Theory of mind in schizophrenia: correlation with clinical symptomatology, emotional recognition and ward behavior.

PubMed

Lee, Woo Kyeong; Kim, Yong Kyu

2013-09-01

Several studies have suggested the presence of a theory of mind (ToM) deficit in schizophrenic disorders. This study examined the relationship of emotion recognition, theory of mind, and ward behavior in patients with schizophrenia. Fifty-five patients with chronic schizophrenia completed measures of emotion recognition, ToM, intelligence, Positive and Negative Syndrome Scale (PANSS) and Nurse's Observation Scale for Inpatient Evaluation (NOSIE). Theory of mind sum score correlated significantly with IQ, emotion recognition, and ward behavior. Ward behavior was linked to the duration of the illness, and even more so to theory of mind deficits. Theory of mind contributed a significant proportion of the amount of variance to explain social behavior on the ward. Considering our study results, impaired theory of mind contributes significantly to the understanding of social competence in patients with schizophrenia. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

Reviving post-take surgical ward round teaching.

PubMed

Force, Jade; Thomas, Ian; Buckley, Frances

2014-04-01

Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p < 0.0001) and perceived learning (p < 0.0001). Consultant surgeons were supportive of the teaching initiative. Support from CTFs on busy PTSWRs optimised student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff. © 2014 John Wiley & Sons Ltd.

A ward without patients.

PubMed

1988-01-02

Walk into Brooke ward and it doesn't feel like a ward at all. There are bright-coloured bedspreads, cuddly toys everywhere, a 1930s ball gown hangs above one of the lockers. And of course, there's Emma, the ward cat - continually fussed over by nurses and residents alike.

A feasibility study comparing UK older adult mental health inpatient wards which use protected engagement time with other wards which do not: study protocol.

PubMed

Nolan, Fiona M; Fox, Chris; Cheston, Richard; Turner, David; Clark, Allan; Dodd, Emily; Khoo, Mary-Ellen; Gray, Richard

2016-01-01

Protected engagement time (PET) is a concept of managing staff time on mental health inpatient wards with the aim of increasing staff and patient interaction. Despite apparent widespread use of PET, there remains a dearth of evidence as to how it is implemented and whether it carries benefits for staff or patients. This protocol describes a study which is being carried out on mental health wards caring for older adults (aged over 65) in England. The study shares a large proportion of the procedures, measures and study team membership of a recently completed investigation of the impact of PET in adult acute mental health wards. The study aims to identify prevalence and components of PET to construct a model for the intervention, in addition to testing the feasibility of the measures and procedures in preparation for a randomised trial. The study comprises four modules and uses a mixed methods approach. Module 1 involves mapping all inpatient wards in England which provide care for older adults, including those with dementia, ascertaining how many of these provide PET and in what way. Module 2 uses a prospective cohort method to compare five older adult mental health wards that use PET with five that do not across three National Health Service (NHS) Foundation Trust sites. The comparison comprises questionnaires, observation tools and routinely collected clinical service data and combines validated measures with questions developed specifically for the study. Module 3 entails an in-depth case study evaluation of three of the participating PET wards (one from each NHS Trust site) using semi-structured interviews with patients, carers and staff. Module 4 describes the development of a model and fidelity scale for PET using the information derived from the other modules with a working group of patients, carers and staff. This is a feasibility study to test the application of the measures and methods in inpatient wards for older adults and develop a draft model for the

Job satisfaction in mainland China: comparing critical care nurses and general ward nurses.

PubMed

Zhang, Aihua; Tao, Hong; Ellenbecker, Carol Hall; Liu, Xiaohong

2013-08-01

To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. A cross-sectional design was selected for this descriptive correlation study. Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse. © 2012 Blackwell Publishing Ltd.

Linking crop yield anomalies to large-scale atmospheric circulation in Europe.

PubMed

Ceglar, Andrej; Turco, Marco; Toreti, Andrea; Doblas-Reyes, Francisco J

2017-06-15

Understanding the effects of climate variability and extremes on crop growth and development represents a necessary step to assess the resilience of agricultural systems to changing climate conditions. This study investigates the links between the large-scale atmospheric circulation and crop yields in Europe, providing the basis to develop seasonal crop yield forecasting and thus enabling a more effective and dynamic adaptation to climate variability and change. Four dominant modes of large-scale atmospheric variability have been used: North Atlantic Oscillation, Eastern Atlantic, Scandinavian and Eastern Atlantic-Western Russia patterns. Large-scale atmospheric circulation explains on average 43% of inter-annual winter wheat yield variability, ranging between 20% and 70% across countries. As for grain maize, the average explained variability is 38%, ranging between 20% and 58%. Spatially, the skill of the developed statistical models strongly depends on the large-scale atmospheric variability impact on weather at the regional level, especially during the most sensitive growth stages of flowering and grain filling. Our results also suggest that preceding atmospheric conditions might provide an important source of predictability especially for maize yields in south-eastern Europe. Since the seasonal predictability of large-scale atmospheric patterns is generally higher than the one of surface weather variables (e.g. precipitation) in Europe, seasonal crop yield prediction could benefit from the integration of derived statistical models exploiting the dynamical seasonal forecast of large-scale atmospheric circulation.

Advancing atmospheric river forecasts into subseasonal-to-seasonal time scales

NASA Astrophysics Data System (ADS)

Baggett, Cory F.; Barnes, Elizabeth A.; Maloney, Eric D.; Mundhenk, Bryan D.

2017-07-01

Atmospheric rivers are elongated plumes of intense moisture transport that are capable of producing extreme and impactful weather. Along the West Coast of North America, they occasionally cause considerable mayhem—delivering flooding rains during periods of heightened activity and desiccating droughts during periods of reduced activity. The intrinsic chaos of the atmosphere makes the prediction of atmospheric rivers at subseasonal-to-seasonal time scales (3 to 5 weeks) an inherently difficult task. We demonstrate here that the potential exists to advance forecast lead times of atmospheric rivers into subseasonal-to-seasonal time scales through knowledge of two of the atmosphere's most prominent oscillations, the Madden-Julian oscillation (MJO) and the quasi-biennial oscillation (QBO). Strong MJO and QBO activity modulates the frequency at which atmospheric rivers strike—offering an opportunity to improve subseasonal-to-seasonal forecast models and thereby skillfully predict atmospheric river activity up to 5 weeks in advance.

Shuttle program: Computing atmospheric scale height for refraction corrections

NASA Technical Reports Server (NTRS)

Lear, W. M.

1980-01-01

Methods for computing the atmospheric scale height to determine radio wave refraction were investigated for different atmospheres, and different angles of elevation. Tables of refractivity versus altitude are included. The equations used to compute the refraction corrections are given. It is concluded that very accurate corrections are determined with the assumption of an exponential atmosphere.

45 CFR 46.409 - Wards.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Wards. 46.409 Section 46.409 Public Welfare... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or...

45 CFR 46.409 - Wards.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Wards. 46.409 Section 46.409 Public Welfare... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or...

45 CFR 46.409 - Wards.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Wards. 46.409 Section 46.409 Public Welfare... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or...

45 CFR 46.409 - Wards.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Wards. 46.409 Section 46.409 Public Welfare... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or...

45 CFR 46.409 - Wards.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Wards. 46.409 Section 46.409 Public Welfare... Protections for Children Involved as Subjects in Research § 46.409 Wards. (a) Children who are wards of the state or any other agency, institution, or entity can be included in research approved under § 46.406 or...

A systems analysis of ward rounds in plastic surgery at a single center

PubMed Central

2017-01-01

Introduction: Ward rounds permeate health care delivery worldwide and form an important daily activity within all hospitals. In this study, the daily morning ward round in plastic surgery was examined from a teleological and systems point of view. Methods: Data were gathered from the following sources to inform the systems analysis: patient interviews, staff interviews, direct observations of the ward round on multiple occasions, and through process mapping. Results: To better understand the ward and its layout, a schematic of it was developed. Following observations of the ward round and the way in which decisions are made on it, an IDEF0 map was developed. Three patients were invited to take part in the study. Three members of staff were interviewed. The overarching themes from the interviews related to aspects of communication which this paper details. Conclusions: This small-scale study demonstrates how the ward round as a process can be assessed, including product quality, process quality, the measurement and management of capacity, the role of standardization, the role and significance of bottlenecks, the key information flows, including the role of feedback, and the motivation and incentives of system participants and ideas for improvement generated. PMID:29177228

Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence.

PubMed

Lepping, P; Steinert, T; Needham, I; Abderhalden, C; Flammer, E; Schmid, P

2009-09-01

Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.

Measuring ward round quality in urology.

PubMed

Darbyshire, Daniel; Barrett, Charlotte; Ross, David; Shackley, David

2015-01-01

Ward rounds are the traditional process by which clinical information is interpreted and management plans made in the inpatient setting and the only time during which patient-doctor interaction can reliably occur. Efforts to improve quality and safety have started looking at the ward round but this has mainly been in the acute medical setting. To begin the quality improvement process for Urological ward rounds. Twenty indicators thought to relate to quality were recorded for every weekday ward round by the Urology team for one month. Twenty ward rounds, 93 patient encounters, were reviewed. A consultant was present for 37% of the patient encounters. 84% of observation charts were reviewed; drug charts 28% and antibiotics 70%. Plans were communicated to the doctors, patient and nursing staff. All notes were typed directly onto the electronic system, 20% of notes were checked by the lead clinician. Mean time per patient was 6 minutes. By starting a discussion about ward rounds we aim to align the process with the broader values of the organisation. Ward rounds can be the cornerstone of delivering safe, clean and personal care and measuring this process is vital to understanding efforts to improve them.

The aurora as a source of planetary-scale waves in the middle atmosphere. [atmospheric turbulence caused by auroral energy absorption

NASA Technical Reports Server (NTRS)

Chiu, Y. T.; Straus, J. M.

1974-01-01

Photographs of global scale auroral forms taken by scanning radiometers onboard weather satellites in 1972 show that auroral bands exhibit well organized wave motion with typical zonal wave number of 5 or so. The scale size of these waves is in agreement with that of well organized neutral wind fields in the 150- to 200-km region during the geomagnetic storm of May 27, 1967. Further, the horizontal scale size revealed by these observations are in agreement with that of high altitude traveling ionospheric disturbances. It is conjectured that the geomagnetic storm is a source of planetary and synoptic scale neutral atmospheric waves in the middle atmosphere. Although there is, at present, no observation of substorm related waves of this scale size at mesospheric and stratospheric altitudes, the possible existence of a new source of waves of the proper scale size to trigger instabilities in middle atmospheric circulation systems may be significant in the study of lower atmospheric response to geomagnetic activity.

Simulation of all-scale atmospheric dynamics on unstructured meshes

NASA Astrophysics Data System (ADS)

Smolarkiewicz, Piotr K.; Szmelter, Joanna; Xiao, Feng

2016-10-01

The advance of massively parallel computing in the nineteen nineties and beyond encouraged finer grid intervals in numerical weather-prediction models. This has improved resolution of weather systems and enhanced the accuracy of forecasts, while setting the trend for development of unified all-scale atmospheric models. This paper first outlines the historical background to a wide range of numerical methods advanced in the process. Next, the trend is illustrated with a technical review of a versatile nonoscillatory forward-in-time finite-volume (NFTFV) approach, proven effective in simulations of atmospheric flows from small-scale dynamics to global circulations and climate. The outlined approach exploits the synergy of two specific ingredients: the MPDATA methods for the simulation of fluid flows based on the sign-preserving properties of upstream differencing; and the flexible finite-volume median-dual unstructured-mesh discretisation of the spatial differential operators comprising PDEs of atmospheric dynamics. The paper consolidates the concepts leading to a family of generalised nonhydrostatic NFTFV flow solvers that include soundproof PDEs of incompressible Boussinesq, anelastic and pseudo-incompressible systems, common in large-eddy simulation of small- and meso-scale dynamics, as well as all-scale compressible Euler equations. Such a framework naturally extends predictive skills of large-eddy simulation to the global atmosphere, providing a bottom-up alternative to the reverse approach pursued in the weather-prediction models. Theoretical considerations are substantiated by calculations attesting to the versatility and efficacy of the NFTFV approach. Some prospective developments are also discussed.

Consumer perspectives in adolescent ward design.

PubMed

Hutton, Alison

2005-05-01

The aim of the study was to gain an understanding of the environment and facilities that adolescents require in a purpose-built adolescent ward. People who are hospitalized have limited control over their care and environment. The experience of hospitalization is also considered a highly stressful event. It is essential that patients have an opportunity to participate in the planning and design of ward environments in order to reduce their stress and better accommodate their treatment needs. An interpretative qualitative design was used. Seven chronically ill adolescents were asked to design their own ward in order to obtain consumer input about what the perceived necessary facilities for adolescent wards. The adolescents provided clear information about the facilities that should be incorporated into an adolescent ward to maintain their privacy and independence. Further research needs to be conducted seeking consumer input, especially if it can enhance the stay of adolescent patients while they are hospitalized. Adolescent voice is more often than not represented by nurses, or other healthcare professionals in the patients' best interest. This practice acts on the assumption that the adult knows best and/or that adolescents are unable to articulate their own needs. Adolescent consumers contribute worthwhile recommendations to how a ward is run providing insight about their needs in the ward environment.

Bottom-up regulation of a pole-ward migratory predator population

PubMed Central

van den Hoff, John; McMahon, Clive R.; Simpkins, Graham R.; Hindell, Mark A.; Alderman, Rachael; Burton, Harry R.

2014-01-01

As the effects of regional climate change are most pronounced at polar latitudes, we might expect polar-ward migratory populations to respond as habitat suitability changes. The southern elephant seal (Mirounga leonina L.) is a pole-ward migratory species whose populations have mostly stabilized or increased in the past decade, the one exception being the Macquarie Island population which has decreased continuously over the past 50 years. To explore probable causes of this anomalous trend, we counted breeding female seals annually between 1988 and 2011 in order to relate annual rates of population change (r) to foraging habitat changes that have known connections with atmospheric variability. We found r (i) varied annually from −0.016 to 0.021 over the study period, (ii) was most effected by anomalous atmospheric variability after a 3 year time lag was introduced (R = 0.51) and (iii) was associated with sea-ice duration (SID) within the seals’ foraging range at the same temporal lag. Negative r years may be extrapolated to explain, at least partially, the overall trend in seal abundance at Macquarie Island; specifically, increasing SID within the seals foraging range has a negative influence on their abundance at the island. Evidence is accruing that suggests southern elephant seal populations may respond positively to a reduced sea-ice field. PMID:24619437

Revised Perturbation Statistics for the Global Scale Atmospheric Model

NASA Technical Reports Server (NTRS)

Justus, C. G.; Woodrum, A.

1975-01-01

Magnitudes and scales of atmospheric perturbations about the monthly mean for the thermodynamic variables and wind components are presented by month at various latitudes. These perturbation statistics are a revision of the random perturbation data required for the global scale atmospheric model program and are from meteorological rocket network statistical summaries in the 22 to 65 km height range and NASA grenade and pitot tube data summaries in the region up to 90 km. The observed perturbations in the thermodynamic variables were adjusted to make them consistent with constraints required by the perfect gas law and the hydrostatic equation. Vertical scales were evaluated by Buell's depth of pressure system equation and from vertical structure function analysis. Tables of magnitudes and vertical scales are presented for each month at latitude 10, 30, 50, 70, and 90 degrees.

The Teamwork Assessment Scale: A Novel Instrument to Assess Quality of Undergraduate Medical Students' Teamwork Using the Example of Simulation-based Ward-Rounds.

PubMed

Kiesewetter, Jan; Fischer, Martin R

2015-01-01

Simulation-based teamwork trainings are considered a powerful training method to advance teamwork, which becomes more relevant in medical education. The measurement of teamwork is of high importance and several instruments have been developed for various medical domains to meet this need. To our knowledge, no theoretically-based and easy-to-use measurement instrument has been published nor developed specifically for simulation-based teamwork trainings of medical students. Internist ward-rounds function as an important example of teamwork in medicine. The purpose of this study was to provide a validated, theoretically-based instrument that is easy-to-use. Furthermore, this study aimed to identify if and when rater scores relate to performance. Based on a theoretical framework for teamwork behaviour, items regarding four teamwork components (Team Coordination, Team Cooperation, Information Exchange, Team Adjustment Behaviours) were developed. In study one, three ward-round scenarios, simulated by 69 students, were videotaped and rated independently by four trained raters. The instrument was tested for the embedded psychometric properties and factorial structure. In study two, the instrument was tested for construct validity with an external criterion with a second set of 100 students and four raters. In study one, the factorial structure matched the theoretical components but was unable to separate Information Exchange and Team Cooperation. The preliminary version showed adequate psychometric properties (Cronbach's α=.75). In study two, the instrument showed physician rater scores were more reliable in measurement than those of student raters. Furthermore, a close correlation between the scale and clinical performance as an external criteria was shown (r=.64) and the sufficient psychometric properties were replicated (Cronbach's α=.78). The validation allows for use of the simulated teamwork assessment scale in undergraduate medical ward-round trainings to reliably

A study of large scale gust generation in a small scale atmospheric wind tunnel with applications to Micro Aerial Vehicles

NASA Astrophysics Data System (ADS)

Roadman, Jason Markos

Modern technology operating in the atmospheric boundary layer can always benefit from more accurate wind tunnel testing. While scaled atmospheric boundary layer tunnels have been well developed, tunnels replicating portions of the atmospheric boundary layer turbulence at full scale are a comparatively new concept. Testing at full-scale Reynolds numbers with full-scale turbulence in an "atmospheric wind tunnel" is sought. Many programs could utilize such a tool including Micro Aerial Vehicle(MAV) development, the wind energy industry, fuel efficient vehicle design, and the study of bird and insect flight, to name just a few. The small scale of MAVs provide the somewhat unique capability of full scale Reynolds number testing in a wind tunnel. However, that same small scale creates interactions under real world flight conditions, atmospheric gusts for example, that lead to a need for testing under more complex flows than the standard uniform flow found in most wind tunnels. It is for these reasons that MAVs are used as the initial testing application for the atmospheric gust tunnel. An analytical model for both discrete gusts and a continuous spectrum of gusts is examined. Then, methods for generating gusts in agreement with that model are investigated. Previously used methods are reviewed and a gust generation apparatus is designed. Expected turbulence and gust characteristics of this apparatus are compared with atmospheric data. The construction of an active "gust generator" for a new atmospheric tunnel is reviewed and the turbulence it generates is measured utilizing single and cross hot wires. Results from this grid are compared to atmospheric turbulence and it is shown that various gust strengths can be produced corresponding to weather ranging from calm to quite gusty. An initial test is performed in the atmospheric wind tunnel whereby the effects of various turbulence conditions on transition and separation on the upper surface of a MAV wing is investigated

Job stressors and social support behaviors: comparing intensive care units to wards in Jordan.

PubMed

Mrayyan, Majd T

2009-02-01

Studies about nurses' stressors and social support behaviors are limited. This study explored differences between Intensive Care Units (ICUs) and wards in regard to Jordanian nurses' job stressors and social support behaviors as well as predictors of the two concepts. A quantitative research design using a survey method was used. The Nursing Stress Scale (NSS) (Gray-Toft & Anderson 1981) and the Inventory of Social Supportive Behaviors (ISSB) (Barrera, Sandler & Ramsay 1981) were used to collect data from a convenience sample of 228 nurses who were working in 12 ICUs and 235 nurses who were working in nine wards of 13 hospitals, with a total response rate of 66.2%. Stressors in ICUs were higher than those in wards. The ICUs scored higher than wards in 'conflict with physicians' subscale of NSS. The ICUs scored higher than wards in 'emotional support' and 'tangible assistance' subscales of ISSB. Shift worked, model of nursing care, and level of education predicted nurses' job stressors in ICUs and wards. 'Model of nursing care' was a shared predictor of social support behaviors in ICUs and wards. High job stressors and low social support behaviors were evidenced in Jordan. Job stressors were higher in ICUs than those in wards, thus more social support behaviors should be provided to nurses in ICUs. Nurses' stressors should be assessed and managed. In all settings in general and in ICUs in particular, nurse managers should use various social support behaviors to buffer the influence of job stressors on nurses.

Simulation for ward processes of surgical care.

PubMed

Pucher, Philip H; Darzi, Ara; Aggarwal, Rajesh

2013-07-01

The role of simulation in surgical education, initially confined to technical skills and procedural tasks, increasingly includes training nontechnical skills including communication, crisis management, and teamwork. Research suggests that many preventable adverse events can be attributed to nontechnical error occurring within a ward context. Ward rounds represent the primary point of interaction between patient and physician but take place without formalized training or assessment. The simulated ward should provide an environment in which processes of perioperative care can be performed safely and realistically, allowing multidisciplinary assessment and training of full ward rounds. We review existing literature and describe our experience in setting up our ward simulator. We examine the facilities, equipment, cost, and personnel required for establishing a surgical ward simulator and consider the scenario development, assessment, and feedback tools necessary to integrate it into a surgical curriculum. Copyright © 2013 Elsevier Inc. All rights reserved.

Development and analysis of prognostic equations for mesoscale kinetic energy and mesoscale (subgrid scale) fluxes for large-scale atmospheric models

NASA Technical Reports Server (NTRS)

Avissar, Roni; Chen, Fei

1993-01-01

Generated by landscape discontinuities (e.g., sea breezes) mesoscale circulation processes are not represented in large-scale atmospheric models (e.g., general circulation models), which have an inappropiate grid-scale resolution. With the assumption that atmospheric variables can be separated into large scale, mesoscale, and turbulent scale, a set of prognostic equations applicable in large-scale atmospheric models for momentum, temperature, moisture, and any other gaseous or aerosol material, which includes both mesoscale and turbulent fluxes is developed. Prognostic equations are also developed for these mesoscale fluxes, which indicate a closure problem and, therefore, require a parameterization. For this purpose, the mean mesoscale kinetic energy (MKE) per unit of mass is used, defined as E-tilde = 0.5 (the mean value of u'(sub i exp 2), where u'(sub i) represents the three Cartesian components of a mesoscale circulation (the angle bracket symbol is the grid-scale, horizontal averaging operator in the large-scale model, and a tilde indicates a corresponding large-scale mean value). A prognostic equation is developed for E-tilde, and an analysis of the different terms of this equation indicates that the mesoscale vertical heat flux, the mesoscale pressure correlation, and the interaction between turbulence and mesoscale perturbations are the major terms that affect the time tendency of E-tilde. A-state-of-the-art mesoscale atmospheric model is used to investigate the relationship between MKE, landscape discontinuities (as characterized by the spatial distribution of heat fluxes at the earth's surface), and mesoscale sensible and latent heat fluxes in the atmosphere. MKE is compared with turbulence kinetic energy to illustrate the importance of mesoscale processes as compared to turbulent processes. This analysis emphasizes the potential use of MKE to bridge between landscape discontinuities and mesoscale fluxes and, therefore, to parameterize mesoscale fluxes

Influence of Parental Encouragement towards Health Care of Their Wards

ERIC Educational Resources Information Center

Sophia, R. Grace; Veliappan, A.

2015-01-01

The purpose of the present study is to explore how parents are encouraging towards health care of their wards. A "Survey Method" was used in the present study. A standardized "Agarwal Parental Encouragement Scale (APES)" was used to collect information from the students. The sample consists of thousand and ninety five higher…

Operation Ward's Island, A Guide to the Trees and Other Features of Ward's Island.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Bureau of Curriculum Development.

This guide for teachers, students, and adults illustrates how it is possible to use Ward's Island as an outdoor laboratory. It contains a guide to 30 kinds of trees on the island, along with clearly drawn maps and illustrations. The guide helps the user to locate these trees along two nature trails. A section called "Ward's Island…

Ward rounds, participants, roles and perceptions: literature review.

PubMed

Walton, Victoria; Hogden, Anne; Johnson, Julie; Greenfield, David

2016-05-09

Purpose - The purpose of this paper is to classify and describe the purpose of ward rounds, who attends each round and their role, and participants' perception of each other's role during the respective ward rounds. Design/methodology/approach - A literature review of face-to-face ward rounds in medical wards was conducted. Peer reviewed journals and government publications published between 2000 and 2014 were searched. Articles were classified according to the type of round described in the study. Purposes were identified using keywords in the description of why the round was carried out. Descriptions of tasks and interactions with team members defined participant roles. Findings - Eight round classifications were identified. The most common were the generalised ward; multidisciplinary; and consultant rounds. Multidisciplinary rounds were the most collaborative round. Medical officers were the most likely discipline to attend any round. There was limited reference to allied health clinicians and patient involvement on rounds. Perceptions attendees held of each other reiterated the need to continue to investigate teamwork. Practical implications - A collaborative approach to care planning can occur by ensuring clinicians and patients are aware of different ward round processes and their role in them. Originality/value - Analysis fulfils a gap in the literature by identifying and analysing the different ward rounds being undertaken in acute medical wards. It identifies the complexities in the long established routine hospital processes of the ward round.

NASA/MSFC FY91 Global Scale Atmospheric Processes Research Program Review

NASA Technical Reports Server (NTRS)

Leslie, Fred W. (Editor)

1991-01-01

The reports presented at the annual Marshall Research Review of Earth Science and Applications are compiled. The following subject areas are covered: understanding of atmospheric processes in a variety of spatial and temporal scales; measurements of geophysical parameters; measurements on a global scale from space; the Mission to Planet Earth Program (comprised of and Earth Observation System and the scientific strategy to analyze these data); and satellite data analysis and fundamental studies of atmospheric dynamics.

The Teamwork Assessment Scale: A Novel Instrument to Assess Quality of Undergraduate Medical Students' Teamwork Using the Example of Simulation-based Ward-Rounds

PubMed Central

Kiesewetter, Jan; Fischer, Martin R.

2015-01-01

Background: Simulation-based teamwork trainings are considered a powerful training method to advance teamwork, which becomes more relevant in medical education. The measurement of teamwork is of high importance and several instruments have been developed for various medical domains to meet this need. To our knowledge, no theoretically-based and easy-to-use measurement instrument has been published nor developed specifically for simulation-based teamwork trainings of medical students. Internist ward-rounds function as an important example of teamwork in medicine. Purposes: The purpose of this study was to provide a validated, theoretically-based instrument that is easy-to-use. Furthermore, this study aimed to identify if and when rater scores relate to performance. Methods: Based on a theoretical framework for teamwork behaviour, items regarding four teamwork components (Team Coordination, Team Cooperation, Information Exchange, Team Adjustment Behaviours) were developed. In study one, three ward-round scenarios, simulated by 69 students, were videotaped and rated independently by four trained raters. The instrument was tested for the embedded psychometric properties and factorial structure. In study two, the instrument was tested for construct validity with an external criterion with a second set of 100 students and four raters. Results: In study one, the factorial structure matched the theoretical components but was unable to separate Information Exchange and Team Cooperation. The preliminary version showed adequate psychometric properties (Cronbach’s α=.75). In study two, the instrument showed physician rater scores were more reliable in measurement than those of student raters. Furthermore, a close correlation between the scale and clinical performance as an external criteria was shown (r=.64) and the sufficient psychometric properties were replicated (Cronbach’s α=.78). Conclusions: The validation allows for use of the simulated teamwork assessment scale

Robot Assisted Surgical Ward Rounds: Virtually Always There.

PubMed

Croghan, Stefanie M; Carroll, Paul; Reade, Sarah; Gillis, Amy E; Ridgway, Paul F

2018-05-02

 While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates 'human' interaction by swiveling and adjusting height to patients' eye-level.   METHODS: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  RESULTS: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  CONCLUSION: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be

Atmospheric and oceanic excitation of decadal-scale Earth orientation variations

NASA Astrophysics Data System (ADS)

Gross, Richard S.; Fukumori, Ichiro; Menemenlis, Dimitris

2005-09-01

The contribution of atmospheric wind and surface pressure and oceanic current and bottom pressure variations during 1949-2002 to exciting changes in the Earth's orientation on decadal timescales is investigated using an atmospheric angular momentum series computed from the National Centers for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR) reanalysis project and an oceanic angular momentum series computed from a near-global ocean model that was forced by surface fluxes from the NCEP/NCAR reanalysis project. Not surprisingly, since decadal-scale variations in the length of day are caused mainly by interactions between the mantle and core, the effect of the atmosphere and oceans is found to be only about 14% of that observed. More surprisingly, it is found that the effect of atmospheric and oceanic processes on decadal-scale changes in polar motion is also only about 20% (x component) and 38% (y component) of that observed. Therefore redistribution of mass within the atmosphere and oceans does not appear to be the main cause of the Markowitz wobble. It is also found that on timescales between 10 days and 4 years the atmospheric and oceanic angular momentum series used here have very little skill in explaining Earth orientation variations before the mid to late 1970s. This is attributed to errors in both the Earth orientation observations prior to 1976 when measurements from the accurate space-geodetic techniques became available and to errors in the modeled atmospheric fields prior to 1979 when the satellite era of global weather observing systems began.

Raising adults as children? A report on milieu therapy in a psychiatric ward in Norway.

PubMed

Oeye, Christine; Bjelland, Anne Karen; Skorpen, Aina; Anderssen, Norman

2009-03-01

Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.

The psychosocial atmosphere in community-based activity centers for people with psychiatric disabilities: visitor and staff perceptions.

PubMed

Jansson, Jan-Åke; Johansson, Håkan; Eklund, Mona

2013-12-01

This study investigated how visitors and staff in community-based activity centers in Sweden perceived the psychosocial atmosphere and whether this could be explained by the centers' orientation (work-oriented versus meeting place-oriented centers). Eighty-eight visitors and 37 staff members at three work-oriented and three meeting place-oriented centers participated. The Community-oriented Programs Environmental Scale was used to estimate the psychosocial atmosphere. The result showed that the psychosocial atmosphere at the centers was in accordance with a supportive ward atmosphere profile. Visitors and staff perceived several aspects of the psychosocial atmosphere differently, especially in the meeting place-oriented centers. The visitors in the meeting place-oriented centers did not perceive the psychosocial atmosphere differently from those visiting the work-oriented centers. The results indicated that the psychosocial atmosphere at the centers was in line with what previous research has shown to be beneficial for visitors regarding outcome and favorable for promoting a good therapeutic alliance and a good functioning in daily life.

Interaction Between the Atmospheric Boundary Layer and Wind Energy: From Continental-Scale to Turbine-Scale

NASA Astrophysics Data System (ADS)

St. Martin, Clara Mae

Wind turbines and groups of wind turbines, or "wind plants", interact with the complex and heterogeneous boundary layer of the atmosphere. We define the boundary layer as the portion of the atmosphere directly influenced by the surface, and this layer exhibits variability on a range of temporal and spatial scales. While early developments in wind energy could ignore some of this variability, recent work demonstrates that improved understanding of atmosphere-turbine interactions leads to the discovery of new ways to approach turbine technology development as well as processes such as performance validation and turbine operations. This interaction with the atmosphere occurs at several spatial and temporal scales from continental-scale to turbine-scale. Understanding atmospheric variability over continental-scales and across plants can facilitate reliance on wind energy as a baseload energy source on the electrical grid. On turbine scales, understanding the atmosphere's contribution to the variability in power production can improve the accuracy of power production estimates as we continue to implement more wind energy onto the grid. Wind speed and directional variability within a plant will affect wind turbine wakes within the plants and among neighboring plants, and a deeper knowledge of these variations can help mitigate effects of wakes and possibly even allow the manipulation of these wakes for increased production. Herein, I present the extent of my PhD work, in which I studied outstanding questions at these scales at the intersections of wind energy and atmospheric science. My work consists of four distinct projects. At the coarsest scales, I analyze the separation between wind plant sites needed for statistical independence in order to reduce variability for grid-integration of wind. At lower wind speeds, periods of unstable and more turbulent conditions produce more power than periods of stable and less turbulent conditions, while at wind speeds closer to

Observational study of aggressive behaviour and coercion on an Indian acute ward.

PubMed

Danivas, Vijay; Lepping, Peter; Punitharani, Shivanna; Gowrishree, Handithavalli; Ashwini, Kundapur; Raveesh, Bevinahalli Nanjegowda; Palmstierna, Tom

2016-08-01

We evaluated prevalence of aggressive behaviour and coercive measures on an acute Indian psychiatric ward where relatives are always present at the ward. Non-interacting, independent observers (specifically trained mental health clinicians) on an Indian acute, 20-bedded psychiatric ward gave structured reports on all violent episodes and coercive measures during a 30-day period. They used the Staff Observation Aggression Scale -Revised, Indian (SOAS-RI). The severity of the SOAS-RI reports were independently analysed by one of the authors. 229 violent incidents were recorded, involving 63% of admitted patients. 27% of all admitted patients were subjected to intravenous injections. Relatives provoked 35% of the incidents and were the target in 56% of the incidents. Patientś own relatives were involved in managing the aggression in 35% of the incidents. Relatives of other patients were involved in 14% of the incidents. The likelihood of a patient to be physically restrained and that a relative would be participating in the coercive measures was increased when medical staff was targeted. Relatives are commonly triggers and victims of aggressions on the inverstigated acute Indian psychiatric wards. Doctors and nurses are less likely to be victims but aggression towards them leads more commonly to coercive measures. Copyright © 2016 Elsevier B.V. All rights reserved.

Atmospheric CO2 variations on millennial-scale during MIS 6

NASA Astrophysics Data System (ADS)

Shin, Jinhwa; Grilli, Roberto; Chappellaz, Jérôme; Teste, Grégory; Nehrbass-Ahles, Christoph; Schmidely, Loïc; Schmitt, Jochen; Stocker, Thomas; Fischer, Hubertus

2017-04-01

Understanding natural carbon cycle / climate feedbacks on various time scales is highly important for predicting future climate changes. Paleoclimate records of Antarctic temperatures, relative sea level and foraminiferal isotope and pollen records in sediment cores from the Portuguese margin have shown climate variations on millennial time scale over the Marine Isotope Stage 6 (MIS 6; from approximately 135 to 190 kyr BP). These proxy data suggested iceberg calving in the North Atlantic result in cooling in the Northern hemisphere and warming in Antarctica by changes in the Atlantic Meridional Overturning Circulation, which is explained by a bipolar see-saw trend in the ocean (Margari et al., 2010). Atmospheric CO2 reconstruction from Antarctic ice cores can provide key information on how atmospheric CO2 concentrations are linked to millennial-scale climate changes. However, existing CO2 records cannot be used to address this relationship because of the lack of suitable temporal resolution. In this work, we will present a new CO2 record with an improved time resolution, obtained from the Dome C ice core (75˚ 06'S, 123˚ 24'E) spanning the MIS 6 period, using dry extraction methods. We will examine millennial-scale features in atmospheric CO2, and their possible links with other proxies covering MIS 6. Margari, V., Skinner, L. C., Tzedakis, P. C., Ganopolski, A., Vautravers, M., and Shackleton, N. J.: The nature of millennial scale climate variability during the past two glacial periods, Nat.Geosci., 3, 127-131, 2010.

Simulated ward round: reducing costs, not outcomes.

PubMed

Ford, Helen; Cleland, Jennifer; Thomas, Ian

2017-02-01

Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.

A Study of the Effects of Large Scale Gust Generation in a Small Scale Atmospheric Wind Tunnel: Application to Micro Aerial Vehicles

NASA Astrophysics Data System (ADS)

Roadman, Jason; Mohseni, Kamran

2009-11-01

Modern technology operating in the atmospheric boundary layer could benefit from more accurate wind tunnel testing. While scaled atmospheric boundary layer tunnels have been well developed, tunnels replicating portions of the turbulence of the atmospheric boundary layer at full scale are a comparatively new concept. Testing at full-scale Reynolds numbers with full-scale turbulence in an ``atmospheric wind tunnel'' is sought. Many programs could utilize such a tool including that of Micro Aerial Vehicles (MAVs) and other unmanned aircraft, the wind energy industry, fuel efficient vehicles, and the study of bird and insect fight. The construction of an active ``gust generator'' for a new atmospheric tunnel is reviewed and the turbulence it generates is measured utilizing single and cross hot wires. Results from this grid are compared to atmospheric turbulence and it is shown that various gust strengths can be produced corresponding to days ranging from calm to quite gusty. An initial test is performed in the atmospheric wind tunnel whereby the effects of various turbulence conditions on transition and separation on the upper surface of a MAV wing is investigated using oil flow visualization.

The global reference atmospheric model, mod 2 (with two scale perturbation model)

NASA Technical Reports Server (NTRS)

Justus, C. G.; Hargraves, W. R.

1976-01-01

The Global Reference Atmospheric Model was improved to produce more realistic simulations of vertical profiles of atmospheric parameters. A revised two scale random perturbation model using perturbation magnitudes which are adjusted to conform to constraints imposed by the perfect gas law and the hydrostatic condition is described. The two scale perturbation model produces appropriately correlated (horizontally and vertically) small scale and large scale perturbations. These stochastically simulated perturbations are representative of the magnitudes and wavelengths of perturbations produced by tides and planetary scale waves (large scale) and turbulence and gravity waves (small scale). Other new features of the model are: (1) a second order geostrophic wind relation for use at low latitudes which does not "blow up" at low latitudes as the ordinary geostrophic relation does; and (2) revised quasi-biennial amplitudes and phases and revised stationary perturbations, based on data through 1972.

Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study.

PubMed

Lantta, Tella; Anttila, Minna; Kontio, Raija; Adams, Clive E; Välimäki, Maritta

2016-01-01

Patient violence against nurses in their work environments is a widespread global concern, particularly in the field of mental health care. A high prevalence of violent events impacts the well-being of nurses and may also impair overall ward climate. However, it has been proposed that nurses' use limited techniques to prevent patient violence, and, therefore, more comprehensive methods for dealing with patient violence are needed. There is still restricted understanding of the ward climate during the occurrence of a violent event as well as how these incidents could be more effectively prevented. This study aimed to explore nurses' experiences of violent events in psychiatric wards, give insight into ward climates and examine suggestions for violence prevention. This study employed a descriptive, exploratory design including focus groups (n = 5) and open-ended questions. The participants were registered and enrolled nurses (n = 22) working on three closed psychiatric in-patient wards in one Finnish hospital district. Focus groups were tape-recorded, transcribed and analyzed with inductive content analysis. Nurses' experiences of violent events included a variety of warning signs and high-risk situations which helped them to predict forthcoming violence. Patient-instigated violent events were described as complicated situations involving both nurses and patients. When the wards were overloaded with work or emotions, or if nurses had become cynical from dealing with such events, well-being of nurses was impaired and nursing care was complicated. Suggestions for violence prevention were identified, and included, for example, more skilled interaction between nurses and patients and an increase in contact between nurses and patients on the ward. This study revealed the complexity of violent events on psychiatric wards as well as the implications of these events on clinical practice development and training, administration and policy. A routine process is needed

Outer scale of atmospheric turbulence

NASA Astrophysics Data System (ADS)

Lukin, Vladimir P.

2005-10-01

In the early 70's, the scientists in Italy (A.Consortini, M.Bertolotti, L.Ronchi), USA (R.Buser, Ochs, S.Clifford) and USSR (V.Pokasov, V.Lukin) almost simultaneously discovered the phenomenon of deviation from the power law and the effect of saturation for the structure phase function. During a period of 35 years we have performed successively the investigations of the effect of low-frequency spectral range of atmospheric turbulence on the optical characteristics. The influence of the turbulence models as well as a outer scale of turbulence on the characteristics of telescopes and systems of laser beam formations has been determined too.

Renormalization group and Ward identities for infrared QED4

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

Mastropietro, Vieri

2007-10-15

A regularized version of Euclidean QED4 in the Feynman gauge is considered, with a fixed ultraviolet cutoff, photon mass of the size of the cutoff, and any value, including zero, of the electron mass. We will prove that the Schwinger functions are expressed by convergent series for small values of the charge and verify the Ward identities, up to corrections which are small for momentum scales far from the ultraviolet cutoff.

Nursing Education Trial Using a Virtual Nightingale Ward.

PubMed

Tsuji, Keiko; Iwata, Naomi; Kodama, Hiromi; Hagiwara, Tomoko; Takai, Kiyako; Sasaki, Yoko; Nagata, Yoshie; Matsumoto, Maki

2017-01-01

Nursing department students are expected to correctly grasp the entire concept of nursing through their education. The authors created a movie of a Nightingale ward (virtual ward, hereafter) with an architectural computer design software for education. The students' reaction to the virtual ward was categorized into three viewpoints: that of nurses, of patients, and of nurses and patients in common. Most of the reactions in each viewpoint were: "easy to observe patients" in the nurses' viewpoint; "no privacy" in the patients' viewpoint; and "wide room" in the common viewpoint, respectively. These reactions show the effectiveness of using a virtual ward in nursing education. Because these reactions are characteristics of a Nightingale ward, and even students, who have generally less experiences, recognized these characteristics from the both viewpoints of nurses and patients.

Delivery of pharmaceutical services at ward level in a teaching hospital.

PubMed

Schellack, N; Martins, V; Botha, N; Meyer, J C

2009-03-01

Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are

Auditing Safety of Compounding and Reconstituting of Intravenous Medicines on Hospital Wards in Finland.

PubMed

Suvikas-Peltonen, Eeva; Palmgren, Joni; Häggman, Verner; Celikkayalar, Ercan; Manninen, Raija; Airaksinen, Marja

2017-01-01

On the hospital wards in Finland, nurses generally reconstitute intravenous medicines, such as antibiotics, analgesics, and antiemetics prescribed by doctors. Medicine reconstitution is prone to many errors. Therefore, it is important to identify incorrect practices in the reconstitution of medicine to improve patient safety in hospitals. The aim of this study was to audit the compounding and reconstituting of intravenous medicines on hospital wards in a secondary-care hospital in Finland by using an assessment tool and microbiological testing for identifying issues posing patient safety risks. A hospital pharmacist conducted an external audit by using a validated 65-item assessment tool for safe-medicine compounding practices on 20 wards of the selected hospital. Also, three different microbiological samples were collected to assure the aseptics. Practices were evaluated using a four-point rating scale of "never performed," "rarely performed," "often performed," and "always performed," and were based on observation and interviews with nurses or ward pharmacists. In addition, glove-, settle plate-, and media fill-tests were collected. Associations between microbial sample results and audit-tool results were discussed. Altogether, only six out of the 65 items were fully implemented in all wards; these were related to logistic practices and quality assurance. More than half of the wards used incorrect practices ("rarely performed" or "never performed") for five items. Most of these obviated practices related to aseptic practices. All media-fill tests were clean but the number of colony forming units in glove samples and settle- plate samples varied from 0 to >100. More contamination was found in wards where environmental conditions were inadequate or the use of gloves was incorrect. Compounding practices were [mostly] quite well adapted, but the aseptic practices needed improvement. Attention should have been directed particularly to good aseptic techniques and

Atmospheric Rivers across Multi-scales of the Hydrologic cycle

NASA Astrophysics Data System (ADS)

Hu, H.

2017-12-01

Atmospheric Rivers (ARs) are defined as filamentary structures with strong water vapor transport in the atmosphere, moving as much water as is discharged by the Amazon River. As a large-scale phenomenon, ARs are embedded in the planetary-scale Rossby waves and account for the majority of poleward moisture transport in the midlatitudes. On the other hand, AR is the fundamental physical mechanism leading to extreme basin-scale precipitation and flooding over the U.S. West Coast in the winter season. The moisture transported by ARs is forced to rise and generate precipitation when it impinges on the mountainous coastal lands. My goal is to build the connection between the multi-scale features associated with ARs with their impacts on local hydrology, with particular focus on the U.S. West Coast. Moving across the different scales I have: (1) examined the planetary-scale dynamics in the upper-troposphere, and established a robust relationship between the two regimes of Rossby wave breaking and AR-precipitation and streamflow along the West Coast; (2) quantified the contribution from the tropics/subtropics to AR-related precipitation intensity and found a significant modulation from the large-scale thermodynamics; (3) developed a water tracer tool in a land surface model to track the lifecycle of the water collected from AR precipitation over the terrestrial system, so that the role of catchment-scale factors in modulating ARs' hydrological consequences could be examined. Ultimately, the information gather from these studies will indicate how the dynamic and thermodynamic changes as a response to climate change could affect the local flooding and water resource, which would be helpful in decision making.

Ward nurses' knowledge of computed tomography scanning.

PubMed

Majeed, M A; Nayeemuddin, M; Christie, M

Patients benefit from and are reassured by advance information on procedures that they are to undergo. Ward nurses should have adequate knowledge of radiological investigations to ensure proper patient preparation and good interdepartmental communication to avoid delays and cancellations. This study was conducted to assess the ward nurses' knowledge of the process of computed tomography (CT) scanning. One hundred and twenty qualified nurses were asked to complete a questionnaire regarding CT scanning. The findings revealed a suboptimal level of awareness about the process. This is probably due to lack of formal teaching for nurses on the wards in regards the different radiological procedures and patient preparation. There is a strong case for better educational talks on rapidly changing radiological techniques for ward staff to ensure high-quality patient care.

Developing non-technical ward-round skills.

PubMed

Harvey, Rachel; Mellanby, Edward; Dearden, Effie; Medjoub, Karima; Edgar, Simon

2015-10-01

Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform. There is evidence that newly qualified doctors are not adequately prepared by their undergraduate experiences for this task. The aim of this study was to analyse the challenges pertaining to non-technical skills that students would face during ward rounds, and to create a model that facilitates the transition from medical student to doctor. A total of 217 final-year medical students completed a simulated ward round. Free-text responses were analysed using template analysis applying an a priori template developed from the literature by the research team. This drew on the generic categories of non-technical skills suggested by Flin et al. Ninety-seven per cent of students agreed or strongly agreed that the simulated ward round improved their insight into the challenges of ward rounds and their perceived ability to work efficiently as an active member of the ward round. The responding students (206) submitted written feedback describing the learning that they planned to use: 800 learning points were recorded, and all could be categorised into one of seven non-technical skills. Conducting clinical 'rounds' is one of the most onerous and important duties that every junior doctor is expected to perform We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum. © 2015 John Wiley & Sons Ltd.

Size Scales for Thermal Inhomogeneities in Mars' Atmosphere Surface Layer: Mars Pathfinder

NASA Technical Reports Server (NTRS)

Mihalov, John D.; Haberle, Robert M.; Seiff, Alvin; Murphy, James R.; Schofield, John T.; DeVincenzi, Donald L. (Technical Monitor)

2000-01-01

Atmospheric temperature measurement at three heights with thin wire thermocouples on the 1.1 m Mars Pathfinder meteorology must allow estimates of the integral scale of the atmospheric thermal turbulence during an 83 sol period that begins in the summer. The integral scale is a measure for regions of perturbations. In turbulent media that roughly characterizes locations where the perturbations are correlated. Excluding some to intervals with violent excursions of the mean temperatures, integral scale values are found that increase relatively rapidly from a few tenths meters or less near down to several meters by mid-morning. During mid-morning, the diurnal and shorter time scale wind direction variations often place the meteorology mast in the thermal wake of the Lander.

The influence of scales of atmospheric motion on air pollution over Portugal

NASA Astrophysics Data System (ADS)

Russo, Ana; Trigo, Ricardo; Mendes, Manuel; Jerez, Sonia; Gouveia, Célia Marina

2014-05-01

Air pollution is determined by the combination of different factors, namely, emissions, physical constrains, meteorology and chemical processes [1,2,3]. The relative importance of such factors is influenced by their interaction on diverse scales of atmospheric motion. Each scale depicts different meteorological conditions, which, when combined with the different air pollution sources and photochemistry, result in varying ambient concentrations [2]. Identifying the dominant scales of atmospheric motion over a given airshed can be of great importance for many applications such as air pollution and pollen dispersion or wind energy management [2]. Portugal has been affected by numerous air pollution episodes during the last decade. These episodes are often related to peak emissions from local industry or transport, but can also be associated to regional transport from other urban areas or to exceptional emission events, such as forest fires. This research aims to identify the scales of atmospheric motion which contribute to an increase of air pollution. A method is proposed for differentiating between the scales of atmospheric motion that can be applied on a daily basis from data collected at several wind-measuring sites in a given airshed and to reanalysis datasets. The method is based on the daily mean wind recirculation and the mean and standard deviation between sites. The determination of the thresholds between scales is performed empirically following the approach of Levy et al. [2] and also through a automatic statistical approach computed taking into account the tails of the distributions (e.g. 95% and 99% percentile) of the different wind samples. A comparison is made with two objective approaches: 1) daily synoptic classification for the same period over the region [4] and 2) a 3-D backward trajectory approach [5,6] for specific episodes. Furthermore, the outcomes are expected to support the Portuguese authorities on the implementation of strategies for a

Scaling laws for perturbations in the ocean-atmosphere system following large CO2 emissions

NASA Astrophysics Data System (ADS)

Towles, N.; Olson, P.; Gnanadesikan, A.

2015-01-01

Scaling relationships are derived for the perturbations to atmosphere and ocean variables from large transient CO2 emissions. Using the carbon cycle model LOSCAR (Zeebe et al., 2009; Zeebe, 2012b) we calculate perturbations to atmosphere temperature and total carbon, ocean temperature, total ocean carbon, pH, and alkalinity, marine sediment carbon, plus carbon-13 isotope anomalies in the ocean and atmosphere resulting from idealized CO2 emission events. The peak perturbations in the atmosphere and ocean variables are then fit to power law functions of the form γDαEbeta, where D is the event duration, E is its total carbon emission, and γ is a coefficient. Good power law fits are obtained for most system variables for E up to 50 000 PgC and D up to 100 kyr. However, these power laws deviate substantially from predictions based on simplified equilibrium considerations. For example, although all of the peak perturbations increase with emission rate E/D, we find no evidence of emission rate-only scaling α + β =0, a prediction of the long-term equilibrium between CO2 input by volcanism and CO2 removal by silicate weathering. Instead, our scaling yields α + β ≃ 1 for total ocean and atmosphere carbon and 0< α + β < 1 for most of the other system variables. The deviations in these scaling laws from equilibrium predictions are mainly due to the multitude and diversity of time scales that govern the exchange of carbon between marine sediments, the ocean, and the atmosphere.

Scaling laws for perturbations in the ocean-atmosphere system following large CO2 emissions

NASA Astrophysics Data System (ADS)

Towles, N.; Olson, P.; Gnanadesikan, A.

2015-07-01

Scaling relationships are found for perturbations to atmosphere and ocean variables from large transient CO2 emissions. Using the Long-term Ocean-atmosphere-Sediment CArbon cycle Reservoir (LOSCAR) model (Zeebe et al., 2009; Zeebe, 2012b), we calculate perturbations to atmosphere temperature, total carbon, ocean temperature, total ocean carbon, pH, alkalinity, marine-sediment carbon, and carbon-13 isotope anomalies in the ocean and atmosphere resulting from idealized CO2 emission events. The peak perturbations in the atmosphere and ocean variables are then fit to power law functions of the form of γ DαEβ, where D is the event duration, E is its total carbon emission, and γ is a coefficient. Good power law fits are obtained for most system variables for E up to 50 000 PgC and D up to 100 kyr. Although all of the peak perturbations increase with emission rate E/D, we find no evidence of emission-rate-only scaling, α + β = 0. Instead, our scaling yields α + β ≃ 1 for total ocean and atmosphere carbon and 0 < α + β < 1 for most of the other system variables.

Investigation of the small-scale structure and dynamics of Uranus' atmosphere

NASA Technical Reports Server (NTRS)

Eshleman, Von R.; Hinson, David P.

1991-01-01

This document constitutes the final technical report of the Uranus Analysis Program. Papers and/or abstracts resulting from this research are presented. The following topics are covered: (1) past and future of radio occultation studies of planetary atmospheres; (2) equatorial waves in the stratosphere of Uranus; (3) the atmosphere of Uranus- results of radio occultation measurements with Voyager 2; (4) Uranus' atmospheric dynamics and circulation; (5) small-scale structure and dynamics in the atmosphere of Uranus; (6) evidence for inertia-gravity waves in the stratosphere of Uranus derived from Voyager 2 radio occultation data; and (7) planetary waves in the equatorial stratosphere of Uranus.

MAGNETIC SCALING LAWS FOR THE ATMOSPHERES OF HOT GIANT EXOPLANETS

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

Menou, Kristen

2012-02-01

We present scaling laws for advection, radiation, magnetic drag, and ohmic dissipation in the atmospheres of hot giant exoplanets. In the limit of weak thermal ionization, ohmic dissipation increases with the planetary equilibrium temperature (T{sub eq} {approx}> 1000 K) faster than the insolation power does, eventually reaching values {approx}> 1% of the insolation power, which may be sufficient to inflate the radii of hot Jupiters. At higher T{sub eq} values still magnetic drag rapidly brakes the atmospheric winds, which reduces the associated ohmic dissipation power. For example, for a planetary field strength B = 10 G, the fiducial scaling lawsmore » indicate that ohmic dissipation exceeds 1% of the insolation power over the equilibrium temperature range T{sub eq} {approx} 1300-2000 K, with a peak contribution at T{sub eq} {approx} 1600 K. Evidence for magnetically dragged winds at the planetary thermal photosphere could emerge in the form of reduced longitudinal offsets for the dayside infrared hotspot. This suggests the possibility of an anticorrelation between the amount of hotspot offset and the degree of radius inflation, linking the atmospheric and interior properties of hot giant exoplanets in an observationally testable way. While providing a useful framework to explore the magnetic scenario, the scaling laws also reveal strong parameter dependencies, in particular with respect to the unknown planetary magnetic field strength.« less

Scaling Characteristics of Mesoscale Wind Fields in the Lower Atmospheric Boundary Layer: Implications for Wind Energy

NASA Astrophysics Data System (ADS)

Kiliyanpilakkil, Velayudhan Praju

Atmospheric motions take place in spatial scales of sub-millimeters to few thousands of kilometers with temporal changes in the atmospheric variables occur in fractions of seconds to several years. Consequently, the variations in atmospheric kinetic energy associated with these atmospheric motions span over a broad spectrum of space and time. The mesoscale region acts as an energy transferring regime between the energy generating synoptic scale and the energy dissipating microscale. Therefore, the scaling characterizations of mesoscale wind fields are significant in the accurate estimation of the atmospheric energy budget. Moreover, the precise knowledge of the scaling characteristics of atmospheric mesoscale wind fields is important for the validation of the numerical models those focus on wind forecasting, dispersion, diffusion, horizontal transport, and optical turbulence. For these reasons, extensive studies have been conducted in the past to characterize the mesoscale wind fields. Nevertheless, the majority of these studies focused on near-surface and upper atmosphere mesoscale regimes. The present study attempt to identify the existence and to quantify the scaling of mesoscale wind fields in the lower atmospheric boundary layer (ABL; in the wind turbine layer) using wind observations from various research-grade instruments (e.g., sodars, anemometers). The scaling characteristics of the mesoscale wind speeds over diverse homogeneous flat terrains, conducted using structure function based analysis, revealed an altitudinal dependence of the scaling exponents. This altitudinal dependence of the wind speed scaling may be attributed to the buoyancy forcing. Subsequently, we use the framework of extended self-similarity (ESS) to characterize the observed scaling behavior. In the ESS framework, the relative scaling exponents of the mesoscale atmospheric boundary layer wind speed exhibit quasi-universal behavior; even far beyond the inertial range of turbulence (Delta

The transition from staff nurse to ward leader.

PubMed

Spencer, Caroline; Al-Sadoon, Tara; Hemmings, Laura; Jackson, Karen; Mulligan, Paul

Moving from the staff nurse to ward sister role involves acquiring a range of skills to lead and motivate a team and ensure standards of care are high. Recognising new ward sisters' need for support, a trust developed a training programme to enable them to develop the necessary skills and provide mutual support. This article discusses the development of the programme and offers the reflections of three ward sisters who participated in it.

Developing skills in clinical leadership for ward sisters.

PubMed

Fenton, Katherine; Phillips, Natasha

The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.

Wind Tunnel to Atmospheric Mapping for Static Aeroelastic Scaling

NASA Technical Reports Server (NTRS)

Heeg, Jennifer; Spain, Charles V.; Rivera, J. A.

2004-01-01

Wind tunnel to Atmospheric Mapping (WAM) is a methodology for scaling and testing a static aeroelastic wind tunnel model. The WAM procedure employs scaling laws to define a wind tunnel model and wind tunnel test points such that the static aeroelastic flight test data and wind tunnel data will be correlated throughout the test envelopes. This methodology extends the notion that a single test condition - combination of Mach number and dynamic pressure - can be matched by wind tunnel data. The primary requirements for affecting this extension are matching flight Mach numbers, maintaining a constant dynamic pressure scale factor and setting the dynamic pressure scale factor in accordance with the stiffness scale factor. The scaling is enabled by capabilities of the NASA Langley Transonic Dynamics Tunnel (TDT) and by relaxation of scaling requirements present in the dynamic problem that are not critical to the static aeroelastic problem. The methodology is exercised in two example scaling problems: an arbitrarily scaled wing and a practical application to the scaling of the Active Aeroelastic Wing flight vehicle for testing in the TDT.

Generalising Ward's Method for Use with Manhattan Distances.

PubMed

Strauss, Trudie; von Maltitz, Michael Johan

2017-01-01

The claim that Ward's linkage algorithm in hierarchical clustering is limited to use with Euclidean distances is investigated. In this paper, Ward's clustering algorithm is generalised to use with l1 norm or Manhattan distances. We argue that the generalisation of Ward's linkage method to incorporate Manhattan distances is theoretically sound and provide an example of where this method outperforms the method using Euclidean distances. As an application, we perform statistical analyses on languages using methods normally applied to biology and genetic classification. We aim to quantify differences in character traits between languages and use a statistical language signature based on relative bi-gram (sequence of two letters) frequencies to calculate a distance matrix between 32 Indo-European languages. We then use Ward's method of hierarchical clustering to classify the languages, using the Euclidean distance and the Manhattan distance. Results obtained from using the different distance metrics are compared to show that the Ward's algorithm characteristic of minimising intra-cluster variation and maximising inter-cluster variation is not violated when using the Manhattan metric.

Evaluating 20th Century precipitation characteristics between multi-scale atmospheric models with different land-atmosphere coupling

NASA Astrophysics Data System (ADS)

Phillips, M.; Denning, A. S.; Randall, D. A.; Branson, M.

2016-12-01

Multi-scale models of the atmosphere provide an opportunity to investigate processes that are unresolved by traditional Global Climate Models while at the same time remaining viable in terms of computational resources for climate-length time scales. The MMF represents a shift away from large horizontal grid spacing in traditional GCMs that leads to overabundant light precipitation and lack of heavy events, toward a model where precipitation intensity is allowed to vary over a much wider range of values. Resolving atmospheric motions on the scale of 4 km makes it possible to recover features of precipitation, such as intense downpours, that were previously only obtained by computationally expensive regional simulations. These heavy precipitation events may have little impact on large-scale moisture and energy budgets, but are outstanding in terms of interaction with the land surface and potential impact on human life. Three versions of the Community Earth System Model were used in this study; the standard CESM, the multi-scale `Super-Parameterized' CESM where large-scale parameterizations have been replaced with a 2D cloud-permitting model, and a multi-instance land version of the SP-CESM where each column of the 2D CRM is allowed to interact with an individual land unit. These simulations were carried out using prescribed Sea Surface Temperatures for the period from 1979-2006 with daily precipitation saved for all 28 years. Comparisons of the statistical properties of precipitation between model architectures and against observations from rain gauges were made, with specific focus on detection and evaluation of extreme precipitation events.

Super Clausius-Clapeyron scaling of extreme hourly precipitation and its relation to large-scale atmospheric conditions

NASA Astrophysics Data System (ADS)

Lenderink, Geert; Barbero, Renaud; Loriaux, Jessica; Fowler, Hayley

2017-04-01

Present-day precipitation-temperature scaling relations indicate that hourly precipitation extremes may have a response to warming exceeding the Clausius-Clapeyron (CC) relation; for The Netherlands the dependency on surface dew point temperature follows two times the CC relation corresponding to 14 % per degree. Our hypothesis - as supported by a simple physical argument presented here - is that this 2CC behaviour arises from the physics of convective clouds. So, we think that this response is due to local feedbacks related to the convective activity, while other large scale atmospheric forcing conditions remain similar except for the higher temperature (approximately uniform warming with height) and absolute humidity (corresponding to the assumption of unchanged relative humidity). To test this hypothesis, we analysed the large-scale atmospheric conditions accompanying summertime afternoon precipitation events using surface observations combined with a regional re-analysis for the data in The Netherlands. Events are precipitation measurements clustered in time and space derived from approximately 30 automatic weather stations. The hourly peak intensities of these events again reveal a 2CC scaling with the surface dew point temperature. The temperature excess of moist updrafts initialized at the surface and the maximum cloud depth are clear functions of surface dew point temperature, confirming the key role of surface humidity on convective activity. Almost no differences in relative humidity and the dry temperature lapse rate were found across the dew point temperature range, supporting our theory that 2CC scaling is mainly due to the response of convection to increases in near surface humidity, while other atmospheric conditions remain similar. Additionally, hourly precipitation extremes are on average accompanied by substantial large-scale upward motions and therefore large-scale moisture convergence, which appears to accelerate with surface dew point. This

Predictors of suicide in the patient population admitted to a locked-door psychiatric acute ward

PubMed Central

Fosse, Roar; Ryberg, Wenche; Carlsson, Merete Kvalsvik; Hammer, Jan

2017-01-01

Objective No prior study appears to have focused on predictors of suicide in the general patient population admitted to psychiatric acute wards. We used a case-control design to investigate the association between suicide risk factors assessed systematically at admission to a locked-door psychiatric acute ward in Norway and subsequent death by suicide. Method From 2008 to 2013, patients were routinely assessed for suicide risk upon admission to the acute ward with a 17-item check list based on recommendations from the Norwegian Directorate of Health and Social Affairs. Among 1976 patients admitted to the ward, 40 patients, 22 men and 18 women, completed suicide within December 2014. Results Compared to a matched control group (n = 120), after correction for multiple tests, suicide completers scored significantly higher on two items on the check list: presence of suicidal thoughts and wishing to be dead. An additional four items were significant in non-corrected tests: previous suicide attempts, continuity of suicidal thoughts, having a suicide plan, and feelings of hopelessness, indifference, and/or aggression. A brief scale based on these six items was the only variable associated with suicide in multivariate regression analysis, but its predictive value was poor. Conclusion Suicide specific ideations may be the most central risk markers for suicide in the general patient population admitted to psychiatric acute wards. However, a low predictive value may question the utility of assessing suicide risk. PMID:28301590

The role of the ward manager in promoting patient safety.

PubMed

Pinnock, David

In this article the role of the ward manager in promoting patient safety is explored. The background to the development of the patient safety agenda is briefly discussed and the relationship between quality and safety is illustrated. The pivotal importance of the role of the ward manager in delivering services to patients is underlined and literature on patient safety is examined to identify what a ward manager can do to make care safer. Possible actions of the ward manager to improve safety discussed in the literature are structured around the Leadership Framework. This framework identifies seven domains for the leadership of service delivery. Ward managers use their personal qualities, and network and work within teams, while managing performance and facilitating innovation, change and measurement for improvement. The challenge of promoting patient safety for ward managers is briefly explored and recommendations for further research are made.

Smoking cessation treatment practices: recommendations for improved adoption on cardiology wards.

PubMed

Berndt, Nadine C; Bolman, Catherine; de Vries, Hein; Segaar, Dewi; van Boven, Irene; Lechner, Lilian

2013-01-01

Smoking cessation treatment practices described by the 5 A's (ask, advise, assess, assist, arrange) are not well applied at cardiology wards because of various reasons, such as a lack of time and appropriate skills of the nursing staff. Therefore, a simplified guideline proposing an ask-advise-refer (AAR) strategy was introduced in Dutch cardiac wards. This study aimed to identify factors that determine the intentions of cardiac ward heads in adopting the simplified AAR guideline, as ward heads are key decision makers in the adoption of new guidelines. Ward heads' perceptions of current smoking cessation practices at the cardiac ward were also investigated. A cross-sectional survey with written questionnaires was conducted among heads of cardiology wards throughout the Netherlands, of whom 117 (64%) responded. According to the heads of cardiac wards, smoking cessation practices by cardiologists and nurses were mostly limited to brief practices that are easy to conduct. Only a minority offered intensive counseling or arranged follow-up contact. Heads with strong intentions of adopting the AAR guideline differed significantly on motivational and organizational attributes and perceived more smoking cessation assistance by other health professionals than did heads with weak intentions of adopting. Positive attitudes, social support toward adoption, and perception of much assistance at the ward were significantly associated with increased intentions to adopt the AAR guideline. Brief smoking cessation practices are adequately performed at cardiac wards, but the most effective practices, offering assistance and arranging for follow-up, are less than optimal. The AAR guideline offers a more feasible approach for busy cardiology wards. To ensure successful adoption of this guideline, the heads of cardiac wards should be convinced of its advantages and be encouraged by a supportive work environment. Policies may also facilitate the adoption of the AAR guideline.

Electronic Printed Ward Round Proformas: Freeing Up Doctors' Time.

PubMed

Fernandes, Darren; Eneje, Philip

2017-01-01

The role of a junior doctor involves preparing for the morning ward round. At a time when there are gaps on rotas and doctors' time is more stretched, this can be a source of significant delay and thus a loss of working time. We therefore looked at ways in which we could make the ward round a more efficient place by introducing specific electronic, printed ward round proformas. We used the average time taken to write proformas per patient and the average time taken per patient on the ward round. This would then enable us to make fair comparisons with future changes that were made using the plan, do, study, and act principles of quality improvement. Our baseline measurement found that the average time taken to write up the proforma for each patient was 1 minute 9 seconds and that the average time taken per patient on the ward round was 8 minutes 30 seconds. With the changes we made during our 3 PDSA cycles and the implementation of an electronic, printed ward round proforma, we found that we were able to reduce the average time spent per patient on the ward round to 6 minutes 32 seconds, an improvement of 1 min 58 seconds per patient. The project has thus enabled us to reduce the time taken per patient during the ward round. This improved efficiency will enable patients to be identified earlier for discharge. It will also aid in freeing up the time of junior doctors, allowing them to complete discharge letters sooner, order investigations earlier and enable them to complete their allocated tasks within contracted hours.

NASA/MSFC FY88 Global Scale Atmospheric Processes Research Program Review

NASA Technical Reports Server (NTRS)

Wilson, Greg S. (Editor); Leslie, Fred W. (Editor); Arnold, J. E. (Editor)

1989-01-01

Interest in environmental issues and the magnitude of the environmental changes continues. One way to gain more understanding of the atmosphere is to make measurements on a global scale from space. The Earth Observation System is a series of new sensors to measure globally atmospheric parameters. Analysis of satellite data by developing algorithms to interpret the radiance information improves the understanding and also defines requirements for these sensors. One measure of knowledge of the atmosphere lies in the ability to predict its behavior. Use of numerical and experimental models provides a better understanding of these processes. These efforts are described in the context of satellite data analysis and fundamental studies of atmospheric dynamics which examine selected processes important to the global circulation.

Macroturbulence in Very High Resolution Atmospheric Models: Evidence for Two Scaling Regimes

NASA Astrophysics Data System (ADS)

Straus, D. M.

2010-12-01

The macro-turbulent properties of the atmosphere's circulation are examined in a number of very high resolution seasonal simulations using the global Nonhydrostatic ICosahedral Atmospheric Model (NICAM) at 7-km horizontal resolution (40 levels), and the forecast model of the European Centre for Medium-Range Weather Forecasts (ECMWF) at T1279 and T2047 spectral resolutions (90-levels). These simulations were carried out as part of an extraordinary collaborative project between the Center for Ocean-Land-Atmosphere Studies (COLA), the University of Tokyo, the Japan Agency for Marine-Earth Science and Technology (JAMSTEC), ECMWF, and the National Institute of Computational Sciences (NICS) The goals of the analysis are to document the rotational and divergence kinetic energy spectral characteristics, to shed light on the different scaling regimes obtained and the role of non-hydrostatic dynamics, and to asses the effects of the smallest scales on the cascades of energy. Simulations with all the models show some evidence of two scaling regimes (power law with steep slope, and a distinctly more shallow slope at smaller scales) for both rotational and divergent kinetic energy. The strength of the evidence for the two-regimes, as well as the wavenumber ranges in which they occur, do differ between models. Analysis of different time scale contributions to the spectra lend insight into the energy transfer mechanism. The implications for dynamical theories of turbulent energy exchange are discussed, as well as difference in approach to compared with multiplicative cascade theories.

Spatial variation of heart failure and air pollution in Warwickshire, UK: an investigation of small scale variation at the ward-level.

PubMed

Bennett, Oscar; Kandala, Ngianga-Bakwin; Ji, Chen; Linnane, John; Clarke, Aileen

2014-12-02

To map using geospatial modelling techniques the morbidity and mortality caused by heart failure within Warwickshire to characterise and quantify any influence of air pollution on these risks. Cross-sectional. Warwickshire, UK. Data from all of the 105 current Warwickshire County wards were collected on hospital admissions and deaths due to heart failure. In multivariate analyses, the presence of higher mono-nitrogen oxide (NOx) in a ward (3.35:1.89, 4.99), benzene (Ben) (31.9:8.36, 55.85) and index of multiple deprivation (IMD; 0.02: 0.01, 0.03), were consistently associated with a higher risk of heart failure morbidity. Particulate matter (Pm; -12.93: -20.41, -6.54) was negatively associated with the risk of heart failure morbidity. No association was found between sulfur dioxide (SO2) and heart failure morbidity. The risk of heart failure mortality was higher in wards with a higher NOx (4.30: 1.68, 7.37) and wards with more inhabitants 50+ years old (1.60: 0.47, 2.92). Pm was negatively associated (-14.69: -23.46, -6.50) with heart failure mortality. SO2, Ben and IMD scores were not associated with heart failure mortality. There was a prominent variation in heart failure morbidity and mortality risk across wards, the highest risk being in the regions around Nuneaton and Bedworth. This study showed distinct spatial patterns in heart failure morbidity and mortality, suggesting the potential role of environmental factors beyond individual-level risk factors. Air pollution levels should therefore be taken into account when considering the wider determinants of public health and the impact that changes in air pollution might have on the health of a population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Spatial variation of heart failure and air pollution in Warwickshire, UK: an investigation of small scale variation at the ward-level

PubMed Central

Bennett, Oscar; Kandala, Ngianga-Bakwin; Ji, Chen; Linnane, John; Clarke, Aileen

2014-01-01

Objectives To map using geospatial modelling techniques the morbidity and mortality caused by heart failure within Warwickshire to characterise and quantify any influence of air pollution on these risks. Design Cross-sectional. Setting Warwickshire, UK. Participants Data from all of the 105 current Warwickshire County wards were collected on hospital admissions and deaths due to heart failure. Results In multivariate analyses, the presence of higher mono-nitrogen oxide (NOx) in a ward (3.35:1.89, 4.99), benzene (Ben) (31.9:8.36, 55.85) and index of multiple deprivation (IMD; 0.02: 0.01, 0.03), were consistently associated with a higher risk of heart failure morbidity. Particulate matter (Pm; −12.93: −20.41, −6.54) was negatively associated with the risk of heart failure morbidity. No association was found between sulfur dioxide (SO2) and heart failure morbidity. The risk of heart failure mortality was higher in wards with a higher NOx (4.30: 1.68, 7.37) and wards with more inhabitants 50+ years old (1.60: 0.47, 2.92). Pm was negatively associated (−14.69: −23.46, −6.50) with heart failure mortality. SO2, Ben and IMD scores were not associated with heart failure mortality. There was a prominent variation in heart failure morbidity and mortality risk across wards, the highest risk being in the regions around Nuneaton and Bedworth. Conclusions This study showed distinct spatial patterns in heart failure morbidity and mortality, suggesting the potential role of environmental factors beyond individual-level risk factors. Air pollution levels should therefore be taken into account when considering the wider determinants of public health and the impact that changes in air pollution might have on the health of a population. PMID:25468504

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

PubMed

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

2016-01-01

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

Noise pollution in intensive care units and emergency wards.

PubMed

Khademi, Gholamreza; Roudi, Masoumeh; Shah Farhat, Ahmad; Shahabian, Masoud

2011-01-01

The improvement of technology has increased noise levels in hospital Wards to higher than international standard levels (35-45 dB). Higher noise levels than the maximum level result in patient's instability and dissatisfaction. Moreover, it will have serious negative effects on the staff's health and the quality of their services. The purpose of this survey is to analyze the level of noise in intensive care units and emergency wards of the Imam Reza Teaching Hospital, Mashhad. This research was carried out in November 2009 during morning shifts between 7:30 to 12:00. Noise levels were measured 10 times at 30-minute intervals in the nursing stations of 10 wards of the emergency, the intensive care units, and the Nephrology and Kidney Transplant Departments of Imam Reza University Hospital, Mashhad. The noise level in the nursing stations was tested for both the maximum level (Lmax) and the equalizing level (Leq). The research was based on the comparison of equalizing levels (Leq) because maximum levels were unstable. In our survey the average level (Leq) in all wards was much higher than the standard level. The maximum level (Lmax) in most wards was 85-86 dB and just in one measurement in the Internal ICU reached 94 dB. The average level of Leq in all wards was 60.2 dB. In emergency units, it was 62.2 dB, but it was not time related. The highest average level (Leq) was measured at 11:30 AM and the peak was measured in the Nephrology nursing station. The average levels of noise in intensive care units and also emergency wards were more than the standard levels and as it is known these wards have vital roles in treatment procedures, so more attention is needed in this area.

Quantifying the imprint of mesoscale and synoptic-scale atmospheric transport on total column carbon dioxide measurements

NASA Astrophysics Data System (ADS)

Torres, A. D.; Keppel-Aleks, G.; Doney, S. C.; Feng, S.; Lauvaux, T.; Fendrock, M. A.; Rheuben, J.

2017-12-01

Remote sensing instruments provide an unprecedented density of observations of the atmospheric CO2 column average mole fraction (denoted as XCO2), which can be used to constrain regional scale carbon fluxes. Inferring fluxes from XCO2 observations is challenging, as measurements and inversion methods are sensitive to not only the imprint local and large-scale fluxes, but also mesoscale and synoptic-scale atmospheric transport. Quantifying the fine-scale variability in XCO2 from mesoscale and synoptic-scale atmospheric transport will likely improve overall error estimates from flux inversions by improving estimates of representation errors that occur when XCO2 observations are compared to modeled XCO2 in relatively coarse transport models. Here, we utilize various statistical methods to quantify the imprint of atmospheric transport on XCO2 observations. We compare spatial variations along Orbiting Carbon Observatory (OCO-2) satellite tracks to temporal variations observed by the Total Column Carbon Observing Network (TCCON). We observe a coherent seasonal cycle of both within-day temporal and fine-scale spatial variability (of order 10 km) of XCO2 from these two datasets, suggestive of the imprint of mesoscale systems. To account for other potential sources of error in XCO2 retrieval, we compare observed temporal and spatial variations of XCO2 to high-resolution output from the Weather Research and Forecasting (WRF) model run at 9 km resolution. In both simulations and observations, the Northern hemisphere mid-latitude XCO2 showed peak variability during the growing season when atmospheric gradients are largest. These results are qualitatively consistent with our expectations of seasonal variations of the imprint of synoptic and mesoscale atmospheric transport on XCO2 observations; suggesting that these statistical methods could be sensitive to the imprint of atmospheric transport on XCO2 observations.

Patient- and ward-level determinants of nursing time in nursing facilities.

PubMed

Laine, Juha; Noro, Anja; Finne-Soveri, Harriet; Häkkinen, Unto

2005-10-01

To explore the patient- and ward-level determinants of wage-adjusted nursing time in long-term care wards for the elderly with a view to improving efficiency of the use of labour resources. The wage-adjusted nursing time given to patients was obtained from a time measurement study. Patient characteristics were based on the Minimum Data Set 2.0 of the Resident Assessment Instrument for nursing homes. Ordinary least-squares regression analysis and multilevel modelling were used to disentangle the effect of patient- and ward-level factors on nursing time. A significant difference in wage-adjusted nursing time between wards was detected, which was partly explained by characteristics of patients in wards. The combination of patients' physical functioning and cognition and the Resource Utilization Groups RUG-III/22 resource use classification explained 20-25% of patients' nursing time over a 24-hour period. Variables related to the operational environment of the ward did not explain differences in wage-adjusted nursing time once the patient profile of the ward had been controlled for. The results also showed notable unmeasured patient and ward level effects, inefficiency and randomness in the allocation of nursing time. By improving the allocation and use of labour resources, the substantial variation in nursing time between wards could be diminished. Managers should allocate their staff primarily according to patients' resource needs.

Review of the outer scale of the atmospheric turbulence

NASA Astrophysics Data System (ADS)

Ziad, Aziz

2016-07-01

Outer scale is a relevant parameter for the experimental performance evaluation of large telescopes. Different techniques have been used for the outer scale estimation. In situ measurements with radiosounding balloons have given very small values of outer scale. This latter has also been estimated directly at the ground level from the wavefront analysis with High Angular Resolution (HAR) techniques using interferometric or Shack-Hartmann or more generally AO systems data. Dedicated instruments have been also developed for the outer scale monitoring such as the Generalized Seeing Monitor (GSM) and the Monitor of Outer Scale Profile (MOSP). The measured values of outer scale from HAR techniques, GSM and MOSP are somewhat coherent and are larger than the in situ results. The main explanation of this difference comes from the definition of the outer scale itself. This paper aims to give a review in a non-exhaustive way of different techniques and instruments for the measurement of the outer scale. Comparisons of outer scale measurements will be discussed in the light of the different definitions of this parameter, the associated observable quantities and the atmospheric turbulence model as well.

Ergonomics in the psychiatric ward towards workers or patients?

PubMed

Silvana, Salerno; Laura, Forcella; Ursula, Di Fabio; Irene, Figà Talamanca; Paolo, Boscolo

2012-01-01

Patient's aggressive behavior is one of the major problem in the psychiatric ward. Here we present the preliminary results of a psychiatric ward case-study, of a public hospital in the Chieti province, in order to plan ergonomic improvement. We applied the Method of Organizational Congruencies in the psychiatric ward in order to study the relationship between organized hospital work and nurses wellbeing in a 24 hour shifts. We observed 58 main phases in the three work shifts. The technical actions are mainly those of any hospital wards (shift briefing, preparing and administering drugs, recording data on clinical charts, etc.). We found important differences mainly due to the nurses overcontrol activities on the patients behavior (preventing suicides or self destructive behavior), the occurrence of restraint procedure towards patients, the pollution due to patient's cigarette smoke. The fear of patient's self destructive behavior or other aggressive behaviour are the main cognitive and social aspects of this hospital ward. Nurses working in this psychiatric ward have to accept: locked doors, poor and polluted environment, restraint procedure with high risk of aggression and no availability of mental health care programs. A new interdisciplinary concept for ergonomics in psychiatry setting may represent a challenge for both nurses and patients and the community.

Multi-Criteria Knapsack Problem for Disease Selection in an Observation Ward

NASA Astrophysics Data System (ADS)

Lurkittikul, N.; Kittithreerapronchai, O.

2014-06-01

The aging population and the introduction of Thailand universal healthcare have increased inpatients and outpatients to public hospitals, particularly to a hospital that provides special and comprehensive health services. Many inpatient wards have experienced large influx of inpatients as the hospitals have to admit all patients regardless their conditions. These overcrowding wards cause stress to medical staffs, block access between medical departments, hospital-acquired infections, and ineffective uses of resources. One way to manage such inundated inpatient is to select some patients whose conditions require less clinical attention or whose lengths of stay are predictable and short and, then, place them at an observation ward. This intermediate ward increases turnover of beds and reduces unnecessary paperwork as patients are considered to be outpatients. In this article, we studied inpatient data of a tertiary care hospital in which an observation ward was considered to alleviate the overcrowding problem at Internal Medicine Department. The analysis of data showed that the hospital can balance inpatient flow by managing a group of patients who is admitted because of treatments ordered by its special clinics. Having explored several alternatives, we suggested patient selection criteria and proposed a layout at an observation ward. The hospital should increase medical beds in a new building ward because the current observation ward can handle 27.3% of total short stay patients, while the observation ward is projected to handle 80% of total short stay patients.

How does the environment impact on the quality of life of advanced cancer patients? A qualitative study with implications for ward design.

PubMed

Rowlands, J; Noble, S

2008-09-01

It is well recognized that the ward environment has an effect on patients' quality of life and may, therefore, impact on the quality of end of life care. The body of evidence that informs ward design policy recommends single-bedded rooms on grounds of reduced infection risk, noise and versatility. Considering the majority of anticipated patient deaths occurring in hospitals, the quality of life aspects of ward design should also be considered. The aim of this study is to explore the views of patients with advanced cancer on the effect the ward environment has on their overall well-being. Semi-structured interviews exploring the experiences of 12 inpatients at a regional cancer centre were recorded and transcribed verbatim. Transcripts were analysed for emerging themes until theoretical saturation. Four major themes emerged: staff behaviours, the immediate environment, single vs. multi-bedded rooms and contact with the outside environment. The attitude, competence and helpfulness of the staff creates the atmosphere of the ward regardless of layout, furnishings, equipment and décor. The majority of the patients in this study expressed a strong preference for a multi-bedded room when they were well enough to interact and a single cubicle when they were very ill or dying, which opposes the current advice for building new hospitals with all single rooms. Although the current policy recommends the use of single-bedded rooms, this study suggests the need for a mix of multi-bedded wards and single rooms with respect to the impact of the environment on patient quality of life.

Why patients need leaders: introducing a ward safety checklist

PubMed Central

Amin, Yogen; Grewcock, Dave; Andrews, Steve; Halligan, Aidan

2012-01-01

The safety and consistency of the care given to hospital inpatients has recently become a particular political and public concern. The traditional ‘ward round’ presents an obvious opportunity for systematically and collectively ensuring that proper standards of care are being achieved for individual patients. This paper describes the design and implementation of a ‘ward safety checklist’ that defines a set of potential risk factors that should be checked on a daily basis, and offers multidisciplinary teams a number of prompts for sharing and clarifying information between themselves, and with the patient, during a round. The concept of the checklist and the desire to improve ward rounds were well received in many teams, but the barriers to adoption were informative about the current culture on many inpatient wards. Although the ‘multidisciplinary ward round’ is widely accepted as good practice, the medical and nursing staff in many teams are failing to coordinate their workloads well enough to make multidisciplinary rounds a working reality. ‘Nursing’ and ‘medical’ care on the ward have become ‘de-coupled’ and the potential consequences for patient safety and good communication are largely self-evident. This problem is further complicated by a medical culture which values the primacy of clinical autonomy and as a result can be resistant to perceived attempts to ‘systematize’ medical care through instruments such as checklists. PMID:22977047

Variability in Costs across Hospital Wards. A Study of Chinese Hospitals

PubMed Central

Adam, Taghreed; Evans, David B.; Ying, Bian; Murray, Christopher J. L.

2014-01-01

Introduction Analysts estimating the costs or cost-effectiveness of health interventions requiring hospitalization often cut corners because they lack data and the costs of undertaking full step-down costing studies are high. They sometimes use the costs taken from a single hospital, sometimes use simple rules of thumb for allocating total hospital costs between general inpatient care and the outpatient department, and sometimes use the average cost of an inpatient bed-day instead of a ward-specific cost. Purpose In this paper we explore for the first time the extent and the causes of variation in ward-specific costs across hospitals, using data from China. We then use the resulting model to show how ward-specific costs for hospitals outside the data set could be estimated using information on the determinants identified in the paper. Methodology Ward-specific costs estimated using step-down costing methods from 41 hospitals in 12 provinces of China were used. We used seemingly unrelated regressions to identify the determinants of variability in the ratio of the costs of specific wards to that of the outpatient department, and explain how this can be used to generate ward-specific unit costs. Findings Ward-specific unit costs varied considerably across hospitals, ranging from 1 to 24 times the unit cost in the outpatient department — average unit costs are not a good proxy for costs at specialty wards in general. The most important sources of variability were the number of staff and the level of capacity utilization. Practice Implications More careful hospital costing studies are clearly needed. In the meantime, we have shown that in China it is possible to estimate ward-specific unit costs taking into account key determinants of variability in costs across wards. This might well be a better alternative than using simple rules of thumb or using estimates from a single study. PMID:24874566

Scale effects in wind tunnel modeling of an urban atmospheric boundary layer

NASA Astrophysics Data System (ADS)

Kozmar, Hrvoje

2010-03-01

Precise urban atmospheric boundary layer (ABL) wind tunnel simulations are essential for a wide variety of atmospheric studies in built-up environments including wind loading of structures and air pollutant dispersion. One of key issues in addressing these problems is a proper choice of simulation length scale. In this study, an urban ABL was reproduced in a boundary layer wind tunnel at different scales to study possible scale effects. Two full-depth simulations and one part-depth simulation were carried out using castellated barrier wall, vortex generators, and a fetch of roughness elements. Redesigned “Counihan” vortex generators were employed in the part-depth ABL simulation. A hot-wire anemometry system was used to measure mean velocity and velocity fluctuations. Experimental results are presented as mean velocity, turbulence intensity, Reynolds stress, integral length scale of turbulence, and power spectral density of velocity fluctuations. Results suggest that variations in length-scale factor do not influence the generated ABL models when using similarity criteria applied in this study. Part-depth ABL simulation compares well with two full-depth ABL simulations indicating the truncated vortex generators developed for this study can be successfully employed in urban ABL part-depth simulations.

The relationship between substance use and exit security on psychiatric wards.

PubMed

Simpson, Alan; Bowers, Len; Haglund, Kristina; Muir-Cochrane, Eimear; Nijman, Henk; Van der Merwe, Marie

2011-03-01

In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming themselves or others, and of people bringing illicit substances into the therapeutic environment. In 2004/2005, a cross sectional survey on 136 acute psychiatric wards across three areas of England was undertaken. A comprehensive range of data including door locking and drug/alcohol use were collected over 6 months on each ward. In 2006, supplementary data on door locking and exit security were collected. Door locking, additional exit security measures and substance misuse rates of the 136 wards were analysed and the associations between these were investigated. No consistent relationships were found with exit security features, intensity of drug/alcohol monitoring procedures, or the locking of the ward door. There were indications that use of breath testing for alcohol might reduce usage and that the use of 'sniffer' dogs was associated with greater alcohol use. Greater exit security or locking of the ward door had no influence on rates of use of alcohol or illicit drugs by inpatients and thus cannot form part of any strategy to control substance use by inpatients. There are some grounds to believe that a greater use of screening might help reduce the frequency of alcohol/substance use on wards and may lead to a reduction in verbal abuse. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Developing a general ward nursing dashboard.

PubMed

Russell, Margot; Hogg, Maggie; Leach, Stuart; Penman, Mags; Friel, Susan

2014-12-15

The seventh and final article in the series on Leading Better Care explores some of the challenges in clinical practice relating to the use of data and making information meaningful to senior charge nurses and ward sisters. It describes the collaborative approach taken by NHS Lanarkshire, which involved nursing staff, programme leads and the eHealth team in the development of a general ward nursing dashboard as a means of ensuring safe, effective person-centred care. The article also illustrates how this web-based data-reporting programme is used to support clinical practice.

Introduction of a new ward round approach in a cardiothoracic critical care unit.

PubMed

Shaughnessy, Liz; Jackson, Jo

2015-07-01

Francis (2013) described inconsistent ward rounds and failures to conduct ward rounds properly as contributing factors to the poor care seen at the Mid Staffordshire Foundation Trust. He suggested that the absence of a nurse at the bedside had clear consequences for communication, ward round efficiency and patient safety. He recommended that nurses should be actively involved in ward rounds and linked this to high quality patient care. To share an experience of introducing a ward round checklist, a bedside nurse verbal summary and the development of standard operating procedure for Ward Rounds in cardiothoracic critical care unit to improve patient safety and care. Semi structured interviews of six registered nurses. A questionnaire to 69 registered nurses. An electronic questionnaire sent to 23 members of the MDT. An observational audit of seven ward rounds reviewing 69 patients. 97% of nurses agreed that verbal summarizing had improved clarity and 90% felt that it had improved patient care. 87% of the MDT respondents stated that they had noticed an improvement in the attendance of the bedside nurse at the ward round review. The ward round checklist reduced omissions. Communication with patients during ward rounds was an area which needed to be improved. The introduction of a new ward round approach and audit of its practice has enabled an improvement in the quality of patient care by: Giving more opportunity for the nurse to participate and feel part of the ward round. Reduction of omissions through the use of a ward round checklist. Improved clarity among the MDT by the use of bedside nurse verbal summarizing of the plan of care. Nurses' full participation in ward rounds is essential to ensure effective communication and enhance patient safety. © 2015 British Association of Critical Care Nurses.

Nursing ward managers' perceptions of pain prevalence at the aged-care facilities in Japan: a nationwide survey.

PubMed

Takai, Yukari; Yamamoto-Mitani, Noriko; Fukahori, Hiroki; Kobayashi, Sayuri; Chiba, Yumi

2013-09-01

This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Does daily nurse staffing match ward workload variability? Three hospitals' experiences.

PubMed

Gabbay, Uri; Bukchin, Michael

2009-01-01

Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity

Spatial patterns in electoral wards with high lymphoma incidence in Yorkshire health region.

PubMed Central

Barnes, N.; Cartwright, R. A.; O'Brien, C.; Roberts, B.; Richards, I. D.; Bird, C. C.

1987-01-01

The possibilities of clustering between those electoral wards which display higher than expected incidences of cases of the lymphomas occurring between 1978 and 1982 are examined. Clusters are defined as being those wards with cases in excess (at a probability of less than 10%) which are geographically adjacent to each other. A separate analysis extends the definition of cluster to include high incidence wards that are adjacent or separated by one other ward. The results indicate that many high incidence lymphoma wards do occur close together and when computer simulations are used to compute expected results, many of the observed results are shown to be highly improbable both in the overall number of clustering wards and in the largest number of wards comprising a 'cluster'. PMID:3663469

Orbital and millennial-scale features of atmospheric CH4 over the past 800,000 years.

PubMed

Loulergue, Laetitia; Schilt, Adrian; Spahni, Renato; Masson-Delmotte, Valérie; Blunier, Thomas; Lemieux, Bénédicte; Barnola, Jean-Marc; Raynaud, Dominique; Stocker, Thomas F; Chappellaz, Jérôme

2008-05-15

Atmospheric methane is an important greenhouse gas and a sensitive indicator of climate change and millennial-scale temperature variability. Its concentrations over the past 650,000 years have varied between approximately 350 and approximately 800 parts per 10(9) by volume (p.p.b.v.) during glacial and interglacial periods, respectively. In comparison, present-day methane levels of approximately 1,770 p.p.b.v. have been reported. Insights into the external forcing factors and internal feedbacks controlling atmospheric methane are essential for predicting the methane budget in a warmer world. Here we present a detailed atmospheric methane record from the EPICA Dome C ice core that extends the history of this greenhouse gas to 800,000 yr before present. The average time resolution of the new data is approximately 380 yr and permits the identification of orbital and millennial-scale features. Spectral analyses indicate that the long-term variability in atmospheric methane levels is dominated by approximately 100,000 yr glacial-interglacial cycles up to approximately 400,000 yr ago with an increasing contribution of the precessional component during the four more recent climatic cycles. We suggest that changes in the strength of tropical methane sources and sinks (wetlands, atmospheric oxidation), possibly influenced by changes in monsoon systems and the position of the intertropical convergence zone, controlled the atmospheric methane budget, with an additional source input during major terminations as the retreat of the northern ice sheet allowed higher methane emissions from extending periglacial wetlands. Millennial-scale changes in methane levels identified in our record as being associated with Antarctic isotope maxima events are indicative of ubiquitous millennial-scale temperature variability during the past eight glacial cycles.

Measuring large-scale vertical motion in the atmosphere with dropsondes

NASA Astrophysics Data System (ADS)

Bony, Sandrine; Stevens, Bjorn

2017-04-01

Large-scale vertical velocity modulates important processes in the atmosphere, including the formation of clouds, and constitutes a key component of the large-scale forcing of Single-Column Model simulations and Large-Eddy Simulations. Its measurement has also been a long-standing challenge for observationalists. We will show that it is possible to measure the vertical profile of large-scale wind divergence and vertical velocity from aircraft by using dropsondes. This methodology was tested in August 2016 during the NARVAL2 campaign in the lower Atlantic trades. Results will be shown for several research flights, the robustness and the uncertainty of measurements will be assessed, ands observational estimates will be compared with data from high-resolution numerical forecasts.

REPRESENTATION OF ATMOSPHERIC MOTION IN MODELS OF REGIONAL-SCALE AIR POLLUTION

EPA Science Inventory

A method is developed for generating ensembles of wind fields for use in regional scale (1000 km) models of transport and diffusion. The underlying objective is a methodology for representing atmospheric motion in applied air pollution models that permits explicit treatment of th...

Test-retest reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale.

PubMed

Gustafsson, Margareta; Blomberg, Karin; Holmefur, Marie

2015-07-01

The Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale evaluates the student nurses' perception of the learning environment and supervision within the clinical placement. It has never been tested in a replication study. The aim of the present study was to evaluate the test-retest reliability of the CLES + T scale. The CLES + T scale was administered twice to a group of 42 student nurses, with a one-week interval. Test-retest reliability was determined by calculations of Intraclass Correlation Coefficients (ICCs) and weighted Kappa coefficients. Standard Error of Measurements (SEM) and Smallest Detectable Difference (SDD) determined the precision of individual scores. Bland-Altman plots were created for analyses of systematic differences between the test occasions. The results of the study showed that the stability over time was good to excellent (ICC 0.88-0.96) in the sub-dimensions "Supervisory relationship", "Pedagogical atmosphere on the ward" and "Role of the nurse teacher". Measurements of "Premises of nursing on the ward" and "Leadership style of the manager" had lower but still acceptable stability (ICC 0.70-0.75). No systematic differences occurred between the test occasions. This study supports the usefulness of the CLES + T scale as a reliable measure of the student nurses' perception of the learning environment within the clinical placement at a hospital. Copyright © 2015 Elsevier Ltd. All rights reserved.

Realistic Modeling of Multi-Scale MHD Dynamics of the Solar Atmosphere

NASA Technical Reports Server (NTRS)

Kitiashvili, Irina; Mansour, Nagi N.; Wray, Alan; Couvidat, Sebastian; Yoon, Seokkwan; Kosovichev, Alexander

2014-01-01

Realistic 3D radiative MHD simulations open new perspectives for understanding the turbulent dynamics of the solar surface, its coupling to the atmosphere, and the physical mechanisms of generation and transport of non-thermal energy. Traditionally, plasma eruptions and wave phenomena in the solar atmosphere are modeled by prescribing artificial driving mechanisms using magnetic or gas pressure forces that might arise from magnetic field emergence or reconnection instabilities. In contrast, our 'ab initio' simulations provide a realistic description of solar dynamics naturally driven by solar energy flow. By simulating the upper convection zone and the solar atmosphere, we can investigate in detail the physical processes of turbulent magnetoconvection, generation and amplification of magnetic fields, excitation of MHD waves, and plasma eruptions. We present recent simulation results of the multi-scale dynamics of quiet-Sun regions, and energetic effects in the atmosphere and compare with observations. For the comparisons we calculate synthetic spectro-polarimetric data to model observational data of SDO, Hinode, and New Solar Telescope.

Design Lessons From the Analysis of Nurse Journeys in a Hospital Ward.

PubMed

Nazarian, Masoumeh; Price, Andrew; Demian, Peter; Malekzadeh, Masoud

2018-01-01

The objective is to establish design strategies to help minimize nurse journeys and inform future decision-making. The impact of the ward layout was investigated through a case study ward in a multispecialty hospital in Tehran. Nurse teams have the most direct contact with ward patients. Time spent on activities not part of care provision should be minimized. Literature suggests that a significant part of nurses' time is spent moving between different places within wards, which emphasizes the importance of ward layout. The ethnographic method was adopted for observing nurses' actions based on routes that form a significant share of nurses' daily journeys. Data were collected from 42 nursing staff over 120 hr during different shifts. This provided empirical data on the frequency of each journey which revealed meaningful patterns. Approximately 1,300 room-to-room journeys were made. Conclusions were drawn about the criticality of each route. There is a significant difference between the frequencies of different routes in the case study ward. The distances between origins and destinations of the most frequently used journeys must remain minimal. Awareness of less frequent routes allows for greater flexibility in ward design. Arrangement of ward spaces can minimize journey times. Healthcare planners and designers can explore the implications of chosen systems on walking distance and, consequently, the nursing staff productivity. For existing wards, rearrangement of space utilization can improve staff productivity. The recommendations can be applied wherever productivity is influenced by walking distances.

Comparing Time-Dependent Geomagnetic and Atmospheric Effects on Cosmogenic Nuclide Production Rate Scaling

NASA Astrophysics Data System (ADS)

Lifton, N. A.

2014-12-01

A recently published cosmogenic nuclide production rate scaling model based on analytical fits to Monte Carlo simulations of atmospheric cosmic ray flux spectra (both of which agree well with measured spectra) (Lifton et al., 2014, Earth Planet. Sci. Lett. 386, 149-160: termed the LSD model) provides two main advantages over previous scaling models: identification and quantification of potential sources of bias in the earlier models, and the ability to generate nuclide-specific scaling factors easily for a wide range of input parameters. The new model also provides a flexible framework for exploring the implications of advances in model inputs. In this work, the scaling implications of two recent time-dependent spherical harmonic geomagnetic models spanning the Holocene will be explored. Korte and Constable (2011, Phys. Earth Planet. Int. 188, 247-259) and Korte et al. (2011, Earth Planet. Sci. Lett. 312, 497-505) recently updated earlier spherical harmonic paleomagnetic models used by Lifton et al. (2014) with paleomagnetic measurements from sediment cores in addition to archeomagnetic and volcanic data. These updated models offer improved accuracy over the previous versions, in part to due to increased temporal and spatial data coverage. With the new models as input, trajectory-traced estimates of effective vertical cutoff rigidity (RC- the standard method for ordering cosmic ray data) yield significantly different time-integrated scaling predictions when compared to the earlier models. These results will be compared to scaling predictions using another recent time-dependent spherical harmonic model of the Holocene geomagnetic field by Pavón-Carrasco et al. (2014, Earth Planet. Sci. Lett. 388, 98-109), based solely on archeomagnetic and volcanic paleomagnetic data, but extending to 14 ka. In addition, the potential effects of time-dependent atmospheric models on LSD scaling predictions will be presented. Given the typical dominance of altitudinal over

Atmospheric forcing of the upper ocean transport in the Gulf of Mexico: From seasonal to diurnal scales

NASA Astrophysics Data System (ADS)

Judt, Falko; Chen, Shuyi S.; Curcic, Milan

2016-06-01

The 2010 Deepwater Horizon oil spill in the Gulf of Mexico (GoM) was an environmental disaster, which highlighted the urgent need to predict the transport and dispersion of hydrocarbon. Although the variability of the atmospheric forcing plays a major role in the upper ocean circulation and transport of the pollutants, the air-sea interaction on various time scales is not well understood. This study provides a comprehensive overview of the atmospheric forcing and upper ocean response in the GoM from seasonal to diurnal time scales, using climatologies derived from long-term observations, in situ observations from two field campaigns, and a coupled model. The atmospheric forcing in the GoM is characterized by striking seasonality. In the summer, the time-average large-scale forcing is weak, despite occasional extreme winds associated with hurricanes. In the winter, the atmospheric forcing is much stronger, and dominated by synoptic variability on time scales of 3-7 days associated with winter storms and cold air outbreaks. The diurnal cycle is more pronounced during the summer, when sea breeze circulations affect the coastal regions and nighttime wind maxima occur over the offshore waters. Realtime predictions from a high-resolution atmosphere-wave-ocean coupled model were evaluated for both summer and winter conditions during the Grand LAgrangian Deployment (GLAD) in July-August 2012 and the Surfzone Coastal Oil Pathways Experiment (SCOPE) in November-December 2013. The model generally captured the variability of atmospheric forcing on all scales, but suffered from some systematic errors.

Hospital admission avoidance through the introduction of a virtual ward.

PubMed

Jones, Joanne; Carroll, Andrea

2014-07-01

The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines.

Interactions between Antarctic sea ice and large-scale atmospheric modes in CMIP5 models

NASA Astrophysics Data System (ADS)

Schroeter, Serena; Hobbs, Will; Bindoff, Nathaniel L.

2017-03-01

The response of Antarctic sea ice to large-scale patterns of atmospheric variability varies according to sea ice sector and season. In this study, interannual atmosphere-sea ice interactions were explored using observations and reanalysis data, and compared with simulated interactions by models in the Coupled Model Intercomparison Project Phase 5 (CMIP5). Simulated relationships between atmospheric variability and sea ice variability generally reproduced the observed relationships, though more closely during the season of sea ice advance than the season of sea ice retreat. Atmospheric influence on sea ice is known to be strongest during advance, and it appears that models are able to capture the dominance of the atmosphere during advance. Simulations of ocean-atmosphere-sea ice interactions during retreat, however, require further investigation. A large proportion of model ensemble members overestimated the relative importance of the Southern Annular Mode (SAM) compared with other modes of high southern latitude climate, while the influence of tropical forcing was underestimated. This result emerged particularly strongly during the season of sea ice retreat. The zonal patterns of the SAM in many models and its exaggerated influence on sea ice overwhelm the comparatively underestimated meridional influence, suggesting that simulated sea ice variability would become more zonally symmetric as a result. Across the seasons of sea ice advance and retreat, three of the five sectors did not reveal a strong relationship with a pattern of large-scale atmospheric variability in one or both seasons, indicating that sea ice in these sectors may be influenced more strongly by atmospheric variability unexplained by the major atmospheric modes, or by heat exchange in the ocean.

Youth Health Coordinating Council Ward 8 Secret Health Clinic Shopper Report

ERIC Educational Resources Information Center

Behrens, Donna

2010-01-01

There are over 70,000 residents in Ward 8, the poorest area of Washington, DC and along with Ward 7, it's most geographically remote. Approximately 36% of the Ward 8 population consists of children and youth, 18 years or younger. Children in the District of Columbia are at greater risk for poorer health and life outcomes than children in other…

Simulation in Urology to Train Non-Technical Skills in Ward Rounds.

PubMed

Somasundram, K; Spence, H; Colquhoun, A J; Mcilhenny, C; Biyani, C S; Jain, S

2018-05-19

We have designed an exercise to train newly appointed Urology trainees in non-technical skills on ward rounds as a part of a simulation 'boot camp'. This paper reports our experience, including a qualitative analysis of participant feedback on the utility of this method of training. The simulations took place in a high-fidelity simulated ward bay. Forty-eight doctors with formal Urology training ranging between 2-60 months (mean 19.1 ± 11.6 months) took part. Thirty-one participants were on a formal Urology specialty training pathway. The remaining participants were core (pre-specialty) surgical trainees. The entry requirement was that participants must be junior-level urologists, ideally at the beginning of specialty training. Participants individually led a simulated ward round, which was devised using actors to play as patients and a simulated 'switchboard' for telephone conversations. Distractions were introduced deliberately for participants to manage an emergent urology-related scenario. 'Freeze-frames' were used to 'pause' the ward-round, whereby observing consultants provided feedback on performance. Following the simulated exercises, a whole-group structured debrief took place. Non-technical skills for surgeons (NOTSS) scores were generated for participants by seven consultant urologists. Participants completed a two-part feedback form. Part-one involved nine questions scored on a Likert scale, and part-two required free-text responses. The mean itemised NOTSS scores for situational awareness, decision-making, communication and teamwork and leadership were 3.01 (SD ± 0.15), 2.95 (SD ± 0.16), 3.05 (SD ± 0.19), 2.98 (SD ± 0.15), respectively. From the thematic analysis, participants commented positively on the number of scenarios per participant, the use of real patient-actors and staff, and the use of 'freeze-frames' for immediate feedback. Residents also provided suggestions for distractions to be considered in the future. This simulated ward round

5. Roof Truss Above Service Area, Roof Truss Above Ward, ...

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

5. Roof Truss Above Service Area, Roof Truss Above Ward, Roof Framing Axonometric - National Home for Disabled Volunteer Soldiers - Battle Mountain Sanitarium, Ward 4, 500 North Fifth Street, Hot Springs, Fall River County, SD

Strengthening the role of the ward manager: a review of the literature.

PubMed

Pegram, Anne M; Grainger, Michelle; Sigsworth, Janice; While, Alison E

2014-09-01

The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. To identify initiatives that have strengthened the ward manager role. A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems. © 2013 John Wiley & Sons Ltd.

Equatorial Mesosphere and Lower Thermosphere/Ionosphere (MLTI) Response to Severe Cyclonic Storm `Aila' and `Ward' observed over North Indian Ocean

NASA Astrophysics Data System (ADS)

G J, B.

2016-12-01

The present work investigates the Equatorial Mesosphere Lower Thermosphere/Ionosphere (MLTI) response to severe cyclonic storm `Aila (23-26 May 2009)' and `Ward (10-16 December 2009)' which were observed over north Indian Ocean during the extended solar minimum of the year 2009. This report reveals the coupling between Tropical Cyclone and MLTI region. Tropical cyclone track and data can be obtained from Indian Meteorological Department (IMD), New Delhi. Mesospheric and Ionospheric variation can be examined with the help of ground based Mesosphere Lower Thermosphere (MLT) radar and Digisonde located at equatorial low latitude station, Tirunelveli (8.7oN, 77.8oE). The Outgoing Long wave Radiation (OLR) data is used as a proxy for identifying the convective activity, which are retrieved from NOAA Climate Data Centre. It is observed that the tropical cyclone induced convection as the driving agent for the increased gravity wave activity in the lower atmosphere. These upward propagating gravity waves deposit their energy and momentum into the upper region of atmosphere as `Travelling Ionospheric Disturbances (TIDs). During the cyclonic storm periods, we found increased gravity wave amplitude with upward propagation in the MLT region. Ionospheric response to severe cyclonic storm is examined with the dynamical parameters, foF2, hmF2, h'F2 and Total Election Content (TEC). Significant increase of foF2 frequency is observed during `Ward' cyclonic storm. Drastic variation in foF2 and h'F2 is observed during Aila cyclonic storm than ward event. More statistical analysis has been done for finding the correlation between cyclonic storm and Ionospheric parameters. Detailed results will be presented in the meeting.

[A project to ameliorate nurses working overtime in psychiatry ward].

PubMed

Feng, Yuen-Hsiang; Li, Hsiu-Chen; Fang, Mao-So

2009-12-01

The authors found nurses working in psychiatry wards were frequently required to work overtime, with average overtime measuring 85 minutes. After analysis, we found main factors leading to overtime to be late new patient admissions, tardy ward inspections by attending physicians, failure to implement workplace regulations, failure by nurses to implement proper shift transfer procedures, and meeting-related delays. This paper proposes an approach by which average overtime for psychiatry ward nurses may be reduced from 85 to 30 minutes. Based on findings, the researchers adjusted the schedule for ward visits by attending physicians, updated and streamlined workplace regulations, ensured administrative procedures were precisely followed, and updated and streamlined standing orders. Average overtime was reduced from 85 to 25 minutes. This research facilitated a reduction in the amount of overtime registered by nurses.

Thermal comfort of patients in hospital ward areas.

PubMed Central

Smith, R. M.; Rae, A.

1977-01-01

The patient is identified as being of prime importance for comfort standards in hospital ward areas, other ward users being expected to adjust their dress to suit the conditions necessary for patients comfort. A study to identify the optimum steady state conditions for patients comfort is then described. Although this study raises some doubts as to the applicability of the standard thermal comfort assessment techniques to ward areas, it is felt that its results give a good indication of the steady-state conditions preferred by the patients. These were an air temperature of between 21-5 degrees and 22 degrees C and a relative humidity of between 30% and 70%, where the air velocity was less than 0-1 m/s and the mean radiant temperature was close to air temperature. PMID:264497

Building-Scale Atmospheric Modeling for Understanding and Anticipating Environmental Risks to Urban Populations

NASA Astrophysics Data System (ADS)

Warner, T. T.; Swerdlin, S. P.; Chen, F.; Hayden, M.

2009-05-01

The innovative use of Computational Fluid-Dynamics (CFD) models to define the building- and street-scale atmospheric environment in urban areas can benefit society in a number of ways. Design criteria used by architectural climatologists, who help plan the livable cities of the future, require information about air movement within street canyons for different seasons and weather regimes. Understanding indoor urban air- quality problems and their mitigation, especially for older buildings, requires data on air movement and associated dynamic pressures near buildings. Learning how heat waves and anthropogenic forcing in cities collectively affect the health of vulnerable residents is a problem in building thermodynamics, human behavior, and neighborhood-scale and street-canyon-scale atmospheric sciences. And, predicting the movement of plumes of hazardous material released in urban industrial or transportation accidents requires detailed information about vertical and horizontal air motions in the street canyons. These challenges are closer to being addressed because of advances in CFD modeling, the coupling of CFD models with models of indoor air motion and air quality, and the coupling of CFD models with mesoscale weather-prediction models. This paper will review some of the new knowledge and technologies that are being developed to meet these atmospheric-environment needs of our growing urban populations.

Studies of regional-scale climate variability and change. Hidden Markov models and coupled ocean-atmosphere modes

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

Ghil, M.; Kravtsov, S.; Robertson, A. W.

2008-10-14

This project was a continuation of previous work under DOE CCPP funding, in which we had developed a twin approach of probabilistic network (PN) models (sometimes called dynamic Bayesian networks) and intermediate-complexity coupled ocean-atmosphere models (ICMs) to identify the predictable modes of climate variability and to investigate their impacts on the regional scale. We had developed a family of PNs (similar to Hidden Markov Models) to simulate historical records of daily rainfall, and used them to downscale GCM seasonal predictions. Using an idealized atmospheric model, we had established a novel mechanism through which ocean-induced sea-surface temperature (SST) anomalies might influencemore » large-scale atmospheric circulation patterns on interannual and longer time scales; we had found similar patterns in a hybrid coupled ocean-atmosphere-sea-ice model. The goal of the this continuation project was to build on these ICM results and PN model development to address prediction of rainfall and temperature statistics at the local scale, associated with global climate variability and change, and to investigate the impact of the latter on coupled ocean-atmosphere modes. Our main results from the grant consist of extensive further development of the hidden Markov models for rainfall simulation and downscaling together with the development of associated software; new intermediate coupled models; a new methodology of inverse modeling for linking ICMs with observations and GCM results; and, observational studies of decadal and multi-decadal natural climate results, informed by ICM results.« less

Contribution of the infrasound technology to characterize large scale atmospheric disturbances and impact on infrasound monitoring

NASA Astrophysics Data System (ADS)

Blanc, Elisabeth; Le Pichon, Alexis; Ceranna, Lars; Pilger, Christoph; Charlton Perez, Andrew; Smets, Pieter

2016-04-01

The International Monitoring System (IMS) developed for the verification of the Comprehensive nuclear-Test-Ban Treaty (CTBT) provides a unique global description of atmospheric disturbances generating infrasound such as extreme events (e.g. meteors, volcanoes, earthquakes, and severe weather) or human activity (e.g. explosions and supersonic airplanes). The analysis of the detected signals, recorded at global scales and over near 15 years at some stations, demonstrates that large-scale atmospheric disturbances strongly affect infrasound propagation. Their time scales vary from several tens of minutes to hours and days. Their effects are in average well resolved by the current model predictions; however, accurate spatial and temporal description is lacking in both weather and climate models. This study reviews recent results using the infrasound technology to characterize these large scale disturbances, including (i) wind fluctuations induced by gravity waves generating infrasound partial reflections and modifications of the infrasound waveguide, (ii) convection from thunderstorms and mountain waves generating gravity waves, (iii) stratospheric warming events which yield wind inversions in the stratosphere, (iv)planetary waves which control the global atmospheric circulation. Improved knowledge of these disturbances and assimilation in future models is an important objective of the ARISE (Atmospheric dynamics Research InfraStructure in Europe) project. This is essential in the context of the future verification of the CTBT as enhanced atmospheric models are necessary to assess the IMS network performance in higher resolution, reduce source location errors, and improve characterization methods.

Impact of large-scale atmospheric refractive structures on optical wave propagation

NASA Astrophysics Data System (ADS)

Nunalee, Christopher G.; He, Ping; Basu, Sukanta; Vorontsov, Mikhail A.; Fiorino, Steven T.

2014-10-01

Conventional techniques used to model optical wave propagation through the Earth's atmosphere typically as- sume flow fields based on various empirical relationships. Unfortunately, these synthetic refractive index fields do not take into account the influence of transient macroscale and mesoscale (i.e. larger than turbulent microscale) atmospheric phenomena. Nevertheless, a number of atmospheric structures that are characterized by various spatial and temporal scales exist which have the potential to significantly impact refractive index fields, thereby resulting dramatic impacts on optical wave propagation characteristics. In this paper, we analyze a subset of spatio-temporal dynamics found to strongly affect optical waves propagating through these atmospheric struc- tures. Analysis of wave propagation was performed in the geometrical optics approximation using a standard ray tracing technique. Using a numerical weather prediction (NWP) approach, we simulate multiple realistic atmospheric events (e.g., island wakes, low-level jets, etc.), and estimate the associated refractivity fields prior to performing ray tracing simulations. By coupling NWP model output with ray tracing simulations, we demon- strate the ability to quantitatively assess the potential impacts of coherent atmospheric phenomena on optical ray propagation. Our results show a strong impact of spatio-temporal characteristics of the refractive index field on optical ray trajectories. Such correlations validate the effectiveness of NWP models as they offer a more comprehensive representation of atmospheric refractivity fields compared to conventional methods based on the assumption of horizontal homogeneity.

An Investigation of Land-Atmosphere Coupling from Local to Regional Scales

NASA Astrophysics Data System (ADS)

Brunsell, N. A.; Van Vleck, E.; Rahn, D. A.

2017-12-01

The exchanges of mass and energy between the surface and atmosphere have been shown to depend upon both local and regional climatic influences. However, the degree of control exerted by the land surface on the coupling metrics is not well understood. In particular, we lack an understanding of the relationship between the local microclimate of a site and the regional forces responsible for land-atmosphere coupling. To address this, we investigate a series of metrics calculated from eddy covariance data and ceilometer data, land surface modeling and remotely sensed observations in the central United States to diagnose these interactions and predict the change from one coupling regime (e.g. wet/dry coupling) to another state. The stability of the coupling is quantified using a Lyapunov exponent based methodology. Through the use of a wavelet information theoretic approach, we isolate the roles local energy partitioning, as well as the temperature and moisture gradients on controlling and changing the coupling regime. Taking a multi-scale observational approach, we first examine the relationship at the tower scale. Using land surface models, we quantify to what extent current models are capable of properly diagnosing the dynamics of the coupling regime. In particular, we focus on the role of the surface moisture and vegetation to initiate and maintain precipitation feedbacks. We extend this analysis to the regional scale by utilizing reanalysis and remotely sensed observations. Thus, we are able to quantify the changes in observed coupling patterns with linkages to local interactions to address the question of the local control that the surface exerts over the maintenance of land-atmosphere coupling.

Heterogeneity and scaling land-atmospheric water and energy fluxes in climate systems

NASA Technical Reports Server (NTRS)

Wood, Eric F.

1993-01-01

The effects of small-scale heterogeneity in land surface characteristics on the large-scale fluxes of water and energy in land-atmosphere system has become a central focus of many of the climatology research experiments. The acquisition of high resolution land surface data through remote sensing and intensive land-climatology field experiments (like HAPEX and FIFE) has provided data to investigate the interactions between microscale land-atmosphere interactions and macroscale models. One essential research question is how to account for the small scale heterogeneities and whether 'effective' parameters can be used in the macroscale models. To address this question of scaling, three modeling experiments were performed and are reviewed in the paper. The first is concerned with the aggregation of parameters and inputs for a terrestrial water and energy balance model. The second experiment analyzed the scaling behavior of hydrologic responses during rain events and between rain events. The third experiment compared the hydrologic responses from distributed models with a lumped model that uses spatially constant inputs and parameters. The results show that the patterns of small scale variations can be represented statistically if the scale is larger than a representative elementary area scale, which appears to be about 2 - 3 times the correlation length of the process. For natural catchments this appears to be about 1 - 2 sq km. The results concerning distributed versus lumped representations are more complicated. For conditions when the processes are nonlinear, then lumping results in biases; otherwise a one-dimensional model based on 'equivalent' parameters provides quite good results. Further research is needed to fully understand these conditions.

Summative Evaluation on the Hospital Wards. What Do Faculty Say to Learners?

ERIC Educational Resources Information Center

Hasley, Peggy B.; Arnold, Robert M.

2009-01-01

No previous studies have described how faculty give summative evaluations to learners on the medical wards. The aim of this study was to describe summative evaluations on the medical wards. Participants were students, house staff and faculty at the University of Pittsburgh. Ward rotation evaluative sessions were tape recorded. Feedback was…

Atmospheric dispersion modelling over complex terrain at small scale

NASA Astrophysics Data System (ADS)

Nosek, S.; Janour, Z.; Kukacka, L.; Jurcakova, K.; Kellnerova, R.; Gulikova, E.

2014-03-01

Previous study concerned of qualitative modelling neutrally stratified flow over open-cut coal mine and important surrounding topography at meso-scale (1:9000) revealed an important area for quantitative modelling of atmospheric dispersion at small-scale (1:3300). The selected area includes a necessary part of the coal mine topography with respect to its future expansion and surrounding populated areas. At this small-scale simultaneous measurement of velocity components and concentrations in specified points of vertical and horizontal planes were performed by two-dimensional Laser Doppler Anemometry (LDA) and Fast-Response Flame Ionization Detector (FFID), respectively. The impact of the complex terrain on passive pollutant dispersion with respect to the prevailing wind direction was observed and the prediction of the air quality at populated areas is discussed. The measured data will be used for comparison with another model taking into account the future coal mine transformation. Thus, the impact of coal mine transformation on pollutant dispersion can be observed.

The effect of intermediate-scale motions on line formation. [sawtooth and sine motions in solar atmosphere

NASA Technical Reports Server (NTRS)

Shine, R. A.

1975-01-01

The problem of LTE and non-LTE line formation in the presence of nonthermal velocity fields with geometric scales between the microscopic and macroscopic limits is investigated in the cases of periodic sinusoidal and sawtooth waves. For a fixed source function (the LTE case), it is shown that time-averaged line profiles progress smoothly from the microscopic to the macroscopic limits as the geometric scale of the motions increases, that the sinusoidal motions produce symmetric time-averaged profiles, and that the sawtooth motions cause a redshift. In several idealized non-LTE cases, it is found that intermediate-scale velocity fields can significantly increase the surface source functions and line-core intensities. Calculations are made for a two-level atom in an isothermal atmosphere for a range of velocity scales and non-LTE coupling parameters and also for a two-level atom and a four-level representation of Na I line formation in the Harvard-Smithsonian Reference Atmosphere (1971) solar model. It is found that intermediate-scale velocity fields in the solar atmosphere could explain the central intensities of the Na I D lines and other strong absorption lines without invoking previously suggested high electron densities.

Doctor Ward's Accidental Terrarium.

ERIC Educational Resources Information Center

Hershey, David R.

1996-01-01

Presents the story of the accidental invention of the Wardian case, or terrarium, by Nathaniel Bagshaw Ward. Advocates the use of this story in teaching precollege biology as an illustration of how a chance event can lead to a major scientific advancement and as an example of the common occurrence of multiple discovery in botany. Contains 34…

Initialization of soil-water content in regional-scale atmospheric prediction models

NASA Technical Reports Server (NTRS)

Smith, Christopher B.; Lakhtakia, Mercedes; Capehart, William J.; Carlson, Toby N.

1994-01-01

The purpose of this study is to demonstrate the feasibility of determining the soil-water content fields required as initial conditions for land surface components within atmospheric prediction models. This is done using a model of the hydrologic balance and conventional meteorological observations, land cover, and soils information. A discussion is presented of the subgrid-scale effects, the integration time, and the choice of vegetation type on the soil-water content patterns. Finally, comparisons are made between two The Pennsylvania State University/National Center for Atmospheric Research mesoscale model simulations, one using climatological fields and the other one using the soil-moisture fields produced by this new method.

Correlation between levels of conflict and containment on acute psychiatric wards: the city-128 study.

PubMed

Bowers, Len; Stewart, Duncan; Papadopoulos, Chris; Iennaco, Joanne DeSanto

2013-05-01

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

Effects of ward rotation on subsequent transition processes of Japanese clinical nurses.

PubMed

Fujino, Mitsuku; Nojima, Yoshiko

2005-03-01

The purpose of this study was to examine the experience of Japanese clinical nurses undertaking a ward rotation in a general hospital, and its effects on subsequent processes relating to: (i) perception of ward rotation; (ii) reactions to the ward transition process; and (iii) outcomes of ward rotation. In-depth interviews were conducted with 21 Japanese clinical nurses who had an average of 8.8 years (SD = 5.50) clinical experience. Findings indicated that participants experienced role overload, role incongruity and/or role underload, role overqualification, or role ambiguity in the new environment. These role stresses created critical emotional distress during the transition process. The high desire for career development facilitated the transition process, while lack of preparation inhibited the transition process. To facilitate smooth transition, well-prepared and structured supports based on reliable interpersonal relationships are necessary. The findings offer significant cues for effective ward rotation programs. The implication for nursing administrators is that appropriate ward rotations enhance confidence and promote effective role development in the new clinical setting.

Martian Atmospheric Modeling of Scale Factors for MarsGRAM 2005 and the MAVEN Project

NASA Technical Reports Server (NTRS)

McCullough, Chris

2011-01-01

For spacecraft missions to Mars, especially the navigation of Martian orbiters and landers, an extensive knowledge of the Martian atmosphere is extremely important. The generally-accepted NASA standard for modeling (MarsGRAM), which was developed at Marshall Space Flight Center. MarsGRAM is useful for task such as aerobraking, performance analysis and operations planning for aerobraking, entry descent and landing, and aerocapture. Unfortunately, the densities for the Martian atmosphere in MarsGRAM are based on table look-up and not on an analytical algorithm. Also, these values can vary drastically from the densities actually experienced by the spacecraft. This does not have much of an impact on simple integrations but drastically affects its usefulness in other applications, especially those in navigation. For example, the navigation team for the Mars Atmosphere Volatile Environment (MAVEN) Project uses MarsGRAM to target the desired atmospheric density for the orbiter's pariapse passage, its closet approach to the planet. After the satellite's passage through pariapsis the computed density is compared to the MarsGRAM model and a scale factor is assigned to the model to account for the difference. Therefore, large variations in the atmosphere from the model can cause unexpected deviations from the spacecraft's planned trajectory. In order to account for this, an analytic stochastic model of the scale factor's behavior is desired. The development of this model will allow for the MAVEN navigation team to determine the probability of various Martian atmospheric variations and their effects on the spacecraft.

Predictors of length of stay in a ward for demented elderly: gender differences.

PubMed

Ono, Toshiyuki; Tamai, Akira; Takeuchi, Daisuke; Tamai, Yuzuru; Iseki, Hidenori; Fukushima, Hiromi; Kasahara, Sumie

2010-09-01

In our previous studies, we found both gender differences among care recipients and predictors that influenced outcomes after discharge from a ward for demented elderly. Here, we investigate predictors that influence the length of stay for each sex. We studied the data of 390 patients with dementia who were hospitalized in a ward for demented elderly between 1 April 2000 and 31 March 2008, and treated until 31 March 2009. The patients were divided into groups classified by gender. We analyzed the gender differences of characteristics and evaluated the predictors that influenced the length of stay in the ward for demented elderly using Cox's proportional hazards model. A model using the initial scores of the Revised Hasegawa Dementia Scale (HDS-R), Assessment Scale for Symptoms of Dementia (ASSD) and Nishimura's activity of daily living scale (N-ADL), which were examined on admission, was named Model 1. In Model 1, we checked the effect of each patient's characteristics, except for complications and destinations, on their length of stay. Model 2 used the final scores of HDS-R, ASSD and N-ADL including complications and destinations. There was a clear gender difference in the length of stay. The length of stay of women was longer than that of men. It was difficult to predict the length of stay in Model 1. Age was the only predictor in women and no predictor was identified in men. In Model 2, complications and the final HDS-R and N-ADL scores were predictors of the length of stay in men. Age, complications and destinations were predictors of the length of stay in women. It was observed that there were gender differences among predictors of the length of stay. However, it was difficult to predict the length of stay on admission. Retrospectively, the length of stay was determined by physical and psychological conditions, not by the social variables in men. In women, it was supposed that the caregiver's wish to give care at home reduced the length of stay. Besides

Identifying the scale-dependent motifs in atmospheric surface layer by ordinal pattern analysis

NASA Astrophysics Data System (ADS)

Li, Qinglei; Fu, Zuntao

2018-07-01

Ramp-like structures in various atmospheric surface layer time series have been long studied, but the presence of motifs with the finer scale embedded within larger scale ramp-like structures has largely been overlooked in the reported literature. Here a novel, objective and well-adapted methodology, the ordinal pattern analysis, is adopted to study the finer-scaled motifs in atmospheric boundary-layer (ABL) time series. The studies show that the motifs represented by different ordinal patterns take clustering properties and 6 dominated motifs out of the whole 24 motifs account for about 45% of the time series under particular scales, which indicates the higher contribution of motifs with the finer scale to the series. Further studies indicate that motif statistics are similar for both stable conditions and unstable conditions at larger scales, but large discrepancies are found at smaller scales, and the frequencies of motifs "1234" and/or "4321" are a bit higher under stable conditions than unstable conditions. Under stable conditions, there are great changes for the occurrence frequencies of motifs "1234" and "4321", where the occurrence frequencies of motif "1234" decrease from nearly 24% to 4.5% with the scale factor increasing, and the occurrence frequencies of motif "4321" change nonlinearly with the scale increasing. These great differences of dominated motifs change with scale can be taken as an indicator to quantify the flow structure changes under different stability conditions, and motif entropy can be defined just by only 6 dominated motifs to quantify this time-scale independent property of the motifs. All these results suggest that the defined scale of motifs with the finer scale should be carefully taken into consideration in the interpretation of turbulence coherent structures.

Nurses caring for ENT patients in a district general hospital without a dedicated ENT ward score significantly less in a test of knowledge than nurses caring for ENT patients in a dedicated ENT ward in a comparable district general hospital.

PubMed

Foxton, C R; Black, D; Muhlschlegel, J; Jardine, A

2014-12-01

To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training. © 2014 John Wiley & Sons Ltd.

Quantifying expert consensus against the existence of a secret, large-scale atmospheric spraying program

NASA Astrophysics Data System (ADS)

Shearer, Christine; West, Mick; Caldeira, Ken; Davis, Steven J.

2016-08-01

Nearly 17% of people in an international survey said they believed the existence of a secret large-scale atmospheric program (SLAP) to be true or partly true. SLAP is commonly referred to as ‘chemtrails’ or ‘covert geoengineering’, and has led to a number of websites purported to show evidence of widespread chemical spraying linked to negative impacts on human health and the environment. To address these claims, we surveyed two groups of experts—atmospheric chemists with expertize in condensation trails and geochemists working on atmospheric deposition of dust and pollution—to scientifically evaluate for the first time the claims of SLAP theorists. Results show that 76 of the 77 scientists (98.7%) that took part in this study said they had not encountered evidence of a SLAP, and that the data cited as evidence could be explained through other factors, including well-understood physics and chemistry associated with aircraft contrails and atmospheric aerosols. Our goal is not to sway those already convinced that there is a secret, large-scale spraying program—who often reject counter-evidence as further proof of their theories—but rather to establish a source of objective science that can inform public discourse.

Leadership support for ward managers in acute mental health inpatient settings.

PubMed

Bonner, Gwen; McLaughlin, Sue

2014-05-01

This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

Parameterization and scaling of arctic ice conditions in the context of ice-atmospheric processes

NASA Technical Reports Server (NTRS)

Barry, R. G.; Steffen, K.; Heinrichs, J. F.; Key, J. R.; Maslanik, J. A.; Serreze, M. C.; Weaver, R. L.

1995-01-01

The goals of this project are to observe how the open water/thin ice fraction in a high-concentration ice pack responds to different short-period atmospheric forcings, and how this response is represented in different scales of observation. The objectives can be summarized as follows: determine the feasibility and accuracy of ice concentration and ice typing by ERS-1 SAR backscatter data, and whether SAR data might be used to calibrate concentration estimates from optical and massive-microwave sensors; investigate methods to integrate SAR data with other satellite data for turbulent heat flux parameterization at the ocean/atmosphere interface; determine how the development and evolution of open water/thin ice areas within the interior ice pack vary under different atmospheric synoptic regimes; compare how open-water/thin ice fractions estimated from large-area divergence measurements differ from fractions determined by summing localized openings in the pack; relate these questions of scale and process to methods of observation, modeling, and averaging over time and space.

REVIEWS OF TOPICAL PROBLEMS: Generation of large-scale eddies and zonal winds in planetary atmospheres

NASA Astrophysics Data System (ADS)

Onishchenko, O. G.; Pokhotelov, O. A.; Astafieva, N. M.

2008-06-01

The review deals with a theoretical description of the generation of zonal winds and vortices in a turbulent barotropic atmosphere. These large-scale structures largely determine the dynamics and transport processes in planetary atmospheres. The role of nonlinear effects on the formation of mesoscale vortical structures (cyclones and anticyclones) is examined. A new mechanism for zonal wind generation in planetary atmospheres is discussed. It is based on the parametric generation of convective cells by finite-amplitude Rossby waves. Weakly turbulent spectra of Rossby waves are considered. The theoretical results are compared to the results of satellite microwave monitoring of the Earth's atmosphere.

Benefits of automated surface decontamination of a radioiodine ward.

PubMed

Westcott, Eliza; Broadhurst, Alicia; Crossley, Steven; Lee, Lloyd; Phan, Xuyen; Scharli, Rainer; Xu, Yan

2012-02-01

A floor-washing robot has been acquired to assist physicists with decontamination of radioiodine therapy ward rooms after discharge of the patient at Sir Charles Gairdner Hospital. The effectiveness of the robot in decontaminating the ward has been evaluated. A controlled experiment was performed by deliberately contaminating a polyvinyl chloride flooring offcut with 131I followed by automated decontamination with the robot. The extent of fixed and removable contamination was assessed before and after decontamination by two methods: (1) direct Geiger-Mueller counting and (2) beta-counting wipe tests. Surface contamination was also assessed in situ on the ward by Geiger-Mueller counting and wipe testing. Contamination maps confirmed that contamination was removed rather than spread around by the robot. Wipe testing revealed that the robot was successful in clearing approximately 60-80% of removable contamination. The robotic floor-washing device was considered suitable to provide effective automated decontamination of the radioiodine ward. In addition, the robot affords other benefits: the time spent by the physicists decontaminating the room is greatly reduced offering financial and occupational safety and health benefits. The robot has also found utility in other decontamination applications in the healthcare environment.

Application of curative therapy in the ward. 1920.

PubMed

Marble, Henry Chase

2009-06-01

This Classic article is a reprint of the original work by Henry Chase Marble, Application of Curative Therapy in the Ward. An accompanying biographical sketch on Henry Chase Marble, MD, is available at DOI 10.1007/s11999-009-0789-7 . The Classic Article is (c)1920 by the Journal of Bone and Joint Surgery, Inc. and is reprinted with permission from Marble HC. Application of curative therapy in the ward. J Bone Joint Surg Am. 1920;2:136-138.

18. View looking NE up corridor showing Wards Island Viaduct ...

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

18. View looking NE up corridor showing Wards Island Viaduct in foreground and Randalls Island Viaduct in background. Wards Island, New York Co., NY. Sec. 4207, MP 8.02. - Northeast Railroad Corridor, Amtrak Route between New Jersey/New York & New York/Connecticut State Lines, New York County, NY

Occupational exposure to cytotoxic drugs in two UK oncology wards

PubMed Central

Ziegler, E; Mason, H; Baxter, P

2002-01-01

Aims: To investigate the potential exposure to cytotoxic drugs of staff on two oncology wards in a large district, UK hospital under normal working conditions. Methods: Cytotoxic drug exposure was monitored in urine samples, surface wipes, and on disposable gloves by using a number of commonly used marker drugs, namely cyclophosphamide, ifosfamide, methotrexate, and the platino coordinated drugs. Questionnaire data on their work practices, potential exposure, use of protective personal equipment, and relevant training were collected from nursing, domestic, and clerical staff on two oncology wards. Results: The majority of staff were female with a mean age of 31 years. Roughly half of the staff studied were specifically trained nurses with an average of 3.5 years experience of administering cytotoxic drugs. No cytotoxic drug preparation or reconstitution was carried out on the wards. Disposable gloves, plastic armlets and aprons, but not eye protection, were invariably worn where there was potential exposure to cytotoxics. No cytotoxic drug was detected in any of the staff's urine samples. Isolated disposable latex gloves from nurses administering drugs showed some contamination, as did some surfaces within the wards' sluice rooms, but not in the ward areas where the drugs were stored and checked prior to administration. Conclusions: The risk management strategies in place, including use of personal protective equipment, staff training, and other organisational measures, have ensured that internal exposure is lower than the detection limits for the current biological monitoring methods. Levels of contamination appear significantly lower than earlier, non-UK published studies where different risk management strategies were in place and, in particular, ward staff may have been involved in some degree of cytotoxic drug reconstitution. PMID:12205233

Lidar Measurements of Atmospheric CO2 From Regional to Global Scales

NASA Technical Reports Server (NTRS)

Lin, Bing; Harrison, F. Wallace; Nehrir, Amin; Browell, Edward; Dobler, Jeremy; Campbell, Joel; Meadows, Byron; Obland, Michael; Ismail, Syed; Kooi, Susan;

Nurse Satisfaction and Burnout in Shanghai Neurology Wards.

PubMed

Jiang, Hui; Li, Chen; Gu, Yan; Lu, Haiyan

2016-01-01

To explore satisfaction and burnout of nurses working in neurology wards in Shanghai, China. A descriptive cross-sectional questionnaire survey. Three hundred and eighty-seven nurses from 23 neurology wards in 21 tertiary general hospitals were recruited using cluster sampling. The valid response rate was 94.83%. Nurse satisfaction with the salary/wages, the job and the nurse staffing level were 21.79%, 37.33%, and 40.87%. A high nurse burnout rate was found as: emotional exhaustion (EE) ≥ 27 (89.92%); depersonalization (DP) ≥ 10 (92.64%); and reduced personal accomplishment (PA)≤ 33 (79.29%). Most nurses in the neurology wards were dissatisfied and had high levels of burnout. Experienced, intermediate and senior nurses were at the highest risk for job turnover. Nurse administrators should take effective measures to increase nurse satisfaction and decrease burnout to retain experienced nurses and keep the stability of nursing workforce. © 2014 Association of Rehabilitation Nurses.

Service audit of a forensic rehabilitation ward.

PubMed

Young, Susan; Gudjonsson, Gisli H; Needham-Bennett, Humphrey; Chick, Kay

2009-10-01

An open forensic rehabilitation ward provides an important link bridging the gap between secure and community provisions. This paper provides an audit of such a service by examining the records of an open forensic rehabilitation ward over a five-year period from 1 June 2000 until 31 May 2005. During the audit period there were 51 admissions, involving 45 different patients, and 50 discharges. The majority of the patients came from secure unit facilities, acute psychiatric wards or home. Thirty-nine patients were discharged either into hostels (66%) or their home (12%). The majority of patients (80%) had on admission a primary diagnosis of either schizophrenia or schizoaffective disorder. Most had an extensive forensic history. The focus of their admission was to assess and treat their mental illness/disorder and offending behaviour and this was successful as the majority of patients were transferred to a community placement after a mean of 15 months. It is essential that there is a well-integrated care pathway for forensic patients, involving constructive liaison with generic services and a well-structured treatment programme which integrates the key principles of the 'recovery model' approach to care.

[Airborne Fungal Aerosol Concentration and Distribution Characteristics in Air- Conditioned Wards].

PubMed

Zhang, Hua-ling; Feng, He-hua; Fang, Zi-liang; Wang, Ben-dong; Li, Dan

2015-04-01

The effects of airborne fungus on human health in the hospital environment are related to not only their genera and concentrations, but also their particle sizes and distribution characteristics. Moreover, the mechanisms of aerosols with different particle sizes on human health are different. Fungal samples were obtained in medicine wards of Chongqing using a six-stage sampler. The airborne fungal concentrations, genera and size distributions of all the sampling wards were investigated and identified in detail. Results showed that airborne fungal concentrations were not correlated to the diseases or personnel density, but were related to seasons, temperature, and relative humidity. The size distribution rule had roughly the same for testing wards in winter and summer. The size distributions were not related with diseases and seasons, the percentage of airborne fungal concentrations increased gradually from stage I to stage III, and then decreased dramatically from stage V to stage VI, in general, the size of airborne fungi was a normal distribution. There was no markedly difference for median diameter of airborne fungi which was less 3.19 μm in these wards. There were similar dominant genera in all wards. They were Aspergillus spp, Penicillium spp and Alternaria spp. Therefore, attention should be paid to improve the filtration efficiency of particle size of 1.1-4.7 μm for air conditioning system of wards. It also should be targeted to choose appropriate antibacterial methods and equipment for daily hygiene and air conditioning system operation management.

Large scale atmospheric waves in the Venus mesosphere as seen by the VeRa Radio Science instrument on Venus Express

NASA Astrophysics Data System (ADS)

Tellmann, S.; Häusler, B.; Hinson, D. P.; Tyler, G. L.; Andert, T. P.; Bird, M. K.; Imamura, T.; Pätzold, M.; Remus, S.

2014-04-01

Atmospheric waves on almost all spatial scales have been observed in the Venus atmosphere in various atmospheric regions. They play a crucial role in the redistribution of energy, momentum, and atmospheric constituent and are thought to be involved in the development and maintenance of the atmospheric superrotation.

Radiosonde observational evidence of the influence of extreme SST gradient upon atmospheric meso-scale circulation

NASA Astrophysics Data System (ADS)

Nishikawa, H.; Tachibana, Y.; Udagawa, Y.

2012-12-01

Although the influence of the anomalous midlatitude SST upon atmospheric local circulation has been getting common in particular over the Kuroshio and the Gulf Stream regions, observational studies on the influence of the Okhotsk Sea, which is to the north of the Kuroshio, upon the atmospheric local circulation is much less than those of the Kuroshio. The climate of the Okhotsk SST is very peculiar. Extremely cold SST spots, whose summertime SST is lower than 5 Celsius degrees, are formed around Kuril Islands. Because SSTs are generally determined by local air-sea interaction as well as temperature advection, it is very difficult to isolate only the oceanic influence upon the atmosphere. The SST in this cold spot is, however, dominated by the tidal mixing, which is independent of the atmospheric processes. This unique condition may ease the account for the oceanic influence only. Although the SST environment of the Okhotsk Sea is good for understanding the oceanic influence upon the atmosphere, only a few studies has been executed in this region because of the difficulty of observations by research vessels in this region, where territory problems between Japan and Russia is unsolved. Because of the scant of direct observation, the Okhotsk Sea was still mysterious. In 2006 August, GPS radiosonde observation was carried out by Russian research vessel Khromov in the Sea of Okhotsk by the cooperation between Japan and Russia, and strong SST gradient of about 7 Celsius degrees/10km was observed around the Kuril Islands. The purpose of this study is to demonstrate observational finding of meso-scale atmospheric anticyclonic circulation influenced by the cold oceanic spot around the Kuril Island. The summaries of the observation are as follows. Meso-scale atmospheric ageostrophic anticyclonic circulation in the atmospheric marine-boundary layer is observed in and around the cold spot. A high air pressure area as compared with other surrounding areas is also located at the

Current and future levels of mercury atmospheric pollution on a global scale

NASA Astrophysics Data System (ADS)

Pacyna, Jozef M.; Travnikov, Oleg; De Simone, Francesco; Hedgecock, Ian M.; Sundseth, Kyrre; Pacyna, Elisabeth G.; Steenhuisen, Frits; Pirrone, Nicola; Munthe, John; Kindbom, Karin

2016-10-01

An assessment of current and future emissions, air concentrations, and atmospheric deposition of mercury worldwide is presented on the basis of results obtained during the performance of the EU GMOS (Global Mercury Observation System) project. Emission estimates for mercury were prepared with the main goal of applying them in models to assess current (2013) and future (2035) air concentrations and atmospheric deposition of this contaminant. The combustion of fossil fuels (mainly coal) for energy and heat production in power plants and in industrial and residential boilers, as well as artisanal and small-scale gold mining, is one of the major anthropogenic sources of Hg emissions to the atmosphere at present. These sources account for about 37 and 25 % of the total anthropogenic Hg emissions globally, estimated to be about 2000 t. Emissions in Asian countries, particularly in China and India, dominate the total emissions of Hg. The current estimates of mercury emissions from natural processes (primary mercury emissions and re-emissions), including mercury depletion events, were estimated to be 5207 t year-1, which represents nearly 70 % of the global mercury emission budget. Oceans are the most important sources (36 %), followed by biomass burning (9 %). A comparison of the 2035 anthropogenic emissions estimated for three different scenarios with current anthropogenic emissions indicates a reduction of these emissions in 2035 up to 85 % for the best-case scenario. Two global chemical transport models (GLEMOS and ECHMERIT) have been used for the evaluation of future mercury pollution levels considering future emission scenarios. Projections of future changes in mercury deposition on a global scale simulated by these models for three anthropogenic emissions scenarios of 2035 indicate a decrease in up to 50 % deposition in the Northern Hemisphere and up to 35 % in Southern Hemisphere for the best-case scenario. The EU GMOS project has proved to be a very important

A holistic approach to ward design.

PubMed

Mozaffar, Farhang; Jamaleddin, Seyyed; Khakzand, Mehdi

2009-06-01

Three Iranian academics examine how existing experience in inpatient and other ward design can be harnessed to ensure the creation of comfortable, relaxing and, as far as is possible, individually "tailored" hospital accommodation in the future.

Information Needs Assessment for a Medicine Ward-Focused Rounding Dashboard.

PubMed

Aakre, Christopher A; Chaudhry, Rajeev; Pickering, Brian W; Herasevich, Vitaly

2016-08-01

To identify the routine information needs of inpatient clinicians on the general wards for the development of an electronic dashboard. Survey of internal medicine and subspecialty clinicians from March 2014-July 2014 at Saint Marys Hospital in Rochester, Minnesota. An information needs assessment was generated from all unique data elements extracted from all handoff and rounding tools used by clinicians in our ICUs and general wards. An electronic survey was distributed to 104 inpatient medical providers. 89 unique data elements were identified from currently utilized handoff and rounding instruments. All data elements were present in our multipurpose ICU-based dashboard. 42 of 104 (40 %) surveys were returned. Data elements important (50/89, 56 %) and unimportant (24/89, 27 %) for routine use were identified. No significant differences in data element ranking were observed between supervisory and nonsupervisory roles. The routine information needs of general ward clinicians are a subset of data elements used routinely by ICU clinicians. Our findings suggest an electronic dashboard could be adapted from the critical care setting to the general wards with minimal modification.

An outbreak of Burkholderia stabilis colonization in a nasal ward.

PubMed

Wang, Lijun; Wang, Mei; Zhang, Junyi; Wu, Wei; Lu, Yuan; Fan, Yanyan

2015-04-01

The aim of this study was to describe an outbreak of Burkholderia stabilis colonization among patients in a nasal ward. Multilocus sequence typing (MLST) was used for the molecular typing of B. stabilis isolates. Microbiological records were reviewed to delineate the colonization outbreak period. One hundred seventy-one cultures of environment and equipment samples from the nasal ward were performed to trace the source of contamination. Infection control measures were taken in order to end the outbreak. All B. stabilis isolates were identified as a new MLST type, ST821. A total of 53 patients carried this B. stabilis in the nasal ward between March and September 2013, which was defined as the outbreak period. The source of the colonization was not determined because all environment cultures were negative for Burkholderia cepacia complex. No further B. stabilis carriers have been found in the ward since the implementation of interventions. Attention must be paid to asymptomatic colonization in order to identify outbreaks early. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Ward Identity and Scattering Amplitudes for Nonlinear Sigma Models

NASA Astrophysics Data System (ADS)

Low, Ian; Yin, Zhewei

2018-02-01

We present a Ward identity for nonlinear sigma models using generalized nonlinear shift symmetries, without introducing current algebra or coset space. The Ward identity constrains correlation functions of the sigma model such that the Adler's zero is guaranteed for S -matrix elements, and gives rise to a subleading single soft theorem that is valid at the quantum level and to all orders in the Goldstone decay constant. For tree amplitudes, the Ward identity leads to a novel Berends-Giele recursion relation as well as an explicit form of the subleading single soft factor. Furthermore, interactions of the cubic biadjoint scalar theory associated with the single soft limit, which was previously discovered using the Cachazo-He-Yuan representation of tree amplitudes, can be seen to emerge from matrix elements of conserved currents corresponding to the generalized shift symmetry.

Creating Readers: Vonda Ward--Broward County Library, Fort Lauderdale, FL

ERIC Educational Resources Information Center

Library Journal, 2004

2004-01-01

This article details the work of Vonda Ward--a middle-school teacher turned librarian. When Vonda Ward was a middle-school teacher, she could not get her students to share her excitement about history because they could not read its stories. That is when she realized how much subject mastery depended on the basics. Broward County Library's leaders…

Iranian nurses' experiences of aggression in psychiatric wards: a qualitative study.

PubMed

Moghadam, Malek Fereidooni; Pazargadi, Mehrnoosh; Khoshknab, Masoud Fallahi

2013-10-01

Aggression from psychiatric patients is a constant problem for care providers that causes major problems in the therapeutic environment, and may have negative effects on the quality of care. Since recognition of aggression with regard to cultural background leads to better control of aggression in the psychiatric wards, this study has been done to clarify Iranian nurses' experiences of aggression in psychiatric wards. A qualitative content analysis study was conducted to explore experiences of nurses. Data analysis revealed four themes: (1) Damage resulting from aggression, (2) Aggression catalysts, (3) Contagious nature of aggression, and (4) Various control strategies. There are various causes for in-patients' aggression, and nurses use various approaches to control it. These approaches are influenced by personnel, facilities, and ward environment. Identifying these factors and strategies can contribute to better management of aggression and, thus, better quality of care in psychiatric wards.

Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh.

PubMed

Zaman, Shahaduz

2004-11-01

An ethnographic exploration was done in an orthopaedic ward of a government teaching hospital in Bangladesh to understand the nature of hospital culture in the context of Bangladeshi society at large. Life and work in the ward result in a culture that is simultaneously created by its inhabitants and the conditions in which they are situated. The study shows that biomedicine is a product of particular social conditions and that the hospital reflects features of its society. Behind the injuries and broken limbs in the ward are stories of violence, crime, and intolerance occurring in a society where masses of people fight over limited resources. In the ward people interact in an extremely hierarchical manner. The patients, who are mainly from poor economic backgrounds, remain at the bottom of the hierarchy. Doctors and other staff members are often professionally frustrated. Strikes related to hospital staff's various professional demands hamper the regular flow of work in the ward. Family members are engaged in nursing and provide various kinds of support to their hospitalized relatives. Patients give small bribes to ward boys and cleaners to obtain their day-to-day necessities. Patients joke with each other and mock senior doctors. Thus, they neutralize their powerlessness and drive away the monotony of their stay. Doctors develop 'indigenous' solutions to orthopaedic problems. Instead of using high-tech devices, they employ instruments made of bamboo, bricks, and razor blades. This study shows how medical practice takes shape in an understaffed, under-resourced and poorly financed hospital operating in a low-income country.

Improving clinical handover in a paediatric ward: implications for nursing management.

PubMed

Mannix, Trudi; Parry, Yvonne; Roderick, Allison

2017-04-01

To describe how nursing staff in a paediatric ward improved the conduct of clinical handover, using a practise development approach. ISBAR (Identify, Situation, Background, Assessment and Recommendation) is a mnemonic tool to aid the safe transfer of patient information in clinical handover. The nurses identified the need to improve the use of ISBAR, and other issues related to handover that could compromise patient safety and constrain family-centred care. Sixty-one percent of nurses on the ward contributed to issue identification and the design of the educational material, including a set of written and video resources and incorporating the role of a handover coach. Staff performance was evaluated before and after access to the resources using self-administered Likert scales, observation and a focus group. After the intervention, there was a stronger relationship between the participants' understanding of ISBAR and their application of it in handover. Further, there were statistically significant increases in improved handover practises, including family inclusion and safety checks. A practise development approach is useful in the provision of education to guide clinical performance in patient handover. Nurse managers can use this approach to empower their staff to make positive changes to practise. © 2017 John Wiley & Sons Ltd.

Simulation of large scale motions and small scale structures in planetary atmospheres and oceans: From laboratory to space experiments on ISS

NASA Astrophysics Data System (ADS)

Egbers, Christoph; Futterer, Birgit; Zaussinger, Florian; Harlander, Uwe

2014-05-01

Baroclinic waves are responsible for the transport of heat and momentum in the oceans, in the Earth's atmosphere as well as in other planetary atmospheres. The talk will give an overview on possibilities to simulate such large scale as well as co-existing small scale structures with the help of well defined laboratory experiments like the baroclinic wave tank (annulus experiment). The analogy between the Earth's atmosphere and the rotating cylindrical annulus experiment only driven by rotation and differential heating between polar and equatorial regions is obvious. From the Gulf stream single vortices seperate from time to time. The same dynamics and the co-existence of small and large scale structures and their separation can be also observed in laboratory experiments as in the rotating cylindrical annulus experiment. This experiment represents the mid latitude dynamics quite well and is part as a central reference experiment in the German-wide DFG priority research programme ("METSTRÖM", SPP 1276) yielding as a benchmark for lot of different numerical methods. On the other hand, those laboratory experiments in cylindrical geometry are limited due to the fact, that the surface and real interaction between polar and equatorial region and their different dynamics can not be really studied. Therefore, I demonstrate how to use the very successful Geoflow I and Geoflow II space experiment hardware on ISS with future modifications for simulations of small and large scale planetary atmospheric motion in spherical geometry with differential heating between inner and outer spheres as well as between the polar and equatorial regions. References: Harlander, U., Wenzel, J., Wang, Y., Alexandrov, K. & Egbers, Ch., 2012, Simultaneous PIV- and thermography measurements of partially blocked flow in a heated rotating annulus, Exp. in Fluids, 52 (4), 1077-1087 Futterer, B., Krebs, A., Plesa, A.-C., Zaussinger, F., Hollerbach, R., Breuer, D. & Egbers, Ch., 2013, Sheet-like and

78 FR 14543 - Ward Transformer Superfund Site; Raleigh, Wake County, NC; Notice of Settlement

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

... ENVIRONMENTAL PROTECTION AGENCY [FRL 9788-2; CERCLA-04-2013-3754] Ward Transformer Superfund Site... Ward Transformer Superfund Site located in Raleigh, Wake County, North Carolina. Under the terms of the.... Submit your comments by Site name Ward Transformer Superfund Site by one of the following methods: [[Page...

The impact on the workload of the Ward Manager with the introduction of administrative assistants.

PubMed

Locke, Rachel; Leach, Camilla; Kitsell, Fleur; Griffith, Jacki

2011-03-01

To evaluate the impact on the workload of the Ward Manager (WM) with the introduction of administrative assistants into eight trusts in the South of England in a year-long pilot. Ward Managers are nurse leaders who are responsible for ward management and delivering expert clinical care to patients. They have traditionally been expected to achieve this role without administrative assistance. Meeting the workload demands of multiple roles and overload has meant the leadership and clinical role has suffered, presenting issues of low morale among existing WMs and issues of recruiting the next generation of WMs. Sixty qualitative interviews were carried out with 16 WMs, 12 Ward Manager Assistants (WMAs), and six senior nurse executives about the impact of the introduction of the WMA post. Quantitative data to measure change in WM workload and ward activity was supplied by 24 wards. Ward Managers reported spending reduced time on administrative tasks and having increased time available to spend on the ward with patients and leading staff. With the introduction of WMAs, there was also improvement in key performance measures (the maintenance of quality under service pressures) and increased staff motivation. There was overwhelming support for the introduction of administrative assistants from participating WMs. The WMAs enabled WMs to spend more time with patients and, more widely, to provide greater support to ward teams. The success of the pilot is reflected in wards working hard to be able to extend contracts of WMAs. The extent of the success is reflected in wards that were not participants in the pilot, observing the benefits of the post, having worked to secure funding to recruit their own WMAs. The widespread introduction of administrative assistance could increase ward productivity and provide support for clinical leaders. Continuing professional development for WMs needs to incorporate training about management responsibilities and how to best use administrative

The locked psychiatric ward: hotel or detention camp for people with dual diagnosis.

PubMed

Terkelsen, Toril Borch; Larsen, Inger Beate

2013-10-01

The concepts of autonomy and liberty are established goals in mental health care; however, involuntary commitment is used towards people with mental health and substance abuse problems (dual diagnosis). To explore how patients and staff act in the context of involuntary commitment, how interactions are described and how they might be interpreted. Ethnographic methodology in a locked psychiatric ward in Norway. Two parallel images emerged: (a) The ward as a hotel. Several patients wanted a locked ward for rest and safety, even when admission was classified as involuntary. The staff was concerned about using the ward for real treatment of motivated people, rather than merely as a comfortable hotel for the unmotivated. (b) The ward as a detention camp. Other patients found involuntary commitment and restrictions in the ward as a kind of punishment, offending them as individuals. Contrary, the staff understood people with dual diagnoses more like a generalized group in need of their control and care. Patients and staff have different perceptions of involuntary commitment. Based on the patients' points of view, mental health care ought to be characterized by inclusion and recognition, treating patients as equal citizens comparable to guests in a hotel.

Multi-Scale Observation and Modelling of Energy and Matter Exchange in the Atmospheric Boundary-Layer (ScaleX Campaigns)

NASA Astrophysics Data System (ADS)

Zeeman, M. J.; Wolz, K.; Adler, B.; Brenner, C.; De Roo, F.; Emeis, S.; Kalthoff, N.; Mauder, M.; Schäfer, K.; Wohlfahrt, G.; Zhao, P.

2016-12-01

We investigated biosphere-atmosphere exchange processes in relation to the atmospheric boundary-layer (ABL) flow in a shallow valley. Land-use heterogeneity and topography can force local atmospheric flow patterns, including local circulations. Such flow patterns can impair current techniques for the quantification and source attribution of surface-exchange fluxes due to flux-divergence, advection and decoupling. Wind field, temperature and humidity structures in the ABL were observed in high resolution with spatially distributed observations in a 1 km3 experimental domain. Remote-sensing observations of wind, temperature and particles in the ABL (Raman-lidar; RASS; ceilometer; microwave radiometer; 3D Doppler-lidar) were combined with a high-resolution network of in-situ observations that included vertical and horizontal profiles of wind, temperature, carbon dioxide, methane and water vapor concentrations. The experiments were co-located with the long-term eddy covariance (EC) observatory Fendt (DE-Fen; ICOS, TERENO) and were part of international cooperative efforts in 2015 and 2016 (the ScaleX campaigns). The gathered experimental data offers a scale-transcending insight in local flow patterns in mountainous terrain and their influence on surface-exchange fluxes of energy and matter as observed by EC and flux-gradient methodology. In addition, the data is used for validation of Large-Eddy Simulations in complex terrain using PALM-LES. Within this modelling framework, virtual measurements are conducted to further assess the importance of three-dimensional advective and horizontal turbulent transport terms.

Spatial correlation of atmospheric wind at scales relevant for large scale wind turbines

NASA Astrophysics Data System (ADS)

Bardal, L. M.; Sætran, L. R.

2016-09-01

Wind measurements a short distance upstream of a wind turbine can provide input for a feedforward wind turbine controller. Since the turbulent wind field will be different at the point/plane of measurement and the rotor plane the degree of correlation between wind speed at two points in space both in the longitudinal and lateral direction should be evaluated. This study uses a 2D array of mast mounted anemometers to evaluate cross-correlation of longitudinal wind speed. The degree of correlation is found to increase with height and decrease with atmospheric stability. The correlation is furthermore considerably larger for longitudinal separation than for lateral separation. The integral length scale of turbulence is also considered.

75 FR 81269 - Ward Transformer Superfund Site Raleigh, Wake County, NC; Notice of Settlements

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... ENVIRONMENTAL PROTECTION AGENCY [Docket EPA-RO4-SFUND-2010-1053, FRL-9243-2] Ward Transformer... entered into a five settlements for reimbursement of past response costs concerning the Ward Transformer... Docket ID No. EPA-RO4- SFUND-2010-1053 or Site name Ward Transformer Superfund Site by one of the...

[Comparison of Aggressive Behavior, Compulsory Medication and Absconding Behavior Between Open and Closed door Policy in an Acute Psychiatric Ward].

PubMed

Cibis, Mara-Lena; Wackerhagen, Carolin; Müller, Sabine; Lang, Undine E; Schmidt, Yvonne; Heinz, Andreas

2017-04-01

Objective According to legal requirements coercive treatment must be limited to acts necessary for the protection of patients and cannot be used for institutional interests. Here, we aimed to test the hypothesis that opening psychiatric wards can reduce the number of aggressive assaults and of coercive treatment without increasing absconding rates. Methods Numbers of absconding, coercive medication, fixation and special security actions were collected retrospectively and compared between phases of closed (N total = 409; N legally committed = 64) and 90 % of daytime opened (N total = 571; N legally committed = 99) doors in an acute psychiatric ward. Results During the phase of opened doors we observed significantly reduced aggressive assaults (p < 0,001) and coercive medication (p = 0,006) compared to the closed setting, while the absconding rate did not change (p = 0,20). Limitation Given the retrospective non-experimental design, no causal interpretations can be drawn. Conclusion The results suggest that open door is associated with reduction of aggressive assaults and coercive medication without increasing absconding rates. This speaks for a stronger implementation of open door policies in acute wards in order to preserve human rights in psychiatry. To collect more robust evidence for this thesis, longer phases should be monitored and moderating variables such as atmosphere and social cohesion should be assessed. © Georg Thieme Verlag KG Stuttgart · New York.

Does time of transfer from critical care to the general wards affect anxiety? A pragmatic prospective cohort study.

PubMed

McCairn, Amanda J; Jones, Christina

2014-08-01

To examine prospectively the impact of transfer time on patient anxiety. A pragmatic prospective cohort study. 14 bed adult intensive care unit (ICU) in a National Health Service teaching hospital trust in the United Kingdom. Critically ill patients staying on the ICU for at least 24 hours and clinically ready for transfer to the general ward completed the Hospital Anxiety and Depression Scale questionnaire (Zigmond and Snaith, 1983) at: pre-transfer - on the critical care (when they were clinically ready for transfer to the general ward), post-transfer - on the general ward. The post-transfer median (range) score for anxiety was 6 (4-10) for day time and higher at 12.5 (9-16) for night time; this was found to be statistically significant U=80, p=0.011, r=0.37 and the post-transfer incidence of anxiety cases was 22% (8/36) for day time and higher at 64% (7/11) for night time; this was found to be statistically significant U=91, p=0.007, r=0.39. This study suggests that transfers at night time are more anxiety provoking for patients than transfers in the day time. Copyright © 2014 Elsevier Ltd. All rights reserved.

Light-front Ward-Takahashi identity for two-fermion systems

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

Marinho, J. A. O.; Frederico, T.; Pace, E.

We propose a three-dimensional electromagnetic current operator within light-front dynamics that satisfies a light-front Ward-Takahashi identity for two-fermion systems. The light-front current operator is obtained by a quasipotential reduction of the four-dimensional current operator and acts on the light-front valence component of bound or scattering states. A relation between the light-front valence wave function and the four-dimensional Bethe-Salpeter amplitude both for bound or scattering states is also derived, such that the matrix elements of the four-dimensional current operator can be fully recovered from the corresponding light-front ones. The light-front current operator can be perturbatively calculated through a quasipotential expansion, andmore » the divergence of the proposed current satisfies a Ward-Takahashi identity at any given order of the expansion. In the quasipotential expansion the instantaneous terms of the fermion propagator are accounted for by the effective interaction and two-body currents. We exemplify our theoretical construction in the Yukawa model in the ladder approximation, investigating in detail the current operator at the lowest nontrivial order of the quasipotential expansion of the Bethe-Salpeter equation. The explicit realization of the light-front form of the Ward-Takahashi identity is verified. We also show the relevance of instantaneous terms and of the pair contribution to the two-body current and the Ward-Takahashi identity.« less

Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study

PubMed Central

Taylor, Natalie; Kellar, Ian; Pye, Victoria; Mohammed, Mohammed A; Lawton, Rebecca

2018-01-01

Objective The positive deviance approach seeks to identify and learn from exceptional performers. Although a framework exists to apply positive deviance within healthcare organisations, there is limited guidance to support its implementation. The approach has also rarely explored exceptional performance on broad outcomes, been implemented at ward level, or applied within the UK. This study develops and critically appraises a pragmatic method for identifying positively deviant wards using a routinely collected, broad measure of patient safety. Design A two-phased observational study was conducted. During phase 1, cross-sectional and temporal analyses of Safety Thermometer data were conducted to identify a discrete group of positively deviant wards that consistently demonstrated exceptional levels of safety. A group of matched comparison wards with above average performances were also identified. During phase 2, multidisciplinary staff and patients on the positively deviant and comparison wards completed surveys to explore whether their perceptions of safety supported the identification of positively deviant wards. Setting 34 elderly medical wards within a northern region of England, UK. Participants Multidisciplinary staff (n=161) and patients (n=188) clustered within nine positively deviant and comparison wards. Results Phase 1: A combination of analyses identified five positively deviant wards that performed best in the region, outperformed their organisation and performed consistently well over 12 months. Five above average matched comparator wards were also identified. Phase 2: Staff and patient perceptions of safety generally supported the identification of positively deviant wards using Safety Thermometer data, although patient perceptions of safety were less concordant with the routinely collected data. Conclusions This study tentatively supports a pragmatic method of using routinely collected data to identify positively deviant elderly medical wards; however

Rolling out Productive Ward foundation modules across a hospital trust.

PubMed

Foster, Sam; Gordon, Pete; McSherry, Wilfred

The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

Authenticity in Learning--Nursing Students' Experiences at a Clinical Education Ward

ERIC Educational Resources Information Center

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silen, Charlotte

2013-01-01

Purpose: This study aims to explore and understand first year nursing students' experiences of learning at a clinical education ward. Design/methodology/approach: The setting is a clinical education ward for nursing students at a department of infectious diseases. A qualitative study was carried out exploring students' encounters with patients,…

Simulation of the small-scale magnetism in main-sequence stellar atmospheres

NASA Astrophysics Data System (ADS)

Salhab, R. G.; Steiner, O.; Berdyugina, S. V.; Freytag, B.; Rajaguru, S. P.; Steffen, M.

2018-06-01

Context. Observations of the Sun tell us that its granular and subgranular small-scale magnetism has significant consequences for global quantities such as the total solar irradiance or convective blueshift of spectral lines. Aims: In this paper, properties of the small-scale magnetism of four cool stellar atmospheres, including the Sun, are investigated, and in particular its effects on the radiative intensity and flux. Methods: We carried out three-dimensional radiation magnetohydrodynamic simulations with the CO5BOLD code in two different settings: with and without a magnetic field. These are thought to represent states of high and low small-scale magnetic activity of a stellar magnetic cycle. Results: We find that the presence of small-scale magnetism increases the bolometric intensity and flux in all investigated models. The surplus in radiative flux of the magnetic over the magnetic field-free atmosphere increases with increasing effective temperature, Teff, from 0.47% for spectral type K8V to 1.05% for the solar model, but decreases for higher effective temperatures than solar. The degree of evacuation of the magnetic flux concentrations monotonically increases with Teff as does their depression of the visible optical surface, that is the Wilson depression. Nevertheless, the strength of the field concentrations on this surface stays remarkably unchanged at ≈1560 G throughout the considered range of spectral types. With respect to the surrounding gas pressure, the field strength is close to (thermal) equipartition for the Sun and spectral type F5V but is clearly sub-equipartition for K2V and more so for K8V. The magnetic flux concentrations appear most conspicuous for model K2V owing to their high brightness contrast. Conclusions: For mean magnetic flux densities of approximately 50 G, we expect the small-scale magnetism of stars in the spectral range from F5V to K8V to produce a positive contribution to their bolometric luminosity. The modulation seems to

A systematic literature review of Releasing Time to Care: The Productive Ward.

PubMed

Wright, Stella; McSherry, Wilfred

2013-05-01

This systematic review provides an overview of the literature published on Releasing Time to Care: The Productive Ward between 2005 and June 2011. Releasing Time to Care: The Productive Ward programme was developed by the NHS Institute for Innovation and Improvement and launched in England in 2007. The programme comprises thirteen modules that aim to increase time for direct patient care, improve the patient and staff experience and make changes to the ward environment to improve efficiency. A systematic literature review. The terms 'Releasing Time to Care' and 'Productive Ward' were applied to key healthcare databases; CINAHL, Medline, Science Direct, ProQuest, Health Business Elite, British Nursing Index, Embase, Health Management Information Consortium and PsychInfo. All papers were read and subject to a quality assessment. The literature search identified 95 unique sources. A lack of research on The Productive Ward programme meant it was necessary to include non-empirical literature. In total, 18 articles met the inclusion criteria. Seven key themes were identified: the patient and staff experience, direct care time, patient safety, financial impact, embedding and sustainability, executive support and leadership, and common barriers and determinants of success. It also highlighted areas that require further exploration such as long-term sustainability of the programme and consistent data measurement between organisations. The review tentatively reports how The Productive Ward programme has been used to transform nursing practice for the benefit of patients and frontline staff, and how it resulted in cost savings. The literature review identified a potential positive results bias in the current literature whereby favourable outcomes were reported. This paper summarises the types of evidence and current literature on The Productive Ward providing a reference for frontline staff implementing the programme. © 2013 Blackwell Publishing Ltd.

Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey.

PubMed

Hunt, Isabelle M; Windfuhr, Kirsten; Swinson, Nicola; Shaw, Jenny; Appleby, Louis; Kapur, Nav

2010-02-03

Suicide prevention by mental health services requires an awareness of the antecedents of suicide amongst high risk groups such as psychiatric in-patients. The goal of this study was to describe the social and clinical characteristics of people who had absconded from an in-patient psychiatric ward prior to suicide, including aspects of the clinical care they received. We carried out a national clinical survey based on a 10-year (1997-2006) sample of people in England and Wales who had died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. There were 1,851 cases of suicide by current psychiatric in-patients, 14% of all patient suicides. 1,292 (70%) occurred off the ward. Four hundred and sixty-nine of these patients died after absconding from the ward, representing 25% of all in-patient suicides and 38% of those that occurred off the ward. Absconding suicides were characterised by being young, unemployed and homeless compared to those who were off the ward with staff agreement. Schizophrenia was the most common diagnosis, and rates of previous violence and substance misuse were high. Absconders were proportionally more likely than in-patients on agreed leave to have been legally detained for treatment, non-compliant with medication, and to have died in the first week of admission. Whilst absconding patients were significantly more likely to have been under a high level of observation, clinicians reported more problems in observation due to either the ward design or other patients on the ward. Measures that may prevent absconding and subsequent suicide amongst in-patients might include tighter control of ward exits, and more intensive observation of patients, particularly in the early days of admission. Improving the ward environment to provide a supportive and less intimidating experience may contribute to reduced risk.

Experimental Study of Small-Scale Mineral Particles in the Atmosphere of Central Asia

NASA Astrophysics Data System (ADS)

Adushkin, V. V.; Chen, B. B.; Popel, S. I.; Dubinskii, A. Yu.; Weidler, P. G.; Friedrich, F.

2018-03-01

An experimental study of small-scale mineral particles in the atmosphere over Kyrgyzstan is carried out. It is shown that the substance of the studied particles corresponds to quartz-enriched minerals, feldspars, layered silicates, minerals containing lime carbonate, etc. Overall, there is a definite correspondence between the mineral particle compositions in the atmosphere of Kyrgyzstan and in the other regions of Central Asia. The constructed size-distribution functions of the particles agree with the results of studying the dust aerosol properties in the deserts of Central Asia obtained in the southwestern part of Tajikistan in 1989.

Clinical Features of Adult Patients Admitted to Pediatric Wards in Japan.

PubMed

Michihata, Nobuaki; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo

2015-10-01

Pediatricians generally need to treat adult patients who require long-term care for pediatric diseases. However, little is known about the characteristics of adult patients in pediatric wards. Using a national inpatient database, the aim of this study was to determine the clinical details of adult patients admitted to pediatric wards in Japanese acute-care hospitals. We extracted all inpatients aged ≥19 years who were admitted to pediatric departments in Japan from April 2012 to March 2013. We examined the patients' main diagnoses and the use of life-supporting home medical devices. Of 417,352 patients admitted to pediatric wards during the study period, we identified 4,729 (1.1%) adult patients. The major diagnoses of the adult patients were malignancy, congenital heart disease, epilepsy, and cerebral palsy. More than 35% of the patients with cerebral palsy had a tracheostomy tube, gastrostomy tube, home central venous alimentation, or home respirator. More than 20% of patients aged ≥40 years in pediatric wards had adult diseases, including ischemic heart diseases, cerebrovascular diseases, and adult malignancy. Many adult patients in pediatric wards had adult diseases. It is essential to establish a disease-oriented support system for adults with chronic conditions that originated in their childhood. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Reflective practice and daily ward reality: a covert power game.

PubMed

Mantzoukas, Stefanos; Jasper, Melanie A

2004-11-01

The concept of reflection is propounded in the literature as an epistemology for practice that enables practitioners to solve their daily problematic situations through conscious thought processes which eventually leads to practice-based knowledge. Hence, reflection became a central tenet of both theory development and educational provision in nursing. Furthermore, this centrality of reflection was reinforced by statutory nursing bodies and service providers by adopting it as the means for carrying out adequate professional practice. Although this may be the case, issues of implementation of reflection within the daily reality of practitioners are frequently overlooked within the literature. Moreover, little consideration appears to be given on the impact that the organizational culture and the politics of power may exert on the implementation of reflective practices within daily ward reality. This paper explores how reflection is viewed by nurses within their daily reality in the medical wards, examines the relationships between the organizational culture of these wards and the practitioners and investigates whether reflective methods of practice were being implemented when the study was conducted. An interpretative ethnographical methodology was implemented and the data collecting methods used were observation, interviews and qualitative content analysis with a group of 16 practising nurses from four medical wards of one NHS Trust in England. Two interviews were conducted with each nurse within 3-week intervals. The content of these interviews evolved from the analysis of episodes of practice observed when the nurses were giving nursing care. These data were supplemented by narratives from the nurses' in the form of written reflective accounts that were analysed via qualitative content analysis techniques. Four themes were generated: (i) relationships between nurses and doctors; (ii) relationships between nurses and managers; (iii) nursing practice; and (iv

Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods.

PubMed

Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

2016-01-01

Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users.

Design in mind: eliciting service user and frontline staff perspectives on psychiatric ward design through participatory methods

PubMed Central

Csipke, Emese; Papoulias, Constantina; Vitoratou, Silia; Williams, Paul; Rose, Diana; Wykes, Til

2016-01-01

Abstract Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. PMID:26886239

Environment in pediatric wards: light, sound, and temperature.

PubMed

Oliveira, Lia; Gomes, Cláudia; Bacelar Nicolau, Leonor; Ferreira, Luís; Ferreira, Rosário

2015-09-01

The mutual relationship between sleep and disease is well known, becoming more relevant whenever the disease leads to hospitalization. We intend to describe patterns of environmental factors of some pediatric wards, and to verify if these are in line with those recommended. As a secondary aim, we characterize sleep quality during hospitalization. Five pediatric wards of a tertiary-level hospital were included. Light, sound, and temperature were measured and assessed through descriptive statistics. The following recommended values were considered: maximum light 100 Lux, maximum sound 45 dB, and optimal temperature 20-24 °C. A questionnaire was prepared to assess children's sleep, and it was completed by a caregiver. Light values were within the desirable limits for 86% of evaluated time. In all wards, the intensity of sound was much higher than desirable, being above 45 dB during 85% of evaluated time. The temperature was above 24 °C during 78% of total time. Based on 34 answered questionnaires (out of 50 distributed), almost half of the respondents believe that sleep quality and restlessness are worse at the hospital. Most children slept for a longer time at home. Eighteen children awoke more times at the hospital, and those awakenings were mostly attributed to noise. The sound and temperature were higher than recommended. The different values between these wards may be due to different levels of care, but this shows that there are no standard rules on this matter. A worse quality and shorter duration of sleep at hospital were reported. Comprehensive studies are necessary to evaluate the impact of environmental factors on disease recovery. Copyright © 2015 Elsevier B.V. All rights reserved.

Improving the ward-based care of patients post-thyroidectomy.

PubMed

Mahalingam, Sridhayan; Singhal, Rachit; Mugilan, Sridhayani; Choudhury, Natasha

2016-11-02

Nursing staff play a crucial role in managing surgical patients in the postoperative period. However, with an increasing risk of subspecialty wards facing closure as a result of financial pressures within the NHS, the knowledge base and expertise of ward-based nursing staff of surgical subspecialties is becoming increasingly limited. Using patients undergoing thyroidectomy as an example, a quality improvement multidisciplinary audit is presented, which shows how simple targeted interventions through a multidisciplinary approach can help maintain high standards of patient care in a secondary care setting.

Learning through participating on an interprofessional training ward.

PubMed

Lidskog, Marie; Löfmark, Anna; Ahlström, Gerd

2009-09-01

Learning in clinical education can be understood as a process of becoming a legitimate participant in the relevant context. Interprofessional training wards (IPTWs) are designed to give students from educational programmes in health and social care a realistic experience of collaboration for the purpose of developing teamwork skills. IPTWs have been found to be appreciated by the students and to influence students' understanding of each other's professions. The aim of this study was to describe and analyse the students' learning on an interprofessional training ward in care for older persons through focusing on the students' ways of participating in the communities of practice on the ward. A case study design was chosen. Multiple data sources were used. The findings show that the students engaged as active participants in the care. At the same time there was sometimes a discrepancy between on the one hand expectations and goals, on the other hand actual participation. There were difficulties in making the training relevant for all the student groups involved. The findings indicate that in the planning of interprofessional education the choice of setting and learning situations is crucial with regard to the learning that will occur.

IKONOS imagery for the Large Scale Biosphere–Atmosphere Experiment in Amazonia (LBA).

Treesearch

George Hurtt; Xiangming Xiao; Michael Keller; Michael Palace; Gregory P. Asner; Rob Braswell; Brond& #305; Eduardo S. zio; Manoel Cardoso; Claudio J.R. Carvalho; Matthew G. Fearon; Liane Guild; Steve Hagen; Scott Hetrick; Berrien Moore III; Carlos Nobre; Jane M. Read; S& aacute; Tatiana NO-VALUE; Annette Schloss; George Vourlitis; Albertus J. Wickel

2003-01-01

The LBA-ECO program is one of several international research components under the Brazilian-led Large Scale Biosphere–Atmosphere Experiment in Amazonia (LBA). The field-oriented research activities of this study are organized along transects and include a set of primary field sites, where the major objective is to study land-use change and ecosystem dynamics, and a...

Protective isolation in single-bed rooms: studies in a modified hospital ward

PubMed Central

Ayliffe, G. A. J.; Collins, B. J.; Lowbury, E. J. L.; Wall, Mary

1971-01-01

Studies were made in a modified hospital ward containing 19 beds, 14 of them in the open ward, one in a window-ventilated side-room, two in rooms with partial-recirculation ventilators giving 7-10 air changes per hour, and two in self-contained isolation suites with plenum ventilation (20 air changes per hour), ultra-violet (UV) barriers at doorways and airlocks. Preliminary tests with aerosols of tracer bacteria showed that few bacteria entered the plenum or recirculation-ventilated rooms. Bacteria released inside mechanically ventilated cubicles escaped into the corridor, but this transfer was reduced by the presence of an airlock. UV barriers at the entrance to the airlock and the cubicle reduced the transfer of bacteria from cubicle to corridor. During a period of 4 years while the ward was in use for surgical and gynaecological patients, the incidence of post-operative sepsis and colonization of wounds by multiple-resistant Staphylococcus aureus was lower (though not significantly lower) in the plenum-ventilated rooms than in the open ward, the recirculator-ventilated cubicles and the window-ventilated cubicles. Nasal acquisition of multiple-resistant Staph. aureus was significantly less common in the plenum-ventilated than in the recirculator-ventilated cubicles and in the other areas. Mean counts of bacteria on settle-plates were significantly lower in the plenum-ventilated cubicles than in the other areas; mean settle-plate counts in the recirculator-ventilated cubicles were significantly lower than in the open ward and in the window-ventilated side-room; similar results were shown by slit-sampling of air. Mean settle-plate counts were significantly lower in all areas when the ward was occupied by female patients. Staph. aureus was rarely carried by air from plenum-ventilated or other cubicles to the open ward, or from the open ward to the cubicles; though staphylococci were transferred from one floor area to another, they did not appear to be redispersed

Implications of atmospheric conditions for analysis of surface temperature variability derived from landscape-scale thermography.

PubMed

Hammerle, Albin; Meier, Fred; Heinl, Michael; Egger, Angelika; Leitinger, Georg

2017-04-01

Thermal infrared (TIR) cameras perfectly bridge the gap between (i) on-site measurements of land surface temperature (LST) providing high temporal resolution at the cost of low spatial coverage and (ii) remotely sensed data from satellites that provide high spatial coverage at relatively low spatio-temporal resolution. While LST data from satellite (LST sat ) and airborne platforms are routinely corrected for atmospheric effects, such corrections are barely applied for LST from ground-based TIR imagery (using TIR cameras; LST cam ). We show the consequences of neglecting atmospheric effects on LST cam of different vegetated surfaces at landscape scale. We compare LST measured from different platforms, focusing on the comparison of LST data from on-site radiometry (LST osr ) and LST cam using a commercially available TIR camera in the region of Bozen/Bolzano (Italy). Given a digital elevation model and measured vertical air temperature profiles, we developed a multiple linear regression model to correct LST cam data for atmospheric influences. We could show the distinct effect of atmospheric conditions and related radiative processes along the measurement path on LST cam , proving the necessity to correct LST cam data on landscape scale, despite their relatively low measurement distances compared to remotely sensed data. Corrected LST cam data revealed the dampening effect of the atmosphere, especially at high temperature differences between the atmosphere and the vegetated surface. Not correcting for these effects leads to erroneous LST estimates, in particular to an underestimation of the heterogeneity in LST, both in time and space. In the most pronounced case, we found a temperature range extension of almost 10 K.

A Scale to Characterize the Strength and Impacts of Atmospheric Rivers

NASA Astrophysics Data System (ADS)

Ralph, F. M.; Rutz, J. J.; Cordeira, J. M.; Dettinger, M. D.; Anderson, M.; Schick, L. J.; Smallcomb, C.; Reynolds, D.

2017-12-01

A scale has been developed to categorize atmospheric river (AR) strength and duration. It is based on the maximum instantaneous vertically intergated water vapor transport (IVT) and the duration of the event at a given point (i.e., the duration of IVT ≥250 kg m-1 s-1, which is a minimal threshold of weak AR conditions). The AR Scale is intuitive, with 5 categories (AR Cats 1-5) arising as a function of maximum IVT intensity and duration of at least minimal AR conditions. These categories provide a wide range of users with a baseline for gauging the potential impacts, both beneficial and hazardous, associated with an AR at their location. It also provides a basis for reporting the occurance of past ARs and of tracking their frequency of occurence over time. This presentation will focus on describing the AR Scale, use and interpretation of this scale, and the spatiotemporal distribution of AR Cat 1-5 events in the Western U.S. during the cool season (October - April) during 1980-2017.

Identifying positively deviant elderly medical wards using routinely collected NHS Safety Thermometer data: an observational study.

PubMed

Baxter, Ruth; Taylor, Natalie; Kellar, Ian; Pye, Victoria; Mohammed, Mohammed A; Lawton, Rebecca

2018-02-16

The positive deviance approach seeks to identify and learn from exceptional performers. Although a framework exists to apply positive deviance within healthcare organisations, there is limited guidance to support its implementation. The approach has also rarely explored exceptional performance on broad outcomes, been implemented at ward level, or applied within the UK. This study develops and critically appraises a pragmatic method for identifying positively deviant wards using a routinely collected, broad measure of patient safety. A two-phased observational study was conducted. During phase 1, cross-sectional and temporal analyses of Safety Thermometer data were conducted to identify a discrete group of positively deviant wards that consistently demonstrated exceptional levels of safety. A group of matched comparison wards with above average performances were also identified. During phase 2, multidisciplinary staff and patients on the positively deviant and comparison wards completed surveys to explore whether their perceptions of safety supported the identification of positively deviant wards. 34 elderly medical wards within a northern region of England, UK. Multidisciplinary staff (n=161) and patients (n=188) clustered within nine positively deviant and comparison wards. Phase 1: A combination of analyses identified five positively deviant wards that performed best in the region, outperformed their organisation and performed consistently well over 12 months. Five above average matched comparator wards were also identified. Phase 2: Staff and patient perceptions of safety generally supported the identification of positively deviant wards using Safety Thermometer data, although patient perceptions of safety were less concordant with the routinely collected data. This study tentatively supports a pragmatic method of using routinely collected data to identify positively deviant elderly medical wards; however, it also highlights the various challenges that are faced

Land-Atmosphere Coupling in the Multi-Scale Modelling Framework

NASA Astrophysics Data System (ADS)

Kraus, P. M.; Denning, S.

2015-12-01

The Multi-Scale Modeling Framework (MMF), in which cloud-resolving models (CRMs) are embedded within general circulation model (GCM) gridcells to serve as the model's cloud parameterization, has offered a number of benefits to GCM simulations. The coupling of these cloud-resolving models directly to land surface model instances, rather than passing averaged atmospheric variables to a single instance of a land surface model, the logical next step in model development, has recently been accomplished. This new configuration offers conspicuous improvements to estimates of precipitation and canopy through-fall, but overall the model exhibits warm surface temperature biases and low productivity.This work presents modifications to a land-surface model that take advantage of the new multi-scale modeling framework, and accommodate the change in spatial scale from a typical GCM range of ~200 km to the CRM grid-scale of 4 km.A parameterization is introduced to apportion modeled surface radiation into direct-beam and diffuse components. The diffuse component is then distributed among the land-surface model instances within each GCM cell domain. This substantially reduces the number excessively low light values provided to the land-surface model when cloudy conditions are modeled in the CRM, associated with its 1-D radiation scheme. The small spatial scale of the CRM, ~4 km, as compared with the typical ~200 km GCM scale, provides much more realistic estimates of precipitation intensity, this permits the elimination of a model parameterization of canopy through-fall. However, runoff at such scales can no longer be considered as an immediate flow to the ocean. Allowing sub-surface water flow between land-surface instances within the GCM domain affords better realism and also reduces temperature and productivity biases.The MMF affords a number of opportunities to land-surface modelers, providing both the advantages of direct simulation at the 4 km scale and a much reduced

'Safety by DEFAULT': introduction and impact of a paediatric ward round checklist.

PubMed

Sharma, Sanjiv; Peters, Mark J

2013-10-11

Poor communication is a source of risk. This can be particularly significant in areas of high clinical acuity such as intensive care. Ward rounds are points where large amounts of information must be communicated in a time-limited environment with many competing interests. This has the potential to reduce effective communication and risk patient safety. Checklists have been used in many industries to improve communication and mitigate risk. We describe the introduction of a ward round safety checklist 'DEFAULT' on a paediatric intensive care unit. A non-blinded, pre- and post-intervention observational study was undertaken in a 12-bedded Level 3 tertiary PICU between July 2009 and December 2011. Ward round stakeholders subjectively liked the checklist and felt it improved communication. Introduction of the ward round checklist was associated with an increase in median days between accidental extubations from 14 (range 2 to 86) to 150 (56 to 365) (Mann-Whitney P <0.0001). The ward round checklist was also associated with an increase in the proportion of invasively ventilated patients with target tidal volumes of <8 ml/kg, which increased from 35 of 71 patients at 08.00 representing a proportion of 0.49 (95% CI 0.38 to 0.60) to 23 of 38 (0.61, 0.45 to 0.74). This represented a trend towards an increased proportion of cases in the target range (z = 1.68, P = 0.09). The introduction of a ward round safety checklist was associated with improved communication and patient safety.

HAPEX-Sahel: A large-scale study of land-atmosphere interactions in the semi-arid tropics

NASA Technical Reports Server (NTRS)

Gutorbe, J-P.; Lebel, T.; Tinga, A.; Bessemoulin, P.; Brouwer, J.; Dolman, A.J.; Engman, E. T.; Gash, J. H. C.; Hoepffner, M.; Kabat, P.

1994-01-01

The Hydrologic Atmospheric Pilot EXperiment in the Sahel (HAPEX-Sahel) was carried out in Niger, West Africa, during 1991-1992, with an intensive observation period (IOP) in August-October 1992. It aims at improving the parameteriztion of land surface atmospheric interactions at the Global Circulation Model (GCM) gridbox scale. The experiment combines remote sensing and ground based measurements with hydrological and meteorological modeling to develop aggregation techniques for use in large scale estimates of the hydrological and meteorological behavior of large areas in the Sahel. The experimental strategy consisted of a period of intensive measurements during the transition period of the rainy to the dry season, backed up by a series of long term measurements in a 1 by 1 deg square in Niger. Three 'supersites' were instrumented with a variety of hydrological and (micro) meteorological equipment to provide detailed information on the surface energy exchange at the local scale. Boundary layer measurements and aircraft measurements were used to provide information at scales of 100-500 sq km. All relevant remote sensing images were obtained for this period. This program of measurements is now being analyzed and an extensive modelling program is under way to aggregate the information at all scales up to the GCM grid box scale. The experimental strategy and some preliminary results of the IOP are described.

The effect of information provision on reduction of errors in intravenous drug preparation and administration by nurses in ICU and surgical wards.

PubMed

Abbasinazari, Mohammad; Zareh-Toranposhti, Samaneh; Hassani, Abdollah; Sistanizad, Mohammad; Azizian, Homa; Panahi, Yunes

2012-01-01

Malpractice in preparation and administration of intravenous (IV) medications has been reported frequently. Inadequate knowledge of nurses has been reported as a cause of such errors. We aimed to evaluate the role of nurses' education via installation of wall posters and giving informative pamphlets in reducing the errors in preparation and administration of intravenous drugs in 2 wards (ICU and surgery) of a teaching hospital in Tehran, Iran. A trained observer stationed in 2 wards in different work shifts. He recorded the nurses' practice regarding the preparation and administration of IV drugs and scored them before and after the education process. 400 observations were evaluated. Of them, 200 were related to before education and 200 were related to after education. On a 0-10 quality scale, mean ± SD scores of before and after education were determined. Mean ± SD scores of before and after education at the 2 wards were 4.51 (± 1.24) and 6.15 (± 1.23) respectively. There was a significant difference between the scores before and after intervention in ICU (P<0.001), surgery (P<0.001), and total two wards (P<0.001). Nurses' education by using wall poster and informative pamphlets regarding the correct preparation and administration of IV drugs can reduce the number of errors.

"Ward v. Wilbanks": Counselor Educators Respond

ERIC Educational Resources Information Center

Burkholder, David; Hall, Stephanie F.; Burkholder, Jessica

2014-01-01

This article investigated 71 counselor educators' perspectives and pedagogical practices related to "Ward v. Wilbanks" (2009) and the American Counseling Association (ACA) response to the case. The authors used qualitative content analysis to identify 6 themes from survey data: (a) views on gatekeeping and student training; (b)…

The relationship between leadership, teamworking, structure, burnout and attitude to patients on acute psychiatric wards

PubMed Central

Nijman, Henk; Simpson, Alan; Jones, Julia

2010-01-01

Background Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards in their rates of these behaviours, and that structure (ward organisation, rules and daily routines) might be the most critical of these. This paper describes the exploration of a large dataset to assess the relationship between structure and other staff variables. Methods A multivariate cross-sectional design was utilised. Data were collected from staff on 136 acute psychiatric wards in 26 NHS Trusts in England, measuring leadership, teamwork, structure, burnout and attitudes towards difficult patients. Relationships between these variables were explored through principal components analysis (PCA), structural equation modelling and cluster analysis. Results Principal components analysis resulted in the identification of each questionnaire as a separate factor, indicating that the selected instruments assessed a number of non-overlapping items relevant for ward functioning. Structural equation modelling suggested a linear model in which leadership influenced teamwork, teamwork structure; structure burnout; and burnout feelings about difficult patients. Finally, cluster analysis identified two significantly distinct groups of wards: the larger of which had particularly good leadership, teamwork, structure, attitudes towards patients and low burnout; and the second smaller proportion which was poor on all variables and high on burnout. The better functioning cluster of wards had significantly lower rates of containment events. Conclusion The overall performance of staff teams is associated with differing rates of containment on wards. Interventions to reduce rates of containment on wards may need to address staff issues at every level, from leadership through to staff

Comparison of student learning in the out-patient clinic and ward round.

PubMed

Davis, M H; Dent, J A

1994-05-01

In undergraduate medical education there is a trend away from ward-based teaching towards out-patient and community-based teaching. To study the potential effects of this altered emphasis on student learning, a pilot group of final-year medical students at the University of Dundee was asked to keep individual structured log-books. These contained details of patients seen during their 3-week orthopaedic attachment in both a ward and out-patient setting. A comparison of perceived learning in the two settings showed that students learned more from attending an out-patient clinic than a ward round, but did not make full use of the learning potential of either. The setting did not particularly influence the balance of learning as categorized here but only the ward round supplied experience of surgical complications. The amount of learning taking place in an out-patient clinic was influenced by student ability, measured by examination performance, but not by clinic work-load. The implications of increased use of out-patient clinics and the advantages and disadvantages of the approach employed are discussed. It is concluded that in the situation studied student learning in the outpatient setting is as good as or superior to the ward setting but should not totally replace it.

The health-care environment on a locked psychiatric ward: an ethnographic study.

PubMed

Johansson, Inger M; Skärsäter, Ingela; Danielson, Ella

2006-12-01

Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.

Continental-scale Validation of MODIS-based and LEDAPS Landsat ETM+ Atmospheric Correction Methods

NASA Technical Reports Server (NTRS)

Ju, Junchang; Roy, David P.; Vermote, Eric; Masek, Jeffrey; Kovalskyy, Valeriy

2012-01-01

The potential of Landsat data processing to provide systematic continental scale products has been demonstrated by several projects including the NASA Web-enabled Landsat Data (WELD) project. The recent free availability of Landsat data increases the need for robust and efficient atmospheric correction algorithms applicable to large volume Landsat data sets. This paper compares the accuracy of two Landsat atmospheric correction methods: a MODIS-based method and the Landsat Ecosystem Disturbance Adaptive Processing System (LEDAPS) method. Both methods are based on the 6SV radiative transfer code but have different atmospheric characterization approaches. The MODIS-based method uses the MODIS Terra derived dynamic aerosol type, aerosol optical thickness, and water vapor to atmospherically correct ETM+ acquisitions in each coincident orbit. The LEDAPS method uses aerosol characterizations derived independently from each Landsat acquisition and assumes a fixed continental aerosol type and uses ancillary water vapor. Validation results are presented comparing ETM+ atmospherically corrected data generated using these two methods with AERONET corrected ETM+ data for 95 10 km×10 km 30 m subsets, a total of nearly 8 million 30 m pixels, located across the conterminous United States. The results indicate that the MODIS-based method has better accuracy than the LEDAPS method for the ETM+ red and longer wavelength bands.

Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis.

PubMed

Krautter, Markus; Andreesen, Sven; Köhl-Hackert, Nadja; Hoffmann, Katja; Herzog, Wolfgang; Nikendei, Christoph

2014-01-01

Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective. To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors. A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis. The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available. On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor-student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians.

Food hygiene on the wards.

PubMed

Steuer, Walter

2007-09-13

A PROBLEM THAT IS OFTEN OVERLOOKED OR SIMPLY NOT GIVEN ENOUGH ATTENTION: the food served to patients from the kitchen is not sterile. If food is allowed to stand at room temperature for a long time, both in the case of food cooked for lunch and of food intended for supper which has been previously chilled, there is the possibility of massive spore germination or of dangerous toxin formation. Therefore regulations on how to handle food and beverages (e.g. tea) must be set out in the infection control policy, and checks carried out to monitor compliance with the rules relating to temperature checks, duration and type of storage, need for reheating, etc. Making staff aware of the issues involved is of paramount importance. These include monitoring hygiene standards in the ward kitchen, formulation of a cleaning policy, periodic bacteriological checks (not only of workstations but also of the dishwasher results), whenever possible the use of disposable cloths for working surfaces and equipment, changing cleaning cloths at least once daily and hygienic hand disinfection before and after handing out food. Foodstuffs brought in by visitors represent a special hygienic and organizational problem because in many cases they already have a high baseline microbial count. Visitors must be made aware that, for example, slices of cake left in the patient's room and often eaten only hours later can pose a risk of infection.In summary, the following principles of food hygiene must be observed on the wards:Maintenance of the cold-hot chainNot only reheat food, but ensure it is well heated throughout Avoid situations giving rise to spore germination in foodstuffs brought in by visitorsCleanliness and minimal contamination of kitchen worktopsCleanliness of crockery and kitchen towels Do not allow food to stand at room temperature for a long time, in particular desserts and confectionery A standard policy must be enforced to define the hygienic status and organization for food

42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards, and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or...

42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards, and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or...

42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards, and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or...

42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards, and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or...

42 CFR 70.7 - Responsibility with respect to minors, wards, and patients.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Responsibility with respect to minors, wards, and... QUARANTINE, INSPECTION, LICENSING INTERSTATE QUARANTINE § 70.7 Responsibility with respect to minors, wards, and patients. A parent, guardian, physician, nurse, or other such person shall not transport, or...

The periodicities in and biometeorological relationships with bed occupancy of an acute psychiatric ward in Antwerp, Belgium

NASA Astrophysics Data System (ADS)

Maes, M.; de Meyer, F.; Peeters, D.; Meltzer, H.; Schotte, C.; Scharpe, S.; Cosyns, P.

1993-06-01

Recently, some investigators have established a seasonal pattern in normal human psychology, physiology and behaviour, and in the incidence of psychiatric psychopathology. In an attempt to elucidate the chronopsy and meteotropism in the latter, we have examined the chronograms of, and the biometeorological relationships to bed occupancy of the psychiatric ward of the Antwerp University Hospital during three consecutive calendar years (1987 1989). Weather data for the vicinity were provided by a local meteorological station and comprise mean atmospheric pressure, air temperature, relative humidity, wind speed and minutes of sunlight and precipitation/day. The number of psychiatric beds occupied during the study period exhibited a significant seasonal variation. Peaks in bed occupancy were observed in March and November, with lows in August. An important part of the variability in the number of beds occupied could be explained by the composite effects of weather variables of the preceding weeks. Our results suggest that short-term fluctuations in atmospheric activity may dictate some of the periodicities in psychiatric psychopathology.

Opening the black box in nursing work and management practice: the role of ward managers.

PubMed

Townsend, Keith; Wilkinson, Adrian; Kellner, Ashlea

2015-03-01

This paper aims to identify and explore key obstacles preventing ward managers from effectively performing the human resource management (HRM) responsibilities required in their role. In the context of increasing costs and the decentralisation of responsibility to ward level, the relevance of the ward manager role within the 'black box' between human resource management and firm performance is becoming increasingly pertinent. This paper presents an intensive case study including 37 interviews across all levels of a hospital where senior management attempted to shift to a high performance model of human resource management. The findings indicated that ward managers played a critical role in maintaining and improving employee performance, although they were restricted from effectively performing their responsibilities due to budget pressure and limited managerial skill development. Our findings support the contention that hospitals would benefit from focusing on the critical role of the ward manager as the central locus of influence in high performance human resource management (HPHRM) systems. Investment into high performance human resource management is discouraged if the hospital cannot adequately enable ward managers who are responsible for implementation. Introduction of managerial skills training to potential and existing ward managers is critical. © 2013 John Wiley & Sons Ltd.

Large scale atmospheric waves in the Venus mesosphere as seen by the VeRa Radio Science instrument on Venus Express

NASA Astrophysics Data System (ADS)

Tellmann, Silvia; Häusler, Bernd; Hinson, David P.; Tyler, G. Leonard; Andert, Thomas P.; Bird, Michael K.; Imamura, Takeshi; Pätzold, Martin; Remus, Stefan

2015-04-01

Atmospheric waves on all spatial scales play a crucial role in the redistribution of energy, momentum, and atmospheric constituent in planetary atmosphere and are thought to be involved in the development and maintenance of the atmospheric superrotation on Venus. The Venus Express Radio-Science Experiment VeRa sounded the Venus neutral atmosphere and ionosphere in Earth occultation geometry using the spacecraft radio subsystem at two coherent frequencies. Radial profiles of neutral number density, covering the altitude range 40-90 km, are then converted to vertical profiles of temperature and pressure, assuming hydrostatic equilibrium. The extensive VeRa data set enables us to study global scale atmospheric wave phenomena like thermal tides in the mesosphere and troposphere. A pronounced local time dependency of the temperature is found in the mesosphere at different altitude levels. Wave-2 structures dominate the low latitude range in the upper mesosphere while the higher latitudes show a strong wave-1 structure at the top of the cloud layer. The investigation of these wave structures provides valuable information about the energy transport in the atmosphere.

Person-centred ward climate as experienced by mentally lucid residents in long-term care facilities.

PubMed

Bergland, Ådel; Hofoss, Dag; Kirkevold, Marit; Vassbø, Tove; Edvardsson, David

2015-02-01

To assess the content validity and reliability of the Person-centred Climate Questionnaire-Patient version in long-term care facilities, to describe residents' perceptions of the extent to which their ward climate was person-centred and to explore whether person-centredness was associated with facility and resident characteristics, such as facility and ward size, having a sensory garden and having a primary caregiver. The importance of the physical environment to persons with dementia has been investigated. However, research is lacking regarding the extent to which mentally lucid residents experience their physical and psycho-social ward climate as person-centred and the factors influencing their experience. Cross-sectional survey design. The Person-centred Climate Questionnaire-Patient version was translated into Norwegian with forward and backward translation. The content validity index for scales was assessed. The Person-centred Climate Questionnaire -Patient version was completed by 145 mentally lucid residents in 17 Norwegian long-term care facilities. Reliability was assessed by Cronbach's α and item-total correlations. Test-retest reliability was assessed by paired samples t-test and Spearman's correlation. To explore differences based on facility and resident characteristics, independent-samples t-test and one-way anova were used. The content validity index for scales was satisfactory. The Person-centred Climate Questionnaire-Patient version was internally consistent and had satisfactory test-retest reliability. The climate was experienced as highly person-centred. No significant differences were found, except that residents in larger facilities experienced the climate as more person-centred in relation to everyday activities (subscale 2) than residents in smaller facilities. The Norwegian version of the Person-centred Climate Questionnaire-Patient version can be regarded as reliable in a long-term care facility context. Perceived degree of person

Healthcare Quality Improvement and 'work engagement'; concluding results from a national, longitudinal, cross-sectional study of the 'Productive Ward-Releasing Time to Care' Programme.

PubMed

White, Mark; Butterworth, Tony; Wells, John Sg

2017-08-01

Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. However Quality Improvement (QI) initiatives have in the past typically faltered because they fail to fully engage healthcare professionals, resulting in apathy and resistance amongst this group of key stakeholders. Productive Ward: Releasing Time to Care (PW) is a ward-based QI programme created to help ward-based teams redesign and streamline the way that they work; leaving more time to care for patients. PW is designed to engage and empower ward-based teams to improve the safety, quality and delivery of care. The main objective of this study was to explore whether PW sustains the 'engagement' of ward-based teams by examining the longitudinal effect that the national QI programme had on the 'work-engagement' of ward-based teams in Ireland. Utilising the Utrecht Work Engagement Scale questionnaire (UWES-17), we surveyed nine PW (intervention) sites from typical acute Medical/Surgical, Rehabilitation and Elderly services (representing the entire cohort of a national phase of PW implementation in Ireland) and a cohort of matched control sites. The numbers surveyed from the PW group at T1 (up to 3 months after commencing the programme) totalled 253 ward-team members and 249 from the control group. At T2 (12 months later), the survey was repeated with 233 ward-team members from the PW sites and 236 from the control group. Overall findings demonstrated that those involved in the QI initiative had higher 'engagement' scores at T1 and T2 in comparison to the control group. Total 'engagement' score (TES), and its 3 dimensions, were all significantly higher in the PW group at T1, but only the Vigour dimension remained significantly higher at T2 (p = 0.006). Our results lend some support to the assertions of the PW initiative itself and suggest that when compared to a control group, ward-based teams involved in the QI programme are more likely

Medical academia clinical experiences of Ward Round Teaching curriculum.

PubMed

Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

2014-01-01

Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

Linearized self-consistent GW approach satisfying the Ward identity

NASA Astrophysics Data System (ADS)

Kuwahara, Riichi; Ohno, Kaoru

2014-09-01

We propose a linearized self-consistent GW approach satisfying the Ward identity. The vertex function derived from the Ward-Takahashi identity in the limit of q =0 and ω -ω'=0 is included in the self-energy and the polarization function as a consequence of the linearization of the quasiparticle equation. Due to the energy dependence of the self-energy, the Hamiltonian is a non-Hermitian operator and quasiparticle states are nonorthonormal and linearly dependent. However, the linearized quasiparticle states recover orthonormality and fulfill the completeness condition. This approach is very efficient, and the resulting quasiparticle energies are greatly improved compared to the nonlinearized self-consistent GW approach, although its computational cost is not much increased. We show the results for atoms and dimers of Li and Na compared with other approaches. We also propose convenient ways to calculate the Luttinger-Ward functional Φ based on a plasmon-pole model and calculate the total energy for the ground state. As a result, we conclude that the linearization improves overall behaviors in the self-consistent GW approach.

Medical academia clinical experiences of Ward Round Teaching curriculum

PubMed Central

Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

2014-01-01

Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members’ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners. PMID:24627858

ECOLOGICAL RESEARCH IN THE LARGE-SCALE BIOSPHERE–ATMOSPHERE EXPERIMENT IN AMAZONIA: EARLY RESULTS.

Treesearch

M. Keller; A. Alencar; G. P. Asner; B. Braswell; M. Bustamente; E. Davidson; T. Feldpausch; E. Fern ndes; M. Goulden; P. Kabat; B. Kruijt; F. Luizao; S. Miller; D. Markewitz; A. D. Nobre; C. A. Nobre; N. Priante Filho; H. Rocha; P. Silva Dias; C von Randow; G. L. Vourlitis

2004-01-01

The Large-scale Biosphere–Atmosphere Experiment in Amazonia (LBA) is a multinational, interdisciplinary research program led by Brazil. Ecological studies in LBA focus on how tropical forest conversion, regrowth, and selective logging influence carbon storage, nutrient dynamics, trace gas fluxes, and the prospect for sustainable land use in the Amazon region. Early...

Experiments on integral length scale control in atmospheric boundary layer wind tunnel

NASA Astrophysics Data System (ADS)

Varshney, Kapil; Poddar, Kamal

2011-11-01

Accurate predictions of turbulent characteristics in the atmospheric boundary layer (ABL) depends on understanding the effects of surface roughness on the spatial distribution of velocity, turbulence intensity, and turbulence length scales. Simulation of the ABL characteristics have been performed in a short test section length wind tunnel to determine the appropriate length scale factor for modeling, which ensures correct aeroelastic behavior of structural models for non-aerodynamic applications. The ABL characteristics have been simulated by using various configurations of passive devices such as vortex generators, air barriers, and slot in the test section floor which was extended into the contraction cone. Mean velocity and velocity fluctuations have been measured using a hot-wire anemometry system. Mean velocity, turbulence intensity, turbulence scale, and power spectral density of velocity fluctuations have been obtained from the experiments for various configuration of the passive devices. It is shown that the integral length scale factor can be controlled using various combinations of the passive devices.

Respiratory support in oncology ward setting: a prospective descriptive study.

PubMed

Mishra, Seema; Bhatnagar, Sushma; Gupta, Deepak; Goyal, Gaurav Nirvani; Agrawal, Ravi; Jain, Roopesh; Chauhan, Himanshu

2009-01-01

Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes. Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation. Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively. Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

Ward mortality after ICU discharge: a multicenter validation of the Sabadell score.

PubMed

Fernandez, Rafael; Serrano, Jose Manuel; Umaran, Isabel; Abizanda, Ricard; Carrillo, Andres; Lopez-Pueyo, Maria Jesus; Rascado, Pedro; Balerdi, Begoña; Suberviola, Borja; Hernandez, Gonzalo

2010-07-01

Tools for predicting post-ICU patients' outcomes are scarce. A single-center study showed that the Sabadell score classified patients into four groups with clear-cut differences in ward mortality. To validate the Sabadell score using a prospective multicenter approach. Thirty-one ICUs in Spain. All patients admitted in the 3-month study period. We recorded variables at ICU admission (age, sex, severity of illness, and do-not-resuscitate orders), during the ICU stay (ICU-specific treatments, ICU-acquired infection, and acute renal failure), and at ICU discharge (Sabadell score). Statistical analyses included one-way ANOVA and multiple regression analysis with ward mortality as the dependent variable. We admitted 4,132 patients (mean age 61.5 +/- 16.7 years) with mean predicted mortality of 23.8 +/- 22.7%; 545 patients (13%) died in the ICU and 3,587 (87%) were discharged to the ward. Overall ward mortality was 6.7%; ward mortality was 1.5% (36/2,422) in patients with score 0 (good prognosis), 9% (64/725) in patients with score 1 (long-term poor prognosis), 23% (79/341) in patients with score 2 (short-term poor prognosis), and 64% (63/99) in patients with score 3 (expected hospital death). Variables associated with ward mortality in the multivariate analysis were predicted risk of death (OR 1.016), ICU readmission (OR 5.9), Sabadell score 1 (OR 4.7), Sabadell score 2 (OR 15.7), and Sabadell score 3 (OR 107.2). We confirm the ability of the Sabadell score at ICU discharge to define four groups of patients with very different likelihoods of hospital survival.

Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff.

PubMed

Morrison, Cecily; Jones, Matthew; Blackwell, Alan; Vuylsteke, Alain

2008-01-01

Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record. A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round.

Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff

PubMed Central

Morrison, Cecily; Jones, Matthew; Blackwell, Alan; Vuylsteke, Alain

2008-01-01

Introduction Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medical record. Methods A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Results Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. Conclusions We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round. PMID:19025662

Factors impacting perceived safety among staff working on mental health wards

PubMed Central

Brown, Andrew; McCabe, Rhiannah; Rogerson, Michelle; Whittington, Richard

2017-01-01

Background Safety at work is a core issue for mental health staff working on in-patient units. At present, there is a limited theoretical base regarding which factors may affect staff perceptions of safety. Aims This study attempted to identify which factors affect perceived staff safety working on in-patient mental health wards. Method A cross-sectional design was employed across 101 forensic and non-forensic mental health wards, over seven National Health Service trusts nationally. Measures included an online staff survey, Ward Features Checklist and recorded incident data. Data were analysed using categorical principal components analysis and ordinal regression. Results Perceptions of staff safety were increased by ward brightness, higher number of patient beds, lower staff to patient ratios, less dayroom space and more urban views. Conclusions The findings from this study do not represent common-sense assumptions. Results are discussed in the context of the literature and may have implications for current initiatives aimed at managing in-patient violence and aggression. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license. PMID:28904814

Factors impacting perceived safety among staff working on mental health wards.

PubMed

Haines, Alina; Brown, Andrew; McCabe, Rhiannah; Rogerson, Michelle; Whittington, Richard

2017-09-01

Safety at work is a core issue for mental health staff working on in-patient units. At present, there is a limited theoretical base regarding which factors may affect staff perceptions of safety. This study attempted to identify which factors affect perceived staff safety working on in-patient mental health wards. A cross-sectional design was employed across 101 forensic and non-forensic mental health wards, over seven National Health Service trusts nationally. Measures included an online staff survey, Ward Features Checklist and recorded incident data. Data were analysed using categorical principal components analysis and ordinal regression. Perceptions of staff safety were increased by ward brightness, higher number of patient beds, lower staff to patient ratios, less dayroom space and more urban views. The findings from this study do not represent common-sense assumptions. Results are discussed in the context of the literature and may have implications for current initiatives aimed at managing in-patient violence and aggression. None. © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license.

Utility of Ward-Based Retinal Photography in Stroke Patients.

PubMed

Frost, Shaun; Brown, Michael; Stirling, Verity; Vignarajan, Janardhan; Prentice, David; Kanagasingam, Yogesan

2017-03-01

Improvements in acute care of stroke patients have decreased mortality, but survivors are still at increased risk of future vascular events and mitigation of this risk requires thorough assessment of the underlying factors leading to the stroke. The brain and eye share a common embryological origin and numerous similarities exist between the small vessels of the retina and brain. Recent population-based studies have demonstrated a close link between retinal vascular changes and stroke, suggesting that retinal photography could have utility in assessing underlying stroke risk factors and prognosis after stroke. Modern imaging equipment can facilitate precise measurement and monitoring of vascular features. However, use of this equipment is a challenge in the stroke ward setting as patients are frequently unable to maintain the required seated position, and pupil dilatation is often not feasible as it could potentially obscure important neurological signs of stroke progression. This small study investigated the utility of a novel handheld, nonmydriatic retinal camera in the stroke ward and explored associations between retinal vascular features and stroke risk factors. This camera circumvented the practical limitations of conducting retinal photography in the stroke ward setting. A positive correlation was found between carotid disease and both mean width of arterioles (r = .40, P = .00571) and venules (r = .30, P = .0381). The results provide further evidence that retinal vascular features are clinically informative about underlying stroke risk factors and demonstrate the utility of handheld retinal photography in the stroke ward. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review.

PubMed

Sarkies, Mitchell N; White, Jennifer; Henderson, Kate; Haas, Romi; Bowles, John

2018-06-18

Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35days (95% CI 0.45 to 4.24, I 2 =0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI -0.01 to 0.19, I 2 =0%), and health-related quality of life (SMD 0.10, 95% CI -0.01 to 0.20, I 2 =0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general

Henry Ward Beecher: A Nation's Tribune.

ERIC Educational Resources Information Center

Chandler, Daniel Ross

Henry Ward Beecher was America's most prominent 19th century liberal preacher and a major spokesperson for New England Transcendentalism. His philosophy integrated four fundamental themes: the creation of a moral code based on the internalization of values and peer group pressures, the establishment of the reform ideal of the impartial nonpartisan…

Aggression in Psychiatric Wards: Effect of the Use of a Structured Risk Assessment.

PubMed

Hvidhjelm, Jacob; Sestoft, Dorte; Skovgaard, Lene Theil; Rasmussen, Kirsten; Almvik, Roger; Bue Bjorner, Jakob

2016-12-01

Health care workers are often exposed to violence and aggression in psychiatric settings. Short-term risk assessments, such as the Brøset Violence Checklist (BVC), are strong predictors of such aggression and may enable staff to take preventive measures against aggression. This study evaluated whether the routine use of the BVC could reduce the frequency of patient aggression. We conducted a study with a semi-random regression discontinuity design in 15 psychiatric wards. Baseline aggression risk was assessed using the Aggression Observation Short Form (AOS) over three months. The BVC was implemented in seven intervention wards, and the risk of aggressive incidents over three months of follow-up was compared with the risk in eight control wards. The analysis was conducted at the ward level because each ward was allocated to the intervention and control groups. At baseline, the risk of aggression varied between wards, from one aggressive incident per patient per 1,000 shifts to 147 aggressive incidents per patient per 1,000 shifts. The regression discontinuity analysis found a 45% reduction in the risk of aggression (Odds Ratio (OR) = 0.55, 95% confidence interval: 0.21-1.43). The study did not find a significant reduction in the risk of aggression after implementing a systematic short-term risk assessment with the BVC. Although our findings suggest that use of the BVC may reduce the risk of aggression, the results need to be confirmed in studies with more statistical power.

[Willingness to implement mental health measures among small-scale enterprise employers in Ohta ward, Tokyo, Japan].

PubMed

Ikeda, Tomoko; Nakata, Akinori; Kobori, Shun-ichi; Hojo, Minoru; Sugishita, Chieko

2002-09-01

Due to the increase in mental health problems among Japanese workers in recent years, effective approaches to address these problems are of growing concern. Although such an effort is now under way in largescale enterprises (LSEs), small-scale enterprises (SSEs) are lagging behind LSEs for a number of reasons. In the present study, to know the reason, the presidents of 263 SSEs (fewer than 50 employees) in the Ohta ward of Tokyo were surveyed with a self-administered questionnaire from October 1999 to March 2000 (response rate, 51.0%). The main business types were manufacturing (71.2%), transportation & storage (6.1%), and construction (5.3%). The results revealed that employers attribute the mental health problems of employees to "Job content/Aptitude for job (78.6%)", "Communication among employees (71.0%)", "Physical problems/Illness (50.4%)", "Family problems (33.6%)". These results are very similar to those obtained in the same enterprises employees survey in 1996, suggesting that employers perceive the factors responsible for employees' mental health problems with substantial accuracy. Sixty-nine point five percent of the employers answered that they need mental health measures for employees. And 62.7% of employers agreed to take mental health measures in their enterprises. Taken together, it is considered that employers are willing to improve their employees' mental health problems. Nevertheless, 95% of employers are doing nothing to improve the situation. The major reasons cited were 1) Cannot obtain a consultant or counselor (44.8%), 2) Lack of time (43.1%), 3) Manpower shortage (41.4%), 4) Difficulty in ensuring employees' privacy (36.2%), and 5) Lack of financial resources (30.2%). The results of the present study suggest that perception of the mental health problems among employers and employees of SSEs in the Ohta area were close to each other. Effective strategies are needed to improve mental health problems in SSEs.

Identifying the nontechnical skills required of nurses in general surgical wards.

PubMed

Marshall, Dianne C; Finlayson, Mary P

2018-04-01

To identify the nontechnical skills (NTS) required of nurses in general surgical wards for safe and effective care. As the largest occupational group, nurses are in an ideal position to block the vulnerabilities of patient adverse events in a surgical ward. Previous studies in the surgical environment have identified the NTS required of nurses for safe care in operating rooms; however, these skills have not been identified for nurses in general surgical wards. A nonparticipant observational descriptive design was used. A purposive sample of 15 registered nurses was recruited from four surgical wards and observed for a full shift on a morning, afternoon or night shift. Nonparticipant observations were conducted using field notes to collect data. A coding frame was developed, and an inductive process was used to analyse the data. A taxonomy comprising seven NTS required of nurses in their roles in surgical ward teams emerged from the data analysis. They are communication, leadership and management, planning, decision-making, situation awareness, teamwork and patient advocacy. Patient care provided by general surgical nurses involved the seven identified key NTS. These particular NTS are an important component of safe nursing practice as they underpin the provision of safe and effective care for general surgical patients. Nurses block the trajectory of error by using NTS to address the vulnerabilities in the system that can lead to adverse patient events. Identifying general surgical nurses' NTS enables the development of teaching strategies that target the learning of those skills to achieve successful work outcomes and improve patient safety. © 2018 John Wiley & Sons Ltd.

Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium.

PubMed

De Gendt, Cindy; Bilsen, Johan; Vander Stichele, Robert; Lambert, Margareta; Den Noortgate, NeleVan; Deliens, Luc

2005-12-01

To describe the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium, and to compare it with the international situation. Structured mail questionnaires. All 94 acute geriatric wards in hospitals in Flanders in 2002 (the year Belgium voted a law on euthanasia). Head geriatricians. A questionnaire was mailed about the existence, development, and implementation of the DNR policy (guidelines and order forms), with a request to return copies of existing DNR guidelines and DNR order forms. The response was 76.6%, with hospital characteristics not significantly different for responders and nonresponders. Development of DNR policy began in 1985, with a step-up in 1997 and 2001. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. Geriatric wards in private hospitals implemented their policy later (P=.01) and more often had order forms (P=.04) than those in public hospitals. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions.

Correlation between large-scale atmospheric fields and the olive pollen season in Central Italy

NASA Astrophysics Data System (ADS)

Avolio, E.; Pasqualoni, L.; Federico, S.; Fornaciari, M.; Bonofiglio, T.; Orlandi, F.; Bellecci, C.; Romano, B.

2008-11-01

Olives are one of the largest crops in the Mediterranean and in central and southern Italy. This work investigates the correlation of the Olea europaea L. pollen season in Perugia, the capital city of the region of Umbria in central Italy, with atmospheric parameters. The aim of the study is twofold. First, we study the correlation between the pollen season and the surface air temperature of the spring and late spring in Perugia. Second, the correlation between the pollen season and large-scale atmospheric patterns is investigated. The average surface temperature in the spring and late spring has a clear impact on the pollen season in Perugia. Years with higher average temperatures have an earlier onset of the pollen season. In particular, a 1°C higher (lower) average surface temperature corresponds to an earlier (later) start of the pollen season of about 1 week. The correlation between the pollen season and large-scale atmospheric patterns of sea level pressure and 500-hPa geopotential height shows that the cyclonic activity in the Mediterranean is unequivocally tied to the pollen season in Perugia. A larger than average cyclonic activity in the Mediterranean Basin corresponds to a later than average pollen season. Larger than average cyclonic activity in Northern Europe and Siberia corresponds to an earlier than average pollen season. A possible explanation of this correlation, that needs further investigation to be proven, is given. These results can have a practical application by using the seasonal forecast of atmospheric general circulation models.

Supporting ward staff in acute care areas: the past, the present and the future?

PubMed

Coad, Sharon; Haines, Susan; Lawrence, Barbara

2002-01-01

Clinical education for acute ward staff caring for critically ill patients has continued to be a strong focus for practice development. Adopting a work-based learning approach to empower ward staff has led to the development of a five-day competency-based high dependency skills course. Developing leadership potential and enhancing networking opportunities for nurses from within critical care and ward areas is essential for the realisation of the aims of Comprehensive Critical Care.

The management pattern carried out in a cataract surgery day ward.

PubMed

Lin, Jing; Fang, Xiaoqun; Wu, Suhong

2013-06-01

To evaluate the management practice and process of a cataract surgery day ward. From January to December in 2012, a portion of the cataract patients were evaluated for the pattern of day ward management. Methods were as follows: 1) Establish the cataract day ward. 2) Enroll the patients who met the following criteria: voluntary, local residents or outsiders who stayed in a hotel near the hospital, accompanied by family, and who had simple senile cataract without any systemic major diseases. 3) Establish the hospitalization process. 4) Analyze the nursing process. After cataract day surgery, the patients were followed for 2 hours and completed a questionnaire about their needs and sentiments. A total of 3971 cases were observed in this study; 49 cases were switched to a normal pattern of hospitalization because of operative complications, 1 case had a strong desire to switch to a normal pattern of hospitalization because of ocular discomfort, 8 cases went back to the hospital for treatment because of ocular pain, and 52 cases called on the phone to seek help. Overall, 3820 cases(96.2%) returned on time the next day to visit the doctor. No patients showed severe postoperative complications and 98% expressed great satisfaction with the day ward process. Only 200 cases expressed great concern about not knowing how to deal with postoperative pain, the changes in condition outside the hospital, the therapeutic effects, and the problem of expense reimburse-ment. Day ward cataract surgery is an efficient and safe mode, and has the potential to relieve the demand for inpatient beds and to ensure timely treatment of the patients. In addition, it helps the patients enjoy health care at public expense, reserving reimbursement for those who need to be hospitalized. Nurses should pay more attention to systemic evaluation of the patients, health education, and psychological guidance, and keep in close communication with doctors, which is the key to ensure the safety of day ward

Continental-Scale Validation of Modis-Based and LEDAPS Landsat ETM + Atmospheric Correction Methods

NASA Technical Reports Server (NTRS)

Ju, Junchang; Roy, David P.; Vermote, Eric; Masek, Jeffrey; Kovalskyy, Valeriy

2012-01-01

The potential of Landsat data processing to provide systematic continental scale products has been demonstratedby several projects including the NASA Web-enabled Landsat Data (WELD) project. The recent freeavailability of Landsat data increases the need for robust and efficient atmospheric correction algorithms applicableto large volume Landsat data sets. This paper compares the accuracy of two Landsat atmospheric correctionmethods: a MODIS-based method and the Landsat Ecosystem Disturbance Adaptive ProcessingSystem (LEDAPS) method. Both methods are based on the 6SV radiative transfer code but have different atmosphericcharacterization approaches. The MODIS-based method uses the MODIS Terra derived dynamicaerosol type, aerosol optical thickness, and water vapor to atmospherically correct ETM+ acquisitions ineach coincident orbit. The LEDAPS method uses aerosol characterizations derived independently from eachLandsat acquisition and assumes a fixed continental aerosol type and uses ancillary water vapor. Validationresults are presented comparing ETM+ atmospherically corrected data generated using these two methodswith AERONET corrected ETM+ data for 95 10 km10 km 30 m subsets, a total of nearly 8 million 30 mpixels, located across the conterminous United States. The results indicate that the MODIS-based methodhas better accuracy than the LEDAPS method for the ETM+ red and longer wavelength bands.

A problem of hospital hygiene: the presence of aspergilli in hospital wards with different air-conditioning features.

PubMed

Perdelli, Fernanda; Sartini, Marina; Spagnolo, Anna Maria; Dallera, Maurizio; Lombardi, Roberto; Cristina, Maria Luisa

2006-06-01

A total of 1,030 microbiological samples were taken in 3 hospital wards with different air-conditioning features: no conditioning system (ward A), a conditioning system equipped with minimum efficiency reporting value (MERV) filters (ward B), and a conditioning system thoroughly maintained and equipped with high-efficiency particulate air (HEPA) filters (absolute) (ward C). The air in each ward was sampled, and the bacterial and fungal concentrations were determined by active and passive methods. The concentration of fungi on surfaces was also determined. Active sampling showed positive samples in wards A and B only, with average values of 0.50 colony-forming units (CFU)/m(3) (95% CI, 0.30 to 0.70) in A and 0.16 CFU/m(3) (95% CI, 0.13 to 0.20) in B. Passive sampling was positive only in ward A (mean, 0.14 CFU/cm(2)/h; 95% CI, 0.13 to 0.15). Aspergillus was found in 27% and 22% of sampled surfaces in wards A and B, respectively, but in no samples from ward C. The most commonly found species was A. fumigatus (76% of cases in A and 34% of cases in B). The results show that the use of air-conditioning systems markedly reduces the concentration of aspergilli in the environment. Proper maintenance of these systems is clearly fundamental if their efficacy is to be ensured.

Errors in fluid therapy in medical wards.

PubMed

Mousavi, Maryam; Khalili, Hossein; Dashti-Khavidaki, Simin

2012-04-01

Intravenous fluid therapy remains an essential part of patients' care during hospitalization. There are only few studies that focused on fluid therapy in the hospitalized patients, and there is not any consensus statement about fluid therapy in patients who are hospitalized in medical wards. The aim of the present study was to assess intravenous fluid therapy status and related errors in the patients during the course of hospitalization in the infectious diseases wards of a referral teaching hospital. This study was conducted in the infectious diseases wards of Imam Khomeini Complex Hospital, Tehran, Iran. During a retrospective study, data related to intravenous fluid therapy were collected by two clinical pharmacists of infectious diseases from 2008 to 2010. Intravenous fluid therapy information including indication, type, volume and rate of fluid administration was recorded for each patient. An internal protocol for intravenous fluid therapy was designed based on literature review and available recommendations. The data related to patients' fluid therapy were compared with this protocol. The fluid therapy was considered appropriate if it was compatible with the protocol regarding indication of intravenous fluid therapy, type, electrolyte content and rate of fluid administration. Any mistake in the selection of fluid type, content, volume and rate of administration was considered as intravenous fluid therapy errors. Five hundred and ninety-six of medication errors were detected during the study period in the patients. Overall rate of fluid therapy errors was 1.3 numbers per patient during hospitalization. Errors in the rate of fluid administration (29.8%), incorrect fluid volume calculation (26.5%) and incorrect type of fluid selection (24.6%) were the most common types of errors. The patients' male sex, old age, baseline renal diseases, diabetes co-morbidity, and hospitalization due to endocarditis, HIV infection and sepsis are predisposing factors for the

The Large-Scale Biosphere-Atmosphere Experiment in Amazonia: Analyzing Regional Land Use Change Effects.

Treesearch

Michael Keller; Maria Assunção Silva-Dias; Daniel C. Nepstad; Meinrat O. Andreae

2004-01-01

The Large-Scale Biosphere-Atmosphere Experiment in Amazonia (LBA) is a multi-disciplinary, multinational scientific project led by Brazil. LBA researchers seek to understand Amazonia in its global context especially with regard to regional and global climate. Current development activities in Amazonia including deforestation, logging, cattle ranching, and agriculture...

The long term recovery of heat and moisture fluxes to the atmosphere following fire in Australia's tropical savanna

NASA Astrophysics Data System (ADS)

Tapper, N.; Beringer, J.; Hutley, L.; Coutts, A.

2003-04-01

Fire is probably the greatest natural and anthropogenic environmental disturbance in Australia's tropical savannas, with the vast area burned each year (up to 250,000 km^2) likely to increase with predicted regional climate change. Globally savanna ecosystems cover 11.5% of the global landscape (Scholes and Hall 1996). As much as 75% of this landscape burns annually (Hao et al., 1990), accounting for more than 40% of all global biomass consumed (Hao and Ward 1993). These landscape-scale fires undoubtedly have massive impacts on regional water, energy and carbon dioxide exchanges and as a result may have important feedbacks to the atmosphere and regional climate. Fire may influence climate directly through the emission of smoke and trace gases from burning, but there are other important impacts of fire that may affect the atmosphere. Fire and the subsequent fire scars are likely to radically alter the surface energy budgets of tropical savannas through reduced surface albedo, increased available energy for partitioning into the convective fluxes, and increased substrate heat flux. The aerodynamic and biological properties of the ecosystem may also change, affecting surface-atmosphere coupling. There is a clear potential to influence atmospheric motion and moist convection at a range of scales. Potential fire scar impacts such as those mentioned above have previously been largely ignored and are the focus of the Savanna Fire Experiment (SAFE). Tower measurements of radiation, heat, moisture and CO_2 fluxes above burned and unburned savanna near Darwin, Australia, were initiated in August 2001 to observe the impacts of fire and fire scarring on flux exchange with the atmosphere, along with the longer term post-fire recovery of fluxes. Intensive field campaigns were mounted in the dry (fire) seasons of both 2001 and 2002, with flux recovery observed into the each of the subsequent monsoon seasons. Results and an early analysis of the time series of heat and moisture

Assessing the climate-scale variability of atmospheric rivers affecting western North America

NASA Astrophysics Data System (ADS)

Gershunov, Alexander; Shulgina, Tamara; Ralph, F. Martin; Lavers, David A.; Rutz, Jonathan J.

2017-08-01

A new method for automatic detection of atmospheric rivers (ARs) is developed and applied to an atmospheric reanalysis, yielding an extensive catalog of ARs land-falling along the west coast of North America during 1948-2017. This catalog provides a large array of variables that can be used to examine AR cases and their climate-scale variability in exceptional detail. The new record of AR activity, as presented, validated and examined here, provides a perspective on the seasonal cycle and the interannual-interdecadal variability of AR activity affecting the hydroclimate of western North America. Importantly, AR intensity does not exactly follow the climatological pattern of AR frequency. Strong links to hydroclimate are demonstrated using a high-resolution precipitation data set. We describe the seasonal progression of AR activity and diagnose linkages with climate variability expressed in Pacific sea surface temperatures, revealing links to Pacific decadal variability, recent regional anomalies, as well as a generally rising trend in land-falling AR activity. The latter trend is consistent with a long-term increase in vapor transport from the warming North Pacific onto the North American continent. The new catalog provides unprecedented opportunities to study the climate-scale behavior and predictability of ARs affecting western North America.

Doctors' and nurses' perceptions of a ward-based pharmacist in rural northern Sweden.

PubMed

Sjölander, Maria; Gustafsson, Maria; Gallego, Gisselle

2017-08-01

Background This project is part of the prospective quasi experimental proof-of-concept investigation of clinical pharmacist intervention study to reduce drug-related problems among people admitted to a ward in a rural hospital in northern Sweden. Objective To explore doctors' and nurses' perceptions and expectations of having a ward-based pharmacist providing clinical pharmacy services. Setting Medical ward in a rural hospital in northern Sweden. Method Eighteen face-to-face semi-structured interviews were conducted with a purposive sample of doctors and nurses working on the ward where the clinical pharmacy service was due to be implemented. Semi-structured interviews were digitally recorded, transcribed and analysed using thematic analysis. Main outcome measure Perceptions and expectations of nurses and doctors. Results Doctors and nurses had limited experience of working with pharmacists. Most had a vague idea of what pharmacists can contribute within a ward setting. Participants, mainly nurses, suggested inventory and drug distribution roles, but few were aware of the pharmacists' skills and clinical competence. Different views were expressed on whether the new clinical pharmacy service would have an impact on workload. However, most participants took a positive view of having a ward-based pharmacist. Conclusion This study provided an opportunity to explore doctors' and nurses' expectations of the role of clinical pharmacists before a clinical pharmacy service was implemented. To successfully implement a clinical pharmacy service, roles, clinical competence and responsibilities should be clearly described. Furthermore, it is important to focus on collaborative working relationships between doctors, nurses and pharmacists.

Active learning on the ward: outcomes from a comparative trial with traditional methods.

PubMed

Melo Prado, Hegla; Hannois Falbo, Gilliatt; Rodrigues Falbo, Ana; Natal Figueirôa, José

2011-03-01

Academic activity during internship is essentially practical and ward rounds are traditionally considered the cornerstone of clinical education. However, the efficacy and effectiveness of ward rounds for learning purposes have been under-investigated and it is necessary to assess alternative educational paradigms for this activity. This study aimed to compare the educational effectiveness of ward rounds conducted with two different learning methodologies. Student subjects were first tested on 30 true/false questions to assess their initial degree of knowledge on pneumonia and diarrhoea. Afterwards, they attended ward rounds conducted using an active and a traditional learning methodology. The participants were submitted to a second test 48hours later in order to assess knowledge acquisition and were asked to answer two questions about self-directed learning and their opinions on the two learning methodologies used. Seventy-two medical students taking part in a paediatric clinic rotation were enrolled. The active methodology proved to be more effective than the traditional methodology for the three outcomes considered: knowledge acquisition (33 students [45.8%] versus 21 students [29.2%]; p=0.03); self-directed learning (38 students [52.8%] versus 11 students [15.3%]; p<0.001), and student opinion on the methods (61 students [84.7%] versus 38 students [52.8%]; p<0.001). The active methodology produced better results than the traditional methodology in a ward-based context. This study seems to be valuable in terms of the new evidence it demonstrates on learning methodologies in the context of the ward round. © Blackwell Publishing Ltd 2011.

Scaling in situ cosmogenic nuclide production rates using analytical approximations to atmospheric cosmic-ray fluxes

NASA Astrophysics Data System (ADS)

Lifton, Nathaniel; Sato, Tatsuhiko; Dunai, Tibor J.

2014-01-01

Several models have been proposed for scaling in situ cosmogenic nuclide production rates from the relatively few sites where they have been measured to other sites of interest. Two main types of models are recognized: (1) those based on data from nuclear disintegrations in photographic emulsions combined with various neutron detectors, and (2) those based largely on neutron monitor data. However, stubborn discrepancies between these model types have led to frequent confusion when calculating surface exposure ages from production rates derived from the models. To help resolve these discrepancies and identify the sources of potential biases in each model, we have developed a new scaling model based on analytical approximations to modeled fluxes of the main atmospheric cosmic-ray particles responsible for in situ cosmogenic nuclide production. Both the analytical formulations and the Monte Carlo model fluxes on which they are based agree well with measured atmospheric fluxes of neutrons, protons, and muons, indicating they can serve as a robust estimate of the atmospheric cosmic-ray flux based on first principles. We are also using updated records for quantifying temporal and spatial variability in geomagnetic and solar modulation effects on the fluxes. A key advantage of this new model (herein termed LSD) over previous Monte Carlo models of cosmogenic nuclide production is that it allows for faster estimation of scaling factors based on time-varying geomagnetic and solar inputs. Comparing scaling predictions derived from the LSD model with those of previously published models suggest potential sources of bias in the latter can be largely attributed to two factors: different energy responses of the secondary neutron detectors used in developing the models, and different geomagnetic parameterizations. Given that the LSD model generates flux spectra for each cosmic-ray particle of interest, it is also relatively straightforward to generate nuclide-specific scaling

[Project to improve abdominal obesity in day care ward psychiatric patients].

PubMed

Liu, Yu-Chieh; Wang, Hui-Yu; Huang, Hui-Ling; Chen, Min-Li

2011-06-01

Over half (57.14%) of patients in our ward suffer from abdominal obesity. This rate is on a continuing upward trend. Reasons for such obesity include lack of physical activity classes, inadequate physical activity, high calorie diets and unhealthy eating habits, chronic diseases and drug side effects, poor motivation to reduce weight, and lack of crisis awareness of abdominal obesity. This project was designed to lessen the problem of abdominal obesity among psychiatric day care inpatients. Resolution measures implemented included: (1) arranging aerobic exercise classes; (2) scheduling classes to teach patients healthy diet habits and knowledge regarding diseases and drugs; (3) holding a waistline reduction competition; (4) displaying health education bulletin boards; (5) holding a quiz contest with prizes for correct answers. The eight abdominally obese patients in the ward achieved an average waist circumference reduction of 2.9 cm and the overall abdominal obesity rate in the ward fell to 35.7%. BMI, eating habits, and awareness of weight loss importance and motivation all improved. The outcome achieved targeted project objectives. We recommend the integration of obesity prevention into routine ward activities and quality control indicators. Nurses should provide patients with weight loss concepts, regularly monitor risk factors, and encourage patient family cooperation to maintain medical care quality.

[Do-not-resuscitate policy on acute geriatric wards in Flanders, Belgium].

PubMed

De Gendt, C; Bilsen, J; Vander Stichele, R; Lambert, M; Van Den Noortgate, N; Deliens, L

2007-10-01

This study describes the historical development and status of a do-not-resuscitate (DNR) policy on acute geriatric wards in Flanders, Belgium. In 2002 (the year Belgium voted a law on euthanasia), a structured mail questionnaire was sent to all head geriatricians of acute geriatric wards in Flanders (N=94). Respondents were asked about the existence, development, and implementation of the DNR policy (guidelines and order forms). The response was 76.6%. Development of DNR policy began in 1985, with a step-up in 1997 and 200l. In 2002, a DNR policy was available in 86.1% of geriatric wards, predominantly with institutional DNR guidelines and individual, patient-specific DNR order forms. The policy was initiated and developed predominantly from an institutional perspective by the hospital. The forms were not standardized and generally lacked room to document patient involvement in the decision making process. Implementation of institutional DNR guidelines and individual DNR order forms on geriatric wards in Flanders lagged behind that of other countries and was still incomplete in 2002. DNR policies varied in content and scope and were predominantly an expression of institutional defensive attitudes rather than a tool to promote patient involvement in DNR and other end-of-life decisions.

Uncovering paradoxes from physicians' experiences of patient-centered ward-round.

PubMed

Bååthe, Fredrik; Ahlborg, Gunnar; Edgren, Lars; Lagström, Annica; Nilsson, Kerstin

2016-05-03

Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement.

Acceptance of the 2009 Henry Baldwin Ward Medal: The accidental parasitologist

USGS Publications Warehouse

Lafferty, Kevin D.

2009-01-01

Members of the Society, President Conn, colleagues, friends, and particularly students, the Ward Medal recipient, from Clarke Read onward, traditionally recounts how their career was shaped. A decade ago, in a crumbling Kona hotel, the ASP's own tattooed lady, Janine Caira, opened her Ward Medal address with: “To all future Ward Medalists, many of whom I trust are sitting in the audience out there today, I say: savor the moment! You have no idea how much easier it is to be sitting out there where you are than standing up here where I am” (Caira 1998). I certainly didn't imagine that Janine was delivering her advice to me and it is presumptuous to imagine my story is a template for shaping a career. As the title of my talk indicates, it was an accident.

Costs of terminal patients who receive palliative care or usual care in different hospital wards.

PubMed

Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

2010-11-01

In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

Patients' approaches to students' learning at a clinical education ward--an ethnographic study.

PubMed

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silén, Charlotte

2014-07-02

It is well known that patients' involvement in health care students' learning is essential and gives students opportunities to experience clinical reasoning and practice clinical skills when interacting with patients. Students encounter patients in different contexts throughout their education. However, looking across the research providing evidence about learning related to patient-student encounters reveals a lack of knowledge about the actual learning process that occurs in encounters between patients and students. The aim of this study was to explore patient-student encounters in relation to students' learning in a patient-centered health-care setting. An ethnographic approach was used to study the encounters between patients and students. The setting was a clinical education ward for nursing students at a university hospital with eight beds. The study included 10 observations with 11 students and 10 patients. The observer followed one or two students taking care of one patient. During the fieldwork observational and reflective notes were taken. After each observation follow-up interviews were conducted with each patient and student separately. Data were analyzed using an ethnographic approach. The most striking results showed that patients took different approaches in the encounters with students. When the students managed to create a good atmosphere and a mutual relationship, the patients were active participants in the students' learning. If the students did not manage to create a good atmosphere, the relationship became one-way and the patients were passive participants, letting the students practice on their bodies but without engaging in a dialogue with the students. Patient-student encounters, at a clinical education ward with a patient-centred pedagogical framework, can develop into either a learning relationship or an attending relationship. A learning relationship is based on a mutual relationship between patients and students resulting in patients

Large-Scale Atmospheric Teleconnection Patterns Associated with the Interannual Variability of Heatwaves in East Asia and Its Decadal Changes

NASA Astrophysics Data System (ADS)

Choi, N.; Lee, M. I.; Lim, Y. K.; Kim, K. M.

2017-12-01

Heatwave is an extreme hot weather event which accompanies fatal damage to human health. The heatwave has a strong relationship with the large-scale atmospheric teleconnection patterns. In this study, we examine the spatial pattern of heatwave in East Asia by using the EOF analysis and the relationship between heatwave frequency and large-scale atmospheric teleconnection patterns. We also separate the time scale of heatwave frequency as the time scale longer than a decade and the interannual time scale. The long-term variation of heatwave frequency in East Asia shows a linkage with the sea surface temperature (SST) variability over the North Atlantic with a decadal time scale (a.k.a. the Atlantic Multidecadal Oscillation; AMO). On the other hands, the interannual variation of heatwave frequency is linked with the two dominant spatial patterns associated with the large-scale teleconnection patterns mimicking the Scandinavian teleconnection (SCAND-like) pattern and the circumglobal teleconnection (CGT-like) pattern, respectively. It is highlighted that the interannual variation of heatwave frequency in East Asia shows a remarkable change after mid-1990s. While the heatwave frequency was mainly associated with the CGT-like pattern before mid-1990s, the SCAND-like pattern becomes the most dominant one after mid-1990s, making the CGT-like pattern as the second. This study implies that the large-scale atmospheric teleconnection patterns play a key role in developing heatwave events in East Asia. This study further discusses possible mechanisms for the decadal change in the linkage between heatwave frequency and the large-scale teleconnection patterns in East Asia such as early melting of snow cover and/or weakening of East Asian jet stream due to global warming.

The nature of large-scale turbulence in the Jovian atmosphere

NASA Technical Reports Server (NTRS)

Mitchell, J. L.

1982-01-01

The energetics and spectral characteristis of quasi-geostrophic turbulence in Jupiter's atmosphere are examined using sequences of Voyager images and infrared temperature soundings. Using global wind measurements momentum transports associated with zonally symmetric stresses and turbulent stresses are quantified. Though a strong up-gradient flux of momentum by eddies was observed, measurements do not preclude the possibility that symmetric stresses play a critical role in maintaining the mean zonal circulation. Strong correlation between the observed meridional distribution of eddy-scale kinetic energy and available potential energy suggests coupling between the observed cloudtop turbulent motions and the upper tropospheric thermodynamics. An Oort energy budget for Jupiter's upper troposphere is formulated.

Effects of a finite outer scale on the measurement of atmospheric-turbulence statistics with a Hartmann wave-front sensor.

PubMed

Feng, Shen; Wenhan, Jiang

2002-06-10

Phase-structure and aperture-averaged slope-correlated functions with a finite outer scale are derived based on the Taylor hypothesis and a generalized spectrum, such as the von Kármán modal. The effects of the finite outer scale on measuring and determining the character of atmospheric-turbulence statistics are shown especially for an approximately 4-m class telescope and subaperture. The phase structure function and atmospheric coherent length based on the Kolmogorov model are approximations of the formalism we have derived. The analysis shows that it cannot be determined whether the deviation from the power-law parameter of Kolmogorov turbulence is caused by real variations of the spectrum or by the effect of the finite outer scale.

Large-Scale, Extratropical Weather Systems within Mars' Atmosphere

NASA Astrophysics Data System (ADS)

Hollingsworth, Jeffery L.

2013-04-01

During late autumn through early spring, extratropical regions on Mars exhibit profound mean zonal equator-to-pole thermal contrasts. The imposition of this strong meridional temperature variation supports intense eastward-traveling, synoptic weather systems (i.e., transient baroclinic/barotropic waves) within Mars' extratropical atmosphere. Such disturbances grow, mature and decay within the east-west varying seasonal-mean midlatitude jet stream (i.e., the polar vortex) on the planet. Near the surface, the weather disturbances indicated large-scale spiraling "comma"-shaped dust cloud structures and scimitar-shaped dust fronts, indicative of processes associated with cyclo-/fronto-genesis. The weather systems occur during specific seasons on Mars, and in both hemispheres. The northern hemisphere (NH) disturbances are significantly more intense than their counterparts in the southern hemisphere (SH). Further, the NH weather systems and accompanying frontal waves appear to have significant impacts on the transport of tracer fields (e.g., particularly dust and to some extent water species (vapor/ice) as well). And regarding dust, frontal waves appear to be key agents in the lifting, lofting, organization and transport of this particular atmospheric aerosol. In this paper, a brief background and supporting observations of Mars' extratropical weather systems is presented. This is followed by a short review of the theory and various modeling studies (i.e., ranging from highly simplified, mechanistic and full global circulation modeling investigations) which have been pursued. Finally, a discussion of outstanding issues and questions regarding the character and nature of Mars' extratropical traveling weather systems is offered.

Large-Scale Extratropical Weather Systems in Mars' Atmosphere

NASA Technical Reports Server (NTRS)

Hollingsworth, Jeffery L.

2013-01-01

During late autumn through early spring, extratropical regions on Mars exhibit profound mean zonal equator-to-pole thermal contrasts. The imposition of this strong meridional temperature variation supports intense eastward-traveling, synoptic weather systems (i.e., transient baroclinic/barotropic waves) within Mars' extratropical atmosphere. Such disturbances grow, mature and decay within the east-west varying seasonal-mean midlatitude jet stream (i.e., the polar vortex) on the planet. Near the surface, the weather disturbances indicated large-scale spiraling "comma"-shaped dust cloud structures and scimitar-shaped dust fronts, indicative of processes associated with cyclo-/fronto-genesis. The weather systems occur during specific seasons on Mars, and in both hemispheres. The northern hemisphere (NH) disturbances are significantly more intense than their counterparts in the southern hemisphere (SH). Further, the NH weather systems and accompanying frontal waves appear to have significant impacts on the transport of tracer fields (e.g., particularly dust and to some extent water species (vapor/ice) as well). And regarding dust, frontal waves appear to be key agents in the lifting, lofting, organization and transport of this particular atmospheric aerosol. In this paper, a brief background and supporting observations of Mars' extratropical weather systems is presented. This is followed by a short review of the theory and various modeling studies (i.e., ranging from highly simplified, mechanistic and full global circulation modeling investigations) which have been pursued. Finally, a discussion of outstanding issues and questions regarding the character and nature of Mars' extratropical traveling weather systems is offered.

Large-scale variations in observed Antarctic Sea ice extent and associated atmospheric circulation

NASA Technical Reports Server (NTRS)

Cavalieri, D. J.; Parkinson, C. L.

1981-01-01

The 1974 Antarctic large scale sea ice extent is studied from data from Nimbus 2 and 5 and temperature and sea level pressure fields from the Australian Meteorological Data Set. Electrically Scanning Microwave Radiometer data were three-day averaged and compared with 1000 mbar atmospheric pressure and sea level pressure data, also in three-day averages. Each three-day period was subjected to a Fourier analysis and included the mean latitude of the ice extent and the phases and percent variances in terms of the first six Fourier harmonics. Centers of low pressure were found to be generally east of regions which displayed rapid ice growth, and winds acted to extend the ice equatorward. An atmospheric response was also noted as caused by the changing ice cover.

Large-scale pollution of the atmosphere over the remote Atlantic Ocean: Evidence from Bermuda

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

Dickerson, R.R.; Doddridge, B.G.; Kelley, P.

1995-05-20

Ozone acts as a greenhouse gas and controls much of the oxidizing capacity of the atmosphere. Photochemical production of ozone in urban areas (smog) is a serious environmental problem, but how far this process extends on regional or global scales remains a major unanswered question in atmospheric science. In summer, Bermuda basks in pristine marine air, but in spring, episodes of high ozone are common. From meteorological analyses and observation of ozone, carbon monoxide, and reactive nitrogen compounds, the authors conclude that half or more of the excess ozone in Bermuda originates from air pollution over eastern North America. 50more » refs., 7 figs., 2 tabs.« less

A ward round proforma improves documentation and communication.

PubMed

Alazzawi, Sulaiman; Silk, Zacharia; Saha, Urmila U; Auplish, Sunil; Masterson, Sean

2016-12-02

This article present the results of an audit cycle which evaluated the quality of inpatient ward round documentation in a busy district general hospital before and after the implementation of a standardized proforma which was specifically designed for trauma and orthopaedic patients. In each cycle, 20 case notes were examined and the data analysed to examine three main areas: Diagnosis, management and/or discharge plan Objective assessments including neurovascular status, weight-bearing status, surgical wound review, observations, results of investigations and decision from the daily trauma meeting Logistics of the documentation such as legibility, date and time, name and grade of the doctor and contact number. This audit demonstrated that using a ward round proforma can significantly enhance the quality of documentation and improve communication between multidisciplinary team members.

The effect of atmospheric variability at intra-seasonal time scale on the SST of the Southwestern Atlantic Continental Shelf

NASA Astrophysics Data System (ADS)

Simionato, Claudia; Clara, Moira Luz; Jaureguizar, Andrés

2017-04-01

The Southwestern Atlantic Continental Shelf is characterized by large SST variability which origin remains unknown. In this work, we use blended SST data provided by NOAA CoastWatch Program, which combine the information coming from infrared and microwave sensors to provide daily images of an intermediate spatial resolution (11 km) with a noise floor of less than 0.2 °C. The data base starts at the middle of 2002, when an increase in signal variance is observed due to the fact that the Advanced Microwave Scanning Radiometer became available and as a consequence to its near all-weather coverage. Several years of observations are thus available, and even though the temporal and spatial resolution of these data is intermediate, they are reasonable for observing and characterizing the most significant patterns of SST variability in the (atmospheric) synoptic to intra-seasonal time scales, so as to help on understanding the physical processes which occur in the area and their forcing mechanisms. As we hypothesize that most of the variability in those time scales is wind forced, the study is complemented with the use of atmospheric observations -coming from remote sensing and reanalysis-. To perform the analysis, the long-term trend, inter-annual and seasonal variability are subtracted to the SST data to obtain the signal on intra-seasonal time scales. Then, Principal Components (EOF) analysis is applied to the data and composites of SST and several meteorological variables (wind, sea level pressure, air temperature, OLR, etc.) are computed for the days when the leading modes are active. It is found that the first three modes account for more than 70% of the variance. Modes 1 and 2 seem to be related to atmospheric waves generated in the tropical Pacific. Those waves, through atmospheric teleconnections, affect the SST on the southwestern South Atlantic Continental Shelf very rapidly. The oceanic anomalies exceed 0.7°C and are quite persistent. Mode 2 seems to be

Images of recovery: a photo-elicitation study on the hospital ward.

PubMed

Radley, Alan; Taylor, Diane

2003-01-01

The authors attempted to discover the part the physical setting of the ward plays in patients' recovery by asking patients to take photographs of their ward, its spaces and objects, and then interviewing them about these images in hospital and subsequently in their homes. Photography allowed the patients to identify and capture aspects of the setting that they found salient and provided the photo-elicitation material for the interviews. Based on these data, the authors present (a) a critical discussion of the use of photography as method and its implications for qualitative analysis, (b) an overview of the kinds of image taken with respect to the ward and the course of patients' recovery, and (c) a theoretical analysis, employing Walter Benjamin's use of the concept of mimesis, that understands recovery as a bodily act in response to the shock to the senses that hospitalization and surgery produce.

Safewards: a new model of conflict and containment on psychiatric wards

PubMed Central

Bowers, L

2014-01-01

Accessible summary Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff. Abstract Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting

Outside the operating room: How a robotics program changed resource utilization on the inpatient Ward.

PubMed

Leung, Annie; Abitbol, Jeremie; Ramana-Kumar, Agnihotram V; Fadlallah, Bassam; Kessous, Roy; Cohen, Sabine; Lau, Susie; Salvador, Shannon; Gotlieb, Walter H

2017-04-01

To analyze the changes in the composition of the gynecologic oncology inpatient ward following the implementation of a robotic surgery program and its impact on inpatient resource utilization and costs. Retrospective review of the medical charts of patients admitted onto the gynecologic oncology ward the year prior to and five years after the implementation of robotics. The following variables were collected: patient characteristics, hospitalization details (reason for admission and length of hospital stay), and resource utilization (number of hospitalization days, consultations, and imaging). Following the introduction of robotic surgery, there were more admissions for elective surgery yet these accounted for only 21% of the inpatient ward in terms of number of hospital days, compared to 36% prior to the robotic program. This coincided with a sharp increase in the overall number of patients operated on by a minimally invasive approach (15% to 76%, p<0.0001). The cost per surgical admission on the inpatient ward decreased by 59% ($9827 vs. $4058) in the robotics era. The robotics program contributed to a ward with higher proportion of patients with complex comorbidities (Charlson≥5: RR 1.06), Stage IV disease (RR 1.30), and recurrent disease (RR 1.99). Introduction of robotic surgery allowed for more patients to be treated surgically while simultaneously decreasing inpatient resource use. With more patients with non-surgical oncological issues and greater medical complexity, the gynecologic oncology ward functions more like a medical rather than surgical ward after the introduction of robotics, which has implications for hospital-wide resource planning. Copyright © 2017 Elsevier Inc. All rights reserved.

Obeying patient's rights on the basis of maternity ward.

PubMed

Leszczyńska, K; Dymczyk, K; Wac, K; Krajewska, K

2005-01-01

This work is an attempt to evaluate the extent of knowledge concerning patient's rights and chances to execute these rights in everyday hospital reality. We have collected opinions of the patients from the maternity ward of Independent Central Public Clinical Hospital of Medical University of Silesia in Katowice. We also interested in participation of medical staff in respecting and realization of patient's rights it has become the main objective of this work. To collect the patient's opinions we used a specially prepared questionnaire which has measured obeying patient's rights in the following aspects: the rights to make decisions, the rights to information including the right to inspect medical data, the right to respect privacy and dignity, the right to treatment and care, the right to be in touch with relatives, the right the priest's care, the rights to file a complaint, the right to obey patient's rights. Patient's rights in a delivery room and a maternity ward are not respected to a satisfactory extent which is confirmed by the research results. During the hospitalization the patients aren't informed and they do not acquire almost any knowledge concerning their rights. The patient staying in a maternity ward is in most cases only a passive receiver of medical service.

An experimental ward. Improving care and learning.

PubMed

Ronan, L; Stoeckle, J D

1992-01-01

The rapidly changing health care system is still largely organized according to old, and increasingly outdated models. The contemporary demands of patient care and residency training call for an experimental ward, which can develop and test new techniques in hospital organization and the delivery of care in a comprehensive way.

REGIONAL-SCALE ATMOSPHERIC MERCURY MODELING

EPA Science Inventory

This PowerPoint presentation gives a short synopsis of the state of the science of atmospheric mercury modeling, including a description of recent publications of model codes by EPA, a description of a recent mercury model intercomparison study, and a description of a synthesis p...

Post natal use of analgesics: comparisons between conventional postnatal wards and a maternity hotel.

PubMed

Nordeng, Hedvig; Eskild, Anne; Nesheim, Britt-Ingjerd

2010-04-01

To investigate factors related to analgesic use after delivery, and especially whether rates of analgesic use were different in a midwife-managed maternity hotel as compared to conventional postnatal wards. One maternity hotel and two conventional postnatal wards at Ullevål University Hospital in Oslo, Norway. Data were obtained from hospital records for 804 women with vaginal deliveries. Postnatal analgesic use. Overall, approximately half the women used analgesics after vaginal delivery in both conventional postnatal wards and maternity hotel. The factors that were significantly associated with use of analgesics postnatally in multivariate analysis were multiparity, having a non-Western ethnicity, smoking in pregnancy, younger age, instrumental delivery, analgesic use during labour, maternal complications post partum, and duration of postnatal stay 4 days or more. The use of analgesics is determined by socio-demographic and obstetric factors rather than the organisation of the ward.

Parameterization and scaling of Arctic ice conditions in the context of ice-atmosphere processes

NASA Technical Reports Server (NTRS)

Barry, R. G.; Heinrichs, J.; Steffen, K.; Maslanik, J. A.; Key, J.; Serreze, M. C.; Weaver, R. W.

1994-01-01

This report summarizes achievements during year three of our project to investigate the use of ERS-1 SAR data to study Arctic ice and ice/atmosphere processes. The project was granted a one year extension, and goals for the final year are outlined. The specific objects of the project are to determine how the development and evolution of open water/thin ice areas within the interior ice pack vary under different atmospheric synoptic regimes; compare how open water/thin ice fractions estimated from large-area divergence measurements differ from fractions determined by summing localized openings in the pack; relate these questions of scale and process to methods of observation, modeling, and averaging over time and space; determine whether SAR data might be used to calibrate ice concentration estimates from medium and low-rate bit sensors (AVHRR and DMSP-OLS) and the special sensor microwave imager (SSM/I); and investigate methods to integrate SAR data for turbulent heat flux parametrization at the atmosphere interface with other satellite data.

The cleaning of ward floors and the bacteriological study of floor-cleaning machines

PubMed Central

Bate, J. G.

1961-01-01

Current trends in ward flooring materials and cleaning methods are considered from the point of view of the hospital bacteriologist. Methods employed in an investigation into the bacteriological safety of a number of floor-cleaning machines are described, and some considerations governing the choice of vacuum cleaners for ward use are discussed. Images PMID:13687726

Atmospheric conditions measured by a wireless sensor network on the local scale

NASA Astrophysics Data System (ADS)

Lengfeld, K.; Ament, F.

2010-09-01

Atmospheric conditions close to the surface, like temperature, wind speed and humidity, vary on small scales because of surface heterogeneities. Therefore, the traditional measuring approach of using a single, highly accurate station is of limited representativeness for a larger domain, because it is not able to determine these small scale variabilities. However, both the variability and the domain averages are important information for the development and validation of atmospheric models and soil-vegetation-atmosphere-transfer (SVAT) schemes. Due to progress in microelectronics it is possible to construct networks of comparably cheap meteorological stations with moderate accuracy. Such a network provides data in high spatial and temporal resolution. The EPFL Lausanne developed such a network called SensorScope, consisting of low cost autonomous stations. Each station observes air and surface temperature, humidity, wind direction and speed, incoming solar radiation, precipitation, soil moisture and soil temperature and sends the data via radio communication to a base station. This base station forwards the collected data via GSM/GPRS to a central server. The first measuring campaign took place within the FLUXPAT project in August 2009. We deployed 15 stations as a twin transect near Jülich, Germany. To test the quality of the low cost sensors we compared two of them to more accurate reference systems. It turned out, that although the network sensors are not highly accurate, the measurements are consistent. Consequently an analysis of the pattern of atmospheric conditions is feasible. The transect is 2.3 km long and covers different types of vegetation and a small river. Therefore, we analyse the influence of different land surfaces and the distance to the river on meteorological conditions. For example, we found a difference in air temperature of 0.8°C between the station closest to and the station farthest from the river. The decreasing relative humidity with

Numerical simulation of small-scale thermal convection in the atmosphere

NASA Technical Reports Server (NTRS)

Somerville, R. C. J.

1973-01-01

A Boussinesq system is integrated numerically in three dimensions and time in a study of nonhydrostatic convection in the atmosphere. Simulation of cloud convection is achieved by the inclusion of parametrized effects of latent heat and small-scale turbulence. The results are compared with the cell structure observed in Rayleigh-Benard laboratory conversion experiments in air. At a Rayleigh number of 4000, the numerical model adequately simulates the experimentally observed evolution, including some prominent transients of a flow from a randomly perturbed initial conductive state into the final state of steady large-amplitude two-dimensional rolls. At Rayleigh number 9000, the model reproduces the experimentally observed unsteady equilibrium of vertically coherent oscillatory waves superimposed on rolls.

Patient and visitor violence towards staff on medical and psychiatric wards in India.

PubMed

Raveesh, B N; Lepping, Peter; Lanka, Sri V K; Turner, Jim; Krishna, Murali

2015-02-01

Patient and visitor violence (PVV) towards staff is common across health settings. It has negative effects on staff and treatment provision. Little data is available from the developing world. To examine the prevalence of PVV in India and make comparisons with the existing data. We administered an abbreviated version of the Survey of Violence Experienced by Staff (SOVES-A) in English in Mysore on medical and psychiatric wards. 249 staff participated. 16% of staff in psychiatric wards were subjected to some form of PVV in the past 4 weeks which is lower than in the developed world. 57% of staff on medical wards experienced PVV which is similar to the developed world. Patients and Visitors were almost equal sources of this violence. Verbal abuse was more common than threats and physical assaults. Training in aggression management may be a protective factor. PVV is a significant problem in India, especially on medical wards. Aggression management training may be a way to reduce the prevalence of PVV. Copyright © 2014 Elsevier B.V. All rights reserved.

Occurrence of airborne vancomycin- and gentamicin-resistant bacteria in various hospital wards in Isfahan, Iran

PubMed Central

Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmad, Hossein; Hassanzadeh, Akbar

2016-01-01

Background: Airborne transmission of pathogenic resistant bacteria is well recognized as an important route for the acquisition of a wide range of nosocomial infections in hospitals. The aim of this study was to determine the prevalence of airborne vancomycin and gentamicin (VM and GM) resistant bacteria in different wards of four educational hospitals. Materials and Methods: A total of 64 air samples were collected from operating theater (OT), Intensive Care Unit (ICU), surgery ward, and internal medicine ward of four educational hospitals in Isfahan, Iran. Airborne culturable bacteria were collected using all glass impingers. Samples were analyzed for the detection of VM- and GM-resistant bacteria. Results: The average level of bacteria ranged from 99 to 1079 CFU/m3. The highest level of airborne bacteria was observed in hospital 4 (628 CFU/m3) and the highest average concentration of GM- and VM-resistant airborne bacteria were found in hospital 3 (22 CFU/m3). The mean concentration of airborne bacteria was the lowest in OT wards and GM- and VM-resistant airborne bacteria were not detected in this ward of hospitals. The highest prevalence of antibiotic-resistant airborne bacteria was observed in ICU ward. There was a statistically significant difference for the prevalence of VM-resistant bacteria between hospital wards (P = 0.012). Conclusion: Our finding showed that the relatively high prevalence of VM- and GM-resistant airborne bacteria in ICUs could be a great concern from the point of view of patients' health. These results confirm the necessity of application of effective control measures which significantly decrease the exposure of high-risk patients to potentially airborne nosocomial infections. PMID:27656612

Occurrence of airborne vancomycin- and gentamicin-resistant bacteria in various hospital wards in Isfahan, Iran.

PubMed

Mirhoseini, Seyed Hamed; Nikaeen, Mahnaz; Khanahmad, Hossein; Hassanzadeh, Akbar

2016-01-01

Airborne transmission of pathogenic resistant bacteria is well recognized as an important route for the acquisition of a wide range of nosocomial infections in hospitals. The aim of this study was to determine the prevalence of airborne vancomycin and gentamicin (VM and GM) resistant bacteria in different wards of four educational hospitals. A total of 64 air samples were collected from operating theater (OT), Intensive Care Unit (ICU), surgery ward, and internal medicine ward of four educational hospitals in Isfahan, Iran. Airborne culturable bacteria were collected using all glass impingers. Samples were analyzed for the detection of VM- and GM-resistant bacteria. The average level of bacteria ranged from 99 to 1079 CFU/m(3). The highest level of airborne bacteria was observed in hospital 4 (628 CFU/m(3)) and the highest average concentration of GM- and VM-resistant airborne bacteria were found in hospital 3 (22 CFU/m(3)). The mean concentration of airborne bacteria was the lowest in OT wards and GM- and VM-resistant airborne bacteria were not detected in this ward of hospitals. The highest prevalence of antibiotic-resistant airborne bacteria was observed in ICU ward. There was a statistically significant difference for the prevalence of VM-resistant bacteria between hospital wards (P = 0.012). Our finding showed that the relatively high prevalence of VM- and GM-resistant airborne bacteria in ICUs could be a great concern from the point of view of patients' health. These results confirm the necessity of application of effective control measures which significantly decrease the exposure of high-risk patients to potentially airborne nosocomial infections.

Challenges of Obtaining Informed Consent in Emergency Ward: A Qualitative Study in One Iranian Hospital

PubMed Central

Davoudi, Nayyereh; Nayeri, Nahid Dehghan; Zokaei, Mohammad Saeed; Fazeli, Nematallah

2017-01-01

Background and Objective: Regarding the fact that emergency ward has unique characteristics, whose uniqueness affects informed consent processes by creating specific challenges. Hence, it seems necessary to identify the process and challenges of informed consent in the emergency ward through a qualitative study to understand actual patients’ and health care providers’ experiences, beliefs, values, and feelings about the informed consent in the emergency ward. Through such studies, new insight can be gained on the process of informed consent and its challenges with the hope that the resulting knowledge will enable the promotion of ethical, legal as well as effective health services to the patients in the emergency ward. Method: In this qualitative study, research field was one of the emergency wards of educational and public hospitals in Iran. Field work and participant observation were carried out for 515 hours from June 2014 to March 2016. Also, conversations and semi-structured interviews based on the observations were conducted. The participants of the study were nurses and physicians working in the emergency ward, as well as patients and their attendants who were involved in the process of obtaining informed consent. Results: Three main categories were extracted from the data: a sense of frustration; reverse protection; and culture of paternalism in consent process. Conclusion: Findings of this study can be utilized in correcting the structures and processes of obtaining informed consent together with promotion of patients' ethical and legal care in emergency ward. In this way, the approaches in consent process will be changed from paternalistic approach to patient-centered care which concomitantly protects patient’s autonomy. PMID:29399235

Theoretical and global scale model studies of the atmospheric sulfur/aerosol system

NASA Technical Reports Server (NTRS)

Kasibhatla, Prasad

1996-01-01

The primary focus during the third-phase of our on-going multi-year research effort has been on 3 activities. These are: (1) a global-scale model study of the anthropogenic component of the tropospheric sulfur cycle; (2) process-scale model studies of the factors influencing the distribution of aerosols in the remote marine atmosphere; and (3) an investigation of the mechanism of the OH-initiated oxidation of DMS in the remote marine boundary layer. In this paper, we describe in more detail our research activities in each of these areas. A major portion of our activities during the fourth and final phase of this project will involve the preparation and submission of manuscripts describing the results from our model studies of marine boundary-layer aerosols and DMS-oxidation mechanisms.

Limits of Freedom: The Ward Churchill Case

ERIC Educational Resources Information Center

O'Nell, Robert M.

2006-01-01

The University of Colorado's Ward Churchill is but the latest in a long line of professors whose volatile statements have created controversy for themselves and their universities. Specific personnel matters in the case have been meticulously addressed in Boulder, but several larger questions have been curiously neglected. One might well ask, for…

Forecasting Daily Patient Outflow From a Ward Having No Real-Time Clinical Data

PubMed Central

Tran, Truyen; Luo, Wei; Phung, Dinh; Venkatesh, Svetha

2016-01-01

Background: Modeling patient flow is crucial in understanding resource demand and prioritization. We study patient outflow from an open ward in an Australian hospital, where currently bed allocation is carried out by a manager relying on past experiences and looking at demand. Automatic methods that provide a reasonable estimate of total next-day discharges can aid in efficient bed management. The challenges in building such methods lie in dealing with large amounts of discharge noise introduced by the nonlinear nature of hospital procedures, and the nonavailability of real-time clinical information in wards. Objective Our study investigates different models to forecast the total number of next-day discharges from an open ward having no real-time clinical data. Methods We compared 5 popular regression algorithms to model total next-day discharges: (1) autoregressive integrated moving average (ARIMA), (2) the autoregressive moving average with exogenous variables (ARMAX), (3) k-nearest neighbor regression, (4) random forest regression, and (5) support vector regression. Although the autoregressive integrated moving average model relied on past 3-month discharges, nearest neighbor forecasting used median of similar discharges in the past in estimating next-day discharge. In addition, the ARMAX model used the day of the week and number of patients currently in ward as exogenous variables. For the random forest and support vector regression models, we designed a predictor set of 20 patient features and 88 ward-level features. Results Our data consisted of 12,141 patient visits over 1826 days. Forecasting quality was measured using mean forecast error, mean absolute error, symmetric mean absolute percentage error, and root mean square error. When compared with a moving average prediction model, all 5 models demonstrated superior performance with the random forests achieving 22.7% improvement in mean absolute error, for all days in the year 2014. Conclusions In the

Multi-time-scale hydroclimate dynamics of a regional watershed and links to large-scale atmospheric circulation: Application to the Seine river catchment, France

NASA Astrophysics Data System (ADS)

Massei, N.; Dieppois, B.; Hannah, D. M.; Lavers, D. A.; Fossa, M.; Laignel, B.; Debret, M.

2017-03-01

In the present context of global changes, considerable efforts have been deployed by the hydrological scientific community to improve our understanding of the impacts of climate fluctuations on water resources. Both observational and modeling studies have been extensively employed to characterize hydrological changes and trends, assess the impact of climate variability or provide future scenarios of water resources. In the aim of a better understanding of hydrological changes, it is of crucial importance to determine how and to what extent trends and long-term oscillations detectable in hydrological variables are linked to global climate oscillations. In this work, we develop an approach associating correlation between large and local scales, empirical statistical downscaling and wavelet multiresolution decomposition of monthly precipitation and streamflow over the Seine river watershed, and the North Atlantic sea level pressure (SLP) in order to gain additional insights on the atmospheric patterns associated with the regional hydrology. We hypothesized that: (i) atmospheric patterns may change according to the different temporal wavelengths defining the variability of the signals; and (ii) definition of those hydrological/circulation relationships for each temporal wavelength may improve the determination of large-scale predictors of local variations. The results showed that the links between large and local scales were not necessarily constant according to time-scale (i.e. for the different frequencies characterizing the signals), resulting in changing spatial patterns across scales. This was then taken into account by developing an empirical statistical downscaling (ESD) modeling approach, which integrated discrete wavelet multiresolution analysis for reconstructing monthly regional hydrometeorological processes (predictand: precipitation and streamflow on the Seine river catchment) based on a large-scale predictor (SLP over the Euro-Atlantic sector). This

Elevation of north facades of #156158 (triple wards) National ...

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

Elevation of north facades of #156-158 (triple wards) - National Home for Disabled Volunteer Soldiers, Pacific Branch, Mental Health Buildings, 11301 Wilshire Boulevard, West Los Angeles, Los Angeles County, CA

The effects of leadership and ward factors on job satisfaction in nursing homes: a multilevel approach.

PubMed

Havig, Anders K; Skogstad, Anders; Veenstra, Marijke; Romøren, Tor I

2011-12-01

To examine (1) the relationships between job satisfaction and task- and relationship-oriented leadership and (2) the direct and moderating effects on job satisfaction of three ward-level factors: workload, use of teams and staff stability. Job satisfaction in nursing homes is vital to meeting the challenges related to recruitment and turnover. Cross-sectional design. A multilevel analysis approach was used to recognise a hierarchal structure of determined factors and to capture variation in job satisfaction at the individual and ward level. A questionnaire was sent to 444 registered nurses, auxiliary nurses and unskilled nursing assistants. Structured interviews were administered to 40 ward managers and 13 directors, and 900 hours of field observations was conducted in 40 nursing home wards throughout Norway. We found a significant relationship between job satisfaction and task-oriented and relationship-oriented leadership styles, with a stronger effect for task orientation. The effect of the two leadership styles varied significantly across wards. Furthermore, staff stability had both a significant positive direct effect and a moderating effect on job satisfaction, whereas the two other ward-level predictors yielded no significant contributions. The relatively stronger effect of task-oriented leadership on job satisfaction, particularly in wards with low staff stability, is in contrast to most previous studies and suggests that there may be specific conditions in nursing homes that favour the use of this leadership style. The varying effect of both leadership styles indicates that staff in different nursing home wards could benefit from the use of different leadership styles. The study highlights the importance of using different leadership behaviour and the importance of high staff stability to ensure job satisfaction among nursing home personnel. © 2011 Blackwell Publishing Ltd.

Subgrid-scale physical parameterization in atmospheric modeling: How can we make it consistent?

NASA Astrophysics Data System (ADS)

Yano, Jun-Ichi

2016-07-01

Approaches to subgrid-scale physical parameterization in atmospheric modeling are reviewed by taking turbulent combustion flow research as a point of reference. Three major general approaches are considered for its consistent development: moment, distribution density function (DDF), and mode decomposition. The moment expansion is a standard method for describing the subgrid-scale turbulent flows both in geophysics and engineering. The DDF (commonly called PDF) approach is intuitively appealing as it deals with a distribution of variables in subgrid scale in a more direct manner. Mode decomposition was originally applied by Aubry et al (1988 J. Fluid Mech. 192 115-73) in the context of wall boundary-layer turbulence. It is specifically designed to represent coherencies in compact manner by a low-dimensional dynamical system. Their original proposal adopts the proper orthogonal decomposition (empirical orthogonal functions) as their mode-decomposition basis. However, the methodology can easily be generalized into any decomposition basis. Among those, wavelet is a particularly attractive alternative. The mass-flux formulation that is currently adopted in the majority of atmospheric models for parameterizing convection can also be considered a special case of mode decomposition, adopting segmentally constant modes for the expansion basis. This perspective further identifies a very basic but also general geometrical constraint imposed on the massflux formulation: the segmentally-constant approximation. Mode decomposition can, furthermore, be understood by analogy with a Galerkin method in numerically modeling. This analogy suggests that the subgrid parameterization may be re-interpreted as a type of mesh-refinement in numerical modeling. A link between the subgrid parameterization and downscaling problems is also pointed out.

Three Bridge Fryer's Ford Bridge, Nimrod Bridge, and Ward's ...

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

Three Bridge - Fryer's Ford Bridge, Nimrod Bridge, and Ward's Crossing Bridge - Fryer's Ford Bridge, Spanning East Fork of Point Remove Creek at Fryer Bridge Road (CR 67), Solgohachia, Conway County, AR

Missed Opportunities for Nutritional Rehabilitation in Children Admitted to Surgical Wards

PubMed Central

Dave, Pooja; Nimbalkar, Somashekhar; Phatak, Ajay; Desai, Rajendra; Srivastava, Shirish

2016-01-01

Background. Malnutrition in children has serious health and economic consequences. We studied documentation of malnutrition, actual prevalence, and treatment given in children admitted to surgical wards. Methods. Retrospective study of 154 patients aged <5 yrs admitted to general surgical, orthopedic, and otorhinolaryngology wards. Records were evaluated for completeness of data, way of documentation, and data quality. Descriptive analysis was done. If malnutrition was not identified and/or proper action was not taken, it was defined as a “missed opportunity.” Results. Of 154 records audited, 100 (64.94%) were males, 108 (70.13%) were from general surgery ward, and 78 (50.65%) were residing in suburban area. The mean (SD) age of the study population was 2.32 (1.16) years whereas mean (SD) duration of stay was 5.84 (6.29) days. Weight and height were mentioned in 116 (75.32%) and 8 (5.19%) records, respectively, mostly by nonsurgical personnel. Documentation and treatment of malnutrition were poor. Out of 106 apparently correct weight records, 19 (17.93%) children were severely undernourished and 30 (28.30%) were moderately undernourished whereas 20 (18.87%) children were not undernourished but required nutritional attention. Conclusion. There is poor documentation of nutritional indicators of children admitted to surgical wards. From data that was available, it is apparent that malnutrition is at high levels. “Identification” and hence management of malnutrition need more attention. PMID:27429836

Clinical leadership for high-quality care: developing future ward leaders.

PubMed

Enterkin, Judith; Robb, Elizabeth; McLaren, Susan

2013-03-01

This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention. © 2012 Blackwell Publishing Ltd.

[Dementia-friendly hospital wards : Expert recommendations for planning and design].

PubMed

Büter, K; Motzek, T; Dietz, B; Hofrichter, L; Junge, M; Kopf, D; von Lützau-Hohlbein, H; Traxler, S; Zieschang, T; Marquardt, G

2017-01-01

Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.

Natural variability of atmospheric temperatures and geomagnetic intensity over a wide range of time scales.

PubMed

Pelletier, Jon D

2002-02-19

The majority of numerical models in climatology and geomagnetism rely on deterministic finite-difference techniques and attempt to include as many empirical constraints on the many processes and boundary conditions applicable to their very complex systems. Despite their sophistication, many of these models are unable to reproduce basic aspects of climatic or geomagnetic dynamics. We show that a simple stochastic model, which treats the flux of heat energy in the atmosphere by convective instabilities with random advection and diffusive mixing, does a remarkable job at matching the observed power spectrum of historical and proxy records for atmospheric temperatures from time scales of one day to one million years (Myr). With this approach distinct changes in the power-spectral form can be associated with characteristic time scales of ocean mixing and radiative damping. Similarly, a simple model of the diffusion of magnetic intensity in Earth's core coupled with amplification and destruction of the local intensity can reproduce the observed 1/f noise behavior of Earth's geomagnetic intensity from time scales of 1 (Myr) to 100 yr. In addition, the statistics of the fluctuations in the polarity reversal rate from time scales of 1 Myr to 100 Myr are consistent with the hypothesis that reversals are the result of variations in 1/f noise geomagnetic intensity above a certain threshold, suggesting that reversals may be associated with internal fluctuations rather than changes in mantle thermal or magnetic boundary conditions.

Natural variability of atmospheric temperatures and geomagnetic intensity over a wide range of time scales

PubMed Central

Pelletier, Jon D.

2002-01-01

The majority of numerical models in climatology and geomagnetism rely on deterministic finite-difference techniques and attempt to include as many empirical constraints on the many processes and boundary conditions applicable to their very complex systems. Despite their sophistication, many of these models are unable to reproduce basic aspects of climatic or geomagnetic dynamics. We show that a simple stochastic model, which treats the flux of heat energy in the atmosphere by convective instabilities with random advection and diffusive mixing, does a remarkable job at matching the observed power spectrum of historical and proxy records for atmospheric temperatures from time scales of one day to one million years (Myr). With this approach distinct changes in the power-spectral form can be associated with characteristic time scales of ocean mixing and radiative damping. Similarly, a simple model of the diffusion of magnetic intensity in Earth's core coupled with amplification and destruction of the local intensity can reproduce the observed 1/f noise behavior of Earth's geomagnetic intensity from time scales of 1 (Myr) to 100 yr. In addition, the statistics of the fluctuations in the polarity reversal rate from time scales of 1 Myr to 100 Myr are consistent with the hypothesis that reversals are the result of variations in 1/f noise geomagnetic intensity above a certain threshold, suggesting that reversals may be associated with internal fluctuations rather than changes in mantle thermal or magnetic boundary conditions. PMID:11875208

Weather Augmented Risk Determination (WARD) System

NASA Astrophysics Data System (ADS)

Niknejad, M.; Mazdiyasni, O.; Momtaz, F.; AghaKouchak, A.

2017-12-01

Extreme climatic events have direct and indirect impacts on society, economy and the environment. Based on the United States Bureau of Economic Analysis (BEA) data, over one third of the U.S. GDP can be considered as weather-sensitive involving some degree of weather risk. This expands from a local scale concrete foundation construction to large scale transportation systems. Extreme and unexpected weather conditions have always been considered as one of the probable risks to human health, productivity and activities. The construction industry is a large sector of the economy, and is also greatly influenced by weather-related risks including work stoppage and low labor productivity. Identification and quantification of these risks, and providing mitigation of their effects are always the concerns of construction project managers. In addition to severe weather conditions' destructive effects, seasonal changes in weather conditions can also have negative impacts on human health. Work stoppage and reduced labor productivity can be caused by precipitation, wind, temperature, relative humidity and other weather conditions. Historical and project-specific weather information can improve better project management and mitigation planning, and ultimately reduce the risk of weather-related conditions. This paper proposes new software for project-specific user-defined data analysis that offers (a) probability of work stoppage and the estimated project length considering weather conditions; (b) information on reduced labor productivity and its impacts on project duration; and (c) probabilistic information on the project timeline based on both weather-related work stoppage and labor productivity. The software (WARD System) is designed such that it can be integrated into the already available project management tools. While the system and presented application focuses on the construction industry, the developed software is general and can be used for any application that involves

Does doctors' workload impact supervision and ward activities of final-year students? A prospective study.

PubMed

Celebi, Nora; Tsouraki, Rodoula; Engel, Corinna; Holderried, Friederike; Riessen, Reimer; Weyrich, Peter

2012-06-11

Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students. A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities--both medical and non-medical--according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question. A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ± 1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown. There was a significant association between ward doctors' supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students.

Synoptic-scale atmospheric conditions associated with flash flooding in watersheds of the Catskill Mountains, New York, USA

NASA Astrophysics Data System (ADS)

Teale, N. G.; Quiring, S. M.

2015-12-01

Understanding flash flooding is important in unfiltered watersheds, such as portions of the New York City water supply system (NYCWSS), as water quality is degraded by turbidity associated with flooding. To further understand flash flooding in watersheds of the NYCWSS, synoptic-scale atmospheric conditions most frequently associated with flash flooding between 1987 and 2013 were examined. Flash floods were identified during this time period using USGS 15-minute discharge data at the Esopus Creek near Allaben, NY and Neversink River at Claryville, NY gauges. Overall, 25 flash floods were detected, occurring over 17 separate flash flood days. These flash flood days were compared to the days on which flash flood warnings encompassing the study area was issued by the National Weather Service. The success rate for which the flash flood warnings for Ulster County coincided with flash flood in the study watershed was 0.09, demonstrating the highly localized nature of flash flooding in the Catskill Mountain region. The synoptic-scale atmospheric patterns influencing the study area were characterized by a principal component analysis and k-means clustering of NCEP/NCAR 500 mb geopotential height reanalysis data. This procedure was executed in Spatial Synoptic Typer Tools 4.0. While 17 unique synoptic patterns were identified, only 3 types were strongly associated with flash flooding events. A strong southwesterly flow suggesting advection of moisture from the Atlantic Ocean and Gulf of Mexico is shown in composites of these 3 types. This multiscalar study thereby links flash flooding in the NYCWSS with synoptic-scale atmospheric circulation.Understanding flash flooding is important in unfiltered watersheds, such as portions of the New York City water supply system (NYCWSS), as water quality is degraded by turbidity associated with flooding. To further understand flash flooding in watersheds of the NYCWSS, synoptic-scale atmospheric conditions most frequently associated with

Los Angeles County Poor Farm, Patient Ward Nos. 210 & ...

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

Los Angeles County Poor Farm, Patient Ward Nos. 210 & 211 - Type B Plan, 7601 Imperial Highway; bounded by Esperanza Street, Laurel Street, Flores Street, and Descanso Street, Downey, Los Angeles County, CA

Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital

PubMed Central

Hung, Man Yui; Wright, David John; Blacklock, Jeanette; Needle, Richard John

2017-01-01

Introduction A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs) in order to inform future innovations of a similar nature. Methods Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance. Results Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months. Discussion It was believed that by locating pharmacists on the ward full time and allowing them to undertake medicines administration and medicines reconciliation, the nursing time would be saved and medicines safety improved. There was however significant learning

Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital.

PubMed

Hung, Man Yui; Wright, David John; Blacklock, Jeanette; Needle, Richard John

2017-01-01

A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs) in order to inform future innovations of a similar nature. Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance. Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months. It was believed that by locating pharmacists on the ward full time and allowing them to undertake medicines administration and medicines reconciliation, the nursing time would be saved and medicines safety improved. There was however significant learning to be derived from the implementation

Biological and physical controls in the Southern Ocean on past millennial-scale atmospheric CO2 changes.

PubMed

Gottschalk, Julia; Skinner, Luke C; Lippold, Jörg; Vogel, Hendrik; Frank, Norbert; Jaccard, Samuel L; Waelbroeck, Claire

2016-05-17

Millennial-scale climate changes during the last glacial period and deglaciation were accompanied by rapid changes in atmospheric CO2 that remain unexplained. While the role of the Southern Ocean as a 'control valve' on ocean-atmosphere CO2 exchange has been emphasized, the exact nature of this role, in particular the relative contributions of physical (for example, ocean dynamics and air-sea gas exchange) versus biological processes (for example, export productivity), remains poorly constrained. Here we combine reconstructions of bottom-water [O2], export production and (14)C ventilation ages in the sub-Antarctic Atlantic, and show that atmospheric CO2 pulses during the last glacial- and deglacial periods were consistently accompanied by decreases in the biological export of carbon and increases in deep-ocean ventilation via southern-sourced water masses. These findings demonstrate how the Southern Ocean's 'organic carbon pump' has exerted a tight control on atmospheric CO2, and thus global climate, specifically via a synergy of both physical and biological processes.

Biological and physical controls in the Southern Ocean on past millennial-scale atmospheric CO2 changes

PubMed Central

Gottschalk, Julia; Skinner, Luke C.; Lippold, Jörg; Vogel, Hendrik; Frank, Norbert; Jaccard, Samuel L.; Waelbroeck, Claire

2016-01-01

Millennial-scale climate changes during the last glacial period and deglaciation were accompanied by rapid changes in atmospheric CO2 that remain unexplained. While the role of the Southern Ocean as a 'control valve' on ocean–atmosphere CO2 exchange has been emphasized, the exact nature of this role, in particular the relative contributions of physical (for example, ocean dynamics and air–sea gas exchange) versus biological processes (for example, export productivity), remains poorly constrained. Here we combine reconstructions of bottom-water [O2], export production and 14C ventilation ages in the sub-Antarctic Atlantic, and show that atmospheric CO2 pulses during the last glacial- and deglacial periods were consistently accompanied by decreases in the biological export of carbon and increases in deep-ocean ventilation via southern-sourced water masses. These findings demonstrate how the Southern Ocean's 'organic carbon pump' has exerted a tight control on atmospheric CO2, and thus global climate, specifically via a synergy of both physical and biological processes. PMID:27187527

Microbiological Assessment of Indoor Air of Teaching Hospital Wards: A case of Jimma University Specialized Hospital.

PubMed

Fekadu, Samuel; Getachewu, Bahilu

2015-04-01

Hospital environment represents a congenial situation where microorganisms and susceptible patients are indoors together. Thus, the objective of this study is to provide fundamental data related to the microbial quality of indoor air of Jimma University Specialized Hospital wards, to estimate the health hazard and to create standards for indoor air quality control. The microbial quality of indoor air of seven wards of Jimma University Specialized Hospital was determined. Passive air sampling technique, using open Petri-dishes containing different culture media, was employed to collect sample twice daily. The concentrations of bacteria and fungi aerosols in the indoor environment of the wards ranged between 2123 - 9733 CFU/m(3). The statistical analysis showed that the concentrations of bacteria that were measured in all studied wards were significantly different from each other (p-value=0.017), whereas the concentrations of fungi that were measured in all sampled wards were not significantly different from each other (p-value=0.850). Moreover, the concentrations of bacteria that were measured at different sampling time (morning and afternoon) were significantly different (p-value =0.001). All wards that were included in the study were heavily contaminated with bacteria and fungi. Thus, immediate interventions are needed to control those environmental factors which favor the growth and multiplication of microbes, and it is vital to control visitors and students in and out the wards. Moreover, it is advisable that strict measures be put in place to check the increasing microbial load in the hospital environment.

[Extralegal coercive measures in psychiatric wards-- patients' perspectives].

PubMed

Jensen, Hans Mørch; Poulsen, Henrik Day

2006-02-06

A revision of the Danish Mental Health Act is planned to take place in 2005-2006. The Ministry of Health requires investigation into whether extralegal coercive measures take place in psychiatric wards. Extralegal coercion refers to restrictions and rules not included in the current Mental Health Act and considered by patients to be coercion. Twenty-two psychiatric patients participated in four group interviews directed by two physicians at four University Hospitals in Copenhagen, Denmark. The patients were asked to define what they perceived as extralegal coercion, house rules and psychiatric treatment. The majority of patients perceived lack of single rooms, restrictions on leaving the ward and shielding, i.e., being confined to one's room, to be extralegal coercion. A few also found the pressure to take medication and collection of clothes items to be extralegal coercion. Rules on smoking, clothing, day and night routines, the use of radio and TV, drugs, alcohol, visits, eating and the use of telephones were considered not extralegal coercion but necessary house rules. House rules should be clear and stated in writing. Restrictions on the use of money and locking of the front door at night were accepted in certain situations, hence not considered to be extralegal coercion. Extralegal coercion does occur in psychiatric wards but in certain situations is accepted if documented. House rules are considered to be necessary and not extralegal coercion. Increased use of compulsory protocols for documenting coercive measures was not considered to be necessary, but documentation in patients' files was useful alternative.

Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.

PubMed

Jangland, Eva; Teodorsson, Therese; Molander, Karin; Muntlin Athlin, Åsa

2018-06-01

To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. A focused ethnographic approach. A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery. © 2017 John Wiley & Sons Ltd.

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation

PubMed Central

Sheard, Laura; Marsh, Claire; O’Hara, Jane; Armitage, Gerry; Wright, John; Lawton, Rebecca

2017-01-01

Objectives A patient safety intervention was tested in a 33-ward randomised controlled trial. No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards. Design Large qualitative process evaluation of the implementation of a patient safety intervention. Setting and participants National Health Service staff based on 17 acute hospital wards located at five hospital sites in the North of England. Data We concentrate on three sources here: (1) analysis of taped discussion between ward staff during action planning meetings; (2) facilitators’ field notes and (3) follow-up telephone interviews with staff focusing on whether action plans had been achieved. The analysis involved the use of pen portraits and adaptive theory. Findings First, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff. Conclusions A dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components. PMID:28710206

Social influence on 5-year survival in a longitudinal chemotherapy ward co-presence network.

PubMed

Lienert, Jeffrey; Marcum, Christopher Steven; Finney, John; Reed-Tsochas, Felix; Koehly, Laura

2017-09-01

Chemotherapy is often administered in openly designed hospital wards, where the possibility of patient-patient social influence on health exists. Previous research found that social relationships influence cancer patient's health; however, we have yet to understand social influence among patients receiving chemotherapy in the hospital. We investigate the influence of co-presence in a chemotherapy ward. We use data on 4,691 cancer patients undergoing chemotherapy in Oxfordshire, United Kingdom who average 59.8 years of age, and 44% are Male. We construct a network of patients where edges exist when patients are co-present in the ward, weighted by both patients' time in the ward. Social influence is based on total weighted co-presence with focal patients' immediate neighbors, considering neighbors' 5-year mortality. Generalized estimating equations evaluated the effect of neighbors' 5-year mortality on focal patient's 5-year mortality. Each 1,000-unit increase in weighted co-presence with a patient who dies within 5 years increases a patient's mortality odds by 42% ( β = 0.357, CI:0.204,0.510). Each 1,000-unit increase in co-presence with a patient surviving 5 years reduces a patient's odds of dying by 30% ( β = -0.344, CI:-0.538,0.149). Our results suggest that social influence occurs in chemotherapy wards, and thus may need to be considered in chemotherapy delivery.

[The Family Counsel for Wards of the state. Its essential role in adoption matters].

PubMed

Thieffry, S

1989-03-01

Every regional branch of the Agency of Health and Social Affairs includes a Child Welfare Service (CWS) whose responsibilities include ensuring the best possible guardianship and future for children registered as Wards of the State. The CWS must immediately register as a Ward of the State every child fitting the criteria for one of the categories defined by the July 11 1966 Act, and take the earliest possible steps towards adoption of such Wards. To achieve these two objectives, a Family Council has been created within the CWS. This Council, that includes eight members with various types of experience or competence in matters of guardianship and adoption, is responsible for pronouncing the registration of Wards and achieving their adoption. Rather than a discussion of general considerations, we have elected to describe the methodical agenda and progress of the Paris CWS Family Council's regular meetings. Emphasis is put on the important aspects of wards eligible for adoption, on the investigation at the homes of candidates and on the "matching" which should be sought for between adoptive families and adoptees. Without doubt, the Family Council's systematic work, denoting a high level of awareness of its responsibilities, is the cause of the significant increase in the number of adoptions and, above all, of the recent availability of adoption to categories that were formerly neglected or permanently "abandoned".

Patients' and relatives' experiences of transfer from intensive care unit to wards.

PubMed

Cullinane, James P; Plowright, Catherine I

2013-11-01

This literature review looks at the evidence around transferring patients from intensive care units (ICU) to wards. The literature informs us that patients and their families experience problems when being transferred from an ICU environment and that this increases overall anxiety. The effects of surviving critical illness often have a profound psychological impact on patients and families This study examines the experiences of adult patients, and their families, following their transfer from the ICU to the ward. Five themes emerged from this literature review: physical responses, psychological responses, information and communication, safety and security, and the needs of relatives. This review reminds us that these problems can be reduced if information and communication around time of transfers were improved. As critical care nurses it is essential that we prepare patients and families for transfer to wards. © 2013 British Association of Critical Care Nurses.

French national survey of inpatient adverse events prospectively assessed with ward staff.

PubMed

Michel, Philippe; Quenon, Jean Luc; Djihoud, Ahmed; Tricaud-Vialle, Sophie; de Sarasqueta, Anne Marie

2007-10-01

To estimate the incidence of adverse events in medical and surgical activity in public and private hospitals, and to assess the clinical situation of patients and the active errors. Prospective assessment of adverse events by external senior nursing and doctor investigators with ward staff. Random three-stage stratified cluster sampling of stays or fractions of stay in a 7-day observation period for each ward. 8754 patients observed in 292 wards in 71 hospitals, over 35,234 hospitalisation days. Number of adverse events in relation to number of days of hospitalisation. The incidence density of adverse events was 6.6 per 1000 days of hospitalisation (95% CI 5.7 to 7.5), of which 35% were preventable. Invasive procedures were the source of half the adverse events, of which 20% were preventable. Adverse events related to the psychological sphere and pain were mostly considered as preventable. Ward staff found it difficult to assess the role of care management in the occurrence of adverse events: 41% of adverse events were expected because of the disease itself, and could have occurred in the absence of the related medical management. At the national level in France, every year 120,000-190,000 adverse events during hospitalisation can be considered as preventable. Areas such as perioperative period and geriatric units should receive closer attention. As adverse events occurred more commonly in vulnerable patients, who are not specifically targeted by clinical guidance, practising evidence-based medicine is not likely to prevent all cases. Therefore clinical risk management should prioritize empowerment of local staff, provision of favourable conditions within the organisation, and staff training based on simple tools appropriate for ward-level identification and analysis of adverse events.

Environmental networks for large-scale monitoring of Earth and atmosphere

NASA Astrophysics Data System (ADS)

Maurodimou, Olga; Kolios, Stavros; Konstantaras, Antonios; Georgoulas, George; Stylios, Chrysostomos

2013-04-01

Installation and operation of instrument/sensor networks are proven fundamental in the monitoring of the physical environment from local to global scale. The advances in electronics, wireless communications and informatics has led to the development of a huge number of networks at different spatial scales that measure, collect and store a wide range of environmental parameters. These networks have been gradually evolved into integrated information systems that provide real time monitoring, forecasts and different products from the initial collected datasets. Instrument/sensor networks have nowadays become important solutions for environmental monitoring, comprising a basic component of fully automated systems developing worldwide that contribute in the efforts for a sustainable Earth's environment (e.g. Hart et al., 2006, Othman et al., 2012). They are also used as a source of data for models parameterization and as verification tools for accuracy assessment techniques of the satellite imagery. Environmental networks can be incorporated into decision support systems (e.g Rizzi et al., 2012) providing informational background along with data from satellites for decision making, manage problems, suggest solutions and best practices for a sustainable management of the environment. This is a comparative study aiming to examine and highlight the significant role of existing instrument/sensor networks for large-scale monitoring of environmental issues, especially atmospheric and marine environment as well as weather and climate. We provide characteristic examples of integrated systems based on large scale instrument/sensor networks along with other sources of data (like satellite datasets) as informational background to measure, identify, monitor, analyze and forecast a vast series of atmospheric parameters (like CO2, O3, particle matter and solar irradiance), weather, climate and their impacts (e.g., cloud systems, lightnings, rainfall, air and surface temperature

Large-eddy Simulation of Stratocumulus-topped Atmospheric Boundary Layers with Dynamic Subgrid-scale Models

NASA Technical Reports Server (NTRS)

Senocak, Inane

2003-01-01

The objective of the present study is to evaluate the dynamic procedure in LES of stratocumulus topped atmospheric boundary layer and assess the relative importance of subgrid-scale modeling, cloud microphysics and radiation modeling on the predictions. The simulations will also be used to gain insight into the processes leading to cloud top entrainment instability and cloud breakup. In this report we document the governing equations, numerical schemes and physical models that are employed in the Goddard Cumulus Ensemble model (GCEM3D). We also present the subgrid-scale dynamic procedures that have been implemented in the GCEM3D code for the purpose of the present study.

Improving detection of patient deterioration in the general hospital ward environment.

PubMed

Vincent, Jean-Louis; Einav, Sharon; Pearse, Rupert; Jaber, Samir; Kranke, Peter; Overdyk, Frank J; Whitaker, David K; Gordo, Federico; Dahan, Albert; Hoeft, Andreas

2018-05-01

: Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring. Early identification can trigger appropriate management, thereby reducing the need for higher acuity care, reducing hospital lengths of stay and admission costs and even, at times, improving survival. However, this degree of monitoring has thus far been considered largely inappropriate for general hospital ward settings due to device costs and the need for staff expertise in data interpretation. In this review, we discuss some developing options to improve patient monitoring and thus detection of deterioration in low acuity general hospital wards.

Prevalence of sarcopenia and its association with activities of daily living and dysphagia in convalescent rehabilitation ward inpatients.

PubMed

Yoshimura, Yoshihiro; Wakabayashi, Hidetaka; Bise, Takahiro; Tanoue, Maiko

2017-09-23

The purpose of this study was to investigate the prevalence of sarcopenia following stroke, musculoskeletal disease, or hospital-associated deconditioning in convalescent rehabilitation ward inpatients. The association between the activities of daily living (ADLs), dysphagia, and sarcopenia was also assessed. A cross-sectional study was performed in consecutive patients admitted to convalescent rehabilitation wards. Sarcopenia was defined as a loss of skeletal muscle mass and decreased muscle strength. The primary outcome was the Functional Independence Measure (FIM) score. Body mass index, Mini Nutritional Assessment-Short Form score, Food Intake Level Scale (FILS) score, Charlson Comorbidity Index, premorbid modified Rankin scale, time from onset, reason for admission, bioelectrical impedance analysis for skeletal muscle mass and fat mass, and handgrip strength were also assessed. Univariate and multivariate analyses were used to determine whether ADLs and dysphagia were associated with sarcopenia. The study included 637 patients (mean age: 74 years; 271 men and 366 women). Sarcopenia was diagnosed in 343 (53.0%) patients (141 men and 202 women). Sarcopenia was identified in 53.6% (125/233) of stroke patients (59.8%, 50.0%, and 34.6% of patients with brain infarctions, brain hemorrhages, and subarachnoid hemorrhages, respectively). Sarcopenia was found in 51.3% (154/300) of patients with musculoskeletal diseases (59.5%, 53.6%, and 36.5% of patients with hip fractures, vertebral compression fractures, and total knee arthroplasty, respectively). Of patients with hospital-associated deconditioning, 61.5% (64/104) had sarcopenia (95.1% and 39.7% of patients with pneumonia and other acute diseases, respectively). Multivariate analysis showed that FIM motor domain and FILS scores were independently associated with skeletal muscle mass loss and decreased muscle strength. The prevalence of sarcopenia in convalescent rehabilitation ward inpatients was 53.0%. ADLs and

Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals.

PubMed

Haug, Jon B; Myhr, Randi; Reikvam, Asmund

2011-12-13

Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics--that is second- and third-generation cephalosporins, carbapenems, and quinolones--in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval. There is a need for caution in

Exploring ward nurses' perceptions of continuing education in clinical settings.

PubMed

Govranos, Melissa; Newton, Jennifer M

2014-04-01

Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. A case study approach was utilized. A major teaching hospital in Melbourne, Australia. A range of clinical nursing staff (n=23). Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong

Contribution from geriatric medicine within acute medical wards.

PubMed Central

Burley, L E; Currie, C T; Smith, R G; Williamson, J

1979-01-01

In 1977 a scheme of attachment to acute medical wards of consultants in geriatric medicine and associated junior medical staff was instituted in a large Edinburgh teaching hospital. The effect on admissions of patients aged 65 and over was examined for comparable periods before and during this arrangement. Mean and median stays were reduced for both sexes but more noticeably for women. The mean stay for all women aged over 65 was reduced from 25 to 16 days and for women aged over 85 from 50 to 19 days. The proportion staying under two weeks was significantly increased in both sexes, and the proportion discharged home also increased, correspondingly fewer patients being transferred to convalescent wards. These changes were not accompanied by increased transfers to the geriatric department, and probably the skills and extra resources available to the geriatric service were the factors mainly responsible for the changes in performance. PMID:572732

Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation.

PubMed

Sheard, Laura; Marsh, Claire; O'Hara, Jane; Armitage, Gerry; Wright, John; Lawton, Rebecca

2017-07-13

A patient safety intervention was tested in a 33-ward randomised controlled trial. No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards. Large qualitative process evaluation of the implementation of a patient safety intervention. National Health Service staff based on 17 acute hospital wards located at five hospital sites in the North of England. We concentrate on three sources here: (1) analysis of taped discussion between ward staff during action planning meetings; (2) facilitators' field notes and (3) follow-up telephone interviews with staff focusing on whether action plans had been achieved. The analysis involved the use of pen portraits and adaptive theory. First, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff. A dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost-effectiveness of Ward Closure to Control Outbreaks of Norovirus Infection in United Kingdom National Health Service Hospitals.

PubMed

Sadique, Zia; Lopman, Ben; Cooper, Ben S; Edmunds, W John

2016-02-01

Norovirus is the most common cause of outbreaks of acute gastroenteritis in National Health Service hospitals in the United Kingdom. Wards (units) are often closed to new admissions to stop the spread of the virus, but there is limited evidence describing the cost-effectiveness of ward closure. An economic analysis based on the results from a large, prospective, active-surveillance study of gastroenteritis outbreaks in hospitals and from an epidemic simulation study compared alternative ward closure options evaluated at different time points since first infection, assuming different efficacies of ward closure. A total of 232 gastroenteritis outbreaks occurring in 14 hospitals over a 1-year period were analyzed. The risk of a new outbreak in a hospital is significantly associated with the number of admission, general medical, and long-stay wards that are concurrently affected but is less affected by the level of community transmission. Ward closure leads to higher costs but reduces the number of new outbreaks by 6%-56% and the number of clinical cases by 1%-55%, depending on the efficacy of the intervention. The incremental cost per outbreak averted varies from £10 000 ($14 000) to £306 000 ($428 000), and the cost per case averted varies from £500 ($700) to £61 000 ($85 000). The cost-effectiveness of ward closure decreases as the efficacy of the intervention increases, and the cost-effectiveness increases with the timing of the intervention. The efficacy of ward closure is critical from a cost-effectiveness perspective. Ward closure may be cost-effective, particularly if targeted to high-throughput units. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Controlled Confrontation: The Ward Grievance Procedure of the California Youth Authority. An Exemplary Project.

ERIC Educational Resources Information Center

National Inst. of Law Enforcement and Criminal Justice (Dept. of Justice/LEAA), Washington, DC.

The Ward Grievance Procedure of the California Youth Authority is one of 17 programs that earned the National Institute's "Exemplary" label. This brochure provides the requisite practical information for those who wish to test or consider testing the ward grievance procedure. The program was developed as a way of dealing with the questions raised…

Ward identity and basis tensor gauge theory at one loop

NASA Astrophysics Data System (ADS)

Chung, Daniel J. H.

2018-06-01

Basis tensor gauge theory (BTGT) is a reformulation of ordinary gauge theory that is an analog of the vierbein formulation of gravity and is related to the Wilson line formulation. To match ordinary gauge theories coupled to matter, the BTGT formalism requires a continuous symmetry that we call the BTGT symmetry in addition to the ordinary gauge symmetry. After classically interpreting the BTGT symmetry, we construct using the BTGT formalism the Ward identities associated with the BTGT symmetry and the ordinary gauge symmetry. For a way of testing the quantum stability and the consistency of the Ward identities with a known regularization method, we explicitly renormalize the scalar QED at one loop using dimensional regularization using the BTGT formalism.

Outbreak of respiratory syncytial virus (RSV) infection in immunocompromised adults on a hematology ward.

PubMed

Jensen, Tomas Ostergaard; Stelzer-Braid, Sacha; Willenborg, Christiana; Cheung, Carol; Andresen, David; Rawlinson, William; Clezy, Kate

2016-10-01

We describe an outbreak of respiratory syncytial virus (RSV) infection on a hematology ward without allogeneic stem cell transplant patients. Twelve patients and one staff member infected with RSV were identified from the laboratory database. Five patients had lower respiratory tract infection, seven had upper respiratory tract infection, one was asymptomatic, and there were two (15.4%) deaths. Most patients had overlapping periods of potential infectiousness on the ward. Sequencing was possible on eight specimens and five of these had identical sequences. Results were consistent with transmission occurring both on the ward and by introduction of RSV from the community. J. Med. Virol. 88:1827-1831, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey.

PubMed

Persenius, Mona; Hall-Lord, Marie-Louise; Wilde-Larsson, Bodil; Carlsson, Eva

2015-09-01

To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards. A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality. Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants. Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results. Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed. The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework. © 2013 John Wiley & Sons Ltd.

Care management and nursing governance in a maternity ward: grounded theory.

PubMed

Copelli, Fernanda Hannah da Silva; Oliveira, Roberta Juliane Tono de; Santos, José Luís Guedes Dos; Magalhães, Aline Lima Pestana; Gregório, Vitória Regina Petters; Erdmann, Alacoque Lorenzini

2017-01-01

To understand the care management strategies used by nurses in the governance of nursing practice in a maternity ward. Qualitative study based on grounded theory conducted with 27 participants, partitioned into four sample groups. The data were collected through semi-structured interviews and analyzed through open, axial, and selective coding. The care management strategies used by the nurses were: planning professional practice, leading the nursing team, search for scientific knowledge, and training inthe best practices in obstetric care. Associating care management with nursing governance can foster better care outcomes and strengthen nursing autonomy when coordinating nursing work in maternity wards.

34 CFR 300.45 - Ward of the State.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Ward of the State. 300.45 Section 300.45 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

34 CFR 300.45 - Ward of the State.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Ward of the State. 300.45 Section 300.45 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

Mapping nurses' activities in surgical hospital wards: A time study.

PubMed

van den Oetelaar, W F J M; van Stel, H F; van Rhenen, W; Stellato, R K; Grolman, W

2018-01-01

Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards. The research took place in an academic hospital in the Netherlands. Six surgical wards were included, capacity 15 to 30 beds. We have used a work sampling methodology where trained observers registered activities of nurses and patient details every ten minutes during the day shift for a time period of three weeks. The work sampling showed that nurses spend between 40.1% and 55.8% of their time on direct patient care. In addition to this, nurses spend between 11.0% and 14.1% on collective patient care. In total, between 52.1% and 68% of time spent on tasks is directly patient related. We found significant differences between wards for 10 of the 21 activity groups. We also found that nurses spend on average 31% with the patient (bedside), which is lower than in another study (37%). However, we noticed a difference between departments. For regular surgical departments in our study this was on average 34% and for two departments that have additional responsibilities in training and education of nursing students, this was on average 25%. We found a relatively low percentage of time spent on direct plus indirect care, and a lower percentage of time spent with the patient. We suspect that this is due to the academic setting of the study; in our hospital, there are more tasks related to education than in hospitals in other study settings. We also found differences between the wards in our study, which are mostly explained by differences

Social influence on 5-year survival in a longitudinal chemotherapy ward co-presence network

PubMed Central

LIENERT, JEFFREY; MARCUM, CHRISTOPHER STEVEN; FINNEY, JOHN; REED-TSOCHAS, FELIX; KOEHLY, LAURA

2018-01-01

Chemotherapy is often administered in openly designed hospital wards, where the possibility of patient–patient social influence on health exists. Previous research found that social relationships influence cancer patient’s health; however, we have yet to understand social influence among patients receiving chemotherapy in the hospital. We investigate the influence of co-presence in a chemotherapy ward. We use data on 4,691 cancer patients undergoing chemotherapy in Oxfordshire, United Kingdom who average 59.8 years of age, and 44% are Male. We construct a network of patients where edges exist when patients are co-present in the ward, weighted by both patients’ time in the ward. Social influence is based on total weighted co-presence with focal patients’ immediate neighbors, considering neighbors’ 5-year mortality. Generalized estimating equations evaluated the effect of neighbors’ 5-year mortality on focal patient’s 5-year mortality. Each 1,000-unit increase in weighted co-presence with a patient who dies within 5 years increases a patient’s mortality odds by 42% (β = 0.357, CI:0.204,0.510). Each 1,000-unit increase in co-presence with a patient surviving 5 years reduces a patient’s odds of dying by 30% (β = −0.344, CI:−0.538,0.149). Our results suggest that social influence occurs in chemotherapy wards, and thus may need to be considered in chemotherapy delivery. PMID:29503731

My Ward: The Story of St Thomas', Guy's and the Evelina Children's Hospitals and their Ward Names Wendy Mathews My Ward: The Story of St Thomas', Guy's and the Evelina Children's Hospitals and their Ward Names | Walpole House Publishing £5 I 135pp | 9780956394200 0956394205 [Formula: see text].

PubMed

2011-05-01

This is a fascinating record of the stories behind the names of wards at three London hospitals and of the hospitals themselves. Made possible by a grant from Guy's and st Thomas' Charity, it is beautifully produced and illustrated and is a great historical read.

Monitoring environmental cleanliness on two surgical wards.

PubMed

Dancer, Stephanie J; White, Liza; Robertson, Chris

2008-10-01

Ten hand-touch sites were screened weekly on two surgical wards over two consecutive six-month periods. The results were analysed using hygiene standards, which specify (i) an aerobic colony count (ACC) > 2.5 cfu/cm(2), and (ii) presence of coagulase-positive staphylococci, as hygiene failures. Sites most often failing the standards were beds and hoist (64%: 33 of 52 weeks), bedside lockers (62%: 32 of 52) and overbed tables (44%: 23 of 52). Methicillin-susceptible/resistant Staphylococcus aureus (MSSA/MRSA) were more often recovered from lockers, overbed tables and beds. Recovery of MSSA/MRSA at any site was significantly associated with an ACC > 2.5 cfu/cm(2) from that site (p = 0.001; OR: 3.35 [95% CI 1.79, 6.28]). In addition, total ACC's > 2.5 cfu/cm(2) each week were significantly associated with weekly bed occupancies > 95% (p = 0.0004; OR: 2.94 [95% CI 1.44, 6.02]). Higher microbial growth levels from hand-touch sites reflect weekly bed occupancies and indicate a risk for both resistant and susceptible S. aureus. These organisms are more likely to be recovered from near-patient sites on the ward.

Impact of air-sea drag coefficient for latent heat flux on large scale climate in coupled and atmosphere stand-alone simulations

NASA Astrophysics Data System (ADS)

Torres, Olivier; Braconnot, Pascale; Marti, Olivier; Gential, Luc

2018-05-01

The turbulent fluxes across the ocean/atmosphere interface represent one of the principal driving forces of the global atmospheric and oceanic circulation. Despite decades of effort and improvements, representation of these fluxes still presents a challenge due to the small-scale acting turbulent processes compared to the resolved scales of the models. Beyond this subgrid parameterization issue, a comprehensive understanding of the impact of air-sea interactions on the climate system is still lacking. In this paper we investigates the large-scale impacts of the transfer coefficient used to compute turbulent heat fluxes with the IPSL-CM4 climate model in which the surface bulk formula is modified. Analyzing both atmosphere and coupled ocean-atmosphere general circulation model (AGCM, OAGCM) simulations allows us to study the direct effect and the mechanisms of adjustment to this modification. We focus on the representation of latent heat flux in the tropics. We show that the heat transfer coefficients are highly similar for a given parameterization between AGCM and OAGCM simulations. Although the same areas are impacted in both kind of simulations, the differences in surface heat fluxes are substantial. A regional modification of heat transfer coefficient has more impact than uniform modification in AGCM simulations while in OAGCM simulations, the opposite is observed. By studying the global energetics and the atmospheric circulation response to the modification, we highlight the role of the ocean in dampening a large part of the disturbance. Modification of the heat exchange coefficient modifies the way the coupled system works due to the link between atmospheric circulation and SST, and the different feedbacks between ocean and atmosphere. The adjustment that takes place implies a balance of net incoming solar radiation that is the same in all simulations. As there is no change in model physics other than drag coefficient, we obtain similar latent heat flux

Does doctors’ workload impact supervision and ward activities of final-year students? A prospective study

PubMed Central

2012-01-01

Background Hospital doctors face constantly increasing workloads. Besides caring for patients, their duties also comprise the education of future colleagues. The aim of this study was to objectively investigate whether the workload arising from increased patient care interferes with student supervision and is associated with more non-medical activities of final-year medical students. Methods A total of 54 final-year students were asked to keep a diary of their daily activities over a three-week period at the beginning of their internship in Internal Medicine. Students categorized their activities – both medical and non-medical - according to whether they had: (1) only watched, (2) assisted the ward resident, (3) performed the activity themselves under supervision of the ward resident, or (4) performed the activity without supervision. The activities reported on a particular day were matched with a ward specific workload-index derived from the hospital information system, including the number of patients treated on the corresponding ward on that day, a correction factor according to the patient comorbidity complexity level (PCCL), and the number of admissions and discharges. Both students and ward residents were blinded to the study question. Results A total of 32 diaries (59 %, 442 recorded working days) were handed back. Overall, the students reported 1.2 ± 1.3 supervised, 1.8 ±1.6 medical and 3.6 ± 1.7 non-medical activities per day. The more supervised activities were reported, the more the number of reported medical activities increased (p < .0001). No relationship between the ward specific workload and number of medical activities could be shown. Conclusions There was a significant association between ward doctors’ supervision of students and the number of medical activities performed by medical students. The workload had no significant effect on supervision or the number of medical or non-medical activities of final-year students. PMID

Constraining regional scale carbon budgets at the US West Coast using a high-resolution atmospheric inverse modeling approach

NASA Astrophysics Data System (ADS)

Goeckede, M.; Michalak, A. M.; Vickers, D.; Turner, D.; Law, B.

2009-04-01

The study presented is embedded within the NACP (North American Carbon Program) West Coast project ORCA2, which aims at determining the regional carbon balance of the US states Oregon, California and Washington. Our work specifically focuses on the effect of disturbance history and climate variability, aiming at improving our understanding of e.g. drought stress and stand age on carbon sources and sinks in complex terrain with fine-scale variability in land cover types. The ORCA2 atmospheric inverse modeling approach has been set up to capture flux variability on the regional scale at high temporal and spatial resolution. Atmospheric transport is simulated coupling the mesoscale model WRF (Weather Research and Forecast) with the STILT (Stochastic Time Inverted Lagrangian Transport) footprint model. This setup allows identifying sources and sinks that influence atmospheric observations with highly resolved mass transport fields and realistic turbulent mixing. Terrestrial biosphere carbon fluxes are simulated at spatial resolutions of up to 1km and subdaily timesteps, considering effects of ecoregion, land cover type and disturbance regime on the carbon budgets. Our approach assimilates high-precision atmospheric CO2 concentration measurements and eddy-covariance data from several sites throughout the model domain, as well as high-resolution remote sensing products (e.g. LandSat, MODIS) and interpolated surface meteorology (DayMet, SOGS, PRISM). We present top-down modeling results that have been optimized using Bayesian inversion, reflecting the information on regional scale carbon processes provided by the network of high-precision CO2 observations. We address the level of detail (e.g. spatial and temporal resolution) that can be resolved by top-down modeling on the regional scale, given the uncertainties introduced by various sources for model-data mismatch. Our results demonstrate the importance of accurate modeling of carbon-water coupling, with the

Small-scale Scheimpflug lidar for aerosol extinction coefficient and vertical atmospheric transmittance detection.

PubMed

Sun, Guodong; Qin, Laian; Hou, Zaihong; Jing, Xu; He, Feng; Tan, Fengfu; Zhang, Silong

2018-03-19

In this paper, a new prototypical Scheimpflug lidar capable of detecting the aerosol extinction coefficient and vertical atmospheric transmittance at 1 km above the ground is described. The lidar system operates at 532 nm and can be used to detect aerosol extinction coefficients throughout an entire day. Then, the vertical atmospheric transmittance can be determined from the extinction coefficients with the equation of numerical integration in this area. CCD flat fielding of the image data is used to mitigate the effects of pixel sensitivity variation. An efficient method of two-dimensional wavelet transform according to a local threshold value has been proposed to reduce the Gaussian white noise in the lidar signal. Furthermore, a new iteration method of backscattering ratio based on genetic algorithm is presented to calculate the aerosol extinction coefficient and vertical atmospheric transmittance. Some simulations are performed to reduce the different levels of noise in the simulated signal in order to test the precision of the de-noising method and inversion algorithm. The simulation result shows that the root-mean-square errors of extinction coefficients are all less than 0.02 km -1 , and that the relative errors of the atmospheric transmittance between the model and inversion data are below 0.56% for all cases. The feasibility of the instrument and the inversion algorithm have also been verified by an optical experiment. The average relative errors of aerosol extinction coefficients between the Scheimpflug lidar and the conventional backscattering elastic lidar are 3.54% and 2.79% in the full overlap heights of two time points, respectively. This work opens up new possibilities of using a small-scale Scheimpflug lidar system for the remote sensing of atmospheric aerosols.

Inappropriate use of urinary catheters and its common complications in different hospital wards.

PubMed

Davoodian, Parivash; Nematee, Maryam; Sheikhvatan, Mehrdad

2012-01-01

Inappropriate use of indwelling urinary catheters (IUCs) and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU) as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6%) had IUCs used appropriately while 42 of them (20.6%) were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%), 16 (19.0%) and 14 patients (24.6%), respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2%) and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

Large Scale Gaussian Processes for Atmospheric Parameter Retrieval and Cloud Screening

NASA Astrophysics Data System (ADS)

Camps-Valls, G.; Gomez-Chova, L.; Mateo, G.; Laparra, V.; Perez-Suay, A.; Munoz-Mari, J.

2017-12-01

Current Earth-observation (EO) applications for image classification have to deal with an unprecedented big amount of heterogeneous and complex data sources. Spatio-temporally explicit classification methods are a requirement in a variety of Earth system data processing applications. Upcoming missions such as the super-spectral Copernicus Sentinels EnMAP and FLEX will soon provide unprecedented data streams. Very high resolution (VHR) sensors like Worldview-3 also pose big challenges to data processing. The challenge is not only attached to optical sensors but also to infrared sounders and radar images which increased in spectral, spatial and temporal resolution. Besides, we should not forget the availability of the extremely large remote sensing data archives already collected by several past missions, such ENVISAT, Cosmo-SkyMED, Landsat, SPOT, or Seviri/MSG. These large-scale data problems require enhanced processing techniques that should be accurate, robust and fast. Standard parameter retrieval and classification algorithms cannot cope with this new scenario efficiently. In this work, we review the field of large scale kernel methods for both atmospheric parameter retrieval and cloud detection using infrared sounding IASI data and optical Seviri/MSG imagery. We propose novel Gaussian Processes (GPs) to train problems with millions of instances and high number of input features. Algorithms can cope with non-linearities efficiently, accommodate multi-output problems, and provide confidence intervals for the predictions. Several strategies to speed up algorithms are devised: random Fourier features and variational approaches for cloud classification using IASI data and Seviri/MSG, and engineered randomized kernel functions and emulation in temperature, moisture and ozone atmospheric profile retrieval from IASI as a proxy to the upcoming MTG-IRS sensor. Excellent compromise between accuracy and scalability are obtained in all applications.

Characteristics of variations of climate change and atmospheric CO2 concentration at different time scales over the past 500 Ma

NASA Astrophysics Data System (ADS)

LIU, Z.; Huang, S. S. X. E. C.; Tang, X.

2015-12-01

It is generally believed that current global warming is due to the persistent rise of atmospheric greenhouse gas CO2. The consensus is based mostly on the observational data of past decades and the polar ice core records. To understand the relationship between climate change and atmospheric CO2, their behaviors over a longer interval at different time scales need to be appreciated. Here, we collect and analyze past 500 Ma records of atmospheric CO2 and temperature in six time periods, namely Phanerozoic, Cenozoic, middle Pleistocene, last deglaciation, past millennium, and recent decades. According to the carriers and time spans, we divide these records into three categories: 1.The millionaire and longer records from model calculation and paleosols/paleobotany proxies. Although the trends of both variables are generally consistent on this time scale, it is difficult to establish a clear causal relationship because of great uncertainties and low resolutions of both sets of data. 2.The orbital scale mainly from the polar ice core. High precise CO2 and temperature reconstructions allow for an examination of the possible role of atmospheric CO2 in the glacial-interglacial transformation. 3.The records at centennial and shorter time scales over the past millennium from ice, snow, and instrumental data. The past millennium records are most abundant and accurate, especially CO2 has been measured directly in recent decades. However, due to the difficulties in distinguishing the effect of CO2 from other factors, there are great uncertainties in the interpretation of climate change versus CO2. Overall, we come to the following conclusions:1.Paleoclimatic reconstructions show that both temperature and atmospheric CO2 have generally decreased over the past 500 Ma. However, there are no consistent sequential orders in the changes between these two variables. 2.The Earth's atmospheric CO2 has a drastic oscillation history. There were many high CO2 periods when the values were

Dementia buddying as a vehicle for person-centred care? The performance of a volunteer-led pilot on two hospital wards.

PubMed

Preston, Claire; Burch, Sarah

2018-01-01

Objectives To understand and explain whether a dementia buddies pilot introduced into two adjacent mental health hospital wards in England was achieving its aim of enhancing person-centred care. Methods The research used a cultural lens to evaluate the dementia buddies pilot. It comprised 20 in-depth semi-structured interviews with staff, volunteers and carers in the two wards where the pilot was introduced. Results The pilot's ability to deliver positive outcomes depended on its compatibility with the culture of the ward and it performed better in the ward where a person-centred culture of care already existed. In this ward, the pilot became a catalyst for improved experience among patients, carers and staff, whereas in the second ward, the pilot faced resistance from staff and achieved less. Conclusions This finding underlines the benefit of focusing on workplace culture to understand the performance of volunteer-led initiatives. It also shows that existing ward culture is a determining factor in the capacity for dementia buddy schemes to act as vehicles for culture change.

Parameterization of plume chemistry into large-scale atmospheric models: Application to aircraft NOx emissions

NASA Astrophysics Data System (ADS)

Cariolle, D.; Caro, D.; Paoli, R.; Hauglustaine, D. A.; CuéNot, B.; Cozic, A.; Paugam, R.

2009-10-01

A method is presented to parameterize the impact of the nonlinear chemical reactions occurring in the plume generated by concentrated NOx sources into large-scale models. The resulting plume parameterization is implemented into global models and used to evaluate the impact of aircraft emissions on the atmospheric chemistry. Compared to previous approaches that rely on corrected emissions or corrective factors to account for the nonlinear chemical effects, the present parameterization is based on the representation of the plume effects via a fuel tracer and a characteristic lifetime during which the nonlinear interactions between species are important and operate via rates of conversion for the NOx species and an effective reaction rates for O3. The implementation of this parameterization insures mass conservation and allows the transport of emissions at high concentrations in plume form by the model dynamics. Results from the model simulations of the impact on atmospheric ozone of aircraft NOx emissions are in rather good agreement with previous work. It is found that ozone production is decreased by 10 to 25% in the Northern Hemisphere with the largest effects in the north Atlantic flight corridor when the plume effects on the global-scale chemistry are taken into account. These figures are consistent with evaluations made with corrected emissions, but regional differences are noticeable owing to the possibility offered by this parameterization to transport emitted species in plume form prior to their dilution at large scale. This method could be further improved to make the parameters used by the parameterization function of the local temperature, humidity and turbulence properties diagnosed by the large-scale model. Further extensions of the method can also be considered to account for multistep dilution regimes during the plume dissipation. Furthermore, the present parameterization can be adapted to other types of point-source NOx emissions that have to be

A multi-scale approach to monitor urban carbon-dioxide emissions in the atmosphere over Vancouver, Canada

NASA Astrophysics Data System (ADS)

Christen, A.; Crawford, B.; Ketler, R.; Lee, J. K.; McKendry, I. G.; Nesic, Z.; Caitlin, S.

2015-12-01

Measurements of long-lived greenhouse gases in the urban atmosphere are potentially useful to constrain and validate urban emission inventories, or space-borne remote-sensing products. We summarize and compare three different approaches, operating at different scales, that directly or indirectly identify, attribute and quantify emissions (and uptake) of carbon dioxide (CO2) in urban environments. All three approaches are illustrated using in-situ measurements in the atmosphere in and over Vancouver, Canada. Mobile sensing may be a promising way to quantify and map CO2 mixing ratios at fine scales across heterogenous and complex urban environments. We developed a system for monitoring CO2 mixing ratios at street level using a network of mobile CO2 sensors deployable on vehicles and bikes. A total of 5 prototype sensors were built and simultaneously used in a measurement campaign across a range of urban land use types and densities within a short time frame (3 hours). The dataset is used to aid in fine scale emission mapping in combination with simultaneous tower-based flux measurements. Overall, calculated CO2 emissions are realistic when compared against a spatially disaggregated scale emission inventory. The second approach is based on mass flux measurements of CO2 using a tower-based eddy covariance (EC) system. We present a continuous 7-year long dataset of CO2 fluxes measured by EC at the 28m tall flux tower 'Vancouver-Sunset'. We show how this dataset can be combined with turbulent source area models to quantify and partition different emission processes at the neighborhood-scale. The long-term EC measurements are within 10% of a spatially disaggregated scale emission inventory. Thirdly, at the urban scale, we present a dataset of CO2 mixing ratios measured using a tethered balloon system in the urban boundary layer above Vancouver. Using a simple box model, net city-scale CO2 emissions can be determined using measured rate of change of CO2 mixing ratios

Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals

PubMed Central

2011-01-01

Background Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. Methods During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics - that is second- and third-generation cephalosporins, carbapenems, and quinolones - in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Results Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval

Examination of particulate matter and heavy metals and their effects in at-risk wards in Washington, DC

NASA Astrophysics Data System (ADS)

Greene, Natasha Ann

One of the major contributions to pollution in the Washington, DC urban environment is particulate matter (PM). Quite often, ambient airborne toxics are closely associated with fine PM (PM2.5). We have performed high-resolution aerosol measurements of PM2.5 in four wards (Ward 1, 4, 5, and 7) of Washington, DC during two intensive observational periods (IOP). The first IOP occurred during the summer of 2003 (June 23rd to August 8th). The second IOP transpired during the late fall season of 2003 (October 20th to December 4 th). The measurement platform consisted of a Laser Particle Counter (LPC) and a Quartz Crystal Microbalance Cascade Impactor (QCM) to obtain both in-situ number and mass density distributions across the measurement sites. The data shows spatial distributions of particulate matter characterized as a function of size and mass properties. The QCM analyses show significant levels (> 15 mug/m3) of ward-averaged PM2.5 in Wards 4, 1, and 7 respectively during the summer IOP. However, all wards were less than the EPA National Ambient Air Quality Standard (NAAQS) of 15 mug/m 3 during the fall IOP ward-averaged measurements. Yet, investigations of the site-averaged measurements during the fall revealed some specific locations in Ward 4 that exceeded the NAAQS. Results also show that the aerosol mass density peaked in the 0.3 mum mode during the summer IOP and in the 0.15 mum mode during the fall IOP. The number density peaked in the 0.3--0.5 mum size range. Accordingly, the distributions have also been analyzed as a function of meteorological factors, such as wind speed and direction via NOAA HYSPLIT trajectories. One important attribute to this study is the evaluation of risks amongst IBC subgroups (youth, adults, elderly, black, white, hispanic, male, and female) for bath pediatric asthma rates and the onset of lung cancer over a lifetime (70-year period) when exposed to these levels of particulates. It has been determined that there are individual excess

Large-Scale Atmosphere-Ocean Coupling.

DTIC Science & Technology

1984-05-01

connection. between Pacific tropical diabatic heating anomalies and extratropical circulation system over the North Pacific from East Asia to the...and G. J. Boer, 1972: REFERENCES The General Circulation of the Tropical Atmosphere and Interaction with Extratropical Latitudes. Vol. 1. MIT Press...implications for the development of severe convective storms . Mom. We& Rev.. Chang, C.-P., and K. M. Lau, 1980: Northeasterly cold surges 167, 682-703. and

Staff perception of patient discharge from ICU to ward-based care.

PubMed

James, Stephen; Quirke, Sara; McBride-Henry, Karen

2013-11-01

The quality of information exchange between intensive care unit (ICU) and ward nurses, when patients are transferred out of intensive care, is important to the continuity of safe care. This research aimed to explore nurses' experiences of the discharge process from ICU to the ward environment. The study was conducted in a New Zealand Metropolitan hospital, using an exploratory descriptive design we adapted a questionnaire based on Whittaker and Ball's research on ICU patient handover. The questionnaires were then analysed using a descriptive thematic approach. The response rate of 48% included 45 ICU and 47 ward nurses. Key findings were that the written and verbal communication needs differ dependent upon setting and the timing of a discharge. Timing of handover also requires negotiation. Being able to negotiate the timing and nature of handover is important for nurses. In addition, standardized approaches to communication are believed to enhance patient safety. Standardized handover, with content and processes that are mutually negotiated, is crucial to providing the safest environment for patients. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

Drinking Water Quality Surveillance in a Vulnerable Urban Ward of Ahmedabad.

PubMed

Iyer, Veena; Choudhury, Nandini; Azhar, Gulrez Shah; Somvanshi, Bhushan

2014-05-01

The World Bank estimates that 21% of all communicable diseases in India are related to unsafe water with diarrhoea alone causing more than 0.1 million deaths annually. The WHO drinking water surveillance parameters of quality, quantity, accessibility, affordability and continuity were assessed in one vulnerable ward of Ahmedabad-a fast growing city in Western India. Interviews with key informants of the ward office, health centre and water supply department, secondary analysis and mapping of field test reports and a questionnaire-based survey of different household types were conducted. We found that Ahmedabad Municipal Corporation (AMC) supplies water to the ward intermittently for two hours during the day. Housing society clusters supplement their AMC water supply with untested bore-well water. The water quality surveillance system is designed for a twenty-four-hour piped distribution of treated surface water. However, in order to maintain surveillance over an intermittent supply that includes ground water, the sampling process should include periodic surveys of water actually consumed by the citizens. The laboratory capacity of the Central Water Testing Laboratory should expand to include more refined tests for microbial and chemical contamination.

Experiences of Patients in Acute and Closed Psychiatric Wards: A Systematic Review.

PubMed

Nugteren, Willem; van der Zalm, Yvonne; Hafsteinsdóttir, Thóra B; van der Venne, Cokky; Kool, Nienke; van Meijel, Berno

2016-10-01

To obtain insight into the patients' experiences during treatment in an acute, closed psychiatric ward. A systematic literature search was conducted in the databases Medline, Embase, CINAHL, and Cochrane. Ten articles were selected. Four main themes emerged from the literature: (a) the inappropriate use of the ward rules, (b) nurses' lack of time for interacting with patients, (c) the feeling of humiliation, and (d) the involvement of significant others. Nurses can use the findings of this systematic review to improve quality of care in acute psychiatric units. © 2015 Wiley Periodicals, Inc.

Land surface hydrology parameterization for atmospheric general circulation models including subgrid scale spatial variability

NASA Technical Reports Server (NTRS)

Entekhabi, D.; Eagleson, P. S.

1989-01-01

Parameterizations are developed for the representation of subgrid hydrologic processes in atmospheric general circulation models. Reasonable a priori probability density functions of the spatial variability of soil moisture and of precipitation are introduced. These are used in conjunction with the deterministic equations describing basic soil moisture physics to derive expressions for the hydrologic processes that include subgrid scale variation in parameters. The major model sensitivities to soil type and to climatic forcing are explored.

The Asian monsoon's role in atmospheric heat transport responses to orbital and millennial-scale climate change

NASA Astrophysics Data System (ADS)

McGee, D.; Green, B.; Donohoe, A.; Marshall, J.

2015-12-01

Recent studies have provided a framework for understanding the zonal-mean position of the tropical rain belt by documenting relationships between rain belt latitude and atmospheric heat transport across the equator (Donohoe et al., 2013). Modern seasonal and interannual variability in globally-averaged rain belt position (often referred to as 'ITCZ position') reflects the interhemispheric heat balance, with the rain belt's displacement toward the warmer hemisphere directly proportional to atmospheric heat transport into the cooler hemisphere. Model simulations suggest that rain belt shifts are likely to have obeyed the same relationship with interhemispheric heat transport in response to past changes in orbital parameters, ice sheets, and ocean circulation. This relationship implies that even small (±1 degree) shifts in the mean rain belt require large changes in hemispheric heat budgets, placing tight bounds on mean rain belt shifts in past climates. This work has primarily viewed tropical circulation in two dimensions, as a pair of zonal-mean Hadley cells on either side of the rain belt that are displaced north and south by perturbations in hemispheric energy budgets, causing the atmosphere to transport heat into the cooler hemisphere. Here we attempt to move beyond this zonal-mean perspective, motivated by arguments that the Asian monsoon system, rather than the zonal-mean circulation, plays the dominant role in annual-mean heat transport into the southern hemisphere in the modern climate (Heaviside and Czaja, 2012; Marshall et al., 2014). We explore a range of climate change experiments, including simulations of North Atlantic cooling and mid-Holocene climate, to test whether changes in interhemispheric atmospheric heat transport are primarily driven by the mean Hadley circulation, the Asian monsoon system, or other regional-scale atmospheric circulation changes. The scalings that this work identifies between Asian monsoon changes and atmospheric heat

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation

PubMed Central

2011-01-01

Background Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale. Method We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England. Results Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation. Conclusions Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms. PMID:21510852

Medical ward round competence in internal medicine - an interview study towards an interprofessional development of an Entrustable Professional Activity (EPA).

PubMed

Wölfel, Teresa; Beltermann, Esther; Lottspeich, Christian; Vietz, Elisa; Fischer, Martin R; Schmidmaier, Ralf

2016-07-11

The medical ward round is a central but complex activity that is of relevance from the first day of work. However, difficulties for young doctors have been reported. Instruction of ward round competence in medical curricula is hampered by the lack of a standardized description of the procedure. This paper aims to identify and describe physicians' tasks and relevant competences for conducting a medical ward round on the first day of professional work. A review of recent literature revealed known important aspects of medical ward rounds. These were used for the development of a semi-structured interview schedule. Medical ward round experts working at different hospitals were interviewed. The sample consisted of 14 ward physicians (M = 8.82 years of work experience) and 12 nurses (M = 14.55 years of work experience) working in different specializations of internal medicine. All interviews were audiotaped, fully transcribed, and analyzed using an inductive-deductive coding scheme. Nine fields of competences with 18 related sub-competences and 62 observable tasks were identified as relevant for conducting a medical ward round. Over 70 % of the experts named communication, collaborative clinical reasoning and organization as essential competences. Deeper analysis further unveiled the importance of self-management, management of difficult situations, error management and teamwork. The study is the first to picture ward round competences and related tasks in detail and to define an EPA "Conducting an internal medicine ward round" based on systematic interprofessional expert interviews. It thus provides a basis for integration of ward round competences in the medical curricula in an evidence based manner and gives a framework for the development of instructional intervention studies and comparative studies in other medical fields.

The Copernicus Atmosphere Monitoring Service: facilitating the prediction of air quality from global to local scales

NASA Astrophysics Data System (ADS)

Engelen, R. J.; Peuch, V. H.

2017-12-01

The European Copernicus Atmosphere Monitoring Service (CAMS) operationally provides daily forecasts of global atmospheric composition and regional air quality. The global forecasting system is using ECMWF's Integrated Forecasting System (IFS), which is used for numerical weather prediction and which has been extended with modules for atmospheric chemistry, aerosols and greenhouse gases. The regional forecasts are produced by an ensemble of seven operational European air quality models that take their boundary conditions from the global system and provide an ensemble median with ensemble spread as their main output. Both the global and regional forecasting systems are feeding their output into air quality models on a variety of scales in various parts of the world. We will introduce the CAMS service chain and provide illustrations of its use in downstream applications. Both the usage of the daily forecasts and the usage of global and regional reanalyses will be addressed.

Large-Scale, Synoptic-Period Weather Systems in Mars' Atmosphere

NASA Astrophysics Data System (ADS)

Hollingsworth, Jeffery L.; Kahre, M.

2013-10-01

During late autumn through early spring, extratropical regions on Mars exhibit profound mean zonal equator-to-pole thermal contrasts associated with its waxing and waning seasonal polar ice caps. The imposition of this strong meridional temperature gradient supports intense eastward-traveling, synoptic-period weather systems (i.e., transient baroclinic/barotropic waves) within Mars' extratropical atmosphere. These disturbances grow, mature and decay within the east-west varying seasonal-mean middle and high-latitude westerly jet stream (i.e., the polar vortex) on the planet. Near the surface, such weather disturbances indicated distinctive, spiraling "comma"-shaped dust cloud structures of large scale, and scimitar-shaped dust fronts, indicative of processes associated with cyclo- and fronto-genesis. The weather systems are most intense during specific seasons on Mars, and in both hemispheres. The northern hemisphere (NH) disturbances appear to be significantly more vigorous than their counterparts in the southern hemisphere (SH). Further, the NH weather systems and accompanying frontal waves appear to have significant impacts on the transport of tracer fields (e.g., particularly dust and to some extent water species (vapor/ice) as well). Regarding dust, frontal waves appear to be key agents in the lifting, lofting, organization and transport of this atmospheric aerosol. A brief background and supporting observations of Mars' extratropical weather systems is presented. This is followed by various modeling studies (i.e., ranging from highly simplified, mechanistic and fully complex global circulation modeling investigations) that we are pursuing. In particular, transport of scalar quantities (e.g., tracers and high-order dynamically revealing diagnostic fields) are investigated. A discussion of outstanding issues and future modeling pursuits is offered related to Mars' extratropical traveling weather systems.

Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle.

PubMed

Johnston, Maximilian J; Arora, Sonal; King, Dominic; Darzi, Ara

2018-01-01

This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety. A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards. Twenty-seven junior and senior surgeons completed validated questionnaires assessing supervision, escalation of care, and safety culture pre and post-intervention along with interviews to further explore the impact of the intervention. Patient outcomes pre and postintervention were also analyzed. Questionnaires revealed significant improvements in supervision postintervention (senior median pre 5 vs post 7, P = 0.002 and junior 4 vs 6, P = 0.039) and senior surgeon approachability (junior 5 vs 6, P = 0.047). Both groups agreed that they would feel safer as a patient in their hospital postintervention (senior 3 vs 4.5, P = 0.021 and junior 3 vs 4, P = 0.034). The interviews confirmed that the safety culture of the department had improved. There were no differences in inpatient mortality, cardiac arrest, reoperation, or readmission rates pre and postintervention. Improving supervision and introducing clear protocols can improve safety culture on the surgical ward. Future work should evaluate the effect these measures have on patient outcomes in multiple institutions.

Ionization in atmospheres of brown dwarfs and extrasolar planets VI: Properties of large-scale discharge events

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

Bailey, R. L.; Helling, Ch.; Hodosán, G.

2014-03-20

Mineral clouds in substellar atmospheres play a special role as a catalyst for a variety of charge processes. If clouds are charged, the surrounding environment becomes electrically activated, and ensembles of charged grains are electrically discharging (e.g., by lightning), which significantly influences the local chemistry creating conditions similar to those thought responsible for life in early planetary atmospheres. We note that such lightning discharges contribute also to the ionization state of the atmosphere. We apply scaling laws for electrical discharge processes from laboratory measurements and numerical experiments to DRIFT-PHOENIX model atmosphere results to model the discharge's propagation downward (as lightning)more » and upward (as sprites) through the atmospheric clouds. We evaluate the spatial extent and energetics of lightning discharges. The atmospheric volume affected (e.g., by increase of temperature or electron number) is larger in a brown dwarf atmosphere (10{sup 8}-10{sup 10} m{sup 3}) than in a giant gas planet (10{sup 4}-10{sup 6} m{sup 3}). Our results suggest that the total dissipated energy in one event is <10{sup 12} J for all models of initial solar metallicity. First attempts to show the influence of lightning on the local gas phase indicate an increase of small carbohydrate molecules like CH and CH{sub 2} at the expense of CO and CH{sub 4}. Dust-forming molecules are destroyed and the cloud particle properties are frozen in unless enough time is available for complete evaporation. We summarize instruments potentially suitable to observe lightning on extrasolar objects.« less

'Take Ten' improving the surgical post-take ward round: a quality improvement project.

PubMed

Banfield, Danielle Alice; Adamson, Carly; Tomsett, Amy; Povey, James; Fordham, Tony; Richards, Sarah Kathryn

2018-01-01

The surgical post-take ward round is a complex multidisciplinary interaction in which new surgical patients are reviewed and management plans formulated. Its fast-paced nature can lead to poor communication and inaccurate or incomplete documentation with potential detriment to patient safety. Junior team members often do not fully understand the diagnosis and management plan. The aims of this project were to improve both communication and documentation on the surgical post-take ward round, influencing patient safety. The ward round was deconstructed to identify individual roles and determine where intervention would have the most impact. Ten important points were identified that should be documented in the management of an acute surgical patient; observations, examination, impression, investigations, antibiotics, intravenous fluids, VTE assessment, nutrition status, estimated length of stay and ceiling of treatment. A 'Take Ten' checklist was devised with these items to be used as a 'time out' after each patient with the whole team for discussion, clarification and clear documentation. Four plan do study act cycles were completed over a period of a year. A retrospective review of post-take documentation preintervention and postintervention was performed, and the percentage of points that were accurately documented was calculated. For further clarification, 2 weekends were compared-one where the checklist was used and one where it was not. Results showed documentation postintervention varied between categories but there was improvement in documentation of VTE assessment, fluids, observations and investigations. On direct comparison of weekends the checklist showed improved documentation in all categories except length of stay. Junior team members found the checklist improved understanding of diagnosis and management plan, and encouraged a more effective ward round. The 'Take Ten' checklist has been well received. Three years on from its inception, the checklist

Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014.

PubMed

Dunn, Angela C; Walker, Tiffany A; Redd, John; Sugerman, David; McFadden, Jevon; Singh, Tushar; Jasperse, Joseph; Kamara, Brima Osaio; Sesay, Tom; McAuley, James; Kilmarx, Peter H

2016-03-01

In the largest Ebola virus disease (EVD) outbreak in history, nosocomial transmission of EVD increased spread of the disease. We report on 2 instances in Sierra Leone where patients unknowingly infected with EVD were admitted to a general hospital ward (1 pediatric ward and 1 maternity ward), exposing health care workers, caregivers, and other patients to EVD. Both patients died on the general wards, and were later confirmed as being infected with EVD. We initiated contact tracing and assessed risk factors for secondary infections to guide containment recommendations. We reviewed medical records to establish the index patients' symptom onset. Health care workers, patients, and caregivers were interviewed to determine exposures and personal protective equipment (PPE) use. Contacts were monitored daily for EVD symptoms. Those who experienced EVD symptoms were isolated and tested. Eighty-two contacts were identified: 64 health care workers, 7 caregivers, 4 patients, 4 newborns, and 3 children of patients. Seven contacts became symptomatic and tested positive for EVD: 2 health care workers (1 nurse and 1 hospital cleaner), 2 caregivers, 2 newborns, and 1 patient. The infected nurse placed an intravenous catheter in the pediatric index patient with only short gloves PPE and the hospital cleaner cleaned the operating room of the maternity ward index patient wearing short gloves PPE. The maternity ward index patient's caregiver and newborn were exposed to her body fluids. The infected patient and her newborn shared the ward and latrine with the maternity ward index patient. Hospital staff members did not use adequate PPE. Caregivers were not offered PPE. Delayed recognition of EVD and inadequate PPE likely led to exposures and secondary infections. Earlier recognition of EVD and adequate PPE might have reduced direct contact with body fluids. Limiting nonhealth-care worker contact, improving access to PPE, and enhancing screening methods for pregnant women, children

From psychiatric ward to the streets and shelters.

PubMed

Forchuk, C; Russell, G; Kingston-Macclure, S; Turner, K; Dill, S

2006-06-01

The issue of discharge from hospital ward to the streets is seldom explored in the literature, but all too commonly experienced by individuals experiencing psychiatric disorders. The Community University Research Alliance on Housing and Mental Health sought to determine how frequently people were discharged from psychiatric wards to shelters or the street in London, Ontario, Canada. A number of data sources were accessed to determine instances of discharges to shelters or the street. Data were analysed to determine the number of moves occurring between hospital and shelter or no fixed address. All datasets revealed the problem of discharge to shelters or the street occurred regularly. All data sources used have the difficulty of likely underestimating the extent of the problem. This type of discharge occurred at least 194 times in 2002 in London, Ontario, Canada. Policies that contribute to this problem include income-support policies, the reduction in psychiatric hospital beds and the lack of community supports. Without recognition, this problem is at risk of remaining invisible with no further improvements to the situation.

Comparative study of the prevalence of sepsis in patients admitted to dermatology and internal medicine wards*

PubMed Central

Almeida, Luiz Maurício Costa; Diniz, Michelle dos Santos; Diniz, Lorena dos Santos; Machado-Pinto, Jackson; Silva, Francisco Chagas Lima

2013-01-01

BACKGROUND Sepsis is a common cause of morbidity and mortality among hospitalized patients. The prevalence of this condition has increased significantly in different parts of the world. Patients admitted to dermatology wards often have severe loss of skin barrier and use systemic corticosteroids, which favor the development of sepsis. OBJECTIVES To evaluate the prevalence of sepsis among patients admitted to a dermatology ward compared to that among patients admitted to an internal medicine ward. METHODS It is a cross-sectional, observational, comparative study that was conducted at Hospital Santa Casa de Belo Horizonte. Data were collected from all patients admitted to four hospital beds at the dermatology and internal medicine wards between July 2008 and July 2009. Medical records were analyzed for the occurrence of sepsis, dermatologic diagnoses, comorbidities, types of pathogens and most commonly used antibiotics. RESULTS We analyzed 185 medical records. The prevalence of sepsis was 7.6% among patients admitted to the dermatology ward and 2.2% (p = 0.10) among those admitted to the internal medicine ward. Patients with comorbidities, diabetes mellitus and cancer did not show a higher incidence of sepsis. The main agent found was Staphylococcus aureus, and the most commonly used antibiotics were ciprofloxacin and oxacillin. There was a significant association between sepsis and the use of systemic corticosteroids (p <0.001). CONCLUSION It becomes clear that epidemiological studies on sepsis should be performed more extensively and accurately in Brazil so that efforts to prevent and treat this serious disease can be made more effectively. PMID:24173179

A ward-based time study of paper and electronic documentation for recording vital sign observations.

PubMed

Wong, David; Bonnici, Timothy; Knight, Julia; Gerry, Stephen; Turton, James; Watkinson, Peter

2017-07-01

To investigate time differences in recording observations and an early warning score using traditional paper charts and a novel e-Obs system in clinical practice. Researchers observed the process of recording observations and early warning scores across 3 wards in 2 university teaching hospitals immediately before and after introduction of the e-Obs system. The process of recording observations included both measurement and documentation of vital signs. Interruptions were timed and subtracted from the measured process duration. Multilevel modeling was used to compensate for potential confounding factors. In all, 577 nurse events were observed (281 paper, 296 e-Obs). The geometric mean time to take a complete set of vital signs was 215 s (95% confidence interval [CI], 177 s-262 s) on paper, and 150 s (95% CI, 130 s-172 s) electronically. The treatment effect ratio was 0.70 (95% CI, 0.57-0.85, P  < .001). The treatment effect ratio in ward 1 was 0.37 (95% CI, 0.26-0.53), in ward 2 was 0.98 (95% CI, 0.70-1.38), and in ward 3 was 0.93 (95% CI, 0.66-1.33). Introduction of an e-Obs system was associated with a statistically significant reduction in overall time to measure and document vital signs electronically compared to paper documentation. The reductions in time varied among wards and were of clinical significance on only 1 of 3 wards studied. Our results suggest that introduction of an e-Obs system could lower nursing workload as well as increase documentation quality. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study.

PubMed

Cowman, Seamus; Bowers, Len

2009-05-01

The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses. Violence is a serious problem in psychiatric services and staff experience significant psychological reactions to being assaulted. Health and Safety Authorities in the UK and Ireland have expressed concern about violence and assault in healthcare, however, there remains a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. A descriptive survey research design was employed. Questionnaires were circulated to all acute wards in London and in Ireland and the resulting data compared. A total of 124 psychiatric wards from London and 43 wards from Ireland were included in this study and response rates of 70% (London) and 86% (Ireland) were obtained. Differences and similarities in safety and security practices were identified between London and Ireland, with Irish wards having generally higher and more intensive levels of security. There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and London. Given the trends in European Union (EU) regulation, there is a strong argument for the publication of acceptable minimum guidelines for safety and security in mental health services across the EU. There must be a concerted effort to ensure that all policy and procedure in safety and security is founded on evidence and best practice. Mental health managers must establish a review of work safety and security procedures and practices. Risk assessment and environmental audits of all mental health clinical environments should be mandatory.

Implementation and Evaluation of a Ward-Based eLearning Program for Trauma Patient Management.

PubMed

Curtis, Kate; Wiseman, Taneal; Kennedy, Belinda; Kourouche, Sarah; Goldsmith, Helen

2016-01-01

The majority of trauma nursing education is focused on the emergency phases of care. We describe the development and evaluation of a trauma eLearning module for the ward environment. The module was developed using adult learning principles and implemented in 2 surgical wards. There were 3 phases of evaluation: (1) self-efficacy of nurses; (2) relevance and usability of the module and; (3) application of knowledge learnt. The majority indicated they had applied new knowledge, particularly when performing a physical assessment (85.7%), communicating (91.4%), and identifying risk of serious illness (90.4%). Self-efficacy relating to confidence in caring for patients, communication, and escalating clinical deterioration improved (p = .023). An eLearning trauma patient assessment module for ward nursing staff improves nursing knowledge and self-efficacy.

Transient behavior of vertical scaling of mesoscale winds in the light of atmospheric turbulence transfer in and between synoptic and mesoscales

NASA Astrophysics Data System (ADS)

Barros, A. P.; Eghdami, M.

2017-12-01

High-resolution ( 1 km) numerical weather prediction models are capable of producing atmospheric spectra over synoptic and mesoscale ranges. Nogueira and Barros (2015) showed using high-resolution simulations in the Andes that the horizontal scale invariant behavior of atmospheric wind and water fields in the model is a process-dependent transient property that varies with the underlying dynamics. They found a sharp transition in the scaling parameters between non-convective and convective conditions. Spectral slopes around 2-2.3 arise under non-convective or very weak convective conditions, whereas in convective situations the transient scaling exponents remain under -5/3. Based on these results, Nogueira and Barros (2015) proposed a new sub-grid scale parameterization of clouds obtained from coarse resolution states alone. High Reynolds number direct numerical simulations of two-dimensional turbulence transfer shows that atmospheric flows involve concurrent direct (downscale) enstrophy transfer in the synoptic scales and inverse (upscale) kinetic energy transfer from the meso- to the synoptic-scales. In this study we use an analogy to investigate the transient behavior of kinetic energy spectra of winds over the Andes and Southern Appalachian Mountains representative of high and middle mountains, respectively. In the unstable conditions and particularly in the Planetary Boundary Layer (PBL) the spectral slopes approach -5/3 associated with the upscale KE turbulence transfer. However, in the stable conditions and above the planetary boundary layer, the spectra slopes approach steeper slopes about -3 associated with the downscale KE transfer. The underlying topography, surface roughness, diurnal heating and cooling and moist processes add to the complexity of the problem by introducing anisotropy and sources and sinks of energy. A comprehensive analysis and scaling of flow behavior conditional on stability regime for both KE and moist processes (total water, cloud

Large-scale coherent structures of suspended dust concentration in the neutral atmospheric surface layer: A large-eddy simulation study

NASA Astrophysics Data System (ADS)

Zhang, Yangyue; Hu, Ruifeng; Zheng, Xiaojing

2018-04-01

Dust particles can remain suspended in the atmospheric boundary layer, motions of which are primarily determined by turbulent diffusion and gravitational settling. Little is known about the spatial organizations of suspended dust concentration and how turbulent coherent motions contribute to the vertical transport of dust particles. Numerous studies in recent years have revealed that large- and very-large-scale motions in the logarithmic region of laboratory-scale turbulent boundary layers also exist in the high Reynolds number atmospheric boundary layer, but their influence on dust transport is still unclear. In this study, numerical simulations of dust transport in a neutral atmospheric boundary layer based on an Eulerian modeling approach and large-eddy simulation technique are performed to investigate the coherent structures of dust concentration. The instantaneous fields confirm the existence of very long meandering streaks of dust concentration, with alternating high- and low-concentration regions. A strong negative correlation between the streamwise velocity and concentration and a mild positive correlation between the vertical velocity and concentration are observed. The spatial length scales and inclination angles of concentration structures are determined, compared with their flow counterparts. The conditionally averaged fields vividly depict that high- and low-concentration events are accompanied by a pair of counter-rotating quasi-streamwise vortices, with a downwash inside the low-concentration region and an upwash inside the high-concentration region. Through the quadrant analysis, it is indicated that the vertical dust transport is closely related to the large-scale roll modes, and ejections in high-concentration regions are the major mechanisms for the upward motions of dust particles.

Interior view of typical ward on second floor, south wing; ...

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

Interior view of typical ward on second floor, south wing; camera facing northwest. - Mare Island Naval Shipyard, Hospital Headquarters, Johnson Lane, west side at intersection of Johnson Lane & Cossey Street, Vallejo, Solano County, CA

North Atlantic explosive cyclones and large scale atmospheric variability modes

NASA Astrophysics Data System (ADS)

Liberato, Margarida L. R.

2015-04-01

Extreme windstorms are one of the major natural catastrophes in the extratropics, one of the most costly natural hazards in Europe and are responsible for substantial economic damages and even fatalities. During the last decades Europe witnessed major damage from winter storms such as Lothar (December 1999), Kyrill (January 2007), Klaus (January 2009), Xynthia (February 2010), Gong (January 2013) and Stephanie (February 2014) which exhibited uncommon characteristics. In fact, most of these storms crossed the Atlantic in direction of Europe experiencing an explosive development at unusual lower latitudes along the edge of the dominant North Atlantic storm track and reaching Iberia with an uncommon intensity (Liberato et al., 2011; 2013; Liberato 2014). Results show that the explosive cyclogenesis process of most of these storms at such low latitudes is driven by: (i) the southerly displacement of a very strong polar jet stream; and (ii) the presence of an atmospheric river (AR), that is, by a (sub)tropical moisture export over the western and central (sub)tropical Atlantic which converges into the cyclogenesis region and then moves along with the storm towards Iberia. Previous studies have pointed to a link between the North Atlantic Oscillation (NAO) and intense European windstorms. On the other hand, the NAO exerts a decisive control on the average latitudinal location of the jet stream over the North Atlantic basin (Woollings et al. 2010). In this work the link between North Atlantic explosive cyclogenesis, atmospheric rivers and large scale atmospheric variability modes is reviewed and discussed. Liberato MLR (2014) The 19 January 2013 windstorm over the north Atlantic: Large-scale dynamics and impacts on Iberia. Weather and Climate Extremes, 5-6, 16-28. doi: 10.1016/j.wace.2014.06.002 Liberato MRL, Pinto JG, Trigo IF, Trigo RM. (2011) Klaus - an exceptional winter storm over Northern Iberia and Southern France. Weather 66:330-334. doi:10.1002/wea.755 Liberato

Impacts of large-scale atmospheric circulation changes in winter on black carbon transport and deposition to the Arctic

NASA Astrophysics Data System (ADS)

Pozzoli, Luca; Dobricic, Srdan; Russo, Simone; Vignati, Elisabetta

2017-10-01

Winter warming and sea-ice retreat observed in the Arctic in the last decades may be related to changes of large-scale atmospheric circulation pattern, which may impact the transport of black carbon (BC) to the Arctic and its deposition on the sea ice, with possible feedbacks on the regional and global climate forcing. In this study we developed and applied a statistical algorithm, based on the maximum likelihood estimate approach, to determine how the changes of three large-scale weather patterns associated with increasing temperatures in winter and sea-ice retreat in the Arctic impact the transport of BC to the Arctic and its deposition. We found that two atmospheric patterns together determine a decreasing winter deposition trend of BC between 1980 and 2015 in the eastern Arctic while they increase BC deposition in the western Arctic. The increasing BC trend is mainly due to a pattern characterized by a high-pressure anomaly near Scandinavia favouring the transport in the lower troposphere of BC from Europe and North Atlantic directly into to the Arctic. Another pattern with a high-pressure anomaly over the Arctic and low-pressure anomaly over the North Atlantic Ocean has a smaller impact on BC deposition but determines an increasing BC atmospheric load over the entire Arctic Ocean with increasing BC concentrations in the upper troposphere. The results show that changes in atmospheric circulation due to polar atmospheric warming and reduced winter sea ice significantly impacted BC transport and deposition. The anthropogenic emission reductions applied in the last decades were, therefore, crucial to counterbalance the most likely trend of increasing BC pollution in the Arctic.

Noether’s second theorem and Ward identities for gauge symmetries

DOE PAGES

Avery, Steven G.; Schwab, Burkhard U. W.

2016-02-04

Recently, a number of new Ward identities for large gauge transformations and large diffeomorphisms have been discovered. Some of the identities are reinterpretations of previously known statements, while some appear to be genuinely new. We present and use Noether’s second theorem with the path integral as a powerful way of generating these kinds of Ward identities. We reintroduce Noether’s second theorem and discuss how to work with the physical remnant of gauge symmetry in gauge fixed systems. We illustrate our mechanism in Maxwell theory, Yang-Mills theory, p-form field theory, and Einstein-Hilbert gravity. We comment on multiple connections between Noether’s secondmore » theorem and known results in the recent literature. Finally, our approach suggests a novel point of view with important physical consequences.« less

Impact of oceanic-scale interactions on the seasonal modulation of ocean dynamics by the atmosphere.

PubMed

Sasaki, Hideharu; Klein, Patrice; Qiu, Bo; Sasai, Yoshikazu

2014-12-15

Ocean eddies (with a size of 100-300 km), ubiquitous in satellite observations, are known to represent about 80% of the total ocean kinetic energy. Recent studies have pointed out the unexpected role of smaller oceanic structures (with 1-50 km scales) in generating and sustaining these eddies. The interpretation proposed so far invokes the internal instability resulting from the large-scale interaction between upper and interior oceanic layers. Here we show, using a new high-resolution simulation of the realistic North Pacific Ocean, that ocean eddies are instead sustained by a different process that involves small-scale mixed-layer instabilities set up by large-scale atmospheric forcing in winter. This leads to a seasonal evolution of the eddy kinetic energy in a very large part of this ocean, with an amplitude varying by a factor almost equal to 2. Perspectives in terms of the impacts on climate dynamics and future satellite observational systems are briefly discussed.

Impact of oceanic-scale interactions on the seasonal modulation of ocean dynamics by the atmosphere

PubMed Central

Sasaki, Hideharu; Klein, Patrice; Qiu, Bo; Sasai, Yoshikazu

2014-01-01

Ocean eddies (with a size of 100–300 km), ubiquitous in satellite observations, are known to represent about 80% of the total ocean kinetic energy. Recent studies have pointed out the unexpected role of smaller oceanic structures (with 1–50 km scales) in generating and sustaining these eddies. The interpretation proposed so far invokes the internal instability resulting from the large-scale interaction between upper and interior oceanic layers. Here we show, using a new high-resolution simulation of the realistic North Pacific Ocean, that ocean eddies are instead sustained by a different process that involves small-scale mixed-layer instabilities set up by large-scale atmospheric forcing in winter. This leads to a seasonal evolution of the eddy kinetic energy in a very large part of this ocean, with an amplitude varying by a factor almost equal to 2. Perspectives in terms of the impacts on climate dynamics and future satellite observational systems are briefly discussed. PMID:25501039

Development of Geospatial Map Based Portal for Delimitation of Mcd Wards

NASA Astrophysics Data System (ADS)

Gupta, A. Kumar Chandra; Kumar, P.; Sharma, P. Kumar

2017-09-01

The Geospatial Delhi Limited (GSDL), a Govt. of NCT of Delhi Company formed in order to provide the geospatial information of National Capital Territory of Delhi (NCTD) to the Government of National Capital Territory of Delhi (GNCTD) and its organs such as DDA, MCD, DJB, State Election Department, DMRC etc., for the benefit of all citizens of Government of National Capital Territory of Delhi (GNCTD). This paper describes the development of Geospatial Map based Portal for Delimitation of MCD Wards (GMPDW) and election of 3 Municipal Corporations of NCT of Delhi. The portal has been developed as a map based spatial decision support system (SDSS) for delimitation of MCD Wards and draw of peripheral wards boundaries to planning and management of MCD Election process of State Election Commission, and as an MCD election related information searching tools (Polling Station, MCD Wards and Assembly constituency etc.,) for the citizens of NCTD. The GMPDW is based on Client-Server architecture model. It has been developed using Arc GIS Server 10.0 with .NET (pronounced dot net) technology. The GMPDW is scalable to enterprise SDSS with enterprise Geo Database & Virtual Private Network (VPN) connectivity. Spatial data to GMPDW includes Enumeration Block (EB) and Enumeration Blocks Group (EBG) boundaries of Citizens of Delhi, Assembly Constituency, Parliamentary Constituency, Election District, Landmark locations of Polling Stations & basic amenities (Police Stations, Hospitals, Schools and Fire Stations etc.). GMPDW could help achieve not only the desired transparency and easiness in planning process but also facilitates through efficient & effective tools for management of MCD election. It enables a faster response to the changing ground realities in the development planning, owing to its in-built scientific approach and open-ended design.

Supervisors' pedagogical role at a clinical education ward - an ethnographic study.

PubMed

Manninen, Katri; Henriksson, Elisabet Welin; Scheja, Max; Silén, Charlotte

2015-01-01

Clinical practice is essential for health care students. The supervisor's role and how supervision should be organized are challenging issues for educators and clinicians. Clinical education wards have been established to meet these challenges and they are units with a pedagogical framework facilitating students' training in real clinical settings. Supervisors support students to link together theoretical and practical knowledge and skills. From students' perspectives, clinical education wards have shown potential to enhance students' learning. Thus there is a need for deeper understanding of supervisors' pedagogical role in this context. We explored supervisors' approaches to students' learning at a clinical education ward where students are encouraged to independently take care of patients. An ethnographic approach was used to study encounters between patients, students and supervisors. The setting was a clinical education ward for nursing students at a university hospital. Ten observations with ten patients, 11 students and five supervisors were included in the study. After each observation, individual follow-up interviews with all participants and a group interview with supervisors were conducted. Data were analysed using an ethnographic approach. Supervisors' pedagogical role has to do with balancing patient care and student learning. The students were given independence, which created pedagogical challenges for the supervisors. They handled these challenges by collaborating as a supervisory team and taking different acts of supervision such as allowing students their independence, being there for students and by applying patient-centredness. The supervisors' pedagogical role was perceived as to facilitate students' learning as a team. Supervisors were both patient- and student-centred by making a nursing care plan for the patients and a learning plan for the students. The plans were guided by clinical and pedagogical guidelines, individually adjusted and

Experimental study of the impact of large-scale wind farms on land-atmosphere exchanges

NASA Astrophysics Data System (ADS)

Zhang, wei; Markfort, Corey; Porté-Agel, Fernando

2013-04-01

Wind energy is one of the fastest growing sources of renewable energy world-wide, and it is expected that many more large-scale wind farms will be built and cover a significant portion of land and ocean surfaces. By extracting kinetic energy from the atmospheric boundary layer and converting it to electricity, wind farms may affect the transport of momentum, heat, moisture and trace gases (e.g. CO2) between the atmosphere and the land surface locally and globally. Understanding wind farm-atmosphere interactions and subsequent environmental impacts are complicated by the effects of turbine array configuration, wind farm size, land-surface characteristics and atmospheric thermal stability. In particular, surface scalar flux is influenced by wind farms and needs to be appropriately parameterized in meso-scale and/or high-resolution numerical models. Wind-tunnel experiments of model wind farms with perfectly aligned and staggered configurations, having the same turbine distribution density, were conducted in a neutral turbulent boundary layer with a surface heat source. Turbulent flow and fluxes over and through the wind farm were measured using a custom x-wire/cold-wire anemometer; and surface scalar flux was measured with an array of surface-mounted heat flux sensors within the quasi-developed flow regime. Although the overall surface heat flux change produced by the wind farms was found to be small, with a net reduction of 4% for the staggered wind farm and nearly zero for the aligned wind farm, the highly heterogeneous spatial distribution of the surface heat flux, dependent on wind farm layout, is significant. The difference between the minimum and maximum surface heat fluxes could be up to 12% and 7% in aligned and staggered wind farms, respectively. This finding is important for planning intensive agriculture practices and optimizing agricultural land use with regard to wind energy project development. The well-controlled wind-tunnel experiments presented here

Evaluating the Productive Ward at an acute NHS trust: experiences and implications of releasing time to care.

PubMed

Wright, Stella; McSherry, Wilfred

2014-07-01

To demonstrate how a national programme aimed to increase the amount of direct time nurses spend with patients', impacts on both staff and patient experience. The Productive Ward is an improvement programme developed by the NHS Institute for Innovation and Improvement (2007, http://www.institute.nhs.uk/quality_and_value/productivity_series/productive_ward.html) which aims to enable nurses to work more efficiently by reviewing process and practice, thus releasing more time to spend on direct patient care. However, there is little empirical published research around the programme, particularly concerning impact, sustainability and the patient perspective. This manuscript presents the findings from qualitative interviews involving both staff and patients. Semi-structured one-to-one interviews were conducted with patients (n = 8) and staff (n = 5) on five case study wards. Seven focus groups were held according to staff grade (n = 29). Despite initial scepticism, most staff embraced the opportunity and demonstrated genuine enthusiasm and energy for the programme. Patients were generally complimentary about their experience as an inpatient, reporting that staff made them feel safe, comfortable and cared for. Findings showed that the aims of the programme were partially met. The implementation of Productive Ward was associated with significant changes to the ward environment and improvements for staff. The programme equipped staff with skills and knowledge which acted as a primer for subsequent interventions. However, there was a lack of evidence to demonstrate that Productive Ward released time for direct patient care in all areas that implemented the programme. Developing robust performance indicators including a system to capture reinvestment of direct care time would enable frontline staff to demonstrate impact of the programme. Additionally, staff will need to ensure that reorganisation and instability across the NHS do not affect sustainability and viability of the

The Productive Ward: releasing Time to Care(™)--what we can learn from the literature for implementation.

PubMed

White, Mark; Wells, John Sg; Butterworth, Tony

2014-10-01

This paper reviews the Productive Ward: Releasing Time to Care™ literature, identifying and discussing the key characteristics that may contribute to successful implementation. It is 5 years since the official UK launch of the Productive Ward, and the Republic of Ireland commenced a phased, national implementation programme in 2011. Thus it is timely to reflect on the implementation lessons learned to date and described in the literature. Using taxonomic mapping, this paper evaluates the current state of the literature that pertains to Productive Ward implementation experience; success factors; reports, and assessments. Seven common contextual characteristics were identified: robust and engaging communication; enabling and empowering roles; appropriate training; project planning and management; leadership; corporate/management engagement and support; and financial and human resource commitment. The key characteristics identified have a direct impact on the implementation of the Productive Ward. The interplay between these key characteristics and how this interplay influences successful implementation of the Productive Ward warrants further research. Acknowledging and embracing the seven characteristics during implementation will positively improve the progress and success of the initiatives implementation. © 2013 John Wiley & Sons Ltd.

The effect of millennial-scale changes in Arabian Sea denitrification on atmospheric CO2.

PubMed

Altabet, Mark A; Higginson, Matthew J; Murray, David W

2002-01-10

Most global biogeochemical processes are known to respond to climate change, some of which have the capacity to produce feedbacks through the regulation of atmospheric greenhouse gases. Marine denitrification-the reduction of nitrate to gaseous nitrogen-is an important process in this regard, affecting greenhouse gas concentrations directly through the incidental production of nitrous oxide, and indirectly through modification of the marine nitrogen inventory and hence the biological pump for CO2. Although denitrification has been shown to vary with glacial-interglacial cycles, its response to more rapid climate change has not yet been well characterized. Here we present nitrogen isotope ratio, nitrogen content and chlorin abundance data from sediment cores with high accumulation rates on the Oman continental margin that reveal substantial millennial-scale variability in Arabian Sea denitrification and productivity during the last glacial period. The detailed correspondence of these changes with Dansgaard-Oeschger events recorded in Greenland ice cores indicates rapid, century-scale reorganization of the Arabian Sea ecosystem in response to climate excursions, mediated through the intensity of summer monsoonal upwelling. Considering the several-thousand-year residence time of fixed nitrogen in the ocean, the response of global marine productivity to changes in denitrification would have occurred at lower frequency and appears to be related to climatic and atmospheric CO2 oscillations observed in Antarctic ice cores between 20 and 60 kyr ago.

Pediatric resident perceptions of shift work in ward rotations.

PubMed

Nomura, Osamu; Mishina, Hiroki; Jasti, Harish; Sakai, Hirokazu; Ishiguro, Akira

2017-10-01

Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education. © 2017 Japan Pediatric Society.

On the outer scale of turbulence in the atmospheric surface layer

NASA Astrophysics Data System (ADS)

de Bruin, H. A. R.; Beyrich, F.

2009-09-01

The well-known Kolmogorov and Tatarskii similarity relations for spectra in the atmospheric surface layer are derived for an eddy-size region between the outer and inner scale (L0 and l0 respectively). Remarkably few studies are devoted to the outer scale L0. Tatarski (1992) defined it through the ratio of twice the variance and the structure parameter of temperature to the power 3/2. In most studies L0 is assumed to be proportional to the height z (Wheelon, 2001, pag. 79). In our study we will introduce an alternative definition for L0.. Next, its behavior will be investigated analyzing different data sets gathered under a wide range of conditions and observations height. During daytime, L0 appears to vary with z indeed, but with lot of scatter and systematic differences. The consequences of these findings for different remote sensing techniques such a scintillometry will be discussed. Tatarskii, V.I., 1992: Review of scintillation phenomena, in: Tatarskii et al. (Eds.): Wave Propagation in Random Media (Scintillation), Spie Press, 2-16. Wheelon, A.D., 2001: Electromagnetic Scintillation, part I Geometrical Optics, Cambridge University Press, 455 pp

Los Angeles County Poor Farm, Patient Wards 201, 202, 203, ...

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

Los Angeles County Poor Farm, Patient Wards 201, 202, 203, 204, 205, 206, 207, 208 & 209 - Type A Plan, 7601 Imperial Highway; bounded by Esperanza Street, Hawthorn Avenue, Laurel Street, and Descanso Street, Downey, Los Angeles County, CA

Patient safety ward round checklist via an electronic app: implications for harm prevention.

PubMed

Keller, C; Arsenault, S; Lamothe, M; Bostan, S R; O'Donnell, R; Harbison, J; Doherty, C P

2017-11-06

Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application. Two research teams were formed; one auditing a medical team to establish a procedural baseline of "usual care" practice and an intervention team concurrently was enforcing the implementation of the checklist. The checklist was comprised of eight standard clinical practice items. The program was conducted over a 2-week period and 1 month later, a retrospective analysis of patient charts was conducted using a global trigger tool to determine variance between the experimental groups. Finally, feedback from the physician participants was considered. The results demonstrated a statistically significant difference on five variables of a total of 16. The auditing team observed low adherence to patient identification (0.0%), hand decontamination (5.5%), and presence of nurse on ward rounds (6.8%). Physician feedback was generally positive. The baseline audit demonstrated significant practice bias on daily ward rounds which tended to omit several key-proven patient safety practices such as prompting hand decontamination and obtaining up to date reports from nursing staff. Results of the intervention arm demonstrate the feasibility of using the Checklist App on daily ward rounds.

The Effects of Land Surface Heating And Roughness Elements on the Structure and Scaling Laws of Atmospheric Boundary Layer Turbulence

NASA Astrophysics Data System (ADS)

Ghannam, Khaled

The atmospheric boundary-layer is the lowest 500-2000 m of the Earth's atmosphere where much of human life and ecosystem services reside. This layer responds to land surface (e.g. buoyancy and roughness elements) and slowly evolving free tropospheric (e.g. temperature and humidity lapse rates) conditions that arguably mediate and modulate biosphere-atmosphere interactions. Such response often results in spatially- and temporally-rich turbulence scales that continue to be the subject of inquiry given their significance to a plethora of applications in environmental sciences and engineering. The work here addresses key aspects of boundary layer turbulence with a focus on the role of roughness elements (vegetation canopies) and buoyancy (surface heating) in modifying the well-studied picture of shear-dominated wall-bounded turbulence. A combination of laboratory channel experiments, field experiments, and numerical simulations are used to explore three distinct aspects of boundary layer turbulence. These are: • The concept of ergodicity in turbulence statistics within canopies: It has been long-recognized that homogeneous and stationary turbulence is ergodic, but less is known about the effects of inhomogeneity introduced by the presence of canopies on the turbulence statistics. A high resolution (temporal and spatial) flume experiment is used here to test the convergence of the time statistics of turbulent scalar concentrations to their ensemble (spatio-temporal) counterpart. The findings indicate that within-canopy scalar statistics have a tendency to be ergodic, mostly in shallow layers (close to canopy top) where the sweeping flow events appear to randomize the statistics. Deeper layers within the canopy are dominated by low-dimensional (quasi-deterministic) von Karman vortices that tend to break ergodicity. • Scaling laws of turbulent velocity spectra and structure functions in near-surface atmospheric turbulence: the existence of a logarithmic scaling in the

New insights on the interaction between atmospheric flow and a full-scale 2.5 MW wind turbine

NASA Astrophysics Data System (ADS)

Chamorro, L. P.; Lee, S.; Olsen, D.; Milliren, C.; Marr, J.; Arndt, R.; Sotiropoulos, F.

2012-12-01

Power fluctuations and fatigue loads are among the most significant problems that wind turbines face throughout their lifetime. Atmospheric turbulence is the common driving mechanism that triggers instabilities on these quantities. Reducing the effects of the fluctuating flow on wind turbines is quite challenging due to the wide variety of length scales present in the boundary layer flow. Each group of these scales, which range from the order of a millimeter to kilometer and larger, plays a characteristic and distinctive role on the performance and structural reliability of wind turbines. This study seeks to contribute toward the understanding on the complex scale-to-scale interaction between wind turbine and flow turbulence. Novel insights into the physical mechanisms that govern the flow/turbine interaction will be discussed. To tackle the problem, we investigate the unsteady behavior of a full-scale 2.5 MW wind turbine under nearly neutral thermal stratification. The study is performed in the Eolos Wind Energy Research Field Station of the University of Minnesota. An instrumented 130 meter meteorological tower located upstream of a Clipper Liberty C96 wind turbine is used to characterize the turbulent flow and atmospheric conditions right upstream of the wind turbine. High resolution and synchronous measurements of the approach wind velocity at several heights, turbine power and strain at the tower foundation are used to determine the scale-to-scale interaction between flow and the wind turbine performance and its physical structure. The spectral distribution of the fluctuating turbine power and instantaneous stresses will be discussed in detail. Characteristic length scales playing a key role on the dynamics of the wind turbine as well as the distinctive effects of flow coherent motions and strong intermittent gusts will also be addressed. Funding was provided by the U.S. Department of Energy (DE-EE0002980) and Xcel Energy through the Renewable Development Fund

Microbial biodiversity of the atmosphere

NASA Astrophysics Data System (ADS)

Klein, Ann Maureen

Microorganisms are critical to the functioning of terrestrial and aquatic ecosystems and may also play a role in the functioning of the atmosphere. However, little is known about the diversity and function of microorganisms in the atmosphere. To investigate the forces driving the assembly of bacterial microbial communities in the atmosphere, I measured temporal variation in bacterial diversity and composition over diurnal and inter-day time scales. Results suggest that bacterial communities in the atmosphere markedly vary over diurnal time scales and are likely structured by inputs from both local terrestrial and long-distance sources. To assess the potential functions of bacteria and fungi in the atmosphere, I characterized total and potentially active communities using both RNA- and DNA-based data. Results suggest there are metabolically active microorganisms in the atmosphere that may affect atmospheric functions including precipitation development and carbon cycling. This dissertation includes previously published and unpublished co-authored material.

NASA/MSFC FY90 Global Scale Atmospheric Processes Research Program Review

NASA Technical Reports Server (NTRS)

Leslie, Fred W. (Editor)

1990-01-01

Research supported by the Global Atmospheric Research Program at the Marshall Space Flight Center on atmospheric remote sensing, meteorology, numerical weather forecasting, satellite data analysis, cloud precipitation, atmospheric circulation, atmospheric models and related topics is discussed.

Working in small-scale, homelike dementia care: effects on staff burnout symptoms and job characteristics. A quasi-experimental, longitudinal study.

PubMed

Zwakhalen, Sandra Mg; Hamers, Jan Ph; van Rossum, Erik; Ambergen, Ton; Kempen, Gertrudis Ijm; Verbeek, Hilde

2018-05-01

This paper reports on a quasi-experimental, longitudinal study on the effects of working in a new type of dementia care facility (i.e. small-scale living facilities) on staff burnout symptoms and job characteristics (job autonomy, social support, physical demands and workload). It is hypothesised that nursing staff working in small-scale facilities experience fewer burnout symptoms, more autonomy and social support, and fewer symptoms of physical demands and workload compared with staff in regular wards. Two types of long-term institutional nursing care settings were included: 28 houses in small-scale living facilities and 21 regular psychogeriatric wards in nursing homes. At baseline and at follow-ups after 6 and 12 months nursing staff were assessed by means of self-report questionnaires. In total, 305 nursing staff members were included in the study, 114 working in small-scale living facilities (intervention group) and 191 in regular wards (control group). No overall effects on burnout symptoms were detected. Significantly fewer physical demands and lower workload were experienced by staff working in small-scale living facilities compared with staff in regular wards. They also experienced more job autonomy. No significant effect was found for overall social support in the total group. This study suggests positive effects of the work environment on several work characteristics. Organisational climate differs in the two conditions, which might account for our results. This may influence nursing staff well-being and has important implications for nursing home managers and policy makers. Future studies should enhance our understanding of the influence of job characteristics on outcomes.

Synoptic-scale characteristics and atmospheric controls of summer heat waves in China

NASA Astrophysics Data System (ADS)

Wang, Weiwen; Zhou, Wen; Li, Xiuzhen; Wang, Xin; Wang, Dongxiao

2016-05-01

Summer heat waves with persistent extreme high temperatures have been occurring with increasing frequency in recent decades. These extreme events have disastrous consequences for human health, economies, and ecosystems. In this study, we examine three summers with intense and protracted heat waves: the summers of 2003, 2006, and 2013, with high temperatures located mainly in southeastern, southwestern, and eastern China, respectively. The synoptic-scale characteristics of these heat waves and associated atmospheric circulation anomalies are investigated. In the early heat wave episode of 2003, a heat center was located in the southeast coastal provinces during the first 20 days of July. The maximum southward displacement of the East Asian jet stream (EAJS) induced anticyclonic anomalies to the south, associated with southwestward intensification of the western North Pacific subtropical high (WNPSH), and extreme high temperatures were found only to the south of the Yangtze River. In the later episode, a poleward displacement of the EAJS and an enhanced WNPSH over the midlatitudes of eastern China resulted in a "heat dome" over the region, and the heat wave extended northward to cover a larger area of eastern China. The coupling between the westward-enhanced WNPSH and poleward-displaced EAJS was found in the East China heat wave of 2013 as well. But the area of high temperatures reached far to the north in August 2013, with below-normal temperatures located in a small region of South China. In the 2006 southwestern drought and heat wave, extreme poleward displacement of the EAJS, associated with extraordinary westward extension of the WNSPH, resulted in further blocking of the moisture supply from the southwest monsoon. Large-scale moisture deficiencies, dry conditions, and downslope winds were common features of all investigated heat wave episodes. But in 2006, low-level heat lows associated with a well-mixed layer due to intensive daytime heating and atmospheric

The "spotlight" ... highlighting researchers at work: Ward McCaughey: "Don't sweat the small stuff"

Treesearch

Sharon Ritter

2008-01-01

Ward McCaughey has spent 99% of his career in forestry research. It appears the aptitude test he took in high school was right; he should be in forestry. Ward is a research forester in the Forests and Woodlands Ecosystems Program for RMRS. He has been on BEMRP's executive committee since 2002. However, his association with BEMRP goes back to its inception in 1994...

Giant Impacts and Earth's Primordial Atmosphere

NASA Astrophysics Data System (ADS)

Agnor, C.; Asphaug, E.

2002-09-01

Estimates of Earth's accretion timescale based on modeling (e.g. Wetherill 1990) and isotopic evidence (Halliday and Porcelli 2000) indicate that the Earth formed in 25-100 Myr. At least a portion of this accretion took place in the presence of the solar nebula. While the problem of nailing down the nebular lifetime remains open, observations of dust disks surrounding young stars and meteoritic evidence suggest that the gas disk existed and was involved in making planetary material for 10 Myr (e.g. Podosek & Cassen 1994, Trilling et al. 2001). The persistence of a remnant of the nebula's original gas disk during terrestrial planet accretion is certainly plausible. The existence of this remnant nebula has dynamical (Agnor & Ward 2002, Kominami & Ida 2002) and geochemical (Porcelli & Pepin 2000) implications for terrestrial planet formation. Nakazawa et al. (1985) explored the structure of Earth's primordial atmosphere as the solar nebula was dissipating. They found that even for low surface densities of nebular gas ( σ gas ~ 1 g cm-2 or ~0.1% of the minimum mass nebula), Earth can capture a significant primordial atmosphere directly from the nebula (i.e. total mass up to a few lunar masses, or ~ 105 times the current atmosphere). Such a massive primordial atmosphere may have played a dynamical role in the formation of the Moon (e.g. models of lunar capture have employed aerodynamic drag in Earth's atmosphere as the primary mechanism for reducing the Moon's orbital energy, Nakazawa et al. 1983). Conversely, the formation of the Moon may have played a role in removing Earth's primordial atmosphere. Giant impacts have been suggested as one possible mechanism that could accomplish global atmospheric removal (Ahrens 1993). We are using smooth particle hydrodynamics (SPH) to model the removal of Earth's primordial atmosphere via giant impact. We employ initial conditions similar to recent works on lunar formation (e.g. Canup & Asphaug 2001) but also include ideal gas

[The current aspects of hospital infections in maternity and neonatal wards].

PubMed

Ribarova, N; Todorova, M; Khristov, Kh

1994-01-01

The epidemiologic, etiologic and clinical structure of HAI in the maternity and neonatal wards in the country for the 1982-1992 period has been specified. 934 women in child-birth and 2357 neonates acquire nosocomial infections at an average annually. A comparatively constant level in HAI epidemic process intensity is observed with inconsiderable diversions in the beginning and by the end of the studied period. Staphylococci like causative agents of HAI take up a leading place in both types of wards with especially marked incidence rate among the newborn children. The predominant clinical forms in the women in child-birth are the surgical wound infections, skin and genital infections and in the neonates--the staphylodermatites, upper respiratory airway infections, pulmonary and enteric infections.

A Census of Atmospheric Variability From Seconds to Decades

NASA Astrophysics Data System (ADS)

Williams, Paul D.; Alexander, M. Joan; Barnes, Elizabeth A.; Butler, Amy H.; Davies, Huw C.; Garfinkel, Chaim I.; Kushnir, Yochanan; Lane, Todd P.; Lundquist, Julie K.; Martius, Olivia; Maue, Ryan N.; Peltier, W. Richard; Sato, Kaoru; Scaife, Adam A.; Zhang, Chidong

2017-11-01

This paper synthesizes and summarizes atmospheric variability on time scales from seconds to decades through a phenomenological census. We focus mainly on unforced variability in the troposphere, stratosphere, and mesosphere. In addition to atmosphere-only modes, our scope also includes coupled modes, in which the atmosphere interacts with the other components of the Earth system, such as the ocean, hydrosphere, and cryosphere. The topics covered include turbulence on time scales of seconds and minutes, gravity waves on time scales of hours, weather systems on time scales of days, atmospheric blocking on time scales of weeks, the Madden-Julian Oscillation on time scales of months, the Quasi-Biennial Oscillation and El Niño-Southern Oscillation on time scales of years, and the North Atlantic, Arctic, Antarctic, Pacific Decadal, and Atlantic Multidecadal Oscillations on time scales of decades. The paper serves as an introduction to a special collection of Geophysical Research Letters on atmospheric variability. We hope that both this paper and the collection will serve as a useful resource for the atmospheric science community and will act as inspiration for setting future research directions.

5. View of northwest corner of East Ward Street and ...

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

5. View of northwest corner of East Ward Street and Dewey Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

Using a Structured Checklist to Improve the Orthopedic Ward Round: A Prospective Cohort Study.

PubMed

Talia, Adrian J; Drummond, James; Muirhead, Cameron; Tran, Phong

2017-07-01

Comprehensive and timely documentation on orthopedic ward rounds continues to be problematic, leading to delayed or inappropriate patient care and miscommunication between health care providers. The authors introduced a simple checklist to improve the documentation on orthopedic ward rounds in their institution. A prospective cohort study was performed. Standard care was provided for cohort A. During a 2-week period, the documentation of patient care by physicians following a ward round was assessed in terms of venous thromboembolism prophylaxis, fasting status, wound or dressing plan, weight-bearing status, and important surgical details. The physicians were blinded to this initial review. For cohort B, a structured ward round checklist was introduced during a 2-week period. A total of 132 patient encounters were recorded in cohort A. Important issues that were rarely discussed included vital signs (11.4%), venous thromboembolism prophylaxis (9.8%), and bowel status (3.8%). Issues that were poorly documented included fasting status (9.1%), wound or dressing plan (6.8%), and weight-bearing status (11.4%). After introduction of the checklist, daily documentation of surgical details improved from 38.6% to 85.3% of patient encounters. Fasting status documentation improved from 9.1% to 70.6% of patient encounters. Venous thromboembolism prophylaxis discussion increased from 9.8% to 45.6% of the time, while its documentation improved from 6.8% to 92.6%. Documentation of weight-bearing status improved from 11.4% to 83.8% (all P<.0001). The use of a structured checklist during orthopedic ward rounds led to significant improvement in both the consideration and the documentation of key aspects of surgical care. [Orthopedics. 2017; 40(4):e663-e667.]. Copyright 2017, SLACK Incorporated.

Labour ward midwives' perceptions of stress.

PubMed

Mackin, P; Sinclair, M

1998-05-01

This exploratory study set out to examine labour ward midwives' perceptions of stress. It utilized a combination of two self-report questionnaires, one devised by McGrath et al. and the GHQ12. Additional qualitative data were collected by asking midwives to produce narratives about recent stressful events. A convenience sample of the 43 midwives formed the study population and a response rate of 77% was achieved. Quantitative data were analysed using descriptive statistics and qualitative narratives were explored for content analysis. Midwives in this study demonstrated their awareness of stress in their working and personal lives and many took active steps to redress the negative effects with exercise, hobbies and talking with colleagues. However, the study revealed that 78% of the midwives indicated that having insufficient time to perform their duties was very stressful, paralleled by their perceived inability to influence work-based decisions. The study revealed that both medical and midwifery colleagues frustrated their endeavours to change an unsatisfactory condition. The GHQ12 revealed 30% of the midwives had scores above the threshold level of 2 indicating psychiatric morbidity and this is of major concern. The narratives revealed that lack of communication between the professionals about decision making was a major source of stress and as a result of this study efforts to improve multidisciplinary communication through the development of journal clubs and planned social activities is under consideration by the unit. Overall, the findings from this study highlight stress as a potential, occupational health problem in the working lives of some labour ward midwives.

Identification and characteristics of imipenem-resistant Acinetobacter baumannii in surgical wards in a Chinese university hospital.

PubMed

Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun

2015-03-01

The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type β-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region.

Fluoride concentrations in urine of delivery ward personnel following exposure to low concentrations of methoxyflurane.

PubMed

Dahlgren, B E

1979-09-01

Midwives and other delivery ward personnel exposed to methoxyflurane do not have measurable traces of the agent in expired air when examined soon after exposure. This may imply a rapid uptake of the anesthetic. If this is the case, then the products of the metabolism of methoxyflurane, such as fluoride, may appear in the urine of such personnel. The present study investigated urinary fluoride levels in 24 delivery ward personnel and compared the values found after methoxyflurane/nitrous oxide analgesia with those measured in the same individuals after exposure to nitrous oxide alone. A highly significant difference was observed. Thus it would appear that, in spite of an apparently adequate system of environmental ventilation, there is a significant uptake of methoxyflurane by delivery ward personnel when this agent is employed for obstetrical analgesia.

Extended-range high-resolution dynamical downscaling over a continental-scale spatial domain with atmospheric and surface nudging

NASA Astrophysics Data System (ADS)

Husain, S. Z.; Separovic, L.; Yu, W.; Fernig, D.

2014-12-01

Extended-range high-resolution mesoscale simulations with limited-area atmospheric models when applied to downscale regional analysis fields over large spatial domains can provide valuable information for many applications including the weather-dependent renewable energy industry. Long-term simulations over a continental-scale spatial domain, however, require mechanisms to control the large-scale deviations in the high-resolution simulated fields from the coarse-resolution driving fields. As enforcement of the lateral boundary conditions is insufficient to restrict such deviations, large scales in the simulated high-resolution meteorological fields are therefore spectrally nudged toward the driving fields. Different spectral nudging approaches, including the appropriate nudging length scales as well as the vertical profiles and temporal relaxations for nudging, have been investigated to propose an optimal nudging strategy. Impacts of time-varying nudging and generation of hourly analysis estimates are explored to circumvent problems arising from the coarse temporal resolution of the regional analysis fields. Although controlling the evolution of the atmospheric large scales generally improves the outputs of high-resolution mesoscale simulations within the surface layer, the prognostically evolving surface fields can nevertheless deviate from their expected values leading to significant inaccuracies in the predicted surface layer meteorology. A forcing strategy based on grid nudging of the different surface fields, including surface temperature, soil moisture, and snow conditions, toward their expected values obtained from a high-resolution offline surface scheme is therefore proposed to limit any considerable deviation. Finally, wind speed and temperature at wind turbine hub height predicted by different spectrally nudged extended-range simulations are compared against observations to demonstrate possible improvements achievable using higher spatiotemporal

Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories.

PubMed

Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine

2010-09-01

Scand J Caring Sci; 2010; 24; 581-591 
 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories   Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory.   To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories.   Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing.   The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff.   The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.

Identifying the Source of Large-Scale Atmospheric Variability in Jupiter

NASA Astrophysics Data System (ADS)

Orton, Glenn

2011-01-01

We propose to use the unique mid-infrared filtered imaging and spectroscopic capabilities of the Subaru COMICS instrument to determine the mechanisms associated with recent unusual rapid albedo and color transformations of several of Jupiter's bands, particularly its South Equatorial Belt (SEB), as a means to understand the coupling between its dynamics and chemistry. These observations will characterize the temperature, degree of cloud cover, and distribution of minor gases that serve as indirect tracers of vertical motions in regions that will be undergoing unusual large-scale changes in dynamics and chemistry: the SEB, as well as regions near the equator and Jupiter's North Temperate Belt. COMICS is ideal for this investigation because of its efficiency in doing both imaging and spectroscopy, its 24.5-mum filter that is unique to 8-meter-class telescopes, its wide field of view that allows imaging of nearly all of Jupiter's disk, coupled with a high diffraction-limited angular resolution and optimal mid-infrared atmospheric transparency.

A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (1) Development of tool.

PubMed

Lakshminarayana, Indumathy; Wall, David; Bindal, Taruna; Goodyear, Helen M

2015-05-01

Leading a ward round is an essential skill for hospital consultants and senior trainees but is rarely assessed during training. To investigate the key attributes for ward round leadership and to use these results to develop a multisource feedback (MSF) tool to assess the ward round leadership skills of senior specialist trainees. A panel of experts comprising four senior paediatric consultants and two nurse managers were interviewed from May to August 2009. From analysis of the interview transcripts, 10 key themes emerged. A structured questionnaire based on the key themes was designed and sent electronically to paediatric consultants, nurses and trainees at a large university hospital (June-October 2010). 81 consultants, nurses and trainees responded to the survey. The internal consistency of this tool was high (Cronbach's α 0.95). Factor analysis showed that five factors accounted for 72% of variance. The five key areas for ward round leadership were communication skills, preparation and organisation, teaching and enthusiasm, team working and punctuality; communication was the most important key theme. A MSF tool for ward round leadership skills was developed with these areas as five domains. We believe that this tool will add to the current assessment tools available by providing feedback about ward round leadership skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

20. West Elevation and Section, Ward 'K', Letterman General Hospital, ...

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

20. West Elevation and Section, Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 2. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

19. First and Second Floors. Ward 'K', Letterman General Hospital, ...

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

19. First and Second Floors. Ward 'K', Letterman General Hospital, Presidio of San Francisco, Cal. Sheet No. 1. May 1917. BUILDING 1049. - Presidio of San Francisco, Letterman General Hospital, Building No. 12, Letterman Hospital Complex, Edie Road, San Francisco, San Francisco County, CA

1. View of north side of East Ward Street west ...

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

1. View of north side of East Ward Street west of North Coweta Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

14. View of southwest corner of East Ward Street and ...

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

14. View of southwest corner of East Ward Street and South McDonald Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

16. View of northeast corner of East Ward Street and ...

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

16. View of northeast corner of East Ward Street and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

4. View of north side of East Ward Street west ...

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

4. View of north side of East Ward Street west of Dewey Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

2. View of north side of East Ward Street east ...

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

2. View of north side of East Ward Street east of North Coweta Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

13. View of south side of East Ward Street east ...

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

13. View of south side of East Ward Street east of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

6. Views of southeast corner of East Ward Street and ...

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

6. Views of southeast corner of East Ward Street and South Coweta Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

12. View of south side of East Ward Street west ...

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

12. View of south side of East Ward Street west of Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

7. View of south side of East Ward Street east ...

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

7. View of south side of East Ward Street east of South Coweta Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

19. View of southeast corner of East Ward Street and ...

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

19. View of southeast corner of East Ward Street and South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

'It teaches you what to expect in future . . . ': interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students.

PubMed

Reeves, Scott; Freeth, Della; McCrorie, Peter; Perry, David

2002-04-01

This paper presents findings from a multimethod evaluation of an interprofessional training ward placement for medical, nursing, occupational therapy and physiotherapy students. Unique in the UK, and following the pioneering work at Linköping, the training ward allowed senior pre-qualification students, under the supervision of practitioners, to plan and deliver interprofessional care for a group of orthopaedic and rheumatology patients. This responsibility enabled students to develop profession-specific skills and competencies in dealing with patients. It also allowed them to enhance their teamworking skills in an interprofessional environment. Student teams were supported by facilitators who ensured medical care was optimal, led reflective sessions and facilitated students' problem solving. Data were collected from all groups of participants involved in the ward: students, facilitators and patients. Methods included questionnaires, interviews and observations. Findings are presented from each participating group, with a particular emphasis placed on the perspective of medicine. The study found that students valued highly the experiential learning they received on the ward and felt the ward prepared them more effectively for future practice. However, many encountered difficulties adopting an autonomous learning style during their placement. Despite enjoying their work on the ward, facilitators were concerned that the demands of their role could result in 'burn-out'. Patients enjoyed their ward experience and scored higher on a range of satisfaction indicators than a comparative group of patients. Participants were generally positive about the training ward. All considered that it was a worthwhile experience and felt the ward should recommence in the near future.

Atmospheric and Oceanic Response to Southern Ocean Deep Convection Oscillations on Decadal to Centennial Time Scales in Climate Models

NASA Astrophysics Data System (ADS)

Martin, T.; Reintges, A.; Park, W.; Latif, M.

2014-12-01

Many current coupled global climate models simulate open ocean deep convection in the Southern Ocean as a recurring event with time scales ranging from a few years to centennial (de Lavergne et al., 2014, Nat. Clim. Ch.). The only observation of such event, however, was the occurrence of the Weddell Polynya in the mid-1970s, an open water area of 350 000 km2 within the Antarctic sea ice in three consecutive winters. Both the wide range of modeled frequency of occurrence and the absence of deep convection in the Weddell Sea highlights the lack of understanding concerning the phenomenon. Nevertheless, simulations indicate that atmospheric and oceanic responses to the cessation of deep convection in the Southern Ocean include a strengthening of the low-level atmospheric circulation over the Southern Ocean (increasing SAM index) and a reduction in the export of Antarctic Bottom Water (AABW), potentially masking the regional effects of global warming (Latif et al., 2013, J. Clim.; Martin et al., 2014, Deep Sea Res. II). It is thus of great importance to enhance our understanding of Southern Ocean deep convection and clarify the associated time scales. In two multi-millennial simulations with the Kiel Climate Model (KCM, ECHAM5 T31 atmosphere & NEMO-LIM2 ~2˚ ocean) we showed that the deep convection is driven by strong oceanic warming at mid-depth periodically overriding the stabilizing effects of precipitation and ice melt (Martin et al., 2013, Clim. Dyn.). Sea ice thickness also affects location and duration of the deep convection. A new control simulation, in which, amongst others, the atmosphere grid resolution is changed to T42 (~2.8˚), yields a faster deep convection flip-flop with a period of 80-100 years and a weaker but still significant global climate response similar to CMIP5 simulations. While model physics seem to affect the time scale and intensity of the phenomenon, the driving mechanism is a rather robust feature. Finally, we compare the atmospheric and

A review of approaches to estimate wildfire plume injection height within large-scale atmospheric chemical transport models

NASA Astrophysics Data System (ADS)

Paugam, R.; Wooster, M.; Freitas, S.; Martin, M. Val

2016-01-01

Landscape fires produce smoke containing a very wide variety of chemical species, both gases and aerosols. For larger, more intense fires that produce the greatest amounts of emissions per unit time, the smoke tends initially to be transported vertically or semi-vertically close by the source region, driven by the intense heat and convective energy released by the burning vegetation. The column of hot smoke rapidly entrains cooler ambient air, forming a rising plume within which the fire emissions are transported. The characteristics of this plume, and in particular the height to which it rises before releasing the majority of the smoke burden into the wider atmosphere, are important in terms of how the fire emissions are ultimately transported, since for example winds at different altitudes may be quite different. This difference in atmospheric transport then may also affect the longevity, chemical conversion, and fate of the plumes chemical constituents, with for example very high plume injection heights being associated with extreme long-range atmospheric transport. Here we review how such landscape-scale fire smoke plume injection heights are represented in larger-scale atmospheric transport models aiming to represent the impacts of wildfire emissions on component of the Earth system. In particular we detail (i) satellite Earth observation data sets capable of being used to remotely assess wildfire plume height distributions and (ii) the driving characteristics of the causal fires. We also discuss both the physical mechanisms and dynamics taking place in fire plumes and investigate the efficiency and limitations of currently available injection height parameterizations. Finally, we conclude by suggesting some future parameterization developments and ideas on Earth observation data selection that may be relevant to the instigation of enhanced methodologies aimed at injection height representation.

Protected engagement time on older adult mental health wards: A thematic analysis of the views of patients, carers, and staff.

PubMed

Dodd, Emily; Cheston, Richard; Procter, Charlie; Heneker, Sarah; Gray, Richard; Fox, Chris; Nolan, Fiona

2018-04-01

During protected engagement time (PET), ward routines are adjusted so that staff can spend time together with patients without interruption. The aim of PET is to increase staff and patient interaction on wards, and ultimately patient well-being. Although PET has been implemented on inpatient wards within the UK, including older adult wards, there is no systematic evidence as to how PET is carried out or how it is experienced by staff, patients, and families. Semistructured interviews were conducted with 28 participants (8 patients, 10 family members, and 10 ward staff) from three different wards with PET, and transcriptions were analysed using thematic analysis. Three themes were identified: (i) the patient is at the heart of care; (ii) PET depends on staff; and (iii) tensions in how PET operates. There was support in our sample for the principles of PET and its potential for a positive impact on patient well-being. However, the implementation of PET was identified as challenging, highlighting an existing tension between an individual's needs and the wider needs of patients on the ward as a whole. The impact of PET was generally described as being dependent on how PET was organized and the level of staff commitment to PET. Participants emphasized that if PET is to be successful, then it should be a fluid process that fits in with the local context. © 2017 Australian College of Mental Health Nurses Inc.

A priori testing of subgrid-scale models for large-eddy simulation of the atmospheric boundary layer

NASA Astrophysics Data System (ADS)

Juneja, Anurag; Brasseur, James G.

1996-11-01

Subgrid-scale models are generally developed assuming homogeneous isotropic turbulence with the filter cutoff lying in the inertial range. In the surface layer and capping inversion regions of the atmospheric boundary layer, the turbulence is strongly anisotropic and, in general, influenced by both buoyancy and shear. Furthermore, the integral scale motions are under-resolved in these regions. Herein we perform direct numerical simulations of shear and buoyancy-generated homogeneous anisotropic turbulence to compute and analyze the actual subgrid-resolved-scale (SGS-RS) dynamics as the filter cutoff moves into the energy-containing scales. These are compared with the SGS-RS dynamics predicted by Smagorinsky-based models with a focus on motivating improved closures. We find that, in general, the underlying assumption of such models, that the anisotropic part of the subgrid stress tensor be aligned with the resolved strain rate tensor, is a poor approximation. Similarly, we find poor alignment between the actual and predicted stress divergence, and find low correlations between the actual and modeled subgrid-scale contribution to the pressure and pressure gradient. Details will be given in the talk.

Disruption of parent participation: nurses' strategies to manage parents on children's wards.

PubMed

Coyne, Imelda

2008-12-01

To investigate parent participation in the hospitalized child's care from the perspectives of children, parents and nurses. Parent participation in the hospitalized child's care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents. Using grounded method, data were collected through in-depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England. The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents' participation and parents had to 'toe the line'. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non-compliance to the set of norms and rules was followed by reward or punishment. The nurses' dependence on parents' active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment. Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents' expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents' participation in care.

17. View of north side of East Ward Street east ...

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

17. View of north side of East Ward Street east of North McDonald Avenue, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

20. View of south side of East Ward Street east ...

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

20. View of south side of East Ward Street east of South McDonald Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

18. View of north side of East Ward Street at ...

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

18. View of north side of East Ward Street at the intersection with North Dart Street, facing northwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

3. View of north side of East Ward Street midblock ...

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

3. View of north side of East Ward Street midblock between North Coweta Avenue and Dewey Avenue. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

Preparing for Exascale: Towards convection-permitting, global atmospheric simulations with the Model for Prediction Across Scales (MPAS)

NASA Astrophysics Data System (ADS)

Heinzeller, Dominikus; Duda, Michael G.; Kunstmann, Harald

2017-04-01

With strong financial and political support from national and international initiatives, exascale computing is projected for the end of this decade. Energy requirements and physical limitations imply the use of accelerators and the scaling out to orders of magnitudes larger numbers of cores then today to achieve this milestone. In order to fully exploit the capabilities of these Exascale computing systems, existing applications need to undergo significant development. The Model for Prediction Across Scales (MPAS) is a novel set of Earth system simulation components and consists of an atmospheric core, an ocean core, a land-ice core and a sea-ice core. Its distinct features are the use of unstructured Voronoi meshes and C-grid discretisation to address shortcomings of global models on regular grids and the use of limited area models nested in a forcing data set, with respect to parallel scalability, numerical accuracy and physical consistency. Here, we present work towards the application of the atmospheric core (MPAS-A) on current and future high performance computing systems for problems at extreme scale. In particular, we address the issue of massively parallel I/O by extending the model to support the highly scalable SIONlib library. Using global uniform meshes with a convection-permitting resolution of 2-3km, we demonstrate the ability of MPAS-A to scale out to half a million cores while maintaining a high parallel efficiency. We also demonstrate the potential benefit of a hybrid parallelisation of the code (MPI/OpenMP) on the latest generation of Intel's Many Integrated Core Architecture, the Intel Xeon Phi Knights Landing.

Moxa-stick suffumigation for disinfecting air in hematology and hematopoietic stem cell transplantation wards with class 100 laminar flow.

PubMed

He, Jing-song; Yang, Qing; Huang, Wei-jia; Hu, Xiao-rong

2014-04-01

To evaluate the effect of moxa-stick suffumigation in the hematology and hematopoietic stem cell transplantation (HSCT) wards with luminar flow. The plate exposure method was used to measure the effect of air-disinfection of moxa-stick suffumigation in hematology and HSCT wards. The yearly average qualified rates of air sampling in HSCT wards were evaluated from 2007 to 2010. To further investigate the disinfecting effect of moxa-stick suffumigation, the colony counts of common pathogens (including Staphylcoccus aureus and Pseudomonas aeruginosa) before and after moxa-stick suffumigation were compared. The mean air quality rates of the HSCT wards with class 100 laminar flow were all above 90.0% (91.2%-96.2%) from 2007 to 2010. Moxa-stick suffumigation effectively decreased the presence of bacteria in the hematology ward's air (P<0.01). The most notable effect was the drastic reduction in the colony counts of Staphylococcus aureus and Pseudomonas aeruginosa on the blood plates exposed to air treated with moxa-stick suffumigation (77.1±52.9 cfu/m(2) vs 196.1±87.5 cfu/m(2), P<0.01; and 100.2±35.3 cfu/m(2) vs 371.5±35.3 cfu/m(2), P<0.01). Moxa-stick suffumigation proved to be a reliable and effective airdisinfection method for hematology and HSCT wards, and hence, it should be employed extensively.

Atmospheric Modeling Using Accelerometer Data During Mars Atmosphere and Volatile Evolution (MAVEN) Flight Operations

NASA Technical Reports Server (NTRS)

Tolson, Robert H.; Lugo, Rafael A.; Baird, Darren T.; Cianciolo, Alicia D.; Bougher, Stephen W.; Zurek, Richard M.

2017-01-01

The Mars Atmosphere and Volatile EvolutioN (MAVEN) spacecraft is a NASA orbiter designed to explore the Mars upper atmosphere, typically from 140 to 160 km altitude. In addition to the nominal science mission, MAVEN has performed several Deep Dip campaigns in which the orbit's closest point of approach, also called periapsis, was lowered to an altitude range of 115 to 135 km. MAVEN accelerometer data were used during mission operations to estimate atmospheric parameters such as density, scale height, along-track gradients, and wave structures. Density and scale height estimates were compared against those obtained from the Mars Global Reference Atmospheric Model and used to aid the MAVEN navigation team in planning maneuvers to raise and lower periapsis during Deep Dip operations. This paper describes the processes used to reconstruct atmosphere parameters from accelerometers data and presents the results of their comparison to model and navigation-derived values.

Scale Dependence of Land Atmosphere Interactions in Wet and Dry Regions as Simulated with NU-WRF over the Southwestern and Southeast US

NASA Technical Reports Server (NTRS)

Zhou, Yaping; Wu, Di; Lau, K.- M.; Tao, Wei-Kuo

2016-01-01

Large-scale forcing and land-atmosphere interactions on precipitation are investigated with NASA-Unified WRF (NU-WRF) simulations during fast transitions of ENSO phases from spring to early summer of 2010 and 2011. The model is found to capture major precipitation episodes in the 3-month simulations without resorting to nudging. However, the mean intensity of the simulated precipitation is underestimated by 46% and 57% compared with the observations in dry and wet regions in the southwestern and south-central United States, respectively. Sensitivity studies show that large-scale atmospheric forcing plays a major role in producing regional precipitation. A methodology to account for moisture contributions to individual precipitation events, as well as total precipitation, is presented under the same moisture budget framework. The analysis shows that the relative contributions of local evaporation and large-scale moisture convergence depend on the dry/wet regions and are a function of temporal and spatial scales. While the ratio of local and large-scale moisture contributions vary with domain size and weather system, evaporation provides a major moisture source in the dry region and during light rain events, which leads to greater sensitivity to soil moisture in the dry region and during light rain events. The feedback of land surface processes to large-scale forcing is well simulated, as indicated by changes in atmospheric circulation and moisture convergence. Overall, the results reveal an asymmetrical response of precipitation events to soil moisture, with higher sensitivity under dry than wet conditions. Drier soil moisture tends to suppress further existing below-normal precipitation conditions via a positive soil moisture-land surface flux feedback that could worsen drought conditions in the southwestern United States.

Micro-spatial distribution of malaria cases and control strategies at ward level in Gwanda district, Matabeleland South, Zimbabwe.

PubMed

Manyangadze, Tawanda; Chimbari, Moses J; Macherera, Margaret; Mukaratirwa, Samson

2017-11-21

Although there has been a decline in the number of malaria cases in Zimbabwe since 2010, the disease remains the biggest public health threat in the country. Gwanda district, located in Matabeleland South Province of Zimbabwe has progressed to the malaria pre-elimination phase. The aim of this study was to determine the spatial distribution of malaria incidence at ward level for improving the planning and implementation of malaria elimination in the district. The Poisson purely spatial model was used to detect malaria clusters and their properties, including relative risk and significance levels at ward level. The geographically weighted Poisson regression (GWPR) model was used to explore the potential role and significance of environmental variables [rainfall, minimum and maximum temperature, altitude, Enhanced Vegetation Index (EVI), Normalized Difference Vegetation Index (NDVI), Normalized Difference Water Index (NDWI), rural/urban] and malaria control strategies [indoor residual spraying (IRS) and long-lasting insecticide-treated nets (LLINs)] on the spatial patterns of malaria incidence at ward level. Two significant clusters (p < 0.05) of malaria cases were identified: (1) ward 24 south of Gwanda district and (2) ward 9 in the urban municipality, with relative risks of 5.583 and 4.316, respectively. The semiparametric-GWPR model with both local and global variables had higher performance based on AICc (70.882) compared to global regression (74.390) and GWPR which assumed that all variables varied locally (73.364). The semiparametric-GWPR captured the spatially non-stationary relationship between malaria cases and minimum temperature, NDVI, NDWI, and altitude at the ward level. The influence of LLINs, IRS and rural or urban did not vary and remained in the model as global terms. NDWI (positive coefficients) and NDVI (range from negative to positive coefficients) showed significant association with malaria cases in some of the wards. The IRS had a protection

View of compartment C110, senior officers ward room from port ...

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

View of compartment C-110, senior officers ward room from port to starboard, showing wooden furnishings, deck stanchions and the olympia's piano. (084) - USS Olympia, Penn's Landing, 211 South Columbus Boulevard, Philadelphia, Philadelphia County, PA

NMMB/BSC-DUST: an online mineral dust atmospheric model from meso to global scales

NASA Astrophysics Data System (ADS)

Haustein, K.; Pérez, C.; Jorba, O.; Baldasano, J. M.; Janjic, Z.; Black, T.; Nickovic, S.

2009-04-01

While mineral dust distribution and effects are important at global scales, they strongly depend on dust emissions that are controlled on small spatial and temporal scales. Most global dust models use prescribed wind fields provided by meteorological centers (e.g., NCEP and ECMWF) and their spatial resolution is currently never better than about 1°×1°. Regional dust models offer substantially higher resolution (10-20 km) and are typically coupled with weather forecast models that simulate processes that GCMs either cannot resolve or can resolve only poorly. These include internal circulation features such as the low-level nocturnal jet which is a crucial feature for dust emission in several dust ‘hot spot' sources in North Africa. Based on our modeling experience with the BSC-DREAM regional forecast model (http://www.bsc.es/projects/earthscience/DREAM/) we are currently implementing an improved mineral dust model [Pérez et al., 2008] coupled online with the new global/regional NMMB atmospheric model under development in NOAA/NCEP/EMC [Janjic, 2005]. The NMMB is an evolution of the operational WRF-NMME extending from meso to global scales. The NMMB will become the next-generation NCEP model for operational weather forecast in 2010. The corresponding unified non-hydrostatic dynamical core ranges from meso to global scale allowing regional and global simulations. It has got an add-on non-hydrostatic module and it is based on the Arakawa B-grid and hybrid pressure-sigma vertical coordinates. NMMB is fully embedded into the Earth System Modeling Framework (ESMF), treating dynamics and physics separately and coupling them easily within the ESMF structure. Our main goal is to provide global dust forecasts up to 7 days at mesoscale resolutions. New features of the model include a physically-based dust emission scheme after White [1979], Iversen and White [1982] and Marticorena and Bergametti [1995] that takes the effects of saltation and sandblasting into account

Medication errors in the obstetrics emergency ward in a low resource setting.

PubMed

Kandil, Mohamed; Sayyed, Tarek; Emarh, Mohamed; Ellakwa, Hamed; Masood, Alaa

2012-08-01

To investigate the patterns of medication errors in the obstetric emergency ward in a low resource setting. This prospective observational study included 10,000 women who presented at the obstetric emergency ward, department of Obstetrics and Gynecology, Menofyia University Hospital, Egypt between March and December 2010. All medications prescribed in the emergency ward were monitored for different types of errors. The head nurse in each shift was asked to monitor each pharmacologic order from the moment of prescribing till its administration. Retrospective review of the patients' charts and nurses' notes was carried out by the authors of this paper. Results were tabulated and statistically analyzed. A total of 1976 medication errors were detected. Administration errors were the commonest error reported. Omitted errors ranked second followed by unauthorized and prescription errors. Three administration errors resulted in three Cesareans were performed for fetal distress because of wrong doses of oxytocin infusion. The rest of errors did not cause patients harm but may have lead to an increase in monitoring. Most errors occurred during night shifts. The availability of automated infusion pumps will probably decrease administration errors significantly. There is a need for more obstetricians and nurses during the nightshifts to minimize errors resulting from working under stressful conditions.

[An analysis of cost and profit of a nursing unit using performance-based costing: case of a general surgical ward in a general hospital].

PubMed

Lim, Ji Young

2008-02-01

The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.

Working in small-scale, homelike dementia care: effects on staff burnout symptoms and job characteristics. A quasi-experimental, longitudinal study

PubMed Central

Zwakhalen, Sandra MG; Hamers, Jan PH; van Rossum, Erik; Ambergen, Ton; Kempen, Gertrudis IJM; Verbeek, Hilde

2018-01-01

Aim This paper reports on a quasi-experimental, longitudinal study on the effects of working in a new type of dementia care facility (i.e. small-scale living facilities) on staff burnout symptoms and job characteristics (job autonomy, social support, physical demands and workload). Methods It is hypothesised that nursing staff working in small-scale facilities experience fewer burnout symptoms, more autonomy and social support, and fewer symptoms of physical demands and workload compared with staff in regular wards. Two types of long-term institutional nursing care settings were included: 28 houses in small-scale living facilities and 21 regular psychogeriatric wards in nursing homes. At baseline and at follow-ups after 6 and 12 months nursing staff were assessed by means of self-report questionnaires. In total, 305 nursing staff members were included in the study, 114 working in small-scale living facilities (intervention group) and 191 in regular wards (control group). Results No overall effects on burnout symptoms were detected. Significantly fewer physical demands and lower workload were experienced by staff working in small-scale living facilities compared with staff in regular wards. They also experienced more job autonomy. No significant effect was found for overall social support in the total group. Conclusions This study suggests positive effects of the work environment on several work characteristics. Organisational climate differs in the two conditions, which might account for our results. This may influence nursing staff well-being and has important implications for nursing home managers and policy makers. Future studies should enhance our understanding of the influence of job characteristics on outcomes. PMID:29805471

Finding the Public in Consumer Research: A Reply to Ward.

ERIC Educational Resources Information Center

August, William; Charren, Peggy

1984-01-01

Discusses Ward's analysis of letters sent to the Federal Trade Commission about children's advertising. Advocates that public opinion research concerning consumer protection issues should include information on the degree to which consumers are informed of their fundamental rights with respect to the consumer issues being studied. (CB)

8. View of south side of East Ward Street midblock ...

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

8. View of south side of East Ward Street midblock between South Coweta Avenue and Sibett Avenue, facing southwest. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

10. View of north side of East Ward Street midblock ...

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

10. View of north side of East Ward Street midblock between Dewey Avenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

15. View of north side of East Ward Street at ...

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

15. View of north side of East Ward Street at the intersection with North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

11. View of north side of East Ward Street midblock ...

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

11. View of north side of East Ward Street midblock between Dewey AVenue and North McDonald Avenue, facing northeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

21. View of south side of East Ward Street midblock ...

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

21. View of south side of East Ward Street midblock between South McDonald Avenue and Fales Avenue, facing southeast. - Gaskin Avenue Neighborhood, Bounded by Dart Street to east, CSX Railroad to south, Pearl & Madison Avenues to west, & Wilson & Gordon Streets to north, Douglas, Coffee County, GA

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards

PubMed Central

Scepanovic, Radisav; Vitorovic, Teodora; Novakovic, Radmila; Milanov, Nenad; Bukumiric, Zoran; Carevic, Biljana; Trajkovic, Jasmina; Rajkovic, Jovana

2017-01-01

In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S) and medical (M) wards of the University Hospital Center “Dr. Dragisa Misovic-Dedinje” (Belgrade, Serbia), in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1%) than on the M (63.2% and 36.9%) wards. The percentage of MDR A. baumannii was not different between S (93.7%) and M (79.5%) wards. An overall antibiotics consumption (defined daily doses/100 bed-days) during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%). The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%), inappropriate dose interval (70.6% vs. 16.9%) or duration of therapy (72.5% vs. 23.1%), a non-documented stop/review data (73.6% vs. 16.9%) and divergence from guidelines (71.9% vs. 23.1%). Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards. PMID:28467437

Differences in antimicrobial consumption, prescribing and isolation rate of multidrug resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii on surgical and medical wards.

PubMed

Zivanovic, Vladimir; Gojkovic-Bukarica, Ljiljana; Scepanovic, Radisav; Vitorovic, Teodora; Novakovic, Radmila; Milanov, Nenad; Bukumiric, Zoran; Carevic, Biljana; Trajkovic, Jasmina; Rajkovic, Jovana; Djokic, Vladimir

2017-01-01

In order to provide guidance data for clinically rational use of an antibiotics consuption, prescribing and prevalence of multidrug resistant (MDR) Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were monitored on the surgical (S) and medical (M) wards of the University Hospital Center "Dr. Dragisa Misovic-Dedinje" (Belgrade, Serbia), in the study period from 2012 to 2015. Appropriateness of antimicrobial use was evaluated using the Global-Prevalence Survey method designed by the University of Antwerp. The percentages of MDR pathogens relative to the total number of isolates of K. pneumoniae and P. aeruginosa were higher on the S (86.2% and 49.1%) than on the M (63.2% and 36.9%) wards. The percentage of MDR A. baumannii was not different between S (93.7%) and M (79.5%) wards. An overall antibiotics consumption (defined daily doses/100 bed-days) during study was 369.7 and 261.5 on the S and M wards, respectively. A total of 225 prescriptions of antimicrobials were evaluated in138 adults admitted to wards on the day of the survey. The percentage of antimicrobials prescribed for prophylaxis on the M and S wards were 0% and 25%, respectively. Therapies were more frequently empiric (S, 86.8% and M, 80%). The percentages of medical errors on the S and M wards were 74.6% and 27.3%, respectively. The quality indicators for antibiotic prescribing on the S and M wards were as follows: the incorrect choice of antimicrobials (35.6% vs. 20.0%), inappropriate dose interval (70.6% vs. 16.9%) or duration of therapy (72.5% vs. 23.1%), a non-documented stop/review data (73.6% vs. 16.9%) and divergence from guidelines (71.9% vs. 23.1%). Treatment based on biomarkers was more common on the M wards as compared to the S wards. The increasing prevalence of MDR pathogens, a very high consumption and incorrect prescribing of antimicrobials need special attention, particularly on the S wards.

Global Scale Atmospheric Processes Research Program Review

NASA Technical Reports Server (NTRS)

Worley, B. A. (Editor); Peslen, C. A. (Editor)

1984-01-01

Global modeling; satellite data assimilation and initialization; simulation of future observing systems; model and observed energetics; dynamics of planetary waves; First Global Atmospheric Research Program Global Experiment (FGGE) diagnosis studies; and National Research Council Research Associateship Program are discussed.

The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol.

PubMed

Timmermans, Marijke J C; van Vught, Anneke J A H; Wensing, Michel; Laurant, Miranda G H

2014-01-28

Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients' length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers' experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist. Findings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments.

Nitrogen removal process optimization in New York City WPCPS: a case study of Wards Island WPCP.

PubMed

Ramalingam, K; Fillos, J; Musabyimana, M; Deur, A; Beckmann, K

2009-01-01

The New York City Department of Environmental Protection has been engaged in a continuous process to develop a nitrogen removal program to reduce the nitrogen mass discharge from its water pollution control plants, (WPCPs), from 49,158 kg/d to 20,105 kg/d by the year 2017 as recommended by the Long Island Sound Study. As part of the process, a comprehensive research effort was undertaken involving bench, pilot and full scale studies to identify the most effective way to upgrade and optimize the existing WPCPs. Aeration tank 13 (AT-13) at the Wards Island WPCP was particularly attractive as a full-scale research facility because its aeration tank with its dedicated final settling tanks and RAS pumps could be isolated from the remaining treatment facilities. The nitrogen removal performance of AT-13, which, at the time, was operated as a "basic step feed BNR Facility", was evaluated and concurrently nitrification kinetic parameters were measured using in-situ bench scale experiments. Additional bench scale experiments provided denitrification rates using different sources of carbon and measurement of the maximum specific growth rate of nitrifying bacteria. The combined findings were then used to upgrade AT-13 to a "full" BNR facility with carbon and alkalinity addition. This paper will focus on the combined bench and full scale results that were the basis for the consequent upgrade.

El Nino as an element of a global-scale wave in the atmosphere-ocean system

NASA Astrophysics Data System (ADS)

Serykh, Ilya; Sonechkin, Dmitry

2016-04-01

The analyses of the real meteorological and oceanographical data, and long runs of the coupled atmosphere-ocean hydro- thermodynamical models identify a spatial-temporal structure of the main mode of the interannual to decadal climatic variations. This mode looks like a global-scale wave that extends from West to East around the Earth, and varies rhythmically. In fact, the establishment of this wave is a generalization and development of the well-known structures of the so-called "teleconnections" in the ocean-atmosphere system. The known regional structures like ENSO, IOD, PDO, IPO, PNA, NAO, AO, ACW and other can be considered as parts of this global-scale wave. Moving eastward around the Earth, this wave triggers El Nino - Southern oscillation events. An index of this wave is proposed as a sum of normalized anomalies of the sea level pressure and the near-surface temperature in 20 locations around the globe. It is proven that the power spectrum of this index is not continuous but discrete in its character. Thus, one can suppose that the dynamics of the global-scale wave is nonchaotic, and so predictable with no limit in principle. The index power spectrum reveals statistically significant peaks at the same periods that are inherent to the power spectra of the traditional ENSO indices. The main peaks are at the sub-harmonics of the well-known Chandler wobble (of the ~1.2 year period) in the Earth's pole motion: 3.6; 4.8; 2.4 years. Some other statistically significant peaks also are seen at the super-harmonics of the Luni-Solar nutation (of the ~18.6 year period), and combinational harmonics of the Schwabe's and Hale's solar activity cycles. Based on the eastward propagation of the global-scale wave, a predictor of ENSO events was suggested. It has high correlation (about 0.7) with Nino indices but leads them on about 12 months. The use of this predictor opens a possibility to overcome the Spring Predictability Barrier in ENSO forecasting.

Continuous Positive Airway Pressure Versus Oxygen Therapy in the Cardiac Surgical Ward: A Randomized Trial.

PubMed

Olper, Luigi; Bignami, Elena; Di Prima, Ambra L; Albini, Santina; Nascimbene, Simona; Cabrini, Luca; Landoni, Giovanni; Alfieri, Ottavio

2017-02-01

Noninvasive ventilation (NIV) is a common technique to manage patients with acute respiratory failure in the intensive care unit. However, use of NIV in general wards is less well described. The authors' aim was to demonstrate efficacy of NIV, applied in a cardiac surgery ward, in improving oxygenation in patients who developed hypoxemic acute respiratory failure after being discharged from the intensive care unit. Randomized, open-label trial. University hospital. Sixty-four patients with hypoxemia (PaO 2 /F I O 2 ratio between 100 and 250) admitted to the main ward after cardiac surgery. Patients were randomized to receive standard treatment (oxygen, early mobilization, a program of breathing exercises and diuretics) or continuous positive airway pressure in addition to standard treatment. Continuous positive airway pressure was administered 3 times a day for 2 consecutive days. Every cycle lasted 1 to 3 hours. All patients completed their 1-year follow-up. Data were analyzed according to the intention-to-treat principle. The primary endpoint was the number of patients with PaO 2 /F I O 2 <200 48 hours after randomization. Continuous positive airway pressure use was associated with a statistically significant reduction in the number of patients with PaO 2 /F I O 2 <200 (4/33 [12%] v 14/31 [45%], p = 0.003). One patient in the control group died at the 30-day follow-up. Among patients with acute respiratory failure following cardiac surgery, administration of continuous positive airway pressure in the main ward was associated with improved respiratory outcome. This was the first study that was performed in the main ward of post-surgical patients with acute respiratory failure. Copyright © 2017 Elsevier Inc. All rights reserved.

Boxer blurring the lines in Ward Valley debate

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

Newman, P.

1994-04-05

This article concerns the controversy over the siting of Ward Valley, a proposed low-level nuclear waste depository in California. The author contends that certain politicians and environmental groups have misrepresented the facts in their opposition to the site. In particular, an accusation about withholding information about the amount of Pu-239 to be stored at the site is false, since that information is available in the public record. Other misrepresentations are presented and discussed.

Cost-effectiveness of ward-based pharmacy care in surgical patients: protocol of the SUREPILL (Surgery & Pharmacy In Liaison) study.

PubMed

de Boer, Monica; Ramrattan, Maya A; Kiewiet, Jordy J S; Boeker, Eveline B; Gombert-Handoko, Kim B; van Lent-Evers, Nicolette A E M; Kuks, Paul F; Dijkgraaf, Marcel G W; Boermeester, Marja A; Lie-A-Huen, Loraine

2011-03-07

Preventable adverse drug events (pADEs) are widely known to be a health care issue for hospitalized patients. Surgical patients are especially at risk, but prevention of pADEs in this population is not demonstrated before. Ward-based pharmacy interventions seem effective in reducing pADEs in medical patients. The cost-effectiveness of these preventive efforts still needs to be assessed in a comparative study of high methodological standard and also in the surgical population. For these aims the SUREPILL (Surgery & Pharmacy in Liaison) study is initiated. A multi-centre controlled trial, with randomisation at ward-level and preceding baseline assessments is designed. Patients admitted to the surgical study wards for elective surgery with an expected length of stay of more than 48 hours will be included. Patients admitted to the intervention ward, will receive ward-based pharmacy care from the clinical pharmacy team, i.e. pharmacy practitioners and hospital pharmacists. This ward-based pharmacy intervention includes medication reconciliation in consultation with the patient at admission, daily medication review with face-to-face contact with the ward doctor, and patient counselling at discharge. Patients admitted in the control ward, will receive standard pharmaceutical care.The primary clinical outcome measure is the number of pADEs per 100 elective admissions. These pADEs will be measured by systematic patient record evaluation using a trigger tool. Patient records positive for a trigger will be evaluated on causality, severity and preventability by an independent expert panel. In addition, an economic evaluation will be performed from a societal perspective with the costs per preventable ADE as the primary economic outcome. Other outcomes of this study are: severity of pADEs, number of patients with pADEs per total number of admissions, direct (non-)medical costs and indirect non-medical costs, extra costs per prevented ADE, number and type of pharmacy

Job satisfaction and intent to leave among psychiatric nurses: closed versus open wards.

PubMed

Baum, Alexander; Kagan, Ilya

2015-08-01

The aim of this study was to investigate: (a) the association between socio-demographic variables, job satisfaction and intent to leave among hospital psychiatric nurses, and (b) the differences in the above between psychiatric nurses working on closed and open wards. After receiving ethical approval, a convenience sample of 52 (70% of total nursing staff) was drawn from psychiatric nurses in a large Israeli psychiatric hospital (95% response rate). The sample completed anonymously a self-administered structured questionnaire. A negative correlation was found between job satisfaction and intent to leave and between age, all categories of seniority, and intent to leave. Closed-ward nurses reported a higher intent to leave psychiatric nursing. Nurses under 35 reported a significantly higher intent to leave psychiatric nursing than nurses over 35. Job satisfaction was significantly higher among full-time nurses than part-time. Psychiatric hospitals need to pay attention to all factors associated with workers' readiness to leave. Given the widespread shortage of nurses, it is especially important that they address the relatively low job satisfaction of both younger and part-time nurses, and the particular stresses that closed-ward nurses work under. Copyright © 2015 Elsevier Inc. All rights reserved.

Nurses' role transition from the clinical ward environment to the critical care environment.

PubMed

Gohery, Patricia; Meaney, Teresa

2013-12-01

To explore the experiences of nurses moving from the ward environment to the critical care environment. Critical care areas are employing nurses with no critical care experience due to staff shortage. There is a paucity of literature focusing on the experiences of nurses moving from the ward environment to the critical care environment. A Heideggerian phenomenology research approach was used in this study. In-depth semi structured interviews, supported with an interview guide, were conducted with nine critical care nurses. Data analysis was guided by Van Manen (1990) approach to phenomenological analysis. Four main themes emerged: The highs and lows, you need support, theory-practice gap, struggling with fear. The participants felt ill prepared and inexperienced to work within the stressful and technical environment of critical care due to insufficient education and support. The study findings indicated that a variety of feelings and emotions are experienced by ward nurses who move into the stressful and technical environment of critical care due to insufficient skills and knowledge. More education and support is required to improve this transition process. Copyright © 2013 Elsevier Ltd. All rights reserved.

Scottish healthcare student's perceptions of an interprofessional ward simulation: An exploratory, descriptive study.

PubMed

Roberts, Fiona E; Goodhand, Kate

2018-03-01

The most memorable learning occurs during placement. Simulated interprofessional learning is a logical learning opportunity to help healthcare professionals work beyond their professional silos. In this qualitative study, we investigated the perceived learning of students from six health professions (adult nursing, diagnostic radiography, occupational therapy, physiotherapy, dietetics, and pharmacy) from their participation in a 45 min interprofessional ward simulation. Semistructured focus groups were undertaken, and data were analyzed using framework analysis. Two overarching themes were evident, each of which had subthemes: (i) the ward simulation as an interprofessional education opportunity (subthemes: reality of situations and interactions); and (ii) the perceived learning achieved (subthemes: professional roles, priorities, respect, communication, teamwork, and quality of care). The results indicated that a short interprofessional ward simulation, unsupported by additional learning opportunities or directed study, is a useful and engaging interprofessional learning opportunity. Students appear to have learnt important key messages central to the interprofessional education curricula to help develop practitioners who can effectively work together as an interprofessional team, and that this learning is partly due to simulation allowing things to go wrong. © 2017 John Wiley & Sons Australia, Ltd.

Temporal trends in self harm and aggression on a paediatric mental health ward.

PubMed

Berntsen, Ellen; Starling, Jean; Durheim, Earle; Hainsworth, Cassandra; de Kloet, Liselotte; Chapman, Lucy; Hancock, Karen

2011-02-01

The aim of this paper is to describe trends in aggression and self harm on a mental health inpatient unit for children and adolescents between January 2006 and August 2009. Various ward interventions and the ward milieu were evaluated as possible explanatory factors for trends. This was a retrospective study whereby incidents of aggression, self harm and seclusion were obtained from a computerized Incident Information Management System (IIMS) database. Trends in incidents were analysed using linear regression analyses. Over a 44-month period, 292 incidents of aggression and 139 incidents of self harm were reported. The use of seclusion and the number of aggressive incidents both significantly decreased over time. Trends suggested a positive relationship between the introduction of restraint training, changes in leadership and full staff complement, and a reduction in aggression and seclusion. Although the findings are limited by their retrospective nature and reliance on formal records, this study suggests that different factors can contribute to decrease the incidence of adverse events on a psychiatric ward. Future prospective research is needed to assess the effectiveness of different interventions in both the prevention and management of self harm, aggression and seclusion in child and adolescent inpatient units.

Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates.

PubMed

Lu, Po-Liang; Siu, L K; Chen, Tun-Chieh; Ma, Ling; Chiang, Wen-Gin; Chen, Yen-Hsu; Lin, Sheng-Fung; Chen, Tyen-Po

2009-10-01

Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified. This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Our results revealed a 17.4% (49/282) contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation.

Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates

PubMed Central

2009-01-01