (NACUBO's) "Guide to Unitizing Investment Pools" addresses the principles and concepts for administering a consolidated investment pool. Unitization is the mechanism by which investment funds are pooled to maximize investment efficiencies and provide information for donors,…

14 CFR 1259.101 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the physical, natural and biological sciences, and engineering, space technology, education, economics... accrediting agency or association. (c) National of the United States means a citizen of the United States or a native resident of a possession of the United States. It does not refer to or include a citizen of...

Infrared Spectral Signatures for Io's Dark and Green Spots

NASA Technical Reports Server (NTRS)

Granahan, J. C.; Fanale, F. P.; Carlson, R.; Smythe, W. D.

2001-01-01

This spectral study of Io identifies the infrared components of the visible spectral units (green and dark) as identified by Galileo. The green units possess sulfur dioxide and the dark units are associated with infrared thermal signatures. Additional information is contained in the original extended abstract.

Post-deployment Mental Health in Reserve and National Guard Service Members: Deploying With or Without One's Unit and Deployment Preparedness.

PubMed

Ursano, Robert J; Wang, Jing; Fullerton, Carol S; Ramsawh, Holly; Gifford, Robert K; Russell, Dale; Cohen, Gregory H; Sampson, Laura; Galea, Sandro

2018-01-01

Given the greater prevalence of post-deployment mental health concerns among reservists, the higher likelihood of deploying without their regular unit, and potentially lower rates of deployment preparedness, we examined associations between deploying with or without one's regular unit (individual augmentee status, IAS), deployment preparedness, and mental health problems including post-traumatic stress disorder (PTSD), depression (MDD), and binge drinking in a nationally representative sample of Reserve Component (RC) Army and Marine-enlisted males (n = 705). A series of multivariate regressions examined the association of mental health with IAS and deployment preparedness, adjusting for demographics. To examine whether deployment preparedness varied by IAS, an IAS × deployment preparedness interaction was included. In an adjusted model, being an individual augmentee and low deployment preparedness were associated with any mental health problem (screening positive for PTSD, MDD, binge drinking, or any combination of the three). There was a significant IAS × deployment preparedness interaction. Mental health problems did not vary by preparedness among individual augmentees. Participants deploying with regular units with low-medium preparedness had greater risk for mental health problems (odds ratio [OR] = 3.69, 95% confidence interval [CI] = 1.78-7.62 and OR = 2.29, 95% CI = 1.12-4.71), than those with high preparedness. RC-enlisted male personnel who deployed without their regular unit were five times more likely to have a mental health problem, and were 61% more likely to report binge drinking. Additionally, those with lower levels of deployment preparedness were up to three times more likely to have a mental health problem and up to six times more likely to report PTSD. The current investigation found that both IAS and deployment preparedness were associated with negative mental health outcomes in a large representative sample of previously deployed RC-enlisted male personnel. In particular, low deployment preparedness was associated with an increased likelihood of PTSD, and deploying without one's regular unit was associated with increased rates of binge drinking. There were also significant main and interaction effects of IAS and deployment preparedness on having a mental health problem. It is possible that limiting the number of RC personnel deploying without their regular unit may help to decrease alcohol misuse among U.S. Armed Services reservists during and after future conflicts. Also, to the extent that deployment preparedness is a modifiable risk factor, future studies should examine whether increasing deployment preparedness could mitigate some of the correlates of deployment-related trauma exposure. Finally, future investigation is needed to explain why those who deploy without their regular unit, but who report high deployment preparedness, remain at elevated risk for mental health problems. It is possible that individual augmentees can benefit from a specific preparation for deployment. Those deploying without their regular unit had higher rates of mental health problems regardless of preparedness. These findings have implications for deployment preparedness training for those deploying without their regular unit. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Source of firearms used by students in school-associated violent deaths--United States, 1992-1999.

PubMed

2003-03-07

During July 1, 1992-June 30, 1999, a total of 323 school-associated violent death events occurred in the United States, resulting in 358 deaths. To guide prevention efforts, CDC examined school-associated firearm violent death events committed by students in elementary and secondary schools in the United States and determined the sources of the firearms used in these events. The findings indicate that, among the incidents for which data are available, the majority of the firearms used in these events were obtained from perpetrators' homes or from friends or relatives. The safe storage of firearms is critically important and should be continued. In addition, other strategies that might prevent firearm-related injuries and deaths among students, such as safety and design changes for firearms, should be evaluated.

Production, Purification and Preliminary X-ray Crystallographic Studies of Adeno-Associated Virus Serotype 9

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

Mitchell, M.; Nam, H; Carter, A

2009-01-01

Adeno-associated virus (AAV) serotype 9, which is under development for gene-delivery applications, shows significantly enhanced capsid-associated transduction efficiency in muscle compared with other AAV serotypes. With the aim of characterizing the structural determinants of this property, the purification, crystallization and preliminary X-ray crystallographic analyses of the AAV9 viral capsid are reported. The crystals diffracted X-rays to 2.8 A resolution using synchrotron radiation and belonged to the trigonal space group P32, with unit-cell parameters a = b = 251.0, c = 640.0 A. There are three complete viral capsids in the crystal unit cell. The orientation and position of the asymmetricmore » unit capsid have been determined by molecular-replacement methods and structure determination is in progress.« less

Immigration, acculturation, and risk factors for obesity and cardiovascular disease: a comparison between Latinos of Peruvian descent in Peru and in the United States.

PubMed

Lizarzaburu, Jesus L; Palinkas, Lawrence A

2002-01-01

To determine whether migration and acculturation was associated with risk factors for obesity and cardiovascular disease, whether this association is linear or curvilinear, and whether the socio-cultural context alters the association between obesity and cardiovascular disease and individual-level variables. Lima, Peru, San Diego and San Francisco, California. Ninety-two Peruvian residents of Lima and 83 Peruvian immigrant residents of California. total cholesterol, blood pressure, body mass index, waist-to-hip ratio. A significant linear association was found between migration and acculturation and alcohol consumption and total cholesterol in men and women, systolic (SBP) and diastolic (DBP) blood pressure and body mass index in men, and physical activity in women. Immigration/acculturation level was a significant independent predictor of total cholesterol. Age and body mass index were independent predictors of total cholesterol only in Peru. Sex was an independent predictor of DBP only in the United States. Body mass index was an in dependent predictor of DBP only in Peru. Household income was an independent predictor of SBP and DBP only in Peru and body mass index only in the United States, while level of education was inversely associated with body mass index only in Peru. Regular strenuous physical activity was an independent predictor of obesity measures only in the United States. The socio-cultural context alters the risk of obesity and cardiovascular disease associated with individual-level variables and accounts for gender and cross-national differences in the migration-illness association.

Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: randomized controlled pilot trial.

PubMed

Lappalainen, Päivi; Kaipainen, Kirsikka; Lappalainen, Raimo; Hoffrén, Henna; Myllymäki, Tero; Kinnunen, Marja-Liisa; Mattila, Elina; Happonen, Antti P; Rusko, Heikki; Korhonen, Ilkka

2013-01-09

Work-related stress is a significant problem for both people and organizations. It may lead to mental illnesses such as anxiety and depression, resulting in increased work absences and disabilities. Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training. The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems. P4Well is a novel intervention which combines modern psychotherapy (the cognitive behavioral therapy and the acceptance and commitment therapy) with personal health technologies to deliver the intervention via multiple channels, includinggroup meetings, Internet/Web portal, mobile phone applications, and personal monitoring devices. This pilot study design was a small-scale randomized controlled trial that compared the P4Well intervention with a waiting list control group. In addition to personal health technologies for self-assessment, the intervention consisted of 3 psychologist-assisted group meetings. Self-assessed psychological measures through questionnaires were collected offline pre- and post-intervention, and 6 months after the intervention for the intervention group. Acceptance and usage of technology tools were measured with user experience questionnaires and usage logs. A total of 24 subjects were randomized: 11 participants were followed up in the intervention group (1 was lost to follow-up) and 12 participants did not receive any intervention (control group). Depressive and psychological symptoms decreased and self-rated health and working ability increased. All participants reported they had benefited from the intervention. All technology tools had active users and 10/11 participants used at least 1 tool actively. Physiological measurements with personal feedback were considered the most useful intervention component. Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms, self-rated health, and self-rated working ability. The intervention seemed to have a positive impact on certain aspects of burnout and job strain, such as cynicism and over-commitment. Future studies need to investigate the effectiveness, benefits, and possible problems of psychological interventions which incorporate new technologies. The Finnish Funding Agency for Technology and Innovation (TEKES), Project number 40011/08.

Better understanding work unit goal orientation: Its emergence and impact under different types of work unit structure.

PubMed

Dragoni, Lisa; Kuenzi, Maribeth

2012-09-01

With a multisource sample comprising 1,150 employees and 230 supervisors, we investigate the effect of leader goal orientation on leader's perceptions of unit performance. We propose that a leader's goal orientation indirectly impacts performance perceptions via the shared achievement goal adopted within the unit (i.e., unit goal orientation). Further, we hypothesize that the presence and impact of unit goal orientation depend on the work unit structure. We find general support for this moderated mediation model, with the strongest evidence being associated with the learning and prove dimensions of goal orientation.

Ergonomic practices within patient care units are associated with musculoskeletal pain and limitations

PubMed Central

Dennerlein, Jack T.; Hopcia, Karen; Sembajwe, Grace; Kenwood, Christopher; Stoddard, Anne M.; Tveito, T. Helene; Hashimoto, Dean M.; Sorensen, Glorian

2013-01-01

Background With the high prevalence of musculoskeletal disorders (MSDs) for patient care unit workers, prevention efforts through ergonomic practices within units may be related to symptoms associated with typical work-related MSDs. Methods We completed a cross-sectional survey of patient care workers (n=1572) in two large academic hospitals in order to evaluate relationships between self-reported musculoskeletal pain, work interference due to this pain, and limitations during activities of daily living (functional limitations) and with ergonomic practices and other organizational policy and practices metrics within the unit. Bivariate and multiple logistic regression analyses tested the significance of these associations. Results Prevalence of self-reported musculoskeletal symptoms in the past 3-months was 74% with 53% reporting pain in the low back. 32.8% reported that this pain interfered with their work duties and 17.7% reported functional limitations in the prior week. Decreased ergonomic practices were significantly associated with reporting pain in four body areas (low back, neck/shoulder, arms, and lower extremity) in the previous 3-months, interference with work caused by this pain, symptom severity and limitations in completing activities of daily living in the past week. Except for low back pain and work interference, these associations remained significant when psychosocial covariates such as psychological demands were included in multiple logistic regressions, Conclusions Ergonomic practices appear to be associated with many of the musculoskeletal symptoms denoting their importance for prevention efforts in acute health care settings. PMID:22113975

Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants.

PubMed

Beltempo, M; Lacroix, G; Cabot, M; Blais, R; Piedboeuf, B

2018-02-01

To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight <1000 g admitted at a 56 bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

PubMed Central

Jakobsen, Louise M; Jorgensen, Anette F B; Thomsen, Birthe L; Greiner, Birgit A; Rugulies, Reiner

2015-01-01

Objectives Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers. Methods Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. Results Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. Conclusions Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions. PMID:26560058

Radio, Television, and Film in the Secondary School, MSA Curriculum Guide 8.

ERIC Educational Resources Information Center

Herman, Deldee M., Ed.; Ratliffe, Sharon A., Ed.

This eight-unit volume of the Michigan Speech Association curriculum guide is designed for use by instructors who teach a one semester course in radio, television, and/or film. It can also be used by those who teach a media unit within an English or speech class. The subject of the first unit is media analysis and evaluation. The second unit is an…

Drive reconfiguration mechanism for tracked robotic vehicle

DOEpatents

Willis, W. David

2000-01-01

Drive reconfiguration apparatus for changing the configuration of a drive unit with respect to a vehicle body may comprise a guide system associated with the vehicle body and the drive unit which allows the drive unit to rotate about a center of rotation that is located at about a point where the drive unit contacts the surface being traversed. An actuator mounted to the vehicle body and connected to the drive unit rotates the drive unit about the center of rotation between a first position and a second position.

Device and method to enhance availability of cluster-based processing systems

NASA Technical Reports Server (NTRS)

Lupia, David J. (Inventor); Ramos, Jeremy (Inventor); Samson, Jr., John R. (Inventor)

2010-01-01

An electronic computing device including at least one processing unit that implements a specific fault signal upon experiencing an associated fault, a control unit that generates a specific recovery signal upon receiving the fault signal from the at least one processing unit, and at least one input memory unit. The recovery signal initiates specific recovery processes in the at least one processing unit. The input memory buffers input data signals input to the at least one processing unit that experienced the fault during the recovery period.

76 FR 64001 - United States Standards for Grades of Frozen Okra

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-17

... to undertaking research and other work associated with revising the grade standards, AMS sought...-327] United States Standards for Grades of Frozen Okra AGENCY: Agricultural Marketing Service, USDA... (USDA) has revised the United States Standards for Grades of Frozen Okra. The grade standards for frozen...

78 FR 29055 - State Medicaid Fraud Control Units; Data Mining

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-17

...] State Medicaid Fraud Control Units; Data Mining AGENCY: Office of Inspector General (OIG), HHS. ACTION... Fraud Control Units (MFCU) from using Federal matching funds to identify fraud through screening and... Control Number (OCN) 0990-0162. Table 2 indicates the paperwork burden associated with the requirements of...

50 CFR 300.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the United States, including, but not limited to, a citizen or resident of the United States, or a... citizen or national of the United States), any corporation, partnership, association, or other entity... one of the six NMFS Regions, described in Table 1 of § 600.502 of this title, or a designee. Science...

50 CFR 300.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the United States, including, but not limited to, a citizen or resident of the United States, or a... citizen or national of the United States), any corporation, partnership, association, or other entity... one of the six NMFS Regions, described in Table 1 of § 600.502 of this title, or a designee. Science...

50 CFR 300.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the United States, including, but not limited to, a citizen or resident of the United States, or a... citizen or national of the United States), any corporation, partnership, association, or other entity... one of the six NMFS Regions, described in Table 1 of § 600.502 of this title, or a designee. Science...

50 CFR 300.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the United States, including, but not limited to, a citizen or resident of the United States, or a... citizen or national of the United States), any corporation, partnership, association, or other entity... one of the six NMFS Regions, described in Table 1 of § 600.502 of this title, or a designee. Science...

Learn, Grow, Become. TSA Edition. Second Edition.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This curriculum guide contains seven Technology Student Association (TSA) units of study for secondary students. The units focus on helping students to develop and apply social, civic, and technology-related skills and achieve course competencies in applied technology courses. Each of the instructional units includes some or all of the basic…

34 CFR 600.52 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... education in professional nursing leading to a degree equivalent to an associate degree in the United States... equivalent to a bachelor of arts, bachelor of science, or bachelor of nursing in the United States, or to a degree equivalent to a graduate degree in nursing in the United States, and including advanced training...

Factors predicting organochlorine pesticide levels in pregnant Latina women living in a United States agricultural area

PubMed Central

Bradman, Asa; Schwartz, Jackie M.; Fenster, Laura; Barr, Dana B.; Holland, Nina T.; Eskenazi, Brenda

2015-01-01

Organochlorine (OC) pesticide use was restricted starting in the 1970s in developed countries and the 1980s and 1990s in developing countries. Current exposure to OC pesticides – DDT, lindane (99% pure gamma-hexachlorocyclohexane (γ-HCH)), hexachlorobenzene (HCB) – occurs on a limited basis. We measured p,p′-DDE, p,p′-DDT, o,p′-DDT, HCB, beta (β)-HCH (the most persistent isomer of technical-grade HCH) and γ-HCH in serum from 426 low-income pregnant Latina women living in an agricultural community in California. Detection frequencies were 94-100%. Median levels (ng/g-lipid) of p,p′-DDE (1,052), p,p′-DDT (13), β-HCH (37) and HCB (65) were significantly higher than U.S. population levels. Multivariate analyses of p,p′-DDE, p,p′-DDT, o,p′-DDT, β-HCH and HCB indicate that time spent living outside the United States and birthplace in an area of Mexico with recent use of OC pesticides were significant predictors of exposure. Time spent living in the United States was associated with increased serum levels of p,p′-DDE and β-HCH, but the increase for each year lived in the United States was lower than for each year lived outside the United States. There was no difference between the increase of HCB levels over time spent in or outside the United States, suggesting current and thus preventable exposure routes. However, we observed no associations between serum levels of any OC compound and current intake of saturated fat or agricultural take-home exposure risk factors. Lactation history and recent weight gain were negatively associated with serum levels of some, but not all OC compounds studied. Smoking history was borderline associated with elevated HCB levels. We observed no significant associations with body mass index. Although the weight of evidence from this study indicates that most exposure occurred prior to moving to the United States, the results for HCB indicate the possibility of ongoing exposure in this country. PMID:17033681

Inter- and intra-disciplinary collaboration and patient safety outcomes in U.S. acute care hospital units: A cross-sectional study.

PubMed

Ma, Chenjuan; Park, Shin Hye; Shang, Jingjing

2018-05-02

Collaboration among healthcare providers has been considered a promising strategy for improving care quality and patient outcomes. Despite mounting evidence demonstrating the impact of collaboration on outcomes of healthcare providers, there is little empirical evidence on the relationship between collaboration and patient safety outcomes, particularly at the patient care unit level. The purpose of this study is to identify the extent to which interdisciplinary collaboration between nurses and physicians and intradisciplinary collaboration among nurses on patient care units are associated with patient safety outcomes. This is a cross-sectional study using nurse survey data and patient safety indicators data from U.S. acute care hospital units. Collaboration at the unit level was measured by two 6-item scales: nurse-nurse interaction scale and nurse-physician interaction scale. Patient outcome measures included hospital-acquired pressure ulcers (HAPUs) and patient falls. The unit of analysis was the patient care unit, and the final sample included 900 units of 5 adult unit types in 160 hospitals in the U.S. Multilevel logistic and Poisson regressions were used to estimate the relationship between collaboration and patient outcomes. All models were controlled for hospital and unit characteristics, and clustering of units within hospitals was considered. On average, units had 26 patients with HAPUs per 1000 patients and 3 patient falls per 1000 patient days. Critical care units had the highest HAPU rate (50/1000 patients) and the lowest fall rate (1/1000 patient days). A one-unit increase in the nurse-nurse interaction scale score led to 31% decrease in the odds of having a HAPU (OR, 0.69; 95% CI, 0.56-0.82) and 8% lower patient fall rate (IRR, 0.92; 95% CI, 0.87-0.98) on a nursing unit. A one-unit increase in the nurse-physician interaction scale score was associated with 19% decrease in the odds of having a HAPU (OR, 0.81; 95% CI, 0.68-0.97) and 13% lower fall rates (IRR, 0.87; 95% CI, 0.82-0.93) on a unit. Both nurse-physician collaboration and nurse-nurse collaboration were significantly associated with patient safety outcomes. Findings from this study suggest that improving collaboration among healthcare providers should be considered as an important strategy for promoting patient safety and both interdisciplinary and intradisciplinary collaboration are critical for achieving better patient outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

Alcohol Consumption in Relation to Risk and Severity of Chronic Widespread Pain: Results From a UK Population‐Based Study

PubMed Central

Beasley, Marcus; Prescott, Gordon J.; McNamee, Paul; Hannaford, Philip C.; McBeth, John; Lovell, Karina; Keeley, Phil; Symmons, Deborah P. M.; Woby, Steve; Norrie, John

2015-01-01

Objective To determine whether the reported level of alcohol consumption is associated with the likelihood of reporting chronic widespread pain (CWP) and, among persons with CWP, the associated disability. Methods In a population‐based study in 2 areas of the UK, participants self‐completed a postal questionnaire. They were classified according to whether they met the American College of Rheumatology definition of CWP and whether the pain was disabling (Chronic Pain Grade III or IV). They reported their usual level of alcohol consumption. Potential confounding factors on which information was available included age, sex, cigarette smoking, employment status, self‐reported weight and height, and level of deprivation. Results A total of 13,574 persons participated (mean age 55 years, 57% women) of whom 2,239 (16.5%) had CWP; 28% reported never regularly consuming alcohol, 28% reported consuming up to 5 units/week, 20% reported 6–10 units/week, and 24% reported >10 units/week. Among persons with CWP, disability was strongly linked to level of alcohol consumption. Prevalence of disability decreased with increasing alcohol consumption up to 35 units/week (odds ratio [OR]21–35 units alcohol/week versus never drinkers 0.33 [95% confidence interval (95% CI) 0.19–0.58]) adjusted for confounders. A similar relationship was found between reporting CWP and level of alcohol consumption (adjusted OR21–35 units alcohol/week versus never drinkers 0.76 [95% CI 0.61–0.94]). Conclusion This study has demonstrated strong associations between level of alcohol consumption and both CWP and related disabilities. However, the available evidence does not allow us to conclude that the association is causal. The strength of the associations means that specific studies to examine this potential relationship are warranted. PMID:26212017

Focus on the legislative approach to short half life radioactive hospital waste releasing.

PubMed

Petrucci, Caterina; Traino, Antonio Claudio

2015-11-01

We propose to summarize the advancements introduced by the new Directive 2013/59/Euratom concerning the concept of clearance, for which the radioactive medical waste represents a typical candidate. We also intend to spotlight disputable points in the regulatory scheme in force in Italy, as well to make a contribution to evaluate whether the practice of patients' urine storing, stated by it, can be regarded to be proper. With directing our interest to radionuclides used in Nuclear Medicine, we first present an overview of how the clearance concept, and that of exemption closely related to it, have been developed from the previous Directive 96/29 to the new one; then we describe the implementation of these concepts in the Italian legislation. Subsequently we estimate the exposure due both to keeping the effluent on site and to direct discharging it to the environment. In line with a well established international consensus, the Directive 2013/59 drives simple and harmonized regulation of clearance. On the contrary, some complexity and lack of consistency can be found in the framework of the national legislation affecting the radioactive medical waste handling. In addition the practice of excreta storing is disputed not to be really beneficial. The opportunity should be taken to make the whole system of these requirements simpler and more consistent and effective when it is revised to transpose the new Directive. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Dust generation at interaction of plasma jet with surfaces

NASA Astrophysics Data System (ADS)

Ticos, Catalin; Toader, Dorina; Banu, Nicoleta; Scurtu, Adrian; Oane, Mihai

2013-10-01

Coatings of W and C with widths of a few microns will be exposed to plasma jet for studying the erosion of the surface and detachment of micron size dust particles. A coaxial plasma gun has been built inside a vacuum chamber for producing supersonic plasma jets. Its design is based on a 50 kJ coaxial plasma gun which has been successfully used for accelerating hypervelocity dust. Initial shots were carried out for a capacitor bank with C = 12 μF and charged up to 2 kV. Currents of tens of amps were measured with a Rogowsky coil and plasma flow speeds of 4 km/s were inferred from high-speed images of jet propagation. An upgrade consisting in adding capacitors in parallel will be performed in order to increase the energy up to 2 kJ. A coil will be installed at the gun muzzle to compress the plasma flow and increase the energy density of the jet on the sample surface. A CCD camera with a maximum recording speed of 100 k fps and a maximum resolution of 1024 × 1024 pixels was set for image acquisition of the plasma and dust. A laser system used to illuminate the ejected dust from the surface includes a laser diode emitting at 650 nm with a beam power of 25 mW. The authors acknowledge support from EURATOM WP13-IPH-A03-P2-02-BS22.

Measurements and simulations of the radiation exposure to aircraft crew workplaces due to cosmic radiation in the atmosphere.

PubMed

Beck, P; Latocha, M; Dorman, L; Pelliccioni, M; Rollet, S

2007-01-01

As required by the European Directive 96/29/Euratom, radiation exposure due to natural ionizing radiation has to be taken into account at workplaces if the effective dose could become more than 1 mSv per year. An example of workers concerned by this directive is aircraft crew due to cosmic radiation exposure in the atmosphere. Extensive measurement campaigns on board aircrafts have been carried out to assess ambient dose equivalent. A consortium of European dosimetry institutes within EURADOS WG5 summarized experimental data and results of calculations, together with detailed descriptions of the methods for measurements and calculations. The radiation protection quantity of interest is the effective dose, E (ISO). The comparison of results by measurements and calculations is done in terms of the operational quantity ambient dose equivalent, H(10). This paper gives an overview of the EURADOS Aircraft Crew In-Flight Database and it presents a new empirical model describing fitting functions for this data. Furthermore, it describes numerical simulations performed with the Monte Carlo code FLUKA-2005 using an updated version of the cosmic radiation primary spectra. The ratio between ambient dose equivalent and effective dose at commercial flight altitudes, calculated with FLUKA-2005, is discussed. Finally, it presents the aviation dosimetry model AVIDOS based on FLUKA-2005 simulations for routine dose assessment. The code has been developed by Austrian Research Centers (ARC) for the public usage (http://avidos.healthphysics.at).

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

PubMed

Atchison, Christie M; Amankwah, Ernest; Wilhelm, Jean; Arlikar, Shilpa; Branchford, Brian R; Stock, Arabela; Streiff, Michael; Takemoto, Clifford; Ayala, Irmel; Everett, Allen; Stapleton, Gary; Jacobs, Marshall L; Jacobs, Jeffrey P; Goldenberg, Neil A

2018-02-01

Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals. The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation. We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression. Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three factors had a markedly increased post-test probability of having hospital-associated venous thromboembolism. Major infection, infancy, and central venous catheterisation are independent risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or cardiac catheter-based intervention, which, in combination, define a high-risk group for hospital-associated venous thromboembolism.

Effective communication network structures for hospital infection prevention: a study protocol.

PubMed

Rangachari, Pavani

2013-01-01

Many hospitals are unable to successfully implement "evidence-based practices" at the unit level. For example, consistent implementation of the central line bundle (CLB), proven to prevent catheter-related bloodstream infections (CRBSIs) is often difficult. This problem has been broadly characterized as "change implementation failure" in health care organizations. Several studies have used retrospective designs to examine the problem; however, there are few prospective studies examining communication dynamics underlying successful implementation of change (eg, evidence-based practices). This prospective study will be set in 2 intensive care units at an academic medical center. At baseline, both units have low compliance with CLB and higher-than-expected CRBSIs. Periodic quality improvement (QI) interventions will be conducted over a 52-week period to promote implementation of CLB in both units. Simultaneously, the following parameters will be examined: (1) Structure and content of communication related to CLB in both units through "communication logs" completed weekly by nurses, physicians, and managers; and (2) outcomes, that is, CLB adherence in both units through weekly chart review. Catheter utilization and CRBSI (infection) rates will serve as additional unit-level outcome measures. The aim is 2-fold: (1) to examine associations between QI interventions and structure and content of communication at the unit level; and (2) to examine associations between structure and content of communication and outcomes at the unit level. The periodic QI interventions are expected to increase CLB adherence and reduce CRBSIs through their influence on structure and content of communication. The prospective design would help examine dynamics in unit-level communication structure and content related to CLB, as well as unit-level outcomes. The study has potential to make significant contributions to theory and practice, particularly if interventions are found to be effective in enabling successful practice change at the unit level. To this effect, the study has potential to provide insights into communication structure and content associated with collective learning and culture change at the unit level. Results and insights are expected to lay a foundation for generating context-sensitive "evidence-based management" strategies for successful practice change at the unit level. An ultimate expected deliverable is the development of an "action-learning framework" for successful implementation of evidence-based practices in health care organizations.

High-threshold motor unit firing reflects force recovery following a bout of damaging eccentric exercise.

PubMed

Macgregor, Lewis J; Hunter, Angus M

2018-01-01

Exercise-induced muscle damage (EIMD) is associated with impaired muscle function and reduced neuromuscular recruitment. However, motor unit firing behaviour throughout the recovery period is unclear. EIMD impairment of maximal voluntary force (MVC) will, in part, be caused by reduced high-threshold motor unit firing, which will subsequently increase to recover MVC. Fourteen healthy active males completed a bout of eccentric exercise on the knee extensors, with measurements of MVC, rate of torque development and surface electromyography performed pre-exercise and 2, 3, 7 and 14 days post-exercise, on both damaged and control limb. EIMD was associated with decreased MVC (235.2 ± 49.3 Nm vs. 161.3 ± 52.5 Nm; p <0.001) and rate of torque development (495.7 ± 136.9 Nm.s-1 vs. 163.4 ± 163.7 Nm.s-1; p <0.001) 48h post-exercise. Mean motor unit firing rate was reduced (16.4 ± 2.2 Hz vs. 12.6 ± 1.7 Hz; p <0.01) in high-threshold motor units only, 48h post-exercise, and common drive was elevated (0.36 ± 0.027 vs. 0.56 ± 0.032; p< 0.001) 48h post-exercise. The firing rate of high-threshold motor units was reduced in parallel with impaired muscle function, whilst early recruited motor units remained unaltered. Common drive of motor units increased in offset to the firing rate impairment. These alterations correlated with the recovery of force decrement, but not of pain elevation. This study provides fresh insight into the central mechanisms associated with EIMD recovery, relative to muscle function. These findings may in turn lead to development of novel management and preventative procedures.

HIV prevention costs and program scale: data from the PANCEA project in five low and middle-income countries.

PubMed

Marseille, Elliot; Dandona, Lalit; Marshall, Nell; Gaist, Paul; Bautista-Arredondo, Sergio; Rollins, Brandi; Bertozzi, Stefano M; Coovadia, Jerry; Saba, Joseph; Lioznov, Dmitry; Du Plessis, Jo-Ann; Krupitsky, Evgeny; Stanley, Nicci; Over, Mead; Peryshkina, Alena; Kumar, S G Prem; Muyingo, Sowedi; Pitter, Christian; Lundberg, Mattias; Kahn, James G

2007-07-12

Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently. The "Prevent AIDS: Network for Cost-Effectiveness Analysis" (PANCEA) project collected 2003 and 2004 cost and output data from 206 HIV prevention programs of six types in five countries. The association between scale and efficiency for each intervention type was examined for each country. Our team characterized the direction, shape, and strength of this association by fitting bivariate regression lines to scatter plots of output levels and unit costs. We chose the regression forms with the highest explanatory power (R2). Efficiency increased with scale, across all countries and interventions. This association varied within intervention and within country, in terms of the range in scale and efficiency, the best fitting regression form, and the slope of the regression. The fraction of variation in efficiency explained by scale ranged from 26-96%. Doubling in scale resulted in reductions in unit costs averaging 34.2% (ranging from 2.4% to 58.0%). Two regression trends, in India, suggested an inflection point beyond which unit costs increased. Unit costs decrease with scale across a wide range of service types and volumes. These country and intervention-specific findings can inform projections of the global cost of scaling up HIV prevention efforts.

High-threshold motor unit firing reflects force recovery following a bout of damaging eccentric exercise

PubMed Central

Macgregor, Lewis J.

2018-01-01

Exercise-induced muscle damage (EIMD) is associated with impaired muscle function and reduced neuromuscular recruitment. However, motor unit firing behaviour throughout the recovery period is unclear. EIMD impairment of maximal voluntary force (MVC) will, in part, be caused by reduced high-threshold motor unit firing, which will subsequently increase to recover MVC. Fourteen healthy active males completed a bout of eccentric exercise on the knee extensors, with measurements of MVC, rate of torque development and surface electromyography performed pre-exercise and 2, 3, 7 and 14 days post-exercise, on both damaged and control limb. EIMD was associated with decreased MVC (235.2 ± 49.3 Nm vs. 161.3 ± 52.5 Nm; p <0.001) and rate of torque development (495.7 ± 136.9 Nm.s-1 vs. 163.4 ± 163.7 Nm.s-1; p <0.001) 48h post-exercise. Mean motor unit firing rate was reduced (16.4 ± 2.2 Hz vs. 12.6 ± 1.7 Hz; p <0.01) in high-threshold motor units only, 48h post-exercise, and common drive was elevated (0.36 ± 0.027 vs. 0.56 ± 0.032; p< 0.001) 48h post-exercise. The firing rate of high-threshold motor units was reduced in parallel with impaired muscle function, whilst early recruited motor units remained unaltered. Common drive of motor units increased in offset to the firing rate impairment. These alterations correlated with the recovery of force decrement, but not of pain elevation. This study provides fresh insight into the central mechanisms associated with EIMD recovery, relative to muscle function. These findings may in turn lead to development of novel management and preventative procedures. PMID:29630622

An Institutional Case Study of Colleges and Universities Associated with Sea Grant in the Pacific Region of the United States

ERIC Educational Resources Information Center

Herrmann, Adelheid C.

2013-01-01

Purpose: The purpose of this study was to examine fishery degree programs at colleges and universities associated with the Sea Grant program in the Pacific region of the United States and to describe how each addresses protecting, rebuilding, and maintaining healthy oceans. Methodology: The study was a qualitative institutional case study that…

Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

ERIC Educational Resources Information Center

Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2012-01-01

The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

Agreement between State of California and California State Employees' Association Covering Bargaining Unit 3, Education and Library, July 1, 1985 through June 30, 1987.

ERIC Educational Resources Information Center

California State Employees' Association, Sacramento.

The collective bargaining agreement between the State of California and California State Employees' Association (CSEA) Bargaining Unit 3, representing all employees in education and library services, is presented covering the period July 1, 1985 through June 30, 1987. The 23 articles cover the following: recognition; CSEA representation rights;…

Serotonin Transporter Gene ("SLC6A4") Methylation Associates with Neonatal Intensive Care Unit Stay and 3-month-old Temperament in Preterm Infants

ERIC Educational Resources Information Center

Montirosso, Rosario; Provenzi, Livio; Fumagalli, Monica; Sirgiovanni, Ida; Giorda, Roberto; Pozzoli, Uberto; Beri, Silvana; Menozzi, Giorgia; Tronick, Ed; Morandi, Francesco; Mosca, Fabio; Borgatti, Renato

2016-01-01

Preterm birth and Neonatal Intensive Care Unit (NICU) stay are early adverse stressful experiences, which may result in an altered temperamental profile. The serotonin transporter gene ("SLC6A4"), which has been linked to infant temperament, is susceptible to epigenetic regulation associated with early stressful experience. This study…

Guidelines for Cognitive Behavioral Training within Doctoral Psychology Programs in the United States: Report of the Inter-Organizational Task Force on Cognitive and Behavioral Psychology Doctoral Education

ERIC Educational Resources Information Center

Klepac, Robert K.; Ronan, George F.; Andrasik, Frank; Arnold, Kevin D.; Belar, Cynthia D.; Berry, Sharon L.; Christofff, Karen A.; Craighead, Linda W.; Dougher, Michael J.; Dowd, E. Thomas; Herbert, James D.; McFarr, Lynn M.; Rizvi, Shireen L.; Sauer, Eric M.; Strauman, Timothy J.

2012-01-01

The Association for Behavioral and Cognitive Therapies initiated an interorganizational task force to develop guidelines for integrated education and training in cognitive and behavioral psychology at the doctoral level in the United States. Fifteen task force members representing 16 professional associations participated in a yearlong series of…

STATEMENT OF VIEWS RELATING TO THE EDUCATION OF THE DEAF IN THE UNITED STATES--1964.

ERIC Educational Resources Information Center

FELLENDORF, GEORGE W.

REPRESENTATIVE OF THE VIEWS OF THE ALEXANDER GRAHAM BELL ASSOCIATION FOR THE DEAF, THIS STATEMENT SETS FORTH THE PURPOSES OF THE BELL ASSOCIATION AND DISCUSSES THE FOLLOWING TOPICS ABOUT DEAF EDUCATION--(1) THEIR AMBITIONS FOR ALL DEAF CHILDREN, (2) A CRITIQUE ON THE EDUCATION OF THE DEAF IN THE UNITED STATES, (3) CONCERN FOR DEAF CHILDREN WHO ARE…

Protocols and Hospital Mortality in Critically ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

PubMed Central

Sevransky, Jonathan E.; Checkley, William; Herrera, Phabiola; Pickering, Brian W.; Barr, Juliana; Brown, Samuel M; Chang, Steven Y; Chong, David; Kaufman, David; Fremont, Richard D; Girard, Timothy D; Hoag, Jeffrey; Johnson, Steven B; Kerlin, Mehta P; Liebler, Janice; O'Brien, James; O'Keefe, Terence; Park, Pauline K; Pastores, Stephen M; Patil, Namrata; Pietropaoli, Anthony P; Putman, Maryann; Rice, Todd W.; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Martin, Greg S

2015-01-01

Objective Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized intensive care units have superior patient outcomes compared with less highly protocolized intensive care units. Design Observational study in which participating intensive care units completed a general assessment and enrolled new patients one day each week. Setting and Patients 6179 critically ill patients across 59 intensive care units in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study Interventions: None Measurements and Main Results The primary exposure was the number of intensive care unit protocols; the primary outcome was hospital mortality. 5809 participants were followed prospectively and 5454 patients in 57 intensive care units had complete outcome data. The median number of protocols per intensive care unit was 19 (IQR 15 to 21.5). In single variable analyses, there were no differences in intensive care unit and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in intensive care units with a high vs. low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p=0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between intensive care units with high vs. low numbers of protocols for lung protective ventilation in ARDS (47% vs. 52%; p=0.28) and for spontaneous breathing trials (55% vs. 51%; p=0.27). Conclusions Clinical protocols are highly prevalent in United States intensive care units. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality. PMID:26110488

Parents' Involvement in Children's Learning in the United States and China: Implications for Children's Academic and Emotional Adjustment

PubMed Central

Cheung, Cecilia Sin-Sze; Pomerantz, Eva M.

2011-01-01

This research examined parents' involvement in children's learning in the United States and China. Beginning in seventh grade, 825 American and Chinese children (mean age = 12.74 years) reported on their parents' involvement in their learning as well as their parents' psychological control and autonomy support every six months until the end of eighth grade. Information on children's academic and emotional adjustment was obtained. American (vs. Chinese) parents' involvement was associated less with their control and more with their autonomy support. Despite these different associations, parents' heightened involvement predicted children's enhanced engagement and achievement similarly in the United States and China. However, it predicted enhanced perceptions of competence and positive emotional functioning more strongly in the United States than China. PMID:21418057

Comparison of rates of reported adverse events associated with i.v. iron products in the United States.

PubMed

Bailie, George R

2012-02-15

An analysis of reported adverse events (AEs) among patients using i.v. iron products, including the newer agent ferumoxytol, is presented. All AE reports to the Food and Drug Administration (FDA) citing iron sucrose, ferric gluconate, high- and low-molecular-weight iron dextran products, or ferumoxytol from October 2009 through June 2010 were evaluated. The rates of various classifications of reported AEs were calculated on a per-unit-sold basis and, for comparison of products supplied in different unit sizes, also in terms of 100-mg dose equivalents (DEq) of iron. A total of 197 reported AEs were identified (a cumulative rate of 14.1 AEs per million units sold). The rates of all AE classifications combined ranged from 5.25 to 746 per million units sold for iron sucrose and ferumoxytol, respectively; using the other method of calculation, the rates ranged from 5.24 per million DEq (iron sucrose) to 147 per million DEq (ferumoxytol). Relative to iron sucrose and sodium ferric gluconate, ferumoxytol was associated with significantly elevated risks of death (odds ratio [OR], 475 and 156, respectively; p < 0.0001), serious nonfatal AEs (OR, 263 and 121, respectively; p < 0.0001), and all evaluated AE classifications combined (OR, 142 and 109, respectively; p < 0.05). Analysis of reports submitted to FDA revealed large differences among i.v. iron products in reported deaths, serious AEs, other major AEs, and other AEs. Iron sucrose and sodium ferric gluconate were associated with much lower rates of AEs per million units sold than iron dextran or ferumoxytol, which were associated with the highest rates of all reported AE classifications.

Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States.

PubMed

Chen, Han-Yang; Chauhan, Suneet P; Ananth, Cande V; Vintzileos, Anthony M; Abuhamad, Alfred Z

2011-06-01

To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality. Copyright © 2011 Mosby, Inc. All rights reserved.

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom12

PubMed Central

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-01-01

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). Objective: The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. Design: In this cross-sectional study of adults aged 39–79 y from the European Prospective Investigation into Cancer and Nutrition–Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom–based supermarket comparison website. Results: Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Conclusions: Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed. PMID:25926505

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom.

PubMed

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-07-01

The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. In this cross-sectional study of adults aged 39-79 y from the European Prospective Investigation into Cancer and Nutrition-Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom-based supermarket comparison website. Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed.

Obesity Risk in Children: The Role of Acculturation in the Feeding Practices and Styles of Low-Income Hispanic Families.

PubMed

Power, Thomas G; O'Connor, Teresia M; Orlet Fisher, Jennifer; Hughes, Sheryl O

2015-12-01

Parent feeding has been associated with child overweight/obesity in low-income families. Because acculturation to the United States has been associated with increased adult obesity, our study aim was to determine whether acculturation was associated with feeding in these populations. Low-income Hispanic mothers of preschoolers were recruited to participate in a longitudinal study examining child eating behaviors. At baseline, mothers completed questionnaires on feeding styles, feeding practices, and acculturation. Regression analyses compared feeding styles and food parenting practices of first-generation, immigrant mothers born outside the United States (n = 138) and mothers born in the United States (n = 31). The correlates of acculturation with these same constructs were also examined. Immigrant mothers reported using highly directive food parenting practices more often than mothers born in the United States, including pressuring their child to consume more food, using food as a reward, and controlling child food intake by limiting less-healthy foods. First-generation mothers were more likely to show authoritarian, and less likely to show indulgent, feeding styles. Greater maternal acculturation was associated with less restriction of food for weight reasons. Although first-generation, immigrant mothers reported using highly controlling food parenting practices with their children, those born in the United States were more indulgent with their children in the feeding context. Mechanisms that promote greater indulgence in more-acculturated mothers need to be identified.

The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey.

PubMed

Mealer, Meredith; Jones, Jacqueline; Newman, Julia; McFann, Kim K; Rothbaum, Barbara; Moss, Marc

2012-03-01

ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses. Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale. Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p<0.001), and a lower prevalence of burnout syndrome (p<0.001). The presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile. Copyright © 2011 Elsevier Ltd. All rights reserved.

Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey.

PubMed

Commodore-Mensah, Yvonne; Ukonu, Nwakaego; Obisesan, Olawunmi; Aboagye, Jonathan Kumi; Agyemang, Charles; Reilly, Carolyn M; Dunbar, Sandra B; Okosun, Ike S

2016-11-04

Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10-1.29), diabetic (OR, 1.43; 95% CI, 1.17-1.73), and hypertensive (OR, 1.18; 95% CI, 1.05-1.32) than those residing in the United States for <10 years. In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Lagoonal deposits in the Upper Cretaceous Rock Springs Formation (Mesaverde Group), southwest Wyoming

USGS Publications Warehouse

Kirschbaum, M.A.

1989-01-01

Most paleogeographic reconstructions of the Rock Springs Formation show shorelines having lobate to arcuate deltas. These shorelines are oriented NE-SW, with the sea to the southeast. Brackish-water bodies are usually shown in interdistributary areas or associated with abandoned delta lobes, and are open to the sea. In this study, a sedimentary sequence 30-50 m thick is interpreted as interdeltaic deposits. Brackish-water deposits within the sequence are interpreted as interdeltaic lagoons rather than interdistributary bays. Three facies associations (units) are recognized in nine measured sections of the study interval. Unit A consists of interbedded sandstone, mudrock and coal which occur in both fining- and coarsening-upward sequences less than 10 m thick. Fining-upward sequences decrease in thickness and frequency upwards in unit A and are interpreted as distributary channels. Coarsening-upward sequences associated with the channels are interpreted as crevasse splays that filled lakes or interdistributary bays. In the upper part of the unit where only minor channels are present, the coarsening-upward sequences are interpreted as bay deltas. Unit B consists of fossiliferous silty shale and bioturbated sandy siltstone. A low-diversity fauna of bivalves, gastropods, ostracods and foraminifers indicates that brackish-water conditions existed. Unit B intertongues with unit A to the northwest and with unit C to the southeast, and is interpreted as lagoonal deposits. Unit C consists of crossbedded and burrowed sandstone in beds 0.5-9 m thick. Sandstones are laterally continuous in the southeast but become tabular bodies enclosed within unit B to the northwest. Laterally continuous sandstones are interpreted as shoreface deposits on the basis of multidirectional crossbeds, marine trace fossils and continuity. Tabular sandstones are interpreted as flood-tidal deltas on the basis of NW-oriented crossbeds, pinchouts to the northwest and enclosure within unit B. Scoured surfaces and rip-up clasts within unit C indicate the presence of tidal channels or inlets. Interpreting unit B as an interdeltaic lagoon rather than an interdistributary bay is dependent on understanding its enclosing strata. The distributary channels of unit A supplied the majority of the sediment in the lower part of the sequence. However, after the lagoon formed, tidal channels and inlets of unit C supplied more sediment to the area than channels of unit A. The shift in sedimentation from a landward to a seaward source reflects the change from a delta plain to an interdeltaic lagoon following abandonment of distributary channels. ?? 1989.

Unit Support Protects Against Sexual Harassment and Assault among National Guard Soldiers

PubMed Central

Walsh, Kate; Galea, Sandro; Cerda, Magdalena; Richards, Catherine; Liberzon, Israel; Tamburrino, Marijo B.; Calabrese, Joseph; Koenen, Karestan C.

2014-01-01

Objective Despite concerns about increased sexual harassment and assault following 2013 legislation repealing the ban on women in combat, little research has examined military factors that could prevent sexual harassment and assault during deployment. This study examined whether unit support, which reflects the quality of service members’ relationships within their unit, protects against sexual harassment and assault during deployment. Methods Participants were 1674 Ohio Army National Guard service members who reported at least one deployment during a telephone survey conducted in 2008-2009. Participants completed measures of sexual harassment/assault, unit support, and psychosocial support. Logistic regression was used to model odds of sexual harassment/assault. Results Approximately 13.2% (n=198) of men and 43.5% (n=74) of women reported sexual harassment, and 1.1% (n=17) of men and 18.8% (n=32) of women reported sexual assault during their most recent deployment. Higher unit support was associated with decreased odds of sexual harassment and assault. Conclusions A substantial proportion of men and women reported sexual harassment/assault. Higher unit support was associated with diminished odds of sexual harassment/assault during deployment. Programming designed to improve unit cohesion has potential to reduce sexual harassment and assault. PMID:25442705

A Review of Factors Influencing the Banking of Collected Umbilical Cord Blood Units

PubMed Central

Allan, David; Petraszko, Tanya; Elmoazzen, Heidi; Smith, Susan

2013-01-01

Umbilical cord blood banking efforts have increased dramatically in the past two decades in response to increasing demand for alternative sources of blood stem cells to support patients requiring hematopoietic stem cell transplantation. Transplant centres have accumulated increasing expertise in their understanding of umbilical cord blood characteristics that are associated with improved outcome following transplantation. These characteristics and factors can assist transplant centres in selecting cord blood units from the worldwide inventory of banked units. Umbilical cord blood banks, therefore, need to remain agile in adjusting the inventory of the banks to address shifts or changes in the needs of transplant centres. Public umbilical cord blood banks face the challenge of building inventory while managing limited resources and are faced with decisions regarding which units can be stored and which units that have been collected should be discarded or used for other endeavours such as research. To this end, we sought to review parameters influencing the decision to bank a collected cord blood unit. In this paper, we will address parameters associated with graft potency and address other factors that guide the decision to bank collected units. PMID:23533442

A Multidisciplinary Clinical Pathway Decreases Rib Fracture-Associated Infectious Morbidity and Mortality in High-Risk Trauma Patients

DTIC Science & Technology

2006-01-01

cough. Pain was assessed during incentive spirometry or coughing using a visual analogue scale (score from 1 to 10) with failure being a score...fracture multidisciplinary clinical pathway. SIMU Surgical Intermediate Care Unit; STICU Shock Trauma Intensive Care Unit; IS incentive spirometry ...monitored bed (Surgical Intermediate Care Unit or Shock Trauma Intensive Care Unit) where they received patient-controlled analgesia and incentive

Comparison of nurse staffing based on changes in unit-level workload associated with patient churn.

PubMed

Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie

2015-04-01

This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.

Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002–20121

PubMed Central

Strollo, Sara; Lionakis, Michail S.; Adjemian, Jennifer; Steiner, Claudia A.

2017-01-01

Invasive candidiasis is a major nosocomial fungal disease in the United States associated with high rates of illness and death. We analyzed inpatient hospitalization records from the Healthcare Cost and Utilization Project to estimate incidence of invasive candidiasis–associated hospitalizations in the United States. We extracted data for 33 states for 2002–2012 by using codes from the International Classification of Diseases, 9th Revision, Clinical Modification, for invasive candidiasis; we excluded neonatal cases. The overall age-adjusted average annual rate was 5.3 hospitalizations/100,000 population. Highest risk was for adults >65 years of age, particularly men. Median length of hospitalization was 21 days; 22% of patients died during hospitalization. Median unadjusted associated cost for inpatient care was $46,684. Age-adjusted annual rates decreased during 2005–2012 for men (annual change –3.9%) and women (annual change –4.5%) and across nearly all age groups. We report a high mortality rate and decreasing incidence of hospitalizations for this disease. PMID:27983497

Epidemiology of Hospitalizations Associated with Invasive Candidiasis, United States, 2002-20121.

PubMed

Strollo, Sara; Lionakis, Michail S; Adjemian, Jennifer; Steiner, Claudia A; Prevots, D Rebecca

2016-01-01

Invasive candidiasis is a major nosocomial fungal disease in the United States associated with high rates of illness and death. We analyzed inpatient hospitalization records from the Healthcare Cost and Utilization Project to estimate incidence of invasive candidiasis-associated hospitalizations in the United States. We extracted data for 33 states for 2002-2012 by using codes from the International Classification of Diseases, 9th Revision, Clinical Modification, for invasive candidiasis; we excluded neonatal cases. The overall age-adjusted average annual rate was 5.3 hospitalizations/100,000 population. Highest risk was for adults >65 years of age, particularly men. Median length of hospitalization was 21 days; 22% of patients died during hospitalization. Median unadjusted associated cost for inpatient care was $46,684. Age-adjusted annual rates decreased during 2005-2012 for men (annual change -3.9%) and women (annual change -4.5%) and across nearly all age groups. We report a high mortality rate and decreasing incidence of hospitalizations for this disease.

Healthcare system and the wealth-health gradient: a comparative study of older populations in six countries.

PubMed

Maskileyson, Dina

2014-10-01

The present study provides a comparative analysis of the association between wealth and health in six healthcare systems (Sweden, the United Kingdom, Germany, the Czech Republic, Israel, the United States). National samples of individuals fifty years and over reveal considerable cross-country variations in health outcomes. In all six countries wealth and health are positively associated. The findings also show that state-based healthcare systems produce better population health outcomes than private-based healthcare systems. The results indicate that in five out of the six countries studied, the wealth-health gradients were remarkably similar, despite significant variations in healthcare system type. Only in the United States was the association between wealth and health substantially different from, and much greater than that in the other five countries. The findings suggest that private-based healthcare system in the U.S. is likely to promote stronger positive associations between wealth and health. Copyright © 2014 Elsevier Ltd. All rights reserved.

Is walkability associated with a lower cardiometabolic risk?

PubMed

Coffee, Neil T; Howard, Natasha; Paquet, Catherine; Hugo, Graeme; Daniel, Mark

2013-05-01

Walkability of residential environments has been associated with more walking. Given the health benefits of walking, it is expected that people living in locations with higher measured walkability should have a lower risk of cardiometabolic diseases. This study tested the hypothesis that higher walkability was associated with a lower cardiometabolic risk (CMR) for two administrative spatial units and three road buffers. Data were from the North West Adelaide Health Study first wave of data collected between 2000 and 2003. CMR was expressed as a cumulative sum of six clinical risk markers, selected to reflect components of the metabolic syndrome. Walkability was based on an established methodology and operationalised as dwelling density, intersection density, land-use mix and retail footprint. Walkability was associated with lower CMR for the three road buffer representations of the built environment but not for the two administrative spatial units. This may indicate a limitation in the use of administrative spatial units for analyses of walkability and health outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Role of pattern recognition receptors of the neurovascular unit in inflamm-aging.

PubMed

Wilhelm, Imola; Nyúl-Tóth, Ádám; Kozma, Mihály; Farkas, Attila E; Krizbai, István A

2017-11-01

Aging is associated with chronic inflammation partly mediated by increased levels of damage-associated molecular patterns, which activate pattern recognition receptors (PRRs) of the innate immune system. Furthermore, many aging-related disorders are associated with inflammation. PRRs, such as Toll-like receptors (TLRs) and nucleotide-binding oligomerization domain-like receptors (NLRs), are expressed not only in cells of the innate immune system but also in other cells, including cells of the neurovascular unit and cerebral vasculature forming the blood-brain barrier. In this review, we summarize our present knowledge about the relationship between activation of PRRs expressed by cells of the neurovascular unit-blood-brain barrier, chronic inflammation, and aging-related pathologies of the brain. The most important damage-associated molecular pattern-sensing PRRs in the brain are TLR2, TLR4, and NLR family pyrin domain-containing protein-1 and pyrin domain-containing protein-3, which are activated during physiological and pathological aging in microglia, neurons, astrocytes, and possibly endothelial cells and pericytes. Copyright © 2017 the American Physiological Society.

Knowledge levels of intensive care nurses on prevention of ventilator-associated pneumonia.

PubMed

Akın Korhan, Esra; Hakverdioğlu Yönt, Gülendam; Parlar Kılıç, Serap; Uzelli, Derya

2014-01-01

Ventilator-associated pneumonia constitutes a significant concern for ventilated patients in the intensive care unit. This study was planned to evaluate the knowledge of nurses working in general intensive care units concerning evidence-based measures for the prevention of ventilator-associated pneumonia. This study design is cross-sectional. It was carried out on nurses working in the general intensive care units of anesthiology and re-animation clinics. Collection of research data was performed by means of a Nurse Identification Form and a Form of Evidence-Based Knowledge concerning the Prevention of Ventilator-Associated Pneumonia. Characterization statistics were shown by percentage, median and interquartile range. Chi-square and Wilcoxon tests and Kruskal-Wallis tests were used as appropriate. The median value of total points scored by nurses on the questionnaire was 4.00 ± 2.00. The difference between the nurses' education levels, duration of work experience and participation in in-service training programmes on ventilator-associated pneumonia prevention and the median value of their total scores on the questionnaire was found to be statistically significant (p < 0.05). The conclusion of the study was that critical care nurses' knowledge about ventilator-associated pneumonia prevention is poor. © 2013 British Association of Critical Care Nurses.

Gastrointestinal health effects associated with the consumption of drinking water produced by point-of-use domestic reverse-osmosis filtration units.

PubMed Central

Payment, P; Franco, E; Richardson, L; Siemiatycki, J

1991-01-01

During a prospective epidemiological study of gastrointestinal health effects associated with the consumption of drinking water produced by reverse-osmosis domestic units, a correlation was demonstrated between the bacterial counts on R2A medium incubated at 35 degrees C and the reported gastrointestinal symptoms in families who used these units. A univariate correlation was found with bacterial counts on R2A medium at 20 degrees C but was confounded by the bacterial counts at 35 degrees C. Other variables, such as family size and amount of water consumed, were not independently explanatory of the rate of illness. These observations raise concerns for the possibility of increased disease associated with certain point-of-use treatment devices for domestic use when high levels of bacterial growth occur. PMID:2059052

Analyses and Comparisons of Science Curricula in Japan and the United States.

ERIC Educational Resources Information Center

Jacobson, Willard J.; And Others

An analysis and comparison of science education in Japan and the United States is presented. Studies in comparative science education, including the first and second International Association for the Evaluation of Educational Achievement (IEA) and the Japan and United States Cooperative Science Project, provide an empirical base for some of the…

76 FR 28459 - Notice of Lodging of Consent Decree Under the Comprehensive Environmental Response, Compensation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-17

... Response, Compensation, and Liability Act Notice is hereby given that on May 11, 2011, a proposed Consent Decree (the ``Decree'') in United States v. Alsol Corporation, SB Building Associates, Limited Partnership, SB Building GP, L.L.C., United States Land Resources, L.P., United States Realty Resources, Inc...

"Chew Heong v. United States": Chinese Exclusion and the Federal Courts

ERIC Educational Resources Information Center

Landman, James H., Ed.

2007-01-01

This article is adapted from "Chew Heong v. United States: Chinese Exclusion and the Federal Courts", written by Lucy Salyer, associate professor of history at the University of New Hampshire, for inclusion in the Federal Judicial Center's project, "Federal Trials and Great Debates in United States History." In 1882, Congress…

Reconceptualising Childhood: Children's Rights and Youth Participation in Schools

ERIC Educational Resources Information Center

Johnny, Leanne

2006-01-01

Article 12 of the United Nations Convention on the Rights of the Child holds that young people have a right to participate in matters affecting them. While all members of the United Nations have ratified the Convention (with the exception of the United States and Somalia), there are numerous challenges associated with implementing the…

Genome-Wide Associations for Multiple Pest Resistances in a Northwestern United States Elite Spring Wheat Panel

USDA-ARS?s Scientific Manuscript database

Northern areas of the western United States are one of the most productive wheat growing regions in the United States. Increasing productivity through breeding is hindered by several biotic stresses which slow and constrain targeted yield improvement. In order to understand genetic variation for str...

Urinary tract infections due to Trichosporon spp. in severely ill patients in an intensive care unit

PubMed Central

Mattede, Maria das Graças Silva; Piras, Cláudio; Mattede, Kelly Dematte Silva; Ferrari, Aline Trugilho; Baldotto, Lorena Simões; Assbu, Michel Silvestre Zouain

2015-01-01

Objective To evaluate the incidence of urinary tract infections due to Trichosporon spp. in an intensive care unit. Methods This descriptive observational study was conducted in an intensive care unit between 2007 and 2009. All consecutive patients admitted to the intensive care unit with a confirmed diagnosis were evaluated. Results Twenty patients presented with urinary tract infections due to Trichosporon spp. The prevalence was higher among men (65%) and among individuals > 70 years of age (55%). The mortality rate was 20%. The average intensive care unit stay was 19.8 days. The onset of infection was associated with prior use of antibiotics and was more frequent in the fall and winter. Conclusion Infection due to Trichosporon spp. was more common in men and among those > 70 years of age and was associated with the use of an indwelling urinary catheter for more than 20 days and with the use of broadspectrum antibiotics for more than 14 days. In addition, patients with urinary infection due to Trichosporon spp. were most often hospitalized in intensive care units in the fall and winter periods. PMID:26465246

A moving paradox: a binational view of obesity and residential mobility.

PubMed

Glick, Jennifer E; Yabiku, Scott T

2015-04-01

This paper takes a unique approach to the study of immigrant and native health differentials by addressing the role of internal as well as international mobility and considering the binational context in which such moves occur. The analyses take advantage of a unique dataset of urban residents in Mexico and the United States to compare Mexican origin immigrants and US-born Spanish-speaking residents in one urban setting in the United States and residents in a similar urban setting in Mexico. The binational approach allows for the test of standard indicators used to proxy acculturation (duration of residence in the United States, household language use) and measures of residential mobility among Mexican-Americans, Mexican immigrants and residents in Mexico. The results confirm a lower prevalence of obesity among Mexicans in Mexico and recent immigrants to the United States when compared to longer residents in the United States. However, for Mexican urban residents, more residential moves are associated with less obesity, while more residential mobility is associated with higher obesity in the urban sample in the United States.

78 FR 22198 - Connect America Fund; A National Broadband Plan for Our Future; Establishing Just and Reasonable...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... waiver, filed by the United States Telecom Association and CTIA--The Wireless Association. The Bureau... States Telecom Association (USTelecom) and CTIA--The Wireless Association (CTIA) (collectively... 22201

The perplexing links between contraceptive sterilization and (dis)advantage in ten low-fertility countries1

PubMed Central

Eeckhaut, Mieke C. W.; Sweeney, Megan M.

2015-01-01

This study investigates the association between sterilization and socioeconomic status in comparative context, using data from the 2006–10 National Survey of Family Growth and the 2004–10 Generations and Gender Surveys. We first confirm that longstanding patterns of association between socioeconomic status and sterilization persist in the contemporary United States. Specifically, female sterilization is associated with economic disadvantage whereas male sterilization is associated with economic advantage. We next show that female sterilization is similarly associated with disadvantage in most study countries, whereas a positive association between socioeconomic advantage and male sterilization is largely unique to the United States. However, while basic demographic background factors such as early childbearing and parity can explain the observed associations in most study countries, a strong gendered association between sterilization and socioeconomic status remains in the U.S. and Belgium even when adjusting for these factors. PMID:26792541

Change in body mass index between pregnancies and the risk of gestational diabetes in a second pregnancy.

PubMed

Ehrlich, Samantha F; Hedderson, Monique M; Feng, Juanran; Davenport, Erica R; Gunderson, Erica P; Ferrara, Assiamira

2011-06-01

To estimate the association between interpregnancy change in body mass index (BMI) and the risk of gestational diabetes mellitus (GDM) in a second pregnancy. In a retrospective cohort analysis of 22,351 women, logistic regression models provided adjusted estimates of the risk of GDM in women gaining 3.0 or more 2.0-2.9, and 1.0-1.9 BMI units, or losing 1.0-2.0 and more than 2.0 units between pregnancies (one BMI unit corresponds to 5.9 pounds for the average height [5 feet 4 inches] of the study population). Women with stable BMIs (±1.0 BMI unit) comprised the reference. For those with GDM in the first pregnancy, the age-adjusted risk of GDM in the second pregnancy was 38.19% (95% confidence interval [CI] 34.96-41.42); for those whose first pregnancy was not complicated by GDM, the risk was 3.52% (95% CI 3.27-3.76). Compared with women who remained stable, interpregnancy BMI gains were associated with an increased risk of GDM in the second pregnancy (odds ratio [OR] 1.71 [95% CI 1.42-2.07] for gaining 1.0-1.9 BMI units; OR 2.46 [95% CI 2.00-3.02] for 2.0-2.9 BMI units; and OR 3.40 [95% CI 2.81-4.12] for 3.0 or more BMI units). The loss of BMI units was associated with a lower risk of GDM only among women who were overweight or obese in the first pregnancy (OR 0.26 [95% CI 0.14-0.47] for the loss of at least 2.0 BMI units). In overweight and obese women, those with GDM in the first pregnancy that did not develop the condition again gained fewer BMI units than those experiencing recurrent GDM (mean change 0.66 [95% CI 0.25-1.07] compared with 2.00 [95% CI 1.56-2.43] BMI units, respectively). Interpregnancy increases in BMI between the first and second pregnancy increases a woman's risk of GDM pregnancy.

What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland

PubMed Central

Parda, Natalia; Stępień, Małgorzata; Zakrzewska, Karolina; Madaliński, Kazimierz; Kołakowska, Agnieszka; Godzik, Paulina; Rosińska, Magdalena

2016-01-01

Objectives Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. Design Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. Setting This study was conducted in primary care units in selected provinces in Poland. Participants A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. Results Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. Conclusions Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed. PMID:27927665

What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland.

PubMed

Parda, Natalia; Stępień, Małgorzata; Zakrzewska, Karolina; Madaliński, Kazimierz; Kołakowska, Agnieszka; Godzik, Paulina; Rosińska, Magdalena

2016-12-07

Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. This study was conducted in primary care units in selected provinces in Poland. A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Compared to Palliative Care, Working in Intensive Care More than Doubles the Chances of Burnout: Results from a Nationwide Comparative Study

PubMed Central

Teixeira, Carla Margarida; Carvalho, Ana Sofia; Hernández-Marrero, Pablo

2016-01-01

Introduction Professionals working in intensive and palliative care units, hence caring for patients at the end-of-life, are at risk of developing burnout. Workplace conditions are determinant factors to develop this syndrome among professionals providing end-of-life care. Objectives To identify and compare burnout levels between professionals working in intensive and palliative care units; and to assess which workplace experiences are associated with burnout. Methods A nationwide, multicentre quantitative comparative survey study was conducted in Portugal using the following instruments: Maslach Burnout Inventory–Human Services Survey, Questionnaire of workplace experiences and ethical decisions, and Questionnaire of socio-demographic and professional characteristics. A total of 355 professionals from 10 intensive care and 9 palliative care units participated in the survey. A series of univariate and multivariate logistic regression analyses were performed; odds ratio sidelong with 95% confidence intervals were calculated. Results 27% of the professionals exhibited burnout. This was more frequent in intensive care units (OR = 2.525, 95% CI: 1.025–6.221, p = .006). Univariate regression analyses showed that higher burnout levels were significantly associated with conflicts, decisions to withhold/withdraw treatment, and implementing palliative sedation. When controlling for socio-demographic and educational characteristics, and setting (intensive care units versus palliative care units), higher burnout levels were significantly and positively associated with experiencing conflicts in the workplace. Having post-graduate education in intensive/palliative care was significantly but inversely associated to higher burnout levels. Conclusions Compared to palliative care, working in intensive care units more than doubled the likelihood of exhibiting burnout. Experiencing conflicts (e.g., with patients and/or families, intra and/or inter-teams) was the most significant determinant of burnout and having post-graduate education in intensive/palliative care protected professionals from developing this syndrome. This highlights the need for promoting empowering workplace conditions, such as team empowerment and conflict management. Moreover, findings suggest the need for implementing quality improvement strategies and organizational redesign strategies aimed at integrating the philosophy, principles and practices of palliative care in intensive care units. PMID:27612293

Effects of self-construal and its relationship with subjective well-being across cultures.

PubMed

Yamaguchi, Ayano; Kim, Min-Sun

2015-01-01

The purpose of this study is to test cross-cultural predictions of the associations between goal pursuits and subjective well-being among 601 college students (200 in Japan and 401 in the United States). The results indicated that interdependence in all cultures was associated with socially oriented subjective well-being. In the United States, it was also correlated with social goal pursuit. However, independence in the United States correlated with individual-oriented subjective well-being, while in Hawaii, it also correlated with hedonic goal pursuit. Discussion of these results and their implications are provided. © The Author(s) 2013.

Use of Six Sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive care unit.

PubMed

Loftus, Kelli; Tilley, Terry; Hoffman, Jason; Bradburn, Eric; Harvey, Ellen

2015-01-01

The creation of a consistent culture of safety and quality in an intensive care unit is challenging. We applied the Six Sigma Define-Measure-Analyze-Improve-Control (DMAIC) model for quality improvement (QI) to develop a long-term solution to improve outcomes in a high-risk neurotrauma intensive care unit. We sought to reduce central line utilization as a cornerstone in preventing central line-associated bloodstream infections (CLABSIs). This study describes the successful application of the DMAIC model in the creation and implementation of evidence-based quality improvement designed to reduce CLABSIs to below national benchmarks.

Impact of water quality on the bacterial populations and off-flavours in recirculating aquaculture systems.

PubMed

Auffret, Marc; Yergeau, Étienne; Pilote, Alexandre; Proulx, Émilie; Proulx, Daniel; Greer, Charles W; Vandenberg, Grant; Villemur, Richard

2013-05-01

A variety of factors affecting water quality in recirculating aquaculture systems (RAS) are associated with the occurrence of off-flavours. In this study, we report the impact of water quality on the bacterial diversity and the occurrence of the geosmin-synthesis gene (geoA) in two RAS units operated for 252 days. Unit 2 displayed a higher level of turbidity and phosphate, which affected the fresh water quality compared with unit 1. In the biofilter, nitrification is one of the major processes by which high water quality is maintained. The bacterial population observed in the unit 1 biofilter was more stable throughout the experiment, with a higher level of nitrifying bacteria compared with the unit 2 biofilter. Geosmin appeared in fish flesh after 84 days in unit 2, whereas it appeared in unit 1 after 168 days, but at a much lower level. The geoA gene was detected in both units, 28 days prior to the detection of geosmin in fish flesh. In addition, we detected sequences associated with Sorangium and Nannocystis (Myxococcales): members of these genera are known to produce geosmin. These sequences were observed at an earlier time in unit 2 and at a higher level than in unit 1. This study confirms the advantages of new molecular methods to understand the occurrence of geosmin production in RAS. © 2012 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd. All rights reserved.

Production, purification and preliminary X-ray crystallographic studies of adeno-associated virus serotype 1

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

Miller, Edward B.; Gurda-Whitaker, Brittney; Govindasamy, Lakshmanan

2006-12-01

Crystals of baculovirus-expressed adeno-associated virus serotype 1 (AAV1) capsids have been grown in the rhombohedral space group R32 (unit-cell parameters a = 254.7 Å, α = 62.3°) and shown to diffract X-rays to at least 2.5 Å resolution. Crystals of baculovirus-expressed adeno-associated virus serotype 1 (AAV1) capsids have been grown in the rhombohedral space group R32 (unit-cell parameters a = 254.7 Å, α = 62.3°) and shown to diffract X-rays to at least 2.5 Å resolution. The diffraction data were subsequently processed and reduced with an overall R{sub sym} of 12.3% and a completeness of 89.0%. Based on the unit-cellmore » volume, rotation-function and translation-function results and packing considerations, there is one virus capsid (60 viral proteins) per unit cell and there are ten viral proteins per crystallographic asymmetric unit. The AAV1 capsid shares both the twofold and threefold crystallographic symmetry operators. The AAV1 data have been initially phased using a polyalanine model (based on the crystal structure of AAV4) to 4.0 Å resolution and the structure determination and refinement is in progress using tenfold noncrystallographic symmetry electron-density averaging.« less

Travailleurs-Euses, Étudiant-Es : Même Combat! Association of Graduate Students Employed at McGill (AGSEM), 2012-2013 Teaching Assistants' Unit Executive

ERIC Educational Resources Information Center

McGill Journal of Education, 2013

2013-01-01

In the wake of the Québec student movement, graduate students of the 2012-2013 executive team for the Teaching Assistants' Unit of the Association of Graduate Students Employed at McGill (AGSEM) reflect on their individual backgrounds and motivations for pursuing union work. With various opportunities for employment on and off campus, what compels…

The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe.

PubMed

DiBonaventura, Marco; Luo, Xuemei; Moffatt, Margaret; Bushmakin, Andrew G; Kumar, Maya; Bobula, Joel

2015-09-01

Vulvovaginal atrophy (VVA) is a condition associated with decreased estrogenization of the vaginal tissue, which can result in vaginal dryness, irritation, and dyspareunia. This study quantified the burden associated with VVA symptoms across the United States and Europe and compared this burden with other chronic conditions. Data were analyzed from the International Women's Health Study, a cross-sectional Internet survey of women aged 40-75 years in the United States and Europe. All postmenopausal women aged 40-75 years were included in the analyses (Germany n=970, Spain n=294, France n=1054, Italy n=387, United Kingdom n=1096, United States n=3267). VVA symptom severity (none, mild, moderate, severe) was assessed using the Menopause Rating Scale and included in general linear models to predict EuroQol-5D (EQ-5D) quality of life scores. The prevalence of VVA symptoms varied between 40.00% (Germany) and 54.42% (Spain), with half of women reporting their symptoms as either moderate or severe. Pooling data from all countries together, each incremental level of severity (none through severe) was associated with a significant decrement in EQ-5D scores (none=0.84 vs. mild=0.81 vs. moderate=0.79 vs. severe=0.74; p<0.05). The decrements in EQ-5D scores associated with moderate to severe VVA symptoms were comparable to those observed in other serious conditions including arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. VVA symptoms are associated with clinically meaningful decrements in quality of life that may be comparable to serious conditions such as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Improved management of VVA symptoms may be required to alleviate the impact of VVA on the quality of life of affected women.

Impact and determinants of nurse turnover: a pan-Canadian study.

PubMed

O'Brien-Pallas, Linda; Murphy, Gail Tomblin; Shamian, Judith; Li, Xiaoqiang; Hayes, Laureen J

2010-11-01

As part of a large study of nursing turnover in Canadian hospitals, the present study focuses on the impact and key determinants of nurse turnover and implications for management strategies in nursing units. Nursing turnover is an issue of ever-increasing priority as work-related stress and job dissatisfaction are influencing nurses' intention to leave their positions. Data sources included the nurse survey, unit managers, medical records and human resources databases. A broad sample of hospitals was represented with nine different types of nursing units included. Nurses turnover is a major problem in Canadian hospitals with a mean turnover rate of 19.9%. Higher levels of role ambiguity and role conflict were associated with higher turnover rates. Increased role conflict and higher turnover rates were associated with deteriorated mental health. Higher turnover rates were associated with lower job satisfaction. Higher turnover rate and higher level of role ambiguity were associated with an increased likelihood of medical error. Managing turnover within nursing units is critical to high-quality patient care. A supportive practice setting in which role responsibilities are understood by all members of the caregiver team would promote nurse retention. Stable nurse staffing and adequate managerial support are essential to promote job satisfaction and high-quality patient care. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Emotional eating and eating psychopathology in nonclinical groups: a cross-cultural comparison of women in Japan and the United Kingdom.

PubMed

Waller, G; Matoba, M

1999-11-01

Emotional eating is associated with eating psychopathology among Western populations. It is not known whether the same conclusions hold in non-Western cultures, where norms for emotional expression differ. This study examined whether emotional eating has the same eating psychopathology correlates in different cultures. Three groups of nonclinical women were compared-Japanese living in Japan; Japanese living in the United Kingdom; and British living in the United Kingdom. They completed an Emotional Eating Scale and the Eating Disorders Inventory. There were different patterns of association between emotional eating and eating attitudes in the three groups. British women showed a strong linkage, Japanese women living in Japan showed no association, and Japanese women in the United Kingdom showed an intermediate pattern. Emotional eating may be less of an index of eating psychopathology in non-Western cultures. However, there appears to be an acculturative process, linking the two when one enters a Western culture. This cross-cultural difference may have implications for the targeting of therapies, although this conclusion requires support from further research. Copyright 1999 by John Wiley & Sons, Inc.

Risk factors for toxoplasmosis in pregnant women in Kent, United Kingdom.

PubMed Central

Nash, J. Q.; Chissel, S.; Jones, J.; Warburton, F.; Verlander, N. Q.

2005-01-01

The aim of this study was to establish the relative importance of various risk factors for toxoplasmosis in a United Kingdom antenatal population. Toxoplasma immune status was determined by an immunoassay and linked to a questionnaire exploring dietary and environmental exposure to toxoplasmosis. The overall seroprevalence found was 9.1% (172/1897). A significantly higher seroprevalence was associated with rural location of the childhood home, childhood home in Europe excluding the United Kingdom, feeding a dog raw meat and increased age. A non-significant higher prevalence of toxoplasmosis was observed in women who had lived with a cat or kitten as a child. In contrast to recent European studies only weak associations between diet and toxoplasmosis were found. Gardening activity was not associated with seropositivity but a non-significant lower seroprevalence was seen in gardeners who always wore gloves. This study confirms that toxoplasma prevalence in the United Kingdom has continued to decline since the 1960s. The increasing seroprevalence with age found in this study, highlights the continuing need to educate women of childbearing age about the risk factors for toxoplasmosis. PMID:15962554

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

PubMed

Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

2014-08-01

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy.

PubMed

Waters, Teresa M; Daniels, Michael J; Bazzoli, Gloria J; Perencevich, Eli; Dunton, Nancy; Staggs, Vincent S; Potter, Catima; Fareed, Naleef; Liu, Minzhao; Shorr, Ronald I

2015-03-01

In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events. United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings. The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.

The United States Does CAIR About Cultural Safety: Examining Cultural Safety Within Indigenous Health Contexts in Canada and the United States.

PubMed

Darroch, Francine; Giles, Audrey; Sanderson, Priscilla; Brooks-Cleator, Lauren; Schwartz, Anna; Joseph, Darold; Nosker, Roger

2017-05-01

This article examines the concept and use of the term cultural safety in Canada and the United States. To examine the uptake of cultural awareness, cultural sensitivity, cultural competence, and cultural safety between health organizations in Canada and the United States, we reviewed position statements/policies of health care associations. The majority of selected health associations in Canada include cultural safety within position statements or organizational policies; however, comparable U.S. organizations focused on cultural sensitivity and cultural competence. Through the work of the Center for American Indian Resilience, we demonstrate that U.S. researchers engage with the tenets of cultural safety-despite not using the language. We recommend that health care providers and health researchers consider the tenets of cultural safety. To address health disparities between American Indian populations and non-American Indians, we urge the adoption of the term and tenets of cultural safety in the United States.

Unexplained illness among Persian Gulf War veterans in an Air National Guard Unit: preliminary report--August 1990-March 1995.

PubMed

1995-06-16

In November 1994, the U.S. Department of Veterans' Affairs (VA), the Department of Defense (DoD), and the Pennsylvania Department of Health requested that CDC investigate a report of unexplained illnesses among members of an Air National Guard (ANG) unit in south-central Pennsylvania (Unit A) who were veterans of the Persian Gulf War (PGW) (August 1990-June 1991). These veterans had been evaluated at a local VA medical center for symptoms that included recurrent rash, diarrhea, and fatigue. A three-stage investigation was planned to 1) verify and characterize signs and symptoms in PGW veterans attending the VA medical center; 2) determine whether the prevalence of symptoms was higher among members of Unit A than among members of other units deployed to the PGW and, if so, whether the increased prevalence was associated with PGW deployment; and 3) characterize the illness and identify associated risk factors. This report presents preliminary findings from stages 1 and 2 (stage 3 is in progress).

Metrication and AIHA.

PubMed

Burnett, R D

1977-05-01

AIHA supports a planned orderly national program for conversion to the metric system and will cooperate with other technical societies and organizations in implementing this voluntary conversion. The Association will use the International System of Units (SI) as modified by the Secretary of Commerce for use in the United States in all official publications, papers and documents. U.S. customary units can be presented in parentheses following the appropriate SI unit, when it is necessary for clarity.

An Approach to Operational Analysis: Doctrinal Task Decomposition

DTIC Science & Technology

2016-08-04

Once the unit is selected , CATS will output all of the doctrinal collective tasks associated with the unit. Currently, CATS outputs this information...Army unit are controlled data items, but for explanation purposes consider this simple example using a restaurant as the unit of interest. Table 1...shows an example Task Model for a restaurant using language and format similar to what CATS provides. Only 3 levels are shown in the example, but

Challenges in Hospital-Associated Infection Management: A Unit Perspective.

PubMed

Stacy, Kathleen M

2015-01-01

Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results. Each initiative presents its own unique set of challenges; however, common issues influence all initiatives. These common issues include organization and unit culture, current clinical practice guidelines being used to drive the initiatives, performance discrepancies on the part of nursing staff, availability of resources including equipment and supplies, monitoring of the data, and conflicting quality improvement priorities.

Perceived ethnic discrimination versus acculturation stress: influences on substance use among Latino youth in the Southwest.

PubMed

Kulis, Stephen; Marsiglia, Flavio Francisco; Nieri, Tanya

2009-12-01

Using a predominately Mexican-origin Latino sample of 5th grade students from the Southwestern United States, this study examined the relative effects of perceived discrimination and acculturation stress on substance use, and it assessed whether these effects were moderated by linguistic acculturation or time in the United States. Although rates of substance use were generally low in the sample, given the young age of the participants, over half (59%) of the sample perceived some discrimination, and almost half (47%) experienced some acculturation stress. Spanish-dominant and bilingual youth perceived more discrimination than English-dominant youth, whereas youth who have been in the United States five or fewer years perceived more discrimination than youth with more time in the United States. Youth who were Spanish-dominant or were recent arrivals experienced the most acculturation stress, with levels declining as linguistic acculturation and time in the United States increased. Multiple regression estimates indicated that perceived discrimination was associated with larger amounts and higher frequency of recent substance use and an array of substance use attitudes, such as stronger intentions to use substances, espousal of pro-drug norms, more positive substance use expectancies, and peer approval of substance use. Although acculturation stress was not associated with substance use, it was positively associated with several substance use attitudes, which are known antecedents of actual use. With a few exceptions, linguistic acculturation and time in the United States did not moderate the effects of perceived discrimination or acculturation stress.

Maximizing donor potential: evolving organ procurement organization metrics and optimizing organ distribution and allocation in the United States.

PubMed

Washburn, Kenneth

2012-11-01

1. Comprehend the basis for liver allocation and distribution in the United States. 2. Understand potential solutions to organ inequalities in the United States. 3. Understand the metrics used to assess the performance of organ procurement organizations. Copyright © 2012 American Association for the Study of Liver Diseases.

Reflections on Race: Affirmative Action Policies Influencing Higher Education in France and the United States

ERIC Educational Resources Information Center

Donahoo, Saran

2008-01-01

Background/Context: Although frequently associated with the United States, affirmative action is not a uniquely American social policy. Indeed, 2003 witnessed review and revision of affirmative action policies affecting higher education institutions in both France and the United States. Using critical race theory (CRT) as a theoretical lens, this…

A Cross-Cultural Assessment of School Connectedness: Testing Measurement Invariance with United States and Chilean Adolescents

ERIC Educational Resources Information Center

Sass, Daniel A.; Castro-Villarreal, Felicia; McWhirter, Benedict T.; McWhirter, Ellen Hawley; Karcher, Michael J.

2011-01-01

Positive associations between measures of school or academic connectedness and behavioral and academic outcomes suggest that connectedness is an important protective factor for adolescents in the United States. However, little is known about the meaning or measurement of academic connectedness, outside the United States, and especially in South…

Interest-Based Curriculum for House Care Services: House Cares.

ERIC Educational Resources Information Center

Natchitoches Parish School Board, LA.

The 11-unit curriculum guide for house care services, a Federally sponsored project, is designed to help students identify interests and develop skills associated with house care services. Two introductory units deal with the world of work and the total area of house care services. The following unit topics are: sanitation and safety; equipment;…

Low prevalence of chytrid fungus (Batrachochytrium dendrobatidis) in amphibians of U.S. headwater streams

USGS Publications Warehouse

Hossack, Blake R.; Adams, Michael J.; Campbell Grant, Evan H.; Pearl, Chistopher A.; Bettaso, James B.; Barichivich, William J.; Lowe, Winsor H.; True, Kimberly; Ware, Joy L.; Corn, Paul Stephen

2010-01-01

Many declines of amphibian populations have been associated with chytridiomycosis, a disease caused by the aquatic fungus Batrachochytrium dendrobatidis (Bd). Despite the relatively high prevalence of chytridiomycosis in stream amphibians globally, most surveys in North America have focused primarily on wetland-associated species, which are frequently infected. To better understand the distribution and prevalence of Bd in headwater amphibian communities, we sampled 452 tailed frogs (Ascaphus truei and Ascaphus montanus) and 304 stream salamanders (seven species in the Dicamptodontidae and Plethodontidae) for Bd in 38, first- to third-order streams in five montane areas across the United States. We tested for presence of Bd by using PCR on skin swabs from salamanders and metamorphosed tailed frogs or the oral disc of frog larvae. We detected Bd on only seven individuals (0.93%) in four streams. Based on our study and results from five other studies that have sampled headwater- or seep-associated amphibians in the United States, Bd has been detected on only 3% of 1,322 individuals from 21 species. These results differ strongly from surveys in Central America and Australia, where Bd is more prevalent on stream-breeding species, as well as results from wetland-associated anurans in the same regions of the United States that we sampled. Differences in the prevalence of Bd between stream- and wetland-associated amphibians in the United States may be related to species-specific variation in susceptibility to chytridiomycosis or habitat differences.

Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

PubMed

Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

2013-12-01

The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

Factors Associated with Type 2 Diabetes Mellitus Treatment Choice Across Four European Countries.

PubMed

Heintjes, Edith M; Overbeek, Jetty A; Hall, Gillian C; Prieto-Alhambra, Daniel; Lapi, Francesco; Hammar, Niklas; Bezemer, Irene D

2017-11-01

The aim of this analysis was to identify factors associated with the choice of type 2 diabetes mellitus (T2DM) therapy at the time of intensification of antidiabetic treatment across 4 European countries. Antidiabetic drug prescription/dispensing records and patients' characteristics were obtained from the electronic health care records of patients with T2DM from the Netherlands (NL), Italy, and Spain (ES) (all, 2007-2011); and the United Kingdom (UK; 2008-2012). Oral monotherapy was defined as first-line; oral dual therapy, as second-line; >2 oral treatments or oral combined with an injectable, as third-line; and injectables only, as fourth-line treatment. Treatment intensification was defined as the start of a higher line of treatment. Comedication, comorbidities, clinical parameters, and other factors associated with treatment choice were identified using multivariate relative risk estimation by Poisson regression with robust error variance. In the 5-year study period, 485,120 patients (79% of the treated T2DM population) underwent treatment intensification. Changes in treatment choice were clearly visible over the study period, such as a decline in the use of thiazolidinediones (NL, ES, UK) and increases in the use of dipeptidyl peptidase-4 inhibitors (DPP4i) (NL, ES, UK) and glucagon-like peptide-1 receptor agonists (UK). With first-line treatment, advanced age and renal comorbidity were associated with the use of sulfonylureas (SUs; all countries), whereas high body mass index (BMI) was inversely associated with SU use in the United Kingdom and Spain. With second-line treatment, advanced age was associated with metformin + SU use (all countries); and renal comorbidity with SU + DPP4i use in the United Kingdom and the Netherlands. High BMI was associated with metformin + thiazolidinedione (TZD) use in the United Kingdom and Spain, and with metformin + DPP4i in the United Kingdom. With third-line treatment, advanced age and renal comorbidity were associated with the use of SU + insulin (NL, ES, UK). Hemoglobin A 1c >8.5% was positively associated, and high BMI was inversely associated, with the use of any third-line combination containing insulin. Across treatment lines TZD and metformin were negatively associated with renal and cardiac morbidity. Second and third line treatment choices strongly depended on prior treatments. With fourth-line treatment, women were more likely to receive glucagon-like peptide-1 receptor agonists than were men in the United Kingdom and Spain. The results suggest that the main factors driving treatment choice at any stage of intensification were age, hemoglobin A 1c , BMI, renal and cardiac morbidity, and treatment history. These drivers were consistent with guidelines on, and contraindications of, specific medications. Differences between countries were generally consistent with, but not solely attributable to, differences in local guidelines and reimbursement policies. Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.

Small scale analogs of the Cayley Formation and Descarts Mountains in impact associated deposits, part C

NASA Technical Reports Server (NTRS)

Head, J. W.

1972-01-01

The exploration of the Cayley Formation and material of the Descartes Mountains and an understanding of the origin and evolution of these units were primary objectives of the Apollo 16 lunar mission. This section examines several areas associated with impact crater deposits that show small-scale features similar in morphology to the regional characteristics of the Cayley and Descartes units shown in the Apollo 16 photography.

Hospital Quality And Intensity Of Spending: Is There An Association?

PubMed Central

Yasaitis, Laura; Fisher, Elliott S.; Skinner, Jonathan S.

2009-01-01

Numerous studies in the United States have examined the association between quality and spending at the regional level. In this paper we evaluate this relationship at the level of individual hospitals, which are a more natural unit of analysis for reporting on and improving accountability. For all of the quality indicators studied, the association with spending is either nil or negative. The absence of positive correlations suggests that some institutions achieve exemplary performance on quality measures in settings that feature lower intensity of care. This finding highlights the need for reporting information on both quality and spending. PMID:19460774

Significant reduction of central line-associated bloodstream infection rates in a tertiary neonatal unit.

PubMed

Rallis, Dimitrios; Karagianni, Paraskevi; Papakotoula, Ifigeneia; Nikolaidis, Nikolaos; Tsakalidis, Christos

2016-04-01

To evaluate the effectiveness of a quality initiative in reducing central line-associated bloodstream infections (CLABSIs) in our neonatal intensive care unit, we designed a prospective study (January 2012-September 2013) estimating CLABSI incidence before and after our implementation. CLABSI rates were significantly decreased after our intervention, from 12 cases per 1,000 central vascular catheter (CVC) days during the preinterventional period to 3.4 cases per 1,000 CVC days during the postinterventional period (P = .004). Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Production, purification and preliminary X-ray crystallographic studies of adeno-associated virus serotype 7

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

Quesada, Odayme; Gurda, Brittney; Govindasamy, Lakshmanan

2007-12-01

Crystals of baculovirus-expressed adeno-associated virus serotype 7 capsids have been produced which diffract X-rays to ∼3.0 Å resolution. Crystals of baculovirus-expressed adeno-associated virus serotype 7 capsids diffract X-rays to ∼3.0 Å resolution. The crystals belong to the rhombohedral space group R3, with unit-cell parameters a = 252.4, c = 591.2 Å in the hexagonal setting. The diffraction data were processed and reduced to an overall completeness of 79.0% and an R{sub merge} of 12.0%. There are three viral capsids in the unit cell. The icosahedral threefold axis is coincident with the crystallographic threefold axis, resulting in one third of amore » capsid (20 monomers) per crystallographic asymmetric unit. The orientation of the viral capsid has been determined by rotation-function searches and is positioned at (0, 0, 0) by packing considerations.« less

Wound botulism acquired in the Amazonian rain forest of Ecuador.

PubMed

Reller, Megan E; Douce, Richard W; Maslanka, Susan E; Torres, Darwin S; Manock, Stephen R; Sobel, Jeremy

2006-04-01

Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly trauma-associated, were reported in the United States. Since 1990, wound botulism associated with injection drug use emerged as the leading cause of wound botulism in the United States; 210 of 217 cases reported to the Centers for Disease Control and Prevention between 1990 and 2002 were associated with drug injection. Despite the worldwide distribution of Clostridium botulinum spores, wound botulism has been reported only twice outside the United States, Europe, and Australia. However, wound botulism may go undiagnosed and untreated in many countries. We report two cases, both with type A toxin, from the Ecuadorian rain forest. Prompt clinical recognition, supportive care, and administration of trivalent equine botulinum antitoxin were life-saving.

Does place of education matter? Contextualizing the education and health status association among Asian Americans.

PubMed

Walton, Emily; Takeuchi, David T; Herting, Jerald R; Alegría, Margarita

2009-01-01

The educational gradient in health is one of the most robust associations in social science research. Results of the current study indicate that, like the pattern observed among other racial and ethnic minority groups, the well-established educational gradient in health is attenuated among Asian Americans. We also show that the gradient association between educational attainment and self-rated health among Asian Americans depends on whether they receive the bulk of their education in the United States or abroad. Compared to the schooling received in the United States, being educated in a foreign country does not result in the same health payoffs for increasing educational attainment. Analysis of an extensive set of mediators indicates that a foreign education restricts economic opportunities, limits positive social interaction, and inhibits English language proficiency. We discuss the implications for Asian Americans, a group composed largely of immigrants who received their education outside the United States.

Local social norms and military sexual stressors: do senior officers' norms matter?

PubMed

Murdoch, Maureen; Pryor, John Barron; Polusny, Melissa Anderson; Gackstetter, Gary D; Ripley, Diane Cowper

2009-10-01

To examine the relative importance of harassment-tolerant norms emanating from troops senior officers, immediate supervisors, and units on troops' sexual stressor experiences and to see whether associations differed by sex. Cross-sectional survey of all 681 willing and confirmed active duty troops enrolled in the VA National Enrollment Database between 1998 and 2002. Findings extended an earlier analysis. After adjusting for other significant correlates, senior officers' perceived tolerance of sexual harassment was not associated with the severity of sexual harassment troops reported (p = 0.64) or with the numbers of sexual identity challenges they reported (p = 0.11). Harassment-tolerant norms emanating from troops' units and immediate supervisors were associated with reporting more severe sexual harassment and more sexual identity challenges (all p < 0.003). Findings generalized across sex. Senior officers' norms did not appear to affect troops' reports of military sexual stressors, but unit norms and immediate supervisors' norms did.

One-day quantitative cross-sectional study of family information time in 90 intensive care units in France.

PubMed

Fassier, Thomas; Darmon, Michel; Laplace, Christian; Chevret, Sylvie; Schlemmer, Benoit; Pochard, Frédéric; Azoulay, Elie

2007-01-01

Providing family members with clear, honest, and timely information is a major task for intensive care unit physicians. Time spent informing families has been associated with effectiveness of information but has not been measured in specifically designed studies. To measure time spent informing families of intensive care unit patients. One-day cross-sectional study in 90 intensive care units in France. Clocked time spent by physicians informing the families of each of 951 patients hospitalized in the intensive care unit during a 24-hr period. Median family information time was 16 (interquartile range, 8-30) mins per patient, with 20% of the time spent explaining the diagnosis, 20% on explaining treatments, and 60% on explaining the prognosis. One third of the time was spent listening to family members. Multivariable analysis identified one factor associated with less information time (room with more than one bed) and seven factors associated with more information time, including five patient-related factors (surgery on the study day, higher Logistic Organ Dysfunction score, coma, mechanical ventilation, and worsening clinical status) and two family-related factors (first contact with family and interview with the spouse). Median information time was 20 (interquartile range, 10-39) mins when three factors were present and 106.5 (interquartile range, 103-110) mins when five were present. This study identifies factors associated with information time provided by critical care physicians to family members of critically ill patients. Whether information time correlates with communication difficulties or communication skills needs to be evaluated. Information time provided by residents and nurses should be studied.

Association Between Sugar-Sweetened Beverage Intake and Proxies of Acculturation Among U.S. Hispanic and Non-Hispanic White Adults

PubMed Central

Park, Sohyun; Blanck, Heidi M.; Dooyema, Carrie A.; Ayala, Guadalupe X.

2015-01-01

Purpose This study examined associations between sugar-sweetened beverage (SSB) intake and acculturation among a sample representing civilian noninstitutionalized U.S. adults. Design Quantitative, cross-sectional study. Setting National. Subjects The 2010 National Health Interview Survey data for 17,142 Hispanics and U.S.-born non-Hispanic whites (≥18 years). Measures The outcome variable was daily SSB intake (nondiet soda, fruit drinks, sports drinks, energy drinks, and sweetened coffee/tea drinks). Exposure variables were Hispanic ethnicity and proxies of acculturation (language of interview, birthplace, and years living in the United States). Analysis We used multivariate logistic regression to estimate adjusted odds ratios (ORs) for the exposure variables associated with drinking SSB ≥ 1 time/d after controlling for covariates. Results The adjusted odds of drinking SSB ≥ 1 time/d was significantly higher among Hispanics who completed the interview in Spanish (OR = 1.65) than U.S.-born non-Hispanic whites. Compared with those who lived in the United States for <5 years, the adjusted odds of drinking SSB ≥ 1 time/d was higher among adults who lived in the United States for 5 to <10 years (OR = 2.72), those who lived in the United States for 10 to <15 years (OR = 2.90), and those who lived in the United States for ≥15 years (OR = 2.41). However, birthplace was not associated with daily SSB intake. Conclusion The acculturation process is complex and these findings contribute to identifying important subpopulations that may benefit from targeted intervention to reduce SSB intake. PMID:27404644

Automatic water inventory, collecting, and dispensing unit

NASA Technical Reports Server (NTRS)

Hall, J. B., Jr.; Williams, E. F.

1972-01-01

Two cylindrical tanks with piston bladders and associated components for automatic filling and emptying use liquid inventory readout devices in control of water flow. Unit provides for adaptive water collection, storage, and dispensation in weightlessness environment.

Association of Safety Culture with Surgical Site Infection Outcomes.

PubMed

Fan, Caleb J; Pawlik, Timothy M; Daniels, Tania; Vernon, Nora; Banks, Katie; Westby, Peggy; Wick, Elizabeth C; Sexton, J Bryan; Makary, Martin A

2016-02-01

Hospital workplace culture may have an impact on surgical outcomes; however, this association has not been established. We designed a study to evaluate the association between safety culture and surgical site infection (SSI). Using the Hospital Survey on Patient Safety Culture and National Healthcare Safety Network definitions, we measured 12 dimensions of safety culture and colon SSI rates, respectively, in the surgical units of Minnesota community hospitals. A Pearson's r correlation was calculated for each of 12 dimensions of surgical unit safety culture and SSI rate and then adjusted for surgical volume and American Society of Anesthesiologists (ASA) classification. Seven hospitals participated in the study, with a mean survey response rate of 43%. The SSI rates ranged from 0% to 30%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of 0 to 100. Ten dimensions of surgical unit safety culture were associated with colon SSI rates: teamwork across units (r = -0.96; 95% CI [-0.76, -0.99]), organizational learning (r = -0.95; 95% CI [-0.71, -0.99]), feedback and communication about error (r = -0.92; 95% CI [-0.56, -0.99]), overall perceptions of safety (r = -0.90; 95% CI [-0.45, -0.99]), management support for patient safety (r = -0.90; 95% CI [-0.44, -0.98]), teamwork within units (r = -0.88; 95% CI [-0.38, -0.98]), communication openness (r = -0.85; 95% CI [-0.26, -0.98]), supervisor/manager expectations and actions promoting safety (r = -0.85; 95% CI [-0.25, -0.98]), non-punitive response to error (r = -0.78; 95% CI [-0.07, -0.97]), and frequency of events reported (r = -0.76; 95% CI [-0.01, -0.96]). After adjusting for surgical volume and ASA classification, 9 of 12 dimensions of surgical unit safety culture were significantly associated with lower colon SSI rates. These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical outcomes. Copyright © 2016. Published by Elsevier Inc.

The effect of nurse manager turnover on patient fall and pressure ulcer rates.

PubMed

Warshawsky, Nora; Rayens, Mary Kay; Stefaniak, Karen; Rahman, Rana

2013-07-01

The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. Patients in medical/surgical units experienced more falls than in intensive care units (F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events. © 2013 John Wiley & Sons Ltd.

Associations between perceived crisis mode work climate and poor information exchange within hospitals.

PubMed

Patterson, Mark E; Bogart, Miller S; Starr, Kathleen R

2015-03-01

Because hospital units operating in crisis mode could create unsafe transitions of care due to miscommunication, our objective was to estimate associations between perceived crisis mode work climate and patient information exchange problems within hospitals. Self-reported data from 247,140 hospital staff members across 884 hospitals were obtained from the 2010 Hospital Survey on Patient Safety Culture. Presence of a crisis mode work climate was defined as respondents agreeing that the hospital unit in which they work tries to do too much too quickly. Presence of patient information exchange problems was defined as respondents agreeing that problems often occur in exchanging patient information across hospital units. Multivariable ordinal regressions estimated the likelihood of perceived problems in exchanging patient information across hospital units, controlling for perceived levels of crisis mode work climate, skill levels, work climate, and hospital infrastructure. Compared to those disagreeing, hospital staff members agreeing that the hospital unit in which they work tries to do too much too quickly were 1.6 times more likely to perceive problems in exchanging patient information across hospital units (odds ratio: 1.6, 95% confidence interval: 1.58-1.65). Hospital staff members perceiving crisis mode work climates within their hospital unit are more likely to perceive problems in exchanging patient information across units, underscoring the need to improve communication during transitions of care. © 2014 Society of Hospital Medicine.

Diversity and distribution patterns of root-associated fungi on herbaceous plants in alpine meadows of southwestern China.

PubMed

Gao, Qian; Yang, Zhu L

2016-01-01

The diversity of root-associated fungi associated with four ectomycorrhizal herbaceous species, Kobresia capillifolia, Carex parva, Polygonum macrophyllum and Potentilla fallens, collected in three sites of alpine meadows in southwestern China, was estimated based on internal transcribed spacer (ITS) rDNA sequence analysis of root tips. Three hundred seventy-seven fungal sequences sorted to 154 operational taxonomical units (sequence similarity of ≥ 97% across the ITS) were obtained from the four plant species across all three sites. Similar taxa (in GenBank with ≥ 97% similarity) were not found in GenBank and/or UNITE for most of the OTUs. Ectomycorrhiz a made up 64% of the fungi operational taxonomic units (OTUs), endophytes constituted 4% and the other 33% were unidentified root-associated fungi. Fungal OTUs were represented by 57% basidiomycetes and 43% ascomycetes. Inocybe, Tomentella/Thelophora, Sebacina, Hebeloma, Pezizomycotina, Cenococcum geophilum complex, Cortinarius, Lactarius and Helotiales were OTU-rich fungal lineages. Across the sites and host species the root-associated fungal communities generally exhibited low host and site specificity but high host and sampling site preference. Collectively our study revealed noteworthy diversity and endemism of root-associated fungi of alpine plants in this global biodiversity hotspot. © 2016 by The Mycological Society of America.

A Cross-Cultural Comparison of Knowledge and Stigma Associated with Autism Spectrum Disorder Among College Students in Lebanon and the United States.

PubMed

Obeid, Rita; Daou, Nidal; DeNigris, Danielle; Shane-Simpson, Christina; Brooks, Patricia J; Gillespie-Lynch, Kristen

2015-11-01

Although misconceptions associated with ASD are apparent worldwide, they may differ across cultures. This study compares knowledge and stigma associated with ASD in a country with limited autism resources, Lebanon, and a country with substantial autism resources, the United States (US). College students in the US (N = 346) and Lebanon (N = 329) completed assessments of knowledge and stigma associated with ASD before and after an online ASD training. Although students in the US exhibited higher overall knowledge and lower stigma towards ASD, certain misconceptions were more apparent in the US than in Lebanon. Participation in the training was associated with decreased stigma and increased knowledge in both countries. Thus, online training may be useful for increasing understanding about ASD internationally.

The stratigraphy and evolution of lower Mount Sharp from spectral, morphological, and thermophysical orbital data sets.

PubMed

Fraeman, A A; Ehlmann, B L; Arvidson, R E; Edwards, C S; Grotzinger, J P; Milliken, R E; Quinn, D P; Rice, M S

2016-09-01

We have developed a refined geologic map and stratigraphy for lower Mount Sharp using coordinated analyses of new spectral, thermophysical, and morphologic orbital data products. The Mount Sharp group consists of seven relatively planar units delineated by differences in texture, mineralogy, and thermophysical properties. These units are (1-3) three spatially adjacent units in the Murray formation which contain a variety of secondary phases and are distinguishable by thermal inertia and albedo differences, (4) a phyllosilicate-bearing unit, (5) a hematite-capped ridge unit, (6) a unit associated with material having a strongly sloped spectral signature at visible near-infrared wavelengths, and (7) a layered sulfate unit. The Siccar Point group consists of the Stimson formation and two additional units that unconformably overlie the Mount Sharp group. All Siccar Point group units are distinguished by higher thermal inertia values and record a period of substantial deposition and exhumation that followed the deposition and exhumation of the Mount Sharp group. Several spatially extensive silica deposits associated with veins and fractures show that late-stage silica enrichment within lower Mount Sharp was pervasive. At least two laterally extensive hematitic deposits are present at different stratigraphic intervals, and both are geometrically conformable with lower Mount Sharp strata. The occurrence of hematite at multiple stratigraphic horizons suggests redox interfaces were widespread in space and/or in time, and future measurements by the Mars Science Laboratory Curiosity rover will provide further insights into the depositional settings of these and other mineral phases.

Unit support protects against sexual harassment and assault among national guard soldiers.

PubMed

Walsh, Kate; Galea, Sandro; Cerda, Magdalena; Richards, Catherine; Liberzon, Israel; Tamburrino, Marijo B; Calabrese, Joseph; Koenen, Karestan C

2014-01-01

Despite concerns about increased sexual harassment and assault after the 2013 legislation repealing the ban on women in combat, little research has examined military factors that could prevent sexual harassment and assault during deployment. This study examined whether unit support, which reflects the quality of service members' relationships within their unit, protects against sexual harassment and assault during deployment. Participants were 1,674 Ohio Army National Guard service members who reported at least one deployment during a telephone survey conducted in 2008 and 2009. Participants completed measures of sexual harassment/assault, unit support, and psychosocial support. Logistic regression was used to model odds of sexual harassment/assault. Approximately 13.2% of men (n = 198) and 43.5% of women (n = 74) reported sexual harassment, and 1.1% of men (n = 17) and 18.8% of women (n = 32) reported sexual assault during their most recent deployment. Greater unit support was associated with decreased odds of sexual harassment and assault. A substantial proportion of men and women reported sexual harassment/assault. Greater unit support was associated with diminished odds of sexual harassment/assault during deployment. Programming designed to improve unit cohesion has the potential to reduce sexual harassment and assault. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

CLABSI Conversations: Lessons From Peer-to-Peer Assessments to Reduce Central Line-Associated Bloodstream Infections.

PubMed

Pham, Julius Cuong; Goeschel, Christine A; Berenholtz, Sean M; Demski, Renee; Lubomski, Lisa H; Rosen, Michael A; Sawyer, Melinda D; Thompson, David A; Trexler, Polly; Weaver, Sallie J; Weeks, Kristina R; Pronovost, Peter J

2016-01-01

A national collaborative helped many hospitals dramatically reduce central line-associated bloodstream infections (CLABSIs), but some hospitals struggled to reduce infection rates. This article describes the development of a peer-to-peer assessment process (CLABSI Conversations) and the practical, actionable practices we discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least 1 year. CLABSI Conversations was designed as a learning-oriented process, in which a team of peers visited hospitals to surface barriers to infection prevention and to share best practices and insights from successful intensive care units. Common practices led to 10 recommendations: executive and board leaders communicate the goal of zero CLABSI throughout the hospital; senior and unit-level leaders hold themselves accountable for CLABSI rates; unit physicians and nurse leaders own the problem; clinical leaders and infection preventionists build infection prevention training and simulation programs; infection preventionists participate in unit-based CLABSI reduction efforts; hospital managers make compliance with best practices easy; clinical leaders standardize the hospital's catheter insertion and maintenance practices and empower nurses to stop any potentially harmful acts; unit leaders and infection preventionists investigate CLABSIs to identify root causes; and unit nurses and staff audit catheter maintenance policies and practices.

Nurses' but not supervisors' safety practices are linked with job satisfaction.

PubMed

Hurtado, David A; Kim, Seung-Sup; Subramanian, S V; Dennerlein, Jack T; Christiani, David C; Hashimoto, Dean M; Sorensen, Glorian

2017-10-01

To test the associations of safety practices as reported by nurses and their respective unit supervisors with job satisfaction. Psychosocial workplace factors are associated with job satisfaction; however, it is unknown whether nurses and supervisors accounts of safety practices are differentially linked to this outcome. Cross-sectional study design including nurses (n = 1052) nested in 94 units in two hospitals in Boston (MA, USA). Safety practices refer to the identification and control of occupational hazards at the unit. Safety practices were measured aggregating nurses' responses per unit, and supervisory levels. Individual's job satisfaction for each nurse was the response variable. Supervisors assessed safety practices more favourably than their unit nursing staff. Adjusted random intercept logistic regressions showed that the odds of higher job satisfaction were higher for nurses at units with better safety practices (OR: 1.67, 95% CI: 1.04, 2.68) compared with nurses at units that averaged lower safety practices. Supervisors' reports of safety practices were not correlated with the job satisfaction of their staff. Adequate safety practices might be a relevant managerial role that enhances job satisfaction among nurses. Nursing supervisors should calibrate their safety assessments with their nursing staff to improve nurses' job satisfaction. © 2017 John Wiley & Sons Ltd.

Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.

PubMed

Reddy, Anita J; Guzman, Jorge A

2016-11-01

Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.

Apollo experience report: Command and service module electrical power distribution on subsystem

NASA Technical Reports Server (NTRS)

Munford, R. E.; Hendrix, B.

1974-01-01

A review of the design philosophy and development of the Apollo command and service modules electrical power distribution subsystem, a brief history of the evolution of the total system, and some of the more significant components within the system are discussed. The electrical power distribution primarily consisted of individual control units, interconnecting units, and associated protective devices. Because each unit within the system operated more or less independently of other units, the discussion of the subsystem proceeds generally in descending order of complexity; the discussion begins with the total system, progresses to the individual units of the system, and concludes with the components within the units.

Hom-associative Ore extensions

NASA Astrophysics Data System (ADS)

Bäck, P.; Richter, J.; Silvestrov, S.

2018-02-01

We introduce hom-associative Ore extensions as non-associative, non-unital Ore extensions with a hom-associative multiplication, as well as give some necessary and sufficient conditions when such exist. Within this framework, we also construct a family of hom-associative Weyl algebras as generalizations of the classical analogue, and prove that they are simple.

A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark.

PubMed

Jakobsen, Louise M; Jorgensen, Anette F B; Thomsen, Birthe L; Greiner, Birgit A; Rugulies, Reiner

2015-11-11

Eldercare workers in Denmark have a higher prevalence of poor psychological health than other occupational groups. We examined the association between working conditions assessed by trained observers and depressive symptoms assessed by self-report in a study of female Danish eldercare workers. Working conditions were observed based on action regulation theory and defined as (1) regulation requirements, a workplace resource providing opportunity for decision-making and skill development and (2) barriers for task completion. We examined the associations of individual and work unit averaged working conditions with depressive symptoms in a sample of 95 individually observed eldercare workers. Further, we examined the association of work unit averaged working conditions with depressive symptoms in a sample of 205 care workers, including both observed and non-observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. Higher levels of regulation requirements were associated with lower depressive symptoms at the individual level (p=0.04), but not at the workplace level. Barriers were not associated with depressive symptoms at the individual level. At the workplace level, a higher number of qualitatively different barriers (p=0.04) and a higher number of barriers for equipment use (p=0.03) were associated with lower levels of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both individual and workplace levels of working conditions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Chronic insufficient sleep and diet quality: Contributors to childhood obesity.

PubMed

Cespedes, Elizabeth M; Hu, Frank B; Redline, Susan; Rosner, Bernard; Gillman, Matthew W; Rifas-Shiman, Sheryl L; Taveras, Elsie M

2016-01-01

To examine associations of chronic insufficient sleep with diet and whether diet explains the sleep-adiposity relationship. In Project Viva, 1,046 parents reported children's sleep duration at 6 m and annually until midchildhood (7 y). The main exposure was a sleep curtailment score (6 m-7 y) ranging from 0 (maximal curtailment) to 13 (adequate sleep). In mid-childhood, parents reported children's diet; researchers measured height/weight. Multivariable linear regression assessed associations of sleep with diet (Youth Healthy Eating Index [YHEI]); sleep with BMI z-score adjusting for YHEI; and, secondarily, joint associations of sleep and YHEI with BMI. Mean (SD) sleep and YHEI scores were 10.21 (2.71) and 58.76 (10.37). Longer sleep duration was associated with higher YHEI in mid-childhood (0.59 points/unit sleep score; 95% CI: 0.32, 0.86). Although higher YHEI was associated with lower BMI z-score (-0.07 units/10-point increase; 95% CI: -0.13, -0.01), adjustment for YHEI did not attenuate sleep-BMI associations. Children with sleep and YHEI scores below the median (<11 and <60) had BMI z-scores 0.34 units higher (95% CI: 0.16, 0.51) than children with sleep and YHEI scores above the median. While parent-reported diet did not explain inverse associations of sleep with adiposity, both sufficient sleep and high-quality diets are important to obesity prevention. © 2015 The Obesity Society.

Graves' hyperthyroidism and moderate alcohol consumption: evidence for disease prevention.

PubMed

Carlé, Allan; Bülow Pedersen, Inge; Knudsen, Nils; Perrild, Hans; Ovesen, Lars; Rasmussen, Lone Banke; Jørgensen, Torben; Laurberg, Peter

2013-07-01

We recently demonstrated that moderate alcohol consumption is associated with a considerable reduction in the risk of autoimmune hypothyroidism, similar to findings in other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. We aimed to study a possible association between alcohol intake and autoimmune Graves' hyperthyroidism. This is a population-based, case-control study. In a well-defined Danish population (2,027,208 person-years of observation), we prospectively identified patients with new overt thyroid dysfunction and studied 272 patients with Graves' hyperthyroidism. For each patient, we recruited four age-gender-region-matched controls with normal thyroid function (n = 1088). Participants gave detailed information on current and previous alcohol intake as well as other factors to be used for analyses. The association between alcohol intake and development of hyperthyroidism was analysed in conditional multivariate Cox regression models. Graves' patients had a lower reported alcohol consumption than controls (median units of alcohol (12 g) per week: 2 vs 4, P < 0·001). In a multivariate regression model, alcohol consumption was associated with a dose-dependent reduction in risk for development of overt Graves' hyperthyroidism. Odds ratios (95% confidence interval) compared with the reference group with a recent (last year) consumption of 1-2 units of alcohol per week were as follows: 0 units/week 1·73 (1·17-2·56), 3-10 units/week 0·56 (0·39-0·79), 11-20 units/week 0·37 (0·21-0·65), ≥21 units/week 0·22 (0·08-0·60). Similar results were found for maximum previous alcohol consumption during a calendar year. No interaction was found with the type of alcohol consumed (wine vs beer), smoking habit, age, gender or region of inhabitancy. Moderate alcohol consumption is associated with a considerable reduction in the risk of Graves' disease with hyperthyroidism--irrespective of age and gender. Autoimmune thyroid disease seems to be much more dependent on environmental factors than hitherto anticipated. © 2012 John Wiley & Sons Ltd.

The Association between Dust Storms and Daily Non-Accidental Mortality in the United States, 1993-2005.

PubMed

Crooks, James Lewis; Cascio, Wayne E; Percy, Madelyn S; Reyes, Jeanette; Neas, Lucas M; Hilborn, Elizabeth D

2016-11-01

The impact of dust storms on human health has been studied in the context of Asian, Saharan, Arabian, and Australian storms, but there has been no recent population-level epidemiological research on the dust storms in North America. The relevance of dust storms to public health is likely to increase as extreme weather events are predicted to become more frequent with anticipated changes in climate through the 21st century. We examined the association between dust storms and county-level non-accidental mortality in the United States from 1993 through 2005. Dust storm incidence data, including date and approximate location, are taken from the U.S. National Weather Service storm database. County-level mortality data for the years 1993-2005 were acquired from the National Center for Health Statistics. Distributed lag conditional logistic regression models under a time-stratified case-crossover design were used to study the relationship between dust storms and daily mortality counts over the whole United States and in Arizona and California specifically. End points included total non-accidental mortality and three mortality subgroups (cardiovascular, respiratory, and other non-accidental). We estimated that for the United States as a whole, total non-accidental mortality increased by 7.4% (95% CI: 1.6, 13.5; p = 0.011) and 6.7% (95% CI: 1.1, 12.6; p = 0.018) at 2- and 3-day lags, respectively, and by an average of 2.7% (95% CI: 0.4, 5.1; p = 0.023) over lags 0-5 compared with referent days. Significant associations with non-accidental mortality were estimated for California (lag 2 and 0-5 day) and Arizona (lag 3), for cardiovascular mortality in the United States (lag 2) and Arizona (lag 3), and for other non-accidental mortality in California (lags 1-3 and 0-5). Dust storms are associated with increases in lagged non-accidental and cardiovascular mortality. Citation: Crooks JL, Cascio WE, Percy MS, Reyes J, Neas LM, Hilborn ED. 2016. The association between dust storms and daily non-accidental mortality in the United States, 1993-2005. Environ Health Perspect 124:1735-1743; http://dx.doi.org/10.1289/EHP216.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

PubMed Central

Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208 (95% CI ± $437). CONCLUSIONS Resident care at our community teaching hospital was associated with significantly higher costs but also with higher payments and greater profitability. PMID:11251744

Nursing staff stress in an intensive care unit.

PubMed

Lochoff, R V; Cane, R D; Buchanan, N; Cox, H J

1977-12-03

The stresses associated with nursing in an intensive care unit were assessed. A comparison was drawn between a group of Black and a group of White nurses. Proposals aimed at reducing the observed stress patterns are suggested.

QUANTITATIVE SOIL DESCRIPTIONS FOR ECOREGIONS OF THE UNITED STATES

EPA Science Inventory

Researchers have defined ecological regions of the United States based on patterns in the coincidence of terrestrial, aquatic, abiotic and biotic characteristics that are associated with spatial differences in ecosystems. Ecoregions potentially facilitate regional research, monit...

Fault tolerant system with imperfect coverage, reboot and server vacation

NASA Astrophysics Data System (ADS)

Jain, Madhu; Meena, Rakesh Kumar

2017-06-01

This study is concerned with the performance modeling of a fault tolerant system consisting of operating units supported by a combination of warm and cold spares. The on-line as well as warm standby units are subject to failures and are send for the repair to a repair facility having single repairman which is prone to failure. If the failed unit is not detected, the system enters into an unsafe state from which it is cleared by the reboot and recovery action. The server is allowed to go for vacation if there is no failed unit present in the system. Markov model is developed to obtain the transient probabilities associated with the system states. Runge-Kutta method is used to evaluate the system state probabilities and queueing measures. To explore the sensitivity and cost associated with the system, numerical simulation is conducted.

Underground Injection Control, Hydraulic Fracturing, and Sources of Drinking Water in the Western United States

NASA Astrophysics Data System (ADS)

Jackson, R. B.; Kang, M.

2016-12-01

Oil and gas extraction is expanding in the United States, attributable to the success of high-volume hydraulic fracturing, and associated wastewater disposal is increasing as a result. The United States currently has approximately 180,000 Class II injection wells associated with the oil and gas industry, more than 50,000 of them in California. Hydraulic fracturing and underground injection often occur many thousands of feet belowground. Previously, however, we documented shallow hydraulic fracturing and other oil and gas activities across the western United States in particular, including California and Wyoming. In eight CA counties, for example, as many as 19% and 35% of oil/gas activities have occurred directly in freshwater zones and USDWs, respectively (Kang and Jackson 2016 PNAS). Here we expand this analysis to examine the underground injection control program and accompanying hydrogeologic variables found in California and elsewhere.

Motor Controller System For Large Dynamic Range of Motor Operation

NASA Technical Reports Server (NTRS)

Howard, David E. (Inventor); Alhorn, Dean C. (Inventor); Smith, Dennis A. (Inventor); Dutton, Kenneth R. (Inventor); Paulson, Mitchell Scott (Inventor)

2006-01-01

A motor controller system uses a rotary sensor with a plurality of signal conditioning units, coupled to the rotary sensor. Each of these units, which is associated with a particular range of motor output shaft rotation rates, generate a feedback signal indicative of the position of the motor s output shaft. A controller (i) converts a selected motor output shaft rotation rate to a corresponding incremental amount of rotational movement for a selected fixed time period, (ii) selects, at periodic completions of the selected fixed time period, the feedback signal from one of the signal conditioning units for which the particular range of motor output shaft rotation rates associated therewith encompasses the selected motor output shaft rotation rate, and (iii) generates a motor drive signal based on a difference between the incremental amount of rotational movement and the feedback signal from the selected one of the signal conditioning Units.

Physical properties of lava flows on the southwest flank of Tyrrhena Patera, Mars

NASA Technical Reports Server (NTRS)

Crown, David A.; Porter, Tracy K.; Greeley, Ronald

1991-01-01

Tyrrhena Patera (TP) (22 degrees S, 253.5 degrees W), a large, low-relief volcano located in the ancient southern highlands of Mars, is one of four highland paterae thought to be structurally associated with the Hellas basin. The highland paterae are Hesperian in age and among the oldest central vent volcanoes on Mars. The morphology and distribution of units in the eroded shield of TP are consistent with the emplacement of pyroclastic flows. A large flank unit extending from TP to the SW contains well-defined lava flow lobes and leveed channels. This flank unit is the first definitive evidence of effusive volcanic activity associated with the highland paterae and may include the best preserved lava flows observed in the Southern Hemisphere of Mars. Flank flow unit averages, channelized flow, flow thickness, and yield strength estimates are discussed. Analysis suggests the temporal evolution of Martian magmas.

Enzootic Rabies Elimination from Dogs and Reemergence in Wild Terrestrial Carnivores, United States

PubMed Central

Reeder, Serena A.; Orciari, Lillian A.; Yager, Pamela A.; Franka, Richard; Blanton, Jesse D.; Zuckero, Letha; Hunt, Patrick; Oertli, Ernest H.; Robinson, Laura E.; Rupprecht, Charles E.

2008-01-01

To provide molecular and virologic evidence that domestic dog rabies is no longer enzootic to the United States and to identify putative relatives of dog-related rabies viruses (RVs) circulating in other carnivores, we studied RVs associated with recent and historic dog rabies enzootics worldwide. Molecular, phylogenetic, and epizootiologic evidence shows that domestic dog rabies is no longer enzootic to the United States. Nonetheless, our data suggest that independent rabies enzootics are now established in wild terrestrial carnivores (skunks in California and north-central United States, gray foxes in Texas and Arizona, and mongooses in Puerto Rico), as a consequence of different spillover events from long-term rabies enzootics associated with dogs. These preliminary results highlight the key role of dog RVs and human–dog demographics as operative factors for host shifts and disease reemergence into other important carnivore populations and highlight the need for the elimination of dog-related RVs worldwide. PMID:19046506

Distribution of indoor radon concentrations in Pennsylvania, 1990-2007

USGS Publications Warehouse

Gross, Eliza L.

2013-01-01

Median indoor radon concentrations aggregated according to geologic units and hydrogeologic settings are useful for drawing general conclusions about the occurrence of indoor radon in specific geologic units and hydrogeologic settings, but the associated data and maps have limitations. The aggregated indoor radon data have testing and spatial accuracy limitations due to lack of available information regarding testing conditions and the imprecision of geocoded test locations. In addition, the associated data describing geologic units and hydrogeologic settings have spatial and interpretation accuracy limitations, which are a result of using statewide data to define conditions at test locations and geologic data that represent a broad interpretation of geologic units across the State. As a result, indoor air radon concentration distributions are not proposed for use in predicting individual concentrations at specific sites nor for use as a decision-making tool for property owners to decide whether to test for indoor radon concentrations at specific property locations.

An observational study of the temporal and spatial patterns of Marek's-disease-associated leukosis condemnation of young chickens in the United States of America

USDA-ARS?s Scientific Manuscript database

Marek's disease, a disease primarily affecting immature chickens, is a worldwide problem that has on at least three occasions threatened the poultry industry in the United States. A rich dataset to study the epidemiology of this disease is available because the United States Department of Agricultu...

CCA 3101/4101 Environmental Humanities: The History of a Unit through an Ecopedagogical Lens

ERIC Educational Resources Information Center

Ryan, John Charles

2012-01-01

In 2011 the author taught, for the first time, the well-established unit CCA3101/4101 Environmental Humanities in the School of Communications and Arts at ECU (Edith Cowan University) in Western Australia. The unit has a 20-year history through associate professor Rod Giblett and parallels the development of the environmental humanities as a field…

78 FR 34639 - Supplemental Final Environmental Impact Statement for the Restart of Healy Power Plant Unit #2

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-10

... Unit 2 of the Healy Power Plant to demonstrate emissions control technologies. In 1994, the DOE... Electric Association (GVEA) since 1967. Healy Unit 2 is a 50 MW coal-fired steam generator owned by AIDEA... RUS. The RUS Electric Program is authorized to make loans and loan guarantees that finance electric...

Lay Understanding of the Causes of Binge Drinking in the United Kingdom and Australia: A Network Diagram Approach

ERIC Educational Resources Information Center

Keatley, David A.; Ferguson, Eamonn; Lonsdale, Adam; Hagger, Martin S.

2017-01-01

Binge drinking is associated with deleterious health, social and economic outcomes. This study explored the lay understanding of the causes of binge drinking in members of the general public in the United Kingdom and Australia. Participants in the United Kingdom (N = 133) and Australia (N = 102) completed a network diagram exercise requiring them…

Evaluation of a Conceptual Geography Unit for Kindergarten. Earth: Man's Home.

ERIC Educational Resources Information Center

Imperatore, William A.

The main hypothesis was that the unit is appropriate for use at the kindergarten level. The evaluation was based upon the examination of four factors: 1) the reliability and item characteristics of the unit text; 2) the effect of bias associated with pupil sex, race, socio-economic status on geography achievement and learning gains; 3) the effect…

75 FR 39203 - Notice of Availability of a Pest Risk Analysis for Importation of Wall Rocket Leaves from the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-08

...] Notice of Availability of a Pest Risk Analysis for Importation of Wall Rocket Leaves from the United... respect to perennial wall rocket leaves grown in the United Kingdom. The analysis evaluates the risks associated with the importation into the continental United States of fresh leaves of perennial wall rocket...

Defining the Role and Responsibility of the Fire Service Within Homeland Security

DTIC Science & Technology

2010-03-01

Occupational Safety and Health NPS Naval Postgraduate School NRF National Response Framework OSHA Occupational Safety and Health Administration ...Kingdom USAR Urban Search and Rescue USFA United States Fire Administration USMA United States Military Academy xiii ACKNOWLEDGMENTS I want...Association (NFPA), the Occupational Safety and Health Administration (OSHA), the United States Fire Administration (USFA), and the National Institute for

Quality and strength of patient safety climate on medical-surgical units.

PubMed

Hughes, Linda C; Chang, Yunkyung; Mark, Barbara A

2009-01-01

Describing the safety climate in hospitals is an important first step in creating work environments where safety is a priority. Yet, little is known about the patient safety climate on medical-surgical units. Study purposes were to describe quality and strength of the patient safety climate on medical-surgical units and explore hospital and unit characteristics associated with this climate. Data came from a larger organizational study to investigate hospital and unit characteristics associated with organizational, nurse, and patient outcomes. The sample for this study was 3,689 RNs on 286 medical-surgical units in 146 hospitals. Nursing workgroup and managerial commitment to safety were the two most strongly positive attributes of the patient safety climate. However, issues surrounding the balance between job duties and safety compliance and nurses' reluctance to reveal errors continue to be problematic. Nurses in Magnet hospitals were more likely to communicate about errors and participate in error-related problem solving. Nurses on smaller units and units with lower work complexity reported greater safety compliance and were more likely to communicate about and reveal errors. Nurses on smaller units also reported greater commitment to patient safety and participation in error-related problem solving. Nursing workgroup commitment to safety is a valuable resource that can be leveraged to promote a sense of personal responsibility for and shared ownership of patient safety. Managers can capitalize on this commitment by promoting a work environment in which control over nursing practice and active participation in unit decisions are encouraged and by developing channels of communication that increase staff nurse involvement in identifying patient safety issues, prioritizing unit-level safety goals, and resolving day-to-day operational problems the have the potential to jeopardize patient safety.

Distribution of muscle fibre conduction velocity for representative samples of motor units in the full recruitment range of the tibialis anterior muscle.

PubMed

Del Vecchio, A; Negro, F; Felici, F; Farina, D

2018-02-01

Motor units are recruited in an orderly manner according to the size of motor neurones. Moreover, because larger motor neurones innervate fibres with larger diameters than smaller motor neurones, motor units should be recruited orderly according to their conduction velocity (MUCV). Because of technical limitations, these relations have been previously tested either indirectly or in small motor unit samples that revealed weak associations between motor unit recruitment threshold (RT) and MUCV. Here, we analyse the relation between MUCV and RT for large samples of motor units. Ten healthy volunteers completed a series of isometric ankle dorsiflexions at forces up to 70% of the maximum. Multi-channel surface electromyographic signals recorded from the tibialis anterior muscle were decomposed into single motor unit action potentials, from which the corresponding motor unit RT, MUCV and action potential amplitude were estimated. Established relations between muscle fibre diameter and CV were used to estimate the fibre size. Within individual subjects, the distributions of MUCV and fibre diameters were unimodal and did not show distinct populations. MUCV was strongly correlated with RT (mean (SD) R 2  = 0.7 (0.09), P < 0.001; 406 motor units), which supported the hypothesis that fibre diameter is associated with RT. The results provide further evidence for the relations between motor neurone and muscle fibre properties for large samples of motor units. The proposed methodology for motor unit analysis has also the potential to open new perspectives in the study of chronic and acute neuromuscular adaptations to ageing, training and pathology. © 2017 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

Proximity to the US-Mexico border: a key to explaining geographic variation in US methamphetamine, cocaine and heroin purity.

PubMed

Cunningham, James K; Maxwell, Jane Carlisle; Campollo, Octavio; Cunningham, Kathryn I; Liu, Lon-Mu; Lin, Hui-Lin

2010-10-01

Although illicit drug purity is a widely discussed health risk, research explaining its geographic variation within a country is rare. This study examines whether proximity to the US-Mexico border, the United States' primary drug import portal, is associated with geographic variation in US methamphetamine, heroin and cocaine purity. Distances (proximity) between the US-Mexico border and locations of methamphetamine, cocaine and heroin seizures/acquisitions (n = 239,070) recorded in STRIDE (System to Retrieve Information from Drug Evidence) were calculated for the period of 1990-2004. The association of drug purity with these distances and other variables, including time and seizure/acquisition size, was examined using hierarchical multivariate linear modeling (HMLM). Coterminous United States. Methamphetamine, cocaine and heroin purity generally decreased with distance from the US-Mexico border. Heroin purity, however, after initially declining with distance, turned upwards-a U-shaped association. During 2000-04, methamphetamine purity also had a U-shaped association with distance. For each of the three drugs, temporal changes in the purity of small acquisitions (<10 g) were typically more dynamic in areas closer to the US-Mexico border. Geographic variance in methamphetamine, cocaine and heroin purity throughout the coterminous United States was associated with US-Mexico border proximity. The U-shaped associations between border-distance and purity for heroin and methamphetamine may be due to imports of those drugs via the eastern United States and southeast Canada, respectively. That said, areas closer to the US-Mexico border generally had relatively high illicit drug purity, as well as more dynamic change in the purity of small ('retail level') drug amounts. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.

Resource variation in colorectal surgery: a national centre level analysis.

PubMed

Drake, T M; Lee, M J; Senapati, A; Brown, S R

2017-07-01

Delivery of quality colorectal surgery requires adequate resources. We set out to assess the relationship between resources and outcomes in English colorectal units. Data were extracted from the Association of Coloproctology of Great Britain and Ireland resource questionnaire to profile resources. This was correlated with Hospital Episode Statistics outcome data including 90-day mortality and readmissions. Patient satisfaction measures were extracted from the Cancer Experience Patient Survey and compared at unit level. Centres were divided by workload into low, middle and top tertile. Completed questionnaires were received from 75 centres in England. Service resources were similar between low and top tertiles in access to Confidential Enquiry into Patient Outcome and Death (CEPOD) theatre, level two or three beds per 250 000 population or the likelihood of having a dedicated colorectal ward. There was no difference in staffing levels per 250 000 unit of population. Each 10% increase in the proportion of cases attempted laparoscopically was associated with reduced 90-day unplanned readmission (relative risk 0.94, 95% CI 0.91-0.97, P < 0.001). The presence of a dedicated colorectal ward (relative risk 0.85, 95% CI 0.73-0.99, P = 0.040) was also associated with a significant reduction in unplanned readmissions. There was no association between staffing or service factors and patient satisfaction. Resource levels do not vary based on unit of population. There is benefit associated with increased use of laparoscopy and a dedicated surgical ward. Alternative measures to assess the relationship between resources and outcome, such as failure to rescue, should be explored in UK practice. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Nurse Continuity and Hospital-Acquired Pressure Ulcers: A Comparative Analysis Using an Electronic Health Record "Big Data" Set.

PubMed

Stifter, Janet; Yao, Yingwei; Lodhi, Muhammad Kamran; Lopez, Karen Dunn; Khokhar, Ashfaq; Wilkie, Diana J; Keenan, Gail M

2015-01-01

Little research demonstrating the association between nurse continuity and patient outcomes exists despite an intuitive belief that continuity makes a difference in care outcomes. The aim of this study was to examine the association of nurse continuity with the prevention of hospital-acquired pressure ulcers (HAPU). A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care data set containing 42,403 episodes documented by 787 nurses, on nine units, in four hospitals and includes nurse staffing and patient characteristics. The HANDS data set resides in a "big data" relational database consisting of 89 tables and 747 columns of data. Via data mining, we created an analytic data set of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the association of nurse continuity and additional nurse-staffing variables on HAPU occurrence. Poor nurse continuity (unit mean continuity index = .21-.42 [1.0 = optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission, as well as patient age, were associated with HAPUs (p < .001). Controlling for patient characteristics, nurse continuity, and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. We demonstrated a high level of variation in the degree of continuity between patient episodes in the HANDS data, showing that it offers rich potential for future study of nurse continuity and its effect on patient outcomes.

Infectious Disease in a Warming World: How Weather Influenced West Nile Virus in the United States (2001–2005)

PubMed Central

Soverow, Jonathan E.; Wellenius, Gregory A.; Fisman, David N.; Mittleman, Murray A.

2009-01-01

Background The effects of weather on West Nile virus (WNV) mosquito populations in the United States have been widely reported, but few studies assess their overall impact on transmission to humans. Objectives We investigated meteorologic conditions associated with reported human WNV cases in the United States. Methods We conducted a case–crossover study to assess 16,298 human WNV cases reported to the Centers for Disease Control and Prevention from 2001 to 2005. The primary outcome measures were the incidence rate ratio of disease occurrence associated with mean weekly maximum temperature, cumulative weekly temperature, mean weekly dew point temperature, cumulative weekly precipitation, and the presence of ≥ 1 day of heavy rainfall (≥ 50 mm) during the month prior to symptom onset. Results Increasing weekly maximum temperature and weekly cumulative temperature were similarly and significantly associated with a 35–83% higher incidence of reported WNV infection over the next month. An increase in mean weekly dew point temperature was significantly associated with a 9–38% higher incidence over the subsequent 3 weeks. The presence of at least 1 day of heavy rainfall within a week was associated with a 29–66% higher incidence during the same week and over the subsequent 2 weeks. A 20-mm increase in cumulative weekly precipitation was significantly associated with a 4–8% increase in incidence of reported WNV infection over the subsequent 2 weeks. Conclusions Warmer temperatures, elevated humidity, and heavy precipitation increased the rate of human WNV infection in the United States independent of season and each others’ effects. PMID:19654911

General intelligence is associated with subclinical inflammation in Nepalese children: A population-based plasma proteomics study.

PubMed

Lee, Sun Eun; West, Keith P; Cole, Robert N; Schulze, Kerry J; Wu, Lee Shu-Fune; Yager, James D; Groopman, John; Christian, Parul

2016-08-01

Improving child cognition in impoverished countries is a public health priority. Yet, biological pathways and associated biomarkers of impaired cognition remain poorly understood and largely unknown, respectively. This study aimed to explore and quantify associations between functional plasma protein biomarkers and childhood intellectual test performance. We applied proteomics to quantify proteins in plasma samples of 249 rural Nepalese children, 6-8years of age who, 1year later at 7-9years of age, were administered the Universal Nonverbal Intelligence Test (UNIT). Among 751 plasma proteins quantified, 22 were associated with UNIT scores, passing a false discovery rate threshold of 5.0% (q<0.05). UNIT scores were higher by 2.3-9.2 points for every 50% increase in relative abundance of two insulin-like growth factor binding proteins (IGFBPs), six subclasses of apolipoprotein (Apo) and transthyretin, and lower by 4.0-15.3 points for each 50% increase in relative abundance of 13 proteins predominantly involved in inflammation. Among them, IGFBP-acid labile subunit, orosomucoid 1 (ORM1), Apo C-I, and pyruvate kinase isoenzymes M1/M2 jointly explained 37% of the variance in UNIT scores. After additional adjustment for height-for-age Z-score and household socio-economic status as indicators of long-term nutritional and social stress, associations with 6 proteins involved in inflammation, including ORM1, α-1-antichymotrypsin, reticulocalbin 1, and 3 components of the complement cascade, remained significant (q<0.05). Using untargeted proteomics, stable, constitutive facets of subclinical inflammation were associated with lower developmental test performance in this rural South Asian child population. Plasma proteomics may offer opportunities to identify functional, antecedent biomarkers of child cognitive development. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Beverage consumption patterns at age 13–17 are associated with weight, height, and BMI at age 17

PubMed Central

Marshall, Teresa A.; Van Buren, John M.; Warren, John J.; Cavanaugh, Joseph E.; Levy, Steven M.

2017-01-01

Background Sugar-sweetened beverages (SSBs) have been associated with obesity in children and adults; however, associations between beverage patterns and obesity are not understood. Objective To describe beverage patterns during adolescence, and the associations between adolescent beverage patterns and age 17 anthropometric measures. Design Cross-sectional analyses of longitudinally-collected data. Participants/setting Participants in the longitudinal Iowa Fluoride Study having at least one beverage questionnaire completed between ages 13.0 and 14.0 years, having a second questionnaire completed between 16.0 and 17.0 years and attending an age 17 clinic exam for weight and height measurements (n=369). Exposure Beverages were collapsed into 4 categories {i.e., 100% juice, milk, water and other sugar-free beverages (water/SFB), and SSBs} for the purpose of clustering. Five beverage clusters were identified from standardized age 13–17 mean daily beverage intakes and named by the authors for the dominant beverage: juice, milk, water/SFB, neutral and SSB. Outcome Age 17 weight, height and BMI. Statistical analyses Ward’s method for clustering of beverage variables. One-way ANOVA and chi-square tests for bivariable associations. Gamma regression for associations of weight or BMI (outcomes) with beverage clusters and demographic variables. Linear regression for associations of height (outcome) with beverage clusters and demographic variables. Results Participants with family incomes < $60,000 trended shorter (1.5±0.8 cm; P=0.070) and were heavier (2.0±0.7 BMI units; P=0.002) than participants with family incomes ≥ 60,000/year. Adjusted mean weight, height and BMI estimates differed by beverage cluster membership. For example, on average, male and female members of the neutral cluster were 4.5 cm (P=0.010) and 4.2 (P=0.034) cm shorter, respectively, than members of the milk cluster. For members of the juice cluster, the mean BMI was lower than for members of the milk cluster (by 2.4 units), water/SFB cluster (3.5 units), neutral cluster (2.2 units) and SSB cluster (3.2 units) (all Ps<0.05). Conclusions Age 13–17 year beverage patterns were associated with age 17 anthropometric measures and BMI in this sample. Beverage patterns might be characteristic of overall food choices and dietary behaviors that influence growth. PMID:28259744

An Alternative Hypothesis for How Microgravity Improves Macromolecular Crystal Quality

NASA Technical Reports Server (NTRS)

Pusey, Marc

2003-01-01

There is a substantial body of experimental evidence, from this and other laboratories, that strongly suggests that for many proteins crystal nucleation and growth is by addition of associated species that are preformed by reversible concentration-driven self association processes in the bulk solution. We have developed a self-association model for the crystal nucleation and growth of the protein chicken egg lysozyme. The model accounts for the obtained crystal symmetry, explains the observed surface structures, and shows the importance of the symmetry obtained by self-association in solution to the process as a whole. This model also offers a possible mechanism for fluid flow effects on the growth process and how microgravity may affect it. While a single lysozyme molecule is relatively small an octamer in the 43 helix configuration (the proposed average sized growth unit) would have a M.W. approx. 115,000 and dimensions of 5.6 x 5.6 x 7.6 nm. Direct AFM measurements of growth unit incorporation indicate that units as wide as 11.2 nm and as long as 11.4 nm (a 24-mer) commonly attach to the crystal. AFM results from Weichmann et al. (Ultramicroscopy 86, 159-166, 2001) suggest that associated species of up to 40-mers in size add to the (101) faces. These measurements reflect the sizes of units that both added and desorbed from the crystal surface. The larger and less isotropic the associated species the more likely that it will be oriented to some degree in a flowing boundary layer, even at the low flow velocities measured about macromolecule crystals. On Earth, concentration gradient driven flow will maintain a high interfacial concentration, i.e., a high level (essentially that of the bulk solution) of solute association at the interface and higher growth rate. Higher growth rates mean an increased probability that misaligned growth units are trapped by subsequent growth layers before they can be desorbed and try again, or that the desorbing species is more likely to be smaller than the adsorbing species. In microgravity the extended diffusive boundary layer will lower the interfacial concentration. This results in a net dissociation of aggregated species that diffuse in from the bulk solution, i.e., smaller associated species, which are more likely able to make multiple attempts to correctly bind, yielding higher quality crystals.

Statistical analysis of the radon-222 potential of rocks in Virginia, U.S.A.

USGS Publications Warehouse

Brown, C. Erwin; Mose, D.G.; Mushrush, G.W.; Chrosniak, C.E.

1992-01-01

More than 3,200 indoor radon-222 (222Rn) measurements were made seasonally in an area of about 1,000 square kilometers of the Coastal Plain and Piedmont physiographic provinces in Virginia, U.S.A. Results of these measurements indicate that some geological units are associated, on the average, with twice as much indoor222Rn as other geological units, and that indoor222Rn varies seasonally. The Kruskal-Wallis test was used to test whether indoor222Rn concentrations for data gathered over the winter and summer seasons differ significantly by rock unit. The tests concluded that indoor222Rn concentrations for different rock units were not equal at the 5-percent significance level. The rocks associated with the highest median indoor222Rn concentration are specific rocks in the Mesozoic Culpeper basin, including shale and siltstone units with Jurassic diabase intrusives, and mica schists in the Piedmont physiographic province. The pre-Triassic Peters Creek Schist has the highest ranking in terms of indoor222Rn concentration. The rocks associated with the lowest indoor222Rn concentrations include coastal plain sediments, the Occoquan Granite, Falls Church Tonalite, Piney Branch Mafic and Ultramafic complex, and unnamed mafic and ultramafic inclusions, respectively. The rocks have been ranked according to observed222Rn concentration by transforming the average rank of indoor222Rn concentrations to z scores. ?? 1992 Springer-Verlag New York Inc.

Factors associated with the process of adaptation among Pakistani adolescent females living in United States.

PubMed

Khuwaja, Salma A; Selwyn, Beatrice J; Mgbere, Osaro; Khuwaja, Alam; Kapadia, Asha; McCurdy, Sheryl; Hsu, Chiehwen E

2013-04-01

This study explored post-migration experiences of recently migrated Pakistani Muslim adolescent females residing in the United States. In-depth, semi-structured interviews were conducted with thirty Pakistani Muslim adolescent females between the ages of 15 and 18 years living with their families in Houston, Texas. Data obtained from the interviews were evaluated using discourse analysis to identify major reoccurring themes. Participants discussed factors associated with the process of adaptation to the American culture. The results revealed that the main factors associated with adaptation process included positive motivation for migration, family bonding, social support networks, inter-familial communication, aspiration of adolescents to learn other cultures, availability of English-as-second-language programs, participation in community rebuilding activities, and faith practices, English proficiency, peer pressure, and inter-generational conflicts. This study provided much needed information on factors associated with adaptation process of Pakistani Muslim adolescent females in the United States. The results have important implications for improving the adaptation process of this group and offer potential directions for intervention and counseling services.

Mortality in hyperglycemic crisis: a high association with infections and cerebrovascular disease.

PubMed

Ekpebegh, C; Longo-Mbenza, B

2013-06-01

Aim of the present study was to determine syndrome specific mortality rates and the precipitating factors associated with deaths following admission for hyperglycemic crisis to a high care unit. Retrospective review of medical records for hyperglycemic crisis at Nelson Mandela Academic Hospital, Mthatha, Eastern Cape Province of South Africa from February 1 2010 to January 31 2011. All admissions were initially into the high care unit. The overall mortality rates (per admissions) was 13.9% (N.=15/108) with syndrome specific mortality rates (per admissions) of 11.9% (N.=8/67), 0% (N.=0/8) and 21.2% (N.=7/33) respectively for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS) and hyperglycemia with dehydration (HD). The precipitating factors that were mainly associated with mortality were infections and cerebrovascular disease (CVD). The patients with CVD who died were all unconscious. There were no deaths where non-compliance with hypoglycaemic agents (14.8%, N.=16/108) was the precipitating factor. The overall mortality rates (per admissions) following high care unit admissions for hyperglycemic crisis was 13.9% with infections and CVD as the precipitating factors most associated with deaths.

An exploration of risk for recurrent falls in two geriatric care settings

PubMed Central

2013-01-01

Background Fall events were examined in two distinct geriatric populations to identify factors associated with repeat fallers, and to examine whether patients who use gait aids, specifically a walker, were more likely to experience repeat falls. Each unit already had a generic program for falls prevention in place. Methods Secondary data analysis was conducted on information collected during the pilot testing of a new quality assurance Incident Reporting Tool between October 2006 and September 2008. The study settings included an in-patient geriatric rehabilitation unit (GRU) and a long stay veterans’ unit (LSVU) in a rehabilitation and long-stay hospital in Ontario. Participants were two hundred and twenty three individuals, aged 65 years or older on these two units, who experienced one or more fall incidents during the study period. Results Logistic regression analyses showed that on the GRU age was significantly associated with repeat falls. On the LSVU first falls in the morning or late evening were associated with repeat falling. Walker as a gait aid listed at time of first fall was not associated with repeat falls. Conclusions This study suggests that different intervention may be necessary in different geriatric settings to identify, for secondary prevention, certain individuals for which the generic programs prove inadequate. Information collection with a specific focus on the issue of repeat falls may be necessary for greater insight. PMID:24106879

Association between addiction treatment staff professional and educational levels and perceptions of organizational climate and resources.

PubMed

Krull, Ivy; Lundgren, Lena; Beltrame, Clelia

2014-01-01

Research studies have identified addiction treatment staff who have higher levels of education as having more positive attitudes about evidence-based treatment practices, science-based training, and the usefulness of evidence-based practices. This study examined associations between addiction treatment staff level of education and their perceptions of 3 measures of organizational change: organizational stress, training resources and staffing resources in their treatment unit. The sample included 588 clinical staff from community-based substance abuse treatment organizations who received Substance Abuse and Mental Health Services Administration (SAMHSA) funding (2003-2008) to implement evidence-based practices (EBPs). Bivariate analysis and regression modeling methods examined the relationship between staff education level (no high school education, high school education, some college, associate's degree, bachelor's degree, master's degree, doctoral degree, and other type of degree such as medical assistant, registered nurse [RN], or postdoctoral) and attitudes about organizational climate (stress), training resources, and staffing resources while controlling for staff and treatment unit characteristics. Multivariable models identified staff with lower levels of education as having significantly more positive attitudes about their unit's organizational capacity. These results contradict findings that addiction treatment staff with higher levels of education work in units with greater levels of organizational readiness for change. It cannot be inferred that higher levels of education among treatment staff is necessarily associated with high levels of organizational readiness for change.

Position of the American Dietetic Association: food insecurity and hunger in the United States.

PubMed

Holben, David H

2006-03-01

It is the position of the American Dietetic Association that systematic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States. The Association believes that immediate and long-range interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, the inclusion of food and nutrition education in all programs providing food and nutrition assistance, and innovative programs to promote and support the economic self-sufficiency of individuals and families, to end food insecurity and hunger in the United States. Food insecurity continues to exist in the United States, with over 38 million people experiencing it sometime in 2004. Negative nutritional and nonnutritional outcomes have been associated with food insecurity in adults, adolescents, and children, including poor dietary intake and nutritional status, poor health, increased risk for the development of chronic diseases, poor psychological and cognitive functioning, and substandard academic achievement. Dietetics professionals can play a key role in ending food insecurity and hunger and are uniquely positioned to make valuable contributions through provision of comprehensive food and nutrition education, competent and collaborative practice, innovative research related to accessing a safe and secure food supply, and advocacy efforts at the local, state, regional, and national levels.

Modeling of the T S D E Heater Test to Investigate Crushed Salt Reconsolidation and Rock Salt Creep for the Underground Disposal of High-Level Nuclear Waste

NASA Astrophysics Data System (ADS)

Blanco Martin, L.; Rutqvist, J.; Birkholzer, J. T.; Wolters, R.; Lux, K. H.

2014-12-01

Rock salt is a potential medium for the underground disposal of nuclear waste because it has several assets, in particular its water and gas tightness in the undisturbed state, its ability to heal induced fractures and its high thermal conductivity as compared to other shallow-crustal rocks. In addition, the run-of-mine, granular salt, may be used to backfill the mined open spaces. We present simulation results associated with coupled thermal, hydraulic and mechanical processes in the TSDE (Thermal Simulation for Drift Emplacement) experiment, conducted in the Asse salt mine in Germany [1]. During this unique test, conceived to simulate reference repository conditions for spent nuclear fuel, a significant amount of data (temperature, stress changes and displacements, among others) was measured at 20 cross-sections, distributed in two drifts in which a total of six electrical heaters were emplaced. The drifts were subsequently backfilled with crushed salt. This test has been modeled in three-dimensions, using two sequential simulators for flow (mass and heat) and geomechanics, TOUGH-FLAC and FLAC-TOUGH [2]. These simulators have recently been updated to accommodate large strains and time-dependent rheology. The numerical predictions obtained by the two simulators are compared within the framework of an international benchmark exercise, and also with experimental data. Subsequently, a re-calibration of some parameters has been performed. Modeling coupled processes in saliniferous media for nuclear waste disposal is a novel approach, and in this study it has led to the determination of some creep parameters that are very difficult to assess at the laboratory-scale because they require extremely low strain rates. Moreover, the results from the benchmark are very satisfactory and validate the capabilities of the two simulators used to study coupled thermal, mechanical and hydraulic (multi-component, multi-phase) processes relative to the underground disposal of high-level nuclear waste in rock salt. References: [1] Bechthold et al., 1999. BAMBUS-I Project. Euratom, Report EUR19124-EN. [2] Blanco Martín et al., 2014. Comparison of two sequential simulators to investigate thermal-hydraulic-mechanical processes related to nuclear waste isolation in saliniferous formations. In preparation.

Calling the Question

ERIC Educational Resources Information Center

Whitehead, Diane

2009-01-01

Association for Childhood Education International (ACEI) has a long and proud history as an association of members dedicated to the cause of childhood education. The word "association" originates from the word "associate," for which there exists several definitions, with the common distinction of joining together or uniting in partnership. When…

25 CFR 700.722 - Grazing associations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... association's constitution and bylaws. (3) The officers other than secretary and treasurer must be grazing permittees on the range unit involved. (4) The association's activities must be governed by a constitution and bylaws acceptable to the Commissioner and signed by him. (5) The association's constitution and...

Risk of Suicide Attempt Associated with Previous Attempts in One’s Army Unit

PubMed Central

Ursano, Robert J.; Kessler, Ronald C.; Naifeh, James A.; Mash, Holly Herberman; Fullerton, Carol S.; Bliese, Paul D.; Zaslavsky, Alan M.; Ng, Tsz Hin Hinz; Aliaga, Pablo A.; Wynn, Gary H.; Dinh, Hieu M.; McCarroll, James E.; Sampson, Nancy A.; Kao, Tzu-Cheg; Schoenbaum, Michael; Heeringa, Steven G.; Stein, Murray B.

2017-01-01

Objective Soldiers’ mental health is adversely affected by the death and injury of other unit members, but it is not known if risk of suicide attempt is influenced by previous suicide attempts in one’s unit. Method Using administrative data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), we identified person-month records for all active duty Regular Army enlisted soldiers who attempted suicide from 2004–2009 (n=9,650) and an equal-probability sample of control person-months (n=153,528). Logistic regression analyses examined the number of past-year suicide attempts in one’s unit as a predictor of subsequent suicide attempt, controlling for socio-demographics, service-related characteristics, prior mental health diagnosis, and other unit variables, including suicide-, combat-, and accident-related unit deaths. We also examined whether the influence of previous unit suicide attempts varied by military occupational specialty (MOS) and unit size. Results In adjusted models, soldiers were more likely to attempt suicide if one or more suicide attempts occurred in their unit during the past year (OR=1.4–2.3; p<0.001), with odds increasing as the number of unit attempts increased. The odds of suicide attempt among soldiers in a unit with five or more past-year attempts was more than twice that of soldiers in a unit with no previous attempts (OR=2.3; 95% CI=2.1–2.6). The association of previous unit suicide attempts with subsequent risk was significant whether soldiers had a combat arms MOS or other MOS (OR=1.4–2.3; p<0.001). It was also significant regardless of unit size, with the highest risk for those in smaller units (1–40 soldiers) (OR=2.1–5.9; p<0.001). The population-attributable risk proportion for one or more unit suicide attempts in the past year indicated that if this risk could be reduced to no unit attempts, 18.2% of attempts would not occur. Conclusions Soldiers’ risk of suicide attempt increased as the number of past-year suicide attempts within their unit increased. This was true for both combat arms and other MOSs, and for units of any size, but particularly for smaller units. Units with a history of suicide attempts may be important targets for preventive interventions. PMID:28746705

Factors associated with maternal death in an intensive care unit

PubMed Central

Saintrain, Suzanne Vieira; de Oliveira, Juliana Gomes Ramalho; Saintrain, Maria Vieira de Lima; Bruno, Zenilda Vieira; Borges, Juliana Lima Nogueira; Daher, Elizabeth De Francesco; da Silva Jr, Geraldo Bezerra

2016-01-01

Objective To identify factors associated with maternal death in patients admitted to an intensive care unit. Methods A cross-sectional study was conducted in a maternal intensive care unit. All medical records of patients admitted from January 2012 to December 2014 were reviewed. Pregnant and puerperal women were included; those with diagnoses of hydatidiform mole, ectopic pregnancy, or anembryonic pregnancy were excluded, as were patients admitted for non-obstetrical reasons. Death and hospital discharge were the outcomes subjected to comparative analysis. Results A total of 373 patients aged 13 to 45 years were included. The causes for admission to the intensive care unit were hypertensive disorders of pregnancy, followed by heart disease, respiratory failure, and sepsis; complications included acute kidney injury (24.1%), hypotension (15.5%), bleeding (10.2%), and sepsis (6.7%). A total of 28 patients died (7.5%). Causes of death were hemorrhagic shock, multiple organ failure, respiratory failure, and sepsis. The independent risk factors associated with death were acute kidney injury (odds ratio [OR] = 6.77), hypotension (OR = 15.08), and respiratory failure (OR = 3.65). Conclusion The frequency of deaths was low. Acute kidney injury, hypotension, and respiratory insufficiency were independent risk factors for maternal death. PMID:28099637

Bypass apparatus and method for series connected energy storage devices

DOEpatents

Rouillard, Jean; Comte, Christophe; Daigle, Dominik

2000-01-01

A bypass apparatus and method for series connected energy storage devices. Each of the energy storage devices coupled to a common series connection has an associated bypass unit connected thereto in parallel. A current bypass unit includes a sensor which is coupled in parallel with an associated energy storage device or cell and senses an energy parameter indicative of an energy state of the cell, such as cell voltage. A bypass switch is coupled in parallel with the energy storage cell and operable between a non-activated state and an activated state. The bypass switch, when in the non-activated state, is substantially non-conductive with respect to current passing through the energy storage cell and, when in the activated state, provides a bypass current path for passing current to the series connection so as to bypass the associated cell. A controller controls activation of the bypass switch in response to the voltage of the cell deviating from a pre-established voltage setpoint. The controller may be included within the bypass unit or be disposed on a control platform external to the bypass unit. The bypass switch may, when activated, establish a permanent or a temporary bypass current path.

Acute Respiratory Distress Syndrome Secondary to Influenza A(H1N1)pdm09: Clinical Characteristics and Mortality Predictors.

PubMed

Hernández-Cárdenas, Carmen Margarita; Serna-Secundino, Héctor; García-Olazarán, José Guadalupe; Aguilar-Pérez, Cristina Leticia; Rocha-Machado, Jesús; Campos-Calderón, Luis Fernando; Lugo-Goytia, Gustavo

2016-01-01

Acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09 virus is the leading cause of death among this patient population. Expanding the knowledge of its course and predictors of mortality is relevant to decision making. We aimed to describe the clinical characteristics and identify factors associated with mortality in patients with acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09 during the 2013-2014 influenza season. This is an observational study of a prospective cohort of 70 patients with acute respiratory distress syndrome and influenza A(H1N1) pdm09 seen in an academic medical center. Multivariate logistic regression was used to identify the independent mortality predictors. Bootstrap was used for internal model validation. This cohort was represented by young adults (43 ± 11 years old). Obesity was present in 62.5% and was not associated with mortality. Mortality at 28 days and at discharge from the respiratory intensive care unit was 14 and 20%, respectively. All patients met the criteria for acute respiratory distress syndrome, 73% had vasodilatory shock, and 27.1% had acute kidney injury on respiratory intensive care unit admission. We observed a high incidence of intensive care unit-acquired weakness (81.4%). Ventilator-associated pneumonia developed in 47.1% and was not associated with mortality. In multivariate analysis, independent risk factors for intensive care unit mortality were age (odds ratio [OR] = 1.102), white blood cell count (OR = 1.22), and lactate dehydrogenase levels (OR = 1.004) on admission to the intensive care unit. We described the clinical characteristics and course of a cohort of patients with acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09, and developed a predictive model of mortality based on the covariates age, levels of lactate dehydrogenase, and white cell count on admission to the respiratory intensive care unit.

The effect of social integration on outcomes after major lower extremity amputation.

PubMed

Hawkins, Alexander T; Pallangyo, Anthony J; Herman, Ayesiga M; Schaumeier, Maria J; Smith, Ann D; Hevelone, Nathanael D; Crandell, David M; Nguyen, Louis L

2016-01-01

Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D. We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (β, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis. In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

PubMed

Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, José Miguel; Cardoso, Graça; King, Michael

2012-01-01

The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. 1750/2495 (70%) users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning). A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care. Interventions that improve quality of care in these settings may promote service users' autonomy.

Is organizational justice climate at the workplace associated with individual-level quality of care and organizational affective commitment? A multi-level, cross-sectional study on dentistry in Sweden.

PubMed

Berthelsen, Hanne; Conway, Paul Maurice; Clausen, Thomas

2018-02-01

The aim of this study is to investigate whether organizational justice climate at the workplace level is associated with individual staff members' perceptions of care quality and affective commitment to the workplace. The study adopts a cross-sectional multi-level design. Data were collected using an electronic survey and a response rate of 75% was obtained. Organizational justice climate and affective commitment to the workplace were measured by items from Copenhagen Psychosocial Questionnaire and quality of care by three self-developed items. Non-managerial staff working at dental clinics with at least five respondents (n = 900 from 68 units) was included in analyses. A set of Level-2 random intercept models were built to predict individual-level organizational affective commitment and perceived quality of care from unit-level organizational justice climate, controlling for potential confounding by group size, gender, age, and occupation. The results of the empty model showed substantial between-unit variation for both affective commitment (ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice climate at the clinical unit level was significantly associated with perceived quality of care and affective commitment to the organization (p < 0.001). Organizational justice climate at work unit level explained all variation in affective commitment among dental clinics and was associated with both the individual staff members' affective commitment and perceived quality of care. These findings suggest a potential for that addressing organizational justice climate may be a way to promote quality of care and enhancing affective commitment. However, longitudinal studies are needed to support causality in the examined relationships. Intervention research is also recommended to probe the effectiveness of actions increasing unit-level organizational justice climate and test their impact on quality of care and affective commitment.

Automated external defibrillators in National Collegiate Athletic Association Division I Athletics.

PubMed

Coris, Eric E; Sahebzamani, Frances; Walz, Steve; Ramirez, Arnold M

2004-01-01

Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers' Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio =.0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit acquisition and implementation with knowledge of the surrounding emergency medical service system, geography of their individual sports medicine facilities, numbers and relative risk of their athletes, and budgetary constraints.

Modern trends in infection control practices in intensive care units.

PubMed

Gandra, Sumanth; Ellison, Richard T

2014-01-01

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection. © The Author(s) 2013.

Widespread Refreezing of Both Surface and Basal Melt Water Beneath the Greenland Ice Sheet

NASA Astrophysics Data System (ADS)

Bell, R. E.; Tinto, K. J.; Das, I.; Wolovick, M.; Chu, W.; Creyts, T. T.; Frearson, N.

2013-12-01

The isotopically and chemically distinct, bubble-free ice observed along the Greenland Ice Sheet margin both in the Russell Glacier and north of Jacobshavn must have formed when water froze from subglacial networks. Where this refreezing occurs and what impact it has on ice sheet processes remain unclear. We use airborne radar data to demonstrate that freeze-on to the ice sheet base and associated deformation produce large ice units up to 700 m thick throughout northern Greenland. Along the ice sheet margin, in the ablation zone, surface meltwater, delivered via moulins, refreezes to the ice sheet base over rugged topography. In the interior, water melted from the ice sheet base is refrozen and surrounded by folded ice. A significant fraction of the ice sheet is modified by basal freeze-on and associated deformation. For the Eqip and Petermann catchments, representing the ice sheet margin and interior respectively, extensive airborne radar datasets show that 10%-13% of the base of the ice sheet and up to a third of the catchment width is modified by basal freeze-on. The interior units develop over relatively subdued topography with modest water flux from basal melt where conductive cooling likely dominates. Steps in the bed topography associated with subglacial valley networks may foster glaciohydraulic supercooling. The ablation zone units develop where both surface melt and crevassing are widespread and large volumes of surface meltwater will reach the base of the ice sheet. The relatively steep topography at the upslope edge of the ablation zone units combined with the larger water flux suggests that supercooling plays a greater role in their formation. The ice qualities of the ablation zone units should reflect the relatively fresh surface melt whereas the chemistry of the interior units should reflect solute-rich basal melt. Changes in basal conditions such as the presence of till patches may contribute to the formation of the large basal units near the Northeast Ice Stream. The contrasting rheology of glacial and interglacial ice may also enhance the deformation associated with freeze-on beneath large ice sheets. The occurrence of basal units both in the ice sheet interior and in the thermally very different ablation zone indicates refreezing is widespread and can occur in many environments beneath an ice sheet. This process appears to influence the morphology and behavior of the ice sheet from top to bottom.

Utility of CT classifications to predict unfavorable outcomes in children with acute pancreatitis.

PubMed

Izquierdo, Yojhan E; Fonseca, Eileen V; Moreno, Luz-Ángela; Montoya, Rubén D; Guerrero Lozano, Rafael

2018-02-21

Computed tomography (CT) is useful for the diagnosis of local complications in children with acute pancreatitis but its role as a prognostic tool remains controversial. To establish the correlation between the CT Severity Index and the Revised Atlanta Classification regarding unfavorable outcomes such as severe acute pancreatitis and need for Pediatric Special Care Unit attention in children with acute pancreatitis. We conducted a retrospective and concordance cohort study in which we obtained abdominal CT scans from 30 patients ages 0 to 18 years with acute pancreatitis. Two pediatric radiologists interpreted the results using the CT Severity Index and the Revised Atlanta Classification. The kappa coefficient was determined for each scale. The association among severe acute pancreatitis, need for admission to the Pediatric Special Care Unit and CT systems were established using chi-square or Mann-Whitney U tests. The best CT Severity Index value to predict the need for admission to the Pediatric Special Care Unit was estimated through a receiver operating characteristic (ROC) curve. Mean CT Severity Index was 5.1±2.8 (mean ± standard deviation on a scale of 0 to 10) for the severe acute pancreatitis group vs. 3.8±2.7 for the mild acute pancreatitis group (P=0.230). The CT Severity Index for the children who were not hospitalized at the Pediatric Special Care Unit was 2.2±2.2 vs. 5.6±2.4 for the group hospitalized at the Pediatric Special Care Unit (P=0.001). Only parenchymal necrosis >30% was associated with severe acute pancreatitis (P=0.021). A CT Severity Index ≥3 has a sensitivity of 89% and specificity of 72% to predict need for admission to the Pediatric Special Care Unit. None of the Revised Atlanta Classification categories was associated with severe acute pancreatitis or admission to the Pediatric Special Care Unit. A CT Severity Index ≥3 in children with acute pancreatitis who require CT assessment based on clinical criteria is associated with the need for admission to the Pediatric Special Care Unit. We found that pancreatic necrosis greater than 30% is the only tomographic parameter related to severe acute pancreatitis. New studies with a greater sample size are necessary to confirm this result.

Association of cutaneous melanoma incidence with area-based socioeconomic indicators-United States, 2004-2006.

PubMed

Singh, Simple D; Ajani, Umed A; Johnson, Christopher J; Roland, Katherine B; Eide, Melody; Jemal, Ahmedin; Negoita, Serban; Bayakly, Rana A; Ekwueme, Donatus U

2011-11-01

Socioeconomic status (SES) has been associated with melanoma incidence and outcomes. Examination of the relationship between melanoma and SES at the national level in the United States is limited. Expanding knowledge of this association is needed to improve early detection and eliminate disparities. We sought to provide a detailed description of cutaneous melanoma incidence and stage of disease in relationship to area-based socioeconomic measures including poverty level, education, income, and unemployment in the United States. Invasive cutaneous melanoma data reported by 44 population-based central cancer registries for 2004 to 2006 were merged with county-level SES estimates from the US Census Bureau. Age-adjusted incidence rates were calculated by gender, race/ethnicity, poverty, education, income, unemployment, and metro/urban/rural status using software. Poisson multilevel mixed models were fitted, and incidence density ratios were calculated by stage for area-based SES measures, controlling for age, gender, and state random effects. Counties with lower poverty, higher education, higher income, and lower unemployment had higher age-adjusted melanoma incidence rates for both early and late stage. In multivariate models, SES effects persisted for early-stage but not late-stage melanoma incidence. Individual-level measures of SES were unavailable, and estimates were based on county-level SES measures. Our findings show that melanoma incidence in the United States is associated with aggregate county-level measures of high SES. Analyses using finer-level SES measures, such as individual or census tract level, are needed to provide more precise estimates of these associations. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Association Between Enteral Feeding, Weight Status, and Mortality in a Medical Intensive Care Unit.

PubMed

Vest, Michael T; Kolm, Paul; Bowen, James; Trabulsi, Jillian; Lennon, Shannon L; Shapero, Mary; McGraw, Patty; Halbert, James; Jurkovitz, Claudine

2018-03-01

Clinical practice guidelines recommend enteral nutrition for most patients receiving mechanical ventilation. However, recently published evidence on the effect of enteral nutrition on mortality, particularly for patients who are well nourished, is conflicting. To examine the association between enteral feeding and hospital mortality in critically ill patients receiving mechanical ventilation and to determine if body mass index mediates this relationship. A retrospective cohort study of patients receiving mechanical ventilation admitted to a medical intensive care unit in 2013. Demographic and clinical variables were collected. Cox proportional hazards regression was used to examine the relationship between an enteral feeding order and hospital mortality and to determine if the relationship was mediated by body mass index. Of 777 patients who had 811 hospitalizations requiring mechanical ventilation, 182 (23.4%) died in the hospital. A total of 478 patients (61.5%) received an order for enteral tube feeding, which was associated with a lower risk of death (hazard ratio, 0.41; 95% CI, 0.29-0.59). Body mass index did not mediate the relationship between mortality and receipt of an order for enteral feeding. Median stay in the unit was 3.6 days. Most deaths (72.0%) occurred more than 48 hours after admission. The finding of a positive association between an order for enteral feeding and survival supports enteral feeding of patients in medical intensive care units. Furthermore, the beneficial effect of enteral feeding appears to apply to patients regardless of body mass index. ©2018 American Association of Critical-Care Nurses.

Medicare intensive care unit use: analysis of incidence, cost, and payment.

PubMed

Cooper, Liesl M; Linde-Zwirble, Walter T

2004-11-01

To determine the incidence, cost, and payment for intensive care unit services among Medicare beneficiaries. Retrospective observational database cohort study. All nonfederal hospitals with intensive care unit beds (n = 5003) paid through the inpatient prospective payment system (IPPS). We used all fiscal year 2000 Medicare IPPS hospitalizations with consistent payment information (n = 10,657,587). None. We examined the distribution of cost and payments overall, by hospital type, and by diagnosis related group. Intensive care was used in 2,353,208 cases (21.1%). The overall incidence was 59.8 cases per thousand beneficiaries in the aged (65+) population, increasing with age from 36.2 (65-69) to 91.6 (85+). Intensive care unit patients cost nearly three times floor patients (4,135 dollars vs. 5,571 dollars), with two thirds of costs associated with the intensive care unit portion of the stay, 2,278 dollars per intensive care unit day. However, intensive care unit cases were paid at a rate only twice floor cases (11,704 dollars vs. 5,835 dollars). Only 83% of costs were paid for intensive care unit patients, compared with 105% for floor patients, generating a 5.8 billion dollars loss to hospitals when intensive care unit care is required. There was a linear association between the percent intensive care unit in a diagnosis related group and the percent paid, with payment >90% of cost only in diagnosis related groups with >/=60% intensive care unit cases. We found that teaching hospitals were better paid than nonteaching hospitals (87% vs. 78% of costs, respectively), but this was only due to indirect medical education payments. Intensive care is common, expensive, and poorly paid in the Medicare population. Few diagnosis related groups have a large enough intensive care unit population to ensure adequate payment. Additional diagnosis related groups for conditions common to the intensive care unit would improve payment and enable incentives for efficiency.

Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries.

PubMed

Penm, Jonathan; MacKinnon, Neil J; Strakowski, Stephen M; Ying, Jun; Doty, Michelle M

2017-03-01

Care coordination has been identified as a key strategy in improving the effectiveness, safety, and efficiency of the US health care system. Our objective was to determine whether population or health care system issues are associated with primary care coordination gaps in the United States and other high-income countries. We analyzed data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis. Respondents were adult primary care patients from 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and the United States. Poor primary care coordination was defined as participants reporting at least 3 gaps in the coordination of care out of a maximum of 5. Analyses were based on 13,958 respondents. The rate of poor primary care coordination was 5.2% (724/13,958 respondents) overall and highest in the United States, at 9.8% (137/1,395 respondents). Multivariate regression analysis among all respondents found that they were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well (odds ratio = 0.6 for each). Poor primary care coordination was more likely to occur among patients with chronic conditions (odds ratios = 1.4-2.1 depending on number) and patients younger than 65 years (odds ratios = 1.6-2.3 depending on age-group). Among US respondents, insurance status, health status, household income, and sex were not associated with poor primary care coordination. The United States had the highest rate of poor primary care coordination among the 11 high-income countries evaluated. An established relationship with a primary care physician was significantly associated with better care coordination, whereas being chronically ill or younger was associated with poorer care coordination. © 2017 Annals of Family Medicine, Inc.

Minding the Gap: Factors Associated With Primary Care Coordination of Adults in 11 Countries

PubMed Central

Penm, Jonathan; MacKinnon, Neil J.; Strakowski, Stephen M.; Ying, Jun; Doty, Michelle M.

2017-01-01

PURPOSE Care coordination has been identified as a key strategy in improving the effectiveness, safety, and efficiency of the US health care system. Our objective was to determine whether population or health care system issues are associated with primary care coordination gaps in the United States and other high-income countries. METHODS We analyzed data from the 2013 Commonwealth Fund International Health Policy (IHP) survey with multivariate logistic regression analysis. Respondents were adult primary care patients from 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, and the United States. Poor primary care coordination was defined as participants reporting at least 3 gaps in the coordination of care out of a maximum of 5. RESULTS Analyses were based on 13,958 respondents. The rate of poor primary care coordination was 5.2% (724/13,958 respondents) overall and highest in the United States, at 9.8% (137/1,395 respondents). Multivariate regression analysis among all respondents found that they were less likely to experience poor primary care coordination if their primary care physician often or always knew their medical history, spent sufficient time, involved them, and explained things well (odds ratio = 0.6 for each). Poor primary care coordination was more likely to occur among patients with chronic conditions (odds ratios = 1.4–2.1 depending on number) and patients younger than 65 years (odds ratios = 1.6–2.3 depending on age-group). Among US respondents, insurance status, health status, household income, and sex were not associated with poor primary care coordination. CONCLUSIONS The United States had the highest rate of poor primary care coordination among the 11 high-income countries evaluated. An established relationship with a primary care physician was significantly associated with better care coordination, whereas being chronically ill or younger was associated with poorer care coordination. PMID:28289109

Association between aggressive care and bereaved families' evaluation of end-of-life care for veterans with non-small cell lung cancer who died in Veterans Affairs facilities.

PubMed

Ersek, Mary; Miller, Susan C; Wagner, Todd H; Thorpe, Joshua M; Smith, Dawn; Levy, Cari R; Gidwani, Risha; Faricy-Anderson, Katherine; Lorenz, Karl A; Kinosian, Bruce; Mor, Vincent

2017-08-15

To the authors' knowledge, little is known regarding the relationship between patients' and families' satisfaction with aggressive end-of-life care. Herein, the authors examined the associations between episodes of aggressive care (ie, chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions) within the last 30 days of life and families' evaluations of end-of-life care among patients with non-small cell lung cancer (NSCLC). A total of 847 patients with NSCLC (34% of whom were aged <65 years) who died in a nursing home or intensive care, acute care, or hospice/palliative care (HPC) unit at 1 of 128 Veterans Affairs Medical Centers between 2010 and 2012 were examined. Data sources included Veterans Affairs administrative and clinical data, Medicare claims, and the Bereaved Family Survey. The response rate for the Bereaved Family Survey was 62%. Greater than 72% of veterans with advanced lung cancer who died in an inpatient setting had at least 1 episode of aggressive care and 31% received chemotherapy within the last 30 days of life. For all units except for HPC, when patients experienced at least 1 episode of aggressive care, bereaved families rated care lower compared with when patients did not receive any aggressive care. For patients dying in an HPC unit, the associations between overall ratings of care and ≥2 inpatient admissions or any episode of aggressive care were not found to be statistically significant. Rates of aggressive care were not associated with age, and family ratings of care were similar for younger and older patients. Aggressive care within the last month of life is common among patients with NSCLC and is associated with lower family evaluations of end-of-life care. Specialized care provided within an HPC unit may mitigate the negative effects of aggressive care on these outcomes. Cancer 2017;123:3186-94. © 2017 American Cancer Society. © 2017 American Cancer Society.

Big five personality factors and suicide rates in the United States: a state-level analysis.

PubMed

Voracek, Martin

2009-08-01

Partly replicating findings from several cross-national studies (of Lester and of Voracek) on possible aggregate-level associations between personality and suicide prevalence, state-level analysis within the United States yielded significantly negative associations between the Big Five factor of Neuroticism and suicide rates. This effect was observed for historical as well as contemporary suicide rates of the total or the elderly population and was preserved with controls for the four other Big Five factors and measures of state wealth. Also conforming to cross-national findings, the Big Five factors of Agreeableness and Extraversion were negatively, albeit not reliably, associated with suicide rates.

US acculturation, food intake, and obesity among Asian-Pacific hotel workers.

PubMed

Novotny, Rachel; Williams, Andrew E; Vinoya, Aleli C; Oshiro, Caryn E S; Vogt, Thomas M

2009-10-01

Both obesity and immigration continue to increase in the United States. Studies suggest that a transition in lifestyle patterns, such as food intake, may mediate the relationship between immigration and obesity. We examine obesity among hotel workers in relation to age, sex, race/ethnicity, and indicators of food intake, immigration, and acculturation. Four thousand five hundred thirty hotel workers in 30 hotels were studied from the first year of the Work, Weight and Wellness program, before intervention (during 2005-2006). Weight and height were measured, whereas race/ethnicity, language, education, immigration, acculturation, and food intake variables were assessed by questionnaire. The study included 43% male and 57% female hotel workers (mean age 44.4+/-11.3 years; 42% Filipino, 32% other Asian, 13% Pacific Islander, 9% white, 1% black/African American, and 3% other race/ethnicity). On average (mean value), 55% of participants were born outside the United States; 57% were overweight or obese (body mass index [BMI] >25). The BMI of those born in the United States was 1.3 higher than that of those born in another country, adjusting for sex and race/ethnicity. Intake of sweet drinks and meat was positively associated with BMI while intake of fruit was negatively associated with BMI. Age at arrival in United States ("generation") was negatively associated with BMI, whereas greater acculturation was positively associated with BMI. Food intake behaviors are probably related to place of birth, generation of migration to the United States, and acculturation. Direct measures of food intake added explanatory power to models, suggesting the importance of food intake to obesity. Further study of the influence of immigration, acculturation, and food intake on obesity using longitudinal study designs is warranted.

Quantifying the hepatotoxic risk of alcohol consumption in patients with rheumatoid arthritis taking methotrexate.

PubMed

Humphreys, Jenny H; Warner, Alexander; Costello, Ruth; Lunt, Mark; Verstappen, Suzanne M M; Dixon, William G

2017-09-01

Patients with rheumatoid arthritis (RA) who take methotrexate (MTX) are advised to limit their alcohol intake due to potential combined hepatotoxicity. However, data are limited to support this. The aim of this study was to quantify the risk of developing abnormal liver blood tests at different levels of alcohol consumption, using routinely collected data from primary care. Patients with RA in the Clinical Practice Research Datalink starting MTX between 1987 and 2016 were included. Hepatotoxicity was defined as transaminitis: alanine transaminase or aspartate aminotransferase more than three times the upper limit of normal. Crude rates of transaminitis were calculated per 1000 person-years, categorised by weekly alcohol consumption in units. Cox proportional hazard models tested the association between alcohol consumption and transaminitis univariately, then age and gender adjusted. 11 839 patients were included, with 530 episodes of transaminitis occurring in 47 090 person-years follow-up. Increased weekly alcohol consumption as a continuous variable was associated with increased risk of transaminitis, adjusted HR (95% CI) per unit consumed 1.01 (1.00 to 1.02); consuming between 15 and 21 units was associated with a possible increased risk of hepatotoxicity, while drinking >21 units per week significantly increased rates of transaminitis, adjusted HR (95% CI) 1.85 (1.17 to 2.93). Weekly alcohol consumption of <14 units per week does not appear to be associated with an increased risk of transaminitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Variable use of amiodarone is associated with a greater risk of recurrence of atrial fibrillation in the critically ill.

PubMed

Mitrić, Goran; Udy, Andrew; Bandeshe, Hiran; Clement, Pierre; Boots, Rob

2016-04-02

Atrial fibrillation is a common rhythm disturbance in the general medical-surgical intensive care unit. Amiodarone is a popular drug in this setting but evidence to inform clinical practice remains scarce. We aimed to identify whether variation in the clinical use of amiodarone was associated with recurrent atrial fibrillation. This was a retrospective audit of 177 critically ill patients who developed new-onset atrial fibrillation after admission to a tertiary level medical-surgical trauma intensive care unit. Patterns of amiodarone prescription (including dosage schedule and duration) were assessed in relation to recurrence of atrial fibrillation during the intensive care unit stay. Known recurrence risk factors, such as inotrope administration, cardiac disease indices, Charlson Comorbidity Index, magnesium concentrations, fluid balance, and potassium concentrations, were also included in adjusted analysis using forward stepwise logistic regression modelling. The cohort had a median (interquartile range) age of 69 years (60-75), Acute Physiology and Chronic Health Evalution II score of 22 (17-28) and Charlson Comorbidity Index of 2 (1-4). A bolus dose of amiodarone followed by infusion (P = 0.02), in addition to continuing amiodarone infusion through to discharge from the intensive care unit (P < 0.001), were associated with less recurrent dysrhythmia. Recurrence after successful treatment was associated with ceasing amiodarone while an inotrope infusion continued (P < 0.001), and was more common in patients with a prior history of congestive cardiac failure (P = 0.04), and a diagnosis of systemic inflammatory response syndrome (P = 0.02). Amiodarone should be administered as a bolus dose followed immediately with an infusion when treating atrial fibrillation in the medical-surgical intensive care unit. Consideration should be given to continuing amiodarone infusions in patients on inotropes until they are ceased.

ERP Subsequent Memory Effects Differ between Inter-Item and Unitization Encoding Tasks

PubMed Central

Kamp, Siri-Maria; Bader, Regine; Mecklinger, Axel

2017-01-01

The “subsequent memory paradigm” is an analysis tool to identify brain activity elicited during episodic encoding that is associated with successful subsequent retrieval. Two commonly observed event-related potential “subsequent memory effects” (SMEs) are the parietal SME in the P300 time window and the frontal slow wave SME, but to date a clear characterization of the circumstances under which each SME is observed is missing. To test the hypothesis that the parietal SME occurs when aspects of an experience are unitized into a single item representation, while inter-item associative encoding is reflected in the frontal slow wave effect, participants were assigned to one of two conditions that emphasized one of the encoding types under otherwise matched study phases of a recognition memory experiment. Word pairs were presented either in the context of a definition that allowed to combine the word pairs into a new concept (unitization or item encoding) or together with a sentence frame (inter-item encoding). Performance on the recognition test did not differ between the groups. The parietal SME was only found in the definition group, supporting the idea that this SME occurs when the components of an association are integrated in a unitized item representation. An early prefrontal negativity also exhibited an SME only in this group, suggesting that the formation of novel units occurs through interactions of multiple brain areas. The frontal slow wave SME was pronounced in both groups and may thus reflect processes generally involved in encoding of associations. Our results provide evidence for a partial dissociation of the eliciting conditions of the two types of SMEs and therefore provide a tool for future studies to characterize the different types of episodic encoding. PMID:28194105

ERP Subsequent Memory Effects Differ between Inter-Item and Unitization Encoding Tasks.

PubMed

Kamp, Siri-Maria; Bader, Regine; Mecklinger, Axel

2017-01-01

The "subsequent memory paradigm" is an analysis tool to identify brain activity elicited during episodic encoding that is associated with successful subsequent retrieval. Two commonly observed event-related potential "subsequent memory effects" (SMEs) are the parietal SME in the P300 time window and the frontal slow wave SME, but to date a clear characterization of the circumstances under which each SME is observed is missing. To test the hypothesis that the parietal SME occurs when aspects of an experience are unitized into a single item representation, while inter-item associative encoding is reflected in the frontal slow wave effect, participants were assigned to one of two conditions that emphasized one of the encoding types under otherwise matched study phases of a recognition memory experiment. Word pairs were presented either in the context of a definition that allowed to combine the word pairs into a new concept (unitization or item encoding) or together with a sentence frame (inter-item encoding). Performance on the recognition test did not differ between the groups. The parietal SME was only found in the definition group, supporting the idea that this SME occurs when the components of an association are integrated in a unitized item representation. An early prefrontal negativity also exhibited an SME only in this group, suggesting that the formation of novel units occurs through interactions of multiple brain areas. The frontal slow wave SME was pronounced in both groups and may thus reflect processes generally involved in encoding of associations. Our results provide evidence for a partial dissociation of the eliciting conditions of the two types of SMEs and therefore provide a tool for future studies to characterize the different types of episodic encoding.

Current state of high-risk infant follow-up care in the United States: results of a national survey of academic follow-up programs.

PubMed

Kuppala, V S; Tabangin, M; Haberman, B; Steichen, J; Yolton, K

2012-04-01

High-risk infant follow-up programs have the potential to act as multipurpose clinics by providing continuity of clinical care, education of health care trainees and facilitating outcome data research. Currently there are no nationally representative data on high-risk infant follow-up practices in the United States. The objective of this study is to collect information about the composition of high-risk infant follow-up programs associated with academic centers in the United States, with respect to their structure, function, funding resources and developmental assessment practices, and to identify the barriers to establishment of such programs. Staff neonatologists, follow-up program directors and division directors of 170 Neonatal Intensive Care Units (NICU) associated with pediatric residency programs were invited to participate in an anonymous online survey from October 2009 to January 2010. The overall response rate was 84%. Ninety three percent of the respondents have a follow-up program associated with their NICU. Birth weight, gestational age and critical illness in the NICU were the major criteria for follow-up care. Management of nutrition and neurodevelopmental assessments was the most common service provided. Over 70% have health care trainees in the clinic. About 75% of the respondents have the neurodevelopmental outcome data available. Most of the respondents reported multiple funding sources. Lack of personnel and funding were the most common causes for not having a follow-up program. High-risk infant follow-up programs associated with academic centers in the United States are functioning as multidisciplinary programs providing clinical care, trainee education and facilitating outcomes research.

Incidence of constipation in an intensive care unit

PubMed Central

Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Guimarães Marshall, Norma

2013-01-01

Objectives To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. Methods The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipation and enteral nutritional support, gastrointestinal changes, stool frequency, ventilatory support, and outcomes were collected and analyzed. Results The initial sample consisted of 127 patients admitted to the unit during the period from January to December 2011. Eighty-four patients were excluded, and the final sample consisted of 43 patients. The incidence of constipation, defined as no bowel movement during the first 4 days of hospitalization, was 72% (n=31). The patients were divided into a control group and a constipated group. The group of constipated patients reached the caloric target, on average, at 6.5 days, and the control group reached the caloric target in 5.6 days (p=0.51). Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. There was an association between evacuation during hospitalization and a longer duration of hospitalization for a subgroup of patients who did not evacuate during the entire period (p=0.009). Conclusion The incidence of constipation in the unit studied was 72%. Only the absence of evacuation during hospitalization was associated with longer hospital stays. Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. PMID:23917972

Incidence of constipation in an intensive care unit.

PubMed

Guerra, Tatiana Lopes de Souza; Mendonça, Simone Sotero; Marshall, Norma Guimarães

2013-01-01

To evaluate the incidence of constipation in critical patients on enteral nutrition in a hospital intensive care unit and to correlate this incidence with the variables found for critical patients. The present investigation was a retrospective analytical study conducted in the intensive care unit of Hospital Regional da Asa Norte (DF) via the analysis of medical records of patients admitted during the period from January to December 2011. Data on the incidence of constipation and enteral nutritional support, gastrointestinal changes, stool frequency, ventilatory support, and outcomes were collected and analyzed. The initial sample consisted of 127 patients admitted to the unit during the period from January to December 2011. Eighty-four patients were excluded, and the final sample consisted of 43 patients. The incidence of constipation, defined as no bowel movement during the first 4 days of hospitalization, was 72% (n=31). The patients were divided into a control group and a constipated group. The group of constipated patients reached the caloric target, on average, at 6.5 days, and the control group reached the caloric target in 5.6 days (p=0.51). Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization. There was an association between evacuation during hospitalization and a longer duration of hospitalization for a subgroup of patients who did not evacuate during the entire period (p=0.009). The incidence of constipation in the unit studied was 72%. Only the absence of evacuation during hospitalization was associated with longer hospital stays. Constipation was not associated with the length of hospital stay, suspension of nutritional support, or outcome of hospitalization.

Increased Heat Generation in Postcardiac Arrest Patients During Targeted Temperature Management Is Associated With Better Outcomes.

PubMed

Uber, Amy J; Perman, Sarah M; Cocchi, Michael N; Patel, Parth V; Ganley, Sarah E; Portmann, Jocelyn M; Donnino, Michael W; Grossestreuer, Anne V

2018-04-03

Assess if amount of heat generated by postcardiac arrest patients to reach target temperature (Ttarget) during targeted temperature management is associated with outcomes by serving as a proxy for thermoregulatory ability, and whether it modifies the relationship between time to Ttarget and outcomes. Retrospective cohort study. Urban tertiary-care hospital. Successfully resuscitated targeted temperature management-treated adult postarrest patients between 2008 and 2015 with serial temperature data and Ttarget less than or equal to 34°C. None. Time to Ttarget was defined as time from targeted temperature management initiation to first recorded patient temperature less than or equal to 34°C. Patient heat generation ("heat units") was calculated as inverse of average water temperature × hours between initiation and Ttarget × 100. Primary outcome was neurologic status measured by Cerebral Performance Category score; secondary outcome was survival, both at hospital discharge. Univariate analyses were performed using Wilcoxon rank-sum tests; multivariate analyses used logistic regression. Of 203 patients included, those with Cerebral Performance Category score 3-5 generated less heat before reaching Ttarget (median, 8.1 heat units [interquartile range, 3.6-21.6 heat units] vs median, 20.0 heat units [interquartile range, 9.0-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.3 hr [interquartile range, 1.5-4.0 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01) than patients with Cerebral Performance Category score 1-2. Nonsurvivors generated less heat than survivors (median, 8.1 heat units [interquartile range, 3.6-20.8 heat units] vs median, 19.0 heat units [interquartile range, 6.5-33.5 heat units]; p = 0.001) and reached Ttarget quicker (median, 2.2 hr [interquartile range, 1.5-3.8 hr] vs median, 3.6 hr [interquartile range, 2.0-5.0 hr]; p = 0.01). Controlling for average water temperature between initiation and Ttarget, the relationship between outcomes and time to Ttarget was no longer significant. Controlling for location, witnessed arrest, age, initial rhythm, and neuromuscular blockade use, increased heat generation was associated with better neurologic (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.039) and survival (adjusted odds ratio, 1.01 [95% CI, 1.00-1.03]; p = 0.045) outcomes. Increased heat generation during targeted temperature management initiation is associated with better outcomes at hospital discharge and may affect the relationship between time to Ttarget and outcomes.

Climatology and Meteorological Evolution of Major Wildfire Events over the Northeast United States

Treesearch

Joseph B. Pollina; Brian A. Colle; Joseph J. Charney

2013-01-01

This study presents a spatial and temporal climatology of major wildfire events, defined as >100 acres burned (>40.47 ha, where 1 ha = 2.47 acre), in the northeast United States from 1999 to 2009 and the meteorological conditions associated with these events. The northeast United States is divided into two regions: region 1 is centered over the higher terrain of...

The Strategy of Defense: A Critical Examination of Global Conflict. A Secondary Level Curriculum for Social Studies.

ERIC Educational Resources Information Center

National Council for Better Education, Alexandria, VA.

The purpose of this guide is to encourage a rational understanding of the problems associated with nuclear armaments and to present a constructive approach to finding a solution. Each unit is introduced with a review of new terms, after which the topic is summarized and then is concluded with a vocabulary review and unit examination. Unit 1…

International Trade: U.S./U.S.S.R. Instructor's Guide [and] Student Materials. Business Issues in the Classroom.

ERIC Educational Resources Information Center

Maxey, Phyllis F.

One of a series of units on business issues designed for secondary school students, this packet examines United States and Soviet trade within the context of worldwide economic and political associations. Introductory in nature, the 5-day unit is suitable for use by itself or as part of a larger study of comparative economic systems, American…

78 FR 18325 - Intent To Prepare an Environmental Impact Statement (EIS) for the Formal Training Unit (FTU) and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... Statement (EIS) for the Formal Training Unit (FTU) and Main Operating Base 1 (MOB 1) for the Beddown of KC... Statement (EIS) for the Formal Training Unit (FTU) and Main Operating Base 1 (MOB 1) for the Beddown of KC...-46A tanker aircraft, associated infrastructure and manpower of the FTU and MOB 1 at existing active...

Auditing the standard of anaesthesia care in obstetric units.

PubMed

Mörch-Siddall, J; Corbitt, N; Bryson, M R

2001-04-01

We undertook an audit of 15 obstetric units in the north of England over a 10-month period to ascertain to what extent they conformed to the Obstetric Anaesthetists' Association 'Recommended Minimum Standards for Obstetric Anaesthetic Services' using a quality assurance approach. We demonstrated that all units conformed to the majority of standards but did not conform in at least one major and minor area.

The United States Army’s Full-Spectrum Training Strategy Challenge

DTIC Science & Technology

2012-05-17

the high operational tempo for deployed and deploying units. Soldiers and units conducted repeat deployments to both Iraq and Afghanistan with little...prevalent in Strategic Operational Design and associated variations of design. Further complicating Israeli ideas of warfare was the notion that...Army to develop an overarching operational framework that finally replaces Airland Battle, like EBO or some variation of operational design. But one