Operating experience feedback report: New plants, Commercial power reactors

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

Dennig, R.L.; O'Reilly, P.D.

1987-07-01

This report documents a detailed review of the cause of unplanned events during the early months of licensed operation for plants licensed between March 1983 and April 1986. The major lessons and corrective actions that appear to have the greatest potential for improving the effectiveness of plant startups are provided for consideration through the operating experience feedback programs and activities of the industry and the NRC staff.

10 CFR 50.73 - Licensee event report system.

Code of Federal Regulations, 2013 CFR

2013-01-01

... scram or reactor trip. (2) General containment isolation signals affecting containment isolation valves... plant design; or (2) Normal and expected wear or degradation. (x) Any event that posed an actual threat...

10 CFR 50.73 - Licensee event report system.

Code of Federal Regulations, 2014 CFR

2014-01-01

... scram or reactor trip. (2) General containment isolation signals affecting containment isolation valves... plant design; or (2) Normal and expected wear or degradation. (x) Any event that posed an actual threat...

10 CFR 50.73 - Licensee event report system.

Code of Federal Regulations, 2012 CFR

2012-01-01

... scram or reactor trip. (2) General containment isolation signals affecting containment isolation valves... plant design; or (2) Normal and expected wear or degradation. (x) Any event that posed an actual threat...

Parametric Analysis of a Turbine Trip Event in a BWR Using a 3D Nodal Code

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

Gorzel, A.

2006-07-01

Two essential thermal hydraulics safety criteria concerning the reactor core are that even during operational transients there is no fuel melting and not-permissible cladding temperatures are avoided. A common concept for boiling water reactors is to establish a minimum critical power ratio (MCPR) for steady state operation. For this MCPR it is shown that only a very small number of fuel rods suffers a short-term dryout during the transient. It is known from experience that the limiting transient for the determination of the MCPR is the turbine trip with blocked bypass system. This fast transient was simulated for a Germanmore » BWR by use of the three-dimensional reactor analysis transient code SIMULATE-3K. The transient behaviour of the hot channels was used as input for the dryout calculation with the transient thermal hydraulics code FRANCESCA. By this way the maximum reduction of the CPR during the transient could be calculated. The fast increase in reactor power due to the pressure increase and to an increased core inlet flow is limited mainly by the Doppler effect, but automatically triggered operational measures also can contribute to the mitigation of the turbine trip. One very important method is the short-term fast reduction of the recirculation pump speed which is initiated e. g. by a pressure increase in front of the turbine. The large impacts of the starting time and of the rate of the pump speed reduction on the power progression and hence on the deterioration of CPR is presented. Another important procedure to limit the effects of the transient is the fast shutdown of the reactor that is caused when the reactor power reaches the limit value. It is shown that the SCRAM is not fast enough to reduce the first power maximum, but is able to prevent the appearance of a second - much smaller - maximum that would occur around one second after the first one in the absence of a SCRAM. (author)« less

A microprocessor tester for the treat upgrade reactor trip system

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

Lenkszus, F.R.; Bucher, R.G.

1985-02-01

The upgrading of the Transient Reactor Test (TREAT) Facility at ANL-Idaho has been designed to provide additional experimental capabilities for the study of core disruptive accident (CDA) phenomena. To improve the analytical extrapolation of test results to full-size assembly bundles, the facility upgrade will increase the maximum size of the test bundle from 7 to 37 fuel pins. By creating a core convertor zone around the test location, the neutron spectrum incident on the test assembly will be hardened and the maximum energy deposited in the sample will be increased. In addition, a programmable Automated Reactor Control System (ARCS) willmore » permit high-power transients up to 11,000 MW having a controlled reactor period of from 15 to 0.1 sec. These modifications to the core neutronics will improve simulation of LMFBR accident conditions. Finally, a sophisticated, multiply-redundant safety system, the Reactor Trip System (RTS), will provide safe operation for both steady state and transient production operating modes. To insure that this complex safety system is functioning properly, a Dedicated Microprocessor Tester (DMT) has been implemented to perform a thorough checkout of the RTS prior to all TREAT operations. A quantitative reliability analysis of the RTS shows that the unreliability, that is, the probability of failure, is acceptable for a 10 hour mission time or risk interval.« less

Breaking America's dependence on imported molybdenum.

PubMed

Einstein, Andrew J

2009-03-01

Approximately 9 million nuclear cardiology studies performed each year in the U.S. use technetium-99m, which is produced from the decay of molybdenum-99. The fragility of the worldwide technetium-99m supply chain has been underscored by current shortages caused by an unplanned shutdown of Europe's largest reactor. The majority of the U.S. supply derives from a reactor in Canada that is nearing the end of its lifespan and whose planned replacements have been cancelled recently. In this article, the clinical importance of technetium-99m and our tenuous dependence on the foreign supply of molybdenum are addressed, along with potential measures that may be taken to ensure that America's supply chain remains unbroken.

76 FR 32237 - Duke Energy Carolinas, LLC; Notice of Withdrawal of Application for Amendments to Renewed...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-03

..., ``Reactor Trip System (RTS) Instrumentation'' and TS 3.3.2, ``Engineered Safety Feature Actuation System (ESFAS) Instrumentation.'' The Commission had previously issued a Notice of Consideration of Issuance of...

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

Steiner, J.L.; Lime, J.F.; Elson, J.S.

One dimensional TRAC transient calculations of the process inherent ultimate safety (PIUS) advanced reactor design were performed for a pump-trip SCRAM. The TRAC calculations showed that the reactor power response and shutdown were in qualitative agreement with the one-dimensional analyses presented in the PIUS Preliminary Safety Information Document (PSID) submitted by Asea Brown Boveri (ABB) to the US Nuclear Regulatory Commission for preapplication safety review. The PSID analyses were performed with the ABB-developed RIGEL code. The TRAC-calculated phenomena and trends were also similar to those calculated with another one-dimensional PIUS model, the Brookhaven National Laboratory developed PIPA code. A TRACmore » pump-trip SCRAM transient has also been calculated with a TRAC model containing a multi-dimensional representation of the PIUS intemal flow structures and core region. The results obtained using the TRAC fully one-dimensional PIUS model are compared to the RIGEL, PIPA, and TRAC multi-dimensional results.« less

Impact of nonabsorbing control rod tips on kinetics feedback for BWR turbine trip without bypass RETRAN-03 analyses

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

Feltus, M.A.; Knerr, R.; Shoop, U.

1993-01-01

RETRAN-03 studies were performed for the boiling water reactor (BWR) turbine trip without bypass (TTWOB) event to investigate how the non-neutron-absorbing material on control rod tips affect scram delay timing and reactivity feedback. Scram delay, Doppler temperature, and moderator void (density) feedback were varied to assess their relative impact on kinetics behavior. Although a generic point-kinetics RETRAN-03 TTWOB model 2 was employed, actual plant information was used to develop the basic and parametric cases.

TREAT Reactor Control and Protection System

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

Lipinski, W.C.; Brookshier, W.K.; Burrows, D.R.

1985-01-01

The main control algorithm of the Transient Reactor Test Facility (TREAT) Automatic Reactor Control System (ARCS) resides in Read Only Memory (ROM) and only experiment specific parameters are input via keyboard entry. Prior to executing an experiment, the software and hardware of the control computer is tested by a closed loop real-time simulation. Two computers with parallel processing are used for the reactor simulation and another computer is used for simulation of the control rod system. A monitor computer, used as a redundant diverse reactor protection channel, uses more conservative setpoints and reduces challenges to the Reactor Trip System (RTS).more » The RTS consists of triplicated hardwired channels with one out of three logic. The RTS is automatically tested by a digital Dedicated Microprocessor Tester (DMT) prior to the execution of an experiment. 6 refs., 5 figs., 1 tab.« less

Design criteria for a self-actuated shutdown system to ensure limitation of core damage. [LMFBR

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

Deane, N.A.; Atcheson, D.B.

1981-09-01

Safety-based functional requirements and design criteria for a self-actuated shutdown system (SASS) are derived in accordance with LOA-2 success criteria and reliability goals. The design basis transients have been defined and evaluated for the CDS Phase II design, which is a 2550 MWt mixed oxide heterogeneous core reactor. A partial set of reactor responses for selected transients is provided as a function of SASS characteristics such as reactivity worth, trip points, and insertion times.

Personal notes [of D.S. Lewis, 7 September 1956 to 31 December 1959

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

Lewis, D.S.

1956-09-07

This report is a copy of the personal log of D.S. Lewis of the Irradiation Processing Dept. of Reactor Operations at Hanford and covers the period from 7 September 1956 through 31 December 1959. Data are presented on the following: (1) basic reactor operating data, including daily operating data, outage resumes, injuries and incidents, charging and tube replacement rates, panellit gage (flowmeter) trip failures, and thermocouple failures, and (2) basic reactor information on the water plant, electrical distribution, VSR`s, HCR`s, Ball 3X, Safety circuits, gas system, effluent system, process tube cross-section, and production scheduling.

Section 7 reactor incident file general information from 1945

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

Not Available

1969-01-10

At 0308 on January 10, 1966, both B and C Reactors ``scrammed`` due to an electrical fault on Line C2-L8 caused by a raccoon coming in contact with the 13-8 KV line on top of transformer No. 2 at 182-B Building. Line C2-L8 relayed out at the 151-B Building. Details of the occurrence at 151-B are covered in the attachment. C-Reactor scrammed due to reduced voltage on the pressure monitor system. The reduction in voltage caused the auxiliary relays of the pressure monitor ground detector to open, de-energizing the end result relays PSR and PSRA. The safety circuit trip identificationmore » system displayed ``Pressure Monitor`` and ``Ground Detector.`` B-Reactor scrammed by a power failure signal from 190-B Building. The power failure relays for pump numbers 1 and 3 opened due to these pumps contributing power to the fault. The power failure relays at 190-B remained open long enough for the end result relays PF and PFA to open. Since these relays are timed delayed, 0.26 seconds, the power failure relays must have remained open at least that long. At the 190-B Building the steam turbines started due to the power failure relays for pump numbers 1 and 3 opening. The main process pumps remained stable and continued to supply normal flow to the reactor. Pumps were tripped from the line at 182-B and 183-B Buildings. The surge suppressors cycled normally and the turbine export pumps started as a result of low export line pressure. No power equipment was affected in C Area.« less

Development of testing and training simulator for CEDMCS in KSNP

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

Nam, C. H.; Park, C. Y.; Nam, J. I.

2006-07-01

This paper presents a newly developed testing and training simulator (TTS) for automatically diagnosing and tuning the Control Element Drive Mechanism Control System (CEDMCS). TTS includes a new automatic, diagnostic, method for logic control cards and a new tuning method for phase synchronous pulse cards. In Korea Standard Nuclear Power Plants (KSNP). reactor trips occasionally occur due to a damaged logic control card in CEDMCS. However, there is no pre-diagnostic tester available to detect a damaged card in CEDMCS before it causes a reactor trip. Even after the reactor trip occurs, it is difficult to find the damaged card. Tomore » find the damaged card. ICT is usually used. ICT is an automated, computer-controlled testing system with measurement capabilities for testing active and passive components, or clusters of components, on printed circuit boards (PCB) and/or assemblies. However, ICT cannot detect a time dependent fault correctly and requires removal of the waterproof mating to perform the test. Therefore, the additional procedure of re-coating the PCB card is required after the test. TTS for CEDMCS is designed based on real plant conditions, both electrically and mechanically. Therefore, the operator can operate the Control Element Drive Mechanism (CEDM), which is mounted on the closure head of the reactor vessel (RV) using the soft control panel in ITS, which duplicates the Main Control Board (MCB) in the Main Control Room (MCR). However, during the generation of electric power in a nuclear power plant, it is difficult to operate the CEDM so a CEDM and Control Element Assembly (CEA) mock-up facility was developed to simulate a real plant CEDM. ITS was used for diagnosing and tuning control logic cards in CEDMCS in the Ulchin Nuclear Power Plant No. 4 during the plant overhaul period. It exhibited good performance in detecting the damaged cards and tuning the phase synchronous pulse cards. In addition, TTS was useful in training the CEDMCS operator by supplying detail signal information from the logic cards. (authors)« less

A Spherical Torus Nuclear Fusion Reactor Space Propulsion Vehicle Concept for Fast Interplanetary Travel

NASA Technical Reports Server (NTRS)

Williams, Craig H.; Borowski, Stanley K.; Dudzinski, Leonard A.; Juhasz, Albert J.

1998-01-01

A conceptual vehicle design enabling fast outer solar system travel was produced predicated on a small aspect ratio spherical torus nuclear fusion reactor. Initial requirements were for a human mission to Saturn with a greater than 5% payload mass fraction and a one way trip time of less than one year. Analysis revealed that the vehicle could deliver a 108 mt crew habitat payload to Saturn rendezvous in 235 days, with an initial mass in low Earth orbit of 2,941 mt. Engineering conceptual design, analysis, and assessment was performed on all ma or systems including payload, central truss, nuclear reactor (including divertor and fuel injector), power conversion (including turbine, compressor, alternator, radiator, recuperator, and conditioning), magnetic nozzle, neutral beam injector, tankage, start/re-start reactor and battery, refrigeration, communications, reaction control, and in-space operations. Detailed assessment was done on reactor operations, including plasma characteristics, power balance, power utilization, and component design.

A New Classification System to Report Complications in Growing Spine Surgery: A Multicenter Consensus Study.

PubMed

Smith, John T; Johnston, Charles; Skaggs, David; Flynn, John; Vitale, Michael

2015-12-01

The use of growth-sparing instrumentation in pediatric spinal deformity is associated with a significant incidence of adverse events. However, there is no consistent way to report these complications, allowing for meaningful comparison of different growth-sparing techniques and strategies. The purpose of this study is to develop consensus for a new classification system to report these complications. The authors, who represent lead surgeons from 5 major pediatric spine centers, collaborated to develop a classification system to report complications associated with growing spine surgery. Following IRB approval, this system was then tested using a minimum of 10 patients from each center with at least 2-year follow-up after initial implantation of growing instrumentation to assess ease of use and consistency in reporting complications. Inclusion criteria were only patients who had surgical treatment of early onset scoliosis and did not include casting or bracing.Complications are defined as an unplanned medical event in the course of treatment that may or may not affect final outcome. Severity refers to the level of care and urgency required to treat the complication, and can be classified as device related or disease related. Severity grade (SV) I is a complication that does not require unplanned surgery, and can be corrected at the next scheduled surgery. SVII requires an unplanned surgery, with SVIIA requiring a single trip and SVIIB needing multiple trips for resolution. SVIII is a complication that substantially alters the planned course of treatment. Disease-related complications are classified as grade SVI if no hospitalization is required and grade SVII if hospitalization is required. SVIV was defined as death, either disease or device related. A total of 65 patients from 5 institutions met enrollment criteria for the study; 56 patients had at least 1 complication and 9 had no complications. There were 14 growing rods, 47 VEPTRs, ,and 4 hybrid constructs. The average age at implant was 4.7 years. There were an average of 5.4 expansions, 1.6 revisions, and 0.8 exchanges per patient. The minimum follow-up was 2 years. The most common complications were migration (60), infection (31), pneumonia (21), and instrumentation failure (23). When classified, the complications were grade I (57), grade IIA (79), grade IIB (10), and grade III (6). Well-documented uncertainty in clinical decision making in this area highlights the need for more rigorous clinical research. Reporting complications standardized for severity and impact on the course of treatment in growing spine surgery is a necessary prerequisite for meaningful comparative evaluation of different treatment options. This study shows that although complications were common, only 9% (SVIII) were severe enough to change the planned course of treatment. We propose that future studies reporting complications of different methods of growth-sparing spine surgery use this classification moving forward so that meaningful comparisons can be made between different treatment techniques.

76 FR 50759 - Applications and Amendments to Facility Operating Licenses Involving Proposed No Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-16

... addition, the requestor/petitioner shall provide a brief explanation of the bases for the contention and a... trip, various pumps and coolers to start, and various valves to open and close), Containment Isolation (closes valves to isolate the Reactor Building interior from the environment), Steam isolation (close all...

(US-Japan workshop on fusion neutronics at Osaka University, Osaka, Japan, May 25--26, and visits to Savar, Bangladesh, April 20--May 19, Beijing, China, May 21--24, and Tokai, Japan, May 29--30): Foreign trip report

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

White, J.E.

1989-06-15

This trip was initiated by a request from IAEA for USA expert assistance in Bangladesh. The Bangladesh Atomic Energy Commission (BAEC) had acquired a 3MW TRIGA MARK-II research reactor and their specialist needed help in the development of computer codes and data for the effective utilization and analysis of their reactor. Nuclear data recognized as an international standard was installed on a BAEC computer at Savar. The traveler was invited to China (PRC) to discuss multigroup cross section processing methods used at ORNL. Also, the traveler participated in a US-Japan workshop on fusion neutronics at Osaka University where he discussedmore » the activities of RSIC. An orientation visit to JAERI resulted in the collection of information of potential use in US DOE programs, a better understanding of their research activities, and an opportunity to develop personal relationships with JAERI staff.« less

DR Reactor VSR channel damage

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

Kempf, F.J.; Rawlins, J.K.

1961-10-30

On July 11, 1961 the Ball 3X System at DR Reactor was inadventently tripped. All vertical safety rods dropped and all channels were filled with balls. This report has the twofold purpose of documenting borescope observations of ten vertical rod channels at DR Reactor and recording the estimated extent of graphite damage resulting from the above incident. Channel damage data are presented on appended drawings. With suitable notations, the tracings of these drawings may be revised to reflect any future graphite damage. All vertical rod channels at DR Reactor were visually examined with a closed circuit television system during ballmore » removal efforts. Typical photographs of trapped balls and ledges, as viewed on the television monitor, are shown. Photographs of typical graphite damage, obtained through the borescope are also included in this report. 3 refs., 8 figs., 1 tab.« less

Foreign Trip Report MATGEN-IV Sep 24- Oct 26, 2007

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

de Caro, M S

2007-10-30

Gen-IV activities in France, Japan and US focus on the development of new structural materials for Gen-IV nuclear reactors. Oxide dispersion strengthened (ODS) F/M steels have raised considerable interest in nuclear applications. Promising collaborations can be established seeking fundamental knowledge of relevant Gen-IV ODS steel properties (see attached travel report on MATGEN- IV 'Materials for Generation IV Nuclear Reactors'). Major highlights refer to results on future Ferritic/Martensitic steel cladding candidates (relevant to Gen-IV materials properties for LFR Materials Program) and on thermodynamic and mechanic behavior of metallic FeCr binary alloys, base matrix for future candidate steels (for the LLNL-LDRD projectmore » on Critical Issues on Materials for Gen-IV Reactors).« less

The optimization of nuclear power plants operation modes in emergency situations

NASA Astrophysics Data System (ADS)

Zagrebayev, A. M.; Trifonenkov, A. V.; Ramazanov, R. N.

2018-01-01

An emergency situations resulting in the necessity for temporary reactor trip may occur at the nuclear power plant while normal operating mode. The paper deals with some of the operation c aspects of nuclear power plant operation in emergency situations and during threatened period. The xenon poisoning causes limitations on the variety of statements of the problem of calculating characteristics of a set of optimal reactor power off controls. The article show a possibility and feasibility of new sets of optimization tasks for the operation of nuclear power plants under conditions of xenon poisoning in emergency circumstances.

Unplanned pregnancy: does past experience influence the use of a contraceptive method?

PubMed

Matteson, Kristen A; Peipert, Jeffrey F; Allsworth, Jenifer; Phipps, Maureen G; Redding, Colleen A

2006-01-01

To investigate whether women between the ages of 14 and 25 years with a past unplanned pregnancy were more likely to use a contraceptive method compared with women without a history of unplanned pregnancy. We analyzed baseline data of 424 nonpregnant women between the ages of 14 and 25 years enrolled in a randomized trial to prevent sexually transmitted diseases and unplanned pregnancy (Project PROTECT). Women at high risk for sexually transmitted diseases or unplanned pregnancy were included. Participants completed a demographic, substance use, and reproductive health questionnaire. We compared women with and without a history of unplanned pregnancy using bivariate analysis and log binomial regression. The prevalence of past unplanned pregnancy in this sample was 43%. Women reporting an unplanned pregnancy were older, and had less education, and were more likely to be nonwhite race or ethnicity. History of an unplanned pregnancy was not associated with usage of a contraceptive method (relative risk 1.01, 95% confidence interval 0.87-1.16) in bivariate analysis or when potential confounders were accounted for in the analysis (adjusted relative risk 1.10, 95% confidence interval 0.95-1.28). Several factors were associated with both unplanned pregnancy and overall contraceptive method use in this population. However, a past unplanned pregnancy was not associated with overall contraceptive method usage. Future studies are necessary to investigate the complex relationship between unplanned pregnancy and contraceptive method use. II-2.

Thermionic reactor ion propulsion system /TRIPS/ - Its multi-mission capability.

NASA Technical Reports Server (NTRS)

Peelgren, M. L.

1972-01-01

The unmanned planetary exploration to be conducted in the last two decades of this century includes many higher energy missions which tax all presently available propulsion systems beyond their limit. One candidate with the versatility and performance to meet these mission objectives is nuclear electric propulsion (NEP). Additionally, the NEP System is feasible in orbit raising operations with the Shuttle or Shuttle/Tug combination. A representative planetary mission is described (Uranus-Neptune flyby with probe), and geocentric performance and tradeoffs are discussed. The NEP System is described in more detail with particular emphasis on the power subsystem consisting of the thermionic reactor, heat rejection subsystem, and neutron shield.

Unplanned Pregnancies, Family Planning Problems, and Child Maltreatment.

ERIC Educational Resources Information Center

Zuravin, Susan J.

1987-01-01

Examined the relationship between contracepting problems, unplanned fertility, and both child abuse and neglect in 518 urban, single parent, public assistance mothers. Findings revealed that increasing numbers of unplanned conceptions increased the probability of both abuse and neglect and that the unplanned conceptions were due to both failure to…

[Unplanned extubation in ICU, and the relevance of non-dependent patient variables the quality of care].

PubMed

González-Castro, A; Peñasco, Y; Blanco, C; González-Fernández, C; Domínguez, M J; Rodríguez-Borregán, J C

2014-01-01

To evaluate, for a consecutive year, the magnitude of unplanned extubation, looking for non-dependent patient variables. Prospective, observational study of cases and controls in a mixed intensive care unit within in a tertiary hospital. Patients were considered cases with more than 24 hours who had an episode of unplanned extubation. Prospective collection of variables case as time of unplanned extubation (collection time), identification of the box where the patient was admitted, presence and type of physical restraint, development of ventilator-associated pneumonia (VAP) and death. There were 17 unplanned extubation in 15 patients, 1.21 unplanned extubation per 100 days of MV. The unplanned extubation had an inhomogeneous spatial distribution (number of boxes). The time distribution of cases compared with controls showed significant differences in time distribution (P=.02). The comparative analysis between cases and controls, showed increased mortality, increased length of ICU stay, longer hospital stay and increased risk for VAP when patients suffer an episode of unplanned extubation. Unplanned extubation occurs most frequently in a given time slot of the day, may play a role in the spatial location of the patient; occurs most often in patients who are in the process of weaning from mechanical ventilation, and develop greater VAP. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Unplanned Drinking and Alcohol-Related Problems: A Preliminary Test of the Model of Unplanned Drinking Behavior

PubMed Central

Pearson, Matthew R.; Henson, James M.

2013-01-01

Much research links impulsivity with alcohol use and problems. In two studies, unplanned (or impulsive) drinking is assessed directly to determine whether it has direct effects on alcohol use and alcohol-related problems. In study 1, we examined whether unplanned drinking serves as a proximal mediator of the effects of impulsivity-like traits on alcohol-related outcomes. With a sample of 211 college student drinkers, we found that the Unplanned Drinking Scale was significantly related to alcohol use, and perhaps more importantly, had a direct effect on alcohol-related problems even after controlling for frequency and quantity of alcohol use. Further, unplanned drinking partially mediated the effects of negative urgency on alcohol-related problems. In study 2, we examined whether unplanned drinking accounts for unique variance in alcohol-related outcomes when controlling for use of protective behavioral strategies. With a sample of 170 college students, we replicated the findings of Study 1 in that the Unplanned Drinking Scale had a significant direct effect on alcohol-related problems even after controlling for alcohol use; further, this effect was maintained when controlling for use of protective behavioral strategies. Limitations include the modest sample sizes and the cross-sectional design. Future directions for testing the Model of Unplanned Drinking Behavior are proposed. PMID:23276312

Risk factors for unplanned and crash dialysis starts: a protocol for a systematic review and meta-analysis.

PubMed

Molnar, Amber O; Hiremath, Swapnil; Brown, Pierre A; Akbari, Ayub

2016-07-19

Many patients with kidney failure "crash" onto dialysis or initiate dialysis in an unplanned fashion. There are varying definitions, but essentially, a patient is labeled as having a crash dialysis start if he or she has little to no care by a nephrologist prior to starting dialysis. A patient is labeled as having an unplanned dialysis start when he or she starts dialysis with a catheter or during a hospitalization. Given the high prevalence and poor outcomes associated with crash and unplanned dialysis starts, it is important to establish a better understanding of patient risk factors. We will conduct a systematic review and meta-analysis with a focus on both crash and unplanned dialysis starts. The first objective will be to determine patient risk factors for crash and unplanned dialysis starts. Secondary objectives will be to determine the most common criteria used to define both crash and unplanned dialysis starts and to determine outcomes associated with crash and unplanned dialysis starts. We will search MEDLINE, EMBASE and Cochrane Library from inception to the present date for all studies that report the characteristics and outcomes of patients who have crash vs. non-crash dialysis starts or unplanned vs. planned dialysis starts. We will also extract from included studies the criteria used to define crash and unplanned dialysis starts. If there are any eligible randomized controlled trials, quality assessment will be performed using the Cochrane Risk of Bias Assessment Tool. Observational studies will be evaluated using the Newcastle-Ottawa Scale. Data will be pooled in meta-analysis if deemed appropriate. The results of this review will inform the design of strategies to help reduce the incidence of crash and unplanned dialysis starts. Prospero CRD42016032916.

The Assessment of the Risk of Unplanned Extubation in an Adult Intensive Care Unit.

PubMed

Aydoğan, Semine; Kaya, Nurten

In order to plan and implement nursing intervention to reduce the incidence rate of unplanned extubation problem in the intensive care unit (ICU), it is necessary to determine the risk factors of unplanned extubation and the patients under risk. This study was undertaken with the aim of evaluating the risk of unplanned extubation of endotracheal tube in adult ICU. This was a case-control study. The population constituted patients hospitalized in the adult ICU during 1-year period in a university hospital. The sample from this population was composed of patients whose extubation was unplanned (30 patients) and the randomly selected patients (60 patients) who were intubated at the same time in the ICU for each patient whose extubation was unplanned. In data collection, the Richmond Agitation-Sedation Scale, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II were utilized. According to the findings, the variables such as sex, age, mechanical ventilation period, and Acute Physiology and Chronic Health Evaluation II and Glasgow Coma Scale scores did not have any effect on the unplanned extubation, but variables such as internal medicine diseases and Richmond Agitation-Sedation Scale did have an effect. It was also revealed that there was no extubation plan in most of the unplanned extubation group, the nurse was anticipating the unplanned extubation, the patient was intubated again, and a complication occurred. The patients who are provided inadequate sedation and analgesia and who have problems in their respiratory system are under risk of unplanned extubation. In order to prevent unplanned extubation, an adequate amount of sedation and private nursing care should be provided to patients in the ICU.

Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013: a cross-sectional study.

PubMed

Gunnarsson, Björn; Smárason, Alexander K; Skogvoll, Eirik; Fasting, Sigurd

2014-10-01

To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. Register-based cross-sectional study. All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital. © 2014 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.

PubMed

Landry, Elizabeth K; Gabriel, Rodney A; Beutler, Sascha; Dutton, Richard P; Urman, Richard D

2017-03-01

Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age <1 year) and children who were classified as American Society of Anesthesiologists physical status classification of III or IV. Likewise, longer case duration and cases requiring general anesthesia were also associated with unplanned ICU admissions. This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

Effect of reactor coolant radioactivity upon configuration feasibility for a nuclear electric propulsion vehicle

NASA Technical Reports Server (NTRS)

Soffer, L.; Wright, G. N.

1973-01-01

A preliminary shielding analysis was carried out for a conceptual nuclear electric propulsion vehicle designed to transport payloads from low earth orbit to synchronous orbit. The vehicle employed a thermionic nuclear reactor operating at 1575 kilowatts and generated 120 kilowatts of electricity for a round-trip mission time of 2000 hours. Propulsion was via axially directed ion engines employing 3300 pounds of mercury as a propellant. The vehicle configuration permitted a reactor shadow shield geometry using LiH and the mercury propellant for shielding. However, much of the radioactive NaK reactor coolant was unshielded and in close proximity to the power conditioning electronics. An estimate of the radioactivity of the NaK coolant was made and its unshielded dose rate to the power conditioning equipment calculated. It was found that the activated NaK contributed about three-fourths of the gamma dose constraint. The NaK dose was considered a sufficiently high fraction of the allowable gamma dose to necessitate modifications in configuration.

Incidence and etiology of unplanned cast changes for fractures in the pediatric population.

PubMed

DiPaola, Matthew J; Abzug, Joshua M; Pizzutillo, Peter D; Herman, Martin J

2014-09-01

The majority of pediatric fractures are treated in casts due to the child's ability to heal rapidly and remodel. Unplanned cast changes are a time and economic burden with potentially adverse effects on fracture management. The purpose of this study is to document the incidence, etiology, and complications related to unplanned cast changes. A prospective study was conducted over a 6-month period to determine the incidence of unplanned cast changes. All casts applied were nonwaterproof. Data collected include the reason for cast placement, type of cast placed, duration of wear before the unplanned change, reason for the unplanned change, experience level of the original cast applicator, and cast-related complications. A total of 1135 casts were placed with 58% placed by a resident, 38% by a cast technician, 2% by a physician's assistant, and 2% by an attending physician. Sixty casts (5.3%) required an unplanned change including 19 short-arm casts, 18 short-leg casts, 17 long-arm casts, 4 thumb spica casts, and 2 long-leg casts. The average duration from cast application until the unplanned change was 13 days. Twenty-eight (47%) were changed for wetness, 20 (33%) for wear/breakage, 2 (3%) for skin irritation, and 10 (17%) for other reasons including objects in the cast and patient self-removal. Two patients had superficial skin infections requiring oral antibiotics. No fracture reductions were lost secondary to an unplanned cast change. The need for an unplanned cast change did not correlate with the level of experience of the applicator. Most unplanned cast changes were the result of patient nonadherence to instructions and not related to cast application technique. Improved patient and family education regarding cast care may reduce the frequency of unplanned cast changes, thus reducing an economic and time burden on the health care system. Level II--prognostic study.

NERVA irradiation program. GTR 23, volume 1: Combined effects of reactor radiation and cryogenic temperature on NERVA structural materials

NASA Technical Reports Server (NTRS)

Mcdaniel, R. H.; Bradford, E. W.; Lewis, J. H.; Wattier, J. B.

1973-01-01

Specimens fabricated from structural materials that were candidates for certain NERVA applications were irradiated in liquid nitrogen (LN2), liquid hydrogen (LH2), water, and air. The specimens irradiated in LN2 were stored in LN2 and finally tested in LN2, or at some higher temperature in a few instances. The specimens irradiated in LH2 underwent an unplanned warmup while in storage so this portion of the test was lost; some specimens were tested in LN2 but none were tested in LH2. The Ground Test Reactor was the radiation source. The test specimens consisted mainly of tensile and fracture toughness specimens of several different materials, but other types of specimens such as tear, flexure, springs, and lubricant were also irradiated. Materials tested include Hastelloy X, Al, Ni steel, steel, Be, ZrC, Ti-6Al-4V, CuB, and Ti-5Al-2.5Sn.

Unplanned hip arthroplasty imposes clinical and cost burdens on treating institutions.

PubMed

Kamath, Atul F; Austin, Daniel C; Derman, Peter B; Israelite, Craig L

2013-12-01

Emergent surgery has been shown to be a risk factor for perioperative complications. Studies suggest that patient morbidity is greater with an unplanned hip arthroplasty, although it is controversial whether unplanned procedures also result in higher patient mortality. The financial impact of these procedures is not fully understood, as the costs of unplanned primary hip arthroplasties have not been studied previously. We asked: (1) What are the institutional costs associated with unplanned hip arthroplasties (primary THA, hemiarthroplasty, revision arthroplasty, including treatment of periprosthetic fractures, dislocations, and infections)? (2) Does timing of surgery (urgent/unplanned versus elective) influence perioperative outcomes such as mortality, length of stay, or need for advanced care? (3) What diagnoses are associated with unplanned surgery and are treated urgently most often? (4) Do demographics and insurance status differ between admission types (unplanned versus elective hip arthroplasty)? We prospectively followed all 419 patients who were admitted to our Level I trauma center in 2011 for procedures including primary THA, hemiarthroplasty, and revision arthroplasty, including the treatment of periprosthetic fractures, dislocations, and infections. Fifty-seven patients who were treated urgently on an unplanned basis were compared with 362 patients who were treated electively. Demographics, admission diagnoses, complications, and costs were recorded and analyzed statistically. Median total costs were 24% greater for patients admitted for unplanned hip arthroplasties (USD 18,206 [USD 15,261-27,491] versus USD 14,644 [USD 13,511-16,309]; p < 0.0001) for patients admitted for elective arthroplasties. Patients with unplanned admissions had a 67% longer median hospital stay (5 days [range, 4-9 days] versus 3 days [range, 3-4 days]; p < 0.0001) for patients with elective admissions. Mortality rates were equivalent between groups (p = 1.0). Femoral fracture (p < 0.0001), periprosthetic fracture (p = 0.01), prosthetic infection (p = 0.005), and prosthetic dislocation (p < 0.0001) were observed at higher rates in the patients with unplanned admissions. These patients were older (p = 0.04), less likely to have commercial insurance (p < 0.0001), more likely to be transferred from another institution (p < 0.0001), and more likely to undergo a revision procedure (p < 0.0001). Unplanned arthroplasty and urgent surgery are associated with increased financial and clinical burdens, which must be accounted for when considering bundled quality and reimbursement measures for these procedures.

Medically Serious Suicide Attempters with or without Plan in Rural China1

PubMed Central

Sun, Long; Zhang, Jie

2015-01-01

Although previous studies have discussed the risk factors of unplanned suicide behavior in several countries, the unplanned suicide attempt in China was not explored in a large sample. We aim to look into the characteristics of unplanned suicide attempters in China, and compare them with those suicide attempters with plans. Subjects were 791 medically serious suicide attempters aged 15–54 years in rural China. The sixth item of Beck’s Suicide Intent Scale (SIS) was used to estimate the planned and unplanned suicide attempt. Logistic regression analysis was performed to examine the factors related to planned or unplanned suicide attempt. The results showed that the planned suicide attempt were associated with higher education, hopelessness and prior suicide act. The unplanned suicide attempt tend to suicide by pesticide and store pesticide at home. A ban of lethal pesticides may be a method for suicide prevention in rural China. PMID:26524517

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

Soubies, B.; Henry, J.Y.; Le Meur, M.

1300 MWe pressurised water reactors (PWRs), like the 1400 MWe reactors, operate with microprocessor-based safety systems. This is particularly the case for the Digital Integrated Protection System (SPIN), which trips the reactor in an emergency and sets in action the safeguard functions. The softwares used in these systems must therefore be highly dependable in the execution of their functions. In the case of SPIN, three players are working at different levels to achieve this goal: the protection system manufacturer, Merlin Gerin; the designer of the nuclear steam supply system, Framatome; the operator of the nuclear power plants, Electricite de Francemore » (EDF), which is also responsible for the safety of its installations. Regulatory licenses are issued by the French safety authority, the Nuclear Installations Safety Directorate (French abbreviation DSIN), subsequent to a successful examination of the technical provisions adopted by the operator. This examination is carried out by the IPSN and the standing group on nuclear reactors. This communication sets out: the methods used by the manufacturer to develop SPIN software for the 1400 MWe PWRs (N4 series); the approach adopted by the IPSN to evaluate the safety software of the protection system for the N4 series of reactors.« less

RETRAN analysis of multiple steam generator blow down caused by an auxiliary feedwater steam-line break

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

Feltus, M.A.

1987-01-01

Analysis results for multiple steam generator blow down caused by an auxiliary feedwater steam-line break performed with the RETRAN-02 MOD 003 computer code are presented to demonstrate the capabilities of the RETRAN code to predict system transient response for verifying changes in operational procedures and supporting plant equipment modifications. A typical four-loop Westinghouse pressurized water reactor was modeled using best-estimate versus worst case licensing assumptions. This paper presents analyses performed to evaluate the necessity of implementing an auxiliary feedwater steam-line isolation modification. RETRAN transient analysis can be used to determine core cooling capability response, departure from nucleate boiling ratio (DNBR)more » status, and reactor trip signal actuation times.« less

Tobacco and alcohol use in adolescents with unplanned pregnancies: relation with family structure, tobacco and alcohol use at home and by friends.

PubMed

Francisco, Vazquez-Nava; Carlos, Vazquez-Rodríguez; Eliza, Vazquez-Rodriguez; Octelina, Castillo-Ruiz; Maria, Iribar Ibabe

2016-03-01

Recent publications show that smoking and alcohol use among adolescents with unplanned pregnancy is increasing and the causes need to be further studied. To determine the association between living in a non-intact family household and the presence of smokers and consumers of alcoholic beverages in the adolescents' environment with smoking and consuming alcoholic beverages in adolescents with unplanned pregnancies. A cross-sectional study was carried out among 785 pregnant adolescents, aged 13-19 years. Data was collected by trained interviewers using a self-administered questionnaire. The association was determined using multivariate logistic regression analysis. In adolescents with unplanned pregnancies, the prevalence of active smoking was 21.2% and of alcohol consumption, 41.5%. The percentage of smoking at home was 57.4% and alcohol consumption, 77.5%. Approximately, 80.3% of adolescents with unplanned pregnancies had friends who smoked and 90.6% consumed alcoholic beverages. Multivariate logistic regression analysis shows that having friends who smoke or who consume alcoholic beverages is the most important risk factor for substance use in adolescents with unplanned pregnancies. Smoking and alcohol consumption at home are not associated with smoking in adolescents with unplanned pregnancies. Socializing with friends who smoke and/or consume alcoholic beverages constitutes the most important risk factor for substance use among adolescents with unplanned pregnancies.

A Passive System Reliability Analysis for a Station Blackout

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

Brunett, Acacia; Bucknor, Matthew; Grabaskas, David

2015-05-03

The latest iterations of advanced reactor designs have included increased reliance on passive safety systems to maintain plant integrity during unplanned sequences. While these systems are advantageous in reducing the reliance on human intervention and availability of power, the phenomenological foundations on which these systems are built require a novel approach to a reliability assessment. Passive systems possess the unique ability to fail functionally without failing physically, a result of their explicit dependency on existing boundary conditions that drive their operating mode and capacity. Argonne National Laboratory is performing ongoing analyses that demonstrate various methodologies for the characterization of passivemore » system reliability within a probabilistic framework. Two reliability analysis techniques are utilized in this work. The first approach, the Reliability Method for Passive Systems, provides a mechanistic technique employing deterministic models and conventional static event trees. The second approach, a simulation-based technique, utilizes discrete dynamic event trees to treat time- dependent phenomena during scenario evolution. For this demonstration analysis, both reliability assessment techniques are used to analyze an extended station blackout in a pool-type sodium fast reactor (SFR) coupled with a reactor cavity cooling system (RCCS). This work demonstrates the entire process of a passive system reliability analysis, including identification of important parameters and failure metrics, treatment of uncertainties and analysis of results.« less

A Biomechanical Comparison of Single-Leg Landing and Unplanned Sidestepping.

PubMed

Chinnasee, Chamnan; Weir, Gillian; Sasimontonkul, Siriporn; Alderson, Jacqueline; Donnelly, Cyril

2018-06-14

Unplanned sidestepping and single-leg landing have both been used to screen athletes for injury risk in sport. The aim of this study was to directly compare the lower limb mechanics of three single-leg landing tasks and an unplanned sidestepping task. Thirteen elite female team sport athletes completed a series of non-contact single-leg drop landings, single-leg countermovement jumps, single-leg jump landings and unplanned sidestepping in a randomized counterbalanced design. Three dimensional kinematics (250 Hz) and ground reaction force (2,000 Hz) data with a participant specific lower limb skeletal model were used to calculate and compare hip, knee and ankle joint kinematics, peak joint moments, instantaneous joint power and joint work during the weight acceptance phase of each sporting task (α=0.05). Peak knee joint moments and relevant injury risk thresholds were used to classify each athlete's anterior cruciate ligament injury risk during unplanned sidestepping and single-leg jump landing. Results showed that peak joint moments, power and work were greater during the single-leg jump landing task when compared to the single-leg drop landings and single-leg countermovement jumps tasks. Peak frontal and sagittal plane knee joint moments, knee joint power, as well as hip and knee joint work were greater during unplanned sidestepping when compared to the landing tasks. Peak ankle joint moments, power and work were greater during the landing tasks when compared to unplanned sidestepping. For 4 of the 13 athletes tested, their anterior cruciate ligament injury risk classification changed depending on whether they performed an unplanned sidestepping or single-leg jump landing testing procedure. To summarize, a single-leg jump landing testing procedure places a larger mechanical on the ankle joint when compared to single-leg drop landings, single-leg countermovement jumps and unplanned sidestepping. An unplanned sidestepping testing procedure places a larger mechanical demand on the knee joint when compared to single-leg landing tasks. Both unplanned sidestepping and single-leg jump landing testing procedures are recommended for classifying an athlete's anterior cruciate ligament injury risk in sport. © Georg Thieme Verlag KG Stuttgart · New York.

From Protocols to Publications: A Study in Selective Reporting of Outcomes in Randomized Trials in Oncology

PubMed Central

Raghav, Kanwal Pratap Singh; Mahajan, Sminil; Yao, James C.; Hobbs, Brian P.; Berry, Donald A.; Pentz, Rebecca D.; Tam, Alda; Hong, Waun K.; Ellis, Lee M.; Abbruzzese, James; Overman, Michael J.

2015-01-01

Purpose The decision by journals to append protocols to published reports of randomized trials was a landmark event in clinical trial reporting. However, limited information is available on how this initiative effected transparency and selective reporting of clinical trial data. Methods We analyzed 74 oncology-based randomized trials published in Journal of Clinical Oncology, the New England Journal of Medicine, and The Lancet in 2012. To ascertain integrity of reporting, we compared published reports with their respective appended protocols with regard to primary end points, nonprimary end points, unplanned end points, and unplanned analyses. Results A total of 86 primary end points were reported in 74 randomized trials; nine trials had greater than one primary end point. Nine trials (12.2%) had some discrepancy between their planned and published primary end points. A total of 579 nonprimary end points (median, seven per trial) were planned, of which 373 (64.4%; median, five per trial) were reported. A significant positive correlation was found between the number of planned and nonreported nonprimary end points (Spearman r = 0.66; P < .001). Twenty-eight studies (37.8%) reported a total of 65 unplanned end points; 52 (80.0%) of which were not identified as unplanned. Thirty-one (41.9%) and 19 (25.7%) of 74 trials reported a total of 52 unplanned analyses involving primary end points and 33 unplanned analyses involving nonprimary end points, respectively. Studies reported positive unplanned end points and unplanned analyses more frequently than negative outcomes in abstracts (unplanned end points odds ratio, 6.8; P = .002; unplanned analyses odd ratio, 8.4; P = .007). Conclusion Despite public and reviewer access to protocols, selective outcome reporting persists and is a major concern in the reporting of randomized clinical trials. To foster credible evidence-based medicine, additional initiatives are needed to minimize selective reporting. PMID:26304898

Unplanned versus planned suicide attempters, precipitants, methods, and an association with mental disorders in a Korea-based community sample.

PubMed

Jeon, Hong Jin; Lee, Jun-Young; Lee, Young Moon; Hong, Jin Pyo; Won, Seung-Hee; Cho, Seong-Jin; Kim, Jin-Yeong; Chang, Sung Man; Lee, Hae Woo; Cho, Maeng Je

2010-12-01

Studies have consistently reported that a considerable proportion of suicidal attempts are unplanned. We have performed the first direct comparison between planned and unplanned attempts including associated methods and precipitants. A total of 6510 adults, who had been randomly selected through a one-person-per-household method, completed interviews (response rate 81.7%). All were interviewed using the K-CIDI and a questionnaire for suicide. Two hundred and eight subjects reported a suicide attempt in their lifetime, one-third of which had been unplanned. These individuals exhibited a lower level of education; however, no significant differences were found with regard to age, gender, marital and economic status. Further, 84.0% of unplanned attempters experienced previous suicidal ideation, experiencing their first attempt 1.9 years before ideation. Additionally, 94.4% of unplanned attempters had precipitants for attempts such as familial conflict and it was also found that methods such as the use of chemical agents or falling were three times more common in unplanned than planned attempters. With respect to unplanned attempters, they exhibited a significant association with alcohol use disorder, major depressive disorder, posttraumatic stress disorder, and bipolar disorder. In particular, bipolar disorder was found to be 3.5 times higher in these individuals. Results have revealed that unplanned suicide attempters experience suicidal ideation and precipitants prior to their attempt. Further, attempts were associated with affective and alcohol use disorders. Therefore, in order to reduce the number of suicidal attempts, it may be useful to evaluate suicidal ideation concurrent to the treatment of existing mental disorders. Copyright © 2010 Elsevier B.V. All rights reserved.

Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

PubMed

Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

2017-01-01

This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes. Copyright © 2016 Elsevier Inc. All rights reserved.

Unplanned admissions in day-case surgery as a clinical indicator for quality assurance.

PubMed

Margovsky, A

2000-03-01

Day surgery is a modern, effective and economical way to treat patients while maintaining the same level of quality of patient care. Quality improvement in day surgery units, however, continues to be an issue due to high rates of unplanned admissions. The aim of the present retrospective study was to investigate reasons for and methods of preventing unplanned postoperative admissions in a day surgical unit over a 12-month period in respect to different surgical specialties. The study was based on an audit from the Endoscopy and Day Surgery Unit (EDSU) at Launceston General Hospital, which provides health care to a population of more than 120000. For the accounted period 920 outpatients had elective day surgical procedures. Overall the unplanned admission rate was 4.7%, and surgical, anaesthetic and social reasons accounted for 58.2, 37.2 and 4.6% of the unplanned admissions, respectively. The highest rate of unplanned admissions was for plastic and reconstructive surgery (12.8%) and orthopaedic surgery (7.5%) despite the relatively small number of patients who underwent such procedures in the day surgery unit. The results also showed a correlation between age group, pre-operative medical status of the patients found suitable for the day surgical procedure and unplanned admissions. Strategies to reduce the unplanned admission rate which include patient selection and pre-operative assessment, patient waiting time and education, pre-operative anaesthesia, follow-up with nursing care and postoperative analgesia are discussed.

Unplanned Pregnancy among Sailors: Background and Opportunities

DTIC Science & Technology

2005-01-05

health assessment. - free, on-line, ready-to-use materials are available to Navy health care professionals for use in patient education and “all-hands...in “all- hands” training and patient education , may help reduce the incidence of unplanned pregnancy among the active duty force. Unplanned

A Call for Research on Planned vs. Unplanned Suicidal Behavior

ERIC Educational Resources Information Center

Conner, Kenneth R.

2004-01-01

Unplanned acts of suicidal behavior involve little preparation or forethought whereas planned acts may be carefully conceived and implemented. Planned acts are associated with greater depression, hopelessness, and lethality, but there are meager data on other factors associated with planning. The prevention of planned and unplanned acts may…

TRACE Model for Simulation of Anticipated Transients Without Scram in a BWR

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

Cheng L. Y.; Baek J.; Cuadra,A.

2013-11-10

A TRACE model has been developed for using theTRACE/PARCS computational package [1, 2] to simulate anticipated transients without scram (ATWS) events in a boiling water reactor (BWR). The model represents a BWR/5 housed in a Mark II containment. The reactor and the balance of plant systems are modeled in sufficient detail to enable the evaluation of plant responses and theeffectiveness of automatic and operator actions tomitigate this beyond design basis accident.The TRACE model implements features thatfacilitate the simulation of ATWS events initiated by turbine trip and closure of the main steam isolation valves (MSIV). It also incorporates control logic tomore » initiate actions to mitigate the ATWS events, such as water levelcontrol, emergency depressurization, and injection of boron via the standby liquid control system (SLCS). Two different approaches have been used to model boron mixing in the lower plenum of the reactor vessel: modulate coolant flow in the lower plenum by a flow valve, and use control logic to modular.« less

Risk factors of hospitalization and readmission of patients with COPD in Hong Kong population: analysis of hospital admission records.

PubMed

Chan, Frank W K; Wong, Fiona Y Y; Yam, Carrie H K; Cheung, Wai-ling; Wong, Eliza L Y; Leung, Michael C M; Goggins, William B; Yeoh, Eng-kiong

2011-08-10

Chronic Obstructive Pulmonary Disease (COPD) accounts for around 4% of all public hospital annual admissions in Hong Kong. By year 2020, COPD will be ranked fifth among the conditions with the highest burden to the society. This study identifies admission and unplanned readmission of COPD patients, factors affecting unplanned readmission, and estimates its cost burden on the public healthcare system in Hong Kong. This is a retrospective study analyzing COPD admissions to all public hospitals in Hong Kong. All admission episodes to acute medical wards with the principal diagnosis of COPD (ICD-9:490-492, 494-496) from January 2006 to December 2007 were captured. Unplanned readmission was defined as an admission which followed a previous admission within 30 days. In 2006 and 2007, 65497 (8.0%) of episodes from medical wards were identified as COPD admissions, and among these, 15882 (24.2%) were unplanned readmissions. The mean age of COPD patients was 76.81 ± 9.59 years and 77% were male. Unplanned readmission was significantly associated with male gender, receiving public assistance and living in nursing homes while no association was found with the Charlson comorbidity index. Patients who were readmitted unplanned had a significant longer acute length of stay (β = 0.3894, P < 0.001) after adjustment for other covariates. Unplanned readmission of COPD patients has a huge impact on the public healthcare system. A systematic approach in programme provision and a good discharge planning process targeting on COPD patients who are at high risk of unplanned readmission are essential.

Accelerator Reactor Coupling for Energy Production in Advanced Nuclear Fuel Cycles

DOE PAGES

Brown, Nicholas R.; Heidet, Florent; Haj Tahar, Malek

2016-01-01

This article is a review of several accelerator–reactor interface issues and nuclear fuel cycle applications of acceleratordriven subcritical systems. The systems considered here have the primary goal of energy production, but that goal is accomplished via a specific application in various proposed nuclear fuel cycles, such as breed-and-burn of fertile material or burning of transuranic material. Several basic principles are reviewed, starting from the proton beam window including the target, blanket, reactor core, and up to the fuel cycle. We focus on issues of interest, such as the impact of the energy required to run the accelerator and associated systemsmore » on the potential electricity delivered to the grid. Accelerator-driven systems feature many of the constraints and issues associated with critical reactors, with the added challenges of subcritical operation and coupling to an accelerator. Reliable accelerator operation and avoidance of beam trips are critically important. One interesting challenge is measurement of blanket subcriticality level during operation. We also review the potential benefits of accelerator-driven systems in various nuclear fuel cycle applications. Ultimately, accelerator-driven subcritical systems with the goal of transmutation of transuranic material have lower 100,000-year radioactivity than a critical fast reactor with recycling of uranium and plutonium.« less

Accelerator–Reactor Coupling for Energy Production in Advanced Nuclear Fuel Cycles

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

Heidet, Florent; Brown, Nicholas R.; Haj Tahar, Malek

2015-01-01

This article is a review of several accelerator-reactor interface issues and nuclear fuel cycle applications of accelerator-driven subcritical systems. The systems considered here have the primary goal of energy production, but that goal is accomplished via a specific application in various proposed nuclear fuel cycles, such as breed-and-burn of fertile material or burning of transuranic material. Several basic principles are reviewed, starting from the proton beam window including the target, blanket, reactor core, and up to the fuel cycle. We focused on issues of interest, e.g. the impact of the energy required to run the accelerator and associated systems onmore » the potential electricity delivered to the grid. Accelerator-driven systems feature many of the constraints and issues associated with critical reactors, with the added challenges of subcritical operation and coupling to an accelerator. Reliable accelerator operation and avoidance of beam trips are a critically important. One interesting challenge is measurement of blanket subcriticality level during operation. We also reviewed the potential benefits of accelerator-driven systems in various nuclear fuel cycle applications. Ultimately, accelerator-driven subcritical systems with the goal of transmutation of transuranic material have lower 100,000-year radioactivity versus a critical fast reactor with recycle of uranium and plutonium.« less

Accelerator-Reactor Coupling for Energy Production in Advanced Nuclear Fuel Cycles

NASA Astrophysics Data System (ADS)

Heidet, Florent; Brown, Nicholas R.; Haj Tahar, Malek

This article is a review of several accelerator-reactor interface issues and nuclear fuel cycle applications of accelerator-driven subcritical systems. The systems considered here have the primary goal of energy production, but that goal is accomplished via a specific application in various proposed nuclear fuel cycles, such as breed-and-burn of fertile material or burning of transuranic material. Several basic principles are reviewed, starting from the proton beam window including the target, blanket, reactor core, and up to the fuel cycle. We focus on issues of interest, such as the impact of the energy required to run the accelerator and associated systems on the potential electricity delivered to the grid. Accelerator-driven systems feature many of the constraints and issues associated with critical reactors, with the added challenges of subcritical operation and coupling to an accelerator. Reliable accelerator operation and avoidance of beam trips are critically important. One interesting challenge is measurement of blanket subcriticality level during operation. We also review the potential benefits of accelerator-driven systems in various nuclear fuel cycle applications. Ultimately, accelerator-driven subcritical systems with the goal of transmutation of transuranic material have lower 100,000-year radioactivity than a critical fast reactor with recycling of uranium and plutonium.

Supplemental Thermal-Hydraulic Transient Analyses of BR2 in Support of Conversion to LEU Fuel

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

Licht, J.; Dionne, B.; Sikik, E.

2016-01-01

Belgian Reactor 2 (BR2) is a research and test reactor located in Mol, Belgium and is primarily used for radioisotope production and materials testing. The Materials Management and Minimization (M3) Reactor Conversion Program of the National Nuclear Security Administration (NNSA) is supporting the conversion of the BR2 reactor from Highly Enriched Uranium (HEU) fuel to Low Enriched Uranium (LEU) fuel. The RELAP5/Mod 3.3 code has been used to perform transient thermal-hydraulic safety analyses of the BR2 reactor to support reactor conversion. A RELAP5 model of BR2 has been validated against select transient BR2 reactor experiments performed in 1963 by showingmore » agreement with measured cladding temperatures. Following the validation, the RELAP5 model was then updated to represent the current use of the reactor; taking into account core configuration, neutronic parameters, trip settings, component changes, etc. Simulations of the 1963 experiments were repeated with this updated model to re-evaluate the boiling risks associated with the currently allowed maximum heat flux limit of 470 W/cm 2 and temporary heat flux limit of 600 W/cm 2. This document provides analysis of additional transient simulations that are required as part of a modern BR2 safety analysis report (SAR). The additional simulations included in this report are effect of pool temperature, reduced steady-state flow rate, in-pool loss of coolant accidents, and loss of external cooling. The simulations described in this document have been performed for both an HEU- and LEU-fueled core.« less

Family Caregiver Knowledge, Patient Illness Characteristics, and Unplanned Hospital Admissions in Older Adults With Cancer.

PubMed

Geddie, Patricia I; Wochna Loerzel, Victoria; Norris, Anne E

2016-07-01

To explore factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions for older adults with cancer.
. A prospective longitudinal design and a retrospective chart review.
. Adult oncology outpatient infusion centers and inpatient units at Orlando Regional Medical Center in Florida.
. A convenience sample of 129 dyads of older adults with cancer and their family caregivers. 
. Family caregiver demographic and side effect knowledge data were collected prospectively during interviews with family caregivers using a newly developed tool, the Nurse Assessment of Family Caregiver Knowledge and Action Tool. Patient demographic and clinical data were obtained through a retrospective chart review. Descriptive statistics and logistic regression analyses were used to evaluate data and examine relationships among variables.
. Patient illness characteristics; impaired function; side effects, such as infection, fever, vomiting, and diarrhea; family caregiver knowledge; and unplanned hospital admissions.
. Unplanned hospital admissions were more likely to occur when older adults had impaired function and side effects, such as infection, fever, vomiting, and diarrhea. Impaired function and family caregiver knowledge did not moderate the effects of these side effects on unplanned hospital admissions. 
. Findings suggest that the presence of impaired function and side effects, such as infection, fever, vomiting, and diarrhea, predict unplanned hospital admissions in older adults with cancer during the active treatment phase. Side effects may or may not be related to chemotherapy and may be related to preexisting comorbidities. 
. Nurses can conduct targeted assessments to identify older adults and their family caregivers who will need additional follow-up and support during the cancer treatment trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to reduce the risk for unplanned admissions.

A SPACESHIP WITH NUCLEAR PROPULSION

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

Polorny, J.

1962-01-01

ABS>A proposed space vehicle with nuclear propulsion for a round-trip Martian mission is described. It would be powered by a 270-Mw graphite- moderated, U-fueled nuclear reactor with a core 1 m high by 1 m in diameter, and use gas as propellant. The gas would be heated to the maximum temperature in the reactor and additionally accelerated by an electromagnetic field. To this end, small quantities of K would be injected into the gas stream to increase its electric conductivity. The required electrical energy would be produced by liquid-Na-cooled thermionic converters. The vehicle would weigh 115000 kg, including 43000 kgmore » of H propellant with tankage, and 7000 kg of sustenance material for one year. Chemical rockets would launch the vehicle with a crew of three men into an earth orbit where nuclear propulsion would take over. Upon reactor start-up, three heat exchangers (minimum dimensions 30 x 18 m) would be fanned out. A shielded well with a diameter of 2.5 m would protect the crew from radiation during reactor operation, passage through the earth radiation belts, and at periods of solar flares. (OTS)« less

Preventing Unplanned Pregnancy and Completing College: An Evaluation of Online Lessons. 2nd Edition

ERIC Educational Resources Information Center

Antonishak, Jill; Connolly, Chelsey

2014-01-01

The National Campaign to Prevent Teen and Unplanned Pregnancy published free online lessons that help students take action to prevent unplanned pregnancy and complete their education. From the fall of 2012 to the spring of 2014, approximately 2,800 students took the online lessons and participated in pre- and post-lesson evaluation surveys at four…

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

ERIC Educational Resources Information Center

Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

2009-01-01

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

Sex education attitudes and outcomes among North American women.

PubMed

Williams, Monnica T; Bonner, Laura

2006-01-01

Attitudes and outcomes of sex education received by North American women are examined via an Internet survey (N = 1,400). Mean age was 19.5, with 24% reporting one or more unplanned pregnancies. Women were more satisfied with sex education from informal sources than from parents, schools, and physicians. Those receiving sex education from parents or schools reported fewer pregnancies and abortions. In school, women receiving a combination of contraceptive and abstinence education and those receiving primarily abstinence education were least likely to experience unplanned pregnancy. Religious identification was significantly related to unplanned pregnancy and type of sex education received from parents. These factors seem to play a significant role in reducing unplanned pregnancy and abortion.

Reduction in Mortality Following Pediatric Rapid Response Team Implementation.

PubMed

Kolovos, Nikoleta S; Gill, Jeff; Michelson, Peter H; Doctor, Allan; Hartman, Mary E

2018-05-01

To evaluate the effectiveness of a physician-led rapid response team program on morbidity and mortality following unplanned admission to the PICU. Before-after study. Single-center quaternary-referral PICU. All unplanned PICU admissions from the ward from 2005 to 2011. The dataset was divided into pre- and post-rapid response team groups for comparison. A Cox proportional hazards model was used to identify the patient characteristics associated with mortality following unplanned PICU admission. Following rapid response team implementation, Pediatric Risk of Mortality, version 3, illness severity was reduced (28.7%), PICU length of stay was less (19.0%), and mortality declined (22%). Relative risk of death following unplanned admission to the PICU after rapid response team implementation was 0.685. For children requiring unplanned admission to the PICU, rapid response team implementation is associated with reduced mortality, admission severity of illness, and length of stay. Rapid response team implementation led to more proximal capture and aggressive intervention in the trajectory of a decompensating pediatric ward patient.

Decision-Making Influences Tibial Impact Accelerations During Lateral Cutting.

PubMed

Lucas, Logan A; England, Benjamin S; Mason, Travis W; Lanning, Christopher R; Miller, Taylor M; Morgan, Alexander M; Almonroeder, Thomas G

2018-05-29

Lower extremity musculoskeletal injuries are common in sports such as basketball and soccer. Athletes competing in sports of this nature must maneuver in response to the actions of their teammates, opponents, etc. This limits their ability to pre-plan movements. The purpose of this study was to compare impact accelerations during pre-planned vs. un-planned lateral cutting. Thirty subjects (15 males, 15 females) performed pre-planned and un-planned cuts while we analyzed impact accelerations using an accelerometer secured to their tibia. For the pre-planned condition, subjects were aware of the movement to perform before initiating a trial. For the un-planned condition, subjects initiated their movement and then reacted to the illumination of one of three visual stimuli which dictated whether they would cut, land, or land-and-jump. A mixed-model ANOVA with a between factor of sex (male, female) and a within factor of condition (pre-planned, un-planned) was used to analyze the magnitude and variability of the impact accelerations for the cutting trials. Both males and females demonstrated higher impact accelerations (p = .010) and a trend toward greater inter-trial variability (p = .073) for the un-planned cutting trials (vs. pre-planned cuts). Un-planned cutting may place greater demands on the musculoskeletal system.

Unplanned admission to intensive care after emergency hospitalisation: risk factors and development of a nomogram for individualising risk.

PubMed

Frost, Steven A; Alexandrou, Evan; Bogdanovski, Tony; Salamonson, Yenna; Parr, Michael J; Hillman, Ken M

2009-02-01

Unplanned admission to an intensive care unit (ICU) is associated with high mortality, having the highest incidence among patients who are emergency admissions to the hospital. This study was designed to identify factors associated with unplanned ICU admission in emergency admissions to hospital and develop an absolute risk tool to individualise the risk of an event during a hospital stay. Emergency department (ED) and in-patient hospital data from a large teaching hospital of consecutive admissions from 1 January 1997 to 31 December 2007 aged over 14 years was included in this study. Patient data extracted from 126826 emergency presentations admitted as in-patients consisted of demographic and clinical variables. During an 11-year period 1582 incident unplanned ICU admissions occurred. Predictors of unplanned ICU admission included older age, being male, having a higher acuity triage category and a history of co-morbid conditions. Emergency department diagnostic groups associated with higher incidence of unplanned ICU admission included: sepsis, acute renal failure, lymphatic-hematopoietic tissue neoplasms, pneumonia, chronic-airways disease and bowel obstruction. The final model used to develop the nomogram had an ROC curve AUC of 0.7. This study identified factors associated with unplanned ICU admission and developed a nomogram to individualise risk prior to a patient being transferred from the ED. This nomogram provides clinicians the opportunity prior to transfer from the ED, to either (1) review the appropriateness of the ward level of planned transfer or (2) flag patients for follow-up on the general ward to assess for deterioration.

Knee mechanics during planned and unplanned sidestepping: a systematic review and meta-analysis.

PubMed

Brown, Scott R; Brughelli, Matt; Hume, Patria A

2014-11-01

Knee joint mechanics during sidestepping are associated with anterior cruciate ligament injury. Unplanned sidestepping more closely emulates game scenarios when compared with planned sidestepping by limiting decision time, increasing knee loading and challenging the integrity of soft-tissue structures in the knee. It is important to quantify the loads that may challenge the integrity of the knee during planned and unplanned sidestepping. Our objective was to review literature on knee mechanics during planned and unplanned phases of sidestepping. PubMed, CINAHL, MEDLINE (EBSCO), SPORTDiscus and Web of Science were searched using the terms knee mechanics OR knee kine*, AND plan*, unplan*, anticipat*, unanticipat*, side*, cut* or chang*. A systematic approach was used to evaluate 4,629 records. Records were excluded when not available in English, only available in abstract of conference proceedings, not involving a change-of-direction sidestep, not comparing planned and unplanned or maintaining a running velocity greater than 2 m s(−1). Included studies were evaluated independently by two authors using a custom-designed methodological quality assessment derived from the Physiotherapy Evidence Database (PEDro) scale and then confirmed by a third author. Only six studies met the inclusion criteria and were retained for meta-analysis. Magnitude-based inferences were used to assess the standardised effect of the differences between planned and unplanned sidestepping. Knee angles and knee moments were extracted and reported for flexion/extension, abduction/adduction and internal/external rotation for initial contact, weight acceptance, peak push-off and final push-off phases of sidestepping. For kinematic variables, unplanned sidestepping produced a wide range of small to large increases in knee extension angles, small and moderate increases in knee abduction angles and a small increase in internal rotation angle relative to planned sidestepping during the sidestepping manoeuvre. For kinetic variables, unplanned sidestepping produced mostly small (small to large) increases in knee flexor moments, small to moderate increases in knee abductor moments and mostly moderate (small to large) increases in internal rotator moments relative to planned sidestepping. Approach velocity constraints during the sidestepping manoeuvre were lifted due to the low number of eligible studies. The varying approach velocities included (ranging from 3.0 to 5.5 m s(−1)) may impact the kinematic and kinetic variables examined in this review. Differences in knee mechanics between planned and unplanned sidestepping exist. The most substantial effects occurred during the weight acceptance phase of sidestepping. It seems that biomechanical factors commonly associated with anterior cruciate ligament injury risk are affected the most during the loading phase compared with peak push-off; made evident in the coronal (abductor) and transverse (internal rotator) knee kinetic data presented in this review. The authors of this review propose a rationale for the incorporation of unplanned sport tasks in the development of anterior cruciate ligament injury screening and in prophylactic training programmes.

A large head circumference is more strongly associated with unplanned cesarean or instrumental delivery and neonatal complications than high birthweight.

PubMed

Lipschuetz, Michal; Cohen, Sarah M; Ein-Mor, Eliana; Sapir, Hanna; Hochner-Celnikier, Drorith; Porat, Shay; Amsalem, Hagai; Valsky, Dan V; Ezra, Yossef; Elami-Suzin, Matan; Paltiel, Ora; Yagel, Simcha

2015-12-01

Fetal size impacts on perinatal outcomes. We queried whether the fetal head, as the fetal part interfacing with the birth canal, might impact on obstetric outcomes more than birthweight (BW). We examined associations between neonatal head circumference (HC) and delivery mode and risk of perinatal complications as compared to high BW. This was an electronic medical records-based study of term singleton births (37-42 weeks' gestation) from January 2010 through December 2012 (N = 24,780, 6343 primiparae). We assessed risks of unplanned cesarean or instrumental delivery and maternal and fetal complications in cases with HC or BW ≥95th centile (large HC, high BW) vs those with parameters <95th centile (normal). Newborns were stratified into 4 subgroups: normal HC/normal BW (reference, n = 22,548, primiparae 5862); normal HC/high BW (n = 817, P = 213); large HC/normal BW (n = 878, P = 265); and large HC/high BW (n = 537, P = 103). Multinomial multivariable regression provided adjusted odds ratio (aOR) while controlling for potential confounders. Infants with HC ≥95th centile (n = 1415) were delivered vaginally in 62% of cases, unplanned cesarean delivery 16%, and instrumental delivery 11.2%; 78.4% of infants with HC <95th centile were delivered vaginally, 7.8% unplanned cesarean, and 6.7% instrumental delivery. Odds ratio (OR) for unplanned cesarean was 2.58 (95% confidence interval [CI], 2.22-3.01) and for instrumental delivery OR was 2.13 (95% CI, 1.78-2.54). In contrast, in those with BW ≥95th centile (n = 1354) 80.3% delivered vaginally, 10.2% by unplanned cesarean (OR, 1.2; 95% CI, 1.01-1.44), and 3.4% instrumental delivery (OR, 0.46; 95% CI, 0.34-0.62) compared to infants with BW <95th centile: spontaneous vaginal delivery, 77.3%, unplanned cesarean 8.2%, instrumental 7.1%. Multinomial regression with normal HC/normal BW as reference group showed large HC/normal BW infants were more likely to be delivered by unplanned cesarean (aOR, 3.08; 95% CI, 2.52-3.75) and instrumental delivery (aOR, 3.03; 95% CI, 2.46-3.75). Associations were strengthened in primiparae. Normal HC/high BW was not associated with unplanned cesarean (aOR, 1.18; 95% CI, 0.91-1.54), while large HC/high BW was (aOR, 1.93; 95% CI, 1.47-2.52). Analysis of unplanned cesarean indications showed large HC infants had more failure to progress (27.7% vs 14.1%, P < .001), while smaller HC infants had more fetal distress (23.4% vs 16.9%, P < .05). A large HC is more strongly associated with unplanned cesarean and instrumental delivery than high BW. Prospective studies are needed to test fetal HC as a predictive parameter for prelabor counseling of women with "big babies." Copyright © 2015 Elsevier Inc. All rights reserved.

Differences in Colonoscopy Quality Among Facilities: Development of a Post-Colonoscopy Risk-Standardized Rate of Unplanned Hospital Visits.

PubMed

Ranasinghe, Isuru; Parzynski, Craig S; Searfoss, Rana; Montague, Julia; Lin, Zhenqiu; Allen, John; Vender, Ronald; Bhat, Kanchana; Ross, Joseph S; Bernheim, Susannah; Krumholz, Harlan M; Drye, Elizabeth E

2016-01-01

Colonoscopy is a common procedure, yet little is known about variations in colonoscopy quality among outpatient facilities. We developed an outcome measure to profile outpatient facilities by estimating risk-standardized rates of unplanned hospital visits within 7 days of colonoscopy. We used a 20% sample of 2010 Medicare outpatient colonoscopy claims (331,880 colonoscopies performed at 8140 facilities) from patients ≥65 years or older, and developed a patient-level logistic regression model to estimate the risk of unplanned hospital visits (ie, emergency department visits, observation stays, and inpatient admissions) within 7 days of colonoscopy. We then used the patient-level risk model variables and hierarchical logistic regression to estimate facility rates of risk-standardized unplanned hospital visits using data from the Healthcare Cost and Utilization Project (325,811 colonoscopies at 992 facilities), from 4 states containing 100% of colonoscopies per facility. Outpatient colonoscopies were followed by 5412 unplanned hospital visits within 7 days (16.3/1000 colonoscopies). Hemorrhage, abdominal pain, and perforation were the most common causes of unplanned hospital visits. Fifteen variables were independently associated with unplanned hospital visits (c = 0.67). A history of fluid and electrolyte imbalance (odds ratio [OR] = 1.43; 95% confidence interval [CI]: 1.29-1.58), psychiatric disorders (OR = 1.34; 95% CI: 1.22-1.46), and, in the absence of prior arrhythmia, increasing age past 65 years (aged >85 years vs 65-69 years: OR = 1.87; 95% CI: 1.54-2.28) were most strongly associated. The facility risk-standardized unplanned hospital visits calculated using Healthcare Cost and Utilization Project data showed significant variation (median 12.3/1000; 5th-95th percentile, 10.5-14.6/1000). Median risk-standardized unplanned hospital visits were comparable between ambulatory surgery centers and hospital outpatient departments (each was 10.2/1000), and ranged from 16.1/1000 in the Northeast to 17.2/1000 in the Midwest. We calculated a risk-adjusted measure of outpatient colonoscopy quality, which shows important variation in quality among outpatient facilities. This measure can make transparent the extent to which patients require follow-up hospital care, help inform patient choices, and assist in quality-improvement efforts. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Comments on the feasibility of developing gas core nuclear reactors. [for manned interplanetary spacecraft propulsion

NASA Technical Reports Server (NTRS)

Rom, F. E.

1969-01-01

Recent developments in the fields of gas core hydrodynamics, heat transfer, and neutronics indicate that gas core nuclear rockets may be feasible from the point of view of basic principles. Based on performance predictions using these results, mission analyses indicate that gas core nuclear rockets may have the potential for reducing the initial weight in orbit of manned interplanetary vehicles by a factor of 5 when compared to the best chemical rocket systems. In addition, there is a potential for reducing total trip times from 450 to 500 days for chemical systems to 250 to 300 days for gas core systems. The possibility of demonstrating the feasibility of gas core nuclear rocket engines by means of a logical series of experiments of increasing difficulty that ends with ground tests of full scale gas core reactors is considered.

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

Volkov, M. S.; Gusev, Yu. P., E-mail: GusevYP@mpei.ru; Monakov, Yu. V.

The insertion of current-limiting reactors into electrical equipment operating at a voltage of 110 and 220 kV produces a change in the parameters of the transient recovery voltages at the contacts of the circuit breakers for disconnecting short circuits, which could be the reason for the increase in the duration of the short circuit, damage to the electrical equipment and losses in the power system. The results of mathematical modeling of the transients, caused by tripping of the short circuit in a reactive electric power transmission line are presented, and data are given on the negative effect of a current-limitingmore » resistor on the rate of increase and peak value of the transient recovery voltages. Methods of ensuring the standard requirements imposed on the parameters of the transient recovery voltages when using current-limiting reactors in the high-voltage electrical equipment of power plants and substations are proposed and analyzed.« less

Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center.

PubMed

Manzano, Joanna-Grace M; Gadiraju, Sahitya; Hiremath, Adarsh; Lin, Heather Yan; Farroni, Jeff; Halm, Josiah

2015-09-01

Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center. We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions. We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values < .01). We observed a high unplanned readmission rate among our population of patients with cancer. The risk factors identified appear to be related to severity of illness and open up opportunities for improving coordination with primary care physicians, oncologists, and other specialists to manage comorbidities, or perhaps transition appropriate patients to palliative care. Our findings will be instrumental for developing targeted interventions to help reduce readmissions at our hospital. Our data also provide direction for appropriate application of readmission quality measures in cancer hospitals. Copyright © 2015 by American Society of Clinical Oncology.

Binge drinking, reflection impulsivity, and unplanned sexual behavior: impaired decision-making in young social drinkers.

PubMed

Townshend, Julia M; Kambouropoulos, Nicolas; Griffin, Alison; Hunt, Frances J; Milani, Raffaella M

2014-04-01

The repeated pattern of heavy intoxication followed by withdrawal from alcohol (i.e., "binge drinking") has been found to have substantial adverse effects on prefrontal neural systems associated with decision-making and impulse control. Repeated binge drinking has been linked to risky and unplanned sexual behavior; however few studies have examined the role of impulsivity and related cognitive processes in understanding this association. The aim of this study was to examine the relationship between binge drinking, "reflection impulsivity" (deficits in gathering and evaluating information during decision-making), alcohol-related expectancies, and unplanned sexual behavior in a sample of young social drinkers. Ninety-two university students completed the alcohol use questionnaire (AUQ) to measure alcohol intake and binge drinking. Two groups (low-binge and high-binge) were generated from the AUQ data. The Information Sampling Task (IST) was used to measure reflection impulsivity; the Alcohol Expectancy Questionnaire (AEQ) for alcohol outcome expectancies; and an unplanned sexual behavior questionnaire, which asked about the number of unplanned sexual events. When compared to the low-binge drinking group, the high-binge drinkers had significantly more unplanned sexual encounters and were impaired on the IST, reflection-impulsivity task. They scored higher on the alcohol expectancy factors of sociability, risk and aggression, negative self-perception, and in particular liquid courage. In a regression analysis, number of unplanned sexual encounters, binge drinking score, and liquid courage were all significantly related. These results support the role of binge drinking in reduced impulse control and decision-making deficits. The findings indicate that high-binge drinkers demonstrate impairments on an impulse control task similar to that observed in dependent samples and this may be a factor in understanding the negative behavioral consequences associated with excessive alcohol use. Copyright © 2014 by the Research Society on Alcoholism.

Caesarean Birth is Associated with Both Maternal and Paternal Origin in Immigrants in Sweden: a Population-Based Study.

PubMed

Juárez, Sol P; Small, Rhonda; Hjern, Anders; Schytt, Erica

2017-11-01

To investigate the association between maternal country of birth and father's origin and unplanned and planned caesarean birth in Sweden. Population-based register study including all singleton births in Sweden between 1999 and 2012 (n = 1 311 885). Multinomial regression was conducted to estimate odds ratios (OR) for unplanned and planned caesarean with 95% confidence intervals for migrant compared with Swedish-born women. Analyses were stratified by parity. Women from Ethiopia, India, South Korea, Chile, Thailand, Iran, and Finland had statistically significantly higher odds of experiencing unplanned (primiparous OR 1.10-2.19; multiparous OR 1.13-2.02) and planned caesarean (primiparous OR 1.18-2.25; multiparous OR 1.13-2.46). Only women from Syria, the former Yugoslavia and Germany had consistently lower risk than Swedish-born mothers (unplanned: primiparous OR 0.76-0.86; multiparous OR 0.74-0.86. Planned; primiparous OR 0.75-0.82; multiparous OR 0.60-0.94). Women from Iraq and Turkey had higher odds of an unplanned caesarean but lower odds of a planned one (among multiparous). In most cases, these results remained after adjustment for available social characteristics, maternal health factors, and pregnancy complications. Both parents being foreign-born increased the odds of unplanned and planned caesarean in primiparous and multiparous women. Unplanned and planned caesarean birth varied by women's country of birth, with both higher and lower rates compared with Swedish-born women, and the father's origin was also of importance. These variations were not explained by a wide range of social, health, or pregnancy factors. © 2017 John Wiley & Sons Ltd.

30-Day Readmission After Spine Surgery: An Analysis of 1400 Consecutive Spine Surgery Patients.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Han, Jing L; Karikari, Isaac O; Cheng, Joseph; Bagley, Carlos A

2017-04-01

Retrospective cohort review. To identify the rates, causes, and risk factors for 30-day unplanned readmissions in after elective spine surgery at our institution. Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in healthcare costs. A total of 1400 patients undergoing elective spine surgery at Duke University Hospital between 2008 and 2010 were included in the study. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay. A total of 132 (9.4%) unplanned early readmissions were identified. The mean ± SD age was 58.6 ± 15.1 years. Lumbar decompression and fusion was the most common procedure The most common causes for readmission were infection or a concern for infection (34.8%) and pain (19.7%), and 26.5% of readmissions required a return to the operating room. The majority of patients that were readmitted presented to the emergency department from home (58.0%) whereas 25.2% were readmitted from a skilled nursing facility. The mean ± SD number of days from discharge to readmission was 9.8 ± 7.9 days and the average length of hospital stay for the readmissions was 7.5 days. This study suggests that infection and refractory pain were the most common primary reasons for unplanned readmission. Efforts at reducing unplanned early readmission after elective spine surgery should be focused on more effective post discharge care.

Unplanned cigarette purchases and tobacco point of sale advertising: a potential barrier to smoking cessation.

PubMed

Clattenburg, Eben J; Elf, Jessica L; Apelberg, Benjamin J

2013-11-01

In the USA, tobacco marketing expenditure is increasingly concentrated at the point of sale (POS). Previous studies have demonstrated an association between exposure to tobacco POS advertising and increased smoking initiation, but limited evidence is available on adult smokers' decisions and behaviours. An immediate post-cigarette purchase survey was administered to 301 cigarette purchasers outside of two grocery stores in Vermont to assess the prevalence of unplanned purchases and opinions about POS tobacco advertising and displays. In total, 11.3% of purchases were reported as unplanned. Certain groups were more likely to make unplanned purchases including: 18-24-year-olds (OR: 2.1, 95% CI 1.0 to 4.4), less than daily smokers (OR: 5.6, 95% CI 1.9 to 16.9), smokers who made 3+ quit attempts in the previous year (OR: 2.4, 95% CI 0.9 to 6.0), those who plan to quit in the next month (OR: 3.7, 95% CI 1.6 to 9.0), and those who agreed that tobacco POS advertising makes quitting smoking harder (OR: 2.3, 95% CI 1.1 to 4.8). Overall, 31.2% of participants agreed that tobacco POS advertising makes quitting smoking harder. Individuals who intended to quit within the next month, made 3+ quit attempts in the last year, or made an unplanned cigarette purchase were the most likely to agree. Young adults and individuals making multiple quit attempts or planning to quit in the next month are more likely to make unplanned cigarette purchases. Reducing unplanned purchases prompted by tobacco POS advertising could improve the likelihood of successful cessation among smokers.

Integrated Risk-Informed Decision-Making for an ALMR PRISM

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

Muhlheim, Michael David; Belles, Randy; Denning, Richard S.

Decision-making is the process of identifying decision alternatives, assessing those alternatives based on predefined metrics, selecting an alternative (i.e., making a decision), and then implementing that alternative. The generation of decisions requires a structured, coherent process, or a decision-making process. The overall objective for this work is that the generalized framework is adopted into an autonomous decision-making framework and tailored to specific requirements for various applications. In this context, automation is the use of computing resources to make decisions and implement a structured decision-making process with limited or no human intervention. The overriding goal of automation is to replace ormore » supplement human decision makers with reconfigurable decision-making modules that can perform a given set of tasks rationally, consistently, and reliably. Risk-informed decision-making requires a probabilistic assessment of the likelihood of success given the status of the plant/systems and component health, and a deterministic assessment between plant operating parameters and reactor protection parameters to prevent unnecessary trips and challenges to plant safety systems. The probabilistic portion of the decision-making engine of the supervisory control system is based on the control actions associated with an ALMR PRISM. Newly incorporated into the probabilistic models are the prognostic/diagnostic models developed by Pacific Northwest National Laboratory. These allow decisions to incorporate the health of components into the decision–making process. Once the control options are identified and ranked based on the likelihood of success, the supervisory control system transmits the options to the deterministic portion of the platform. The deterministic portion of the decision-making engine uses thermal-hydraulic modeling and components for an advanced liquid-metal reactor Power Reactor Inherently Safe Module. The deterministic multi-attribute decision-making framework uses various sensor data (e.g., reactor outlet temperature, steam generator drum level) and calculates its position within the challenge state, its trajectory, and its margin within the controllable domain using utility functions to evaluate current and projected plant state space for different control decisions. The metrics that are evaluated are based on reactor trip set points. The integration of the deterministic calculations using multi-physics analyses and probabilistic safety calculations allows for the examination and quantification of margin recovery strategies. This also provides validation of the control options identified from the probabilistic assessment. Thus, the thermalhydraulics analyses are used to validate the control options identified from the probabilistic assessment. Future work includes evaluating other possible metrics and computational efficiencies, and developing a user interface to mimic display panels at a modern nuclear power plant.« less

[Association between unplanned pregnancy and adolescence onset asthma].

PubMed

Vázquez-Nava, Francisco; Gil-Lara, Bertoldo; Cruz-Torres, Leoncio; Vázquez-Rodríguez, Carlos F; Vázquez-Rodríguez, Eliza M; Felizardo-Ávalos, Jorge; Llanes-Castillo, Arturo; Córdova-Fernández, José A

2013-01-01

The association between asthma and pregnancy has been documented previously. The relationship between unplanned pregnancy and onset asthma in adolescence has not been studied. To determine the association between unplanned pregnancy and adolescence onset asthma. A cross-sectional study was done gathering information about asthma, unplanned pregnancy, family atopy and active or passive smoking in 3,130 adolescents aged 13-19 years. Asthma diagnosis was established through a selfquestionnaire based on the International Study of Asthma and Allergy in Childhood. Odds ratios for asthma were determined using logistic regression model and chi-squared test. Mean age of the participants was 16.37 ± 1.93 years. The prevalence of active smoking was 16.1%, of passive smoking 40% and of family atopy 9.8%. From the pregnant adolescents (785), 59.5% reported had planned not to have a child before pregnancy. Prevalence of wheezing during the year prior to the study was 9.3% and of wheezing during the pregnancy 2%. The prevalence of adolescence onset asthma was 5.4%. The age of initiation of asthma in the adolescence was 14.75 ± 1.60 years. The analysis showed that unplanned pregnancy has a slight risk for the development of asthma during adolescence. (Crude OR=1.03; CI 95% 1.02-1.05; p=0.000). Unplanned pregnancy, family atopy, active smoking and smoking friends are associated with the onset-asthma in the adolescence.

Unplanned Complex Suicide-A Consideration of Multiple Methods.

PubMed

Ateriya, Navneet; Kanchan, Tanuj; Shekhawat, Raghvendra Singh; Setia, Puneet; Saraf, Ashish

2018-05-01

Detailed death investigations are mandatory to find out the exact cause and manner in non-natural deaths. In this reference, use of multiple methods in suicide poses a challenge for the investigators especially when the choice of methods to cause death is unplanned. There is an increased likelihood that doubts of homicide are raised in cases of unplanned complex suicides. A case of complex suicide is reported where the victim resorted to multiple methods to end his life, and what appeared to be an unplanned variant based on the death scene investigations. A meticulous crime scene examination, interviews of the victim's relatives and other witnesses, and a thorough autopsy are warranted to conclude on the cause and manner of death in all such cases. © 2017 American Academy of Forensic Sciences.

Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women.

PubMed

Christofides, Nicola J; Jewkes, Rachel K; Dunkle, Kristin L; McCarty, Frances; Jama Shai, Nwabisa; Nduna, Mzikazi; Sterk, Claire

2014-01-01

Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. Teenage girls, aged 15-18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21-0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05-2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07-0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58-0.83 and OR 0.78; 95% CI 0.64-0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07-6.25, and OR 2.21 95% CI 1.13-4.29). Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented.

Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support.

PubMed

Barton, Katherine; Redshaw, Maggie; Quigley, Maria A; Carson, Claire

2017-01-26

Research into the impact of unintended pregnancy on the wellbeing of women tends to focus on pregnancies ending in either termination or lone motherhood. Unintended pregnancy is common in partnered women, but little is known about the association between unintended pregnancy and postpartum affective disorders, such as depression and anxiety in this group. Poor relationship quality and lack of social support are considered risk factors for psychological distress (PD). We examined the association between unplanned motherhood and subsequent PD in partnered women, for whom evidence is sparse, accounting for the role of relationship quality and social support. Data for 12,462 partnered mothers were drawn from the first survey of Millennium Cohort Study, completed at 9 months postpartum. Women reported whether their baby was planned, and how they felt when they discovered that they were pregnant. Pregnancy intention is categorised as "planned", "unplanned/happy", "unplanned/ambivalent" and "unplanned/unhappy". PD was assessed using the modified 9-item Rutter Malaise Inventory. Social support was measured by a composite score for perceived support, and a measure of actual support from friends and family. Relationship quality was assessed using a modified Golombok-Rust Inventory of Marital State. The effect of pregnancy intention on the odds of PD at 9 months was estimated, adjusting for potential confounding factors. All analyses were weighted for response and design effects. In total 32.8%(weighted) (4343/12462) of mothers reported an unplanned pregnancy: 23.3 wt% (3087) of mothers felt happy, 3.5 wt% (475) ambivalent, and 6.0 wt% (781) unhappy upon discovery. Unplanned pregnancy was associated with a significantly increased odds of PD compared to planned (OR 1.73 (95%CI: 1.53, 1.95)). This was more pronounced among women who reported negative or ambivalent feelings in early pregnancy (OR 2.72 (95%CI:2.17, 3.41) and 2.56 (95%CI:1.95, 3.34), respectively), than those who reported positive feelings (OR 1.39 (95%CI:1.21, 1.60)). Adjustment for relationship quality, in particular, reduced odds of PD after unplanned pregnancy (e.g. from 2.19 (95%C: 1.74, 2.74) to 1.63 (95% CI: 1.29, 2.07 in the unplanned, unhappy group compared to the planned). A third of partnered mothers reported that their pregnancy was unintended, yet this group is under-researched. Unplanned motherhood was associated with increased risk of PD at 9 months postpartum, particularly among women who felt unhappy or ambivalent at the start. The roles of relationship quality and social support require further investigation, as possible means to intervene and improve maternal wellbeing.

A CFD Model for High Pressure Liquid Poison Injection for CANDU-6 Shutdown System No. 2

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

Bo Wook Rhee; Chang Jun Jeong; Hye Jeong Yun

2002-07-01

In CANDU reactor one of the two reactor shutdown systems is the liquid poison injection system which injects the highly pressurized liquid neutron poison into the moderator tank via small holes on the nozzle pipes. To ensure the safe shutdown of a reactor it is necessary for the poison curtains generated by jets provide quick, and enough negative reactivity to the reactor during the early stage of the accident. In order to produce the neutron cross section necessary to perform this work, the poison concentration distribution during the transient is necessary. In this study, a set of models for analyzingmore » the transient poison concentration induced by this high pressure poison injection jet activated upon the reactor trip in a CANDU-6 reactor moderator tank has been developed and used to generate the poison concentration distribution of the poison curtains induced by the high pressure jets injected into the vacant region between the pressure tube banks. The poison injection rate through the jet holes drilled on the nozzle pipes is obtained by a 1-D transient hydrodynamic code called, ALITRIG, and this injection rate is used to provide the inlet boundary condition to a 3-D CFD model of the moderator tank based on CFX4.3, a CFD code, to simulate the formation of the poison jet curtain inside the moderator tank. For validation, an attempt was made to validate this model against a poison injection experiment performed at BARC. As conclusion this set of models is judged to be appropriate. (authors)« less

Leading unplanned change.

PubMed

Erickson, Jeanette Ives

2014-03-01

The article presents reflections on how Magnet® principles help nurse leaders through unplanned change using the 1-year anniversary of the Boston Marathon bombings and the response at Massachusetts General Hospital as an exemplar.

Incidence, Risk Factors, and Costs for Hospital Returns After Total Joint Arthroplasties.

PubMed

Sibia, Udai S; Mandelblatt, Abigail E; Callanan, Maura A; MacDonald, James H; King, Paul J

2017-02-01

Unplanned hospital returns after total joint arthroplasty (TJA) reduce any cost savings in a bundled reimbursement model. We examine the incidence, risk factors, and costs for unplanned emergency department (ED) visits and readmissions within 30 days of index TJA. We retrospectively reviewed a consecutive series of 655 TJAs (382 total knee arthroplasty and 273 total hip arthroplasty) performed between April 2014 and March 2015. Preoperative diagnosis was osteoarthritis of the hip or knee (97%) or avascular necrosis of the hip (3%). Hospital costs were recorded for each ED visit and readmission episode. Of the 655 TJAs reviewed, 55 (8.4%) returned to the hospital. Of these hospital returns, 35 patients (5.3%) returned for a total of 36 unplanned ED visits whereas the remaining 20 patients (3.1%) presented 22 readmissions within 30 days of index TJA. The 2 most common reasons for unplanned ED visits were postoperative pain/swelling (36%) and medication-related side effects (22%). Avascular necrosis of the hip was a significant risk factor for an unplanned ED visit (7.27 odds ratio [OR], 95% confidence interval [CI] 1.67-31.61, P = .008). Multiple logistic regression analysis revealed the following risk factors for readmission: body mass index (1.10 OR, 95% CI 1.02-1.78, P = .013), comorbidity >2 (2.07 OR, 95% CI 1.06-6.95, P = .037), and prior total knee arthroplasty (2.61 OR, 95% CI 1.01-6.72, P = .047). Ambulating on the day of surgery trended toward a lower risk for readmission (0.13 OR, 95% CI 0.02-1.10, P = .061). The 2 most common reasons for readmission were ileus (23%) and cellulitis (18%). The total cost associated with unplanned ED visits were $15,427 whereas costs of readmissions totaled $142,654. Unplanned ED visits and readmissions in the forthcoming bundled payments reimbursement model will reduce cost savings from rapid recovery protocols for TJA. Identifying and mitigating preventable causes of unplanned visits and readmissions will be critical to improving care and controlling costs. Copyright © 2016 Elsevier Inc. All rights reserved.

The risk of placenta accreta following primary cesarean delivery.

PubMed

Zeevi, Gil; Tirosh, Dan; Baron, Joel; Sade, Maayan Yitshak; Segal, Adi; Hershkovitz, Reli

2018-05-01

To (a) evaluate the risk for placenta accreta following primary cesarean section (CS), in regard to the stage of labor, the cesarean section was taken (elective prelabor vs. unplanned during labor); and (b) investigate whether the association between placenta accreta and maternal and neonatal complications is modified by the type of the primary CS. In a population-based retrospective cohort study, we included all singleton deliveries occurred in Soroka University Medical Center between 1991 and 2015, of women who had a history of a single CS. The deliveries were divided into three groups according to the delivery stage the primary CS was carried out: 'Unplanned 1' (first stage-up to 10 cm), 'Unplanned 2' (second stage-10 cm) and 'Elective' prelabor CS. We assessed the association between the study group and placenta accreta using logistic generalized estimation equation (GEE) models. We additionally assessed maternal and neonatal complications associated with placenta accreta among women who had elective and unplanned CS separately. We included 22,036 deliveries to 13,727 women with a history of one CS, of which 0.9% (n = 207) had placenta accreta in the following pregnancies: 12% (n = 25) in the 'Unplanned 1' group, 7.2% (n = 15) in the ' Unplanned 2' group and 80.8% (n = 167) in the 'elective' group. We found no difference in the risk for subsequent placenta accreta between the groups. In a stratified analysis by the timing of the primary cesarean delivery, the risk for maternal complications, associated with placenta accreta, was more pronounced among women who had an unplanned CS (OR 27.96, P < 0.01) compared to women who had an elective cesarean delivery (OR 13.72, P < 0.01). The stage in which CS is performed has no influence on the risk for placenta accreta in the following pregnancies, women who had an unplanned CS are in a higher risk for placenta accrete-associated maternal complications. This should be taken into consideration while counselling women about their risk while considering trial of labor after cesarean section.

Unplanned health care tourism.

PubMed

Powell, Suzanne K

2015-01-01

Health care tourism is often a preplanned event carefully laying out all the details. Sometimes, when one least expects it, medical care is needed outside of the mainland. This Editorial speaks to an unplanned experience.

The socioeconomic consequences of teenage childbearing: findings from a natural experiment.

PubMed

Grogger, J; Bronars, S

1993-01-01

A study based on census data from 1970 and 1980 examines the socioeconomic effects of unplanned teenage childbearing by comparing teenage mothers whose first birth was to twins with those whose first birth was to a single infant. Among black women, an unplanned teenage birth--represented by the secondborn twin--results in significantly lower rates of high school graduation and labor-force participation and significantly higher rates of poverty and welfare recipiency. Ten years after giving birth, black women who have an unplanned child are also significantly less likely than women who have not to be currently married, but are not less likely to have ever been married. Like black women, white women who have an unplanned teenage birth have significantly higher rates of poverty and welfare recipiency; they also have significantly lower family earnings and household income.

Causes of unplanned hemodialysis initiation.

PubMed

Gomis Couto, A; Teruel Briones, J L; Fernández Lucas, M; Rivera Gorrin, M; Rodríguez Mendiola, N; Jiménez Álvaro, S; Quereda Rodríguez-Navarro, C

2011-01-01

Half of patients starting chronic hemodialysis used a transient vascular catheter as a vascular access (unplanned initiation). An objective of the Quality Management Group of the Spanish Society of Nephrology is to achieve that 80% of the patients starting hemodialysis do it with an arteriovenous fistula. We want to review the causes of non-planned hemodialysis nowadays. In 2010, 43 patients had started chronic hemodialysis in the Hospital Ramón y Cajal in Madrid (Spain). Mean age was 61 years, 79% were men, the most frequent cause of chronic renal disease was the diabetes (23%) and Charlson Comorbidity Index was 6.3 ± 2.6. The unplanned hemodialysis occurred in 20 patients (47%), without any differences with the 23 patients who began planned hemodialysis, in none of the clinical or demographic parameters analyzed. The main cause of unplanned hemodialysis was the acute exacerbation of chronic kidney disease stage 3 or 4, previously stable, secondary to an unforeseeable intercurrent process (8 patients, 40% of the cases). One patient began after a non-recovery acute renal failure and in other 6 patients, the reason of unplanned hemodialysis initiation was not attributable to the operation Health System (in 3 cases unknown kidney chronic disease and in the other 3 cases it was patient´s responsibility). Only in 5 cases (25%), the cause could be corrigible. Most causes of unplanned hemodialysis does not come from the healthcare organization and therefore not easy to resolve it. Consequently, the objective of the Quality Group will be difficult to be achieved.

Trip report on IAEA Training Workshop on Implementation of Integrated Management Systems for Research Reactors (T3-TR-45496).

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

Pratt, Richard J.

2013-11-01

From 17-21 June 2013, Sandia National Laboratories, Technical Area-V (SNL TA-V) represented the United States Department of Energy/National Nuclear Security Administration (DOE/NNSA) at the International Atomic Energy Agency (IAEA) Training Workshop (T3-TR-45486). This report gives a breakdown of the IAEA regulatory structure for those unfamiliar, and the lessons learned and observations that apply to SNL TA-V that were obtained from the workshop. The Safety Report Series, IAEA workshop final report, and SNL TA-V presentation are included as attachments.

Risk factors for unplanned and unwanted teenage pregnancies occurring over two years of follow-up among a cohort of young South African women

PubMed Central

Christofides, Nicola J.; Jewkes, Rachel K.; Dunkle, Kristin L.; McCarty, Frances; Shai, Nwabisa Jama; Nduna, Mzikazi; Sterk, Claire

2014-01-01

Background Although teenage pregnancies in South Africa have declined, the short and longer term health and social consequences are a potential public health concern. This longitudinal study aimed to describe the range of risk and protective factors for incident unwanted and unplanned pregnancies occurring over 2 years of follow-up among a cohort of adolescent women in the Eastern Cape, South Africa. It also investigated the relationship between gender inequality and gender-based violence and subsequent unplanned and unwanted pregnancies among the cohort. Objective Teenage girls, aged 15–18 years (n=19), who were volunteer participants in a cluster randomized controlled trial and who had data from at least one follow-up were included in this analysis. To assess risk and protective factors for incident unwanted or unplanned pregnancies, we constructed multivariate polytomous regression models adjusting for sampling clusters as latent variables. Covariates included age, having a pregnancy prior to baseline, education, time between interviews, study intervention arm, contraceptive use, experience of intimate partner violence, belief that the teenage girl and her boyfriend are mutual main partners, and socioeconomic status. Results Overall, 174 pregnancies occurred over the 2-year follow-up period. Beliefs about relationship control were not associated with unwanted and unplanned pregnancies, nor were experiences of forced first sex or coerced sex under the age of 15. Hormonal contraception was protective against unplanned pregnancies (OR 0.40; 95% CI 0.21–0.79); however, using condoms was not protective. Physical abuse (OR 1.69; 95% CI 1.05–2.72) was a risk factor for, and having a pregnancy prior to baseline was protective against an unwanted pregnancy (OR 0.25; 95% CI 0.07–0.80). Higher socioeconomic status was protective for both unplanned and unwanted pregnancies (OR 0.69; 95% CI 0.58–0.83 and OR 0.78; 95% CI 0.64–0.96). Believing that the teenage girl and her boyfriend were mutual main partners doubled the odds of reporting both an unplanned and unwanted pregnancy (OR 2.58 95% CI 1.07–6.25, and OR 2.21 95% CI 1.13–4.29). Conclusion Although some of the measures of gender inequity were not associated with unplanned and unwanted pregnancies, there is evidence of the role of both gender power and socioeconomic status. This was evident in teenage girls who experienced physical violence being more likely to have an unwanted pregnancy. Interventions to prevent teenage pregnancies need to be tailored by socioeconomic status because some teenagers may see having a pregnancy as a way to have a more secure future. Interventions that engage with relationship dynamics of teenagers are essential if unwanted and unplanned pregnancies are to be prevented. PMID:25150027

Scram recoveries---C Reactor

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

Constable, D.W.; Pierce, J.R.; Wood, S.A.

1962-04-26

The purpose of this report is to discuss the observations made on two equilibrium scram recovery startups (April 5 and April 16). Normally, the two startups would have little significance but unusual ruptures were experienced in the top near section of the reactor shortly after both startups, which indicates that some similarity could exist between the two. The ruptures were unusual in that the two tubes involved both had multiple ruptures. One tube contained two E{sup 2} ruptures and the other tube contained three overbore metal ruptures. The overbore tube also contained three incipient ruptures (uranium split under the can).more » The initial rise to power on both startups appeared to be normal with the flux peaking on the near side as expected. On the April 16 startup the maximum level reached was 1050 at which time a rupture in overbore tube 3062 caused on increase in pressure resulting in a high trip on the Panellit gauge. A level of 1600 was reached on the April 5 startup which was held for approximately 14 hours at which time the reactor was shut down due to rupture indications on row 29.« less

Measuring pregnancy planning: A psychometric evaluation and comparison of two scales.

PubMed

Drevin, Jennifer; Kristiansson, Per; Stern, Jenny; Rosenblad, Andreas

2017-11-01

To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale. The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level. Cross-sectional design. In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation. All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability. The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning. © 2017 John Wiley & Sons Ltd.

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes

PubMed Central

Congdon, Peter

2016-01-01

Background: Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. Methods: This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. Results: As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Conclusions: Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables. PMID:27598184

Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes.

PubMed

Congdon, Peter

2016-09-01

Enhanced quality of care and improved access are central to effective primary care management of long term conditions. However, research evidence is inconclusive in establishing a link between quality of primary care, or access, and adverse outcomes, such as unplanned hospitalisation. This paper proposes a structural equation model for quality and access as latent variables affecting adverse outcomes, such as unplanned hospitalisations. In a case study application, quality of care (QOC) is defined in relation to diabetes, and the aim is to assess impacts of care quality and access on unplanned hospital admissions for diabetes, while allowing also for socio-economic deprivation, diabetes morbidity, and supply effects. The study involves 90 general practitioner (GP) practices in two London Clinical Commissioning Groups, using clinical quality of care indicators, and patient survey data on perceived access. As a single predictor, quality of care has a significant negative impact on emergency admissions, and this significant effect remains when socio-economic deprivation and morbidity are allowed. In a full structural equation model including access, the probability that QOC negatively impacts on unplanned admissions exceeds 0.9. Furthermore, poor access is linked to deprivation, diminished QOC, and larger list sizes. Using a Bayesian inference methodology, the evidence from the analysis is weighted towards negative impacts of higher primary care quality and improved access on unplanned admissions. The methodology of the paper is potentially applicable to other long term conditions, and relevant when care quality and access cannot be measured directly and are better regarded as latent variables.

Unplanned extubations in an intensive care unit: Findings from a critical incident technique.

PubMed

Danielis, Matteo; Chiaruttini, Simona; Palese, Alvisa

2018-05-15

Patients on mechanical ventilation are at risk of experiencing a potentially life-threatening unplanned extubation in the intensive care unit, which can lead to arrhythmias, bronchial aspiration, difficulty in reintubation or even sudden cardiac arrest. Although incidence and outcomes of the phenomenon have been documented in several quantitative studies, no studies have investigated the antecedents as experienced by critical care nurses. To gain a greater understanding of the antecedents of unplanned extubations. A qualitative study design involving the critical-incident technique. A total of 10 registered nurses who reported one or more episodes of unplanned extubations were involved in an in-depth interview. According to the nurses' experience, episodes of unplanned extubations are determined by predisposing, precipitating and mediating factors. The predisposing factors have been recognised in the (a) weaning programme (expected/unexpected decreased sedation) and in the (b) patient factors (increased needs due to discomfort, restlessness and desire to communicate). The precipitating factors have been divided into (a) organisational (failures in multi-professional communication), (b) environmental (excessive environmental chaos and barriers preventing direct surveillance) and (c) nursing care factors (ensuring privacy by creating barriers, avoiding disturbing other patients and poor nurse-to-patient ratio). Among the mediating factors, which are affected by the precipitating factors, decreased surveillance and mechanical restraints' use have been identified. Identifying risk factors of unplanned extubation, specifically those that are modifiable, such as increasing interprofessional communication, reducing excessive environment chaos, implementing strategies aimed at overcoming barriers threatening direct surveillance and ensuring appropriate nurse-to-patient ratio, can prevent the occurrence of these events. Copyright © 2018 Elsevier Ltd. All rights reserved.

A One-year, Short-Stay Crewed Mars Mission Using Bimodal Nuclear Thermal Electric Propulsion (BNTEP) - A Preliminary Assessment

NASA Technical Reports Server (NTRS)

Burke, Laura M.; Borowski, Stanley K.; McCurdy, David R.; Packard, Thomas W.

2013-01-01

A crewed mission to Mars poses a significant challenge in dealing with the physiological issues that arise with the crew being exposed to a near zero-gravity environment as well as significant solar and galactic radiation for such a long duration. While long surface stay missions exceeding 500 days are the ultimate goal for human Mars exploration, short round trip, short surface stay missions could be an important intermediate step that would allow NASA to demonstrate technology as well as study the physiological effects on the crew. However, for a 1-year round trip mission, the outbound and inbound hyperbolic velocity at Earth and Mars can be very large resulting in a significant propellant requirement for a high thrust system like Nuclear Thermal Propulsion (NTP). Similarly, a low thrust Nuclear Electric Propulsion (NEP) system requires high electrical power levels (10 megawatts electric (MWe) or more), plus advanced power conversion technology to achieve the lower specific mass values needed for such a mission. A Bimodal Nuclear Thermal Electric Propulsion (BNTEP) system is examined here that uses three high thrust Bimodal Nuclear Thermal Rocket (BNTR) engines allowing short departure and capture maneuvers. The engines also generate electrical power that drives a low thrust Electric Propulsion (EP) system used for efficient interplanetary transit. This combined system can help reduce the total launch mass, system and operational requirements that would otherwise be required for equivalent NEP or Solar Electric Propulsion (SEP) mission. The BNTEP system is a hybrid propulsion concept where the BNTR reactors operate in two separate modes. During high-thrust mode operation, each BNTR provides 10's of kilo-Newtons of thrust at reasonably high specific impulse (Isp) of 900 seconds for impulsive transplanetary injection and orbital insertion maneuvers. When in power generation/EP mode, the BNTR reactors are coupled to a Brayton power conversion system allowing each reactor to generate 100's of kWe of electrical power to a very high Isp (3000 s) EP thruster system for sustained vehicle acceleration and deceleration in heliocentric space.

A One-year, Short-Stay Crewed Mars Mission Using Bimodal Nuclear Thermal Electric Propulsion (BNTEP) - A Preliminary Assessment

NASA Technical Reports Server (NTRS)

Burke, Laura A.; Borowski, Stanley K.; McCurdy, David R.; Packard, Thomas W.

2013-01-01

A crewed mission to Mars poses a signi cant challenge in dealing with the physiolog- ical issues that arise with the crew being exposed to a near zero-gravity environment as well as signi cant solar and galactic radiation for such a long duration. While long sur- face stay missions exceeding 500 days are the ultimate goal for human Mars exploration, short round trip, short surface stay missions could be an important intermediate step that would allow NASA to demonstrate technology as well as study the physiological e ects on the crew. However, for a 1-year round trip mission, the outbound and inbound hy- perbolic velocity at Earth and Mars can be very large resulting in a signi cant propellant requirement for a high thrust system like Nuclear Thermal Propulsion (NTP). Similarly, a low thrust Nuclear Electric Propulsion (NEP) system requires high electrical power lev- els (10 megawatts electric (MWe) or more), plus advanced power conversion technology to achieve the lower speci c mass values needed for such a mission. A Bimodal Nuclear Thermal Electric Propulsion (BNTEP) system is examined here that uses three high thrust Bimodal Nuclear Thermal Rocket (BNTR) engines allowing short departure and capture maneuvers. The engines also generate electrical power that drives a low thrust Electric Propulsion (EP) system used for ecient interplanetary transit. This combined system can help reduce the total launch mass, system and operational requirements that would otherwise be required for equivalent NEP or Solar Electric Propulsion (SEP) mission. The BNTEP system is a hybrid propulsion concept where the BNTR reactors operate in two separate modes. During high-thrust mode operation, each BNTR provides 10's of kilo- Newtons of thrust at reasonably high speci c impulse (Isp) of 900 seconds for impulsive trans-planetary injection and orbital insertion maneuvers. When in power generation / EP mode, the BNTR reactors are coupled to a Brayton power conversion system allowing each reactor to generate 100's of kWe of electrical power to a very high Isp (3000 s) EP thruster system for sustained vehicle acceleration and deceleration in heliocentric space.

Fuel Cycle System Analysis Handbook

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

Steven J. Piet; Brent W. Dixon; Dirk Gombert

2009-06-01

This Handbook aims to improve understanding and communication regarding nuclear fuel cycle options. It is intended to assist DOE, Campaign Managers, and other presenters prepare presentations and reports. When looking for information, check here. The Handbook generally includes few details of how calculations were performed, which can be found by consulting references provided to the reader. The Handbook emphasizes results in the form of graphics and diagrams, with only enough text to explain the graphic, to ensure that the messages associated with the graphic is clear, and to explain key assumptions and methods that cause the graphed results. Some ofmore » the material is new and is not found in previous reports, for example: (1) Section 3 has system-level mass flow diagrams for 0-tier (once-through), 1-tier (UOX to CR=0.50 fast reactor), and 2-tier (UOX to MOX-Pu to CR=0.50 fast reactor) scenarios - at both static and dynamic equilibrium. (2) To help inform fast reactor transuranic (TRU) conversion ratio and uranium supply behavior, section 5 provides the sustainable fast reactor growth rate as a function of TRU conversion ratio. (3) To help clarify the difference in recycling Pu, NpPu, NpPuAm, and all-TRU, section 5 provides mass fraction, gamma, and neutron emission for those four cases for MOX, heterogeneous LWR IMF (assemblies mixing IMF and UOX pins), and a CR=0.50 fast reactor. There are data for the first 10 LWR recycle passes and equilibrium. (4) Section 6 provides information on the cycle length, planned and unplanned outages, and TRU enrichment as a function of fast reactor TRU conversion ratio, as well as the dilution of TRU feedstock by uranium in making fast reactor fuel. (The recovered uranium is considered to be more pure than recovered TRU.) The latter parameter impacts the required TRU impurity limits specified by the Fuels Campaign. (5) Section 7 provides flows for an 800-tonne UOX separation plant. (6) To complement 'tornado' economic uncertainty diagrams, which show at a glance combined uncertainty information, section 9.2 has a new set of simpler graphs that show the impact on fuel cycle costs for once through, 1-tier, and 2-tier scenarios as a function of key input parameters.« less

Mining transportation information from social media for planned and unplanned events.

DOT National Transportation Integrated Search

2016-05-01

The objective of this project is on mining social media data to deduce useful travelers information with : a special emphasis under events, including both planned events (such as sporting games), and : unplanned events (such as traffic accidents)....

Risk factors for unplanned pregnancy in women with mental illness living in a developing country.

PubMed

du Toit, Elsa; Jordaan, Esme; Niehaus, Dana; Koen, Liezl; Leppanen, Jukka

2018-06-01

Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. In this quantitative, descriptive study, we investigated both socio-demographic factors and variables relating to mental illness itself that may place women at an increased risk of experiencing unplanned pregnancy. Data was gathered at two maternal mental health clinics in Cape Town by means of semi-structured interviews. Univariate analyses of the data revealed five independent key risk factors for unplanned pregnancy: lower levels of education, unmarried status, belonging to the Colored ethnic population, substance use, and having a history of two or more suicide attempts. Some of these factors overlap with findings of similar studies, but others are unique to the specific population (women with mental illness within a developing country). Screening of women based on these risk predictors may pave the way for early interventions and reduce the incidence of unplanned pregnancy and the negative consequences thereof in the South African population.

Predictors and causes of unplanned re-operations in outpatient plastic surgery: a multi-institutional analysis of 6749 patients using the 2011 NSQIP database.

PubMed

Lim, Seokchun; Jordan, Sumanas W; Jain, Umang; Kim, John Y S

2014-08-01

Studies that evaluate the predictors and causes of unplanned re-operation in outpatient plastic surgery. This study retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and identified all plastic surgery outpatient cases performed in 2011. Multiple logistic regression analysis was utilised to identify independent risk factors and causes of unplanned reoperations. Of the 6749 outpatient plastic surgery cases identified, there were 125 (1.9%) unplanned re-operations (UR). Regression analysis demonstrated that body mass index (BMI, OR = 1.041, 95% CI = 1.019-1.065), preoperative open wound/wound infection (OR = 3.498, 95% CI = 1.593-7.678), American Society of Anesthesiologists (ASA) class 3 (OR = 2.235, 95% CI = 1.048-4.765), and total work relative value units (RVU, OR = 1.014, 95% CI = 1.005-1.024) were significantly predictive of UR. Additionally, the presence of any complication was significantly associated with UR (OR = 15.065, 95% CI = 5.705-39.781). In an era of outcomes-driven medicine, unplanned re-operation is a critical quality indicator for ambulatory plastic surgery facilities. The identified risk factors will aid in surgical planning and risk adjustment.

What weekday? How acute? An analysis of reported planned and unplanned GP visits by older multi-morbid patients in the Patient Journey Record System database.

PubMed

Surate Solaligue, David Emanuel; Hederman, Lucy; Martin, Carmel Mary

2014-08-01

Timely access to general practitioner (GP) care is a recognized strategy to address avoidable hospitalization. Little is known about patients seeking planned (decided ahead) and unplanned (decided on day) GP visits. The Patient Journey Record System (PaJR) provides a biopsychosocial real-time monitoring and support service to chronically ill and older people over 65 who may be at risk of an avoidable hospital admission. This study aims to describe reported profiles associated with planned and unplanned GP visits during the week in the PaJR database of regular outbound phone calls made by Care Guides to multi-morbid older patients. One hundred fifty consecutive patients with one or more chronic condition (including chronic obstructive pulmonary disease, heart/vascular disease, heart failure and/or diabetes), one or more hospital admission in previous year, and consecutively recruited from hospital discharge, out-of-hour care and GP practices comprised the study sample. Using a semistructured script, Care Guides telephoned the patients approximately every 3 week days, and entered call data into the PaJR database in 2011. The PaJR project identified and prompted unplanned visits according to its algorithms. Logistic regression modelling and descriptive statistics identified significant predictors of planned and unplanned visits and patterns of GP visits on weekdays reported in calls. In 5096 telephone calls, unplanned versus planned GP visits were predicted by change in health state, significant symptom concerns, poor self-rated health, bodily pain and concerns about caregiver or intimates. Calls not reporting visits had significantly fewer of these features. Planned visits were associated with general and medication concerns, reduced social participation and feeling down. Planned visits were highest on Monday and trended downwards to Fridays. Unplanned visits were reported at the same rate each weekday and more frequently when the interval between calls was ≥3 days. The PaJR project Care Guides advised patients to make unplanned visits in 6.3% of calls and advised planned GP visits in 2.5% of calls. Unplanned GP visits consistently indicated a significant change to worse health with planned visits presenting less acuity in this study of older multi-morbid patients in general practice, when monitored by regular calls at about every 3 days. The PaJR study actively prompted GP visits according to its algorithms. Assessing and predicting acuity in older multi-morbid patients appears to be a promising strategy to improve access to primary care, and thus to reducing avoidable hospital utilization. Further research is needed to investigate the topic on a wider scale. © 2014 John Wiley & Sons, Ltd.

Mars manned fusion spaceship

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

Hedrick, J.; Buchholtz, B.; Ward, P.

1991-01-01

Fusion Propulsion has an enormous potential for space exploration in the near future. In the twenty-first century, a usable and efficient fusion rocket will be developed and in use. Because of the great distance between other planets and Earth, efficient use of time, fuel, and payload is essential. A nuclear spaceship would provide greater fuel efficiency, less travel time, and a larger payload. Extended missions would give more time for research, experiments, and data acquisition. With the extended mission time, a need for an artificial environment exists. The topics of magnetic fusion propulsion, living modules, artificial gravity, mass distribution, spacemore » connection, and orbital transfer to Mars are discussed. The propulsion system is a magnetic fusion reactor based on a tandem mirror design. This allows a faster, shorter trip time and a large thrust to weight ratio. The fuel proposed is a mixture of deuterium and helium. Helium can be obtained from lunar mining. There will be minimal external radiation from the reactor resulting in a safe, efficient propulsion system.« less

Mars manned fusion spaceship

NASA Technical Reports Server (NTRS)

Hedrick, James; Buchholtz, Brent; Ward, Paul; Freuh, Jim; Jensen, Eric

1991-01-01

Fusion Propulsion has an enormous potential for space exploration in the near future. In the twenty-first century, a usable and efficient fusion rocket will be developed and in use. Because of the great distance between other planets and Earth, efficient use of time, fuel, and payload is essential. A nuclear spaceship would provide greater fuel efficiency, less travel time, and a larger payload. Extended missions would give more time for research, experiments, and data acquisition. With the extended mission time, a need for an artificial environment exists. The topics of magnetic fusion propulsion, living modules, artificial gravity, mass distribution, space connection, and orbital transfer to Mars are discussed. The propulsion system is a magnetic fusion reactor based on a tandem mirror design. This allows a faster, shorter trip time and a large thrust to weight ratio. The fuel proposed is a mixture of deuterium and helium-3. Helium-3 can be obtained from lunar mining. There will be minimal external radiation from the reactor resulting in a safe, efficient propulsion system.

Trace Assessment for BWR ATWS Analysis

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

Cheng, L.Y.; Diamond, D.; Arantxa Cuadra, Gilad Raitses, Arnold Aronson

2010-04-22

A TRACE/PARCS input model has been developed in order to be able to analyze anticipated transients without scram (ATWS) in a boiling water reactor. The model is based on one developed previously for the Browns Ferry reactor for doing loss-of-coolant accident analysis. This model was updated by adding the control systems needed for ATWS and a core model using PARCS. The control systems were based on models previously developed for the TRAC-B code. The PARCS model is based on information (e.g., exposure and moderator density (void) history distributions) obtained from General Electric Hitachi and cross sections for GE14 fuel obtainedmore » from an independent source. The model is able to calculate an ATWS, initiated by the closure of main steam isolation valves, with recirculation pump trip, water level control, injection of borated water from the standby liquid control system and actuation of the automatic depres-surization system. The model is not considered complete and recommendations are made on how it should be improved.« less

Predictors of Residual Disease after Unplanned Excision of Soft Tissue Sarcomas

PubMed Central

Gingrich, Alicia A.; Elias, Alexandra; Michael Lee, Chia-Yuan; Nakache, Yves-Paul N.; Li, Chin-Shang; Shah, Dhruvil R.; Boutin, Robert D.; Canter, Robert J.

2016-01-01

Background Unplanned excision of soft tissue sarcomas (STS) is an important quality of care issue given the morbidity related to tumor bed excision. Since not all patients harbor residual disease at the time of re-excision, we sought to determine predictors of residual STS following unplanned excision. Methods We identified 76 patients from a prospective database (1/1/2008 – 9/30/2014) who received a diagnosis of primary STS following unplanned excision on the trunk or extremities. We used univariable and multivariable analyses to evaluate predictors of residual STS as the primary endpoint. We calculated the sensitivity/specificity and accuracy of interval magnetic resonance imaging (MRI) to predict residual sarcoma at re-excision. Results Mean age was 52 years, and 63.2% were male. 50% had fragmented unplanned excision. Among patients undergoing re-excision, residual STS was identified in 70%. On univariable analysis, MRI showing gross disease and fragmented excision were significant predictors of residual STS (OR 10.59, 95% CI 2.14–52.49, P=0.004 and OR 3.61, 95% CI 1.09–11.94, P=0.035, respectively). On multivariable analysis, tumor size predicted distant recurrence and overall survival. When we combined equivocal and positive MRI, the sensitivity and specificity of MRI for predicting residual STS were 86.7% (95% CI 73.2–95.0%) and 57.9% (95% CI 33.5–79.8%), with an overall accuracy of 78.1% (95% CI 66.0–87.5%). Conclusions 70% of patients undergoing repeat excision after unplanned excision of STS harbor residual sarcoma. Although interval MRI and fragmented excision appear to be the most significant predictors of residual STS, the accuracy of MRI remains modest, especially given the incidence of equivocal MRI. PMID:27993214

Predicting 7-day, 30-day and 60-day all-cause unplanned readmission: a case study of a Sydney hospital.

PubMed

Maali, Yashar; Perez-Concha, Oscar; Coiera, Enrico; Roffe, David; Day, Richard O; Gallego, Blanca

2018-01-04

The identification of patients at high risk of unplanned readmission is an important component of discharge planning strategies aimed at preventing unwanted returns to hospital. The aim of this study was to investigate the factors associated with unplanned readmission in a Sydney hospital. We developed and compared validated readmission risk scores using routinely collected hospital data to predict 7-day, 30-day and 60-day all-cause unplanned readmission. A combination of gradient boosted tree algorithms for variable selection and logistic regression models was used to build and validate readmission risk scores using medical records from 62,235 live discharges from a metropolitan hospital in Sydney, Australia. The scores had good calibration and fair discriminative performance with c-statistic of 0.71 for 7-day and for 30-day readmission, and 0.74 for 60-day. Previous history of healthcare utilization, urgency of the index admission, old age, comorbidities related to cancer, psychosis, and drug-abuse, abnormal pathology results at discharge, and being unmarried and a public patient were found to be important predictors in all models. Unplanned readmissions beyond 7 days were more strongly associated with longer hospital stays and older patients with higher number of comorbidities and higher use of acute care in the past year. This study demonstrates similar predictors and performance to previous risk scores of 30-day unplanned readmission. Shorter-term readmissions may have different causal pathways than 30-day readmission, and may, therefore, require different screening tools and interventions. This study also re-iterates the need to include more informative data elements to ensure the appropriateness of these risk scores in clinical practice.

A prospective analysis of unplanned patient-initiated contacts in an adult cystic fibrosis centre.

PubMed

Burnet, Espérie; Hubert, Dominique; Champreux, Juliette; Honoré, Isabelle; Kanaan, Reem; Panzo, Rosewilta; Burgel, Pierre-Régis

2018-05-07

Timely response should be provided when patients contact the cystic fibrosis (CF) centre in between scheduled visits. Little data exist on unplanned patient-initiated contacts in CF adults. A two-stage prospective study was undertaken from 1 January to 31 December 2015 at Cochin Hospital, Paris (France). The first stage included all adults (≥18 years) who initiated unplanned contacts to the CF centre over four months. Four physicians and three nurses systematically recorded unplanned patient-initiated contacts. The data was analysed to determine why and how patients contacted the CF centre and time spent responding to their request(s). The second stage (one physician, three nurses) lasted twelve months and explored whether high contact frequency was associated with disease severity, using multivariate logistic regression. In the first stage, 259 of 410 patients (63%) initiated at least one unplanned contact, corresponding to 1067 contacts over 4 months. Patients favoured email with physicians (61% of contacts) and telephone with nurses (87% of contacts). Total time spent by the 7 caregivers on providing responses was 8 h/work week. Reasons for contacting the CF centre varied greatly, but <20% of contacts were directly related to symptom management. In the second stage, 180 of 212 patients (85%) initiated 1876 contacts over 12 months. Factors associated with ≥5 contacts/year were female sex, FEV 1  ≤ 30% predicted, ≥5 physician visits/year, and ≥ 1 hospital admission/year. Answering unplanned patient-initiated contacts represented a significant workload for CF caregivers. Increased disease severity was associated with high contact frequency. Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

A preliminary inquiry on the problem of unplanned (extra-quota) second births.

PubMed

Zhao, L; Zhu, C

1984-01-01

The resurgence of child births in China in 1981 was marked by a decline in the multiparity birth rates and a drastic rise in the rate of unplanned 2nd births, resulting in unplanned 2nd births outnumbering multiparity births. The aim of this investigation was to find the objective and subjective causes for the unplanned 2nd births and explore ways to bring them under strict control. In the countryside there are loud voices that give insufficient labor as their reason for wanting 2nd births. An analysis of 923 cases of unplanned 2nd births in connection with the economic conditions of the families, the sex of the 1st births, intervals between the births, and the parents' cultural level shows that 61.87% of the total number of families suffered a decline in their income. The effect of the sex of the 1st birth over the 2nd birth varies with different localities. Among those having unplanned births, illiterates accounted for more than 35% in Nanzheng and Yanchuan counties and over 20% in Mianxian and Wubao counties. The current rise in 2nd births is due mainly not to economic reasons but to social and psychological reasons. To effectively hold down 2nd births under the current conditions, the following suggestions are offered: 1) step up propaganda and education work to gradually raise people's consciousness for practicing family planning, 2) family planning measures of economic restriction and reward must be implemented, 3) on the basis of enforcing the new marriage law, late marriage should be promoted, 4) a population tax should be imposed, and 5) social insurance for the elderly should be enlarged.

10 CFR 40.60 - Reporting requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... available and operable to perform the required safety function. (3) An event that requires unplanned medical treatment at a medical facility of an individual with spreadable radioactive contamination on the individual's clothing or body. (4) An unplanned fire or explosion damaging any licensed material or any device...

Pediatric Admissions After Dental Care Under General Anesthesia: A Retrospective Study at a Tertiary Care Center.

PubMed

Lucy, Anna L; Gandhi, Roopa P; Gross, Lilyana; McNair, Bryan

2017-05-15

The purpose of this study was to identify factors associated with planned and unplanned pediatric hospital admissions following dental treatment under general anesthesia (DGA) in a tertiary care center. Dental and medical records of 100 subjects one to 20 years of age, with a known history of admission after DGA, were reviewed retrospectively for patient-, procedure-, and anesthesia-related factors as well as adverse events following DGA. During the review period (December 3, 2011 to June 30, 2015), 10,371 subjects underwent DGA, of which 100 subjects (less than one percent) required admission. A significant association was found between postoperative (PO) recovery time and unplanned admissions following DGA (P<0.001). Adverse post-operative events significantly associated with unplanned admissions included emesis (P=0.01) and hypoxia (P<0.001). Patients who were classified as having American Anesthesiology Association (ASA) III status were more frequently admitted following DGA. Adverse events such as emesis and hypoxia were significantly associated with patients with an unplanned admission.

Analyzing the effect of selected control policy measures and sociodemographic factors on alcoholic beverage consumption in Europe within the AMPHORA project: statistical methods.

PubMed

Baccini, Michela; Carreras, Giulia

2014-10-01

This paper describes the methods used to investigate variations in total alcoholic beverage consumption as related to selected control intervention policies and other socioeconomic factors (unplanned factors) within 12 European countries involved in the AMPHORA project. The analysis presented several critical points: presence of missing values, strong correlation among the unplanned factors, long-term waves or trends in both the time series of alcohol consumption and the time series of the main explanatory variables. These difficulties were addressed by implementing a multiple imputation procedure for filling in missing values, then specifying for each country a multiple regression model which accounted for time trend, policy measures and a limited set of unplanned factors, selected in advance on the basis of sociological and statistical considerations are addressed. This approach allowed estimating the "net" effect of the selected control policies on alcohol consumption, but not the association between each unplanned factor and the outcome.

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.

PubMed

Roy, Anil K; Chu, Jason; Bozeman, Caroline; Sarda, Samir; Sawvel, Michael; Chern, Joshua J

2017-06-01

OBJECTIVE Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery. METHODS Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations. RESULTS Cerebrospinal fluid shunt-and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43-2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32-2.96, p < 0.05]). CONCLUSIONS Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When reoperations were unplanned, contributing factors could be both surgeon related and system related. Further study is required to determine the extent to which these reoperations are preventable. The utility of unplanned reoperation as a quality indicator is dependent on proper definition, analysis, and calculation.

The prevalence of unplanned pregnancy ending in birth, associated factors, and health outcomes.

PubMed

Goossens, J; Van Den Branden, Y; Van der Sluys, L; Delbaere, I; Van Hecke, A; Verhaeghe, S; Beeckman, D

2016-12-01

What are associated factors of unplanned pregnancies ending in birth? Pregnancies that were less planned were associated with women of lower socio-economic status (SES), an unhealthier lifestyle before and during the pregnancy, more stress, and less social support. In Europe, the prevalence of unplanned pregnancy leading to birth varies. Unplanned pregnancy is more common among socially disadvantaged women, and associated with adverse pregnancy outcomes. In a cross-sectional study, 517 women were recruited from May through September 2015. Women were recruited from six hospitals in Flanders, Belgium. Data from self-report and medical records were collected during the first 5 days postpartum. The validated London Measure of Unplanned Pregnancy was used to collect data regarding pregnancy planning. Data were analysed with Mann-Whitney U tests, Kruskal-Wallis tests, and multiple linear regression analysis. The majority of the pregnancies (83%) ending in birth were planned, 15% were ambivalent, and 2% unplanned. Women who are multigravida (95% CI -0.30 to -0.02), less well educated (95% CI 0.07-0.85), single or having a non-cohabiting relationship (95% CI 0.01-2.53), having history of drug abuse (95% CI -2.07 to -0.35), and experiencing intimate partner violence (95% CI -3.82 to -1.59) tended to have a significantly higher risk of a less planned pregnancy. Less planned pregnancies were significantly associated with initially unwanted pregnancies (P < 0.001), no folic acid or vitamin use before pregnancy (P < 0.001), lower number of prenatal visits (P = 0.03), smoking during pregnancy (P < 0.001), more stress (P = 0.002), lower relationship satisfaction (P = 0.001), and less social support (P < 0.001). Less planned pregnancies were also significantly associated with hyperemesis (P < 0.001) and shorter duration of delivery (P = 0.03). No differences were found in neonatal outcomes. The prevalence of unplanned pregnancies is probably underestimated due to overrepresentation of women with higher SES in this study. Women's emotions may have influenced the answer to certain questions. Owing to the cross-sectional design, no causal relationships could be established. This study emphasizes the importance of targeting socially disadvantaged women in the prevention of unplanned pregnancies. This study was funded by the Research Foundation - Flanders (FWO). The authors have no conflict of interests. Not applicable. © The Author 2016. Published by Oxford University Press on behalf of the European Society of HumanReproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Race and Sex Differences in Post-Myocardial Infarction Angina Frequency and Risk of 1-Year Unplanned Rehospitalization.

PubMed

Hess, Connie N; Kaltenbach, Lisa A; Doll, Jacob A; Cohen, David J; Peterson, Eric D; Wang, Tracy Y

2017-02-07

Race and sex disparities in in-hospital treatment and outcomes of patients with acute myocardial infarction (MI) have been described, but little is known about race and sex differences in post-MI angina and long-term risk of unplanned rehospitalization. We examined race and sex differences in post-MI angina frequency and 1-year unplanned rehospitalization to identify factors associated with unplanned rehospitalization, testing for whether race and sex modify these relationships. Using TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) data, we examined 6-week and 1-year angina frequency and 1-year unplanned rehospitalization stratified by race and sex among MI patients treated with percutaneous coronary intervention. We used multivariable logistic regression to assess factors associated with unplanned rehospitalization and tested for interactions among angina frequency, race, and sex. A total of 11 595 MI patients survived to 1 year postdischarge; there were 66.6% white male patients, 24.3% white female patients, 5.3% black male patients, and 3.8% black female patients. Overall, 29.7% had angina at 6 weeks, and 20.6% had angina at 1 year postdischarge. Relative to white patients, black patients were more likely to have angina at 6 weeks (female: 44.2% versus 31.8%; male: 33.5% versus 27.1%; both P<0.0001) and 1 year (female: 49.4% versus 38.9%; male: 46.3% versus 31.1%; both P<0.0001). Rates of 1-year unplanned rehospitalization were highest among black female patients (44.1%), followed by white female patients (38.4%), black male patients (36.4%), and white male patients (30.2%, P<0.0001). In the multivariable model, 6-week angina was most strongly associated with unplanned rehospitalization (hazard ratio, 1.49; 95% confidence interval, 1.36-1.62; P<0.0001); this relationship was not modified by race or sex (adjusted 3-way P interaction =0.41). One-fifth of MI patients treated with percutaneous coronary intervention report 1-year postdischarge angina, with black and female patients more likely to have angina and to be rehospitalized. Better treatment of post-MI angina may improve patient quality of life and quality of care and help to lower rates of rehospitalization overall and particularly among black and female patients, given their high prevalence of post-MI angina. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503. © 2017 American Heart Association, Inc.

Predicting the Necessity for Extracorporeal Circulation During Lung Transplantation: A Feasibility Study.

PubMed

Hinske, Ludwig Christian; Hoechter, Dominik Johannes; Schröeer, Eva; Kneidinger, Nikolaus; Schramm, René; Preissler, Gerhard; Tomasi, Roland; Sisic, Alma; Frey, Lorenz; von Dossow, Vera; Scheiermann, Patrick

2017-06-01

The factors leading to the implementation of unplanned extracorporeal circulation during lung transplantation are poorly defined. Consequently, the authors aimed to identify patients at risk for unplanned extracorporeal circulation during lung transplantation. Retrospective data analysis. Single-center university hospital. A development data set of 170 consecutive patients and an independent validation cohort of 52 patients undergoing lung transplantation. The authors investigated a cohort of 170 consecutive patients undergoing single or sequential bilateral lung transplantation without a priori indication for extracorporeal circulation and evaluated the predictive capability of distinct preoperative and intraoperative variables by using automated model building techniques at three clinically relevant time points (preoperatively, after endotracheal intubation, and after establishing single-lung ventilation). Preoperative mean pulmonary arterial pressure was the strongest predictor for unplanned extracorporeal circulation. A logistic regression model based on preoperative mean pulmonary arterial pressure and lung allocation score achieved an area under the receiver operating characteristic curve of 0.85. Consequently, the authors developed a novel 3-point scoring system based on preoperative mean pulmonary arterial pressure and lung allocation score, which identified patients at risk for unplanned extracorporeal circulation and validated this score in an independent cohort of 52 patients undergoing lung transplantation. The authors showed that patients at risk for unplanned extracorporeal circulation during lung transplantation could be identified by their novel 3-point score. Copyright © 2017 Elsevier Inc. All rights reserved.

The effect of retail cigarette pack displays on unplanned purchases: results from immediate postpurchase interviews.

PubMed

Carter, O B J; Mills, B W; Donovan, R J

2009-06-01

To assess the influence of point-of-sale (POS) cigarette displays on unplanned purchases. Intercept interviews were conducted with customers observed purchasing cigarettes from retail outlets featuring POS cigarette displays. Measures included intention to purchase cigarettes prior to entering the store, unprompted and prompted salience of POS tobacco displays, urge to buy cigarettes as a result of seeing the POS display, brand switching and support for a ban on POS cigarette displays. In total, 206 daily smokers aged 18-76 years (90 male, 116 female) were interviewed. Unplanned cigarette purchases were made by 22% of participants. POS displays influenced nearly four times as many unplanned purchases as planned purchases (47% vs 12%, p<0.01). Brand switching was reported among 5% of participants, half of whom were influenced by POS displays. Four times as many smokers were supportive of a ban on POS tobacco displays than unsupportive (49% vs 12%), and 28% agreed that such a ban would make it easier to quit. POS tobacco displays act as a form of advertising even in the absence of advertising materials. They stimulate unplanned cigarette purchases, play an important role in brand selection and tempt smokers trying to quit. This justifies removing POS tobacco displays from line of sight-something that very few smokers in our sample would object to.

Pregnancy and Single Parenthood in the Navy: Results of a 1997 Survey.

DTIC Science & Technology

1998-09-01

rates for age cohorts. Half of the women experiencing an unplanned pregnancy were not using birth control , whereas the pill was the most failure-prone...shore duty; (2) attempt to reduce unplanned pregnancies by improving birth control education and expanding family planning efforts; and (3) emphasize

Adult Couples Facing a Planned or an Unplanned Pregnancy: Two Realities

ERIC Educational Resources Information Center

Bouchard, Genevieve

2005-01-01

This study examined demographic, individual, and relational factors that differentiate adult couples facing an unplanned pregnancy carried to term from those facing a planned pregnancy. One hundred and eighteen couples expecting their first child completed, along with a demographic questionnaire, measures of personality, perceived stress,…

Importance of fuel treatment for limiting moderate-to-high intensity fire: Findings from comparative fire modeling

Treesearch

Geoffrey J. Cary; Ian D. Davies; Ross A. Bradstock; Robert E. Keane; Mike D. Flannigan

2017-01-01

Context: Wildland fire intensity influences natural communities, soil properties, erosion, and sequestered carbon. Measuring effectiveness of fuel treatment for reducing area of higher intensity unplanned fire is argued to be more meaningful than determining effect on total unplanned area burned. Objectives...

Gesture, Meaning, and Thinking-for-Teaching in Unplanned Vocabulary Explanations

ERIC Educational Resources Information Center

van Compernolle, Rémi A.; Smotrova, Tetyana

2017-01-01

In this article, we examine the ways in which an ESL instructor constructs contextually relevant meanings through the synchronization of speech and gesture during unplanned vocabulary explanations. Video recorded data are analysed, with focus on an in-class homework review in which students demonstrated difficulty in comprehending several key…

Planned and Unplanned Childbearing among Unmarried Women.

ERIC Educational Resources Information Center

Musick, Kelly

2002-01-01

Uses data from the 1995 National Survey of Family Growth to examine social, demographic, and economic correlates of planned and unplanned childbearing among unmarried women. Finds that low education increases the likelihood such childbearing outside of marriage for all race and ethnic groups. Results suggest ways in which the meaning of…

Efficiencies and Optimization of Weak Base Anion Ion-Exchange Resin for Groundwater Hexavalent Chromium Removal at Hanford

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

Nesham, Dean O.; Ivarson, Kristine A.; Hanson, James P.

2014-02-03

The U.S. Department of Energy’s (DOE’s) contractor, CH2M HILL Plateau Remediation Company, has successfully converted a series of groundwater treatment facilities to use a new treatment resin that is delivering more than $3 million in annual cost savings and efficiency in treating groundwater contamination at the DOE Hanford Site in southeastern Washington State. During the production era, the nuclear reactors at the Hanford Site required a continuous supply of high-quality cooling water during operations. Cooling water consumption ranged from about 151,417 to 378,541 L/min (40,000 to 100,000 gal/min) per reactor, depending on specific operating conditions. Water from the Columbia Rivermore » was filtered and treated chemically prior to use as cooling water, including the addition of sodium dichromate as a corrosion inhibitor. Hexavalent chromium was the primary component of the sodium dichromate and was introduced into the groundwater at the Hanford Site as a result of planned and unplanned discharges from the reactors starting in 1944. Groundwater contamination by hexavalent chromium and other contaminants related to nuclear reactor operations resulted in the need for groundwater remedial actions within the Hanford Site reactor areas. Beginning in 1995, groundwater treatment methods were evaluated, leading to the use of pump-and-treat facilities with ion exchange using Dowex™ 21K, a regenerable, strong-base anion exchange resin. This required regeneration of the resin, which was performed offsite. In 2008, DOE recognized that regulatory agreements would require significant expansion for the groundwater chromium treatment capacity. As a result, CH2M HILL performed testing at the Hanford Site in 2009 and 2010 to demonstrate resin performance in the specific groundwater chemistry at different waste sites. The testing demonstrated that a weak-base anion, single-use resin, specifically ResinTech SIR-700 ®, was effective at removing chromium, had a significantly higher capacity, could be disposed of efficiently onsite, and would eliminate the complexities and programmatic risks from sampling, packaging, transportation, and return of resin for regeneration.« less

Nuclear reactor power for an electrically powered orbital transfer vehicle

NASA Technical Reports Server (NTRS)

Jaffe, L.; Beatty, R.; Bhandari, P.; Chow, E.; Deininger, W.; Ewell, R.; Fujita, T.; Grossman, M.; Kia, T.; Nesmith, B.

1987-01-01

To help determine the systems requirements for a 300-kWe space nuclear reactor power system, a mission and spacecraft have been examined which utilize electric propulsion and this nuclear reactor power for multiple transfers of cargo between low earth orbit (LEO) and geosynchronous earth orbit (GEO). A propulsion system employing ion thrusters and xenon propellant was selected. Propellant and thrusters are replaced after each sortie to GEO. The mass of the Orbital Transfer Vehicle (OTV), empty and dry, is 11,000 kg; nominal propellant load is 5000 kg. The OTV operates between a circular orbit at 925 km altitude, 28.5 deg inclination, and GEO. Cargo is brought to the OTV by Shuttle and an Orbital Maneuvering Vehicle (OMV); the OTV then takes it to GEO. The OTV can also bring cargo back from GEO, for transfer by OMV to the Shuttle. OTV propellant is resupplied and the ion thrusters are replaced by the OMV before each trip to GEO. At the end of mission life, the OTV's electric propulsion is used to place it in a heliocentric orbit so that the reactor will not return to earth. The nominal cargo capability to GEO is 6000 kg with a transit time of 120 days; 1350 kg can be transferred in 90 days, and 14,300 kg in 240 days. These capabilities can be considerably increased by using separate Shuttle launches to bring up propellant and cargo, or by changing to mercury propellant.

Unplanned pregnancies in the United States.

PubMed

Grimes, D A

1986-03-01

Unplanned pregnancies constitute an epidemic in the United States. Over 3 million unplanned pregnancies occur, and over 1.5 million induced abortions are performed each year. Women of minority races and those with less than 12 years of education are at high risk of having unwanted children. Fear of complications (not the complications themselves) is the most powerful deterrent to women's use of contraception. Much of this fear is due to bad press. Recent good news about contraception, such as protection against ovarian and endometrial cancer, protection against ectopic pregnancy, and absence of teratogenic effects, has not received appropriate media coverage. For healthy women younger than 35 years, failure to use fertility control is more dangerous than use of any method.

Effects of competition on hospital quality: an examination using hospital administrative data.

PubMed

Palangkaraya, Alfons; Yong, Jongsay

2013-06-01

This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.

Planned and Unplanned Aspects of Occupational Choices by Youth. Final Report.

ERIC Educational Resources Information Center

Ellis, Robert A.; And Others

This document includes reports on four subjects relevant to planned and unplanned aspects of occupational choices by youth. (1) "Toward a Morphology of Occupational Choice," by Robert A. Ellis and others, discusses intrinsic features and extrinsic rewards of work, extra-role considerations, and goal perception as major influences on occupational…

It's Not about Me: College Women and Unplanned Pregnancy

ERIC Educational Resources Information Center

Hardy, Jayne W.

2011-01-01

The purpose of this qualitative study was to explore the experiences of single college women who had an unplanned pregnancy while attending a small private four-year university in the upper midwest. The conceptual framework used to provide direction for this study was social constructivism. A phenomenological approach was used to seek the reality…

Reducing unplanned pregnancy and abortion in Zimbabwe through postabortion contraception.

PubMed

Johnson, Brooke R; Ndhlovu, Singatsho; Farr, Sherry L; Chipato, Tsungai

2002-06-01

In many countries, women treated for complications from spontaneous or unsafely induced abortion lack access to contraceptive services. As a result, many of them soon have a subsequent unplanned pregnancy or a repeat abortion, placing their health at increased risk. This report presents the results of a prospective intervention study on postabortion family planning conducted in the two largest public hospitals in Zimbabwe. Women at Harare Central Hospital, in the capital, received a postabortion family planning intervention, and Mpilo Central Hospital, in Bulawayo, served as the control site. The study cohort was 982 women, 527 of whom were followed for a 12-month period. During the follow-up period, significantly more women used highly effective methods of contraception, significantly fewer unplanned pregnancies occurred, and fewer repeat abortions were performed at the intervention site than at the control site. These results offer compelling evidence that ward-based contraceptive services provided to women treated for incomplete abortion can significantly reduce subsequent unplanned pregnancies. The results also suggest that postabortion family planning services can reduce the incidence of repeat abortion.

Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.

PubMed

Polites, Stephanie F; Potter, Donald D; Glasgow, Amy E; Klinkner, Denise B; Moir, Christopher R; Ishitani, Michael B; Habermann, Elizabeth B

2017-08-01

Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Unplanned 30-day readmissions following general and thoracic surgical procedures in children <18 were identified from the 2012-2014 National Surgical Quality Improvement Program- Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05). Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. III. Copyright © 2017 Elsevier Inc. All rights reserved.

Contrasting fire responses to climate and management: insights from two Australian ecosystems.

PubMed

King, Karen J; Cary, Geoffrey J; Bradstock, Ross A; Marsden-Smedley, Jonathan B

2013-04-01

This study explores effects of climate change and fuel management on unplanned fire activity in ecosystems representing contrasting extremes of the moisture availability spectrum (mesic and arid). Simulation modelling examined unplanned fire activity (fire incidence and area burned, and the area burned by large fires) for alternate climate scenarios and prescribed burning levels in: (i) a cool, moist temperate forest and wet moorland ecosystem in south-west Tasmania (mesic); and (ii) a spinifex and mulga ecosystem in central Australia (arid). Contemporary fire activity in these case study systems is limited, respectively, by fuel availability and fuel amount. For future climates, unplanned fire incidence and area burned increased in the mesic landscape, but decreased in the arid landscape in accordance with predictions based on these limiting factors. Area burned by large fires (greater than the 95th percentile of historical, unplanned fire size) increased with future climates in the mesic landscape. Simulated prescribed burning was more effective in reducing unplanned fire activity in the mesic landscape. However, the inhibitory effects of prescribed burning are predicted to be outweighed by climate change in the mesic landscape, whereas in the arid landscape prescribed burning reinforced a predicted decline in fire under climate change. The potentially contrasting direction of future changes to fire will have fundamentally different consequences for biodiversity in these contrasting ecosystems, and these will need to be accommodated through contrasting, innovative management solutions. © 2012 Blackwell Publishing Ltd.

The relevance, biases, and importance of digitising opportunistic non-standardised collections: A case study in Iberian harvestmen fauna with BOS Arthropod Collection datasets (Arachnida, Opiliones).

PubMed

Merino-Sáinz, Izaskun; Torralba-Burrial, Antonio; Anadón, Araceli

2014-01-01

In this study, we analyse the relevance of harvestmen distribution data derived from opportunistic, unplanned, and non-standardised collection events in an area in the north of the Iberian Peninsula. Using specimens deposited in the BOS Arthropod Collection at the University of Oviedo, we compared these data with data from planned, standardised, and periodic collections with pitfall traps in several locations in the same area. The Arthropod Collection, begun in 1977, includes specimens derived from both sampling types, and its recent digitisation allows for this type of comparative analysis. Therefore, this is the first data-paper employing a hybrid approach, wherein subset metadata are described alongside a comparative analysis. The full dataset can be accessed through Spanish GBIF IPT at http://www.gbif.es:8080/ipt/archive.do?r=Bos-Opi, and the metadata of the unplanned collection events at http://www.gbif.es:8080/ipt/resource.do?r=bos-opi_unplanned_collection_events. We have mapped the data on the 18 harvestmen species included in the unplanned collections and provided records for some species in six provinces for the first time. We have also provided the locations of Phalangium opilio in eight provinces without published records. These results highlight the importance of digitising data from unplanned biodiversity collections, as well as those derived from planned collections, especially in scarcely studied groups and areas.

Peritonitis in Rwanda: Epidemiology and risk factors for morbidity and mortality.

PubMed

Ndayizeye, Leonard; Ngarambe, Christian; Smart, Blair; Riviello, Robert; Majyambere, Jean Paul; Rickard, Jennifer

2016-12-01

Few studies discuss causes and outcomes of peritonitis in low-income settings. This study describes epidemiology of patients with peritonitis at a Rwandan referral hospital. Identification of risk factors associated with mortality and unplanned reoperation could improve management of peritonitis. Data were collected on demographics, clinical presentation, operative findings, and outcomes for all patients with peritonitis. Multivariate regression analysis identified factors associated with in-hospital mortality and unplanned reoperation. A total of 280 patients presented with peritonitis over a 6-month period. Causes of peritonitis were complications of intestinal obstruction (39%) and appendicitis (17%). Thirty-six (13%) patients required unplanned reoperation, and in-hospital mortality was 17%. Factors associated with increased odds of in-hospital mortality were unplanned reoperation (adjusted odds ratio 34.12), vasopressor use (adjusted odds ratio 24.91), abnormal white blood cell count (adjusted odds ratio 12.6), intensive care unit admission (adjusted odds ratio 9.06), and American Society of Anesthesiologist score ≥3 (adjusted odds ratio 7.80). Factors associated with increased odds of unplanned reoperation included typhoid perforation (adjusted odds ratio 5.92) and hypoxia on admission (adjusted odds ratio 3.82). Peritonitis in Rwanda presents with high morbidity and mortality. Minimizing delays in care is important, as many patients with intestinal obstruction present with features of peritonitis. A better understanding of patient care and management prior to arrival at the referral hospital is needed to identify areas for improvement at the health center and district hospital. Copyright © 2016 Elsevier Inc. All rights reserved.

The relevance, biases, and importance of digitising opportunistic non-standardised collections: A case study in Iberian harvestmen fauna with BOS Arthropod Collection datasets (Arachnida, Opiliones)

PubMed Central

Merino-Sáinz, Izaskun; Torralba-Burrial, Antonio; Anadón, Araceli

2014-01-01

Abstract In this study, we analyse the relevance of harvestmen distribution data derived from opportunistic, unplanned, and non-standardised collection events in an area in the north of the Iberian Peninsula. Using specimens deposited in the BOS Arthropod Collection at the University of Oviedo, we compared these data with data from planned, standardised, and periodic collections with pitfall traps in several locations in the same area. The Arthropod Collection, begun in 1977, includes specimens derived from both sampling types, and its recent digitisation allows for this type of comparative analysis. Therefore, this is the first data-paper employing a hybrid approach, wherein subset metadata are described alongside a comparative analysis. The full dataset can be accessed through Spanish GBIF IPT at http://www.gbif.es:8080/ipt/archive.do?r=Bos-Opi, and the metadata of the unplanned collection events at http://www.gbif.es:8080/ipt/resource.do?r=bos-opi_unplanned_collection_events. We have mapped the data on the 18 harvestmen species included in the unplanned collections and provided records for some species in six provinces for the first time. We have also provided the locations of Phalangium opilio in eight provinces without published records. These results highlight the importance of digitising data from unplanned biodiversity collections, as well as those derived from planned collections, especially in scarcely studied groups and areas. PMID:24843271

New Utility for an Old Tool

PubMed Central

Odonkor, Charles A.; Schonberger, Robert B.; Dai, Feng; Shelley, Kirk H.; Silverman, David G.; Barash, Paul G.

2013-01-01

Objective The primary aim of this study was to design prediction models based on a functional marker (preoperative gait-speed) to predict readiness for home discharge time of ≤ 90 minutes, and to identify those at risk for unplanned admissions, after elective ambulatory surgery. Design This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models. Results After adjustment for covariates, gait speed with adjusted odds ratio = 3.71 (95% CI: 1.21-11.26), p=0.02; was independently associated with early home discharge readiness ≤90 minutes. Importantly, gait speed dichotomized as greater or less than 1 m/s predicted unplanned admissions with odds ratio = 0.35 (95% CI: 0.16 to 0.76, p=0.008) for those with speeds ≥ 1 m/s in comparison to those with speed < 1 m/s. In a separate model, prior history of cardiac surgery with adjusted odds ratio =7.5 (95% CI: 2.34-24.41)(p=0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant. Conclusions This study demonstrates use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions, after elective ambulatory surgery. PMID:24051992

Association between age at first sexual intercourse and knowledge, attitudes and practices regarding reproductive health and unplanned pregnancy: a cross-sectional study.

PubMed

Shu, C; Fu, A; Lu, J; Yin, M; Chen, Y; Qin, T; Shang, X; Wang, X; Zhang, M; Xiong, C; Yin, P

2016-06-01

Age at first sexual intercourse (AFSI) is decreasing among adolescents in developed nations. An early sexual debut has been associated, to some extent, with multiple sexual partners, infrequent use of condoms, unplanned pregnancy, unsafe abortion, and sexually transmitted disease and human immunodeficiency virus infection. Unplanned pregnancy among adolescents has both physical and social adverse effects. In total, 78,400 self-administered anonymous questionnaires were distributed to college students in seven cities in China to determine the age at which Chinese college students first engage in sexual activity, and the association between AFSI and knowledge, attitudes and practices (KAP) regarding reproductive health and unplanned pregnancy. Approximately 10,164 students reported that they were sexually active, and most reported that they had engaged in sexual intercourse for the first time during college. The average AFSI was 20.14 [standard deviation (SD) 2.98] years, and the average AFSI by gender was 19.97 (SD 2.97) years for males and 20.41 (SD 2.97) years for females. The unplanned pregnancy rate among the participants was 34.03%. Participants lacked knowledge about contraception and reproductive health, although most believed that it is necessary to have this knowledge. Participants' attitudes towards premarital sex were varied. Factors that were found to be associated with unplanned pregnancy were AFSI, contraceptive methods used for first sexual act, and whether contraceptive methods were used for every sexual act. The college period is a key time for Chinese students in terms of becoming sexually active. As such, comprehensive and informative reproductive health education should be provided before and during the college period. Furthermore, reproductive health education should include appropriate sexual morality education and comprehensive sex education. Gender traits and needs should be considered in sex education. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Women undergoing aortic surgery are at higher risk for unplanned readmissions compared with men especially when discharged home.

PubMed

Flink, Benjamin J; Long, Chandler A; Duwayri, Yazan; Brewster, Luke P; Veeraswamy, Ravi; Gallagher, Katherine; Arya, Shipra

2016-06-01

Women undergoing vascular surgery have higher morbidity and mortality. Our study explores gender-based differences in patient-centered outcomes such as readmission, length of stay (LOS), and discharge destination (home vs nonhome facility) in aortic aneurysm surgery. Patients were identified from the American College of Surgeons National Surgical Quality Improvement Project database (2011-2013) undergoing abdominal, thoracic, and thoracoabdominal aortic aneurysms (N = 17,763), who were discharged and survived their index hospitalization. The primary outcome was unplanned readmission, and secondary outcomes were discharge to a nonhome facility, LOS, and reasons for unplanned readmission. Univariate, multivariate, and stratified analyses based on gender and discharge destination were used. Overall, 1541 patients (8.7%) experienced an unplanned readmission, with a significantly higher risk in women vs men (10.8% vs 8%; P < .001) overall (Procedure subtypes: abdominal aortic aneurysm [10.1% vs 7.7%; P < .001], thoracic aortic aneurysm [14.1% vs 13.5%; P = .8], and thoracoabdominal aortic aneurysm [14.8% vs 10%; P = .051]). The higher odds of readmission in women compared with men persisted in multivariate analysis after controlling for covariates (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4). Similarly, the rate of discharge to a nonhome facility was nearly double in women compared with men (20.6% vs 10.7%; P < .001), but discharge to a nonhome facility was not a significant predictor of unplanned readmission. Upon stratification by discharge destination, the higher odds of readmissions in women compared with men occurred in patients who were discharged home (OR, 1.2; 95% CI, 1.02-1.4) but not in those who were discharged to a nonhome facility (OR, 1.06; 95% CI, 0.8-1.4). Significant differences in LOS were seen in patients who were discharged home. No gender differences were found in reasons for readmission with the three most common reasons being thromboembolic events, wound infections, and pneumonia. Gender disparity exists in the risk of unplanned readmission among aortic aneurysm surgery patients. Women who were discharged home have a higher likelihood of unplanned readmission despite longer LOS than men. These data suggest that further study into the discharge planning processes, social factors, and use of rehabilitation services is needed for women undergoing aortic procedures to decrease readmissions. Published by Elsevier Inc.

Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program

PubMed Central

Sherrod, Brandon A.; Johnston, James M.; Rocque, Brandon G.

2017-01-01

Objective Readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for readmission after pediatric neurosurgical procedures. Methods The American College of Surgeons National Surgical Quality Improvement Program–Pediatric database was queried for pediatric patients treated by a neurosurgeon from 2012 to 2013. Procedures were categorized by current procedural terminology code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmission within 30 days of the primary procedure. Results A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). Spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures had the lowest unplanned readmission rates. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI and wound disruption: OR > 12 and p < 0.001 for each). Postoperative pneumonia (OR 4.294, p < 0.001), urinary tract infection (OR 4.262, p < 0.001), and sepsis (OR 2.616, p = 0.006) also independently increased the readmission risk. Independent patient risk factors for unplanned readmission included Native American race (OR 2.363, p = 0.019), steroid use > 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.014). Conclusions This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery, potentially helping to focus efforts at lowering readmission rates, minimizing patient risk, and lowering costs for health care systems. PMID:27184348

Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.

PubMed

Sherrod, Brandon A; Johnston, James M; Rocque, Brandon G

2016-09-01

OBJECTIVE Hospital readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for patient readmission after pediatric neurosurgical procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database was queried for pediatric patients treated by a neurosurgeon between 2012 and 2013. Procedures were categorized by current procedural terminology (CPT) code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmissions within 30 days of the primary procedure. RESULTS A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%; CPT codes 62225 and 62230), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). The lowest unplanned readmission rates were for spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI, and wound disruption: OR > 12 and p < 0.001 for each). Postoperative pneumonia (OR 4.294, p < 0.001), urinary tract infection (OR 4.262, p < 0.001), and sepsis (OR 2.616, p = 0.006) also independently increased the readmission risk. Independent patient risk factors for unplanned readmission included Native American race (OR 2.363, p = 0.019), steroid use > 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.029). CONCLUSIONS This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery, potentially helping to focus efforts at lowering readmission rates, minimizing patient risk, and lowering costs for health care systems.

Motor and Cognitive Functional Status Are Associated with 30-day Unplanned Rehospitalization Following Post-Acute Care in Medicare Fee-for-Service Beneficiaries.

PubMed

Middleton, Addie; Graham, James E; Lin, Yu-Li; Goodwin, James S; Bettger, Janet Prvu; Deutsch, Anne; Ottenbacher, Kenneth J

2016-12-01

The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 stipulates that standardized functional status (self-care and mobility) and cognitive function data will be used for quality reporting in post-acute care settings. Thirty-day post-discharge unplanned rehospitalization is an established quality metric that has recently been extended to post-acute settings. The relationships between the functional domains in the IMPACT Act and 30-day unplanned rehospitalization are poorly understood. To determine the degree to which discharge mobility, self-care, and cognitive function are associated with 30-day unplanned rehospitalization following discharge from post-acute care. This was a retrospective cohort study. Inpatient rehabilitation facilities submitting claims and assessment data to the Centers for Medicare and Medicaid Services in 2012-2013. Medicare fee-for-service enrollees discharged from post-acute rehabilitation in 2012-2013. The sample included community-dwelling adults admitted for rehabilitation following an acute care stay who survived for 32 days following discharge (N = 252,406). Not applicable. Thirty-day unplanned rehospitalization following post-acute rehabilitation. The unadjusted 30-day unplanned rehospitalization rate was 12.0 % (n = 30,179). Overall, patients dependent at discharge for mobility had a 50 % increased odds of rehospitalization (OR = 1.50, 95 % CI: 1.42-1.59), patients dependent for self-care a 36 % increased odds (OR = 1.36, 95 % CI: 1.27-1.47), and patients dependent for cognition a 19 % increased odds (OR = 1.19, 95 % CI: 1.09-1.29). Patients dependent for both self-care and mobility at discharge (n = 8312, 3.3 %) had a 16.1 % (95 % CI: 15.3-17.0 %) adjusted rehospitalization rate versus 8.5 % (95 % CI: 8.3-8.8 %) for those independent for both (n = 74,641; 29.6 %). The functional domains identified in the IMPACT Act were associated with 30-day unplanned rehospitalization following post-acute care in this large national sample. Further research is needed to better understand and improve the functional measures, and to determine if their association with rehospitalizations varies across post-acute settings, patient populations, or episodes of care.

Health care utilisation among older persons with intellectual disability and dementia: a registry study.

PubMed

Axmon, A; Karlsson, B; Ahlström, G

2016-12-01

Both persons with intellectual disability (ID) and persons with dementia have high disease burdens, and consequently also high health care needs. As life expectancy increases for persons with ID, the group of persons with the dual diagnosis of ID and dementia will become larger. Through national registries, we identified 7936 persons who had received support directed to persons with ID during 2012, and an age- and gender-matched sample from the general population. A national registry was also used to collect information on health care utilisation (excluding primary care) for the period 2002-2012. Health care utilisation was measured as presence and number of planned and unplanned in-patient and out-patient visits, as well as length of stay. In comparison with persons with ID but without dementia, persons with ID and dementia were more likely to have at least one planned out-patient visit (odds ratio [OR] 8.07), unplanned out-patient visit (OR 2.41), planned in-patient visit (OR 2.76) or unplanned in-patient visit (OR 4.19). However, among those with at least one of each respective outcome, the average number of visits did not differ between those with and without dementia. Persons with ID and dementia were less likely to have at least one planned out-patient visit than persons with dementia in the general population sample (OR 0.40), but more likely to have at least one unplanned in-patient visit (OR 1.90). No statistically significant differences were found for having at least one unplanned out-patient or planned in-patient visit. Nevertheless, among those with at least one unplanned out-patient visit, the number of visits was higher in the general population sample. Persons with ID and dementia are less likely to receive planned health care than persons with dementia in the general population. They have, however, higher levels of unplanned health care utilisation. This may be an indication that the current support system is not sufficient to meet the challenges of increased longevity among persons with ID. © 2016 The Authors. Journal of Intellectual Disability Research published by MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disibilities and John Wiley & Sons Ltd.

Lake Holloman Recreational Area Development Environmental Assessment

DTIC Science & Technology

2009-08-01

facilities Total daily trips are applied to the following factors depending on the corresponding years. Year 2005 through 2009: VOCE = .016...Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E = .0022...Trips COE = .262 * Trips To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 NOx (tons/yr) = NOxE * DPYII/2000

Navy Explosive Ordnance Disposal School Master Development Plan for Test Area D-51 Final Environmental Assessment

DTIC Science & Technology

2008-01-01

Year 2005 through 2009: VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips...NOxE = .013 * Trips PM10E = .0022 * Trips COE = .262 * Trips To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII

A potassium Rankine multimegawatt nuclear electric propulsion concept

NASA Technical Reports Server (NTRS)

Baumeister, E.; Rovang, R.; Mills, J.; Sercel, J.; Frisbee, R.

1990-01-01

Multimegawatt nuclear electric propulsion (NEP) has been identified as a potentially attractive option for future space exploratory missions. A liquid-metal-cooled reactor, potassium Rankine power system that is being developed is suited to fulfill this application. The key features of the nuclear power system are described, and system characteristics are provided for various potential NEP power ranges and operational lifetimes. The results of recent mission studies are presented to illustrate some of the potential benefits to future space exploration to be gained from high-power NEP. Specifically, mission analyses have been performed to assess the mass and trip time performance of advanced NEP for both cargo and piloted missions to Mars.

Does an Unplanned Pregnancy Have Long-Term Implications for Mother-Child Relationships?

ERIC Educational Resources Information Center

Nelson, Jackie A.; O'Brien, Marion

2012-01-01

The effect of pregnancy planning on the quality of mother-adolescent relationships 15 years later was examined among 373 first-time parents and 472 experienced parents using a mediated moderation model. Among first-time mothers only, the experience of an unplanned pregnancy was related to higher maternal depressive symptoms when mothers also…

Benefits of Using Planned Comparisons Rather Than Post Hoc Tests: A Brief Review with Examples.

ERIC Educational Resources Information Center

DuRapau, Theresa M.

The rationale behind analysis of variance (including analysis of covariance and multiple analyses of variance and covariance) methods is reviewed, and unplanned and planned methods of evaluating differences between means are briefly described. Two advantages of using planned or a priori tests over unplanned or post hoc tests are presented. In…

Unplanned Terminology Development: A Synchronic and Diachronic Study on Economic Terms in Turkish Newspapers

ERIC Educational Resources Information Center

Karabacak, Erkan

2009-01-01

This study deals with unplanned terminology development in the subject field of economics within media discourse. It examines how economic terms in Turkish newspapers emerge, are used, and cease. This developmental process is also analyzed through productivity of economic terms and the factors affect them. The subject terms are also analyzed as a…

Factors that Adolescent Males Take into Account in Decisions about an Unplanned Pregnancy

ERIC Educational Resources Information Center

Corkindale, Carolyn J.; Condon, John T.; Russell, Alan; Quinlivan, Julie A.

2009-01-01

Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young men's influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a…

Processes and Factors Underlying Adolescent Males' Attitudes and Decision-Making in Relation to an Unplanned Pregnancy

ERIC Educational Resources Information Center

Condon, John T.; Corkindale, Carolyn J.; Russell, Alan; Quinlivan, Julie A.

2006-01-01

This research examined adolescent males' decision-making when confronted with a hypothetical unplanned pregnancy in a sexual partner. An innovative methodology, involving a computerized simulation game was utilized with 386 Australian males (mean age of 15 years). Data were gathered from responses made during the simulation, and questionnaires…

Strategy, structure, and patient quality outcomes in ambulatory surgery centers (1997-2004).

PubMed

Chukmaitov, Askar; Devers, Kelly J; Harless, David W; Menachemi, Nir; Brooks, Robert G

2011-04-01

The purpose of this study was to examine potential associations among ambulatory surgery centers' (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures. The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume of procedures may be associated with a decrease in unplanned hospitalizations at ASCs.

Final Environmental Assessment for the Military Family Housing Privatization Initiative Columbus Air Force Base, Mississippi

DTIC Science & Technology

2005-05-03

daily trips are applied to the following factors depending on the corresponding years. Year 2005 through 2009: VOCE = .016 * Trips NOxE = .015...Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E = .0022 * Trips COE...262 * Trips To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 NOx (tons/yr) = NOxE * DPYII/2000 PM10 (tons/yr

Final Environmental Assessment for the Okaloosa Regional Airport Expansion at Eglin Air Force Base, FL

DTIC Science & Technology

2006-06-01

construction Total daily trips are then applied to the following factors depending on the corresponding years. Year 2005 through 2009: VOCE ...016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E...0022 * Trips COE = .262 * Trips To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 Nox (tons/yr) = NOxE

How to Conduct a Research Field Trip

ERIC Educational Resources Information Center

Wacker, David G.

1974-01-01

Discusses the three phases of a three-day intensive research study field trip: planning and pre-trip training; actual trip; and post-trip report, research and data organization, and final trip evaluation. Included is a sample program of the limnology field trip taken by the Grafton High School, Wisconsin. (CC)

Final Environmental Assessment: For Construction of an Addition to the Joint Strike Fighter Reprogramming Facility, Building 614, on Eglin Air Force Base, Florida

DTIC Science & Technology

2007-01-01

VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013...Trips PM10E = .0022 * Trips COE = .262 * Trips E = emissions To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 lbs

Final Environmental Assessment for Construction of a Precision Measurement Equipment Laboratory Facility on Eglin Air Force Base, FL

DTIC Science & Technology

2006-10-01

daily trips are then applied to the following factors depending on the corresponding years. Year 2005 through 2009: VOCE = .016 * Trips NOxE...015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E = .0022 * Trips COE...262 * Trips E = emissions To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 lbs/ton NOx (tons/yr) = NOxE * DPYII

Supervisory Control System Architecture for Advanced Small Modular Reactors

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

Cetiner, Sacit M; Cole, Daniel L; Fugate, David L

2013-08-01

This technical report was generated as a product of the Supervisory Control for Multi-Modular SMR Plants project within the Instrumentation, Control and Human-Machine Interface technology area under the Advanced Small Modular Reactor (SMR) Research and Development Program of the U.S. Department of Energy. The report documents the definition of strategies, functional elements, and the structural architecture of a supervisory control system for multi-modular advanced SMR (AdvSMR) plants. This research activity advances the state-of-the art by incorporating decision making into the supervisory control system architectural layers through the introduction of a tiered-plant system approach. The report provides a brief history ofmore » hierarchical functional architectures and the current state-of-the-art, describes a reference AdvSMR to show the dependencies between systems, presents a hierarchical structure for supervisory control, indicates the importance of understanding trip setpoints, applies a new theoretic approach for comparing architectures, identifies cyber security controls that should be addressed early in system design, and describes ongoing work to develop system requirements and hardware/software configurations.« less

[Epidemiology of induced abortion in France].

PubMed

Vigoureux, S

2016-12-01

Conduct a synthesis of existing knowledge about the frequency of induced abortion or termination of pregnancy and unplanned pregnancies, the exposure factors of unplanned pregnancies and abortion and the associated morbidity and mortality. Consultation of The Medline database, and national and international reports on abortions in France and in developed countries. Voluntary termination of pregnancy is an induced abortion, opted for non-medical reasons, which in France can be performed before 14 weeks of gestation. Abortion is a common procedure, with rare complications, amounting to about 220,000 procedures per year in France with a stable rate over decades. Similarly to births, women aged 20 to 24 are most affected. The possibility of an abortion exists for all women; this potential event, however, is not equal for each and varies by age of women, socio-professional situations, geographical origins, marital status and past or present domestic and sexual violence. The French historical analysis shows that for 50 years the increase in contraceptive prevalence rate is associated with a decrease in the frequency of unplanned pregnancies. It is therefore possible that the prevention of unplanned pregnancy through early uptake of contraception and contraception options by women is related to a woman's lifestyle. Nonetheless, the number of abortion remains stable since its decriminalization despite the large increase in medicalized contraceptive prevalence rate. Good knowledge of the epidemiology of voluntary termination of pregnancy and unplanned pregnancies is a prerequisite to better adopt prevention and case management strategies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Technical performance score is associated with outcomes after the Norwood procedure.

PubMed

Nathan, Meena; Sleeper, Lynn A; Ohye, Richard G; Frommelt, Peter C; Caldarone, Christopher A; Tweddell, James S; Lu, Minmin; Pearson, Gail D; Gaynor, J William; Pizarro, Christian; Williams, Ismee A; Colan, Steven D; Dunbar-Masterson, Carolyn; Gruber, Peter J; Hill, Kevin; Hirsch-Romano, Jennifer; Jacobs, Jeffrey P; Kaltman, Jonathan R; Kumar, S Ram; Morales, David; Bradley, Scott M; Kanter, Kirk; Newburger, Jane W

2014-11-01

The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial. We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned reinterventions that occurred before discharge from the Norwood hospitalization. Multivariable regression examined the association of the TPS with interval to first extubation, Norwood length of stay, death or transplantation, unplanned postdischarge reinterventions, and neurodevelopment at 14 months old. Of 549 patients undergoing a Norwood procedure, 356 (65%) had an echocardiogram adequate to assess atrial septal restriction or arch obstruction or an unplanned reintervention, enabling calculation of the TPS. On multivariable regression, adjusting for preoperative variables, a better TPS was an independent predictor of a shorter interval to first extubation (P=.019), better transplant-free survival before Norwood discharge (P<.001; odds ratio, 9.1 for inadequate vs optimal), shorter hospital length of stay (P<.001), fewer unplanned reinterventions between Norwood discharge and stage II (P=.004), and a higher Bayley II psychomotor development index at 14 months (P=.031). The TPS was not associated with transplant-free survival after Norwood discharge, unplanned reinterventions after stage II, or the Bayley II mental development index at 14 months. TPS is an independent predictor of important outcomes after Norwood and could serve as a tool for quality improvement. Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

Unplanned Reoperations in Neurosurgical Patients Due to Postoperative Bleeding

PubMed Central

Zheng, Xin-Rui; Chen, Tao; Yang, Yue-Fan; Rao, Wei; Wang, Guan-Ying; Zhang, Shan-Hong; Fei, Zhou

2015-01-01

Abstract The aim of this study is to investigate the incidence of unplanned reoperations from all causes due to bleeding in neurosurgical patients. The medical records of patients who received neurosurgical procedures at our hospital were retrospectively reviewed and data of patients who received reoperations were extracted and summarized. A literature review was conducted of the Medline, Cochrane, EMBASE, and Google Scholar databases up to November 2013. The main outcome measure was the rate of unplanned reoperations due to bleeding. At our hospital, 68 patients with a mean age of 41.5 ± 21.5 years (range, 7 months to 76 years) received an unplanned reoperation. More than 70% of the patients were older than 18 years, 64.7% were males, and 94.1% had cranial surgery. Almost 60% of the patients received >1 blood transfusion (58.8%) after the first surgery. Of the 68 patients, 35 (51.5%) received a second operation due to bleeding. Univariate logistic regression analysis only showed that an increasing time interval between the first and second surgery was associated with a decreased chance of the reoperation being performed due to bleeding (odds ratio [OR] = 0.843, 95% confidence interval [CI]: 0.720–0.987; P = .033). Of 229 studies identified, 5 retrospective reports with a total of 1375 patients were included in the analysis. The rate of reoperations for bleeding in the 5 studies ranged from 4.2% to 31.5%. Employing measures to reduce postoperative bleeding may help reduce the rate of unplanned neurosurgical reoperations. PMID:26061301

Factors affecting unplanned readmissions from community hospitals to acute hospitals: a prospective observational study.

PubMed

Leong, Ian Y O; Chan, Siew-Pang; Tan, Boon-Yeow; Sitoh, Yih-Yiow; Ang, Yan-Hoon; Merchant, Reshma; Kanagasabai, Kala; Lee, Patricia S Y; Pang, Weng-Sun

2009-02-01

While the readmission rate from community hospitals is known, the factors affecting it are not. Our aim was to determine the factors predicting unplanned readmissions from community hospitals (CHs) to acute hospitals (AHs). This was an observational prospective cohort study, involving 842 patients requiring post-acute rehabilitation in 2 CHs admitted from 3 AHs in Singapore. We studied the role of the Cumulative Illness Rating Scale (CIRS) organ impairment scores, the Mini-mental State Examination (MMSE) score, the Shah modified Barthel Index (BI) score, and the triceps skin fold thickness (TSFT) in predicting the rate of unplanned readmissions (UR), early unplanned readmissions (EUPR) and late unplanned readmissions (LUPR). We developed a clinical prediction rule to determine the risk of UR and EUPR. The rates of EUPR and LUPR were 7.6% and 10.3% respectively. The factors that predicted UR were the CIRS-heart score, the CIRS-haemopoietic score, the CIRS-endocrine / metabolic score and the BI on admission. The MMSE was predictive of EUPR. The TSFT and CIRS-liver score were predictive of LUPR. Upon receiver operator characteristics analysis, the clinical prediction rules for the prediction of EUPR and UR had areas under the curve of 0.745 and 0.733 respectively. The likelihood ratios of the clinical prediction rules for EUPR and UR ranged from 0.42 to 5.69 and 0.34 to 3.16 respectively. Patients who have UR can be identified by the admission BI, the MMSE, the TSFT and CIRS scores in the cardiac, haemopoietic, liver and endocrine/metabolic systems.

New utility for an old tool: can a simple gait speed test predict ambulatory surgical discharge outcomes?

PubMed

Odonkor, Charles A; Schonberger, Robert B; Dai, Feng; Shelley, Kirk H; Silverman, David G; Barash, Paul G

2013-10-01

The primary aims of this study were to design prediction models based on a functional marker (preoperative gait speed) to predict readiness for home discharge time of 90 mins or less and to identify those at risk for unplanned admissions after elective ambulatory surgery. This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models. After adjustment for covariates, gait speed with adjusted odds ratio of 3.71 (95% confidence interval, 1.21-11.26), P = 0.02, was independently associated with early home discharge readiness of 90 mins or less. Importantly, gait speed dichotomized as greater or less than 1 m/sec predicted unplanned admissions, with odds ratio of 0.35 (95% confidence interval, 0.16-0.76, P = 0.008) for those with speeds 1 m/sec or greater in comparison with those with speeds less than 1 m/sec. In a separate model, history of cardiac surgery with adjusted odds ratio of 7.5 (95% confidence interval, 2.34-24.41; P = 0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant. This study demonstrates the use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions after elective ambulatory surgery.

Definition of Readmission in 3,041 Patients Undergoing Hepatectomy

PubMed Central

Brudvik, Kristoffer W; Mise, Yoshihiro; Conrad, Claudius; Zimmitti, Giuseppe; Aloia, Thomas A; Vauthey, Jean-Nicolas

2015-01-01

Background Readmission rates of 9.7%–15.5% after hepatectomy have been reported. These rates are difficult to interpret due to variability in the time interval used to monitor readmission. The aim of this study was to refine the definition of readmission after hepatectomy. Study Design A prospectively maintained database of 3041 patients who underwent hepatectomy from 1998 through 2013 was merged with the hospital registry to identify readmissions. Area under the curve (AUC) analysis was used to determine the time interval that best captured unplanned readmission. Results Readmission rates at 30 days, 90 days, and 1 year after discharge were 10.7% (n = 326), 17.3% (n = 526), and 31.9% (n = 971) respectively. The time interval that best accounted for unplanned readmissions was 45 days after discharge (AUC, 0.956; p < 0.001), during which 389 patients (12.8%) were readmitted (unplanned: n = 312 [10.3%]; planned: n = 77 [2.5%]). In comparison, the 30 days after surgery interval (used in the ACS-NSQIP database) omitted 65 (26.3%) unplanned readmissions. Multivariate analysis revealed the following risk factors for unplanned readmission: diabetes (odds ratio [OR], 1.6; p = 0.024), right hepatectomy (OR, 2.1; p = 0.034), bile duct resection (OR, 1.9; p = 0.034), abdominal complication (OR, 1.8; p = 0.010), and a major postoperative complication (OR, 2.4; p < 0.001). Neither index hospitalization > 7 days nor postoperative hepatobiliary complications were independently associated with readmission. Conclusions To accurately assess readmission after hepatectomy, patients should be monitored 45 days after discharge. PMID:26047760

Definition of Readmission in 3,041 Patients Undergoing Hepatectomy.

PubMed

Brudvik, Kristoffer W; Mise, Yoshihiro; Conrad, Claudius; Zimmitti, Giuseppe; Aloia, Thomas A; Vauthey, Jean-Nicolas

2015-07-01

Readmission rates of 9.7% to 15.5% after hepatectomy have been reported. These rates are difficult to interpret due to variability in the time interval used to monitor readmission. The aim of this study was to refine the definition of readmission after hepatectomy. A prospectively maintained database of 3,041 patients who underwent hepatectomy from 1998 through 2013 was merged with the hospital registry to identify readmissions. Area under the curve (AUC) analysis was used to determine the time interval that best captured unplanned readmission. Readmission rates at 30 days, 90 days, and 1 year after discharge were 10.7% (n = 326), 17.3% (n = 526), and 31.9% (n = 971) respectively. The time interval that best accounted for unplanned readmissions was 45 days after discharge (AUC, 0.956; p < 0.001), during which 389 patients (12.8%) were readmitted (unplanned: n = 312 [10.3%]; planned: n = 77 [2.5%]). In comparison, the 30 days after surgery interval (used in the ACS-NSQIP database) omitted 65 (26.3%) unplanned readmissions. Multivariate analysis revealed the following risk factors for unplanned readmission: diabetes (odds ratio [OR] 1.6; p = 0.024), right hepatectomy (OR 2.1; p = 0.034), bile duct resection (OR 1.9; p = 0.034), abdominal complication (OR 1.8; p = 0.010), and a major postoperative complication (OR 2.4; p < 0.001). Neither index hospitalization > 7 days nor postoperative hepatobiliary complications were independently associated with readmission. To accurately assess readmission after hepatectomy, patients should be monitored 45 days after discharge. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Informed consumer or unlucky visitor? A profile of German patients who received dental services abroad.

PubMed

Panteli, Dimitra; Augustin, Uta; Röttger, Julia; Struckmann, Verena; Verheyen, Frank; Wagner, Caroline; Busse, Reinhard

2015-10-01

A common characteristic of sending countries in cross-border dental care is that of high costs and/or high copayments for dental services. This study aims to provide an insight into the characteristics of German patients receiving planned and emergency (unplanned) dental care abroad and their satisfaction with received services. The Europabefragung is a postal survey carried out by Techniker Krankenkasse for patients who are treated in EU/EEA countries. This study uses data from the Europabefragung 2012. The survey was sent to 45 189 individuals; descriptive statistics for the subset of respondents who received emergency (unplanned) or planned dental treatment are presented. There were 18 339 responses to the questionnaire, out of which 17 543 were deemed valid; 1416 respondents had received emergency (unplanned) (78%) or planned (22%) dental care and were included in the analysis. There were clear differences between unplanned and planned treatments regarding country and type of treatment as well as satisfaction with different aspects of treatment and the need for follow-up care. Overall, satisfaction with treatment was high for both groups; individuals who had received planned treatment were more satisfied on all aspects of care and reported a need for follow-up care less frequently. While German patients who received both emergency (unplanned) and planned services abroad are mostly satisfied with their experience, some concerns arise with regard to continuity of care. Types of information provided to patients seeking care abroad and dissemination modalities should be carefully planned. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Shaw Air Force Base Infrastructure Project Environmental Assessment

DTIC Science & Technology

2008-09-01

are the applied to the following factors depending on the corresponding years. Year 2009: VOCE = .016 * Trips NOXE = .015 * Trips PM10E...0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOXE = .013 * Trips PM10E = .0022 * Trips COE = .262 * Trips To...convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 Nox (tons/yr) = NOxE * DPYII/2000 PM10(tons/yr) = PM10E

Alaska Native and Rural Youths' Views of Sexual Health: A Focus Group Project on Sexually Transmitted Diseases, HIV/AIDS, and Unplanned Pregnancy

ERIC Educational Resources Information Center

Leston, Jessica D.; Jessen, Cornelia M.; Simons, Brenna C.

2012-01-01

Background: The disparity in rates of sexually transmitted diseases (STDs), HIV/AIDS, and unplanned pregnancy between Alaska Native (AN) and non-AN populations, particularly among young adults and females, is significant and concerning. Focus groups were conducted to better understand the knowledge, attitudes, and beliefs of rural Alaska youth…

Planned versus Unplanned Contrasts: Exactly Why Planned Contrasts Tend To Have More Power against Type II Error.

ERIC Educational Resources Information Center

Wang, Lin

The literature is reviewed regarding the difference between planned contrasts, OVA and unplanned contrasts. The relationship between statistical power of a test method and Type I, Type II error rates is first explored to provide a framework for the discussion. The concepts and formulation of contrast, orthogonal and non-orthogonal contrasts are…

Alcohol consumption and its related harms in The Netherlands since 1960: relationships with planned and unplanned factors.

PubMed

Knibbe, Ronald A; Derickx, Mieke; Allamani, Allaman; Massini, Giulia

2014-10-01

to establish which unplanned (social developments) and planned (alcohol policy measures) factors are related to per capita consumption and alcohol-related harms in the Netherlands. linear regression was used to establish which of the planned and unplanned factors were most strongly connected with alcohol consumption and harms. Artificial Neural Analysis (ANN) was used to inspect the interconnections between all variables. mothers age at birth was most strongly associated with increase in consumption. The ban on selling alcoholic beverages at petrol station was associated with a decrease in consumption. The linear regression of harms did not show any relation between alcohol policy measures and harms. The ANN-analyses indicate a very high interconnectedness between all variables allowing no causal inferences. Exceptions are the relation between price of beer and wine and the consumption of these beverages and the relation between a decrease in transport mortality and the increased use of breathalyzers tests and a restriction of paracommercial selling. unplanned factors are most strongly associated with per capita consumption and harms. ANN-analysis indicates that price of alcoholic beverages, breath testing, and restriction of sales may have had some influence. The study's limitations are noted.

Eliminating health disparities in unintended pregnancy with long-acting reversible contraception (LARC).

PubMed

Parks, Caitlin; Peipert, Jeffrey F

2016-06-01

Significant public health disparities exist surrounding teen and unplanned pregnancy in the United States. Women of color and those with lower education and socioeconomic status are at much greater risk of unplanned pregnancy and the resulting adverse outcomes. Unplanned pregnancies reduce educational and career opportunities and may contribute to socioeconomic deprivation and widening income disparities. Long-acting reversible contraception (LARC), including intrauterine devices and implants, offer the opportunity to change the default from drifting into parenthood to planned conception. LARC methods are forgettable; once placed, they offer highly effective, long-term pregnancy prevention. Increasing evidence in the medical literature demonstrates the population benefits of use of these methods. However, barriers to more widespread use of LARC methods persist and include educational, access, and cost barriers. With increasing insurance coverage under the Affordable Care Act and more widespread, no-cost coverage of methods, more and more women are choosing intrauterine devices and the contraceptive implant. Increasing the use of highly effective contraceptive methods may provide one solution to the persistent problem of the health disparities of unplanned and teen pregnancies in the United States and improve women's and children's health. Copyright © 2016 Elsevier Inc. All rights reserved.

The spatial study of unplanned settlements on the coastal of Belawan Medan fishermen village

NASA Astrophysics Data System (ADS)

Marpaung, B. O. Y.; Winny Silaban, Nadia

2018-03-01

One of the determining factors that formed informal settlements is the high demand for homes that are not comparable with the homes that were provided by the government. The settlement of Fisherman Village in Belawan Medan was built without a plan by settlers and was not involve government interference so that the spatial pattern formed uncontrollable. The shape of space that stretches represents the distribution of unplanned space. The purpose of this study is to find the structure of settlement and the relationship between the space structures with the spatial pattern in Belawan Medan Fishermen Village. In the process of collecting data, the researcher makes the maps of the observation area, the structure of the space, and the relationship between one space function with the other space functions. Also, the researchers identify the spacing pattern and the effect of one spatial element against the other. This study found a similar spatial pattern between one unplanned settlement and another unplanned settlement and there are also some tendencies of Belawan Medan Fishermen Village settlers when building the built environment in the relationship between building masses and the road network.

Environmental Assessment for the Construction of a Three-Bay Multi-Aircraft Hangar Tinker Air Force Base, Oklahoma

DTIC Science & Technology

2008-01-01

Years 2005 through 2009: VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Appendix A: Air Quality January 2008...Final EA for the Construction of a Three-Bay Multi-Aircraft Hangar Page A-9 Tinker Air Force Base, Oklahoma Years 2010 and beyond: VOCE = .012...Trips NOxE = .013 * Trips PM10E = .0022 * Trips COE = .262 * Trips To convert from pounds per day to tons per year: VOC (tons/year) = VOCE

Multi-destination trip patterns

Treesearch

Susan I. Stewart; Christine A. Vogt

1996-01-01

In a 1993 article in Annals, Leu, Crompton, and Fesenmaier (LCF) presented a model of multi-destination pleasure trips. In the article, they question the practice of modeling pleasure trips as single destination trips, and put forward conceptual arguments suggesting that most trips "are not simple origin-destination trips: (1993:291) but...

Revised Final Environmental Review for the Construction of a New Base Exchange at Kadena Air Base, Okinawa, Japan

DTIC Science & Technology

2007-05-01

factors depending on the corresponding years. Year 2005 through 2009: VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262...Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E = .0022 * Trips COE = .262 * Trips To convert from pounds per day to...tons per year: VOC (tons/yr) = VOCE * DPYII/2000 Nox (tons/yr) = NOxE * DPYII/2000 PM10(tons/yr) = PM10E * DPYII/2000 CO (tons/yr) = COE * DPYII

Navy Explosive Ordnance Disposal School Master Development Plan for Test Area D-51, Eglin Air Force Base, Florida

DTIC Science & Technology

2008-01-25

depending on the corresponding years. Year 2005 through 2009: VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year...2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E = .0022 * Trips COE = .262 * Trips To convert from pounds per day to tons per year...VOC (tons/yr) = VOCE * DPYII/2000 NOx (tons/yr) = NOxE * DPYII/2000 PM10 (tons/yr) = PM10E * DPYII/2000 CO (tons/yr) = COE * DPYII/2000

Using risk analysis to reveal opportunities for the management of unplanned ignitions in wilderness

Treesearch

Kevin Barnett; Carol Miller; Tyron J. Venn

2016-01-01

A goal of fire management in wilderness is to allow fire to play its natural ecological role without intervention. Unfortunately, most unplanned ignitions in wilderness are suppressed, in part because of the risk they might pose to values outside of the wilderness. We capitalize on recent advances in fire risk analysis to demonstrate a risk-based approach for revealing...

The Association Between Limited English Proficiency and Unplanned Emergency Department Revisit Within 72 Hours.

PubMed

Ngai, Ka Ming; Grudzen, Corita R; Lee, Roy; Tong, Vicky Y; Richardson, Lynne D; Fernandez, Alicia

2016-08-01

Language barriers are known to negatively affect many health outcomes among limited English proficiency patient populations, but little is known about the quality of care such patients receive in the emergency department (ED). This study seeks to determine whether limited English proficiency patients experience different quality of care than English-speaking patients in the ED, using unplanned revisit within 72 hours as a surrogate quality indicator. We conducted a retrospective cohort study in an urban adult ED in 2012, with a total of 41,772 patients and 56,821 ED visits. We compared 2,943 limited English proficiency patients with 38,829 English-speaking patients presenting to the ED after excluding patients with psychiatric complaints, altered mental status, and nonverbal states, and those with more than 4 ED visits in 12 months. Two main outcomes-the risk of inpatient admission from the ED and risk of unplanned ED revisit within 72 hours-were measured with odds ratios from generalized estimating equation multivariate models. Limited English proficiency patients were more likely than English speakers to be admitted (32.0% versus 27.2%; odds ratio [OR]=1.20; 95% confidence interval [CI] 1.11 to 1.30). This association became nonsignificant after adjustments (OR=1.04; 95% CI 0.95 to 1.15). Included in the analysis of ED revisit within 72 hours were 32,857 patients with 45,546 ED visits; 4.2% of all patients (n=1,380) had at least 1 unplanned revisit. Limited English proficiency patients were more likely than English speakers to have an unplanned revisit (5.0% versus 4.1%; OR=1.19; 95% CI 1.02 to 1.45). This association persisted (OR=1.24; 95% CI 1.02 to 1.53) after adjustment for potential confounders, including insurance status. We found no difference in hospital admission rates between limited English proficiency patients and English-speaking patients. Yet limited English proficiency patients were 24% more likely to have an unplanned ED revisit within 72 hours, with an absolute difference of 0.9%, suggesting challenges in ED quality of care. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure - Using Technology to Prepare for the Next Pandemic.

PubMed

Rainey, Jeanette J; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O'Sullivan, Megan

During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10-18, 2012 teachers' strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure – Using Technology to Prepare for the Next Pandemic

PubMed Central

Rainey, Jeanette J.; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O’Sullivan, Megan

2016-01-01

Background During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. Methods As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10–18, 2012 teachers’ strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. Results We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Conclusion Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process. PMID:27655229

Walk Score, Transportation Mode Choice, and Walking Among French Adults: A GPS, Accelerometer, and Mobility Survey Study.

PubMed

Duncan, Dustin T; Méline, Julie; Kestens, Yan; Day, Kristen; Elbel, Brian; Trasande, Leonardo; Chaix, Basile

2016-06-20

Few studies have used GPS data to analyze the relationship between Walk Score, transportation choice and walking. Additionally, the influence of Walk Score is understudied using trips rather than individuals as statistical units. The purpose of this study is to examine associations at the trip level between Walk Score, transportation mode choice, and walking among Paris adults who were tracked with GPS receivers and accelerometers in the RECORD GPS Study. In the RECORD GPS Study, 227 participants were tracked during seven days with GPS receivers and accelerometers. Participants were also surveyed with a GPS-based web mapping application on their activities and transportation modes for all trips (6969 trips). Walk Score, which calculates neighborhood walkability, was assessed for each origin and destination of every trip. Multilevel logistic and linear regression analyses were conducted to estimate associations between Walk Score and walking in the trip or accelerometry-assessed number of steps for each trip, after adjustment for individual/neighborhood characteristics. The mean overall Walk Scores for trip origins were 87.1 (SD = 14.4) and for trip destinations 87.1 (SD = 14.5). In adjusted trip-level associations between Walk Score and walking only in the trip, we found that a walkable neighborhood in the trip origin and trip destination was associated with increased odds of walking in the trip assessed in the survey. The odds of only walking in the trip were 3.48 (95% CI: 2.73 to 4.44) times higher when the Walk Score for the trip origin was "Walker's Paradise" compared to less walkable neighborhoods (Very/Car-Dependent or Somewhat Walkable), with an identical independent effect of trip destination Walk Score on walking. The number of steps per 10 min (as assessed with accelerometry) was cumulatively higher for trips both originating and ending in walkable neighborhoods (i.e., "Very Walkable"). Walkable neighborhoods were associated with increases in walking among adults in Paris, as documented at the trip level. Creating walkable neighborhoods (through neighborhood design increased commercial activity) may increase walking trips and, therefore, could be a relevant health promotion strategy to increase physical activity.

Walk Score, Transportation Mode Choice, and Walking Among French Adults: A GPS, Accelerometer, and Mobility Survey Study

PubMed Central

Duncan, Dustin T.; Méline, Julie; Kestens, Yan; Day, Kristen; Elbel, Brian; Trasande, Leonardo; Chaix, Basile

2016-01-01

Background: Few studies have used GPS data to analyze the relationship between Walk Score, transportation choice and walking. Additionally, the influence of Walk Score is understudied using trips rather than individuals as statistical units. The purpose of this study is to examine associations at the trip level between Walk Score, transportation mode choice, and walking among Paris adults who were tracked with GPS receivers and accelerometers in the RECORD GPS Study. Methods: In the RECORD GPS Study, 227 participants were tracked during seven days with GPS receivers and accelerometers. Participants were also surveyed with a GPS-based web mapping application on their activities and transportation modes for all trips (6969 trips). Walk Score, which calculates neighborhood walkability, was assessed for each origin and destination of every trip. Multilevel logistic and linear regression analyses were conducted to estimate associations between Walk Score and walking in the trip or accelerometry-assessed number of steps for each trip, after adjustment for individual/neighborhood characteristics. Results: The mean overall Walk Scores for trip origins were 87.1 (SD = 14.4) and for trip destinations 87.1 (SD = 14.5). In adjusted trip-level associations between Walk Score and walking only in the trip, we found that a walkable neighborhood in the trip origin and trip destination was associated with increased odds of walking in the trip assessed in the survey. The odds of only walking in the trip were 3.48 (95% CI: 2.73 to 4.44) times higher when the Walk Score for the trip origin was “Walker’s Paradise” compared to less walkable neighborhoods (Very/Car-Dependent or Somewhat Walkable), with an identical independent effect of trip destination Walk Score on walking. The number of steps per 10 min (as assessed with accelerometry) was cumulatively higher for trips both originating and ending in walkable neighborhoods (i.e., “Very Walkable”). Conclusions: Walkable neighborhoods were associated with increases in walking among adults in Paris, as documented at the trip level. Creating walkable neighborhoods (through neighborhood design increased commercial activity) may increase walking trips and, therefore, could be a relevant health promotion strategy to increase physical activity. PMID:27331818

Building a Community of Experience.

ERIC Educational Resources Information Center

Matthews, Kelly

2002-01-01

Discusses how field trips can build a community of experience in preschool settings. Focuses on what to consider when planning field trips, how to reduce field trip costs, adjustments to be made during the trip, and ways to bring the trip to the preschool setting. Suggests activities after the field trip, and destinations related to the arts,…

Unplanned pregnancy-risks and use of emergency contraception: a survey of two Nigerian Universities.

PubMed

Ajayi, Anthony Idowu; Nwokocha, Ezebunwa Ethelbert; Adeniyi, Oladele Vincent; Ter Goon, Daniel; Akpan, Wilson

2017-06-02

The vulnerabilities of young women of low socio-economic status and those with little or no formal education tend to dominate the discourse on unplanned pregnancy, unsafe abortion and emergency contraception (EC) in sub-Saharan Africa. This article draws on a survey conducted among female undergraduate students to shed light on sexual behaviour and the dynamics of emergency contraceptive use among this cohort. The survey involved 420 female undergraduate students drawn using a multistage sampling technique, while a self-administered questionnaire was used for data collection. Univariate and bivariate analyses were applied to examine the factors associated with the use of emergency contraception. Of the 176 female students who reported being sexually active in the year preceding the survey, only 38.6% reported the use of condom during the entire year. Of those who reported unplanned pregnancy anxiety n = 94, about 30.1% used EC, 20.4% used non-EC pills as EC, while others reported having used no EC. A few respondents (n = 3) had terminated a pregnancy under unsafe conditions. Awareness of EC (p < 0.001), knowledge of timing of EC (p = 0.001), perceived risk of unplanned pregnancy (p < 0.001), and level of study (p = 0.013), were significantly correlated with the use of EC. The study revealed that educated youths engaged in high-risk sexual activities and also, sought recourse to unproven and unsafe contraceptive methods. Poor knowledge of EC methods and timing of use, as well as wrong perception about EC side effects, are barriers to the utilisation of EC for the prevention of unplanned pregnancy among the study participants.

Physical activity and unplanned illness-related work absenteeism: Data from an employee wellness program.

PubMed

Losina, Elena; Yang, Heidi Y; Deshpande, Bhushan R; Katz, Jeffrey N; Collins, Jamie E

2017-01-01

Illness-related absenteeism is a major threat to work productivity. Our objective was to assess the relationship between physical activity and unplanned illness-related absenteeism from work. We implemented physical activity program for sedentary non-clinician employees of a tertiary medical center. Financial rewards were available for reaching accelerometer-measured ambulatory physical activity goals over a 24-week period. We categorized participants into three groups based on mean levels of physical activity: low (0-74 min/week), medium (75-149 min/week) and meeting CDC guidelines (≥150 min/week). We built a multivariable Poisson regression model to evaluate the relationship between physical activity and rates of unplanned illness-related absenteeism. The sample consisted of 292 employees who participated in the program. Their mean age was 38 years (SD 11), 83% were female, and 38% were obese. Over the 24 intervention weeks, participants engaged in a mean of 90 min/week (SD 74) of physical activity and missed a mean of 14 hours of work (SD 38) due to illness. Unplanned absenteeism due to illness was associated with physical activity. As compared to the group meeting CDC guidelines, in multivariable analyses those in the medium physical activity group had a 2.4 (95% CI 1.3-4.5) fold higher rate of illness-related absenteeism and those in the lowest physical activity group had a 3.5 (95% CI 1.7-7.2) fold higher rate of illness-related absenteeism. Less physical activity was associated with more illness-related absenteeism. Workforce-based interventions to increase physical activity may thus be a promising vehicle to reduce unplanned illness-related absenteeism.

Multicenter study of endoscopic preoperative biliary drainage for malignant hilar biliary obstruction: E-POD hilar study.

PubMed

Nakai, Yousuke; Yamamoto, Ryuichi; Matsuyama, Masato; Sakai, Yuji; Takayama, Yukiko; Ushio, Jun; Ito, Yukiko; Kitamura, Katsuya; Ryozawa, Shomei; Imamura, Tsunao; Tsuchida, Kouhei; Hayama, Jo; Itoi, Takao; Kawaguchi, Yoshiaki; Yoshida, Yu; Sugimori, Kazuya; Shimura, Kenji; Mizuide, Masafumi; Iwai, Tomohisa; Nishikawa, Ko; Yagioka, Hiroshi; Nagahama, Masatsugu; Toda, Nobuo; Saito, Tomotaka; Yasuda, Ichiro; Hirano, Kenji; Togawa, Osamu; Nakamura, Kenji; Maetani, Iruru; Sasahira, Naoki; Isayama, Hiroyuki

2018-05-01

Endoscopic nasobiliary drainage (ENBD) is often recommended in preoperative biliary drainage (PBD) for hilar malignant biliary obstruction (MBO), but endoscopic biliary stent (EBS) is also used in the clinical practice. We conducted this large-scale multicenter study to compare ENBD and EBS in this setting. A total of 374 cases undergoing PBD including 281 ENBD and 76 EBS for hilar MBO in 29 centers were retrospectively studied. Extrahepatic cholangiocarcinoma (ECC) accounted for 69.8% and Bismuth-Corlette classification was III or more in 58.8% of the study population. Endoscopic PBD was technically successful in 94.6%, and adverse event rate was 21.9%. The rate of post-endoscopic retrograde cholangiopancreatography pancreatitis was 16.0%, and non-endoscopic sphincterotomy was the only risk factor (odds ratio [OR] 2.51). Preoperative re-intervention was performed in 61.5%: planned re-interventions in 48.4% and unplanned re-interventions in 31.0%. Percutaneous transhepatic biliary drainage was placed in 6.4% at the time of surgery. The risk factors for unplanned procedures were ECC (OR 2.64) and total bilirubin ≥ 10 mg/dL (OR 2.18). In surgically resected cases, prognostic factors were ECC (hazard ratio [HR] 0.57), predraiange magnetic resonance cholangiopancreatography (HR 1.62) and unplanned re-interventions (HR 1.81). EBS was not associated with increased adverse events, unplanned re-interventions, or a poor prognosis. Our retrospective analysis did not demonstrate the advantage of ENBD over EBS as the initial PBD for resectable hilar MBO. Although the technical success rate of endoscopic PBD was high, its re-intervention rate was not negligible, and unplanned re-intervention was associated with a poor prognosis in resected hilar MBO. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Changes in muscle activation following balance and technique training and a season of Australian football.

PubMed

Donnelly, C J; Elliott, B C; Doyle, T L A; Finch, C F; Dempsey, A R; Lloyd, D G

2015-05-01

Determine if balance and technique training implemented adjunct to 1001 male Australian football players' training influenced the activation/strength of the muscles crossing the knee during pre-planned and unplanned sidestepping. Randomized Control Trial. Each Australian football player participated in either 28 weeks of balance and technique training or 'sham' training. Twenty-eight Australian football players (balance and technique training, n=12; 'sham' training, n=16) completed biomechanical testing pre-to-post training. Peak knee moments and directed co-contraction ratios in three degrees of freedom, as well as total muscle activation were calculated during pre-planned and unplanned sidestepping. No significant differences in muscle activation/strength were observed between the 'sham' training and balance and technique training groups. Following a season of Australian football, knee extensor (p=0.023) and semimembranosus (p=0.006) muscle activation increased during both pre-planned sidestepping and unplanned sidestepping. Following a season of Australian football, total muscle activation was 30% lower and peak valgus knee moments 80% greater (p=0.022) during unplanned sidestepping when compared with pre-planned sidestepping. When implemented in a community level training environment, balance and technique training was not effective in changing the activation of the muscles crossing the knee during sidestepping. Following a season of Australian football, players are better able to support both frontal and sagittal plane knee moments. When compared to pre-planned sidestepping, Australian football players may be at increased risk of anterior cruciate ligament injury during unplanned sidestepping in the latter half of an Australian football season. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Unplanned medication discontinuation as a potential pharmacovigilance signal: a nested young person cohort study

PubMed Central

2014-01-01

Background Because of relatively small treatment numbers together with low adverse drug reaction (ADR) reporting rates the timely identification of ADRs affecting children and young people is problematic. The primary objective of this study was to assess the utility of unplanned medication discontinuation as a signal for possible ADRs in children and young people. Methods Using orlistat as an exemplar, all orlistat prescriptions issued to patients up to 18 years of age together with patient characteristics, prescription duration, co-prescribed medicines and recorded clinical (Read) codes were identified from the Primary Care Informatics Unit database between 1st Jan 2006-30th Nov 2009. Binary logistic regression was used to assess association between characteristics and discontinuation. Results During the study period, 79 patients were prescribed orlistat (81% female, median age 17 years). Unplanned medication discontinuation rates for orlistat were 52% and 77% at 1 and 3-months. Almost 20% of patients were co-prescribed an anti-depressant. One month unplanned medication discontinuation was significantly lower in the least deprived group (SIMD 1–2 compared to SIMD 9–10 OR 0.09 (95% CI0.01 – 0.83)) and those co-prescribed at least one other medication. At 3 months, discontinuation was higher in young people (≥17 yr versus, OR 3.07 (95% CI1.03 – 9.14)). Read codes were recorded for digestive, respiratory and urinary symptoms around the time of discontinuation for 24% of patients. Urinary retention was reported for 7.6% of patients. Conclusions Identification of unplanned medication discontinuation using large primary care datasets may be a useful tool for pharmacovigilance signal generation and detection of potential ADRs in children and young people. PMID:24594374

Physical activity and unplanned illness-related work absenteeism: Data from an employee wellness program

PubMed Central

Yang, Heidi Y.; Katz, Jeffrey N.; Collins, Jamie E.

2017-01-01

Background Illness-related absenteeism is a major threat to work productivity. Our objective was to assess the relationship between physical activity and unplanned illness-related absenteeism from work. Methods We implemented physical activity program for sedentary non-clinician employees of a tertiary medical center. Financial rewards were available for reaching accelerometer-measured ambulatory physical activity goals over a 24-week period. We categorized participants into three groups based on mean levels of physical activity: low (0–74 min/week), medium (75–149 min/week) and meeting CDC guidelines (≥150 min/week). We built a multivariable Poisson regression model to evaluate the relationship between physical activity and rates of unplanned illness-related absenteeism. Results The sample consisted of 292 employees who participated in the program. Their mean age was 38 years (SD 11), 83% were female, and 38% were obese. Over the 24 intervention weeks, participants engaged in a mean of 90 min/week (SD 74) of physical activity and missed a mean of 14 hours of work (SD 38) due to illness. Unplanned absenteeism due to illness was associated with physical activity. As compared to the group meeting CDC guidelines, in multivariable analyses those in the medium physical activity group had a 2.4 (95% CI 1.3–4.5) fold higher rate of illness-related absenteeism and those in the lowest physical activity group had a 3.5 (95% CI 1.7–7.2) fold higher rate of illness-related absenteeism. Discussion Less physical activity was associated with more illness-related absenteeism. Workforce-based interventions to increase physical activity may thus be a promising vehicle to reduce unplanned illness-related absenteeism. PMID:28472084

Contraceptive failure after hysteroscopic sterilization: Analysis of clinical and demographic data from 103 unplanned pregnancies

PubMed Central

Li, Xiang; Jones, Christopher A.; Wood, Samuel H.

2015-01-01

Objective This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS). Methods A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS. Results Mean (±SD) patient age and body mass index (BMI) were 29.5±4.6 years and 27.7±6.1 kg/m2, respectively. Peak pregnancy incidence was reported at 10 months after HS, although <3% of unplanned pregnancies occurred within the first three months following HS. Mean (±SD) interval between HS and pregnancy was 19.6±14.9 (range, 2 to 84) months. Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents. Conclusion This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue. PMID:26623413

Association of prophylactic endotracheal intubation in critically ill patients with upper GI bleeding and cardiopulmonary unplanned events.

PubMed

Hayat, Umar; Lee, Peter J; Ullah, Hamid; Sarvepalli, Shashank; Lopez, Rocio; Vargo, John J

2017-09-01

Prophylactic endotracheal intubation (PEI) is often advocated to mitigate the risk of cardiopulmonary adverse events in patients presenting with brisk upper GI bleeding (UGIB). However, the benefit of such a measure remains controversial. Our study aimed to compare the incidence of cardiopulmonary unplanned events between critically ill patients with brisk UGIB who underwent endotracheal intubation versus those who did not. Patients aged 18 years or older who presented at Cleveland Clinic between 2011 and 2014 with hematemesis and/or patients with melena with consequential hypovolemic shock were included. The primary outcome was a composite of several cardiopulmonary unplanned events (pneumonia, pulmonary edema, acute respiratory distress syndrome, persistent shock/hypotension after the procedure, arrhythmia, myocardial infarction, and cardiac arrest) occurring within 48 hours of the endoscopic procedure. Propensity score matching was used to match each patient 1:1 in variables that could influence the decision to intubate. These included Glasgow Blatchford Score, Charleston Comorbidity Index, and Acute Physiology and Chronic Health Evaluation scores. Two hundred patients were included in the final analysis. The baseline characteristics, comorbidity scores, and prognostic scores were similar between the 2 groups. The overall cardiopulmonary unplanned event rates were significantly higher in the intubated group compared with the nonintubated group (20% vs 6%, P = .008), which remained significant (P = .012) after adjusting for the presence of esophageal varices. PEI before an EGD for brisk UGIB in critically ill patients is associated with an increased risk of unplanned cardiopulmonary events. The benefits and risks of intubation should be carefully weighed when considering airway protection before an EGD in this group of patients. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

26 CFR 49.4264(e)-1 - Round trips.

Code of Federal Regulations, 2010 CFR

2010-04-01

... two separate trips, i.e., one trip from the point of departure to the destination and a second trip in... followed on the return trip from the destination to the point of departure as was taken on the going trip... destination but with one or more intermediate stops en route) the point farthest from the point of departure...

Solar Electric Propulsion for Mars Exploration

NASA Technical Reports Server (NTRS)

Hack, Kurt J.

1998-01-01

Highly propellant-efficient electric propulsion is being combined with advanced solar power technology to provide a non-nuclear transportation option for the human exploration of Mars. By virtue of its high specific impulse, electric propulsion offers a greater change in spacecraft velocity for each pound of propellant than do conventional chemical rockets. As a result, a mission to Mars based on solar electric propulsion (SEP) would require fewer heavy-lift launches than a traditional all-chemical space propulsion scenario would. Performance, as measured by mass to orbit and trip time, would be comparable to the NASA design reference mission for human Mars exploration, which utilizes nuclear thermal propulsion; but it would avoid the issues surrounding the use of nuclear reactors in space.

Questionnaire-based person trip visualization and its integration to quantitative measurements in Myanmar

NASA Astrophysics Data System (ADS)

Kimijiama, S.; Nagai, M.

2016-06-01

With telecommunication development in Myanmar, person trip survey is supposed to shift from conversational questionnaire to GPS survey. Integration of both historical questionnaire data to GPS survey and visualizing them are very important to evaluate chronological trip changes with socio-economic and environmental events. The objectives of this paper are to: (a) visualize questionnaire-based person trip data, (b) compare the errors between questionnaire and GPS data sets with respect to sex and age and (c) assess the trip behaviour in time-series. Totally, 345 individual respondents were selected through random stratification to assess person trip using a questionnaire and GPS survey for each. Conversion of trip information such as a destination from the questionnaires was conducted by using GIS. The results show that errors between the two data sets in the number of trips, total trip distance and total trip duration are 25.5%, 33.2% and 37.2%, respectively. The smaller errors are found among working-age females mainly employed with the project-related activities generated by foreign investment. The trip distant was yearly increased. The study concluded that visualization of questionnaire-based person trip data and integrating them to current quantitative measurements are very useful to explore historical trip changes and understand impacts from socio-economic events.

Pit Latrine Emptying Behavior and Demand for Sanitation Services in Dar Es Salaam, Tanzania

PubMed Central

Jenkins, Marion W.; Cumming, Oliver; Cairncross, Sandy

2015-01-01

Pit latrines are the main form of sanitation in unplanned areas in many rapidly growing developing cities. Understanding demand for pit latrine fecal sludge management (FSM) services in these communities is important for designing demand-responsive sanitation services and policies to improve public health. We examine latrine emptying knowledge, attitudes, behavior, trends and rates of safe/unsafe emptying, and measure demand for a new hygienic latrine emptying service in unplanned communities in Dar Es Salaam (Dar), Tanzania, using data from a cross-sectional survey at 662 residential properties in 35 unplanned sub-wards across Dar, where 97% had pit latrines. A picture emerges of expensive and poor FSM service options for latrine owners, resulting in widespread fecal sludge exposure that is likely to increase unless addressed. Households delay emptying as long as possible, use full pits beyond what is safe, face high costs even for unhygienic emptying, and resort to unsafe practices like ‘flooding out’. We measured strong interest in and willingness to pay (WTP) for the new pit emptying service at 96% of residences; 57% were WTP ≥U.S. $17 to remove ≥200 L of sludge. Emerging policy recommendations for safe FSM in unplanned urban communities in Dar and elsewhere are discussed. PMID:25734790

Validation of a pregnancy planning measure for Arabic-speaking women.

PubMed

Almaghaslah, Eman; Rochat, Roger; Farhat, Ghada

2017-01-01

The prevalence of unplanned pregnancy in Saudi Arabia has not been thoroughly investigated. To conduct a psychometric evaluation study of the Arabic version of the London Measure of Unplanned Pregnancy (LMUP). To evaluate the psychometric properties of the LMUP, we conducted a self-administered online survey among 796 ever-married Saudi women aged 20-49 years, and a re-test survey among 24 women. The psychometric properties evaluated included content validity measured by content validity index (CVI), structural validity assessed by exploratory factor analysis (EFA), substantive validity assessed by hypothesis testing, contextual stability for the test-retest assessed by weighted Kappa, and internal consistency assessed by Cronbach's alpha. The psychometric analysis of the Arabic version of LMUP exhibited valid and reliable properties. The CVIs for individual items and at the scale level were >0.7. EFA confirmed a unidimensional extraction of the scale item. Hypothesis testing confirmed expected associations. The tool was stable with weighted kappa = 0.78 and Cronbach's alpha = 0.88. In this study, the validity and reliability of the Arabic version of the LMUP were confirmed according to well-known psychometric criteria. This LMUP version can be used in research studies among Arabic-speaking women to measure unplanned pregnancy and investigate correlates and outcomes related to unplanned pregnancy.

Unplanned readmission after hospital discharge in burn patients in Iran.

PubMed

Jafaryparvar, Zakiyeh; Adib, Masoomeh; Ghanbari, Atefeh; Leyli, Ehsan Kazemnezhad

2018-02-21

Burns are considered as one of the most serious health problems throughout the world. They may lead to adverse consequences and outcomes. One of these outcomes is unplanned readmission. Unplanned readmission has been commonly used as a quality indicator by hospitals and governments. This study aimed to determine the predictors of unplanned readmission in patients with burns hospitalized in a burn center in the North of Iran (Guilan province, Rasht). This retrospective analytic study has been done on the medical records of hospitalized patients with burns in Velayat Sub-Specialty Burn and Plastic Surgery Center, Rasht, Iran during 2008-2013. In general, 703 medical records have been reviewed but statistical analysis was performed on 626 medical records. All data were entered in SPSS (version 16) and analyzed by descriptive and inferential statistics. Among 626 patients with burns, the overall readmission rate was 5.1%. Predictors of readmission included total body surface area (OR 1.030, CI 1.011-1.049), hypertension (OR 2.923, CI 1.089-7.845) and skin graft (OR 7.045, CI 2.718-18.258). Considering the outcome, predictors following burn have a crucial role in the allocation of treatment cost for patients with burns and they can be used as one of the quality indicators for health care providers and governments.

Internal trip capture estimator for mixed-use developments.

DOT National Transportation Integrated Search

2007-12-01

This report describes a spreadsheet tool for estimating trip generation for mixed-use developments, : accounting for internal trip capture. Internal trip capture is the portion of trips generated by a mixed-use : development that both begin and end w...

Final Environmental Assessment: To Relocate Air Force Explosive Ordnance Disposal Administrative Complex at Eglin Air Force Base

DTIC Science & Technology

2006-10-01

Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE = .012 * Trips NOxE = .013 * Trips PM10E = .0022 * Trips COE...Air Force Base, Florida To convert from pounds per day to tons per year: VOC (tons/yr) = VOCE * DPYII/2000 NOx (tons/yr) = NOxE * DPYII/2000

The sex and age of older adults influence the outcome of induced trips.

PubMed

Pavol, M J; Owings, T M; Foley, K T; Grabiner, M D

1999-02-01

Falls are a significant source of morbidity and mortality in older adults, with up to 53% of these falls due to tripping. To aid in fall prevention, there is a need to identify the factors that determine whether a trip is recoverable and those factors that increase an older adult's risk of falling. Trips were induced during gait in 79 healthy, community-dwelling, safety-harnessed older adults (50 women) using a concealed, mechanical obstacle. Trip outcomes were graded as recoveries, falls, rope-assists, or misses. Kinematics were recorded during normal gait, without and with the safety harness. Selected gait parameters were compared to determine whether the experimental conditions affected gait at the time of the trip. Thirty-nine trip outcomes were classified as recoveries, 10 as falls, 12 as rope-assists, and 18 as misses. Women fell more than four times as frequently as men. Women younger than 70 years fell more than three times as frequently as those older. Trip outcomes in the men were essentially unaffected by age. The foot obstructed to induce the trip did not affect the trip outcome. The presence of the safety harness had almost no effect on gait. The length of the stride preceding the trip did not differ from normal. The majority of trips in healthy older adults did not result in falls. Older women were more likely than men to fall following a trip. The likelihood of falling from a trip was greatest in the youngest older women.

Decommissioning the physics laboratory, building 777-10A, at the Savannah River Site (SRS)

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

Musall, John C.; Cope, Jeff L.

2008-01-15

SRS recently completed a four year mission to decommission {approx}250 excess facilities. As part of that effort, SRS decommissioned a 48,000 ft{sup 2} laboratory that housed four low-power test reactors, formerly used by SRS to determine reactor physics. This paper describes and reviews the decommissioning, with a focus on component segmentation and handling (i.e. hazardous material removal, demolition, and waste handling). The paper is intended to be a resource for engineers, planners, and project managers, who face similar decommissioning challenges. Building 777-10A, located at the south end of SRS's A/M-Area, was built in 1953 and had a gross area of {approx}48,000 ft{sup 2}. Building 777-10A had two main areas: a west wing, which housed four experimental reactors and associated equipment; and an east wing, which housed laboratories, and shops, offices. The reactors were located in two separate areas: one area housed the Process Development Pile (PDP) reactor and the Lattice Test Reactor (LTR), while the second area housed the Standard Pile (SP) and the Sub-critical Experiment (SE) reactors. The west wing had five levels: three below and three above grade (floor elevations of -37', -28', -15', 0', +13'/+16' and +27' (roof elevation of +62')), while the east wing had two levels: one below and one above grade (floor elevations of -15' and 0' (roof elevation of +16')). Below-grade exterior walls were constructed of reinforced concrete, {approx}1' thick. In general, above-grade exterior walls were steel frames covered by insulation and corrugated, asbestos-cement board. The two interior walls around the PDP/LTR were reinforced concrete {approx}5' thick and {approx}30' high, while the SP/SE reactors resided in a reinforced, concrete cell with 3.5'-6' thick walls/roof. All other interior walls were constructed of metal studs covered with either asbestos-cement or gypsum board. In general, the floors were constructed of reinforced concrete on cast-in-place concrete beams below-grade and concrete on metal beams above-grade. The roofs were flat concrete slabs on metal beams. Building 777-10A was an important SRS research and development location. The reactors helped determine safe operational limits and loading patterns for fuel used in the SRS production reactors, and supported various low power reactor physics studies. All four reactors were shut down and de-inventoried in the 1970's. The building was DD and R 2007, Chattanooga, Tennessee, September 16-19, 2007 169 subsequently used by various SRS organizations for office space, audio/visual studio, and computer network hub. SRS successfully decommissioned Building 777-10A over a thirty month period at a cost of {approx}more » $$14 M ({approx}$$290/ft{sup 2}). The decommissioning was a complex and difficult effort due to the building's radiological contamination, height, extensive basement, and thick concrete walls. Extensive planning and extensive hazard analysis (e.g. of structural loads/modifications leading to unplanned collapse) ensured the decommissioning was completed safely and without incident. The decommissioning met contract standards for residual contamination and physical/chemical hazards, and was the last in a series of decommissioning projects that prepared the lower A/M-Area for SRS's environmental restoration program.« less

Geology of the National Capital Region: field trip guidebook

USGS Publications Warehouse

Burton, William; Southworth, Scott

2004-01-01

The 2004 Joint Northeast-Southeast Section Meeting of the Geological Society of America is the fourth such meeting and the third to be held in or near Washington, D.C. This guidebook and the field trips presented herein are intended to provide meeting participants, as well as other interested readers, a means to understand and enjoy the rich geological and historical legacy of the National Capital Region. The field trips cover all of the major physiographic and geologic provinces of the central Appalachians in the Mid-Atlantic region. Trip 1 outlines the tectonic history of northern Virginia along an east-to-west transect from the Coastal Plain province to the Blue Ridge province, whereas the other field trips each focus on a specific province. From west to east, these excursions investigate the paleoclimate controls on the stratigraphy of the Paleozoic rocks of the Allegheny Plateau and Valley and Ridge province in West Virginia, Pennsylvania, and Maryland (Trip 3); Eocene volcanic rocks that intrude Paleozoic rocks in the westernmost Valley and Ridge province in Virginia and West Virginia (Trip 4); age, petrology, and structure of Mesoproterozoic gneisses and granitoids located in the Blue Ridge province within and near Shenandoah National Park, Virginia (Trip 2); the use of argon data to unravel the complex structural and thermal history of the metamorphic rocks of the eastern Piedmont province in Maryland and Virginia (Trip 5); the use of cosmogenic isotopes to understand the timing of bedrock incision and formation of terraces along the Potomac River in the eastern Piedmont province near Great Falls, Virginia and Maryland (Trip 6); the nature of the boundary between rocks of the Goochland and Chopawamsic terranes in the eastern Piedmont of Virginia (Trip 7); the role of bluffs and fluvial terraces of the Coastal Plain in the Civil War Battle of Fredericksburg, Virginia (Trip 8); and the Tertiary lithology and paleontology of Coastal Plain strata around the Chesapeake Bay of Virginia and Maryland (Trip 9). Some of the field trips present new geochronological research that uses isotopic techniques to unravel Earth history and processes, including U-Pb dating to determine the timing of metamorphism and igneous activity associated with the Mesoproterozoic Grenville orogeny (Trip 2); argon (4DAr/39Ar) analysis to understand the complex Paleozoic history of deformation and metamorphism in the Piedmont (Trip 5); and cosmogenic beryllium-10 data to derive exposure ages of landforms and deposits of the Potomac River valley (Trip 6). Several trips shed insight on significant or enigmatic geologic features of the region. Trip 3 presents evidence for global paleoclimate controls on the Paleozoic stratigraphy of the Appalachian basin, including evidence for Late Devonian glacial deposits. Trip 4 investigates unusual Eocene igneous rocks in the Eastern United States, and Trip 2 visits several local ductile high-strain zones, offering geologists opportunities to consider the importance of such structures relative to the poorly understood Rockfish Valley fault zone in the Blue Ridge province. In the Piedmont province, Trip 7 focuses on a controversial terrane boundary, whereas Trip 5 crosses several lithologic belts with distinct thermotectonic histories that suggest terrane boundaries. Trip 6 sheds new light on the erosional history of a major river gorge cut into crystalline rocks in the Fall Zone.Four trips are recommended for Earth science teachers and are cosponsored by the National Association of Geologic Teachers (NAGT). These trips focus on the tectonic history of northern Virginia (Trip 1), terraces of the Potomac River at Great Falls and cosmogenic isotope analysis to date the terraces and the incision history (Trip 6), and Tertiary lithology and paleontology of the Chesapeake Bay region (Trip 9). Trip 8 takes advantage of the rich Civil War history of this region to look at the role that geology played in the strategies and outcome of the Battle of Fredericksburg. This guidebook is the result of much hard work by many individuals. The editors wish to thank the field trip leaders and authors, the technical reviewers, and Nancy Stamm of ths USGS Geologic Names Committee. We also owe a very special thanks to Linda Gundersen, Chief Scientist, Geologic Discipline, USGS, who provided funding for the guidebook.

TRIP-Br2 promotes oncogenesis in nude mice and is frequently overexpressed in multiple human tumors

PubMed Central

Cheong, Jit Kong; Gunaratnam, Lakshman; Zang, Zhi Jiang; Yang, Christopher M; Sun, Xiaoming; Nasr, Susan L; Sim, Khe Guan; Peh, Bee Keow; Rashid, Suhaimi Bin Abdul; Bonventre, Joseph V; Salto-Tellez, Manuel; Hsu, Stephen I

2009-01-01

Background Members of the TRIP-Br/SERTAD family of mammalian transcriptional coregulators have recently been implicated in E2F-mediated cell cycle progression and tumorigenesis. We, herein, focus on the detailed functional characterization of the least understood member of the TRIP-Br/SERTAD protein family, TRIP-Br2 (SERTAD2). Methods Oncogenic potential of TRIP-Br2 was demonstrated by (1) inoculation of NIH3T3 fibroblasts, which were engineered to stably overexpress ectopic TRIP-Br2, into athymic nude mice for tumor induction and (2) comprehensive immunohistochemical high-throughput screening of TRIP-Br2 protein expression in multiple human tumor cell lines and human tumor tissue microarrays (TMAs). Clinicopathologic analysis was conducted to assess the potential of TRIP-Br2 as a novel prognostic marker of human cancer. RNA interference of TRIP-Br2 expression in HCT-116 colorectal carcinoma cells was performed to determine the potential of TRIP-Br2 as a novel chemotherapeutic drug target. Results Overexpression of TRIP-Br2 is sufficient to transform murine fibroblasts and promotes tumorigenesis in nude mice. The transformed phenotype is characterized by deregulation of the E2F/DP-transcriptional pathway through upregulation of the key E2F-responsive genes CYCLIN E, CYCLIN A2, CDC6 and DHFR. TRIP-Br2 is frequently overexpressed in both cancer cell lines and multiple human tumors. Clinicopathologic correlation indicates that overexpression of TRIP-Br2 in hepatocellular carcinoma is associated with a worse clinical outcome by Kaplan-Meier survival analysis. Small interfering RNA-mediated (siRNA) knockdown of TRIP-Br2 was sufficient to inhibit cell-autonomous growth of HCT-116 cells in vitro. Conclusion This study identifies TRIP-Br2 as a bona-fide protooncogene and supports the potential for TRIP-Br2 as a novel prognostic marker and a chemotherapeutic drug target in human cancer. PMID:19152710

Markov Model of Accident Progression at Fukushima Daiichi

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

Cuadra A.; Bari R.; Cheng, L-Y

2012-11-11

On March 11, 2011, a magnitude 9.0 earthquake followed by a tsunami caused loss of offsite power and disabled the emergency diesel generators, leading to a prolonged station blackout at the Fukushima Daiichi site. After successful reactor trip for all operating reactors, the inability to remove decay heat over an extended period led to boil-off of the water inventory and fuel uncovery in Units 1-3. A significant amount of metal-water reaction occurred, as evidenced by the quantities of hydrogen generated that led to hydrogen explosions in the auxiliary buildings of the Units 1 & 3, and in the de-fuelled Unitmore » 4. Although it was assumed that extensive fuel damage, including fuel melting, slumping, and relocation was likely to have occurred in the core of the affected reactors, the status of the fuel, vessel, and drywell was uncertain. To understand the possible evolution of the accident conditions at Fukushima Daiichi, a Markov model of the likely state of one of the reactors was constructed and executed under different assumptions regarding system performance and reliability. The Markov approach was selected for several reasons: It is a probabilistic model that provides flexibility in scenario construction and incorporates time dependence of different model states. It also readily allows for sensitivity and uncertainty analyses of different failure and repair rates of cooling systems. While the analysis was motivated by a need to gain insight on the course of events for the damaged units at Fukushima Daiichi, the work reported here provides a more general analytical basis for studying and evaluating severe accident evolution over extended periods of time. This work was performed at the request of the U.S. Department of Energy to explore 'what-if' scenarios in the immediate aftermath of the accidents.« less

Variation in readmission and mortality following hospitalisation with a diagnosis of heart failure: prospective cohort study using linked data.

PubMed

Korda, Rosemary J; Du, Wei; Day, Cathy; Page, Karen; Macdonald, Peter S; Banks, Emily

2017-03-21

Hospitalisation for heart failure is common and post-discharge outcomes, including readmission and mortality, are often poor and are poorly understood. The purpose of this study was to examine patient- and hospital-level variation in the risk of 30-day unplanned readmission and mortality following discharge from hospital with a diagnosis of heart failure. Prospective cohort study using data from the Sax Institute's 45 and Up Study, linking baseline survey (Jan 2006-April 2009) to hospital and mortality data (to Dec 2011). Primary outcomes in those admitted to hospital with heart failure included unplanned readmission, mortality and combined unplanned readmission/mortality, within 30 days of discharge. Multilevel models quantified the variation in outcomes between hospitals and examined associations with patient- and hospital-level characteristics. There were 5074 participants with a heart failure admission discharged from 251 hospitals; 1052 (21%) had unplanned readmissions, 186 (3.7%) died, and 1146 (23%) had either/both outcomes within 30 days of discharge. Crude outcomes varied across hospitals, but between-hospital variation explained little of the total variation in outcomes (intraclass correlation coefficients (ICC) after inclusion of patient factors: 30-day unplanned readmission ICC = 0.0125 (p = 0.24); death ICC = 0.0000 (p > 0.99); unplanned readmission/death ICC = 0.0266 (p = 0.07)). Patient characteristics associated with a higher risk of unplanned readmission included: being male (male vs female, adjusted odds ratio (aOR) = 1.18, 95% CI: 1.00-1.37); prior hospitalisation for cardiovascular disease (aOR = 1.44, 1.08-1.91) and for anemia (aOR = 1.36, 1.14-1.63); comorbidities at admission (severe vs none: aOR = 1.26, 1.03-1.54); lower body-mass-index (obese vs normal weight: aOR = 0.77, 0.63-0.94); and lower social interaction scores. Similarly, risk of 30-day mortality was associated with patient- rather than hospital-level factors, in particular age (≥85y vs 45-< 75y: aOR = 3.23, 1.93-5.41) and comorbidity (severe vs none: aOR = 2.68, 1.82-3.94). The issue of high readmission and mortality rates in people with heart failure appear to be system-wide, with the variation in these outcomes essentially attributable to variation between patients rather than hospitals. The findings suggest that there are limitations in using these outcomes as hospital performance measures in this patient population and support the need for patient-centred strategies to optimise heart failure management and outcomes.

Field Trips. Beginnings Workshop.

ERIC Educational Resources Information Center

Cartwright, Sally; Aronson, Susan S.; Stacey, Susan; Winbush, Olga

2001-01-01

Five articles highlight benefits and organization of field trips: (1) "Field Trips Promote Child Learning at Its Best"; (2) "Planning for Maximum Benefit, Minimum Risk"; (3) "Coaching Community Hosts"; (4) "The Story of a Field Trip: Trash and Its Place within Children's Learning and Community"; and (5) "Field Trip Stories and Perspectives" (from…

50 CFR 622.43 - Commercial trip limits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Reef Fish Resources of the Gulf of Mexico § 622.43 Commercial trip limits. Commercial trip limits are limits on the... with any trip or possession limit applicable to state waters. A species subject to a trip limit...

28 CFR 570.42 - Non-medical escorted trips.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Non-medical escorted trips. 570.42... RELEASE COMMUNITY PROGRAMS Escorted Trips § 570.42 Non-medical escorted trips. (a) Non-medical escorted trips allow an inmate to leave the institution under staff escort for approved, non-medical reasons...

28 CFR 570.41 - Medical escorted trips.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Medical escorted trips. 570.41 Section... COMMUNITY PROGRAMS Escorted Trips § 570.41 Medical escorted trips. (a) Medical escorted trips are intended to provide an inmate with medical treatment not available within the institution. There are two types...

28 CFR 570.41 - Medical escorted trips.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Medical escorted trips. 570.41 Section... COMMUNITY PROGRAMS Escorted Trips § 570.41 Medical escorted trips. (a) Medical escorted trips are intended to provide an inmate with medical treatment not available within the institution. There are two types...

2004 Annual Health Physics Report for the HEU Transparency Program

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

Radev, R

2005-04-01

During the 2004 calendar year, LLNL provided health physics support for the Highly Enriched Uranium Transparency Implementation Program (HEU-TIP) in external and internal radiation protection and technical expertise into matters related to BDMS radioactive sources and Russian radiation safety regulatory compliance. For the calendar year 2004, there were 200 person-trips that required dose monitoring of the U.S. monitors. Of the 200 person-trips, 183 person-trips were SMVs and 17 person-trips were Transparency Monitoring Office (TMO) trips. Eight person-trips from the SMV trips were continuation trips of TMO monitors to facilities other than UEIP. The LLNL Safety Laboratories' Division provided the dosimetrymore » services for the HEU-TIP monitors.« less

Impacts of energy consumption and emissions on the trip cost without late arrival at the equilibrium state

NASA Astrophysics Data System (ADS)

Tang, Tie-Qiao; Wang, Tao; Chen, Liang; Shang, Hua-Yan

2017-08-01

In this paper, we apply a car-following model, fuel consumption model, emission model and electricity consumption model to explore the influences of energy consumption and emissions on each commuter's trip costs without late arrival at the equilibrium state. The numerical results show that the energy consumption and emissions have significant impacts on each commuter's trip cost without late arrival at the equilibrium state. The fuel cost and emission cost prominently enhance each commuter's trip cost and the trip cost increases with the number of vehicles, which shows that considering the fuel cost and emission cost in the trip cost will destroy the equilibrium state. However, the electricity cost slightly enhances each commuter's trip cost, but the trip cost is still approximately a constant, which indicates that considering the electricity cost in the trip cost does not destroy the equilibrium state.

Hours Lost to Planned and Unplanned Dental Visits Among US Adults.

PubMed

Kelekar, Uma; Naavaal, Shillpa

2018-01-11

Poor oral health is associated with lost hours at work or school, which may affect a person's productivity. The objective of our study was to estimate work or school hours lost to dental visits among adults aged 18 and older by the types of visits (emergency or unplanned; routine, planned, or orthodontic; or cosmetic) and to determine the factors associated with hours lost. We used the most recent Oral Health Supplement data, from the 2008 National Health Interview Survey (NHIS), to estimate the total hours lost at work or school for dental visits among adults in the United States. The associations of the hours lost in unplanned and planned dental visits with socioeconomic characteristics, oral health status, and affordability were calculated. We used χ 2 tests and logistic regression to determine associations at P < .05. An average of 320.8 million work or school hours were lost annually for dental care in the United States, of which 92.4 million hours were for emergency (unplanned) care (0.99 h/adult), 159.8 million for routine (planned) care or orthodontic care (1.71 h/adult), and 68.6 million for cosmetic care (0.73 h/adult). Adults with poor oral health were more likely to lose one or more hours in unplanned dental visits (OR = 5.60; 95% confidence interval [CI], 3.25-9.63) than those who reported very good oral health. Not being able to afford dental care was positively associated with more work hours lost in unplanned care (odds ratio [OR] = 2.56; 95% CI, 1.76-3.73). Compared with Hispanic adults, non-Hispanic white adults (OR = 2.09; 95% CI, 1.40-3.11) and non-Hispanic Asian adults and adults of other races/ethnicities (OR =1.91; 95% CI, 1.06-3.47) were more likely to lose any hours for planned care. Consistently, those with more than a high school education were more likely to lose any hours in planned care (OR = 1.39; 95% CI, 1.06-1.83) than those with a high school education or less. Dental problems result in hours lost from work and may adversely affect a person's productivity. There is disparity in lost hours at work by race/ethnicity and dental care affordability.

Language Travel or Language Tourism: Have Educational Trips Changed So Much?

ERIC Educational Resources Information Center

Laborda, Jesus Garcia

2007-01-01

This article points out the changes in organization, students and language learning that language trips, as contrasted with educational trips (of which language trips are a subgroup) have gone through in the last years. The article emphasizes the need to differentiate between language trips and language tourism based on issues of additional…

Teachers as Secondary Players: Involvement in Field Trips to Natural Environments

ERIC Educational Resources Information Center

Alon, Nirit Lavie; Tal, Tali

2017-01-01

This study focused on field trips to natural environments where the teacher plays a secondary role alongside a professional guide. We investigated teachers' and field trip guides' views of the teacher's role, the teacher's actual function on the field trip, and the relationship between them. We observed field trips, interviewed teachers and…

Field Trips Put Chemistry in Context for Non-Science Majors

ERIC Educational Resources Information Center

Peterman, Keith E.

2008-01-01

Field trips can provide excellent real-world learning situations for students in non-science major chemistry courses. The field trips described in this article are accessible, most trips can be completed within a scheduled three-hour laboratory time period, and they can be conducted at minimal cost. These field trips significantly enhanced student…

Field Trips as Valuable Learning Experiences in Geography Courses

ERIC Educational Resources Information Center

Krakowka, Amy Richmond

2012-01-01

Field trips have been acknowledged as valuable learning experiences in geography. This article uses Kolb's (1984) experiential learning model to discuss how students learn and how field trips can help enhance learning. Using Kolb's experiential learning theory as a guide in the design of field trips helps ensure that field trips contribute to…

TRIP13 impairs mitotic checkpoint surveillance and is associated with poor prognosis in multiple myeloma

PubMed Central

Song, Dongliang; Hu, Liangning; Xie, Bingqian; Wang, Houcai; Gao, Lu; Gao, Minjie; Xu, Hongwei; Xu, Zhijian; Wu, Xiaosong; Zhang, Yiwen; Zhu, Weiliang; Zhan, Fenghuang; Shi, Jumei

2017-01-01

AAA-ATPase TRIP13 is one of the chromosome instability gene recently established in multiple myeloma (MM), the second most common and incurable hematological malignancy. However, the specific function of TRIP13 in MM is largely unknown. Using sequential gene expression profiling, we demonstrated that high TRIP13 expression levels were positively correlated with progression, disease relapse, and poor prognosis in MM patients. Overexpressing human TRIP13 in myeloma cells prompted cell growth and drug resistance, and overexpressing murine TRIP13, which shares 93% sequence identity with human TRIP13, led to colony formation of NIH/3T3 fibroblasts in vitro and tumor formation in vivo. Meanwhile, the knockdown of TRIP13 inhibited myeloma cell growth, induced cell apoptosis, and reduced tumor burden in xenograft MM mice. Mechanistically, we observed that the overexpression of TRIP13 abrogated the spindle checkpoint and induced proteasome-mediated degradation of MAD2 primarily through the Akt pathway. Thus, our results demonstrate that TRIP13 may serve as a biomarker for MM disease development and prognosis, making it a potential target for future therapies. PMID:28157697

Trade, TRIPS, and pharmaceuticals.

PubMed

Smith, Richard D; Correa, Carlos; Oh, Cecilia

2009-02-21

The World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) set global minimum standards for the protection of intellectual property, substantially increasing and expanding intellectual-property rights, and generated clear gains for the pharmaceutical industry and the developed world. The question of whether TRIPS generates gains for developing countries, in the form of increased exports, is addressed in this paper through consideration of the importance of pharmaceuticals in health-care trade, outlining the essential requirements, implications, and issues related to TRIPS, and TRIPS-plus, in which increased restrictions are imposed as part of bilateral free-trade agreements. TRIPS has not generated substantial gains for developing countries, but has further increased pharmaceutical trade in developed countries. The unequal trade between developed and developing countries (ie, exporting and importing high-value patented drugs, respectively) raises the issue of access to medicines, which is exacerbated by TRIPS-plus provisions, although many countries have not even enacted provision for TRIPS flexibilities. Therefore this paper focuses on options that are available to the health community for negotiation to their advantage under TRIPS, and within the presence of TRIPS-plus.

Understanding and managing the effects of battery charger and inverter aging

NASA Astrophysics Data System (ADS)

Gunther, W.; Aggarwal, S.

An aging assessment of battery chargers and inverters was conducted under the auspices of the NRC's Nuclear Plant Aging Research (NPAR) Program. The intentions of this program are to resolve issues related to the aging and service wear of equipment and systems at operating reactor facilities and to assess their impact on safety. Inverters and battery chargers are used in nuclear power plants to perform significant functions related to plant safety and availability. The specific impact of a battery charger or inverter failure varies with plant configuration. Operating experience data have demonstrated that reactor trips, safety injection system actuations, and inoperable emergency core cooling systems have resulted from inverter failures; and dc bus degradation leading to diesel generator inoperability or loss of control room annunication and indication have resulted from battery and battery charger failures. For the battery charger and inverter, the aging and service wear of subcomponents have contributed significantly to equipment failures. This paper summarizes the data and then describes methods that can be used to detect battery charger and inverter degradation prior to failure, as well as methods to minimize the failure effects. In both cases, the managing of battery charger and inverter aging is emphasized.

TRACE/PARCS Analysis of ATWS with Instability for a MELLLA+BWR/5

DOE PAGES

L. Y. Cheng; Baek, J. S.; Cuadra, A.; ...

2016-06-06

A TRACE/PARCS model has been developed to analyze anticipated transient without SCRAM (ATWS) events for a boiling water reactor (BWR) operating in the maximum extended load line limit analysis-plus (MELLLA+) expanded operating domain. The MELLLA+ domain expands allowable operation in the power/flow map of a BWR to low flow rates at high power conditions. Such operation exacerbates the likelihood of large amplitude power/flow oscillations during certain ATWS scenarios. The analysis shows that large amplitude power/flow oscillations, both core-wide and out-of-phase, arise following the establishment of natural circulation flow in the reactor pressure vessel (RPV) after the trip of the recirculationmore » pumps and an increase in core inlet subcooling. The analysis also indicates a mechanism by which the fuel may experience heat-up that could result in localized fuel damage. TRACE predicts the heat-up to occur when the cladding surface temperature exceeds the minimum stable film boiling temperature after periodic cycles of dryout and rewet; and the fuel becomes “locked” into a film boiling regime. Further, the analysis demonstrates the effectiveness of the simulated manual operator actions to suppress the instability.« less

Getting out and about in older adults: the nature of daily trips and their association with objectively assessed physical activity.

PubMed

Davis, Mark G; Fox, Kenneth R; Hillsdon, Melvyn; Coulson, Jo C; Sharp, Debbie J; Stathi, Afroditi; Thompson, Janice L

2011-10-21

A key public health objective is increasing health-enhancing physical activity (PA) for older adults (OAs). Daily trip frequency is independently associated with objectively assessed PA volumes (OAs). Little is known about correlates and these trips' transport mode, and how these elements relate to PA. to describe the frequency, purpose, and travel mode of daily trips in OAs, and their association with participant characteristics and objectively-assessed PA. Participants (n = 214, aged 78.1 SD 5.7 years), completed a seven-day trips log recording daily-trip frequency, purpose and transport mode. Concurrently participants wore an accelerometer which provided mean daily steps (steps·d-1), and minutes of moderate to vigorous PA (MVPA·d-1). Participants' physical function (PF) was estimated and demographic, height and weight data obtained. Trip frequency was associated with gender, age, physical function, walking-aid use, educational attainment, number of amenities within walking distance and cars in the household. Participants reported 9.6 (SD 4.2) trips per week (trips·wk-1). Most trips (61%) were by car (driver 44%, passenger 17%), 30% walking or cycling (active) and 9% public transport/other. Driving trips·wk-1 were more common in participants who were males (5.3 SD 3.6), well-educated (5.0 SD 4.3), high functioning (5.1 SD 4.6), younger (5.6 SD 4.9), affluent area residents (5.1 SD 4.2) and accessing > one car (7.2 SD 4.7). Active trips·wk-1 were more frequent in participants who were males (3.4 SD 3.6), normal weight (3.2 SD 3.4), not requiring walking aids (3.5 SD 3.3), well-educated (3.7 SD 0.7), from less deprived neighbourhoods (3.9 SD 3.9) and with ≥ 8 amenities nearby (4.4 SD 3.8).Public transport, and active trip frequency, were significantly associated with steps·d-1 (p < 0.001), even after adjustment for other trip modes and potential confounders. Public transport, active, or car driving trips were independently associated with minutes MVPA·d-1 (p < 0.01). Daily trips are associated with objectively-measured PA as indicated by daily MVPA and steps. Public transport and active trips are associated with greater PA than those by car, especially as a car passenger. Strategies encouraging increased trips, particularly active or public transport trips, in OAs can potentially increase their PA and benefit public health.

Addressing legal and political barriers to global pharmaceutical access: options for remedying the impact of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the imposition of TRIPS-plus standards.

PubMed

Cohen-Kohler, Jillian Clare; Forman, Lisa; Lipkus, Nathaniel

2008-07-01

Despite myriad programs aimed at increasing access to essential medicines in the developing world, the global drug gap persists. This paper focuses on the major legal and political constraints preventing implementation of coordinated global policy solutions - particularly, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and bilateral and regional free trade agreements. We argue that several policy and research routes should be taken to mitigate the restrictive impact of TRIPS and TRIPS-plus rules, including greater use of TRIPS flexibilities, advancement of human rights, and an ethical framework for essential medicines distribution, and a broader campaign that debates the legitimacy of TRIPS and TRIPS-plus standards themselves.

Collaborative Research: Bringing Problem Solving in the Field into the Classroom: Developing and Assessing Virtual Field Trips for Teaching Sedimentary and Introductory Geology

NASA Astrophysics Data System (ADS)

Wang, P.; Caldwell, M.

2012-12-01

Coastal Florida offers a unique setting for the facilitation of learning about a variety of modern sedimentary environments. Despite the conflicting concept of "virtual" and "actual" field trip, and the uncertainties associated with the implementation and effectiveness, virtual trips provide likely the only way to reach a large diversified student population and eliminate travel time and expenses. In addition, with rapidly improving web and visualization technology, field trips can be simulated virtually. It is therefore essential to systematically develop and assess the educational effectiveness of virtual field trips. This project is developing, implementing, and assessing a series of virtual field trips for teaching undergraduate sedimentary geology at a large four-year research university and introductory geology at a large two-year community college. The virtual field trip is based on a four-day actual field trip for a senior level sedimentary geology class. Two versions of the virtual field trip, one for advanced class and one for introductory class, are being produced. The educational outcome of the virtual field trip will be compared to that from actual field trip. This presentation summarizes Year 1 achievements of the three-year project. The filming, editing, and initial production of the virtual field trip have been completed. Formative assessments were conducted by the Coalition for Science Literacy at the University of South Florida. Once tested and refined, the virtual field trips will be disseminated through broadly used web portals and workshops at regional and national meetings.

Personal and trip characteristics associated with safety equipment use by injured adult bicyclists: a cross-sectional study

PubMed Central

2012-01-01

Background The aim of this study was to estimate use of helmets, lights, and visible clothing among cyclists and to examine trip and personal characteristics associated with their use. Methods Using data from a study of transportation infrastructure and injuries to 690 adult cyclists in Toronto and Vancouver, Canada, we examined the proportion who used bike lights, conspicuous clothing on the torso, and helmets on their injury trip. Multiple logistic regression was used to examine associations between personal and trip characteristics and each type of safety equipment. Results Bike lights were the least frequently used (20% of all trips) although they were used on 77% of trips at night. Conspicuous clothing (white, yellow, orange, red) was worn on 33% of trips. Helmets were used on 69% of trips, 76% in Vancouver where adult helmet use is required by law and 59% in Toronto where it is not. Factors positively associated with bike light use included night, dawn and dusk trips, poor weather conditions, weekday trips, male sex, and helmet use. Factors positively associated with conspicuous clothing use included good weather conditions, older age, and more frequent cycling. Factors positively associated with helmet use included bike light use, longer trip distances, hybrid bike type, not using alcohol in the 6 hours prior to the trip, female sex, older age, higher income, and higher education. Conclusions In two of Canada’s largest cities, helmets were the most widely used safety equipment. Measures to increase use of visibility aids on both daytime and night-time cycling trips may help prevent crashes. PMID:22966752

Analysis of electric vehicle's trip cost allowing late arrival

NASA Astrophysics Data System (ADS)

Leng, Jun-Qiang; Liu, Wei-Yi; Zhao, Lin

2017-05-01

In this paper, we use a car-following model to study each electric vehicle's trip cost and the total trip cost allowing late arrival. The numerical result show that the electricity cost has great effects on each commuter's trip cost and the total trip costs and that these effects are dependent on each commuter's time headway at the origin, but the electricity cost has no prominent impacts on the minimum value of total trip cost under each commuter's different time headway at the origin.

Analysis of electric vehicle's trip cost without late arrival

NASA Astrophysics Data System (ADS)

Leng, Jun-Qiang; Zhao, Lin

2017-03-01

In this paper, we use a car-following model to study each electric vehicle's trip cost and the corresponding total trip cost without late arrival. The numerical result show that the electricity cost has significant effects on each electric vehicle's trip cost and the corresponding total trip costs and that the effects are dependent on its time headway at the origin, but the electricity cost has no prominent effects on the minimum value of the system's total trip cost.

Open the Door Let's Explore: Neighborhood Field Trips for Young Children.

ERIC Educational Resources Information Center

Redleaf, Rhoda

Designed as a resource for teachers and parents, this guide contains activities to help children from 2 to 8 years old learn from neighborhood walks and field trips. Information is presented on: field trips as an approach to learning, learning processes of children, and techniques to make trips meaningful. Teaching material for each trip includes…

A Field Trip without Buses: Connecting Your Students to Scientists through a Virtual Visit

ERIC Educational Resources Information Center

Adedokun, Omolola; Parker, Loran Carleton; Loizzo, Jamie; Burgess, Wilella; Robinson, J. Paul

2011-01-01

One school offers zipTrips as an alternative to actual field trips taken outside of school. ZipTrips are web- and broadcast-delivered electronic field trips that include online videos, lesson plans, and a live, 45-minute interactive program consisting of four core components: an in-studio audience, live interaction with scientists, prerecorded…

Field Trips: Tradition in Jeopardy

ERIC Educational Resources Information Center

Wheeler, Ginger

2011-01-01

The school field trip: something fun, different, exciting, exhausting--a break from the school day grind. But the field trip has ramifications beyond just getting out of school for the day. For students, the field trip is to the classroom what the big game is to athletes. For museums and other attractions, the field trip is a way to cultivate…

MITEE: A Compact Ultralight Nuclear Thermal Propulsion Engine for Planetary Science Missions

NASA Astrophysics Data System (ADS)

Powell, J.; Maise, G.; Paniagua, J.

2001-01-01

A new approach for a near-term compact, ultralight nuclear thermal propulsion engine, termed MITEE (Miniature Reactor Engine) is described. MITEE enables a wide range of new and unique planetary science missions that are not possible with chemical rockets. With U-235 nuclear fuel and hydrogen propellant the baseline MITEE engine achieves a specific impulse of approximately 1000 seconds, a thrust of 28,000 newtons, and a total mass of only 140 kilograms, including reactor, controls, and turbo-pump. Using higher performance nuclear fuels like U-233, engine mass can be reduced to as little as 80 kg. Using MITEE, V additions of 20 km/s for missions to outer planets are possible compared to only 10 km/s for H2/O2 engines. The much greater V with MITEE enables much faster trips to the outer planets, e.g., two years to Jupiter, three years to Saturn, and five years to Pluto, without needing multiple planetary gravity assists. Moreover, MITEE can utilize in-situ resources to further extend mission V. One example of a very attractive, unique mission enabled by MITEE is the exploration of a possible subsurface ocean on Europa and the return of samples to Earth. Using MITEE, a spacecraft would land on Europa after a two-year trip from Earth orbit and deploy a small nuclear heated probe that would melt down through its ice sheet. The probe would then convert to a submersible and travel through the ocean collecting samples. After a few months, the probe would melt its way back up to the MITEE lander, which would have replenished its hydrogen propellant by melting and electrolyzing Europa surface ice. The spacecraft would then return to Earth. Total mission time is only five years, starting from departure from Earth orbit. Other unique missions include Neptune and Pluto orbiter, and even a Pluto sample return. MITEE uses the cermet Tungsten-UO2 fuel developed in the 1960's for the 710 reactor program. The W-UO2 fuel has demonstrated capability to operate in 3000 K hydrogen for many hours - a much longer period than the approximately one hour burn time for MITEE. Using this cermet fuel, and technology available from other nuclear propulsion programs, MITEE could be developed and ready for implementation in a relatively short time, i.e., approximately seven years. An overview description of the MITEE engine and its performance capabilities is provided.

Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power.

PubMed

Rosenbaum, Janet E; Zenilman, Jonathan; Rose, Eve; Wingood, Gina; DiClemente, Ralph

2016-06-01

Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15-21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.

Impact of high- versus low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery.

PubMed

Boon, Martijn; Martini, Chris; Yang, H Keri; Sen, Shuvayu S; Bevers, Rob; Warlé, Michiel; Aarts, Leon; Niesters, Marieke; Dahan, Albert

2018-01-01

Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose versus low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 versus 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% vs. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12-0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.

Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction.

PubMed

Wang, Yun; Eldridge, Noel; Metersky, Mark L; Sonnenfeld, Nancy; Fine, Jonathan M; Pandolfi, Michelle M; Eckenrode, Sheila; Bakullari, Anila; Galusha, Deron H; Jaser, Lisa; Verzier, Nancy R; Nuti, Sudhakar V; Hunt, David; Normand, Sharon-Lise T; Krumholz, Harlan M

2016-07-12

Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30-day mortality and unplanned readmission rates for Medicare fee-for-service patients hospitalized for acute myocardial infarction (AMI). Using 2009-2013 medical record-abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed-effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital-specific risk-standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital-specific 30-day all-cause risk-standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk-standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79-8.94) and 3.44% points (95% CI, 0.19-6.68) for the risk-standardized mortality and unplanned readmission rates, respectively. For Medicare fee-for-service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30-day all-cause mortality and on unplanned readmissions. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Using Virtual Field Trips to Connect Students with University Scientists: Core Elements and Evaluation of zipTrips[TM

ERIC Educational Resources Information Center

Adedokun, Omolola A.; Hetzel, Kristin; Parker, Loran Carleton; Loizzo, Jamie; Burgess, Wilella D.; Robinson, J. Paul

2012-01-01

Physical field trips to scientists' work places have been shown to enhance student perceptions of science, scientists and science careers. Although virtual field trips (VFTs) have emerged as viable alternatives (or supplements) to traditional physical fieldtrips, little is known about the potential of virtual field trips to provide the same or…

Cybertrips in Social Studies. Online Field Trips for All Ages.

ERIC Educational Resources Information Center

Mandel, Scott

The Internet can take students on virtual field trips to anywhere earth, under the seas, out in space, or back in time. This book demonstrates how teachers can use the Internet to take students on field trips. Composed of two parts, part 1, "Preparing for the Trip," discusses the background of virtual field trips what they are, and why…

46 CFR 62.35-50 - Tabulated monitoring and safety control requirements for specific systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Status Main (Propulsion steam) turbine (2) (2) (2) (4, 5) Manual trip Main propulsion, diesel (1) (1) (1... Temperature High Generators Ship service (1) (1) Starting pressure/voltage Low Tripped Emergency (5) (5) (5) Turbogenerator (1,6) (1,6) (6) Manual trip Diesel (1,7) (1,7) (7) (5) Manual trip Auxiliary boiler Run Trip (12...

Using Vessel Monitoring System Data to Identify and Characterize Trips Made by Fishing Vessels in the United States North Pacific

PubMed Central

Haynie, Alan C.

2016-01-01

Time spent fishing is the effort metric often studied in fisheries but it may under-represent the effort actually expended by fishers. Entire fishing trips, from the time vessels leave port until they return, may prove more useful for examining trends in fleet dynamics, fisher behavior, and fishing costs. However, such trip information is often difficult to resolve. We identified ~30,000 trips made by vessels that targeted walleye pollock (Gadus chalcogrammus) in the Eastern Bering Sea from 2008–2014 by using vessel monitoring system (VMS) and landings data. We compared estimated trip durations to observer data, which were available for approximately half of trips. Total days at sea were estimated with < 1.5% error and 96.4% of trip durations were either estimated with < 5% error or they were within expected measurement error. With 99% accuracy, we classified trips as fishing for pollock, for another target species, or not fishing. This accuracy lends strong support to the use of our method with unobserved trips across North Pacific fisheries. With individual trips resolved, we examined potential errors in datasets which are often viewed as “the truth.” Despite having > 5 million VMS records (timestamps and vessel locations), this study was as much about understanding and managing data errors as it was about characterizing trips. Missing VMS records were pervasive and they strongly influenced our approach. To understand implications of missing data on inference, we simulated removal of VMS records from trips. Removal of records straightened (i.e., shortened) vessel trajectories, and travel distances were underestimated, on average, by 1.5–13.4% per trip. Despite this bias, VMS proved robust for trip characterization and for improved quality control of human-recorded data. Our scrutiny of human-reported and VMS data advanced our understanding of the potential utility and challenges facing VMS users globally. PMID:27788174

Using Vessel Monitoring System Data to Identify and Characterize Trips Made by Fishing Vessels in the United States North Pacific.

PubMed

Watson, Jordan T; Haynie, Alan C

2016-01-01

Time spent fishing is the effort metric often studied in fisheries but it may under-represent the effort actually expended by fishers. Entire fishing trips, from the time vessels leave port until they return, may prove more useful for examining trends in fleet dynamics, fisher behavior, and fishing costs. However, such trip information is often difficult to resolve. We identified ~30,000 trips made by vessels that targeted walleye pollock (Gadus chalcogrammus) in the Eastern Bering Sea from 2008-2014 by using vessel monitoring system (VMS) and landings data. We compared estimated trip durations to observer data, which were available for approximately half of trips. Total days at sea were estimated with < 1.5% error and 96.4% of trip durations were either estimated with < 5% error or they were within expected measurement error. With 99% accuracy, we classified trips as fishing for pollock, for another target species, or not fishing. This accuracy lends strong support to the use of our method with unobserved trips across North Pacific fisheries. With individual trips resolved, we examined potential errors in datasets which are often viewed as "the truth." Despite having > 5 million VMS records (timestamps and vessel locations), this study was as much about understanding and managing data errors as it was about characterizing trips. Missing VMS records were pervasive and they strongly influenced our approach. To understand implications of missing data on inference, we simulated removal of VMS records from trips. Removal of records straightened (i.e., shortened) vessel trajectories, and travel distances were underestimated, on average, by 1.5-13.4% per trip. Despite this bias, VMS proved robust for trip characterization and for improved quality control of human-recorded data. Our scrutiny of human-reported and VMS data advanced our understanding of the potential utility and challenges facing VMS users globally.

Echoes from the Field: An Ethnographic Investigation of Outdoor Science Field Trips

NASA Astrophysics Data System (ADS)

Boxerman, Jonathan Zvi

As popular as field trips are, one might think they have been well-studied. Nonetheless, field trips have not been heavily studied, and little research has mapped what actually transpires during field trips. Accordingly, to address this research gap, I asked two related research questions. The first question is a descriptive one: What happens on field trips? The second question is explanatory: What field trip events are memorable and why? I employed design research and ethnographic methodologies to study learning in naturally occurring contexts. I collaborated with middle-school science teachers to design and implement more than a dozen field trips. The field trips were nested in particular biology and earth sciences focal units. Students were tasked with making scientific observations in the field and then analyzing this data during classroom activities. Audio and video recording devices captured what happened during the field trips, classroom activities and discussions, and the interviews. I conducted comparative microanalysis of videotaped interactions. I observed dozens of events during the field trips that reverberated across time and place. I characterize the features of these events and the objects that drew interest. Then, I trace the residue across contexts. This study suggests that field trips could be more than one-off experiences and have the potential to be resources to seed and enrich learning and to augment interest in the practice of science.

Thyroid hormone receptor interactor 13 (TRIP13) overexpression associated with tumor progression and poor prognosis in lung adenocarcinoma.

PubMed

Li, Wei; Zhang, Gengyan; Li, Xiaojun; Wang, Xiaojing; Li, Qing; Hong, Lei; Shen, Yuangbing; Zhao, Chenling; Gong, Xiaomeng; Chen, Yuqing; Zhou, Jihong

2018-05-15

Thyroid hormone receptor interactor 13 (TRIP13) is an AAA + -ATPase that plays a key role in mitotic checkpoint complex inactivation and is associated with the progression of several cancers. However, its role in lung adenocarcinogenesis remains unknown. Here, we report that TRIP13 is highly overexpressed in multiple lung adenocarcinoma cell lines and tumor tissues. Clinically, TRIP13 expression is positively associated with tumor size, T-stage, and N-stage, and Kaplan-Meier analysis revealed that heightened TRIP13 expression is associated with lower overall survival. TRIP13 promotes lung adenocarcinoma cell proliferation, clonogenicity, and migration while inhibiting apoptosis and G2/M phase shift in vitro. Accordingly, TRIP13-silenced xenograft tumors displayed significant growth inhibition in vivo. Bioinformatics analysis demonstrated that TRIP13 interacts with a protein network associated with dsDNA break repair and PI3K/Akt signaling. TRIP13 upregulatesAkt Ser473 and downregulatesAkt Thr308 /mTOR Ser2448 activity, which suppresses accurate dsDNA break repair. TRIP13 also downregulates pro-apoptotic Bad Ser136 and cleaved caspase-3 while upregulating survivin. In conclusion, heightened TRIP13 expression appears to promote lung adenocarcinoma tumor progression and displays potential as a therapeutic target or biomarker for lung adenocarcinoma. Copyright © 2018 Elsevier Inc. All rights reserved.

How Combined Trip Purposes Are Associated with Transport Choice for Short Distance Trips. Results from a Cross-Sectional Study in the Netherlands

PubMed Central

Scheepers, Eline; Slinger, Minke; Wendel-Vos, Wanda; Schuit, Jantine

2014-01-01

Background One way to increase physical activity is to stimulate a shift from car use to walking or cycling. In single-purpose trips, purpose was found to be an important predictor of transport choice. However, as far as known, no studies have been conducted to see how trips with combined purposes affect this decision. This study was designed to provide insight into associations between combined purposes and transport choice. Methods An online questionnaire (N = 3,663) was used to collect data concerning transport choice for four primary purposes: shopping, going to public natural spaces, sports, and commuting. Per combination of primary trip purpose and transport choice, participants were asked to give examples of secondary purposes that they combine with the primary purpose. Logistic regression analyses were used to model the odds of both cycling and walking versus car use. Results Primary trip purposes combined with commuting, shopping, visiting private contacts or medical care were more likely to be made by car than by cycling or walking. Combinations with visiting catering facilities, trips to social infrastructure facilities, recreational outings, trips to facilities for the provision of daily requirements or private contacts during the trip were more likely to be made by walking and/or cycling than by car. Conclusion Combined trip purposes were found to be associated with transport choice. When stimulating active transport focus should be on the combined-trip purposes which were more likely to be made by car, namely trips combined with commuting, other shopping, visiting private contacts or medical care. PMID:25474653

Predictive Trip Detection for Nuclear Power Plants

NASA Astrophysics Data System (ADS)

Rankin, Drew J.; Jiang, Jin

2016-08-01

This paper investigates the use of a Kalman filter (KF) to predict, within the shutdown system (SDS) of a nuclear power plant (NPP), whether safety parameter measurements have reached a trip set-point. In addition, least squares (LS) estimation compensates for prediction error due to system-model mismatch. The motivation behind predictive shutdown is to reduce the amount of time between the occurrence of a fault or failure and the time of trip detection, referred to as time-to-trip. These reductions in time-to-trip can ultimately lead to increases in safety and productivity margins. The proposed predictive SDS differs from conventional SDSs in that it compares point-predictions of the measurements, rather than sensor measurements, against trip set-points. The predictive SDS is validated through simulation and experiments for the steam generator water level safety parameter. Performance of the proposed predictive SDS is compared against benchmark conventional SDS with respect to time-to-trip. In addition, this paper analyzes: prediction uncertainty, as well as; the conditions under which it is possible to achieve reduced time-to-trip. Simulation results demonstrate that on average the predictive SDS reduces time-to-trip by an amount of time equal to the length of the prediction horizon and that the distribution of times-to-trip is approximately Gaussian. Experimental results reveal that a reduced time-to-trip can be achieved in a real-world system with unknown system-model mismatch and that the predictive SDS can be implemented with a scan time of under 100ms. Thus, this paper is a proof of concept for KF/LS-based predictive trip detection.

Using a Field Trip Inventory to Determine If Listening to Elementary School Students' Conversations, While on a Zoo Field Trip, Enhances Preservice Teachers' Abilities to Plan Zoo Field Trips

NASA Astrophysics Data System (ADS)

Patrick, Patricia; Mathews, Cathy; Tunnicliffe, Sue Dale

2013-10-01

This study investigated whether listening to spontaneous conversations of elementary students and their teachers/chaperones, while they were visiting a zoo, affected preservice elementary teachers' conceptions about planning a field trip to the zoo. One hundred five preservice elementary teachers designed field trips prior to and after listening to students' conversations during a field trip to the zoo. In order to analyze the preservice teachers' field trip designs, we conducted a review of the literature on field trips to develop the field trip inventory (FTI). The FTI focussed on three major components of field trips: cognitive, procedural, and social. Cognitive components were subdivided into pre-visit, during-visit, and post-visit activities and problem-solving. Procedural components included information about the informal science education facility (the zoo) and the zoo staff and included advanced organizers. Social components on student groups, fun, control during the zoo visit, and control of student learning. The results of the investigation showed that (a) the dominant topic in conversations among elementary school groups at the zoo was management, (b) procedural components were mentioned least often, (c) preservice teachers described during-visit activities more often than any other characteristic central to field trip design, (d) seven of the nine characteristics listed in the FTI were noted more frequently in the preservice teachers' field trip designs after they listened to students' conversations at the zoo, and (e) preservice teachers thought that students were not learning and that planning was important.

Analysis of the equilibrium trip cost accounting for the fuel cost in a single-lane traffic system without late arrival

NASA Astrophysics Data System (ADS)

Tang, Tie-Qiao; Wang, Tao; Chen, Liang; Huang, Hai-Jun

2018-01-01

In this paper, we introduce the fuel cost into each commuter's trip cost, define a new trip cost without late arrival and its corresponding equilibrium state, and use a car-following model to explore the impacts of the fuel cost on each commuter's departure time, departure interval, arrival time, arrival interval, traveling time, early arrival time and trip cost at the above equilibrium state. The numerical results show that considering the fuel cost in each commuter's trip cost has positive impacts on his trip cost and fuel cost, and the traffic situation in the system without late arrival, i.e., each commuter should explicitly consider the fuel cost in his trip cost.

Analysis of the trip costs of a traffic corridor with two entrances and one exit under car-following model

NASA Astrophysics Data System (ADS)

Tang, Tie-Qiao; Wang, Tao; Chen, Liang; Shang, Hua-Yan

2017-11-01

In this paper, we first define each commuter's first, second and third trip costs, and then apply the full velocity difference model and the VT-Micro model to explore each commuter's three trip costs and the system's corresponding total trip costs in a traffic corridor with two entrances and one exit. The numerical results show that one entrance has prominent effects on the commuter's three trip costs and the system's corresponding total trip cost and that the impacts are directly related to the commuter's departure interval at this entrance. The results can provide some suggestions for reducing the commuters' trip costs in a traffic corridor with two entrances and one exit.

VMT-based traffic impact assessment : development of a trip length model.

DOT National Transportation Integrated Search

2010-06-01

This report develops models that relate the trip-lengths to the land-use characteristics at : the trip-ends (both production- and attraction-ends). Separate models were developed by trip : purpose. The results indicate several statistically significa...

Trip internalization in multi-use developments.

DOT National Transportation Integrated Search

2014-04-01

Internal trip capture refers to how the number trips to and from a development are reduced by the proximity of : complementary land uses within the development (e.g., residential to retail). Internal trips occur within the : development and do not en...

Trip Planning State of the Practice.

DOT National Transportation Integrated Search

2002-07-01

Automated trip planning is one of the easiest ways for transit users to identify their best choice of routes using the Internet. Trip planners use an input form to obtain information on desired trip characteristics then automatically generate an itin...

Planning the Unplanned Experiment: Assessing the Efficacy of Standards for Safety Critical Software

NASA Technical Reports Server (NTRS)

Graydon, Patrick J.; Holloway, C. Michael

2015-01-01

We need well-founded means of determining whether software is t for use in safety-critical applications. While software in industries such as aviation has an excellent safety record, the fact that software aws have contributed to deaths illustrates the need for justi ably high con dence in software. It is often argued that software is t for safety-critical use because it conforms to a standard for software in safety-critical systems. But little is known about whether such standards `work.' Reliance upon a standard without knowing whether it works is an experiment; without collecting data to assess the standard, this experiment is unplanned. This paper reports on a workshop intended to explore how standards could practicably be assessed. Planning the Unplanned Experiment: Assessing the Ecacy of Standards for Safety Critical Software (AESSCS) was held on 13 May 2014 in conjunction with the European Dependable Computing Conference (EDCC). We summarize and elaborate on the workshop's discussion of the topic, including both the presented positions and the dialogue that ensued.

The New Rich and Their Unplanned Births: Stratified Reproduction under China's Birth-planning Policy.

PubMed

Shi, Lihong

2017-12-01

This article explores the creation and ramifications of a stratified reproductive system under China's state control of reproduction. Within this system, an emerging group of "new rich" are able to circumvent birth regulations and have unplanned births because of their financial capabilities and social networks. While China's birth-planning policy is meant to be enforced equally for all couples, the unequal access to wealth and bureaucratic power as a result of China's widening social polarization has created disparate reproductive rights and experiences. This article identifies three ways in which reproductive privileges are created. It further explores how a stratified reproductive system under state population control reinforces social polarization. While many socially marginalized couples are unable to register their unplanned children for citizenship status and social benefits, the new rich are able to legitimate their births and transfer their privilege and status to their children, thus reproducing a new generation of elites. © 2016 by the American Anthropological Association.

Fuel Cell Electric Vehicle Composite Data Products | Hydrogen and Fuel

Science.gov Websites

Ambient Temperature CDP FCEV 35, 2/19/16 Time Between Trips CDP FCEV 36, 5/1/16 Time Between Trips and Trip Ambient Temperature CDP FCEV 37, 5/1/16 Trips per Hour CDP FCEV 38, 2/19/16 Trips per Hour by Fuel Vehicle Miles Between Fills by Month CDP FCEV 56, 3/1/16 Reliability Maintenance Causes and Effects-Stack

Using a Field Trip Inventory to Determine If Listening to Elementary School Students' Conversations, While on a Zoo Field Trip, Enhances Preservice Teachers' Abilities to Plan Zoo Field Trips

ERIC Educational Resources Information Center

Patrick, Patricia; Mathews, Cathy; Tunnicliffe, Sue Dale

2013-01-01

This study investigated whether listening to spontaneous conversations of elementary students and their teachers/chaperones, while they were visiting a zoo, affected preservice elementary teachers' conceptions about planning a field trip to the zoo. One hundred five preservice elementary teachers designed field trips prior to and after…

Trip attraction rates of shopping centers in Northern New Castle County, Delaware.

DOT National Transportation Integrated Search

2004-07-01

This report presents the trip attraction rates of the shopping centers in Northern New : Castle County in Delaware. The study aims to provide an alternative to ITE Trip : Generation Manual (1997) for computing the trip attraction of shopping centers ...

Factors associated with healthy and unhealthy workplace eating behaviours in individuals with overweight/obesity with and without binge eating disorder

PubMed Central

Leung, S. L.; Barber, J. A.; Burger, A.

2018-01-01

Summary Objective Most Americans spend an average of 8 hours per day in the workplace. Current understanding of eating behaviours in the workplace and their association with overweight, obesity and binge eating disorder (BED) is limited. Workplace eating behaviours and weight‐related self‐efficacy were examined in a sample of 98 individuals with overweight or obesity, with or without BED. Design Participants completed the Weight Efficacy Lifestyle Questionnaire, Work and Social Adjustment Scale, Worker's Perception of Environmental Factors, and a Workplace Questionnaire. Results Eating unplanned food occurred on average 2.43 times per week (SD = 3.37), and eating unplanned food even when meals were brought from home occurred on average 1.28 times per week (SD = 1.84). Individuals with BED purchased lunch even when they brought food from home significantly more frequently than did individuals without BED. Those with BED also reported significantly poorer work and social adjustment related to binge eating as compared with those without BED. The most significant barriers to healthy eating in the workplace were coworker influence, eating more food in general and more junk food in response to stress, eating unplanned food at work and time constraints. Conclusions These factors may be important to target in weight‐loss treatment to increase individuals' weight loss success. As individuals with BED may be the most vulnerable to eating unplanned foods, clinicians may want to focus on this potential barrier in BED treatment. PMID:29670748

Some folded issues related to over-shielded and unplanned rooms for medical linear accelerators - A case study

NASA Astrophysics Data System (ADS)

Muhammad, Wazir; Ullah, Asad; Hussain, Amjad; Ali, Nawab; Alam, Khan; Khan, Gulzar; Matiullah; Maeng, Seongjin; Lee, Sang Hoon

2015-08-01

A medical linear accelerator (LINAC) room must be properly shielded to limit the outside radiation exposure to an acceptable safe level defined by individual state and international regulations. However, along with this prime objective, some additional issues are also important. The current case-study was designed to unfold the issues related to over-shielded and unplanned treatment rooms for LINACs. In this connection, an apparently unplanned and over-shielded treatment room of 610 × 610 cm2 in size was compared with a properly designed treatment room of 762 × 762 cm2 in size ( i.e., by following the procedures and recommendations of the IAEA Safety Reports Series No. 47 and NCRP 151). Evaluation of the unplanned room indicated that it was over-shielded and that its size was not suitable for total body irradiation (TBI), although the license for such a treatment facility had been acquired for the installed machine. An overall 14.96% reduction in the total shielding volume ( i.e., concrete) for an optimally planned room as compared to a non-planned room was estimated. Furthermore, the inner room's dimensions were increased by 25%, in order to accommodate TBI patients. These results show that planning and design of the treatment rooms are imperative to avoid extra financial burden to the hospitals and to provide enough space for easy and safe handling of the patients. A spacious room is ideal for storing treatment accessories and facilitates TBI treatment.

Factors associated with healthy and unhealthy workplace eating behaviours in individuals with overweight/obesity with and without binge eating disorder.

PubMed

Leung, S L; Barber, J A; Burger, A; Barnes, R D

2018-04-01

Most Americans spend an average of 8 hours per day in the workplace. Current understanding of eating behaviours in the workplace and their association with overweight, obesity and binge eating disorder (BED) is limited. Workplace eating behaviours and weight-related self-efficacy were examined in a sample of 98 individuals with overweight or obesity, with or without BED. Participants completed the Weight Efficacy Lifestyle Questionnaire, Work and Social Adjustment Scale, Worker's Perception of Environmental Factors, and a Workplace Questionnaire. Eating unplanned food occurred on average 2.43 times per week (SD = 3.37), and eating unplanned food even when meals were brought from home occurred on average 1.28 times per week (SD = 1.84). Individuals with BED purchased lunch even when they brought food from home significantly more frequently than did individuals without BED. Those with BED also reported significantly poorer work and social adjustment related to binge eating as compared with those without BED. The most significant barriers to healthy eating in the workplace were coworker influence, eating more food in general and more junk food in response to stress, eating unplanned food at work and time constraints. These factors may be important to target in weight-loss treatment to increase individuals' weight loss success. As individuals with BED may be the most vulnerable to eating unplanned foods, clinicians may want to focus on this potential barrier in BED treatment.

The importance of holiday trips for people with chronic mental health problems.

PubMed

Pols, Jeannette; Kroon, Hans

2007-02-01

Although research findings point to the importance of leisure activities for people with severe mental illness, there is no research into the specific effects of holiday trips. This Open Forum describes the experience of going on holiday trips for people with chronic mental health problems in the Netherlands. A qualitative research design was used. Material for the research was collected by participant observation on two trips and in-depth interviews of 11 travelers and four psychiatric nurses who accompanied the travelers. The trips contributed to rehabilitation by promoting and supporting, among other things, community participation, social relations, skill development, and new perceptions of identity. The trips also helped travelers to maintain balance in everyday life. For the nurses the trips provided a learning environment outside of medical institutions.

Survey on how fluctuating petrol prices are affecting Malaysian large city dwellers in changing their trip patterns

NASA Astrophysics Data System (ADS)

Rohani, M. M.; Pahazri, N.

2018-04-01

Rising fuel prices shocks have a significant impact on the way of life of most Malaysians. Due to the rising of oil prices, the costs of travel for private vehicle users are therefore increasing. The study was conducted based on the objective of studying the impact of rising fuel prices on three types of trip patterns of Malaysians who are living in the city areas. The three types of trip patterns are, workplaces trip, leisure trip and personal purposes trip during the weekdays. This study was conducted by distributing questionnaires to respondents of private vehicle users in selected city such as Johor Bahru, Kuala Lumpur, Putrajaya, Melaka, Perak, Selangor and Kelantan. This study, found that the trip patterns of those who were using their own vehicles had changed after the rising of fuel prices. The changes showed that many private vehicle users were taking steps to save money on petrol by adjusting their trips.

TRIP13 promotes error-prone nonhomologous end joining and induces chemoresistance in head and neck cancer

PubMed Central

Banerjee, Rajat; Russo, Nickole; Liu, Min; Basrur, Venkatesha; Bellile, Emily; Palanisamy, Nallasivam; Scanlon, Christina S.; van Tubergen, Elizabeth; Inglehart, Ronald C.; Metwally, Tarek; Mani, Ram-Shankar; Yocum, Anastasia; Nyati, Mukesh K.; Castilho, Rogerio M.; Varambally, Sooryanarayana; Chinnaiyan, Arul M.

2014-01-01

Head and neck cancer (SCCHN) is a common, aggressive, treatment-resistant cancer with a high recurrence rate and mortality, but the mechanism of treatment-resistance remains unclear. Here we describe a mechanism where the AAA-ATPase TRIP13 promotes treatment-resistance. Overexpression of TRIP13 in non-malignant cells results in malignant transformation. High expression of TRIP13 in SCCHN leads to aggressive, treatment-resistant tumors and enhanced repair of DNA damage. Using mass spectrometry, we identify DNA-PKcs complex proteins that mediate non homologous end joining (NHEJ), as TRIP13 binding partners. Using repair-deficient reporter systems, we show that TRIP13 promotes NHEJ, even when homologous recombination is intact. Importantly, overexpression of TRIP13 sensitizes SCCHN to an inhibitor of DNA-PKcs. Thus, this study defines a new mechanism of treatment resistance in SCCHN and underscores the importance of targeting NHEJ to overcome treatment failure in SCCHN and potentially in other cancers that overexpress TRIP13. PMID:25078033

The AAA+ ATPase TRIP13 remodels HORMA domains through N-terminal engagement and unfolding

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

Ye, Qiaozhen; Kim, Dong Hyun; Dereli, Ihsan

Proteins of the conserved HORMA domain family, including the spindle assembly checkpoint protein MAD2 and the meiotic HORMADs, assemble into signaling complexes by binding short peptides termed “closure motifs”. The AAA+ ATPase TRIP13 regulates both MAD2 and meiotic HORMADs by disassembling these HORMA domain–closure motif complexes, but its mechanisms of substrate recognition and remodeling are unknown. Here, we combine X-ray crystallography and crosslinking mass spectrometry to outline how TRIP13 recognizes MAD2 with the help of the adapter protein p31comet. We show that p31comet binding to the TRIP13 N-terminal domain positions the disordered MAD2 N-terminus for engagement by the TRIP13 “poremore » loops”, which then unfold MAD2 in the presence of ATP. N-terminal truncation of MAD2 renders it refractory to TRIP13 action in vitro, and in cells causes spindle assembly checkpoint defects consistent with loss of TRIP13 function. Similar truncation of HORMAD1 in mouse spermatocytes compromises its TRIP13-mediated removal from meiotic chromosomes, highlighting a conserved mechanism for recognition and disassembly of HORMA domain–closure motif complexes by TRIP13.« less

A case study of urban student and teacher experiences surrounding an outdoor environmental science field trip

NASA Astrophysics Data System (ADS)

Preusch, Peggy L.

2009-12-01

Field trips provide opportunities for students to experience many different contexts beyond the classroom, and are a popular choice of K-12 teachers in the US. Recent interest in learning that occurs at informal science education centers such as museums, zoos and aquariums has stimulated studies of the relationship between learning in and outside of schools. Although many studies focus on the teachers, the contexts, and/or the students during the field trip, only a few look at the entire process of learning by including the classroom setting before and after the field trip. This study was designed to develop understandings of the student process of learning during and surrounding an environmental science field trip to an outdoor setting. John Dewey's extensive writings on the relationship between experience and learning informed the analysis, creating a focus on active and passive elements of the experience, continuity within and across contexts, the interactive nature of the experience and the importance of subject matter. An exploration of environmental education (EE), environmental science (ES), and nature study as content revealed the complexities of the subject matter of the field trip that make its presentation problematic. An urban school was chosen to contribute to the research literature about urban student learning in outdoor environments. During the field trip, the students' active engagement with each other and the environment supported meaningful remembrances of the field trip experiences during interviews after the field trip. The students accurately described plants and animals they had observed in different habitats during the field trip. They also made connections with their home life and prior experiences in the outdoors as they discussed the field trip and drew pictures that represented their experiences. One student integrated his outdoor experience with a language arts assignment as he reflected deeply on the field trip. One implication of this study is that educational experiences in outdoor natural environments are complex in ways that contribute to lack of continuity between science lessons in an elementary classroom and environmental science field trip. Long term relationships between schools and informal settings that recognize the strengths of both contexts in terms of student learning processes surrounding field trip experiences are needed to strengthen the educative process for field trip participants.

Examining the Role of Trip Length in Commuter Decisions to Use Public Transportation

DOT National Transportation Integrated Search

2010-06-01

Traveler trip length has for years been used as a fundamental indicator of the best mix of transit modes and user perceptions of travel cost for transit versus auto. This study examines traveler trip lengths across transit modes, work trip duration f...

30 CFR 57.14162 - Trip lights.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Trip lights. 57.14162 Section 57.14162 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND... Devices and Maintenance Requirements § 57.14162 Trip lights. On underground rail haulage, trip lights...

30 CFR 57.14162 - Trip lights.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Trip lights. 57.14162 Section 57.14162 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND... Devices and Maintenance Requirements § 57.14162 Trip lights. On underground rail haulage, trip lights...

30 CFR 57.14162 - Trip lights.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Trip lights. 57.14162 Section 57.14162 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND... Devices and Maintenance Requirements § 57.14162 Trip lights. On underground rail haulage, trip lights...

30 CFR 57.14162 - Trip lights.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Trip lights. 57.14162 Section 57.14162 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND... Devices and Maintenance Requirements § 57.14162 Trip lights. On underground rail haulage, trip lights...

30 CFR 57.14162 - Trip lights.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Trip lights. 57.14162 Section 57.14162 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND... Devices and Maintenance Requirements § 57.14162 Trip lights. On underground rail haulage, trip lights...

Food-purchasing patterns for home: a grocery store-intercept survey.

PubMed

Yoo, Sunmi; Baranowski, Tom; Missaghian, Mariam; Baranowski, Janice; Cullen, Karen; Fisher, Jennifer O; Watson, Kathy; Zakeri, Issa F; Nicklas, Theresa

2006-05-01

To identify the most common frequency of food-purchasing patterns and relate this pattern to characteristics of individuals and families. A customer-intercept survey was conducted in the greater Houston area, Texas, USA, in 2002. The frequency of food shopping at supermarkets, convenience stores and restaurants to buy food for eating at home was assessed. A total of 823 adults (78.5% female; mean age 37.4 years) who went to any of several grocery or convenience stores, including European, Hispanic and African Americans, and Asian/Pacific Islanders. Major food-shopping patterns were a weekly big trip with a few small trips (34.9%), biweekly big trips with a few small trips (21.9%), no big shopping trips (15.4%), a weekly big trip without small trips (13.9%), a monthly big trip (8.3%), and biweekly big trips without small trips (6.4%). While 61.1% of participants never went to convenience stores to buy fruit and vegetables (F&V) for eating at home, 67% went to restaurants for F&V. African American families shopped for food least frequently, while Asian American families shopped for food most frequently. Educational level was negatively associated with the use of convenience stores and positively associated with take-away from restaurants. There is substantial variability in the frequency of food shopping. Future research on food shopping should incorporate this variable.

The Use of Field Trips in Air-Photo Interpretation and Remote-Sensing Classes.

ERIC Educational Resources Information Center

Giardino, John Richard; Fish, Ernest Bertley

1986-01-01

Advocates the use of field trips for improving students' image-interpretation abilities. Presents guidelines for developing a field trip for an aerial-photo interpretation class or a remote-sensing class. Reviews methodology employed, content emphasis, and includes an exercise that was used on a trip. (ML)

50 CFR 622.278 - Commercial trip limits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Dolphin and Wahoo Fishery Off the Atlantic States § 622.278 Commercial trip limits. Commercial trip limits are... in this section with any trip or possession limit applicable to state waters. A species subject to a...

50 CFR 622.278 - Commercial trip limits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Dolphin and Wahoo Fishery Off the Atlantic States § 622.278 Commercial trip limits. Commercial trip limits are... in this section with any trip or possession limit applicable to state waters. A species subject to a...

Multiple Stages of Weekend Field Trips To Expose Students to Nature: Emphasis on Discovery and Awareness.

ERIC Educational Resources Information Center

Krupa, James J.

2002-01-01

Describes the three stages of a field trip and reviews stage 1, weekend field trips, which focuses on an organism's morphology, behavior, and ecology. Presents activities on salamanders, small mammals, fish, birds, and bats. Explains the difficulties of weekend trips. (YDS)

Actual and Virtual Reality: Making the Most of Field Trips.

ERIC Educational Resources Information Center

Bellan, Jennifer Marie; Scheurman, Geoffrey

1998-01-01

Argues that a virtual field trip can complement and enhance a real one. Discusses the benefits and pitfalls of both types of field trips. Outlines a series of student and teacher activities combining an actual field trip and a virtual one to Fort Snelling in St. Paul, Minnesota. (MJP)

78 FR 53486 - Addition of Round-Trip Mailer Product to the Competitive Product List

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... POSTAL SERVICE Addition of Round-Trip Mailer Product to the Competitive Product List AGENCY... request with the Postal Regulatory Commission to add a product called ``Round-Trip Mailer'' to the...] filed with the Postal Regulatory Commission (Commission) a request to add a ``Round-Trip Mailer...

28 CFR 570.45 - Violation of escorted trip.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Violation of escorted trip. 570.45 Section 570.45 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE COMMUNITY PROGRAMS AND RELEASE COMMUNITY PROGRAMS Escorted Trips § 570.45 Violation of escorted trip. (a) Staff shall process as...

The Challenges in Meeting OSD’s Obligation and Expenditure Rate Goals: A Closer Look at Potential Causal Factors, Their Groupings, and How They Modulate

DTIC Science & Technology

2013-10-01

F22 Defense Contract Audit Agency (DCAA) administrative actions 44% 3.92 2.61 F23 Unplanned Congressional adds to Program Baseline (PB) request 43...materialized F21 Program delays from prerequisite events F22 DCAA administrative actions F23 Unplanned Congressional adds to PB request F24...functional areas (F27) and Tenure of PM and others in key positions (F46); and DCMA administrative actions (F36) and DCAA administrative actions ( F22

Connections and lingering presence as cocreated art.

PubMed

Dempsey, Leona F

2008-10-01

Parse described nursing practice as a performing art where the nurse is like a dancer. Just as in any dance performance, unplanned events may occur. When a nurse is artistically living, unique and meaningful performances might emerge from unplanned events. In this practice column, the author describes how shifting experiences surfaced with unforeseen connections and lingering presence during her study of feeling confined. In her study she was in true presence with men living in prison, who were diagnosed with severe mental illness. The humanbecoming school of thought was the nursing perspective guiding the research study.

Building electronic forms for elderly program: integrated care model for high risk elders in Hong Kong.

PubMed

Yiu, Rex; Fung, Vicky; Szeto, Karen; Hung, Veronica; Siu, Ricky; Lam, Johnny; Lai, Daniel; Maw, Christina; Cheung, Adah; Shea, Raman; Choy, Anna

2013-01-01

In Hong Kong, elderly patients discharged from hospital are at high risk of unplanned readmission. The Integrated Care Model (ICM) program is introduced to provide continuous and coordinated care for high risk elders from hospital to community to prevent unplanned readmission. A multidisciplinary working group was set up to address the requirements on developing the electronic forms for ICM program. Six (6) forms were developed. These forms can support ICM service delivery for the high risk elders, clinical documentation, statistical analysis and information sharing.

Application of a hurdle negative binomial count data model to demand for bass fishing in the southeastern United States.

PubMed

Bilgic, Abdulbaki; Florkowski, Wojciech J

2007-06-01

This paper identifies factors that influence the demand for a bass fishing trip taken in the southeastern United States using a hurdle negative binomial count data model. The probability of fishing for a bass is estimated in the first stage and the fishing trip frequency is estimated in the second stage for individuals reporting bass fishing trips in the Southeast. The applied approach allows the decomposition of the effects of factors responsible for the decision to take a trip and the trip number. Calculated partial and total elasticities indicate a highly inelastic demand for the number of fishing trips as trip costs increase. However, the demand can be expected to increase if anglers experience a success measured by the number of caught fish or their size. Benefit estimates based on alternative estimation methods differ substantially, suggesting the need for testing each modeling approach applied in empirical studies.

2010 Annual Health Physics Report for the HEU Transparency Program

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

Radev, Radoslav

2011-05-16

During the 2010 calendar year, Lawrence Livermore National Laboratory (LLNL) provided health physics support for the Highly Enriched Uranium (HEU) Transparency Program for external and internal radiation protection. LLNL also provided technical expertise related to BDMS radioactive sources and Russian radiation safety regulatory compliance. For the calendar year 2010, there were 141 person-trips that required dose monitoring of the U.S. monitors. Of the 141 person-trips, 129 person-trips were Special Monitoring Visits (SMVs) and 12 person-trips were Transparency Monitoring Office (TMO) trips. In 8 of these TMO trips the TMO monitors participated also in the UEIE SMVs and in 2 TMOmore » trips the TMO monitors participated in UEIE and MPA SMVs. There were three monitoring visits (source changes) that were back-to-back SMVs with a total of 25 monitors. LLNL’s Hazard Control Department laboratories provided the dosimetry services for the HEU Transparency monitors.« less

49 CFR 1510.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... that is not a round trip. Origin point means the location at which a trip on a complete air travel... accumulated travel mileage credits in a customer loyalty program, whether or not the term frequent flyer is... Administration by an air carrier as required by this part. Round trip means a trip on an air travel itinerary...

49 CFR 236.560 - Contact element, mechanical trip type; location with respect to rail.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Contact element, mechanical trip type; location... Instructions; Locomotives § 236.560 Contact element, mechanical trip type; location with respect to rail. Contact element of automatic train stop device of the mechanical trip type shall be maintained at a height...

Tourism, Field Trips and Geographic Education.

ERIC Educational Resources Information Center

Dilsaver, Lary M.

In university level geography education, both a market and a need exist for "learning trips" combining the elements of a field trip with those of a commercial tour. Planning such trips involves four steps. The first of these is to establish the conditions of the tour, including identification of the topical focus, specific destinations and sites…

Teachers' Sources of Knowledge for Field Trip Practices

ERIC Educational Resources Information Center

Rebar, Bryan M.

2012-01-01

Teachers draw from many personal and professional experiences when organising and leading field trips. In order to identify the influences on teachers' field trip practices, I used surveys, interviews, artifacts and observations gathered from teachers who led trips to an aquarium. Findings clarified the types of influence and the impact that these…

Geography via Aerial Field Trips: Do It This Way, 6.

ERIC Educational Resources Information Center

Richason, Benjamin F., Jr.; Guell, Carl E.

To provide guidance for geography teachers, this booklet presents information on how to plan and execute aerial field trips. The aerial field trip can be employed as an effective visual aid technique in the teaching of geography, especially for presenting earth generalizations and interrelationships. The benefits of an aerial field trip are…

Revisiting Virtual Field Trips: Perspectives of College Science Instructors

ERIC Educational Resources Information Center

Lei, Simon A.

2015-01-01

Field trips are an important component of upper undergraduate and graduate-level science courses, especially in the fields of biology, geoscience, and environmental science. Field trips can provide a new perspective to a course's content and quality. Science field trips can facilitate active student learning, yet often can be constrained by time,…

Flow in Rotating Serpentine Coolant Passages With Skewed Trip Strips

NASA Technical Reports Server (NTRS)

Tse, David G.N.; Steuber, Gary

1996-01-01

Laser velocimetry was utilized to map the velocity field in serpentine turbine blade cooling passages with skewed trip strips. The measurements were obtained at Reynolds and Rotation numbers of 25,000 and 0.24 to assess the influence of trips, passage curvature and Coriolis force on the flow field. The interaction of the secondary flows induced by skewed trips with the passage rotation produces a swirling vortex and a corner recirculation zone. With trips skewed at +45 deg, the secondary flows remain unaltered as the cross-flow proceeds from the passage to the turn. However, the flow characteristics at these locations differ when trips are skewed at -45 deg. Changes in the flow structure are expected to augment heat transfer, in agreement with the heat transfer measurements of Johnson, et al. The present results show that trips are skewed at -45 deg in the outward flow passage and trips are skewed at +45 deg in the inward flow passage maximize heat transfer. Details of the present measurements were related to the heat transfer measurements of Johnson, et al. to relate fluid flow and heat transfer measurements.

An experimental investigation of energy absorption in TRIP steel under impact three-point bending deformation

NASA Astrophysics Data System (ADS)

Pham, Hang; Iwamoto, Takeshi

2015-09-01

TRIP (Transformation-induced Plasticity) steel is nowadays in widespread use in the automobile industry because of their favorable mechanical properties such as high strength, excellent formability and toughness because of strain-induced martensitic transformation. Moreover, when TRIP steel is applied to the components of the vehicles, it is expected that huge amount of kinetic energy will be absorbed into both plastic deformation and martensitic transformation during the collision. Basically, bending deformation due to buckling is one of the major crash deformation modes of automobile structures. Thus, an investigation of energy absorption during bending deformation at high impact velocity for TRIP steel is indispensable. Although TRIP steel have particularly attracted the recent interest of the scientific community, just few studies can be found on the energy absorption characteristic of TRIP steel, especially at impact loading condition. In present study, experimental investigations of bending deformation behaviors of TRIP steel are conducted in the three-point bending tests for both smooth and pre-cracked specimen. Then, energy absorption characteristic during plastic deformation and fracture process at high impact velocity in TRIP steel will be discussed.

Elementary school children's science learning from school field trips

NASA Astrophysics Data System (ADS)

Glick, Marilyn Petty

This research examines the impact of classroom anchoring activities on elementary school students' science learning from a school field trip. Although there is prior research demonstrating that students can learn science from school field trips, most of this research is descriptive in nature and does not examine the conditions that enhance or facilitate such learning. The current study draws upon research in psychology and education to create an intervention that is designed to enhance what students learn from school science field trips. The intervention comprises of a set of "anchoring" activities that include: (1) Orientation to context, (2) Discussion to activate prior knowledge and generate questions, (3) Use of field notebooks during the field trip to record observations and answer questions generated prior to field trip, (4) Post-visit discussion of what was learned. The effects of the intervention are examined by comparing two groups of students: an intervention group which receives anchoring classroom activities related to their field trip and an equivalent control group which visits the same field trip site for the same duration but does not receive any anchoring classroom activities. Learning of target concepts in both groups was compared using objective pre and posttests. Additionally, a subset of students in each group were interviewed to obtain more detailed descriptive data on what children learned through their field trip.

Urban commuting: crowdedness and catecholamine excretion.

PubMed

Lundberg, U

1976-09-01

Male passengers regularly commuting by train on the Stockholm-Nynäshamn line were investigated on two morning trips to Stockholm. These trips were made under different levels of crowding, before (Trip 1) and after (Trip 2) a period of gas rationing during the oil crisis in 1974. However, seats were available for almost everyone during both trips. One group of subjects boarded the train at its first stop (Nynäshamn), the other midway on its route (Västerhaninge). Physiological reactions were assessed from the rate of catecholamine excretion in urine and subjective experiences were measured by self-ratings. The results showed that feelings of discomfort grew more intense as the train approached Stockholm and the number of passengers increased. Perceived crowdedness increased as the square of the number of passengers. During both trips the subjects from Nynäshamn (longer trip) had a lower rate of adrenaline and noradrenaline excretion on the train than those from Västerhaninge. Furthermore, it was found that the rate of adrenaline excretion was higher for both groups during Trip 2, when the train was more crowded. The results support previous findings indicating that the stress involved in travelling by train varies more with the social and ecological conditions of the trip than with its length or duration.

Time-to-burnout data for a prototypical ITER divertor tube during a simulated loss of flow accident

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

Marshall, T.D.; Watson, R.D.; McDonald, J.M.

The Loss of Flow Accident (LOFA) is a serious safety concern for the International Thermonuclear Experimental Reactor (ITER) as it has been suggested that greater than 100 seconds are necessary to safely shutdown the plasma when ITER is operating at full power. In this experiment, the thermal response of a prototypical ITER divertor tube during a simulated LOFA was studied. The divertor tube was fabricated from oxygen-free high-conductivity copper to have a square geometry with a circular coolant channel. The coolant channel inner diameter was 0.77 cm, the heated length was 4.0 cm, and the heated width was 1.6 cm.more » The mockup did not feature any flow enhancement techniques, i.e., swirl tape, helical coils, or internal fins. One-sided surface heating of the mockup was accomplished through the use of the 30 kW Sandia Electron Beam Test System. After reaching steady state temperatures in the mockup, as determined by two Type-K thermocouples installed 0.5 mm beneath the heated surface, the coolant pump was manually tripped off and the coolant flow allowed to naturally coast down. Electron beam heating continued after the pump trip until the divertor tube`s heated surface exhibited the high temperature transient normally indicative of rapidly approaching burnout. Experimental data showed that time-to-burnout increases proportionally with increasing inlet velocity and decreases proportionally with increasing incident heat flux.« less

Field trips and their effect on student achievement in and attitudes toward science: A comparison of a physical versus a virtual field trip to the Indian River Lagoon

NASA Astrophysics Data System (ADS)

Garner, Lesley Cochran

The purpose of this study was to determine the effect of physical and virtual field trips on students' achievement in estuarine ecology and their attitudes toward science. The study also assessed the effect of students' learning styles, the interaction between group membership and learning styles, and the effect of group membership on students' ability to answer questions at different levels of Bloom's (1956) taxonomy. Working with a convenient sample of 67 freshmen and sophomore non-science majors, students were randomly assigned to one of two treatment groups (physical, n = 32 and virtual, n = 35). Prior to treatment, students' learning styles were determined, students were pre-assessed on the two targeted measures, and all students attended four consecutive, in-class, 75-minute lectures on estuarine ecology and the Indian River Lagoon (IRL). Pre-assessed data indicated no significant differences between the groups on the two dependent measures. On the weekend following the lecture series, the physical field trip group engaged in a set of predetermined activities at the IRL for 2 hours in the morning. Later that afternoon, the virtual field trip group participated in a 2-hour virtual trip to the IRL that exactly matched the physical field trip activities. This virtual trip incorporated the CD-ROM The Living Lagoon: An Electronic Field Trip. Following each trip, students were post-assessed using the same pre-assessment instruments. MANCOVA results indicated no significant differences on all research factors (i.e., group membership, learning style, and group-learning style interaction). Data analysis also revealed that there was no significant effect of group membership on students' ability to answer questions at different levels of Bloom's taxonomy. These findings imply that educators can integrate virtual field trips that are structured in the same manner as their corresponding physical field trips without significantly impacting student achievement or attitudes.

A forest bathing trip increases human natural killer activity and expression of anti-cancer proteins in female subjects.

PubMed

Li, Q; Morimoto, K; Kobayashi, M; Inagaki, H; Katsumata, M; Hirata, Y; Hirata, K; Shimizu, T; Li, Y J; Wakayama, Y; Kawada, T; Ohira, T; Takayama, N; Kagawa, T; Miyazaki, Y

2008-01-01

We previously reported that forest bathing trips enhanced human NK activity, number of NK cells, and intracellular anti-cancer proteins in lymphocytes, and that the increased NK activity lasted for more than 7 days after the trip in male subjects. In the present study, we investigated the effect of forest bathing trip on human NK activity in female subjects. Thirteen healthy nurses, age 25-43 years, professional career 4-18 years, were selected with informed consent. The subjects experienced a three-day/two-night trip to forest fields. On day 1, the subjects walked for two hours in the afternoon in a forest field; on day 2, they walked for two hours each in the morning and afternoon in two different forest fields; and on day 3, the subjects finished the trip and returned to Tokyo after drawing blood and completing a questionnaire. Blood and urine were sampled on the second and third days during the trip, and on days 7 and 30 after the trip. NK activity, numbers of NK and T cells, and granulysin, perforin, and granzymes A/B-expressing lymphocytes in the blood samples, the concentrations of estradiol and progesterone in serum, and the concentrations of adrenaline and noradrenaline in urine were measured. Similar control measurements were made before the trip on a normal working day. The concentrations of phytoncides in the forests were measured. The forest bathing trip significantly increased NK activity and the numbers of NK, perforin, granulysin, and granzymes A/B-expressing cells and significantly decreased the percentage of T cells, and the concentrations of adrenaline and noradrenaline in urine. The increased NK activity lasted for more than 7 days after the trip. Phytoncides, such as alpha-pinene and beta-pinene were detected in forest air. These findings indicate that a forest bathing trip also increased NK activity, number of NK cells, and levels of intracellular anti-cancer proteins in female subjects, and that this effect lasted at least 7 days after the trip. Phytoncides released from trees and decreased stress hormone levels may partially contribute to the increased NK activity.

Effects of a 3-year nurse-based case management in aged patients with acute myocardial infarction on rehospitalisation, mortality, risk factors, physical functioning and mental health. a secondary analysis of the randomized controlled KORINNA study.

PubMed

Kirchberger, Inge; Hunger, Matthias; Stollenwerk, Björn; Seidl, Hildegard; Burkhardt, Katrin; Kuch, Bernhard; Meisinger, Christa; Holle, Rolf

2015-01-01

Home-based secondary prevention programs led by nurses have been proposed to facilitate patients' adjustment to acute myocardial infarction (AMI). The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI. In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models. Three hundred forty patients were allocated to receive case-management (n = 168) or usual care (n = 172). During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI) 0.67-1.19; p = 0.439), blood pressure, cholesterol level, instrumental activities of daily life (IADL) (only for men), and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women), and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group. A nurse-based management among elderly patients with AMI did not significantly affect time to unplanned readmissions or death during a three-year follow-up. However, the results indicate that functional status and malnutrition risk can be improved. Current Controlled Trials ISRCTN02893746.

Variations in first-time caesarean birth between Eastern African immigrants and Australian-born women in public care: A population-based investigation in Victoria.

PubMed

Belihu, Fetene B; Small, Rhonda; Davey, Mary-Ann

2017-06-01

Caesarean section (CS) rates are known to vary by country, migration status and social group. However, little population-based, confounder adjusted evidence exists on caesarean rate for African immigrants in Australia. To investigate disparities in first-time caesarean, mainly unplanned caesarean in labour for women born in Eritrea, Ethiopia, Somalia and Sudan relative to Australian-born women in public care. A population-based study of 237 943 Australian and 4057 Eastern African singleton births between 1999 and 2007, was conducted using Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis by parity, adjusting for confounders selected a priori, was performed for first-time unplanned caesarean in labour and overall caesarean. Primiparae born in each of the Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea adjusted odds ratio (OR adj ) 2.04 95% CI (1.41, 2.97), Ethiopia OR adj 2.08 95% CI (1.62, 2.68), Somalia OR adj 1.62 95% CI (1.25, 2.10) and Sudan OR adj 1.39 95% CI (1.03, 1.87). Similarly, multiparae from Eastern African countries had elevated odds of unplanned caesarean in labour: Eritrea OR adj 2.13 95%CI(1.15, 3.97), Ethiopia OR adj 2.05 95% CI (1.38, 3.03), Somalia OR adj 2.16 95% CI (1.69, 2.77) and Sudan OR adj 1.81 95% CI (1.32, 2.49). The odds of any first-time caesarean (planned or unplanned) were elevated for primiparae born in all countries except Sudan and for multiparae born in Ethiopia and Somalia. We observed substantial variations in a first-time CS between Eastern African and Australian-born women in Victoria, Australia. However, these disparities were unexplained by socio-demographic and clinical risks, suggesting the potential importance of other factors such as communication difficulties, support systems for immigrant pregnant women and possible differences in care. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial.

PubMed

Bell, Susan P; Schnipper, Jeffrey L; Goggins, Kathryn; Bian, Aihua; Shintani, Ayumi; Roumie, Christianne L; Dalal, Anuj K; Jacobson, Terry A; Rask, Kimberly J; Vaccarino, Viola; Gandhi, Tejal K; Labonville, Stephanie A; Johnson, Daniel; Neal, Erin B; Kripalani, Sunil

2016-05-01

Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. Randomized, controlled trial with concealed allocation and blinded outcome assessors Two tertiary care academic medical centers Adults hospitalized with a diagnosis of ACS and/or ADHF. Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported. A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition. A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.

A comparative analysis of readmission rates after outpatient cosmetic surgery.

PubMed

Mioton, Lauren M; Alghoul, Mohammed S; Kim, John Y S

2014-02-01

Despite the increasing scrutiny of surgical procedures, outpatient cosmetic surgery has an established record of safety and efficacy. A key measure in assessing surgical outcomes is the examination of readmission rates. However, there is a paucity of data on unplanned readmission following cosmetic surgery procedures. The authors studied readmission rates for outpatient cosmetic surgery and compared the data with readmission rates for other surgical procedures. The 2011 National Surgical Quality Improvement Program (NSQIP) data set was queried for all outpatient procedures. Readmission rates were calculated for the 5 surgical specialties with the greatest number of outpatient procedures and for the overall outpatient cosmetic surgery population. Subgroup analysis was performed on the 5 most common cosmetic surgery procedures. Multivariate regression models were used to determine predictors of readmission for cosmetic surgery patients. The 2879 isolated outpatient cosmetic surgery cases had an associated 0.90% unplanned readmission rate. The 5 specialties with the highest number of outpatient surgical procedures were general, orthopedic, gynecologic, urologic, and otolaryngologic surgery; their unplanned readmission rates ranged from 1.21% to 3.73%. The 5 most common outpatient cosmetic surgery procedures and their associated readmission rates were as follows: reduction mammaplasty, 1.30%; mastopexy, 0.31%; liposuction, 1.13%; abdominoplasty, 1.78%; and breast augmentation, 1.20%. Multivariate regression analysis demonstrated that operating time (in hours) was an independent predictor of readmission (odds ratio, 1.40; 95% confidence interval, 1.08-1.81; P=.010). Rates of unplanned readmission with outpatient cosmetic surgery are low and compare favorably to those of other outpatient surgeries.

Out of the blue: Untangling the association between impulsivity and planning in self-harm.

PubMed

Rawlings, Jodie; Shevlin, Mark; Corcoran, Rhiannon; Morriss, Richard; Taylor, Peter James

2015-09-15

Planned and unplanned acts of self-harm may have distinct clinical and psychological correlates. Trait impulsivity is one factor that might be expected to determine whether self-harm is planned. Research so far has focussed on suicide attempts and little is known about how individuals engaging in planned and unplanned acts of self-harm differ. The aim of the current study was to examine how individuals who report planned self-harm, unplanned self-harm, and no self-harm differ in terms of impulsivity and affective symptoms (depression, anxiety, and activated mood). An online survey of University students (n = 1350) was undertaken including measures of impulsivity, affective symptoms and self-harm. Analyses made use of a multinomial logistic regression model with affective and cognitive forms of impulsivity estimated as latent variables. Trait affective impulsivity, but not cognitive, was a general risk factor for whether self-harm occurred. There was no evidence of differences between planned and unplanned self-harm. Affective symptoms of depression and anxiety mediated the relationship between affective impulsivity and self-harm. The study was cross-sectional, relied on a student sample which may not generalise to other populations. Trait affective impulsivity is associated with self-harm but it appears to be mediated by depression and anxiety symptoms. The exact relationships between trait affective impulsivity, depression, anxiety and self-harm require further longitudinal research in clinical populations but might lead to improved risk assessment and new therapeutic approaches to self-harm. Copyright © 2015 Elsevier B.V. All rights reserved.

Time to CUSUM: simplified reporting of outcomes in colorectal surgery.

PubMed

Bowles, Thomas A; Watters, David A

2007-07-01

Surgical audit has added value when outcomes can be compared and individual surgeons receive feedback. It is expected that surgeons compare their results with others in similar local practice, the published work, or peers from a craft group audit. Although feedback and comparison are worthy aims, for many surgeons the standards have not been agreed nor is there a craft group audit. The aim of this paper was to develop a reporting format for surgeons carrying out colorectal surgery in a regional hospital. The performance of 13 individual surgeons was analysed using a comprehensive colorectal audit with more than 600 cases. Feedback included caseload and type. Risk stratification of outcomes included; operation urgency, age and Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity. Outcome measures were anastomotic leaks, end stoma rates, unplanned reoperations and mortality. Visual feedback included cumulative summation graphs for elective leaks, mortality and unplanned reoperations. A single A4 page of an individuals performance could be prepared that allowed comparison to the groups data overall. Alerts were set at 2-5% elective leaks, 4-7.5% mortality and 4-11% unplanned return to theatre. Cumulative summation graphs added to this allowed a visual guide to the key performance indicators. Surgeons need to determine how they will review their individual and collective results. These are equally important to the reported work. Detailed analysis of risk-stratified data should occur. Binary outcomes such as leak, mortality and unplanned reoperations may be followed by cumulative summation graphs. This provides a continually updated method of feedback, enabling immediate visual feedback of a surgeon's performance.

Echoes from the Field: An Ethnographic Investigation of Outdoor Science Field Trips

ERIC Educational Resources Information Center

Boxerman, Jonathan Zvi

2013-01-01

As popular as field trips are, one might think they have been well-studied. Nonetheless, field trips have not been heavily studied, and little research has mapped what actually transpires during field trips. Accordingly, to address this research gap, I asked two related research questions. The first question is a descriptive one: What happens on…

26 CFR 49.4264(e)-1 - Round trips.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 16 2011-04-01 2011-04-01 false Round trips. 49.4264(e)-1 Section 49.4264(e)-1... TAXES FACILITIES AND SERVICES EXCISE TAXES Transportation of Persons § 49.4264(e)-1 Round trips. (a) In general. For purposes of the regulations in this subpart, a round trip shall be considered to consist of...

26 CFR 49.4264(e)-1 - Round trips.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 16 2013-04-01 2013-04-01 false Round trips. 49.4264(e)-1 Section 49.4264(e)-1... TAXES FACILITIES AND SERVICES EXCISE TAXES Transportation of Persons § 49.4264(e)-1 Round trips. (a) In general. For purposes of the regulations in this subpart, a round trip shall be considered to consist of...

26 CFR 49.4264(e)-1 - Round trips.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 16 2012-04-01 2012-04-01 false Round trips. 49.4264(e)-1 Section 49.4264(e)-1... TAXES FACILITIES AND SERVICES EXCISE TAXES Transportation of Persons § 49.4264(e)-1 Round trips. (a) In general. For purposes of the regulations in this subpart, a round trip shall be considered to consist of...

49 CFR 236.531 - Trip arm; height and distance from rail.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Trip arm; height and distance from rail. 236.531... Train Stop, Train Control and Cab Signal Systems Rules and Instructions; Roadway § 236.531 Trip arm; height and distance from rail. Trip arm of automatic train stop device when in the stop position shall be...

49 CFR 236.531 - Trip arm; height and distance from rail.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Trip arm; height and distance from rail. 236.531... Train Stop, Train Control and Cab Signal Systems Rules and Instructions; Roadway § 236.531 Trip arm; height and distance from rail. Trip arm of automatic train stop device when in the stop position shall be...

49 CFR 236.531 - Trip arm; height and distance from rail.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Trip arm; height and distance from rail. 236.531... Train Stop, Train Control and Cab Signal Systems Rules and Instructions; Roadway § 236.531 Trip arm; height and distance from rail. Trip arm of automatic train stop device when in the stop position shall be...

49 CFR 236.531 - Trip arm; height and distance from rail.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Trip arm; height and distance from rail. 236.531... Train Stop, Train Control and Cab Signal Systems Rules and Instructions; Roadway § 236.531 Trip arm; height and distance from rail. Trip arm of automatic train stop device when in the stop position shall be...

49 CFR 236.531 - Trip arm; height and distance from rail.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Trip arm; height and distance from rail. 236.531... Train Stop, Train Control and Cab Signal Systems Rules and Instructions; Roadway § 236.531 Trip arm; height and distance from rail. Trip arm of automatic train stop device when in the stop position shall be...

A Contingent Trip Model for Estimating Rail-trail Demand

Treesearch

Carter J. Betz; John C. Bergstrom; J. Michael Bowker

2003-01-01

The authors develop a contingent trip model to estimate the recreation demand for and value of a potential rail-trail site in north-east Georgia. The contingent trip model is an alternative to travel cost modelling useful for ex ante evaluation of proposed recreation resources or management alternatives. The authors estimate the empirical demand for trips using a...

Valuation of travel time savings in viewpoint of WTA.

PubMed

Shao, Chang-Qiao; Liu, Yang; Liu, Xiao-Ming

2014-01-01

In order to investigate the issues in measurement of value of travel time savings (VTTS), the willingness-to-accept (WTA) for the private car owner is studied by using surveyed data. It is convincing that trip purpose, trip length, time savings, cost savings, income, and allowance from employee have effects on the WTA. Moreover, influences of these variables are not the same for different trip purposes. For commuting trips, effects of income and allowance from employee are significant while time savings and cost savings are dominated for leisure and shopping trips. It is also found that WTA is much higher than expected which implies that there are a group of drivers who are not prone to switching to other trip modes other than passenger car.

The efficacy of a programme of landslide risk reduction in areas of unplanned housing in the Eastern Caribbean.

PubMed

Anderson, Malcolm G; Holcombe, Elizabeth; Esquivel, Maricarmen; Toro, Joaquin; Ghesquiere, Francis

2010-04-01

Poor countries are disproportionately affected by the cost of disasters. Yet there is evidence of the benefits of seeking to mitigate the impact of a disaster, compared with the costs incurred in 'making good' after a major event has occurred. This article reviews a programme of landslide risk reduction in unplanned communities in the Eastern Caribbean. The construction of appropriate surface water management measures, based on the application of scientific and engineering principles, has been demonstrated to reduce the hazard from rainfall-triggered landslides. Adopting a community-based approach additionally delivers social and environmental benefits relating to employment generation, improvements in the environmental conditions within the community, and improvements slope management practices. The sustained implementation of the community-based projects has provided the necessary evidence-base for these practices to influence Government policy and practice, and gain recognition from regional development agencies. The strategic and incremental uptake of the community-based methodology is demonstrated to be an effective means for delivering physical landslide risk reduction measures in the most 'at risk' areas of unplanned housing.

Sexual violence as a risk factor for family planning-related outcomes among young Burundian women.

PubMed

Elouard, Yajna; Weiss, Carine; Martin-Hilber, Adriane; Merten, Sonja

2018-01-01

The study aimed to examine associations between experience of sexual violence and family planning-related outcomes. A multi-stage cluster survey was conducted among a representative sample of 744 young women aged 15-24 in eight provinces in Burundi. The prevalence of young women who reported having ever been physically forced to have sexual intercourse was 26.1%. Young women who had experienced sexual violence (ever) were 2.5 times more likely not to have used any modern contraceptives in the 12 months preceding the survey. They were also 2.3 times more likely to report that their last pregnancy was unplanned. Higher odds of not being able to negotiate contraceptive use with their partners were only reported by young women having experienced sexual violence in the 12 months prior to the survey when adjusted for confounders. Sexual violence was found to be significantly associated with contraceptive negotiation and use as well as unplanned pregnancy. Weak perceived ability to negotiate contraceptive use highlights gender inequalities leaving young women vulnerable to unprotected sex and thus unplanned pregnancies.

Cranking Out Adventure: A Bike Leader's Guide to Trial and Error Touring.

ERIC Educational Resources Information Center

Rohnke, Karl

The product of a 3,355 mile bicycle trip involving a co-ed group of teenagers and a leader (N=12), this guide to bike riding trips presents practical and philosophical insights gained by the Project Adventure leader who conducted the trip. Detailed lists of pre- and on-trip requirements are presented. Specifically, there are sections devoted to…

Affective and cognitive effects of information use over the course of a vacation

Treesearch

Christine A. Vogt; Susan I. Stewart

1998-01-01

From pre-trip planning through post-trip remembering, vacations unfold over long periods of time. Through the course of a trip the same travel information may be used repeatedly but with different levels of success and satisfaction. These experiential fluctuations over time were examined in a study of trip planners, who collected information from a chamber of commerce...

Field trip guide to the 2010 Schultz Fire Burn Area

Treesearch

Karen Koestner; Anne Youberg; Daniel G. Neary

2011-01-01

This field trip guide was created for a September 18th, 2011, field trip to the 2010 Schultz Fire burn area northeast of Flagstaff, Arizona, as part of the Arizona Hydrological Society's Annual Symposium. The guide provides background information on the 2010 Schultz Fire and aftermath (Section 1), site-specific information for each stop on the field trip (Section...

The Effectiveness of a Virtual Field Trip (VFT) Module in Learning Biology

ERIC Educational Resources Information Center

Haris, Norbaizura; Osman, Kamisah

2015-01-01

Virtual Field Trip is a computer aided module of science developed to study the Colonisation and Succession in Mangrove Swamps, as an alternative to the real field trip in Form for Biology. This study is to identify the effectiveness of the Virtual Field Trip (VFT) module towards the level of achievement in the formative test for this topic. This…

Relationship between Objectively Measured Transportation Behaviors and Health Characteristics in Older Adults.

PubMed

Takemoto, Michelle; Carlson, Jordan A; Moran, Kevin; Godbole, Suneeta; Crist, Katie; Kerr, Jacqueline

2015-10-30

This study used objective Global Positioning Systems (GPS) to investigate the relationship between pedestrian and vehicle trips to physical, cognitive, and psychological functioning in older adults living in retirement communities. Older adults (N = 279; mean age = 83 ± 6 years) wore a GPS and accelerometer for 6 days. Participants completed standard health measures. The Personal Activity and Location Measurement System (PALMS) was used to calculate the average daily number of trips, distance, and minutes traveled for pedestrian and vehicle trips from the combined GPS and accelerometer data. Linear mixed effects regression models explored relationships between these transportation variables and physical, psychological and cognitive functioning. Number, distance, and minutes of pedestrian trips were positively associated with physical and psychological functioning but not cognitive functioning. Number of vehicle trips was negatively associated with fear of falls; there were no other associations between the vehicle trip variables and functioning. Vehicle travel did not appear to be related to functioning in older adults in retirement communities except that fear of falling was related to number of vehicle trips. Pedestrian trips had moderate associations with multiple physical and psychological functioning measures, supporting a link between walking and many aspects of health in older adults.

Operative variables are better predictors of postdischarge infections and unplanned readmissions in vascular surgery patients than patient characteristics.

PubMed

Hicks, Caitlin W; Bronsert, Michael; Hammermeister, Karl E; Henderson, William G; Gibula, Douglas R; Black, James H; Glebova, Natalia O

2017-04-01

Although postoperative readmissions are frequent in vascular surgery patients, the reasons for these readmissions are not well characterized, and effective approaches to their reduction are unknown. Our aim was to analyze the reasons for vascular surgery readmissions and to report potential areas for focused efforts aimed at readmission reduction. The 2012 to 2013 American College of Surgeons National Quality Improvement Program (ACS NSQIP) data set was queried for vascular surgery patients. Multivariable models were developed to analyze risk factors for postdischarge infections, the major drivers of unplanned 30-day readmissions. We identified 86,403 vascular surgery patients for analysis. Thirty-day readmission occurred in 8827 (10%), of which 8054 (91%) were unplanned. Of the unplanned readmissions, 61% (n = 4951) were related to the index vascular surgery procedure. Infectious complications were the most common reason for a surgery-related readmission (1940 [39%]), with surgical site infection being the most common type of infection related to unplanned readmission. Multivariable analysis showed the top five preoperative risk factors for postdischarge infections were the presence of a preoperative open wound, inpatient operation, obesity, work relative value unit, and insulin-dependent diabetes (but not diabetes managed with oral medications). Cigarette smoking was a weak predictor and came in tenth in the mode (overall C index, 0.657). When operative and postoperative factors were included in the model, total operative time was the strongest predictor of postdischarge infectious complications (odds ratio [OR] 1.2 for each 1-hour increase in operative time), followed by presence of a preoperative open wound (OR, 1.5), inpatient operation (OR, 2), obesity (OR, 1.8), and discharge to rehabilitation facility (OR, 1.7; P < .001 for all). Insulin-dependent diabetes, cigarette smoking, dialysis dependence, and female gender were also predictive, albeit with smaller effects (OR, 1.1-1.3 for all; P < .001). The overall fit of the multivariable model was fair (C statistic, 0.686). Infectious complications dominate the reasons for unplanned 30-day readmissions in vascular surgery patients. We have identified preoperative, operative, and postoperative risk factors for these infections with the goal of reducing these complications and thus readmissions. Expected patient risk factors, such as diabetes, obesity, renal insufficiency, and cigarette smoking, were less important in predicting infectious complications compared with operative time, presence of a preoperative open wound, and inpatient operation. Our findings suggest that careful operative planning and expeditious operations may be the most effective approaches to reducing infections and thus readmissions in vascular surgery patients. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Does Strict Adherence to the Ponseti Method Improve Isolated Clubfoot Treatment Outcomes? A Two-institution Review.

PubMed

Miller, Nancy H; Carry, Patrick M; Mark, Bryan J; Engelman, Glenn H; Georgopoulos, Gaia; Graham, Sue; Dobbs, Matthew B

2016-01-01

Despite being recognized as the gold standard in isolated clubfoot treatment, the Ponseti casting method has yielded variable results. Few studies have directly compared common predictors of treatment failure between institutions with high versus low failure rates. We asked: (1) is the provider's rigid adherence to the Ponseti method associated with a lower likelihood of unplanned clubfoot surgery, and (2) at the institution that did not adhere rigidly to Ponseti's principles, are any demographic or treatment-related factors associated with increased likelihood of unplanned clubfoot surgery? After institutional review board approval, a consecutive series of patients with a diagnosis of isolated clubfoot who underwent treatment between January 2003 and December 2007 were identified. At Institution 1, 91 of 133 patients met the eligibility criteria and were followed for a minimum of 2 years compared with 58 of 58 patients at Institution 2. At Institution 1, 16 providers managed care using a conservative casting approach based on the Ponseti method. However, treatment was adapted by the provider(s). At Institution 2, one orthopaedic surgeon managed care with strict adherence to the Ponseti method. Surgical indications at both institutions included the presence of a persistent equinovarus foot position while standing. A chart review was used to collect data related to proportion of patients undergoing unplanned additional treatment for deformity recurrences after Ponseti casting, demographics, and treatment patterns. The proportion of subjects who underwent unplanned major surgical intervention was greater (odds ratio [OR], 51.1; 95% CI, 6.8-384.0; p < 0.001) at Institution 1 (60 of 131, 47%) compared with Institution 2 (two of 91, 2%). There was no difference (p = 0.200) in the proportion of patients who underwent additional casting, repeat tendo Achilles lengthening, and/or anterior tibialis tendon transfer only (minor recurrence) at Institution 1 (nine of 131, 7%) compared with Institution 2 (11 of 91, 13%). At Institution 1, an increase in the number of revision casts (multiple vs no casts, hazard ratio [HR] = 3.9; 95% CI, 2.0-7.6; p < 0.001) and an increase in the number of cast-related complications (multiple vs no complications, HR = 2.8; 95% CI, 1.2-6.7; p = 0.019) were associated with increased risk of major surgery in the multivariate analysis. Rigid commitment to the Ponseti method in the conservative treatment of patients with isolated clubfoot was associated with a lower risk of subsequent unplanned surgical intervention. In addition, clubfoot treatment programs that use a care model that prioritizes continuity in care and dedication to the Ponseti method may decrease the proportion of patients who undergo unplanned surgical intervention. Level III, therapeutic study.

2007 Rocky Mountain Section Friends of the Pleistocene Field Trip - Quaternary Geology of the San Luis Basin of Colorado and New Mexico, September 7-9, 2007

USGS Publications Warehouse

Machette, Michael N.; Coates, Mary-Margaret; Johnson, Margo L.

2007-01-01

Prologue Welcome to the 2007 Rocky Mountain Cell Friends of the Pleistocene Field Trip, which will concentrate on the Quaternary geology of the San Luis Basin of Colorado and New Mexico. To our best knowledge, Friends of the Pleistocene (FOP) has never run a trip through the San Luis Basin, although former trips in the region reviewed the 'Northern Rio Grande rift' in 1987 and the 'Landscape History and Processes on the Pajarito Plateau' in 1996. After nearly a decade, the FOP has returned to the Rio Grande rift, but to an area that has rarely hosted a trip with a Quaternary focus. The objective of FOP trips is to review - in the field - new and exciting research on Quaternary geoscience, typically research being conducted by graduate students. In our case, the research is more topically oriented around three areas of the San Luis Basin, and it is being conducted by a wide range of Federal, State, academic, and consulting geologists. This year's trip is ambitious?we will spend our first day mainly on the Holocene record around Great Sand Dunes National Park and Preserve, the second day on the Quaternary stratigraphy around the San Luis Hills, including evidence for Lake Alamosa and the 1.0 Ma Mesita volcano, and wrap up the trip's third day in the Costilla Plain and Sunshine Valley reviewing alluvial stratigraphy, the history of the Rio Grande, and evidence for young movement on the Sangre de Cristo fault zone. In the tradition of FOP trips, we will be camping along the field trip route for this meeting. On the night before our trip, we will be at the Great Sand Dunes National Park and Preserve's Pinyon Flats Campground, a group facility located about 2 miles north of the Visitors Center. After the first day's trip, we will dine and camp in the Bachus pit, about 3 miles southwest of Alamosa. For the final night (after day 2), we will bed down at La Junta Campground at the Bureau of Land Management (BLM) Wild and Scenic Rivers State Recreation Area, west of Questa, New Mexico, overlooking a majestic canyons of the Rio Grande and Red River. This is the 48th meeting of the Rocky Mountain Section of FOP, which was initiated by Gerry Richmond (USGS-Denver, deceased) in 1952 (see the following table, which lists all the Rocky Mountain Section field trips). The Rocky Mountain Section has been inactive for three years owing to a series of problems, including an unfortunate cancellation of Dennis Dahms' trip to the southern Wind River Range in 2005. Hopefully, this year's trip will provide the logistical initiative and scientific momentum for future Friends of the Pleistocene trips in the Rocky Mountain region.

Visiting a forest, but not a city, increases human natural killer activity and expression of anti-cancer proteins.

PubMed

Li, Q; Morimoto, K; Kobayashi, M; Inagaki, H; Katsumata, M; Hirata, Y; Hirata, K; Suzuki, H; Li, Y J; Wakayama, Y; Kawada, T; Park, B J; Ohira, T; Matsui, N; Kagawa, T; Miyazaki, Y; Krensky, A M

2008-01-01

We previously reported that a forest bathing trip enhanced human NK activity, number of NK cells, and intracellular anti-cancer proteins in lymphocytes. In the present study, we investigated how long the increased NK activity lasts and compared the effect of a forest bathing trip on NK activity with a trip to places in a city without forests. Twelve healthy male subjects, age 35-56 years, were selected with informed consent. The subjects experienced a three-day/two-night trip to forest fields and to a city, in which activity levels during both trips were matched. On day 1, subjects walked for two hours in the afternoon in a forest field; and on day 2, they walked for two hours in the morning and afternoon, respectively, in two different forest fields; and on day 3, the subjects finished the trip and returned to Tokyo after drawing blood samples and completing the questionnaire. Blood and urine were sampled on the second and third days during the trips, and on days 7 and 30 after the trip, and NK activity, numbers of NK and T cells, and granulysin, perforin, and granzymes A/B-expressing lymphocytes in the blood samples, and the concentration of adrenaline in urine were measured. Similar measurements were made before the trips on a normal working day as the control. Phytoncide concentrations in forest and city air were measured. The forest bathing trip significantly increased NK activity and the numbers of NK, perforin, granulysin, and granzyme A/B-expressing cells and significantly decreased the concentration of adrenaline in urine. The increased NK activity lasted for more than 7 days after the trip. In contrast, a city tourist visit did not increase NK activity, numbers of NK cells, nor the expression of selected intracellular anti-cancer proteins, and did not decrease the concentration of adrenaline in urine. Phytoncides, such as alpha-pinene and beta-pinene were detected in forest air, but almost not in city air. These findings indicate that a forest bathing trip increased NK activity, number of NK cells, and levels of intracellular anti-cancer proteins, and that this effect lasted at least 7 days after the trip. Phytoncides released from trees and decreased stress hormone may partially contribute to the increased NK activity.

Factors Which Influence Learning Ability during a Scientific Field Trip in a Natural Environment.

ERIC Educational Resources Information Center

Orion, Nir; Hofstein, Avi

The main goal of this study was to obtain insight about the factors that influence students' ability to learn during a field trip, in order to improve the planning and execution of learning field trips. The study was conducted in the context of a 1-day geological field trip for high school students in Israel. Three domains were tested by…

41 CFR 302-5.8 - How many househunting trips may my agency authorize in connection with a particular transfer?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false How many househunting trips may my agency authorize in connection with a particular transfer? 302-5.8 Section 302-5.8 Public... EXPENSES Employee's Allowance For Househunting Trip Expenses § 302-5.8 How many househunting trips may my...

A Trip to the Zoo: Children's Words and Photographs.

ERIC Educational Resources Information Center

DeMarie, Darlene

Field trips are a regular part of many programs for young children. Field trips can serve a variety of purposes, such as exposing children to new things or helping children to see familiar things in new ways. The purpose of this study was to learn the meaning children gave to a field trip. Cameras were made available to each of the children in a…

Final Environmental Assessment to Implement the Defense Base Closure and Realignment Commission Recommendations for Shaw Air Force Base, South Carolina

DTIC Science & Technology

2007-07-01

corresponding years. Year 2005 through 2009: VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Year 2010 and beyond: VOCE ... VOCE * DPYII/2000 Nox (tons/yr) = NOxE * DPYII/2000 PM10(tons/yr) = PM10E * DPYII/2000 CO (tons/yr) = COE * DPYII/2000 Where: Commercial

Ambient and microenvironmental particles and exhaled nitric oxide before and after a group bus trip.

PubMed

Adar, Sara Dubowsky; Adamkiewicz, Gary; Gold, Diane R; Schwartz, Joel; Coull, Brent A; Suh, Helen

2007-04-01

Airborne particles have been linked to pulmonary oxidative stress and inflammation. Because these effects may be particularly great for traffic-related particles, we examined associations between particle exposures and exhaled nitric oxide (FE(NO)) in a study of 44 senior citizens, which involved repeated trips aboard a diesel bus. Samples of FE(NO) collected before and after the trips were regressed against microenvironmental and ambient particle concentrations using mixed models controlling for subject, day, trip, vitamins, collection device, mold, pollen, room air nitric oxide, apparent temperature, and time to analysis. Although ambient concentrations were collected at a fixed location, continuous group-level personal samples characterized microenvironmental exposures throughout facility and trip periods. In pre-trip samples, both microenvironmental and ambient exposures to fine particles were positively associated with FE(NO). For example, an interquartile increase of 4 microg/m(3) in the daily microenvironmental PM(2.5) concentration was associated with a 13% [95% confidence interval (CI), 2-24%) increase in FE(NO). After the trips, however, FE(NO) concentrations were associated pre-dominantly with microenvironmental exposures, with significant associations for concentrations measured throughout the whole day. Associations with exposures during the trip also were strong and statistically significant with a 24% (95% CI, 15-34%) increase in FE(NO) predicted per interquartile increase of 9 microg/m(3) in PM(2.5). Although pre-trip findings were generally robust, our post-trip findings were sensitive to several influential days. Fine particle exposures resulted in increased levels of FE(NO) in elderly adults, suggestive of increased airway inflammation. These associations were best assessed by microenvironmental exposure measurements during periods of high personal particle exposures.

Ambient and Microenvironmental Particles and Exhaled Nitric Oxide Before and After a Group Bus Trip

PubMed Central

Adar, Sara Dubowsky; Adamkiewicz, Gary; Gold, Diane R.; Schwartz, Joel; Coull, Brent A.; Suh, Helen

2007-01-01

Objectives Airborne particles have been linked to pulmonary oxidative stress and inflammation. Because these effects may be particularly great for traffic-related particles, we examined associations between particle exposures and exhaled nitric oxide (FENO) in a study of 44 senior citizens, which involved repeated trips aboard a diesel bus. Methods Samples of FENO collected before and after the trips were regressed against microenvironmental and ambient particle concentrations using mixed models controlling for subject, day, trip, vitamins, collection device, mold, pollen, room air nitric oxide, apparent temperature, and time to analysis. Although ambient concentrations were collected at a fixed location, continuous group-level personal samples characterized microenvironmental exposures throughout facility and trip periods. Results In pre-trip samples, both microenvironmental and ambient exposures to fine particles were positively associated with FENO. For example, an interquartile increase of 4 μg/m3 in the daily microenvironmental PM2.5 concentration was associated with a 13% [95% confidence interval (CI), 2–24%) increase in FENO. After the trips, however, FENO concentrations were associated pre-dominantly with microenvironmental exposures, with significant associations for concentrations measured throughout the whole day. Associations with exposures during the trip also were strong and statistically significant with a 24% (95% CI, 15–34%) increase in FENO predicted per interquartile increase of 9 μg/m3 in PM2.5. Although pre-trip findings were generally robust, our post-trip findings were sensitive to several influential days. Conclusions Fine particle exposures resulted in increased levels of FENO in elderly adults, suggestive of increased airway inflammation. These associations were best assessed by microenvironmental exposure measurements during periods of high personal particle exposures. PMID:17450216

Household-based trip survey procedure

DOT National Transportation Integrated Search

1993-02-22

This memorandum describes the development of interim trip production cross-classification models for four home-based trip purposes: home-based work (HBW), home-based shopping and personal business (HBPB), home-based social and recreational (HBSR), an...

Trip generation studies for special generators.

DOT National Transportation Integrated Search

2010-02-01

This research examines the effects of town centers and senior housing developments on : surrounding roadways and nearby transit. The Institute of Transportation Engineers (ITE) : Trip Generation Manual, which determines number of trips produced or at...

Boundary Layer Transition and Trip Effectiveness on an Apollo Capsule in the JAXA High Enthalpy Shock Tunnel (HIEST) Facility

NASA Technical Reports Server (NTRS)

Kirk, Lindsay C.; Lillard, Randolph P.; Olejniczak, Joseph; Tanno, Hideyuki

2015-01-01

Computational assessments were performed to size boundary layer trips for a scaled Apollo capsule model in the High Enthalpy Shock Tunnel (HIEST) facility at the JAXA Kakuda Space Center in Japan. For stagnation conditions between 2 MJ/kg and 20 MJ/kg and between 10 MPa and 60 MPa, the appropriate trips were determined to be between 0.2 mm and 1.3 mm high, which provided kappa/delta values on the heatshield from 0.15 to 2.25. The tripped configuration consisted of an insert with a series of diamond shaped trips along the heatshield downstream of the stagnation point. Surface heat flux measurements were obtained on a capsule with a 250 mm diameter, 6.4% scale model, and pressure measurements were taken at axial stations along the nozzle walls. At low enthalpy conditions, the computational predictions agree favorably to the test data along the heatshield centerline. However, agreement becomes less favorable as the enthalpy increases conditions. The measured surface heat flux on the heatshield from the HIEST facility was under-predicted by the computations in these cases. Both smooth and tripped configurations were tested for comparison, and a post-test computational analysis showed that kappa/delta values based on the as-measured stagnation conditions ranged between 0.5 and 1.2. Tripped configurations for both 0.6 mm and 0.8 mm trip heights were able to effectively trip the flow to fully turbulent for a range of freestream conditions.

Methods for analysis of passenger trip performance in a complex networked transportation system

NASA Astrophysics Data System (ADS)

Wang, Danyi

2007-12-01

The purpose of the Air Transportation System (ATS) is to provide safe and efficient transportation service of passengers and cargo. The on-time performance of a passenger's trip is a critical performance measurement of the Quality of Service (QOS) provided by any Air Transportation System. QOS has been correlated with airline profitability, productivity, customer loyalty and customer satisfaction (Heskett et al. 1994). Btatu and Barnhart have shown that official government and airline on-time performance metrics (i.e. flight-centric measures of air transportation) fail to accurately reflect the passenger experience (Btatu and Barnhart, 2005). Flight-based metrics do not include the trip delays accrued by passengers who were re-booked due to cancelled flights or missed connections. Also, flight-based metrics do not quantify the magnitude of the delay (only the likelihood) and thus fails to provide the consumer with a useful assessment of the impact of a delay. Passenger-centric metrics have not been developed because of the unavailability of airline proprietary data, which is also protected by anti-trust collusion concerns and civil liberty privacy restrictions. Moveover, the growth of the ATS is trending out of the historical range. The objectives of this research were to (1) estimate ATS-wide passenger trip delay using publicly accessible flight data, and (2) investigate passenger trip dynamics out of the range of historical data by building a passenger flow simulation model to predict impact on passenger trip time given anticipated changes in the future. The first objective enables researchers to conduct historical analysis on passenger on-time performance without proprietary itinerary data, and the second objective enables researchers to conduct experiments outside the range of historic data. The estimated passenger trip delay was for 1,030 routes between the 35 busiest airports in the United States in 2006. The major findings of this research are listed as follows: 1. High passenger trip delays are disproportionately generated by cancelled flights and missed connections. Passengers scheduled on cancelled flights or missed connections represent 3 percent of total enplanements, but generated 45 percent of total passenger trip delay. On average, passengers scheduled on cancelled flights experienced 607 minutes delay, and passengers who missed the connections experienced 341 minutes delay in 2006. The heavily skewed distribution of passenger trip delay reveals the fact that a small proportion of passengers experience heavy delays, which can not be reflected by flight-based performance metrics. 2. Trend analysis for passenger trip delays from 2000 to 2006 shows the increase in flight operations slowed down and leveled off in 2006, while enplanements kept increasing. This is due to the continuous increase in load factor. Load factor has increased from 69% in 2003 to 80% in 2006. Passenger performance is very sensitive to changes in flight operations: annual total passenger trip delay was increased by 17% and 7% from 2004 to 2005, and from 2005 to 2006, while flight operations barely increased (0.5% from 2004 to 2005, and no increase from 2005 to 2006) during the same time period. 3. Passenger trip delay is shown to have an asymmetric performance of passenger trip delay in terms of routes. Seventeen percent of the 1030 routes generated 50 percent of total passenger trip delays. An interesting observation is that routes between the New York metropolitan area and the Washington D.C. metropolitan area have the highest average passenger trip delays in the system. 4. In terms of airports, there is also an asymmetric performance of passenger trip delay. Nine of the 35 busiest airports generated 50 percent of total passenger trip delays. Some airports, especially major hubs, impact the passenger trip delays significantly more than others. Recognition of this asymmetric performance can help reduce the total passenger trip delay propagation in the air transportation network by making changes primarily in major airports, such as Atlanta, GA (ATL), Chicago O'Hare (ORD) and Newark (EWR) airports. 5. Congestion Flight Delay, Load Factor, Flight Cancellation Time, and Airline Cooperation Policy are the most significant factors affecting total passenger trip delay in the system.

Evidence, explanations, and recommendations for teachers' field trip strategies

NASA Astrophysics Data System (ADS)

Rebar, Bryan

Field trips are well recognized by researchers as an educational approach with the potential to complement and enhance classroom science teaching by exposing students to unique activities, resources, and content in informal settings. The following investigation addresses teachers' field trip practices in three related manuscripts: (1) A study examining the details of teachers' pedagogical strategies intended to facilitate connections between students' experiences and the school curricula while visiting an aquarium; (2) A study documenting and describing sources of knowledge that teachers draw from when leading field trips to an aquarium; (3) A position paper that reviews and summarizes research on effective pedagogical strategies for field trips. Together these three pieces address key questions regarding teachers' practices on field trips: (1) What strategies are teachers employing (and not employing) during self-guided field trips to facilitate learning tied to the class curriculum? (2) What sources of knowledge do teachers utilize when leading field trips? (3) How can teachers be better prepared to lead trips that promote learning? The Oregon Coast Aquarium served as the field trip site for teachers included in this study. The setting suited these questions because the aquarium serves tens of thousands of students on field trips each year but provides no targeted programming for these students as they explore the exhibits. In other words, the teachers who lead field trips assume much of the responsibility for facilitating students' experience. In order to describe and characterize teachers' strategies to link students' experiences to the curriculum, a number of teachers (26) were observed as they led their students' visit to the public spaces of the aquarium. Artifacts, such as worksheets, used during the visit were collected for analysis as well. Subsequently, all teachers were surveyed regarding their use of the field trip and their sources of knowledge for their practices. A subset of eight teachers were interviewed using guided conversations in order to shed further light on their use of the aquarium field trip and their pedagogical preparation. Data from all sources were organized by repeating ideas relevant to the questions of interest. The resulting evidence was interpreted to support distinct categories of teacher strategies and experience and related claims about these strategies and experiences. Thus, findings reveal that teachers attempt to link the curriculum to the activities, resources, and content encountered on the trip using a variety of connections. However, these curriculum connections are characterized as products of opportunistic situations and reveal limited depth. Evidence further indicates that teachers treat the aquarium visit as a background experience for their students rather than as an opportunity to introduce new concepts or do an activity that is integrated into the curriculum. Nevertheless, teachers included in this study were leading field trips that created countless learning opportunities for their students. Because training specific to field trips is rarely included in preservice programs, teachers were asked about influences on their field trip practice with specific focus on observed strategies. Findings suggest four categories of training experiences that teachers apply to their practice: (1) informal mentoring; (2) past experience trip leading; (3) outdoor education training; (4) traditional education training. Overall findings along with a review of previous research are suggestive of many ways in which efforts to enhance students' learning opportunities may be developed by means of support for teachers. Foremost among recommendations is the idea that field trip pedagogy be integrated into science methods courses required for preservice teachers (the premise for the final manuscript). Furthermore, the findings of this study may serve as a starting point for museums interested in the development of specific support and teacher professional development activities intended to enhance teachers' use of their resources as learning opportunities for their students. Among the implications is the idea that museums and other institutions developing teacher professional development activities might capitalize on teachers' existing sources of knowledge, for example by providing structured support for peer-mentoring and guided reflections related to field trip preparations and skills.

Field Guide to the Geology of Parts of the Appalachian Highlands and Adjacent Interior Plains.

ERIC Educational Resources Information Center

McKenzie, Garry D.; Utgard, Russell O.

This field guide is the basis for a five-day, 1000-mile trip through six states and six geomorphic provinces. The trip and the pre- and post-trip exercises included in the guide constitute a three credit course at The Ohio State University entitled "Field Geology for Science Teachers." The purpose of the trip is to study the regional geology,…

Determination of Biology Department Students' Past Field Trip Experiences and Examination of Their Self-Efficacy Beliefs in Planning and Organising Educational Field Trips

ERIC Educational Resources Information Center

Bozdogan, Aykut Emre

2015-01-01

The purpose of this study is to determine the past field trip experiences of pre-service teachers who are graduates of Faculty of Sciences, Department of Biology and who had pedagogical formation training certificate and to examine their self-efficacy beliefs in planning and organizing field trips with regard to different variables. The study was…

Factors affecting the value of a wilderness visit: a contingent valuation study of Caribou-Speckled Mountain Wilderness users

Treesearch

Jeffery A. Michael; Stephen Reiling; Hsiang-Tai Cheng

1995-01-01

A dichotomous choice contingent valuation model is estimated using an on-site survey of Caribou-Speckled Mountain Wilderness visitors. The results indicate that pre-trip expectations of various trip attributes such as congestion have a greater impact on a trip?s value than the actual conditions of the visit. This research also shows that future economic studies of an...

The Ruthenostannylene Complex [Cp*(IXy)H2 Ru-Sn-Trip]: Providing Access to Unusual Ru-Sn Bonded Stanna-imine, Stannene, and Ketenylstannyl Complexes.

PubMed

Liu, Hsueh-Ju; Ziegler, Micah S; Tilley, T Don

2015-05-26

Reactivity studies of the thermally stable ruthenostannylene complex [Cp*(IXy)(H)2 Ru-Sn-Trip] (1; IXy=1,3-bis(2,6-dimethylphenyl)imidazol-2-ylidene; Cp*=η(5) -C5 Me5 ; Trip=2,4,6-iPr3 C6 H2 ) with a variety of organic substrates are described. Complex 1 reacts with benzoin and an α,β-unsaturated ketone to undergo [1+4] cycloaddition reactions and afford [Cp*(IXy)(H)2 RuSn(κ(2) -O,O-OCPhCPhO)Trip] (2) and [Cp*(IXy)(H)2 RuSn(κ(2) -O,C-OCPhCHCHPh)Trip] (3), respectively. The reaction of 1 with ethyl diazoacetate resulted in a tin-substituted ketene complex [Cp*(IXy)(H)2 RuSn(OC2 H5 )(CHCO)Trip] (4), which is most likely a decomposition product from the putative ruthenium-substituted stannene complex. The isolation of a ruthenium-substituted stannene [Cp*(IXy)(H)2 RuSn(=Flu)Trip] (5) and stanna-imine [Cp*(IXy)(H)2 RuSn(κ(2) -N,O-NSO2 C6 H4 Me)Trip] (6) complexes was achieved by treatment of 1 with 9-diazofluorene and tosyl azide, respectively. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Object-based image analysis and data mining for building ontology of informal urban settlements

NASA Astrophysics Data System (ADS)

Khelifa, Dejrriri; Mimoun, Malki

2012-11-01

During recent decades, unplanned settlements have been appeared around the big cities in most developing countries and as consequence, numerous problems have emerged. Thus the identification of different kinds of settlements is a major concern and challenge for authorities of many countries. Very High Resolution (VHR) Remotely Sensed imagery has proved to be a very promising way to detect different kinds of settlements, especially through the using of new objectbased image analysis (OBIA). The most important key is in understanding what characteristics make unplanned settlements differ from planned ones, where most experts characterize unplanned urban areas by small building sizes at high densities, no orderly road arrangement and Lack of green spaces. Knowledge about different kinds of settlements can be captured as a domain ontology that has the potential to organize knowledge in a formal, understandable and sharable way. In this work we focus on extracting knowledge from VHR images and expert's knowledge. We used an object based strategy by segmenting a VHR image taken over urban area into regions of homogenous pixels at adequate scale level and then computing spectral, spatial and textural attributes for each region to create objects. A genetic-based data mining was applied to generate high predictive and comprehensible classification rules based on selected samples from the OBIA result. Optimized intervals of relevant attributes are found, linked with land use types for forming classification rules. The unplanned areas were separated from the planned ones, through analyzing of the line segments detected from the input image. Finally a simple ontology was built based on the previous processing steps. The approach has been tested to VHR images of one of the biggest Algerian cities, that has grown considerably in recent decades.

Risk factors for unplanned readmissions in older adult trauma patients in Washington State: a competing risk analysis.

PubMed

Fawcett, Vanessa J; Flynn-O'Brien, Katherine T; Shorter, Zeynep; Davidson, Giana H; Bulger, Eileen; Rivara, Frederick P; Arbabi, Saman

2015-03-01

Hospital readmission is a significant contributor to increasing health care use related to caring for older trauma patients. This study was undertaken with the following aims: determine the proportion of older adult trauma patients who experience unplanned readmission, as well as risk factors for these readmissions and identify the most common readmission diagnoses among these patients. We conducted a retrospective cohort study of trauma patients age 55 years and older who survived their hospitalization at a statewide trauma center between 2009 and 2010. Linking 3 statewide databases, nonelective readmission rates were calculated for 30 days, 6 months, and 1 year after index discharge. Competing risk regression was used to determine risk factors for readmission and account for the competing risk of dying without first being readmitted. Subhazard ratios (SHR) are reported, indicating the relative risk of readmission by 30 days, 6 months, and 1 year. The cumulative readmission rates for the 14,536 participants were 7.9%, 18.9%, and 25.2% at 30 days, 6 months, and 1 year, respectively. In multivariable models, the strongest risk factors for readmission at 1 year (based on magnitude of SHR) were severe head injury (adjusted SHR = 1.47; 95% CI, 1.24-1.73) and disposition to a skilled nursing facility (SHR = 1.54; 95% CI, 1.39-1.71). The diagnoses most commonly associated with readmission were atrial fibrillation, anemia, and congestive heart failure. In this statewide study, unplanned readmissions after older adult trauma occurred frequently up to 1 year after discharge, particularly for patients who sustained severe head trauma and who could not be discharged home independently. Examining common readmission diagnoses might inform the development of interventions to prevent unplanned readmissions. Copyright © 2015 American College of Surgeons. All rights reserved.

Impact of UK Primary Care Policy Reforms on Short-Stay Unplanned Hospital Admissions for Children With Primary Care-Sensitive Conditions.

PubMed

Cecil, Elizabeth; Bottle, Alex; Sharland, Mike; Saxena, Sonia

2015-01-01

We aimed to assess the impact of UK primary care policy reforms implemented in April 2004 on potentially avoidable unplanned short-stay hospital admissions for children with primary care-sensitive conditions. We conducted an interrupted time series analysis of hospital admissions for all children aged younger than 15 years in England between April 2000 and March 2012 using data from National Health Service public hospitals in England. The main outcomes were annual short-stay (<2-day) unplanned hospital admission rates for primary care-sensitive infectious and chronic conditions. There were 7.8 million unplanned admissions over the study period. More than one-half (4,144,729 of 7,831,633) were short-stay admissions for potentially avoidable infectious and chronic conditions. The primary care policy reforms of April 2004 were associated with an 8% increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3% annual increasing trend. Policy reforms were not associated with an increase in short-stay admission rates for infectious illness, which were increasing by 5% annually before April 2004. The proportion of primary care-referred admissions was falling before the reforms, and there were further sharp reductions in 2004. The introduction of primary care policy reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions, and with more children being admitted through emergency departments. Short-stay admission rates for primary care-sensitive infectious illness increased more steadily and could be related to lowered thresholds for hospital admission. © 2015 Annals of Family Medicine, Inc.

Objectively assessed physical activity and subsequent health service use of UK adults aged 70 and over: a four to five year follow up study.

PubMed

Simmonds, Bethany; Fox, Kenneth; Davis, Mark; Ku, Po-Wen; Gray, Selena; Hillsdon, Melvyn; Sharp, Debbie; Stathi, Afroditi; Thompson, Janice; Coulson, Joanna; Trayers, Tanya

2014-01-01

To examine the associations between volume and intensity of older peoples' physical activity, with their subsequent health service usage over the following four to five years. A prospective cohort design using baseline participant characteristics, objectively assessed physical activity and lower limb function provided by Project OPAL (Older People and Active Living). OPAL-PLUS provided data on numbers of primary care consultations, prescriptions, unplanned hospital admissions, and secondary care referrals, extracted from medical records for up to five years following the baseline OPAL data collection. OPAL participants were a diverse sample of 240 older adults with a mean age of 78 years. They were recruited from 12 General Practitioner surgeries from low, middle, and high areas of deprivation in a city in the West of England. Primary care consultations, secondary care referrals, unplanned hospital admissions, number of prescriptions and new disease diagnoses were assessed for 213 (104 females) of the original 240 OPAL participants who had either consented to participate in OPAL-PLUS or already died during the follow-up period. In regression modelling, adjusted for socio-economic variables, existing disease, weight status, minutes of moderate-to-vigorous physical activity (MVPA) per day predicted subsequent numbers of prescriptions. Steps taken per day and MVPA also predicted unplanned hospital admissions, although the strength of the effect was reduced when further adjustment was made for lower limb function. Community-based programs are needed which are successful in engaging older adults in their late 70s and 80s in more walking, MVPA and activity that helps them avoid loss of physical function. There is a potential for cost savings to health services through reduced reliance on prescriptions and fewer unplanned hospital admissions.

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

PubMed

Varacallo, Matthew; Mattern, Patrick; Acosta, Jonathan; Toossi, Nader; Denehy, Kevin; Harding, Susan

2018-05-03

To determine the independent risk factors associated with increasing costs and unplanned hospital readmissions in the 90-day episode of care (EOC) for isolated operative ankle fractures at our institution. Retrospective cohort study SETTING:: Level I Trauma Center PATIENTS:: Two hundred ninety-nine patients undergoing open reduction internal fixation (ORIF) for the treatment of an acute, isolated ankle fracture between 2010 and 2015. none MAIN OUTCOME MEASUREMENTS:: Independent risk factors for increasing 90-day EOC costs and unplanned hospital readmission rates. Orthopedic (64.9%) and podiatry (35.1%) patients were included. The mean index admission cost was $14,048.65 ± $5,797.48. Outpatient cases were significantly cheaper compared to inpatient cases ($10,164.22 ± $3,899.61 versus $15,942.55 ± $5,630.85, respectively, p < 0.001).Unplanned readmission rates were 5.4% (16/299) and 6.7% (20/299) at 30- and 90-days, respectively, and were often (13/20, 65.0%) due to surgical site infections. Independent risk factors for unplanned hospital readmissions included treatment by the podiatry service (p = 0.024), and an American Society of Anesthesiologists (ASA) score of ≥ 3 (p = 0.017). Risk factors for increasing total post discharge costs included treatment by the podiatry service (p = 0.011), and male gender (p = 0.046). Isolated operative ankle fractures are a prime target for EOC cost containment strategy protocols. Our institutional cost analysis study suggests that independent financial clinical risk factors in this treatment cohort includes podiatry as the treating surgical service and patients with an ASA score ≥ 3, with the former also independently increasing total post-discharge costs in the 90-day EOC. Outpatient procedures were associated with about a one-third reduction in total costs compared to the inpatient subgroup.

Use of case-time-control design in pharmacovigilance applications: exploration with high-risk medications and unplanned hospital admissions in the Western Australian elderly.

PubMed

Price, Sylvie D; Holman, C D'Arcy J; Sanfilippo, Frank M; Emery, Jon D

2013-11-01

To use a case-time-control design to derive preliminary estimates of unplanned hospitalisations attributable to suspected high-risk medications in elderly Western Australians. Using pharmaceutical claims linked to inpatient and other health records, the study applied a case-time-control design and conditional logistic regression to estimate odds ratios (ORs) for unplanned hospital admissions associated with anticoagulants, antirheumatics, opioids, corticosteroids and four major groups of cardiovascular drugs. Attributable fractions (AFs) were derived from the ORs to estimate the number and proportion of admissions associated with drug exposure. Results were compared with those obtained from a more conventional method using International Classification of Diseases (ICD) external cause codes to identify admissions related to adverse drug events. The study involved 1 899 699 index hospital admissions. Six of the eight drug groups were associated with an increased risk of unplanned hospitalisation, opioids (adjusted OR = 1.81, 95%CI 1.75-1.88; AF = 44.9%) and corticosteroids (1.48, 1.42-1.54; 32.2%) linked with the highest risks. For all six, the estimated number of hospitalisations attributed to the medication in the exposed was higher (two to 31-fold) when derived from the case-time-control design compared with identification from ICD codes. This study provides an alternative approach for identifying potentially harmful medications and suggests that the use of ICD external causes may underestimate adverse drug events. It takes drug exposure into account, can be applied to individual medications and may overcome under-reporting issues associated with conventional methods. The approach shows great potential as part of a post-marketing pharmacovigilance monitoring system in Australia and elsewhere. Copyright © 2013 John Wiley & Sons, Ltd.

Postoperative Care Fragmentation and 30-Day Unplanned Readmissions After Head and Neck Cancer Surgery

PubMed Central

Graboyes, Evan M.; Kallogjeri, Dorina; Saeed, Mohammed J.; Olsen, Margaret A.; Nussenbaum, Brian

2017-01-01

Objectives Post-discharge care fragmentation, readmission to a hospital other than the one performing the surgery, hasn’t been described in head and neck cancer patients. We sought to determine the frequency, risk factors, and outcomes for head and neck cancer patients experiencing post-discharge care fragmentation. Design Retrospective cohort study Methods We analyzed patients in the 2008–2010 California State Inpatient Database with a 30-day unplanned readmission following head and neck cancer surgery. The frequency of post-discharge care fragmentation, patient- and hospital-level risk factors for care fragmentation, readmission diagnosis, and readmission outcomes were determined. Results Of 561 patients with a 30-day unplanned readmission, 210 (37.4%) were readmitted to a hospital other than the one performing the surgery. Surgical hospitalization length of stay ≥ 15 days (OR 1.87; 95% CI 1.13–3.10) and discharge to a care facility (OR 2.85; 95% CI 1.77–4.58) were associated with care fragmentation. Overall, 39.8% of unplanned 30-day readmissions (223/561) were treatment complications and 30.9% of treatment complication readmissions (69/223) occurred at a non-index hospital. Patients with post-discharge care fragmentation had a 2.1-fold increased risk of in-hospital mortality within 30 days of readmission compared to patients readmitted to the index hospital (95% CI 1.04–4.26). Conclusions Post-discharge care fragmentation following head and neck cancer surgery is common, as 37% of readmitted patients, and 31% of patients readmitted with a treatment complication, are readmitted to a hospital other than the surgical hospital. Head and neck cancer patients experiencing care fragmentation are at increased risk of in-hospital mortality within 30 days of readmission. PMID:27740687

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement.

PubMed

McLaughlin, Nancy; Jin, Peng; Martin, Neil A

2015-07-01

Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery. All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated. The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days. This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.

Prevalence of pregnancy experiences and contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia

PubMed Central

2014-01-01

Background This study aimed to investigate the prevalence of pregnancy experience and its association with contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia. Methods A cross-sectional survey was conducted in 2012 among the Kerinchi suburban community. Of the total 3,716 individuals surveyed, young single adults between 18 and 35 years old were questioned with regard to their experience with unplanned pregnancy before marriage. Contraceptive knowledge was assessed by a series of questions on identification of method types and the affectivity of condoms for the prevention of sexually transmitted diseases. Results A total of 226 female and 257 male participants completed the survey. In total, eight female (3.5%) participants reported experience with an unplanned pregnancy before marriage, and five male (1.9 %) participants had the experience of impregnating their partners. The participants had a mean total score of 3.15 (SD = 1.55) for contraceptive knowledge out of a possible maximum score of five. Female participants who had experienced an unplanned pregnancy had a significantly lower contraceptive knowledge score (2.10 ± 1.48) than who had never experienced pregnancy (3.30 ± 1.35), p<0.05. Likewise, male participants who had experienced impregnating their partners had a significantly lower contraceptive knowledge score (1.60 ± 1.50) than those who did not have such experience (3.02 ± 1.59), p<0.05. Conclusion The results showed evidence of premarital unplanned pregnancy among this suburban community. The low level of contraceptive knowledge found in this study indicates the need for educational strategies designed to improve contraceptive knowledge. PMID:25438066

Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery.

PubMed

Graboyes, Evan M; Kallogjeri, Dorina; Saeed, Mohammed J; Olsen, Margaret A; Nussenbaum, Brian

2017-04-01

Postdischarge care fragmentation, readmission to a hospital other than the one performing the surgery, has not been described in head and neck cancer patients. We sought to determine the frequency, risk factors, and outcomes for head and neck cancer patients experiencing postdischarge care fragmentation. Retrospective cohort study. We analyzed patients in the 2008 to 2010 California State Inpatient Database with a 30-day unplanned readmission following head and neck cancer surgery. The frequency of postdischarge care fragmentation, patient- and hospital-level risk factors for care fragmentation, readmission diagnosis, and readmission outcomes were determined. Of 561 patients with a 30-day unplanned readmission, 210 (37.4%) were readmitted to a hospital other than the one performing the surgery. Surgical hospitalization length of stay ≥15 days (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.13-3.10) and discharge to a care facility (OR: 2.85, 95% CI: 1.77-4.58) were associated with care fragmentation. Overall, 39.8% of unplanned 30-day readmissions (223/561) were treatment complications, and 30.9% of treatment complication readmissions (69/223) occurred at a nonindex hospital. Patients with postdischarge care fragmentation had a 2.1-fold increased risk of in-hospital mortality within 30 days of readmission compared to patients readmitted to the index hospital (95% CI: 1.04-4.26). Postdischarge care fragmentation following head an neck cancer surgery is common, as 37% of readmitted patients and 31% of patients readmitted with a treatment complication are readmitted to a hospital other than the surgical hospital. Head and neck cancer patients experiencing care fragmentation are at increased risk of in-hospital mortality within 30 days of readmission. 4. Laryngoscope, 127:868-874, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Designing local solutions for emptying pit latrines in low-income urban settlements (Malawi)

NASA Astrophysics Data System (ADS)

Chipeta, W. C.; Holm, R. H.; Kamanula, J. F.; Mtonga, W. E.; de los Reyes, F. L.

2017-08-01

A lack of effective options in local technology poses challenges when onsite household sanitation facilities are eventually filled to capacity in unplanned settlement areas within Mzuzu City, located in northern Malawi. Vacuum trucks currently dominate the market but focus on emptying septic tanks in the more easily accessible planned settlement areas, rather than servicing the pit latrines common in unplanned settlement areas. As a result, households in the unplanned settlement areas within Mzuzu rely primarily on manual pit emptying (i.e., shoveling by hand) or digging a new pit latrine. These practices have associated health risks and are limited by space constraints. This research focused on filling the technological gap through the design, development, and testing of a pedal powered modified Gulper pump using locally available materials and fabrication. A modified pedal powered Gulper technology was developed and demonstrated to be capable of lifting fecal sludge from a depth of 1.5 m with a mean flow rate of 0.00058 m3/s. If the trash content was low, a typical pit latrine with a volume of 1-4 m3 could be emptied within 1-2 h. Based on the findings in our research Phase IV, the pedal powered Gulper modification is promising as a potential emptying technology for lined pit latrines in unplanned settlement areas. The success rate of the technology is about 17% (5 out 30 sampled lined pit latrines were successful) and reflects the difficulty in finding a single technology that can work well in all types of pit latrines with varying contents. We note that cost should not be the only design criteria and acknowledge the challenge of handling trash in pit latrines.

Unplanned gait termination in individuals with multiple sclerosis.

PubMed

Roeing, Kathleen L; Moon, Yaejin; Sosnoff, Jacob J

2017-03-01

Despite the pervasive nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine unplanned gait termination with and without cognitive distractors in individuals with MS compared to healthy controls. Thirty-one individuals with MS and 14 healthy controls completed a series of unplanned gait termination tasks over a pressure sensitive walkway under distracting and non-distracting conditions. Individuals with MS were further broken down into groups based on assistive device use: (no assistive device (MS noAD ) n=18; and assistive device (MS AD ) n=13). Individuals with MS who walked with an assistive device (MS AD : 67.8±15.1cm/s) walked slower than individuals without an assistive device (MS noAD : 110.4±32.3cm/s, p<0.01) and controls (120.0±30.0cm/s; p<0.01). There was a significant reduction in velocity in the cognitively distracting condition (93.4±32.1cm/s) compared to the normal condition [108.8±36.2cm/s; F(1,43)=3.4, p=0.04]. All participants took longer to stop during the distracting condition (1.7±0.6s) than the non-distracting condition (1.4±0.4s; U=673.0 p<0.01). After controlling for gait velocity, post-hoc analysis revealed the MS AD group took significantly longer to stop compared to the control group (p=0.05). Further research investigating the control of unplanned gait termination in MS is warranted. Copyright © 2017 Elsevier B.V. All rights reserved.

Women’s experiences with unplanned pregnancy and abortion in Kenya: A qualitative study

PubMed Central

Ngui, Felistah Mbithe; Hall, Kelli Stidham; Gerdts, Caitlin

2018-01-01

Background Safe and legal abortions are rarely practiced in the public health sector in Kenya, and rates of maternal mortality and morbidity from unsafe abortion is high. Little is known about women’s experiences seeking and accessing abortion in informal settlements in Nairobi, Kenya. Methods Seven focus group discussions were conducted with a total of 71 women and girls recruited from an informal settlement in Nairobi. The interview guide explored participants’ perceptions of unplanned pregnancy, abortion, and access to sexual and reproductive health information in their community. Thematic analysis of the focus group transcripts was conducted using MAX QDA Release 12. Results Participants described a variety of factors that influence women’s experiences with abortion in their communities. According to participants, limited knowledge of sexual and reproductive health information and lack of access to contraception led to unplanned pregnancy among women in their community. Participants cited stigma and loss of opportunities that women with unplanned pregnancies face as the primary reasons why women seek abortions. Participants articulated stigma as the predominant barrier women in their communities face to safe abortion. Other barriers, which were often interrelated to stigma, included lack of education about safe methods of abortion, perceived illegality of abortion, as well as limited access to services, fear of mistreatment, and mistrust of health providers and facilities. Conclusions Women in informal settlements in Nairobi, Kenya face substantial barriers to regulating their fertility and lack access to safe abortion. Policy makers and reproductive health advocates should support programs that employ harm reduction strategies and increase women’s knowledge of and access to medication abortion outside the formal healthcare system. PMID:29370220

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study.

PubMed

de Bruijne, Martine C; van Rosse, Floor; Uiters, Ellen; Droomers, Mariël; Suurmond, Jeanine; Stronks, Karien; Essink-Bot, Marie-Louise

2013-12-01

Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02-1.08] for other non-Western patients to 1.14 (95% CI 1.07-1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18-1.30) and Surinamese patients (OR 1.11, 95% CI 1.07-1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals' control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.

Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study

PubMed Central

van Rosse, Floor; Uiters, Ellen; Droomers, Mariël; Suurmond, Jeanine; Stronks, Karien; Essink-Bot, Marie-Louise

2013-01-01

Background: Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. Methods: We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. Results: Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02–1.08] for other non-Western patients to 1.14 (95% CI 1.07–1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18–1.30) and Surinamese patients (OR 1.11, 95% CI 1.07–1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. Conclusion: We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals’ control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates. PMID:23388242

Drivers of 30-Day Readmission in Elderly Patients (>65 Years Old) After Spine Surgery: An Analysis of 500 Consecutive Spine Surgery Patients.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Han, Jing; Karikari, Isaac O; Cheng, Joseph; Bagley, Carlos A

2017-01-01

Early readmission after spine surgery is being used as a proxy for quality of care. One-fifth of patients are rehospitalized within 30 days after spine surgery, and more than one-third within 90 days; however, there is a paucity of data about the cause of early readmissions in elderly patients after elective spine surgery. A total of 500 elderly patients (>65 years old) undergoing elective spine surgery at a major academic hospital were included in the study. We identified all unplanned readmissions within 30 days of discharge. Unplanned readmissions were defined to have occurred as a result of either a surgical or a nonsurgical complication. Patient records were reviewed to determine the cause of readmission and the length of hospital stay. A total of 50 (10%) unplanned early readmissions were identified. The mean ± SD age was 72.54 ± 5.84 years. The mean ± SD number of days from discharge to readmission was 11.02 ± 7.25 days, and the average length of hospital stay for the readmissions was 7.7 days. The majority of patients that were readmitted presented to the emergency department from home (46%), whereas 38% were readmitted from a skilled nursing facility. The most common causes for readmission were infection or a concern for infection (42%) and pain (14%), with 32% of readmissions requiring a return to the operating room. Our study suggests that in elderly patients undergoing elective spine surgery, infection or a concern for infection, pain, and altered mental status were the most common primary reasons for unplanned readmission. Copyright © 2016 Elsevier Inc. All rights reserved.

Short-Term Adverse Outcomes After Deep Brain Stimulation Treatment in Patients with Parkinson Disease.

PubMed

Hu, Kejia; Moses, Ziev B; Hutter, Matthew M; Williams, Ziv

2017-02-01

Despite ongoing progress in our understanding of long-term outcomes after neuromodulation procedures, acute adverse outcomes shortly after deep brain stimulation (DBS) treatment have remained remarkably limited. To identify risk factors associated with acute 30-day outcomes after DBS treatment in patients with Parkinson disease (PD). We evaluated patients who underwent DBS treatment for PD from 2005 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program database. We used bivariate analysis and multivariate logistic regression to identify short-term postoperative outcomes, including 30-day complication, discharge destination, and unplanned readmission. Overall, 650 patients with PD underwent DBS procedures and complications were identified in 32 patients (4.9%). Of 481 patients who had complete discharge data, 18 patients (3.7%) were discharged to a facility and 16 patients (3.3%) experienced an unplanned readmission. Patients with PD who were obese (P = 0.045), who had preoperative anemia (P = 0.008), and who experienced longer operative durations (P = 0.01) had increased odds of postoperative complications. Inpatient status (P = 0.001), dependent functional status (P < 0.001), and anemia (P = 0.043) were all associated with discharge to a facility other than home. Longer operative duration (P = 0.013), anemia (P = 0.036), and dependent functional status (P = 0.03) were significantly associated with unplanned readmission. As expected, complications increased the likelihood of unplanned readmission (P < 0.001). This study provides individualized estimates of the risks associated with short-term adverse outcomes based on patient demographics and comorbidities. These data can be used as an adjunct for short-term risk stratification of patients with PD being considered for DBS treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Causes, costs, and risk factors for unplanned return visits after adenotonsillectomy in children.

PubMed

Duval, Melanie; Wilkes, Jacob; Korgenski, Kent; Srivastava, Rajendu; Meier, Jeremy

2015-10-01

To review the causes, costs, and risk factors for unplanned return visits and readmissions after pediatric adenotonsillectomy (T&A). Review of administrative database of outpatient adenotonsillectomy performed at any facility within a vertically integrated health care system in the Intermountain West on children age 1-18 years old between 1998 and 2012. Data reviewed included demographic variables, diagnosis associated with return visit and costs associated with return visits. Data from 39,906 children aged 1-18 years old were reviewed. A total of 2499 (6.3%) children had unplanned return visits. The most common reasons for return visits were bleeding (2.3%), dehydration, (2.3%) and throat pain (1.2%). After multivariate analysis, the main risk factors for any type of return visits were Medicaid insurance (OR=1.64 95% CI 1.47-1.84), Hispanic race (OR=1.36 95% CI 1.13-1.64), and increased severity of illness (SOI) (OR=11.29 95% CI 2.69-47.4 for SOI=3). The only factor associated with increased odds of requiring an inpatient admission on return visit was length of time spent in PACU (p<0.001). A linear relationship was also observed between the child's age and the risk of post-tonsillectomy hemorrhage. Children with increased severity of illness, those insured with Medicaid, and children of Hispanic ethnicity should be targeted with increased education and interventions in order to reduce unplanned visits after T&A. Further studies on post-tonsillectomy complications should include evaluating the effect of surgical technique and post-operative pain management on all complications and not solely post-tonsillectomy hemorrhage. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Hospital readmission risks in older adults following inpatient subacute care: A six-month follow-up study.

PubMed

Lee, Den-Ching A; Williams, Cylie; Lalor, Aislinn F; Brown, Ted; Haines, Terry P

2018-05-09

High rates of unplanned hospital readmissions are a burden on healthcare systems and individuals. This study examined factors at, and after initial hospital discharge and their associations with unplanned hospital readmission for older adults up to six months post-discharge from subacute care. Older subacute care patients were surveyed prior to discharge, and assessed monthly post-discharge for six months. Data included the Geriatric Depression Scale, Phone-Fitt sub-scales, Friendship Scale, modified Lubben Social Network Scale, unplanned hospital readmission, self-reported physical capacity and falls in the last month were collected. Regression analyses were used to examine relationships between unplanned hospital readmission and variables that may predispose this outcome. Participants (n = 311) completed the baseline assessment. N = 218 (70%) completed all at six-month post-discharge. Eighty-nine (29%) participants shared 143 readmissions. Those with cancer history (adjusted OR [95% CI]) (1.97 [1.15, 3.39]), neurological disease other than stroke (2.95 [1.32, 6.57]) and dependence on others to assist in bending tasks (1.94 [1.14, 3.29]) at initial discharge were associated with readmission within six months post-discharge. Those who fell in the last month (adjusted OR [robust 95% CI]) (2.28 [1.43, 3.64]), being less physical active (0.98 [0.96, 0.99]), and dependence on others in moving around residence (2.63 [1.37, 5.06]) after initial discharge were associated with a readmission in the next month within six months post-discharge. Trials investigating the effectiveness of strategies to reduce falls, build physical capacity, increase physical activity level, and connection with health care services after discharge to prevent readmission are warranted. Copyright © 2018 Elsevier B.V. All rights reserved.

Effectiveness of the surgical safety checklist in a high standard care environment.

PubMed

Lübbeke, Anne; Hovaguimian, Frederique; Wickboldt, Nadine; Barea, Christophe; Clergue, François; Hoffmeyer, Pierre; Walder, Bernhard

2013-05-01

Use of surgical safety checklists has been associated with significant reduction in postoperative surgical site infection (SSI), morbidity, and mortality. To evaluate the effectiveness of an intraoperative checklist in high-risk surgical patients in a high standard care environment with long-standing regular perioperative safety control programs. Quasi-experiment pre-post checklist implementation. Surgical patients above 16 years with an American Society of Anesthesiologists (ASA) score 3-5 operated upon at a large tertiary hospital. Unplanned return to operating room for any reason, reoperation for SSI, unplanned admission to intensive care unit, and in-hospital death within 30 days. A total of 609 patients (53% elective, 85% ASA 3, mean age 70 y) were included before and 1818 after implementation (52% elective, 87% ASA 3, mean age 69 y), the latter with 552, 558, and 708 in period I, II, and III, respectively. Comparing preimplementation to postimplementation periods: unplanned return to operating room occurred in 45/609 (7.4%) versus 109/1818 (6.0%) interventions [adjusted risk ratios (RR) 0.82; 95% confidence interval (CI), 0.59-1.14]; reoperation for SSI in 18/609 (3.0%) versus 109/1818 (1.7%) interventions (adjusted RR 0.56; 95% CI, 0.32-1.00); unplanned admission to intensive care unit in 17 (2.8%) versus 48 (2.6%) interventions (adjusted RR 0.90; 95% CI, 0.52-1.55); and in-hospital death occurred in 26 (4.3%) versus 108 (5.9%) patients (adjusted RR 1.44; 95% CI, 0.97-2.14). Checklist use during 77 interventions prevented 1 reoperation for SSI. A trend toward reduced reoperation rates for SSI was observed after checklist implementation in this high standard care environment; no influence on other outcome measures was observed.

Utility of the HARP Diabetes Risk Calculator in Identifying Patients with Type 2 Diabetes at Risk of Unplanned Hospital Presentations.

PubMed

McGrath, Rachel T; Dryden, Justin C; Newlyn, Neroli; Pamplona, Elline; O'Dea, Judy; Hocking, Samantha L; Glastras, Sarah J; Fulcher, Gregory R

2018-03-31

Prevention of hospitalisation is an important aspect of type 2 diabetes (T2D) management. We retrospectively determined the utility of the Hospital Admission Risk Programme (HARP) Diabetes Risk Calculator (HARP tool) in identifying patients with T2D more likely to have unplanned hospital presentations. The HARP tool includes a clinical assessment score (Part A) and a psychosocial and self-management impact score (Part B), and categorises patients into low, medium, high or urgent risk of acute hospitalisation. It was completed for T2D patients attending Royal North Shore Hospital, Sydney in 2013. Within the cohort of 278 patients (age 65.3 ± 10.5 years; 62.9% male; diabetes duration 10.7 ± 6.6 years), 67.3% were classified as low risk, 32.7% as medium risk and none as high or urgent risk. Following adjustment for confounders, a medium HARP score was associated with a 3.1-fold increased risk of unplanned hospital presentations in the subsequent 12 months (95% CI: 1.35 to 7.31; p = 0.008). Part A scores were significantly higher for patients that presented to hospital compared to those that did not (14.2 ± 6.8 vs. 11.4 ± 5.5; p = 0.034), whereas there was no difference in Part B scores (p = 0.860). In patients with low and medium HARP scores, clinical features were more predictive of hospital presentations than certain psychosocial or self-management factors in the cohort. Further studies are required to characterise unplanned hospitalisation in patients with higher HARP scores, or whether additional psychosocial assessments could improve the tool's predictability. This article is protected by copyright. All rights reserved.

Prevalence of pregnancy experiences and contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia.

PubMed

Wong, Li Ping; Atefi, Narges; Majid, Hazreen Abd; Su, Tin Tin

2014-01-01

This study aimed to investigate the prevalence of pregnancy experience and its association with contraceptive knowledge among single adults in a low socio-economic suburban community in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted in 2012 among the Kerinchi suburban community. Of the total 3,716 individuals surveyed, young single adults between 18 and 35 years old were questioned with regard to their experience with unplanned pregnancy before marriage. Contraceptive knowledge was assessed by a series of questions on identification of method types and the affectivity of condoms for the prevention of sexually transmitted diseases. A total of 226 female and 257 male participants completed the survey. In total, eight female (3.5%) participants reported experience with an unplanned pregnancy before marriage, and five male (1.9 %) participants had the experience of impregnating their partners. The participants had a mean total score of 3.15 (SD = 1.55) for contraceptive knowledge out of a possible maximum score of five. Female participants who had experienced an unplanned pregnancy had a significantly lower contraceptive knowledge score (2.10 ± 1.48) than who had never experienced pregnancy (3.30 ± 1.35), p<0.05. Likewise, male participants who had experienced impregnating their partners had a significantly lower contraceptive knowledge score (1.60 ± 1.50) than those who did not have such experience (3.02 ± 1.59), p<0.05. The results showed evidence of premarital unplanned pregnancy among this suburban community. The low level of contraceptive knowledge found in this study indicates the need for educational strategies designed to improve contraceptive knowledge.

Indications for mode of delivery in pregnant women with inflammatory bowel disease

PubMed Central

Burke, Kristin E.; Haviland, Miriam J.; Hacker, Michele R.; Shainker, Scott A.; Cheifetz, Adam S.

2017-01-01

Background Reasons for the increased incidence of cesarean delivery among women with inflammatory bowel disease remain unclear. We assessed cesarean delivery incidence and factors influencing mode of delivery in women with inflammatory bowel disease. Methods We performed a 10-year retrospective cohort study of nulliparous women who delivered a singleton infant at our institution. We compared risk for each mode of delivery in women with Crohn's disease and ulcerative colitis to women without inflammatory bowel disease. We assessed mode of delivery indications for patients with inflammatory bowel disease and whether cesarean deliveries were planned. Results The overall incidence of cesarean delivery among women with Crohn's disease (24/59; 40.7%) was similar to women without inflammatory bowel disease (7868/21805; 36.1%) (RR 1.1 [95% CI: 0.83,1.5]; p=0.46), but was increased in the subgroups with active and inactive perianal disease (RR 2.3; p<0.01). Women with ulcerative colitis had a 1.8-fold increased relative risk of cesarean delivery (41/65; 63.1%) (95% CI 1.5, 2.1; p<0.01), with highest incidence in patients with ileal pouch-anal anastomosis. Forty-nine percent of ulcerative colitis and 66.7% of Crohn's disease cesarean deliveries were unplanned, with only one unplanned delivery performed for active inflammatory bowel disease. Most unplanned deliveries were for arrest of descent/dilation and non-reassuring fetal heart tracings. Seventy-five percent of planned cesarean deliveries were for inflammatory bowel disease-related indications. Conclusions Women with ulcerative colitis and perianal Crohn's disease have an increased incidence of cesarean delivery. At least half of cesarean deliveries are unplanned. PMID:28426453

Measurement and structural invariance of the US version of the Birth Satisfaction Scale-Revised (BSS-R) in a large sample.

PubMed

Martin, Colin R; Hollins Martin, Caroline J; Burduli, Ekaterina; Barbosa-Leiker, Celestina; Donovan-Batson, Colleen; Fleming, Susan E

2017-08-01

The 10-item Birth Satisfaction Scale-Revised (BSS-R) is being increasingly used internationally. The use of the measure and the concept has gathered traction in the United States following the development of a US version of the tool. A limitation of previous studies of the measurement characteristics of the BSS-R is modest sample size. Unplanned pregnancy is recognised as being associated with a range of negative birth outcomes, but the relationship to birth satisfaction has received little attention, despite the importance of birth satisfaction to a range of postnatal outcomes. The current investigation sought to evaluate the measurement characteristics of the BSS-R in a large postpartum sample. Multiple Groups Confirmatory Factor Analysis (MGCFA) was used to evaluate a series of measurement and structural models of the BSS-R to evaluate fundamental invariance characteristics using planned/unplanned pregnancy status to differentiate groups. Complete data from N=2116 women revealed that the US version of the BSS-R offers an excellent fit to data and demonstrates full measurement and structural invariance. Little difference was observed between women on the basis of planned/unplanned pregnancy stratification on measures of birth satisfaction. The established relationship between unplanned pregnancy and negative perinatal outcomes was not found to extend to birth satisfaction in the current study. The BSS-R demonstrated exemplary measurement and structural invariance characteristics. The current study strongly supports the use of the US version of the BSS-R to compare birth satisfaction across different groups of women with theoretical and measurement confidence. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Remote management of heart failure using implantable electronic devices

PubMed Central

Morgan, John M.; Kitt, Sue; Gill, Jas; McComb, Janet M.; Ng, Ghulam Andre; Raftery, James; Roderick, Paul; Seed, Alison; Williams, Simon G.; Witte, Klaus K.; Wright, David Jay; Harris, Scott; Cowie, Martin R.

2017-01-01

Abstract Aims Remote management of heart failure using implantable electronic devices (REM-HF) aimed to assess the clinical and cost-effectiveness of remote monitoring (RM) of heart failure in patients with cardiac implanted electronic devices (CIEDs). Methods and results Between 29 September 2011 and 31 March 2014, we randomly assigned 1650 patients with heart failure and a CIED to active RM or usual care (UC). The active RM pathway included formalized remote follow-up protocols, and UC was standard practice in nine recruiting centres in England. The primary endpoint in the time to event analysis was the 1st event of death from any cause or unplanned hospitalization for cardiovascular reasons. Secondary endpoints included death from any cause, death from cardiovascular reasons, death from cardiovascular reasons and unplanned cardiovascular hospitalization, unplanned cardiovascular hospitalization, and unplanned hospitalization. REM-HF is registered with ISRCTN (96536028). The mean age of the population was 70 years (range 23–98); 86% were male. Patients were followed for a median of 2.8 years (range 0–4.3 years) completing on 31 January 2016. Patient adherence was high with a drop out of 4.3% over the course of the study. The incidence of the primary endpoint did not differ significantly between active RM and UC groups, which occurred in 42.4 and 40.8% of patients, respectively [hazard ratio 1.01; 95% confidence interval (CI) 0.87–1.18; P = 0.87]. There were no significant differences between the two groups with respect to any of the secondary endpoints or the time to the primary endpoint components. Conclusion Among patients with heart failure and a CIED, RM using weekly downloads and a formalized follow up approach does not improve outcomes. PMID:28575235

Teachers as Secondary Players: Involvement in Field Trips to Natural Environments

NASA Astrophysics Data System (ADS)

Alon, Nirit Lavie; Tal, Tali

2017-08-01

This study focused on field trips to natural environments where the teacher plays a secondary role alongside a professional guide. We investigated teachers' and field trip guides' views of the teacher's role, the teacher's actual function on the field trip, and the relationship between them. We observed field trips, interviewed teachers and guides, and administered questionnaires. We found different levels of teacher involvement, ranging from mainly supervising and giving technical help, to high involvement especially in the cognitive domain and sometimes in the social domain. Analysis of students' self-reported outcomes showed that the more students believe their teachers are involved, the higher the self-reported learning outcomes.

Trip generation and data analysis study.

DOT National Transportation Integrated Search

2015-09-01

Through the Trip Generation and Data Analysis Study, the District of Columbia Department of : Transportation (DDOT) is undertaking research to better understand multimodal urban trip generation : at mixed-use sites in the District. The study is helpi...

Special land use trip generation in Virginia.

DOT National Transportation Integrated Search

1981-01-01

Vehicle trip rates at shopping centers, apartment complexes, and subdivisions throughout Virginia were determined from seven-day volume counts. These rates were then compared with rates reported in four recognized sources of trip rate statistics and ...

Transit Reliability Information Program (TRIP) : Final Technical Report

DOT National Transportation Integrated Search

1984-05-01

The Transit Reliability Information Program (TRIP) is a government-initiated program to assist the transit industry in satisfying its need for rail transit car subsystem reliability information. TRIP provided this assistance through the operation of ...

50 CFR 622.43 - Commercial trip limits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ADMINISTRATION, DEPARTMENT OF COMMERCE FISHERIES OF THE CARIBBEAN, GULF OF MEXICO, AND SOUTH ATLANTIC Reef Fish Resources of the Gulf of Mexico § 622.43 Commercial trip limits. Commercial trip limits are limits on the...

Worksite trip reduction model and manual

DOT National Transportation Integrated Search

2004-04-01

According to Institute of Transportation Engineers, assessing the trip reduction claims from transportation demand management (TDM) programs is an issue for estimating future traffic volumes from trip generation data. To help assess those claims, a W...

Transit Reliability Information Program (TRIP) Phase I Report

DOT National Transportation Integrated Search

1981-06-01

The Transit Reliability Information Program (TRIP) is a government initiated program to assist the transit industry in satisfying its need for transit reliability information. TRIP provides this assistance through the operation of a national reliabil...

Inherent Safety Characteristics of Advanced Fast Reactors

NASA Astrophysics Data System (ADS)

Bochkarev, A. S.; Korsun, A. S.; Kharitonov, V. S.; Alekseev, P. N.

2017-01-01

The study presents SFR transient performance for ULOF events initiated by pump trip and pump seizure with simultaneous failure of all shutdown systems in both cases. The most severe cases leading to the pin cladding rupture and possible sodium boiling are demonstrated. The impact of various features on SFR inherent safety performance for ULOF events was analysed. The decrease in hydraulic resistance of primary loop and increase in primary pump coast down time were investigated. Performing analysis resulted in a set of recommendations to varying parameters for the purpose of enhancing the inherent safety performance of SFR. In order to prevent the safety barrier rupture for ULOF events the set of thermal hydraulic criteria defining the ULOF transient processes dynamics and requirements to these criteria were recommended based on achieved results: primary sodium flow dip under the natural circulation asymptotic level and natural circulation rise time.

Spacecraft and mission design for the SP-100 flight experiment

NASA Technical Reports Server (NTRS)

Deininger, William D.; Vondra, Robert J.

1988-01-01

The design and performance of a spacecraft employing arcjet nuclear electric propulsion, suitable for use in the SP-100 Space Reactor Power System (SRPS) Flight Experiment, are outlined. The vehicle design is based on a 93 kW(e) ammonia arcjet system operating at an experimentally measured specific impulse of 1031 s and an efficiency of 42.3 percent. The arcjet/gimbal assemblies, power conditioning subsystem, propellant feed system, propulsion system thermal control, spacecraft diagnostic instrumentation, and the telemetry requirements are described. A 100 kW(e) SRPS is assumed. The spacecraft mass is baselined at 5675 kg excluding the propellant and propellant feed system. Four mission scenarios are described which are capable of demonstrating the full capability of the SRPS. The missions considered include spacecraft deployment to possible surveillance platform orbits, a spacecraft storage mission, and an orbit raising round trip corresponding to possible orbit transfer vehicle (OTV) missions.

Effect of weather on pedestrian trip count and duration: City-scale evaluations using mobile phone application data.

PubMed

Vanky, Anthony P; Verma, Santosh K; Courtney, Theodore K; Santi, Paolo; Ratti, Carlo

2017-12-01

We examined the association between meteorological (weather) conditions in a given locale and pedestrian trips frequency and duration, through the use of locative digital data. These associations were determined for seasonality, urban microclimate, and commuting. We analyzed GPS data from a broadly available activity tracking mobile phone application that automatically recorded 247,814 trips from 5432 unique users in Boston and 257,697 trips from 8256 users in San Francisco over a 50-week period. Generally, we observed increased air temperature and the presence of light cloud cover had a positive association with hourly trip frequency in both cities, regardless of seasonality. Temperature and weather conditions generally showed greater associations with weekend and discretionary travel, than with weekday and required travel. Weather conditions had minimal association with the duration of the trip, once the trip was initiated. The observed associations in some cases differed between the two cities. Our study illustrates the opportunity that emerging technology presents to study active transportation, and exposes new methods to wider consideration in preventive medicine.

Study on the Strain Hardening Behaviors of TWIP/TRIP Steels

NASA Astrophysics Data System (ADS)

Huang, T. T.; Dan, W. J.; Zhang, W. G.

2017-10-01

Due to the complex coupling of twinning-induced plasticity (TWIP), transformation-induced plasticity (TRIP), and dislocation glide in TWIP/TRIP steels, it is difficult as well as essential to build a comprehensive strain hardening model to describe the interactions between different deformation mechanisms ( i.e., deformation twinning, martensitic transformation, and dislocation glide) and the resulted strain hardening behaviors. To address this issue, a micromechanical model is established in this paper to predict the deformation process of TWIP/TRIP steels considering both TWIP and TRIP effects. In the proposed model, the generation of deformation twinning and martensitic transformation is controlled by the stacking fault energy (SFE) of the material. In the thermodynamic calculation of SFE, deformation temperature, chemical compositions, microstrain, and temperature rise during deformation are taken into account. Varied by experimental results, the developed model can predict the stress-strain response and strain hardening behaviors of TWIP/TRIP steels precisely. In addition, the improved strength and enhanced strain hardening in Fe-Mn-C TWIP/TRIP steels due to the increased carbon content is also analyzed, which consists with literature.

Multi-Destination and Multi-Purpose Trip Effects in the Analysis of the Demand for Trips to a Remote Recreational Site

NASA Astrophysics Data System (ADS)

Martínez-Espiñeira, Roberto; Amoako-Tuffour, Joe

2009-06-01

One of the basic assumptions of the travel cost method for recreational demand analysis is that the travel cost is always incurred for a single purpose recreational trip. Several studies have skirted around the issue with simplifying assumptions and dropping observations considered as nonconventional holiday-makers or as nontraditional visitors from the sample. The effect of such simplifications on the benefit estimates remains conjectural. Given the remoteness of notable recreational parks, multi-destination or multi-purpose trips are not uncommon. This article examines the consequences of allocating travel costs to a recreational site when some trips were taken for purposes other than recreation and/or included visits to other recreational sites. Using a multi-purpose weighting approach on data from Gros Morne National Park, Canada, we conclude that a proper correction for multi-destination or multi-purpose trip is more of what is needed to avoid potential biases in the estimated effects of the price (travel-cost) variable and of the income variable in the trip generation equation.

An evaluation of the transferability of cross classification trip generation models.

DOT National Transportation Integrated Search

1978-01-01

This report describes the results of the application in Virginia of the trip generation procedures described in the Federal Highway Administration report entitled Trip Generation Analysis and published in 1975. Cross classification models, disaggrega...

Trip generation studies for special generators : final report, December 2009.

DOT National Transportation Integrated Search

2009-09-01

This research examines the effects of town centers and senior housing developments on surrounding roadways and nearby transit. The Institute of Transportation Engineers (ITE) Trip Generation Manual, which determines number of trips produced or attrac...

Trip generation characteristics of special generators

DOT National Transportation Integrated Search

2010-03-01

Special generators are introduced in the sequential four-step modeling procedure to represent certain types of facilities whose trip generation characteristics are not fully captured by the standard trip generation module. They are also used in the t...

Improved trip generation data for Texas using workplace and special generator surveys : workshop materials.

DOT National Transportation Integrated Search

2014-08-01

Workshop Objectives: : Present Texas Trip Generation Manual : How developed : How it can be used, built upon : Provide examples and discuss : Present Generic WP Attraction Rates : Review Trip Attractions and Advanced Models

Confessions of a Tenured Professor: Knowing Your Place--A "Professor" and "Travel-Writing Teacher" Returns to Scotland on a Study-Abroad Trip

ERIC Educational Resources Information Center

Irvine, Colin

2010-01-01

Colin Irvine shares that being "lashed to the mast" by virtue of his recent tenure, he often finds himself seeking imaginative ways within the profession to turn trips and long weekends into work. This particular trip was one in which he ended up heading off to Scotland with mostly Medieval Studies majors on a study-abroad trip. Having…

Final Environmental Assessment for the Military Family Housing Privatization Initiative

DTIC Science & Technology

2006-09-01

Year 2005 through 2009: VOCE = .016 * Trips NOxE = .015 * Trips PM10E = .0022 * Trips COE = .262 * Trips Appendix A Additional Materials Final...Environmental Assessment Page A-39 Military Family Housing Privatization Initiative Robins Air Force Base, Georgia Year 2010 and beyond: VOCE ...yr) = VOCE * DPYII/2000 NOx (tons/yr) = NOxE * DPYII/2000 PM10 (tons/yr) = PM10E * DPYII/2000 CO (tons/yr) = COE * DPYII/2000 Where: Area of

Colorado geology then and now: following the route of the Colorado Scientific Society's 1901 trip through central Colorado

USGS Publications Warehouse

Simmons, Beth

2013-01-01

In 1901, Charles Van Hise asked Samuel Emmons and Whitman Cross to organize a grand excursion across Colorado as part of the combined meeting of the American Association for the Advancement of Science, GSA, and the Colorado Scientific Society (CSS). This trip replays part of that 10-day excursion across Colorado. Shortened to three days, this trip takes in some of the same sites as the 1901 trip, plus adds others of interest along the route where CSS members are reinventing geological interpretations. The trip will follow the precedent set in 1901; CSS members will serve as “site or stop hosts” in addition to the trip leader and drivers. While walking in the steps of the most famous of our profession we will also see some of the most magnificent scenery of Colorado.

2005 Annual Health Physics Report for HEU Transparency Program

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

Radev, R

2006-04-21

During the 2005 calendar year, LLNL provided health physics support for the Highly Enriched Uranium Transparency Program (HEU-TP) in external and internal radiation protection and technical expertise into matters related to BDMS radioactive sources and Russian radiation safety regulatory compliance. For the calendar year 2005, there were 161 person-trips that required dose monitoring of the U.S. monitors. Of the 161 person-trips, 149 person-trips were SMVs and 12 person-trips were Transparency Monitoring Office (TMO) trips. Additionally, there were 11 monitoring visits by TMO monitors to facilities other than UEIE and 3 to UEIE itself. There were two monitoring visits (source changes)more » that were back to back with 16 monitors. Each of these concurring visits were treated as single person-trips for dosimetry purposes. Counted individually, there were 191 individual person-visits in 2005. The LLNL Safety Laboratories Division provided the dosimetry services for the HEU-TP monitors.« less

Human Factors and Technical Considerations for a Computerized Operator Support System Prototype

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

Ulrich, Thomas Anthony; Lew, Roger Thomas; Medema, Heather Dawne

2015-09-01

A prototype computerized operator support system (COSS) has been developed in order to demonstrate the concept and provide a test bed for further research. The prototype is based on four underlying elements consisting of a digital alarm system, computer-based procedures, PI&D system representations, and a recommender module for mitigation actions. At this point, the prototype simulates an interface to a sensor validation module and a fault diagnosis module. These two modules will be fully integrated in the next version of the prototype. The initial version of the prototype is now operational at the Idaho National Laboratory using the U.S. Departmentmore » of Energy’s Light Water Reactor Sustainability (LWRS) Human Systems Simulation Laboratory (HSSL). The HSSL is a full-scope, full-scale glass top simulator capable of simulating existing and future nuclear power plant main control rooms. The COSS is interfaced to the Generic Pressurized Water Reactor (gPWR) simulator with industry-typical control board layouts. The glass top panels display realistic images of the control boards that can be operated by touch gestures. A section of the simulated control board was dedicated to the COSS human-system interface (HSI), which resulted in a seamless integration of the COSS into the normal control room environment. A COSS demonstration scenario has been developed for the prototype involving the Chemical & Volume Control System (CVCS) of the PWR simulator. It involves a primary coolant leak outside of containment that would require tripping the reactor if not mitigated in a very short timeframe. The COSS prototype presents a series of operator screens that provide the needed information and soft controls to successfully mitigate the event.« less

Studying Geology of Central Texas through Web-Based Virtual Field Trips

NASA Astrophysics Data System (ADS)

Chan, C.; Khan, S. D.; Wellner, J. S.

2007-12-01

Each year over 2500 students, mainly non-science majors, take introductory geology classes at the University of Houston. Optional field trips to Central Texas for these classes provide a unique learning opportunity for students to experience geologic concepts in a real world context. The field trips visit Enchanted Rock, Inks Lake, Bee Cave Road, Lion Mountain, and Slaughter Gap. Unfortunately, only around 10% of our students participate in these field trips. We are developing a web-based virtual field trip for Central Texas to provide an additional effective learning experience for students in these classes. The module for Enchanted Rock is complete and consists of linked geological maps, satellite imagery, digital elevation models, 3-D photography, digital video, and 3-D virtual reality visualizations. The ten virtual stops focus on different geologic process and are accompanied by questions and answers. To test the efficacy of the virtual field trip, we developed a quiz to measure student learning and a survey to evaluate the website. The quiz consists of 10 questions paralleling each stop and information on student attendance on the Central Texas field trip and/or the virtual field trip. From the survey, the average time spent on the website was 26 minutes, and overall the ratings of the virtual field trip were positive. Most noticeably students responded that the information on the website was relevant to their class and that the pictures, figures, and animations were essential to the website. Although high correlation coefficients between responses were expected for some questions (i.e., 0.89 for "The content or text of the website was clear" and "The information on the website was easy to read"), some correlations were less expected: 0.77 for "The number of test questions was appropriate" and "The information on the website was easy to read," and 0.70 for "The test questions reinforced the material presented on the website" and "The information on the website is relevant to my class." These virtual field trips provide an alternative for students who cannot attend the actual field trips. They also allow transfer students to experience these sites before attending upper level field trips, which often return to study these sites in more detail. These modules provide a valuable supplementary experience for all students, as they emphasize skills for which we are presently unable to provide sufficient practice in lecture, fieldtrips, or laboratory. Public access to the field trips is available at: http://geoinfo.geosc.uh.edu/VR/

Identification of new TRIP12 variants and detailed clinical evaluation of individuals with non-syndromic intellectual disability with or without autism

PubMed Central

Lüdecke, H.-J.; Pettersson, M.; Albrecht, B.; Bernier, R. A.; Cremer, K.; Eichler, E. E.; Falkenstein, D.; Gerdts, J.; Jansen, S.; Kuechler, A.; Kvarnung, M.; Lindstrand, A.; Nilsson, D.; Nordgren, A.; Pfundt, R.; Spruijt, L.; Surowy, H. M.; de Vries, B. B. A.; Wieland, T.; Engels, H.; Strom, T. M.; Kleefstra, T.; Wieczorek, D.

2018-01-01

The ubiquitin pathway is an enzymatic cascade including activating E1, conjugating E2, and ligating E3 enzymes, which governs protein degradation and sorting. It is crucial for many physiological processes. Compromised function of members of the ubiquitin pathway leads to a wide range of human diseases, such as cancer, neurodegenerative diseases, and neurodevelopmental disorders. Mutations in the thyroid hormone receptor interactor 12 (TRIP12) gene (OMIM 604506), which encodes an E3 ligase in the ubiquitin pathway, have been associated with autism spectrum disorder (ASD). In addition to autistic features, TRIP12 mutation carriers showed intellectual disability (ID). More recently, TRIP12 was postulated as a novel candidate gene for intellectual disability in a meta-analysis of published ID cohorts. However, detailed clinical information characterizing the phenotype of these individuals was not provided. In this study, we present seven novel individuals with private TRIP12 mutations including two splice site mutations, one nonsense mutation, three missense mutations, and one translocation case with a breakpoint in intron 1 of the TRIP12 gene and clinically review four previously published cases. The TRIP12 mutation-positive individuals presented with mild to moderate ID (10/11) or learning disability [intelligence quotient (IQ) 76 in one individual], ASD (8/11) and some of them with unspecific craniofacial dysmorphism and other anomalies. In this study, we provide detailed clinical information of 11 TRIP12 mutation-positive individuals and thereby expand the clinical spectrum of the TRIP12 gene in non-syndromic intellectual disability with or without ASD. PMID:27848077

Being outside learning about science is amazing: A mixed methods study

NASA Astrophysics Data System (ADS)

Weibel, Michelle L.

This study used a convergent parallel mixed methods design to examine teachers' environmental attitudes and concerns about an outdoor educational field trip. Converging both quantitative data (Environmental Attitudes Scale and teacher demographics) and qualitative data (Open-Ended Statements of Concern and interviews) facilitated interpretation. Research has shown that adults' attitudes toward the environment strongly influence children's attitudes regarding the environment. Science teachers' attitudes toward nature and attitudes toward children's field experiences influence the number and types of field trips teachers take. Measuring teacher attitudes is a way to assess teacher beliefs. The one day outdoor field trip had significant outcomes for teachers. Quantitative results showed that practicing teachers' environmental attitudes changed following the Forever Earth outdoor field trip intervention. Teacher demographics showed no significance. Interviews provided a more in-depth understanding of teachers' perspectives relating to the field trip and environmental education. Four major themes emerged from the interviews: 1) environmental attitudes, 2) field trip program, 3) integrating environmental education, and 4) concerns. Teachers' major concern, addressed prior to the field trip through the Open-Ended Statements of Concern, was focused on students (i.e., behavior, safety, content knowledge) and was alleviated following the field trip. Interpretation of the results from integrating the quantitative and qualitative results shows that teachers' personal and professional attitudes toward the environment influence their decision to integrate environmental education in classroom instruction. Since the Forever Earth field trip had a positive influence on teachers' environmental attitudes, further research is suggested to observe if teachers integrate environmental education in the classroom to reach the overall goal of increasing environmental literacy.

Identification of new TRIP12 variants and detailed clinical evaluation of individuals with non-syndromic intellectual disability with or without autism.

PubMed

Bramswig, Nuria C; Lüdecke, H-J; Pettersson, M; Albrecht, B; Bernier, R A; Cremer, K; Eichler, E E; Falkenstein, D; Gerdts, J; Jansen, S; Kuechler, A; Kvarnung, M; Lindstrand, A; Nilsson, D; Nordgren, A; Pfundt, R; Spruijt, L; Surowy, H M; de Vries, B B A; Wieland, T; Engels, H; Strom, T M; Kleefstra, T; Wieczorek, D

2017-02-01

The ubiquitin pathway is an enzymatic cascade including activating E1, conjugating E2, and ligating E3 enzymes, which governs protein degradation and sorting. It is crucial for many physiological processes. Compromised function of members of the ubiquitin pathway leads to a wide range of human diseases, such as cancer, neurodegenerative diseases, and neurodevelopmental disorders. Mutations in the thyroid hormone receptor interactor 12 (TRIP12) gene (OMIM 604506), which encodes an E3 ligase in the ubiquitin pathway, have been associated with autism spectrum disorder (ASD). In addition to autistic features, TRIP12 mutation carriers showed intellectual disability (ID). More recently, TRIP12 was postulated as a novel candidate gene for intellectual disability in a meta-analysis of published ID cohorts. However, detailed clinical information characterizing the phenotype of these individuals was not provided. In this study, we present seven novel individuals with private TRIP12 mutations including two splice site mutations, one nonsense mutation, three missense mutations, and one translocation case with a breakpoint in intron 1 of the TRIP12 gene and clinically review four previously published cases. The TRIP12 mutation-positive individuals presented with mild to moderate ID (10/11) or learning disability [intelligence quotient (IQ) 76 in one individual], ASD (8/11) and some of them with unspecific craniofacial dysmorphism and other anomalies. In this study, we provide detailed clinical information of 11 TRIP12 mutation-positive individuals and thereby expand the clinical spectrum of the TRIP12 gene in non-syndromic intellectual disability with or without ASD.

Isolation and characterization of an RIP (ribosome-inactivating protein)-like protein from tobacco with dual enzymatic activity.

PubMed

Sharma, Neelam; Park, Sang-Wook; Vepachedu, Ramarao; Barbieri, Luigi; Ciani, Marialibera; Stirpe, Fiorenzo; Savary, Brett J; Vivanco, Jorge M

2004-01-01

Ribosome-inactivating proteins (RIPs) are N-glycosidases that remove a specific adenine from the sarcin/ricin loop of the large rRNA, thus arresting protein synthesis at the translocation step. In the present study, a protein termed tobacco RIP (TRIP) was isolated from tobacco (Nicotiana tabacum) leaves and purified using ion exchange and gel filtration chromatography in combination with yeast ribosome depurination assays. TRIP has a molecular mass of 26 kD as evidenced by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and showed strong N-glycosidase activity as manifested by the depurination of yeast rRNA. Purified TRIP showed immunoreactivity with antibodies of RIPs from Mirabilis expansa. TRIP released fewer amounts of adenine residues from ribosomal (Artemia sp. and rat ribosomes) and non-ribosomal substrates (herring sperm DNA, rRNA, and tRNA) compared with other RIPs. TRIP inhibited translation in wheat (Triticum aestivum) germ more efficiently than in rabbit reticulocytes, showing an IC50 at 30 ng in the former system. Antimicrobial assays using highly purified TRIP (50 microg mL(-1)) conducted against various fungi and bacterial pathogens showed the strongest inhibitory activity against Trichoderma reesei and Pseudomonas solancearum. A 15-amino acid internal polypeptide sequence of TRIP was identical with the internal sequences of the iron-superoxide dismutase (Fe-SOD) from wild tobacco (Nicotiana plumbaginifolia), Arabidopsis, and potato (Solanum tuberosum). Purified TRIP showed SOD activity, and Escherichia coli Fe-SOD was observed to have RIP activity too. Thus, TRIP may be considered a dual activity enzyme showing RIP-like activity and Fe-SOD characteristics.

Oregon statewide transit trip planning evaluation plan

DOT National Transportation Integrated Search

2003-05-09

The Trip Planner is intended to make public transportation of all kinds easier to use by increasing the availability, quality, and amount of information about these services, and improving the ability of travelers to plan a trip, especially using mul...

Simulating household travel survey data in metropolitan areas.

DOT National Transportation Integrated Search

2003-09-01

Census data provide a rich range of socioeconomic characteristics from which it is shown that trip characteristics can be simulated. This report summarizes research into the simulation of the trips and trip characteristics for a random sample of hous...

1977 Nationwide Personal Transportation Study : vehicle occupancy

DOT National Transportation Integrated Search

1981-04-01

This report is part of a series that presents findings from the 1977 Nationwide Personal Transportation Study (NPTS). This report contains average vehicle occupancy rates by trip characteristics (trip purpose, trip length, time of day and day of the ...

A Biomes Field Trip.

ERIC Educational Resources Information Center

Leonard, William H.; And Others

1983-01-01

Describes a field trip designed to give students opportunities to experience relevant data leading to concepts in biogeography. Suggests that teachers (including college instructors) adapt the areas studied and procedures used to their own locations. Includes a suggested field trip handout. (JN)

Multimodal Trip Planner System final evaluation report.

DOT National Transportation Integrated Search

2011-05-01

This evaluation of the Multimodal Trip Planning System (MMTPS) is the culmination of a multi-year project evaluating the development and deployment of a multimodal trip planner in the Chicagoland area between 2004 and 2010. The report includes an ove...

Trip generation at Virginia agritourism land uses.

DOT National Transportation Integrated Search

2016-06-01

When new agritourism land uses are initially proposed, a lack of data on how many vehicle trips these uses tend to create : (known as trip generation) means that there is limited guidance available for transportation planners and engineers to make : ...

Residential trip generation : ground counts versus surveys.

DOT National Transportation Integrated Search

2003-01-01

Residential trip generation rates, defined herein as the total number of vehicle trips per household during a 24-hour period, are a fundamental component of transportation planning. When agencies have different estimates of these rates for the same m...

Sigsearch: a new term for post hoc unplanned search for statistically significant relationships with the intent to create publishable findings.

PubMed

Hashim, Muhammad Jawad

2010-09-01

Post-hoc secondary data analysis with no prespecified hypotheses has been discouraged by textbook authors and journal editors alike. Unfortunately no single term describes this phenomenon succinctly. I would like to coin the term "sigsearch" to define this practice and bring it within the teaching lexicon of statistics courses. Sigsearch would include any unplanned, post-hoc search for statistical significance using multiple comparisons of subgroups. It would also include data analysis with outcomes other than the prespecified primary outcome measure of a study as well as secondary data analyses of earlier research.

Sometimes You Do Get a Second Chance: Emergency Contraception for Adolescents.

PubMed

Rome, Ellen S; Issac, Veronica

2017-04-01

Unplanned or unintended pregnancy remains a significant challenge for adolescents; many teens who plan ahead but opt not to choose long-acting reversible contraceptive methods have high failure rates with condom usage, oral contraceptives, and other less long-acting methods. Emergency contraception (EC) remains a necessity for those adolescents seeking a second chance to prevent the unintended consequences of unplanned sexual activity. At present, 5 postcoital methods remain available as EC globally: intrauterine devices, ulipristal acetate, a selective progesterone modulator, mifepristone; levonorgestrel, and ethinyl estradiol plus levonorgestrel or norgestrel (rarely used now that progestin only methods are more readily available). Copyright © 2017 Elsevier Inc. All rights reserved.

Covariate Imbalance and Adjustment for Logistic Regression Analysis of Clinical Trial Data

PubMed Central

Ciolino, Jody D.; Martin, Reneé H.; Zhao, Wenle; Jauch, Edward C.; Hill, Michael D.; Palesch, Yuko Y.

2014-01-01

In logistic regression analysis for binary clinical trial data, adjusted treatment effect estimates are often not equivalent to unadjusted estimates in the presence of influential covariates. This paper uses simulation to quantify the benefit of covariate adjustment in logistic regression. However, International Conference on Harmonization guidelines suggest that covariate adjustment be pre-specified. Unplanned adjusted analyses should be considered secondary. Results suggest that that if adjustment is not possible or unplanned in a logistic setting, balance in continuous covariates can alleviate some (but never all) of the shortcomings of unadjusted analyses. The case of log binomial regression is also explored. PMID:24138438

You Can't Reach for the Stars if You are Tripping Over the Ground! (Preventing Slips, Trips, and Falls)

NASA Technical Reports Server (NTRS)

Miller, Darcy; Raysich, Mark; Kirkland, Mary

2016-01-01

Although there are very few mishaps related to ground, vehicle or payload processing at the Kennedy Space Center (KSC), employees have experienced a significant number of injuries due to slips, trips, and falls outside of performing flight processing operations. Slips, trips, and falls are major causes of occupational injuries at KSC, the National Aeronautics and Space Administration (NASA), and in general industry. To help KSC employees avoid these injuries, and allow them to be fully productive, KSC launched an initiative in 2013 to reduce slips, trips, and falls. This initiative is based on a four-part model focusing on DATA analysis, HAZARD awareness, PREVENTIVE methods, and BALANCE.

Risk profiles associated with postnatal depressive symptoms among women in a public sector hospital in Mexico: the role of sociodemographic and psychosocial factors.

PubMed

de Castro, Filipa; Place, Jean Marie S; Billings, Deborah L; Rivera, Leonor; Frongillo, Edward A

2015-06-01

This study examined the association between postnatal depressive symptoms and a set of demographic and psychosocial factors among 604 women attending a public hospital for postnatal care in Mexico City. Specific profiles of women that would indicate an increased probability for developing postnatal depression (PND) based on discrete combinations of risk and protective factors were generated. In a logistic model, followed by the estimation of predicted probabilities, we examined the association between depressive symptomatology and psychosocial factors: low social support, unplanned pregnancies, history of depression, and exposure to moderate or severe intimate partner violence (IPV) during pregnancy. Postnatal depressive symptomatology was reported by 10.6 % of the women, as measured by scores at 12 or above on the Edinburgh Postnatal Depression Scale. The cumulative probability of presenting PND in the simultaneous presence of the psychosocial factors was 67.0 %; however, this could be reduced to 5.5 % through preventive measures that work to eliminate low social support, unplanned pregnancy, and exposure to severe IPV during pregnancy. Early identification of psychosocial risk factors, specifically low social support, unplanned pregnancies, history of depression, and exposure to violence during pregnancy, is recommended.

Model of unplanned smoking initiation of children and adolescents: an integrated stage model of smoking behavior.

PubMed

Kremers, S P J; Mudde, A N; De Vries, H

2004-05-01

Two lines of psychological research have attempted to spell out the stages of adolescent smoking initiation. The first has focused on behavioral stages of smoking initiation, while the second line emphasized motivational stages. A large international sample of European adolescents (N = 10,170, mean age = 13.3 years) was followed longitudinally. Self-reported motivational and behavioral stages of smoking initiation were integrated, leading to the development of the Model of Unplanned Smoking Initiation of Children and Adolescents (MUSICA). The MUSICA postulates that youngsters experiment with smoking while they are in an unmotivated state as regards their plans for smoking regularly in the future. More than 95% of the total population resided in one of the seven stages distinguished by MUSICA. The probability of starting to smoke regularly during the 12 months follow-up period increased with advanced stage assignment at baseline. Unique social cognitive predictors of stage progression from the various stages were identified, but effect sizes of predictors of transitions were small. The integration of motivational and behavioral dimensions improves our understanding of the process of smoking initiation. In contrast to current theories of smoking initiation, adolescent uptake of smoking behavior was found to be an unplanned action.

Is there a disparity in the hospital care received under a universal health insurance program in Taiwan?

PubMed

Hsiao, Yu-Yu; Cheng, Shou-Hsia

2013-07-01

To analyze the disparity in hospital care among people of various socio-economic status (SES) under a universal health insurance scheme. A survey questionnaire was mailed to discharged patients in October 2010. This study included 183 large-scale hospitals in Taiwan. A total of 3015 patients/caregivers completed the questionnaires, which yielded a response rate of 58%. Three variables were included. The two access-to-care variables were admission route and accreditation level of the hospital in which the patient stayed. A structured questionnaire, the patient-reported hospital quality (PRHQ), was included to characterize patient's experience of hospital stay. Patients with lower education were less likely to be admitted to a hospital according to a planned schedule, or to choose an Medical Center Hospital. However, SES was not associated with the PRHQ scores. Furthermore, patients with unplanned admission were associated with lower PRHQ scores than those with planned admission to the hospital. Under the universal health insurance system in Taiwan, lower education is associated with unplanned admission to a hospital, which might result in poorer perceived quality of care. Reducing unplanned admission is a challenge for health authorities in the future.

The Impact of Telehealth and Care Coordination on the Number and Type of Clinical Visits for Children With Medical Complexity.

PubMed

McKissick, Holly D; Cady, Rhonda G; Looman, Wendy S; Finkelstein, Stanley M

The purpose of this analysis was to evaluate the effects of an advanced practice nurse-delivered telehealth intervention on health care use by children with medical complexity (CMC). Because CMC account for a large share of health care use costs, finding effective ways to care for them is an important challenge requiring exploration. This was a secondary analysis of data from a randomized clinical trial with a control group and two intervention groups. The focus of the analysis was planned and unplanned clinical and therapy visits by CMC over a 30-month data collection period. Nonparametric tests were used to compare visit counts among and within the three groups. The number of unplanned visits decreased over time across all groups, with the greatest decrease in the video telehealth intervention group. Planned visits were higher in the video telehealth group across all time periods. Advanced practice registered nurse-delivered telehealth care coordination may support a shift from unplanned to planned health care service use among CMC. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Sexual Health and Responsibility Program (SHARP): Preventing HIV, STIs, and Unplanned Pregnancies in the Navy and Marine Corps

PubMed Central

MacDonald, Michael R. (Bob)

2013-01-01

In 1999, the Navy and Marine Corps Public Health Center converted an HIV train-the-trainer program into a broader effort of preventing not just HIV, but also other sexually transmitted infections (STIs) and unplanned pregnancies. The premise for this broader approach was that a more comprehensive sexual health promotion message of STI, HIV, and unplanned pregnancy prevention is more likely to include at least one personally relevant concern for any given individual and is, therefore, more likely to be internalized and acted upon by the greatest number of individuals, and that risk reduction for any one of these consequences of sexual activity may reduce risk for all. This new effort was labeled the Sexual Health and Responsibility Program (SHARP). Within the Navy and Marine Corps, SHARP has become a focal and trusted source of sexual health promotion products, consultative services, and training, as well as a conduit for multidisciplinary collaboration and coordination. The existence of this central sexual health program normalizes integrated and comprehensive sexual health messages, enables efficiencies, promotes program and policy uniformity, and provides a forum for cross-organizational collaboration and continuous improvement. PMID:23450888

Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study.

PubMed

Engjom, Hilde M; Morken, Nils-Halvdan; Høydahl, Even; Norheim, Ole F; Klungsøyr, Kari

2017-08-01

Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5-4.9) and contributed 2% (95% confidence interval, 1.2-3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time <1 hour, 1-2 hours, and >2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have an important impact on perinatal health in high-income countries and also for low-risk births. The results show the importance of skilled birth attendance and warrant attention from clinicians and policy makers to negative consequences of reduced access to institutions. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study

PubMed Central

Eastwood, Kathryn; Smith, Karen; Morgans, Amee; Stoelwinder, Johannes

2017-01-01

Objective To investigate the appropriateness of cases presenting to the emergency department (ED) following ambulance-based secondary telephone triage. Design A pragmatic retrospective cohort analysis of all the planned and unplanned ED presentations within 48 hours of a secondary telephone triage. Setting The secondary telephone triage service, called the Referral Service, and the hospitals were located in metropolitan Melbourne, Australia and operated 24 hours a day, servicing 4.25 million people. The Referral Service provides an in-depth secondary triage of cases classified as low acuity when calling the Australian emergency telephone number. Population Cases triaged by the Referral Service between September 2009 and June 2012 were linked to ED and hospital admission records (N=44,523). Planned ED presentations were cases referred to the ED following the secondary triage, unplanned ED presentations were cases that presented despite being referred to alternative care pathways. Main outcome measures Appropriateness was measured using an ED suitability definition and hospital admission rates. These were compared with mean population data which consisted of all of the ED presentations for the state (termed the ‘average Victorian ED presentation’). Results Planned ED presentations were more likely to be ED suitable than unplanned ED presentations (OR 1.62; 95% CI 1.5 to 1.7; p<0.001) and the average Victorian ED presentation (OR 1.85; 95% CI 1.01 to 3.4; p=0.046). They were also more likely to be admitted to the hospital than the unplanned ED presentation (OR 1.5; 95% CI 1.4 to 1.6; p<0.001) and the average Victorian ED presentation (OR 2.3, 95% CI 2.24 to 2.33; p<0.001). Just under 15% of cases diverted away from the emergency care pathways presented in the ED (unplanned ED attendances), and 9.5% of all the alternative care pathway cases were classified as ED suitable and 6.5% were admitted to hospital. Conclusions Secondary telephone triage was able to appropriately identify many ED suitable cases, and while most cases referred to alternative care pathways did not present in the ED. Further research is required to establish that these were not inappropriately triaged away from the emergency care pathways. PMID:29038180

Variables associated with emergency department and/or unplanned hospital utilization for children with epilepsy.

PubMed

Patel, Anup D

2014-02-01

In the United States, approximately one million people are evaluated annually in an emergency department (ED) for the diagnosis of a seizure or epilepsy. The highest percentages of these patients are less than five years of age. No studies have been performed on assessing potential variables associated with recurrent ED visits and/or unplanned hospitalizations for children with epilepsy. Institutional review board approval from Nationwide Children's Hospital was obtained prior to study initiation. An accountable care organization (ACO), Partner for Kids (PFK), database was searched for patients with the highest and the lowest number of ED visits and/or unplanned hospitalizations from 2007 through 2011 using ICD-9 codes of 345.xx and 780.39. The patients were stratified into a high and a low utilizer group. The total number of visits and their associated health care costs were noted for each patient. In total, 120 patients were included for review. Information on the total number of no-shows to outpatient neurology clinic visits and telephone calls to neurology triage nursing was noted. A chart review was performed by a pediatric epileptologist to determine if each individual patient was an appropriate candidate for an emergency seizure treatment. The dose of emergency seizure medication was cross-checked to the patient's actual dose during the time of ED or hospital presentation to determine if the dose given was high, low, or accurate based on dosing recommendations. Multivariable logistic regression was used to test the effects of factors. When controlling for other factors, patients who were given an incorrect or no emergency seizure dosing had a high probability of having multiple ED visits/unplanned hospitalizations compared with patients who were given correct dosing (odds ratio=11.28, 95% CI of odds ratio=(2.42, 52.63), p value<0.01 (p=0.0021)). Using a similar model, patients who experienced a higher number of no-shows to clinic visits had a higher probability of having multiple ED visits/unplanned hospitalizations (odds ratio=5.73 per 1 more number of no-show, 95% CI of odds ratio=(1.78, 18.44), p value<0.01 (p=0.0034)). Future studies are planned to target these risk factors with the goal of decreased ED and/or hospital utilization for children with epilepsy. Copyright © 2013 Elsevier Inc. All rights reserved.

Fellows in the Middle: Fabulous Field Trips

NASA Astrophysics Data System (ADS)

West, Mary Lou

2008-05-01

Montclair State University's NSF GK-12 Program focuses on grades 7 and 8 in five urban public school districts in northern New Jersey. Each year four fieldtrips are taken by the students, middle school teachers, and graduate student Fellows. Many interdisciplinary hands-on lessons are written for use before, during and after each trip with this year's theme of Earth history. The Sterling Hill Mine trip evoked lessons on geology, economics, crystal structure, density, and pH. A virtual trip (webcam link) to scientists in the rainforest of Panama prompted critical thinking, categorizing layers and animals, and construction of model food webs. In the field trip to the NJ School of Conservation the students will build model aquifers, measure tree heights, and measure stream flow to compare to their Hackensack River. Finally the students will travel to MSU for a Math/Science Day with research talks, lab tours, hands-on activities, and a poster session. In January 2008 seventeen teachers, Fellows, and grant personnel took a field trip to China to set up collaborations with researchers and schools in Beijing and Xi'an, including the Beijing Ancient Observatory. All field trips are fabulous! Next year (IYA) our theme will be planetary science and will feature field trips to the Newark Museum's Dreyfuss Planetarium, BCC Buehler Challenger & Science Center, and star parties. We look forward to invigorating middle school science and mathematics with exciting astronomy. Funded by NSF #0638708

Understanding taxi travel patterns

NASA Astrophysics Data System (ADS)

Cai, Hua; Zhan, Xiaowei; Zhu, Ji; Jia, Xiaoping; Chiu, Anthony S. F.; Xu, Ming

2016-09-01

Taxis play important roles in modern urban transportation systems, especially in mega cities. While providing necessary amenities, taxis also significantly contribute to traffic congestion, urban energy consumption, and air pollution. Understanding the travel patterns of taxis is thus important for addressing many urban sustainability challenges. Previous research has primarily focused on examining the statistical properties of passenger trips, which include only taxi trips occupied with passengers. However, unoccupied trips are also important for urban sustainability issues because they represent potential opportunities to improve the efficiency of the transportation system. Therefore, we need to understand the travel patterns of taxis as an integrated system, instead of focusing only on the occupied trips. In this study we examine GPS trajectory data of 11,880 taxis in Beijing, China for a period of three weeks. Our results show that taxi travel patterns share similar traits with travel patterns of individuals but also exhibit differences. Trip displacement distribution of taxi travels is statistically greater than the exponential distribution and smaller than the truncated power-law distribution. The distribution of short trips (less than 30 miles) can be best fitted with power-law while long trips follow exponential decay. We use radius of gyration to characterize individual taxi's travel distance and find that it does not follow a truncated power-law as observed in previous studies. Spatial and temporal regularities exist in taxi travels. However, with increasing spatial coverage, taxi trips can exhibit dual high probability density centers.

A day trip to a forest park increases human natural killer activity and the expression of anti-cancer proteins in male subjects.

PubMed

Li, Qing; Kobayashi, M; Inagaki, H; Hirata, Y; Li, Y J; Hirata, K; Shimizu, T; Suzuki, H; Katsumata, M; Wakayama, Y; Kawada, T; Ohira, T; Matsui, N; Kagawa, T

2010-01-01

We previously reported that 2-night/3-day trips to forest parks enhanced human NK activity, the number of NK cells, and intracellular anti-cancer proteins in lymphocytes, and that this increased NK activity lasted for more than 7 days after the trip in both male and female subjects. In the present study, we investigated the effect of a day trip to a forest park on human NK activity in male subjects. Twelve healthy male subjects, aged 35-53 years, were selected after giving informed consent. The subjects experienced a day trip to a forest park in the suburbs of Tokyo. They walked for two hours in the morning and afternoon, respectively, in the forest park on Sunday. Blood and urine were sampled in the morning of the following day and 7 days after the trip, and the NK activity, numbers of NK and T cells, and granulysin, perforin, and granzyme A/B-expressing lymphocytes, the concentration of cortisol in blood samples, and the concentration of adrenaline in urine were measured. Similar measurements were made before the trip on a weekend day as the control. Phytoncide concentrations in the forest were measured. The day trip to the forest park significantly increased NK activity and the numbers of CD16(+) and CD56(+) NK cells, perforin, granulysin, and granzyme A/B-expressing NK cells and significantly decreased CD4(+) T cells, the concentrations of cortisol in the blood and adrenaline in urine. The increased NK activity lasted for 7 days after the trip. Phytoncides, such as isoprene, alpha-pinene, and beta-pinene, were detected in the forest air. These findings indicate that the day trip to the forest park also increased the NK activity, number of NK cells, and levels of intracellular anti-cancer proteins, and that this effect lasted for at least 7 days after the trip. Phytoncides released from trees and decreased stress hormone levels may partially contribute to the increased NK activity.

TRIP : The Transportation Remuneration and Incentive Program in West Virginia, 1974-1979

DOT National Transportation Integrated Search

1982-07-01

Between July 1974 and June 1979, the State of West Virginia was host to the largest Federal demonstration program for improving rural transit service called Transportation Remuneration Incentive Program (TRIP). The remuneration part of TRIP (ticket s...

Putting a "New Kick" into the Adult Education Program

ERIC Educational Resources Information Center

Hammack, Merle S.

1978-01-01

A vocational agriculture instructor describes the adult education tour program in Ferris, Texas, involving farm bus trips and plane trips to various farming areas and industries. The trips were financed by the participants and some business firms and organizations. (MF)

Does the circadian clock drift when pilots fly multiple transpacific flights with 1- to 2-day layovers?

PubMed

Gander, Philippa; Mulrine, Hannah M; van den Berg, Margo J; Wu, Lora; Smith, Alexander; Signal, Leigh; Mangie, Jim

2016-01-01

On trips with multiple transmeridian flights, pilots experience successive non-24 h day/night cycles with circadian and sleep disruption. One study across a 9-day sequence of transpacific flights (no in-flight sleep, 1-day layovers between flights) reported an average period in the core body temperature rhythm of 24.6 h (circadian drift). Consequently, pilots were sometimes flying through the circadian performance nadir and had to readapt to home base time at the end of the trip. The present study examined circadian drift in trip patterns with longer flights and in-flight sleep. Thirty-nine B747-400 pilots (19 captains, 20 first officers, mean age = 55.5 years) were monitored on 9- to 13-day trips with multiple return flights between East Coast USA and Japan (in 4-pilot crews) and between Japan and Hawaii (in 3-pilot crews), with 1-day layovers between each flight. Measures included total in-flight sleep (actigraphy, log books) and top of descent (TOD) measures of sleepiness (Karolinska Sleepiness Scale), fatigue (Samn-Perelli Crew Status Check) and psychomotor vigilance task (PVT) performance. Circadian rhythms of individual pilots were not monitored. To detect circadian drift, mixed-model analysis of variance examined whether for a given flight, total in-flight sleep and TOD measures varied according to when the flight occurred in the trip sequence. In addition, sleep propensity curves for pre-trip and post-trip days were examined (Chi-square periodogram analyses). Limited data suggest that total in-flight sleep of relief crew at landing may have decreased across successive East Coast USA-Japan (flights 1, 3, 5 or 7; median arrival 03:45 Eastern Daylight Time (EDT)). However, PVT response speed at TOD was faster on East Coast USA-Japan flights later in the trip. On these flights, circadian drift would result in flights later in the trip landing closer to the evening wake maintenance zone, when sleep is difficult and PVT response speeds are fastest. On Japan-East Coast USA flights (flights 2, 4, 6 or 8; median arrival time 14:52 EDT), PVT response speeds were slower on flight 8 than on flight 2. Circadian drift would move these arrivals progressively earlier in the SCN pacemaker cycle, where PVT response speeds are slower. Across the five post-trip days, 12 pilots (Group A) immediately resumed their pre-trip sleep pattern of a single nocturnal sleep episode; 9 pilots (Group B) had a daytime nap on most days that moved progressively earlier until it merged with nocturnal sleep and 17 pilots (Group C) had nocturnal sleep and intermittent naps. Chi-square periodogram analyses of the sleep propensity curves for each group across baseline and post-trip days suggest full adaptation to EDT from post-trip day 1 (dominant period = 24 h). However, in Groups B and C, the patterns of split sleep post-trip compared to pre-trip suggest that this may be misleading. We conclude that the trends in total in-flight sleep and significant changes in PVT performance speed at TOD provide preliminary evidence for circadian drift, as do persistent patterns of split sleep post-trip. However, new measures to track circadian rhythms in individual pilots are needed to confirm these findings.

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

PubMed

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

2016-07-27

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

Comparison of the effectiveness of real and virtual field trips in biology and ecology classes in lower secondary school based on the example of the Maribor island natural educational trail

NASA Astrophysics Data System (ADS)

Puhek, Miro

The present doctoral thesis presents a case study within the scope of which real and virtual field trips have been compared. The emphasis of the study was on determining the levels of knowledge gain effectiveness in the fields of biology and ecology in the final triad (third) of lower secondary school education. The analysis included students completing various tasks along the Maribor Island natural education trail, which had been digitized and inserted into Geopedia. The study was conducted in autumn of 2011 and included 464 students (enrolled in grades from 6 to 9) from 11 lower secondary schools located in the Maribor area. The results have generally shown minute differences between the levels of knowledge acquisition effectiveness between both field trips. During the real field trip, the majority of the students included in the study achieved better results particularly at tasks where they were able to benefit from first-hand experience. During the virtual field trip, individual students were more successful at tasks where they were allowed to access a computer in order to obtain additional information. Within the scope of the study, we had also surveyed lower secondary and secondary school teachers on the frequency of including field trips in the curriculum, on the obstacles that the teachers faced with regard to including field work in it, and on their views on real and virtual field trips. The survey included a total of 386 teachers, the majority whom were teaching the subjects of biology, geography, and natural science. The results have shown that the surveyed teachers regard field trips as a very important educational method that particularly encourages experience-based learning in nature. The views of the teachers on virtual field trips were generally positive, but only when regarded and applied as a supplemental teaching tool and not as a substitute for real field trips.

Trip Report, Europe - November/December 1994

DOT National Transportation Integrated Search

1995-01-12

THIS TRIP REPORT IS PREPARED AS A DELIVERABLE UNDER THE FHWA CONTRACT NO. DTFH61-93-C-00064. THE REPORT WILL BEGIN WITH A BRIEF DESCRIPTION OF THE PURPOSES AND DESTINATIONS OF THE TWO-WEEK EUROPEAN TRIP TAKEN BY THE CONSULTANT IN NOVEMBER/DECEMBER 19...

Mobile Interventional Stroke Teams Lead to Faster Treatment Times for Thrombectomy in Large Vessel Occlusion.

PubMed

Wei, Daniel; Oxley, Thomas J; Nistal, Dominic A; Mascitelli, Justin R; Wilson, Natalie; Stein, Laura; Liang, John; Turkheimer, Lena M; Morey, Jacob R; Schwegel, Claire; Awad, Ahmed J; Shoirah, Hazem; Kellner, Christopher P; De Leacy, Reade A; Mayer, Stephan A; Tuhrim, Stanley; Paramasivam, Srinivasan; Mocco, J; Fifi, Johanna T

2017-12-01

Endovascular recanalization treatment for acute ischemic stroke is a complex, time-sensitive intervention. Trip-and-treat is an interhospital service delivery model that has not previously been evaluated in the literature and consists of a shared mobile interventional stroke team that travels to primary stroke centers to provide on-site interventional capability. We compared treatment times between the trip-and-treat model and the traditional drip-and-ship model. We performed a retrospective analysis on 86 consecutive eligible patients with acute ischemic stroke secondary to large vessel occlusion who received endovascular treatment at 4 hospitals in Manhattan. Patients were divided into 2 cohorts: trip-and-treat (n=39) and drip-and-ship (n=47). The primary outcome was initial door-to-puncture time, defined as the time between arrival at any hospital and arterial puncture. We also recorded and analyzed the times of last known well, IV-tPA (intravenous tissue-type plasminogen activator) administration, transfer, and reperfusion. Mean initial door-to-puncture time was 143 minutes for trip-and-treat and 222 minutes for drip-and-ship ( P <0.0001). Although there was a trend in longer puncture-to-recanalization times for trip-and-treat ( P =0.0887), initial door-to-recanalization was nonetheless 79 minutes faster for trip-and-treat ( P <0.0001). There was a trend in improved admission-to-discharge change in National Institutes of Health Stroke Scale for trip-and-treat compared with drip-and-ship ( P =0.0704). Compared with drip-and-ship, the trip-and-treat model demonstrated shorter treatment times for endovascular therapy in our series. The trip-and-treat model offers a valid alternative to current interhospital stroke transfers in urban environments. © 2017 American Heart Association, Inc.

Inspection of the Secretary of Energy`s foreign travel

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

NONE

1996-10-07

On December 9, 1995, the Secretary of Energy requested that the Department`s Inspector General (IG) conduct a thorough examination of all Secretarial foreign travel from 1993 to December 1995 to include the purpose of each trip, the activities of each Federal participant in each trip, the funding of each trip, and claims for reimbursements for expenses by Federal trip participants. The Secretary also requested that the review include an assessment of travel authorization, voucher, traveler reimbursement, and auditing systems employed by the Department to identify steps that could be taken to reduce errors and improve accounting oversight. Additionally, the Secretarymore » requested that the Inspector General conduct a thorough examination of the establishment and filling of the Department`s Ombudsman position. The Office of Inspector General (OIG) initiated a review into these matters and assigned primary responsibility for the review to the Office of Inspections. The purpose of this inspection was to conduct a thorough examination of the 16 Secretarial foreign trips from June 1993 to December 1995. This report focuses on the four trade missions because of their extent and cost. We examined a number of Departmental management systems and processes involved in planning and executing the 16 foreign trips. To determine the actual cost of the 16 trips, it was necessary to determine who participated in the trips and to identify the individual travel costs. We were required to perform extensive reviews of records and conduct a large number of interviews because the Department could not provide any specific documents that could accurately account for who actually participated on the 16 trips. Having identified who participated, it was then necessary to examine key aspects of the Department`s management systems. Our report contains 31 recommendations for corrective action.« less

Daily Variations in Spring Break Alcohol and Sexual Behaviors Based on Intentions, Perceived Norms, and Daily Trip Context

PubMed Central

Patrick, Megan E.; Lee, Christine M.

2012-01-01

Objective: Given the known risks of alcohol use and sexual behavior for college students on Spring Break, this study was designed to document the behaviors and correlates associated with being on a Spring Break trip on a given day (controlling for average time on a trip). Method: Participants were undergraduate students (n = 261; 55% women) who reported that they planned to go on a Spring Break trip. Web-based survey responses before and after Spring Break documented perceived norms, intentions, and actual behavior on each of the 10 days of Spring Break. Results: Students who went on longer trips, who previously engaged in more heavy episodic drinking, or who had greater pre–Spring Break intentions to drink reported greater alcohol use during Spring Break. Similarly, students with greater pre–Spring Break intentions to have sex, greater perceived norms for sex, or more previoussexual partners had greater odds of having sex. On days students were on trips, they had a greater likelihood of having sex, drinking to higher estimated blood alcohol concentrations, consuming more drinks, and reporting perceived drunkenness than on nontrip days, especially if they had intentions to have sex and drink alcohol (and, for models predicting sexual behavior and drunkenness, had greater perceived norms for sex and drinking). Conclusions: Students who went on Spring Break trips engaged in more risk behaviors. In addition, the context of being on a trip on a given day was associated with increased risk, especially if they had stronger intentions and, in some cases, higher perceived norms. Further research is needed to describe the contexts of Spring Break trips and how to intervene effectively. PMID:22630797

KSC-2012-6320

NASA Image and Video Library

2012-11-28

KSC-2012-6320 – CAPE CANAVERAL, Fla. - Stephen Anthony works with an experimental reactor as part of the trash-to-gas project at NASA's Kennedy Space Center in Florida. A group of six researchers at Kennedy and groups from NASA centers in Ohio, California and Texas wrote in a recent paper that the current methods of handling trash – either carrying it along on the round trip through space or gathering it into an expendable module and burning it up in Earth's atmosphere – are not suitable answers for missions that go beyond Earth orbit or even past the moon. Working in a laboratory at Kennedy, Hintze's team built an 80-pound device that looks like a three-foot-long metal pipe to test theories about incinerating a variety of trash ranging from used clothes to uneaten food. The reactor holds more than three quarts of material and burns at about 1,000 degrees F, about twice the maximum temperature of an average household oven. It's expected to take astronauts four hours to burn a day's worth of trash from a crew of four. During the course of a year in space – one half the length of time a mission to Mars is expected to take – trash processing for a crew of four would create about 2,200 pounds of methane fuel, enough to power a launch from the lunar surface, Hintze said. Photo credit: NASA/Dmitri Gerondidakis

KSC-2012-6321

NASA Image and Video Library

2012-11-28

KSC-2012-6321 – CAPE CANAVERAL, Fla. – Anne Caraccio works with an experimental reactor as part of the trash-to-gas project at NASA's Kennedy Space Center in Florida. A group of six researchers at Kennedy and groups from NASA centers in Ohio, California and Texas wrote in a recent paper that the current methods of handling trash – either carrying it along on the round trip through space or gathering it into an expendable module and burning it up in Earth's atmosphere – are not suitable answers for missions that go beyond Earth orbit or even past the moon. Working in a laboratory at Kennedy, Hintze's team built an 80-pound device that looks like a three-foot-long metal pipe to test theories about incinerating a variety of trash ranging from used clothes to uneaten food. The reactor holds more than three quarts of material and burns at about 1,000 degrees F, about twice the maximum temperature of an average household oven. It's expected to take astronauts four hours to burn a day's worth of trash from a crew of four. During the course of a year in space – one half the length of time a mission to Mars is expected to take – trash processing for a crew of four would create about 2,200 pounds of methane fuel, enough to power a launch from the lunar surface, Hintze said. Photo credit: NASA/Dmitri Gerondidakis

Implicit time-integration method for simultaneous solution of a coupled non-linear system

NASA Astrophysics Data System (ADS)

Watson, Justin Kyle

Historically large physical problems have been divided into smaller problems based on the physics involved. This is no different in reactor safety analysis. The problem of analyzing a nuclear reactor for design basis accidents is performed by a handful of computer codes each solving a portion of the problem. The reactor thermal hydraulic response to an event is determined using a system code like TRAC RELAP Advanced Computational Engine (TRACE). The core power response to the same accident scenario is determined using a core physics code like Purdue Advanced Core Simulator (PARCS). Containment response to the reactor depressurization in a Loss Of Coolant Accident (LOCA) type event is calculated by a separate code. Sub-channel analysis is performed with yet another computer code. This is just a sample of the computer codes used to solve the overall problems of nuclear reactor design basis accidents. Traditionally each of these codes operates independently from each other using only the global results from one calculation as boundary conditions to another. Industry's drive to uprate power for reactors has motivated analysts to move from a conservative approach to design basis accident towards a best estimate method. To achieve a best estimate calculation efforts have been aimed at coupling the individual physics models to improve the accuracy of the analysis and reduce margins. The current coupling techniques are sequential in nature. During a calculation time-step data is passed between the two codes. The individual codes solve their portion of the calculation and converge to a solution before the calculation is allowed to proceed to the next time-step. This thesis presents a fully implicit method of simultaneous solving the neutron balance equations, heat conduction equations and the constitutive fluid dynamics equations. It discusses the problems involved in coupling different physics phenomena within multi-physics codes and presents a solution to these problems. The thesis also outlines the basic concepts behind the nodal balance equations, heat transfer equations and the thermal hydraulic equations, which will be coupled to form a fully implicit nonlinear system of equations. The coupling of separate physics models to solve a larger problem and improve accuracy and efficiency of a calculation is not a new idea, however implementing them in an implicit manner and solving the system simultaneously is. Also the application to reactor safety codes is new and has not be done with thermal hydraulics and neutronics codes on realistic applications in the past. The coupling technique described in this thesis is applicable to other similar coupled thermal hydraulic and core physics reactor safety codes. This technique is demonstrated using coupled input decks to show that the system is solved correctly and then verified by using two derivative test problems based on international benchmark problems the OECD/NRC Three mile Island (TMI) Main Steam Line Break (MSLB) problem (representative of pressurized water reactor analysis) and the OECD/NRC Peach Bottom (PB) Turbine Trip (TT) benchmark (representative of boiling water reactor analysis).

Establishment of Local Trip Generation Rates or Equations for Mixed-Use Developments in Kansas

DOT National Transportation Integrated Search

2012-10-01

Currently, the trip generation rates and equations contained in the Institute of Transportation Engineers (ITE) : Trip Generation Manual, 8th Edition are based on the information collected at single-use, free-standing sites and cannot : be directly a...

1977 Nationwide Personal Transportation Study : home-to-work trips and travel

DOT National Transportation Integrated Search

1980-12-01

This report is part of a series that presents findings from the 1977 Nationwide Personal Transportation Study (NPTS). This report describes home-to-work trips and trave l in 1977. The home-to-work trip purpose is explored relative to location, househ...

Trip generation studies for special generators : research summary , December 17, 2009.

DOT National Transportation Integrated Search

2009-12-17

The Institute of Transportation Engineers (ITE) Trip Generation, 7th ed., which determines the number of : trips produced or attracted by different developments, does not include town centers as a type of land use. It : has also been argued that the ...

Analysis of Transportation Energy Consumption: En Route Towards Carbon Reduction for Sustainable Campus

NASA Astrophysics Data System (ADS)

Sukor, Nur Sabahiah Abdul; Asmah Hassan, Sitti

2017-08-01

This paper reports the estimation of transportation energy consumption based on the travel behaviour characteristics of the population in the Engineering Campus, Universiti Sains Malaysia. The travel behaviour characteristics include the travel distance, travel speed, number of trips per day, and modal share of the transport, which only focused on the trips that were made inside the campus. The travel behaviour data were collected through online and pencil-and-paper questionnaire survey involving 1000 respondents including staffs and students, which is equivalent to 25% of the total population. The result from the survey showed that a total of 1897 trips per day were made by the motorised vehicle owners including car and motorcycle owners. The total trip length per day was 1056.29 km with an average speed of 45km/h. The average trip for each person was four trips per day. The estimate energy consumption from the motorised vehicles in this campus was reported to be 1.25E9 MJ.

Crew factors in flight operations 6: Psychophysiological responses to helicopter operations

NASA Technical Reports Server (NTRS)

Gander, Philippa H.; Barnes, Rory M.; Gregory, Kevin B.; Connell, Linda J.; Miller, Donna L.; Graeber, R. Curtis

1994-01-01

Thirty-two helicopter pilots were studied before, during, and after 4-5 day trips providing support services from Aberdeen, Scotland, to rigs in the North Sea oil fields. Early on-duty times obliged subjects to wake up 1.5 hours earlier on trip days than on pretrip days. Consequently, they slept nearly an hour less per night on trips. They reported more fatigue on post-trip days than on pretrip days, suggesting a cumulative effect of duty-related activities and sleep loss. Fatigue and negative affect were higher, and activation lower, by the end of trip days than by the end of pretrip days. The earlier a subject went on duty, the lower his activation by the end of the day. Caffeine consumption increased 42 percent on trip days. The incidence of headache doubled, of back pain increased twelve fold, and of burning eyes quadrupled. In the aircraft studied, thermal discomfort and high vibration levels were common. The longer pilots remained on duty, the more negative their mood became.

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips

PubMed Central

Alsharif, Naser Z.; Rovers, John; Connor, Sharon; White, Nicole D.; Hogue, Michael D.

2017-01-01

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors’ collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities. PMID:28381883

Vanpool trip planning based on evolutionary multiple objective optimization

NASA Astrophysics Data System (ADS)

Zhao, Ming; Yang, Disheng; Feng, Shibing; Liu, Hengchang

2017-08-01

Carpool and vanpool draw a lot of researchers’ attention, which is the emphasis of this paper. A concrete vanpool operation definition is given, based on the given definition, this paper tackles vanpool operation optimization using user experience decline index(UEDI). This paper is focused on making each user having identical UEDI and the system having minimum sum of all users’ UEDI. Three contributions are made, the first contribution is a vanpool operation scheme diagram, each component of the scheme is explained in detail. The second contribution is getting all customer’s UEDI as a set, standard deviation and sum of all users’ UEDI set are used as objectives in multiple objective optimization to decide trip start address, trip start time and trip destination address. The third contribution is a trip planning algorithm, which tries to minimize the sum of all users’ UEDI. Geographical distribution of the charging stations and utilization rate of the charging stations are considered in the trip planning process.

Recommendations for Planning and Managing International Short-term Pharmacy Service Trips.

PubMed

Johnson, Kalin L; Alsharif, Naser Z; Rovers, John; Connor, Sharon; White, Nicole D; Hogue, Michael D

2017-03-25

International pharmacy service trips by schools and colleges of pharmacy allow students to provide health care to medically underserved areas. A literature review (2000-2016) in databases and Internet searches with specific keywords or terms was performed to assess current practices to establish and maintain successful pharmacy service trips. Educational documents such as syllabi were obtained from pharmacy programs and examined. A preliminary draft was developed and authors worked on sections of interest and expertise. Considerations and current recommendations are provided for the key aspects of the home institution and the host country requirements for pharmacy service trips based on findings from a literature search and the authors' collective, extensive experience. Evaluation of the trip and ethical considerations are also discussed. This article serves as a resource for schools and colleges of pharmacy that are interested in the development of new pharmacy service trips and provides key considerations for continuous quality improvement of current or future activities.

Using GPS, GIS, and Accelerometer Data to Predict Transportation Modes.

PubMed

Brondeel, Ruben; Pannier, Bruno; Chaix, Basile

2015-12-01

Active transportation is a substantial source of physical activity, which has a positive influence on many health outcomes. A survey of transportation modes for each trip is challenging, time-consuming, and requires substantial financial investments. This study proposes a passive collection method and the prediction of modes at the trip level using random forests. The RECORD GPS study collected real-life trip data from 236 participants over 7 d, including the transportation mode, global positioning system, geographical information systems, and accelerometer data. A prediction model of transportation modes was constructed using the random forests method. Finally, we investigated the performance of models on the basis of a limited number of participants/trips to predict transportation modes for a large number of trips. The full model had a correct prediction rate of 90%. A simpler model of global positioning system explanatory variables combined with geographical information systems variables performed nearly as well. Relatively good predictions could be made using a model based on the 991 trips of the first 30 participants. This study uses real-life data from a large sample set to test a method for predicting transportation modes at the trip level, thereby providing a useful complement to time unit-level prediction methods. By enabling predictions on the basis of a limited number of observations, this method may decrease the workload for participants/researchers and provide relevant trip-level data to investigate relations between transportation and health.

Flat Plate Boundary Layer Stimulation Using Trip Wires and Hama Strips

NASA Astrophysics Data System (ADS)

Peguero, Charles; Henoch, Charles; Hrubes, James; Fredette, Albert; Roberts, Raymond; Huyer, Stephen

2017-11-01

Water tunnel experiments on a flat plate at zero angle of attack were performed to investigate the effect of single roughness elements, i.e., trip wires and Hama strips, on the transition to turbulence. Boundary layer trips are traditionally used in scale model testing to force a boundary layer to transition from laminar to turbulent flow at a single location to aid in scaling of flow characteristics. Several investigations of trip wire effects exist in the literature, but there is a dearth of information regarding the influence of Hama strips on the flat plate boundary layer. The intent of this investigation is to better understand the effects of boundary layer trips, particularly Hama strips, and to investigate the pressure-induced drag of both styles of boundary layer trips. Untripped and tripped boundary layers along a flat plate at a range of flow speeds were characterized with multiple diagnostic measurements in the NUWC/Newport 12-inch water tunnel. A wide range of Hama strip and wire trip thicknesses were used. Measurements included dye flow visualization, direct skin friction and parasitic drag force, boundary layer profiles using LDV, wall shear stress fluctuations using hot film anemometry, and streamwise pressure gradients. Test results will be compared to the CFD and boundary layer model results as well as the existing body of work. Conclusions, resulting in guidance for application of Hama strips in model scale experiments and non-dimensional predictions of pressure drag will be presented.

Effectiveness of the Treatment Readiness and Induction Program for Increasing Adolescent Motivation for Change

PubMed Central

Becan, Jennifer E.; Knight, Danica K.; Crawley, Rachel D.; Joe, George W.; Flynn, Patrick M.

2014-01-01

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (Time 1) and 35 days after admission (Time 2). The design consisted of a comparison sample (n = 281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n = 238). Repeated measures ANCOVAs were conducted using each Time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. PMID:25456094

Chemistry in Action: How to Plan a Visit to the Chemical Industry.

ERIC Educational Resources Information Center

Nae, Hemi; And Others

1982-01-01

Presents guidelines for field trips to chemical industries. Includes examples of objectives, administrative aspects (time off from school, contact persons, transportation, pre/post-trip discussions, and guides at the industrial facility). Includes an evaluation of trips taken to industrial plants in Israel. (JN)

Establishment of Local Trip Generation Rates or Equations for Mixed-Use Developments in Kansas : Technical Summary

DOT National Transportation Integrated Search

2012-10-01

Currently, the trip generation rates and equations contained in the Institute of Transportation Engineers (ITE) Trip Generation Manual, 8th Edition are based on the information collected at single-use, free-standing sites and cannot be directly appli...

More Virtual Field Trips.

ERIC Educational Resources Information Center

Cooper, Gail; Cooper, Gary

This directory covers additional Web sites and opportunities that have appeared in the year since the original book, "Virtual Field Trips," was published. The field trips provided are appropriate for K-12 students and designed to meet the goals and interests of educators. Organized by subjects and cross-referenced for quick and easy…

Effectiveness of Field Trips in Teaching Groundwater Concepts.

ERIC Educational Resources Information Center

Pederson, Darryll T.

1979-01-01

The field trip procedures described were devised for use with freshman college students as an alternative to a classroom or laboratory session. Pre-test and post-test of students' knowledge of groundwater concepts show significant change in students' understanding of groundwater occurance and movement following such a trip. (RE)

Inferring High-Resolution Individual’s Activity and Trip Purposes with the Fusion of Social Media, Land Use and Connected Vehicle Trajectories

DOT National Transportation Integrated Search

2017-11-30

Trip purpose is crucial to travel behavior modeling and travel demand estimation for transportation planning and investment decisions. However, the spatial-temporal complexity of human activities makes the prediction of trip purpose a challenging pro...

46 CFR 11.705 - Route familiarization requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... limitations specified in this section, the number of round trips required to qualify an applicant for a... endorsement as first-class pilot shall furnish evidence of having completed a minimum number of round trips... sought. Evidence of having completed a minimum number of round trips while serving as an observer...

46 CFR 11.705 - Route familiarization requirements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... limitations specified in this section, the number of round trips required to qualify an applicant for a... endorsement as first-class pilot shall furnish evidence of having completed a minimum number of round trips... sought. Evidence of having completed a minimum number of round trips while serving as an observer...

46 CFR 11.705 - Route familiarization requirements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... limitations specified in this section, the number of round trips required to qualify an applicant for a... endorsement as first-class pilot shall furnish evidence of having completed a minimum number of round trips... sought. Evidence of having completed a minimum number of round trips while serving as an observer...

Funding and Philosophy: A Conversation About Band Trips and Fund Raising.

ERIC Educational Resources Information Center

Hoffer, Charles R.

1992-01-01

A hypothetical conversation between Thoughtful Principal and Music Teacher raises some basic issues about fund raising, booster activities, and band trips. Considerations about contest criteria, door-to-door selling, student costs, support for nonband musical programs, and the educational and motivational value of band trips are discussed. (MLH)

30 CFR 56.19067 - Trips during shift changes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Trips during shift changes. 56.19067 Section 56.19067 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL... Hoisting Procedures § 56.19067 Trips during shift changes. During shift changes, an authorized person shall...

30 CFR 57.19067 - Trips during shift changes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Trips during shift changes. 57.19067 Section 57.19067 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL... Hoisting Hoisting Procedures § 57.19067 Trips during shift changes. During shift changes, an authorized...

A Day at the Museums

ERIC Educational Resources Information Center

Hubel, Joy Alter

2009-01-01

The school field trip, once a supporting player in a well-rounded education, is slowly becoming endangered. Widespread budget cuts have made happily anticipated class trips to museums, zoos, and other cultural destinations increasingly scarce. A librarian may be able to rescue the field trip from extinction by transforming the school building into…

Student Attitudes toward and Recall of Outside Day: An Environmental Science Field Trip

ERIC Educational Resources Information Center

Nadelson, Louis S.; Jordan, J. Richard

2012-01-01

Field trips are effective because they situate learning and facilitate knowledge transfer, thereby influencing students learning attitudes, interests, and motivation. Variations in field trip configurations and the subsequent affective and cognitive influences provided the motivation for this study of Outside Day--an environmental education field…

Time signal distribution in communication networks based on synchronous digital hierarchy

NASA Technical Reports Server (NTRS)

Imaoka, Atsushi; Kihara, Masami

1993-01-01

A new method that uses round-trip paths to accurately measure transmission delay for time synchronization is proposed. The performance of the method in Synchronous Digital Hierarchy networks is discussed. The feature of this method is that it separately measures the initial round trip path delay and the variations in round-trip path delay. The delay generated in SDH equipment is determined by measuring the initial round-trip path delay. In an experiment with actual SDH equipment, the error of initial delay measurement was suppressed to 30ns.

2007 Annual Health Physics Report for the HEU Transparency Program

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

Radev, R

2008-04-09

During the 2007 calendar year, Lawrence Livermore National Laboratory (LLNL) provided health physics support for the Highly Enriched Uranium (HEU) Transparency Program for external and internal radiation protection and technical expertise related to BDMS radioactive sources and Russian radiation safety regulatory compliance. For the calendar year 2007, there were 172 person-trips that required dose monitoring of the U.S. monitors. Of the 172 person-trips, 160 person-trips were SMVs and 12 person-trips were Transparency Monitoring Office (TMO) trips. There were 12 monitoring visits by TMO monitors to facilities other than UEIE and 10 to UEIE itself. There were two monitoring visits (sourcemore » changes) that were back to back with 14 monitors. LLNL's Hazard Control Division laboratories provided the dosimetry services for the HEU Transparency monitors.« less

Managing the effect of TRIPS on availability of priority vaccines.

PubMed Central

Milstien, Julie; Kaddar, Miloud

2006-01-01

The stated purpose of intellectual property protection is to stimulate innovation. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires all Members of the World Trade Organization (WTO) to enact national laws conferring minimum standards of intellectual property protection by certain deadlines. Critics of the Agreement fear that such action is inconsistent with ensuring access to medicines in the developing world. A WHO convened meeting on intellectual property rights and vaccines in developing countries, on which this paper is based, found no evidence that TRIPS has stimulated innovation in developing market vaccine development (where markets are weak) or that protection of intellectual property rights has had a negative effect on access to vaccines. However, access to future vaccines in the developing world could be threatened by compliance with TRIPS. The management of such threats requires adherence of all countries to the Doha Declaration on TRIPS, and the protections guaranteed by the Agreement itself, vigilance on TRIPS-plus elements of free trade agreements, developing frameworks for licensing and technology transfer, and promoting innovative vaccine development in developing countries. The role of international organizations in defining best practices, dissemination of information, and monitoring TRIPS impact will be crucial to ensuring optimal access to priority new vaccines for the developing world. PMID:16710544

Field Trip - Conservation of Carnivores in Namibia

NASA Astrophysics Data System (ADS)

Gibson, Amanda

2017-04-01

Field trips are a key component of our curriculum at ISWB. Classroom teaching is invaluable but field trips provide pupils with a tangible connection to pertinent issues of conservation. ISWB realises the importance of out of the classroom learning in field trips and to this end our students have an opportunity to partake in a number of 3-5 day field trips per academic year. In 2016, several Year 8, 9, 10, 11 and 12 students visited the AfriCat Foundation on Okonjima in central Namibia for 4 days to learn about the conservation of the predator population in Namibia. The trips were very successful and another trip this year to AfriCat North close to Etosha National Park, where the students will work closely with the local farming communities, is planned. AfriCat provides Environmental Education programmes for the youth of Namibia giving them a greater understanding of the importance of wildlife conservation. Their main objective is promoting predator and environmental awareness amongst the youth of Namibia. AfriCat Environmental Education Programme is based on 1997 UNESCO-UNEP Environmental Education objectives. "Attitudes: To raise concern about problems, values, personal responsibility and willingness to participate/act. In the end, we conserve only what we love. We will love only what we understand. We will understand only what we are taught."

Hybrid intelligent monironing systems for thermal power plant trips

NASA Astrophysics Data System (ADS)

Barsoum, Nader; Ismail, Firas Basim

2012-11-01

Steam boiler is one of the main equipment in thermal power plants. If the steam boiler trips it may lead to entire shutdown of the plant, which is economically burdensome. Early boiler trips monitoring is crucial to maintain normal and safe operational conditions. In the present work two artificial intelligent monitoring systems specialized in boiler trips have been proposed and coded within the MATLAB environment. The training and validation of the two systems has been performed using real operational data captured from the plant control system of selected power plant. An integrated plant data preparation framework for seven boiler trips with related operational variables has been proposed for IMSs data analysis. The first IMS represents the use of pure Artificial Neural Network system for boiler trip detection. All seven boiler trips under consideration have been detected by IMSs before or at the same time of the plant control system. The second IMS represents the use of Genetic Algorithms and Artificial Neural Networks as a hybrid intelligent system. A slightly lower root mean square error was observed in the second system which reveals that the hybrid intelligent system performed better than the pure neural network system. Also, the optimal selection of the most influencing variables performed successfully by the hybrid intelligent system.

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

PubMed

Smith, Matthew Lee; Prohaska, Thomas R; MacLeod, Kara E; Ory, Marcia G; Eisenstein, Amy R; Ragland, David R; Irmiter, Cheryl; Towne, Samuel D; Satariano, William A

2017-02-10

Background : Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods : Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results : Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions : Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

PubMed Central

Smith, Matthew Lee; Prohaska, Thomas R.; MacLeod, Kara E.; Ory, Marcia G.; Eisenstein, Amy R.; Ragland, David R.; Irmiter, Cheryl; Towne, Samuel D.; Satariano, William A.

2017-01-01

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients. PMID:28208610

Spatial interaction models from Irish commuting data: variations in trip length by occupation and gender

NASA Astrophysics Data System (ADS)

O'Kelly, Morton E.; Niedzielski, Michael A.; Gleeson, Justin

2012-10-01

Core and peripheral contrasts in journey-to-work trip length can be interpreted as imputing the relative value of origin and destination accessibility (yielding theoretical proxies for rent and wages). Because the main variables are shown to be critically dependent on spatial structure, they may be interpreted as showing the shadow prices due to comparative location. There is also a unifying connection between these results and the existing literature on many dimensions: rent gradients, accessibility, and emissivity. In an empirical example, the advantages of a panoramic view of national commuting statistics are shown, using an Irish data set. Variations in the rates of participation in trip making by location, occupation, and gender are examined. Places that emit more trips than would be expected from their relative location are identified. Further, examining ways in which such emissivity is sensitive to a change in trip length highlights the regions where trips could possibly be adjusted to produce a shorter average trip length or which might be especially sensitive to reduction in employment. A careful reinterpretation of one of the key outputs from a calibrated spatial interaction model is shown to be consistent with the declining rent gradient expected from Alonso's theory of land use.

Antiretroviral treatment interruptions induced by the Kenyan postelection crisis are associated with virological failure.

PubMed

Mann, Marita; Diero, Lameck; Kemboi, Emmanuel; Mambo, Fidelis; Rono, Mary; Injera, Wilfred; Delong, Allison; Schreier, Leeann; Kaloustian, Kara W; Sidle, John; Buziba, Nathan; Kantor, Rami

2013-10-01

Antiretroviral treatment interruptions (TIs) cause suboptimal clinical outcomes. Data on TIs during social disruption are limited. We determined effects of unplanned TIs after the 2007-2008 Kenyan postelection violence on virological failure, comparing viral load (VL) outcomes in HIV-infected adults with and without conflict-induced TI. Two hundred and one patients were enrolled, median 2.2 years after conflict and 4.3 years on treatment. Eighty-eight patients experienced conflict-related TIs and 113 received continuous treatment. After adjusting for preconflict CD4, patients with TIs were more likely to have detectable VL, VL >5,000 and VL >10,000. Unplanned conflict-related TIs are associated with increased likelihood of virological failure.

Transitions of Care Model Inclusive of Unplanned Care Improves the Patient Experience

PubMed Central

Cox, Jon; Teague, Stephanie; Beck, Eric

2016-01-01

A major emphasis in health care is creating an experience whereby patients receive the right care at the right time from the right provider in the right setting at the right cost. Over the past several decades, there has been considerable effort in the area of medical management, with prior authorization, gatekeeper utilization management regimens, and other techniques designed to guide patients and caregivers into desired treatment pathways. Alternatively, the concept of demand management may be employed to achieve these desired outcomes by giving patients meaningful, expanded choices beyond traditional acute-care settings. The implementation of a novel, patient-centered, unplanned care delivery model is described along with illustrative case studies. PMID:28725828

Measuring pregnancy planning: An assessment of the London Measure of Unplanned Pregnancy among urban, south Indian women

PubMed Central

Rocca, Corinne H.; Krishnan, Suneeta; Barrett, Geraldine; Wilson, Mark

2010-01-01

We evaluated the psychometric properties of the London Measure of Unplanned Pregnancy among Indian women using classical methods and Item Response Modeling. The scale exhibited good internal consistency and internal structure, with overall scores correlating well with each item’s response categories. Items performed similarly for pregnant and non-pregnant women, and scores decreased with increasing parity, providing evidence for validity. Analyses also detected limitations, including infrequent selection of middle response categories and some evidence of differential item functioning by parity. We conclude that the LMUP represents an improvement over existing measures but recommend steps for enhancing scale performance for this cultural context. PMID:21170147

Career-focused field trips as experienced by at-risk rural students: A case study

NASA Astrophysics Data System (ADS)

Hutson, Tommye L.

A lack of recent research focused on field trips as pedagogy in K-12 settings established the foundation for this work. The research design followed multiple-case case study model. The participants were four male students from a small rural high school in central Texas. Each participant, previously labeled as academically "at-risk", had identified an inability to describe connections between academic science content as presented in their common classes and future jobs, vocational training, and/or careers requiring higher education. Because the participants had no directed field excursions addressing this desirable knowledge and/or skill, a career-focused field trip was designed to address the self-identified deficit reported by the participants. The specific research questions were: (1) How does the ability to describe connections between academic science content (biology, chemistry, and physics) and future careers change as rural students experience a purposeful excursion to a post-secondary facility providing vocational training? (2) When do the connection(s) between content and future careers become evident to students? (3) What effects or impact do newly discovered connections have on rural students' aspirations with regard to future career or higher education options? Data were gathered using existing school records, an initial survey, one-to-one interviews conducted before and after the field trip, focus groups conducted before and after the field trip, and observations during the field trip. Data analysis revealed that all participants were able to describe various connections between academic content and careers after the field trip, as well as identify a specific incident that initially established those connections. In addition, all of the participants reported discovering options for careers during the field trip not previously realized or considered. Each participant indicated that they found field trips to be effective. As a result of their singular experience, they collectively voiced a belief that career-focused field trips should be included in all required science classes starting in late middle school and continuing through at least the 10th grade.

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change.

PubMed

Becan, Jennifer E; Knight, Danica K; Crawley, Rachel D; Joe, George W; Flynn, Patrick M

2015-03-01

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (time 1) and 35 days after admission (time 2). The design consisted of a comparison sample (n=281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n=238). Repeated measures ANCOVAs were conducted using each time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race-ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation. Copyright © 2015 Elsevier Inc. All rights reserved.

Exploring the use of Virtual Field Trips with elementary school teachers: A collaborative action research approach

NASA Astrophysics Data System (ADS)

Scott, Jeffrey Lance

This research examines how elementary school teachers, when supported, use Virtual Field Trips (VFTs) to address the curricula in meaningful ways. I conducted a qualitative study with six teachers, in a collaborative action research context over a six month period. The teachers, five males and one female, all taught either grade five or six and utilized Virtual Field Trips within a variety of curricula areas including science, social studies, music and language arts. In addition, the thesis examines resulting integration of technology into the regular classroom program as a product of the utilization of Virtual Field Trips. The process of collaborative action research was applied as a means of personal and professional growth both for the participants and the researcher/facilitator. By the end of the research study, all participants had learned to integrate Virtual Field Trips into their classroom program, albeit with different levels of success and in different curricula areas. The development of attitudes, skills and knowledge for students and teachers alike was fostered through the participation in Virtual Field Trips. A common concern regarding the utilization of Virtual Field Trips was the time spent locating an appropriate site that met curricula expectations. Participation in the collaborative action research process allowed each teacher to grow professionally, personally and socially. Each participant strongly encouraged the utilization of a long term project with a common area of exploration as a means for positive professional development. Implications and recommendations for future research on the utilization of Virtual Field Trips, as well as the viability of collaborative action research to facilitate teacher development are presented.

A Systematic Review of Economic Analysis of Surgical Mission Trips Using the World Health Organization Criteria.

PubMed

Nolte, Michael T; Maroukis, Brianna L; Chung, Kevin C; Mahmoudi, Elham

2016-08-01

Although the World Health Organization (WHO) has developed tools to standardize economic evaluations of global health interventions, little is known about the cost-effectiveness of surgical mission trips and their economic values. Our objective was to systematically evaluate the current literature on surgical volunteering trips to measure their adherence to WHO CHOosing Interventions that are cost-effective (WHO-CHOICE). We hypothesized that the majority of studies use some type of cost-effectiveness analysis that do not adhere to these standards. A systematic review of Pubmed, Medline, and Embase databases was performed in accordance with PRISMA guidelines, with inclusion criteria set a priori. Of the 908 publications screened, 72 were selected for full text review; 17 met inclusion criteria. Only 17 out of 72 studies reported some type of economic analysis. We categorized the studies into service, educational, and combination (service and educational) surgical trips. Although seven of the service studies calculated the cost per disability-adjusted life year averted, the results were not based on WHO-CHOICE standards to facilitate comparisons among alternative options. Furthermore, none of the three educational trips calculated the value of the education provided, but only published cost estimates of the resources used during the trip. Although a few studies performed some type of economic analysis, owing to their non-adherence to WHO-CHOICE standards, the results were not comparable to other studies. International surgical trips are expensive. To improve the efficacy and optimal use of limited resources, studies on surgical trips should follow the guidelines set by the WHO-CHOICE.

'Sea legs': sharpened Romberg test after three days on a live-aboard dive boat.

PubMed

Gibbs, Clinton R; Commons, Katherine H; Brown, Lawrence H; Blake, Denise F

2010-12-01

The sharpened Romberg test (SRT) is commonly used by diving and hyperbaric physicians as an indicator of neurological decompression illness (DCI). People who spend a prolonged time on a boat at sea experience impairment in their balance on returning to shore, a condition known as mal de debarquement ('sea legs'). This conditioning of the vestibular system to the rocking motion of a boat at sea may impact on the utility of the SRT in assessing a diver with potential DCI after a live-aboard dive trip. To assess the impact 'sea legs' has on the SRT after three days on a live-aboard dive trip. Thirty-nine staff and passengers of a three-day, live-aboard dive trip performed a SRT before and after their journey, with assessment of potential variables, including middle ear barotrauma, alcohol consumption, sea-sickness and occult DCI. There was no statistically significant impact on SRT performance, with 100% completion pre-trip and 35 out of 36 divers (97.2%) post-trip. There were trends towards more attempts being required and time needed for successful SRT post-trip, but these were not statistically significant. There was a small, but noteworthy incidence of middle-ear barotrauma, with seven people affected pre-trip, and 13 post-trip. There was a higher incidence in student divers. Middle-ear barotrauma did not appear to have a direct impact on SRT performance. There was no significant impact on SRT performance resulting from 'sea legs' after three days at sea. Recreational divers, especially dive students, have a substantial incidence of mild middle ear barotrauma.

Exploring utilitarian and hedonic antecedents for adopting information from a recommendation agent and unplanned purchase behaviour

NASA Astrophysics Data System (ADS)

Huang, Li-Ting

2016-01-01

Research indicated that in order for properly utilizing recommendation agents (RAs), customers must rationally evaluate capability and suggestions of RAs during the interaction process. However, enjoying interactive processes and interface is also important. Methods for increasing user enjoyment of RAs are yet unknown. This study investigated the influences of utilitarian and hedonic factors on intention to adopt RAs suggestions and their antecedents. Involvement influences relative importance of utilitarian and hedonic factors. Contrary to common assumptions, customers may make unplanned purchases, rather than rational purchase. A field experiment with 2 × 2 × 2 factorial design reveals main findings. First, information diagnosticity and enjoyment enhance adoption intention simultaneously. Information diagnosticity is more important than enjoyment. Diagnosticity was determined by outcome similarity, and enjoyment was determined by both outcome similarity and atmospherics. The context of interacting with RAs is important. Outcome similarity even directly affects adoption intention. Second, highly involved users considered enjoyment and diagnosticity when forming adoption intentions, while users with low involvement only considered enjoyment. Third, information cascades altered the relationship between adoption intention and unplanned purchases. Most customers change selection after seeing ratings from other customers, even if they originally strongly want to adoption suggestion from RAs. Theoretical and managerial implications are proposed.

Induced abortion is not associated with a higher likelihood of depression in Curaçao women.

PubMed

Boersma, Adriana A; van den Berg, Desirée; van Lunsen, Rik H W; Laan, Ellen T M

2014-10-01

To investigate the risk of developing a depression after induced abortion. A prospective cohort study conducted in Curaçao which involved 92 women having an induced abortion and 37 women delivering after an unplanned or unwanted pregnancy, who served as controls. All participants completed the Center of Epidemiological Studies Depression (CES-D) scale before and two to three weeks after the abortion or delivery. Following the abortion, significantly fewer women were at risk of depression (30%) as compared to when still pregnant (60%). Mean depression scores were significantly lower after- than before the procedure. The likelihood of depression post-abortum (30%) was similar to that after delivery of an unplanned/unwanted child (22%). Even though women in the abortion group more often reported having suffered from depression in the past than controls, they were not at greater risk of depression after their pregnancy had ended. Curaçao women's risk of developing a depression following an (early) induced abortion is not greater than that after carrying to term an unplanned/unwanted pregnancy. We recommend that the results of this study be taken into account in case the Curaçao government should consider legalisation of induced abortion in the near future.

Early Discharge and Home Care After Unplanned Cesarean Birth: Nursing Care Time

PubMed Central

Brooten, Dorothy; Knapp, Helen; Borucki, Lynne; Jacobsen, Barbara; Finkler, Steven; Arnold, Lauren; Mennuti, Michael

2013-01-01

Objective This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. Design A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. Setting An urban tertiary-care hospital. Patients The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborns was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Interventions Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Outcome Measure Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. Results More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Conclusions Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group. PMID:8892128

Inequalities in microbial contamination of drinking water supplies in urban areas: the case of Lilongwe, Malawi.

PubMed

Boakye-Ansah, Akosua Sarpong; Ferrero, Giuliana; Rusca, Maria; van der Zaag, Pieter

2016-10-01

Over past decades strategies for improving access to drinking water in cities of the Global South have mainly focused on increasing coverage, while water quality has often been overlooked. This paper focuses on drinking water quality in the centralized water supply network of Lilongwe, the capital of Malawi. It shows how microbial contamination of drinking water is unequally distributed to consumers in low-income (unplanned areas) and higher-income neighbourhoods (planned areas). Microbial contamination and residual disinfectant concentration were measured in 170 water samples collected from in-house taps in high-income areas and from kiosks and water storage facilities in low-income areas between November 2014 and January 2015. Faecal contamination (Escherichia coli) was detected in 10% of the 40 samples collected from planned areas, in 59% of the 64 samples collected from kiosks in the unplanned areas and in 75% of the 32 samples of water stored at household level. Differences in water quality in planned and unplanned areas were found to be statistically significant at p < 0.05. Finally, the paper shows how the inequalities in microbial contamination of drinking water are produced by decisions both on the development of the water supply infrastructure and on how this is operated and maintained.

Denial of women's rights to contraception in southeastern Nigeria.

PubMed

Chigbu, Chibuike O; Onyebuchi, Azubuike K; Onwudiwe, Elijah N; Iwuji, Stella E

2013-05-01

To evaluate the opinions and experiences of married women in southeastern Nigeria regarding their rights to contraception, in addition to the impact of the denial of women's contraceptive rights on unplanned pregnancy rate. A cross-sectional survey of women who registered for prenatal care at 2 federal tertiary healthcare facilities in southeastern Nigeria was conducted. Randomly selected samples of participants were interviewed via a structured, pretested questionnaire. In total, 1204 women participated in the survey. Overall, 526 (43.7%) were unaware of their rights to contraception. Denial of contraceptive rights was reported by 522 (43.4%) women. In total, 174/317 (54.9%) women with unplanned pregnancies blamed denial of access to contraception for their pregnancies. Among the women who had used contraception previously, 61.9% reported that the decision to do so was taken by their spouse. Formal education seemed to increase women's level of awareness of their rights to contraception (P=0.001) but it did not influence the exercising of such rights. A considerable proportion of women in southeastern Nigeria are being denied their rights to contraception, mainly owing to a culture of male dominance. There may be significant health implications for women with unplanned pregnancies arising from such denials. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Incorporating "Virtual" and "Real World" Field Trips into Introductory Geography Modules

ERIC Educational Resources Information Center

Friess, Daniel A.; Oliver, Grahame J. H.; Quak, Michelle S. Y.; Lau, Annie Y. A.

2016-01-01

The "field trip" is a key pedagogical tool within geographical education to encourage deep learning, though they are increasingly difficult to implement due to reduced budgets, safety concerns and increasing class sizes. We incorporated three field-learning activities into a large introductory module. A traditional staff-led trip was the…

Forests and Flowers. A Spring Activity Packet for Third Grade.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on plants and…

Ecology of an Estuary: Chesapeake Bay. A Guide for Middle School Teachers.

ERIC Educational Resources Information Center

Fleming, Cris; Swarth, Christopher

This environmental education teaching guide for middle school teachers features information on the National Estuarine Reserve System in Maryland. Pre-trip field activities, field trip activities, and post-trip activities are discussed, and a list of useful resources and organizations is provided. Reproducible handouts are included throughout the…

The Case of the Field Trip Disaster

ERIC Educational Resources Information Center

Collins, Loucrecia; Redcross, Joseph

2005-01-01

For decades, the instructional field trip has been viewed as a strategy to enhance students' learning experiences. Yet what happens when an award-winning teacher is accused of choking a student while on a field trip? Tempers flare among community members, parents contact the police, and the principal is assigned the daunting task of investigating…

Signs of Fall. A Fall Activity Packet for Pre-School.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on the characteristics of…

8th Grade Canadian Trip.

ERIC Educational Resources Information Center

Jelinek, Gilbert; Schoenike, Paul

Ideas are offered for helping eighth-grade students incorporate an at-home field trip to Canada into a social studies unit. The teachers who developed the unit state that students can complete the 21-day imaginary trip in five hours of classroom time when appropriate materials are available and the classroom environment is conducive to working on…

Nature's Hitchhikers. A Fall Activity Packet for Second Grade.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on the characteristics of…

49 CFR 37.189 - Service requirement for OTRB demand-responsive systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... business of transporting people, whose operations affect commerce, and that provide demand-responsive OTRB... all passengers to reserve space on the bus three months before the trip date. This requirement applies... request for space on the trip and an accessible OTRB 48 hours before the trip date, the operator could...

49 CFR 37.189 - Service requirement for OTRB demand-responsive systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... business of transporting people, whose operations affect commerce, and that provide demand-responsive OTRB... all passengers to reserve space on the bus three months before the trip date. This requirement applies... request for space on the trip and an accessible OTRB 48 hours before the trip date, the operator could...

49 CFR 37.189 - Service requirement for OTRB demand-responsive systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... business of transporting people, whose operations affect commerce, and that provide demand-responsive OTRB... all passengers to reserve space on the bus three months before the trip date. This requirement applies... request for space on the trip and an accessible OTRB 48 hours before the trip date, the operator could...

49 CFR 37.189 - Service requirement for OTRB demand-responsive systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... business of transporting people, whose operations affect commerce, and that provide demand-responsive OTRB... all passengers to reserve space on the bus three months before the trip date. This requirement applies... request for space on the trip and an accessible OTRB 48 hours before the trip date, the operator could...

Collecting Planarians: A Good Choice for a Field Trip.

ERIC Educational Resources Information Center

Cha, Heeyoung

2001-01-01

Describes a field trip to collect planarians as successful in generating interest in the sciences. This activity is suitable for all grade levels as a field trip or biology lab. Planarians can be easily collected from streams across the United States. Once in the classroom, planaria are easily fed and cared for. (SAH)

Energy Around Us. A Fall Activity Packet for Fourth Grade.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on energy uses, energy…

Pedagogical Souvenirs: An Art Educator's Reflections on Field Trips as Professional Development

ERIC Educational Resources Information Center

Kushins, Jodi

2015-01-01

This essay explores the nature and importance of field trips as sites for artistic development, intellectual fulfillment, and pedagogical inspiration. The author weaves personal reflections from a professional field trip and experience teaching art education online with creative and pedagogical references to make a case for experiential learning…

Open the Door, Let's Explore More! Field Trips of Discovery for Young Children.

ERIC Educational Resources Information Center

Redleaf, Rhoda

Designed as a resource for teachers and parents, this guide contains activities to help children in primary grades learn from walks and field trips. Chapter 1, "Experience and Learning," discusses general information about how young children learn and the contribution of field trips to children's perception, language, memory, and logical…

Student Self-Reported Learning Outcomes of Field Trips: The Pedagogical Impact

ERIC Educational Resources Information Center

Alon, Nirit Lavie; Tal, Tali

2015-01-01

In this study, we used the classification and regression trees (CART) method to draw relationships between student self-reported learning outcomes in 26 field trips to natural environments and various characteristics of the field trip that include variables associated with preparation and pedagogy. We wished to examine the extent to which the…

Michigan Natural History. A Spring Activity Packet for Fourth Grade.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on the natural history of…

Reading the Rocks. A Fall Activity Packet for Fifth Grade.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on various geological…

Thinking outside the Classroom: Integrating Field Trips into a First-Year Undergraduate Chemistry Curriculum

ERIC Educational Resources Information Center

Forest, Kaya; Rayne, Sierra

2009-01-01

Studies on student learning during primary- and secondary-school course-related field trip activities have shown lasting cognitive and socio-cultural effects. However, fewer studies have investigated the potential benefits of incorporating field trip activities into post-secondary education. The curriculum in a first-year university chemistry…

Spring Birds. A Spring Activity Packet for First Grade.

ERIC Educational Resources Information Center

Jackson Community Coll., MI. Dahlem Environmental Education Center.

This instructional packet is one of 14 school environmental education programs developed for use in the classroom and at the Dahlem Environmental Education Center (DEEC) of the Jackson Community College (Michigan). Provided in the packet are pre-trip activities, field trip activities, and post-trip activities which focus on the characteristics of…