WorldWideScience

Sample records for based stockpile stewardship

  1. Science-based stockpile stewardship at Los Alamos National Laboratory

    International Nuclear Information System (INIS)

    Immele, J.

    1995-01-01

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

  2. Multiscale science for science-based stockpile stewardship

    Energy Technology Data Exchange (ETDEWEB)

    Margolin, L.; Sharp, D.

    2000-12-01

    This is the final report of a three-year, Laboratory-Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). The goal of this project has been to develop and apply the methods of multi scale science to the problems of fluid and material mixing due to instability and turbulence, and of materials characterization. Our specific focus has been on the SBSS (science-based stockpile stewardship) issue of assessing the performance of a weapons with off-design, aged, or remanufactured components in the absence of full-scale testing. Our products are physics models, based on microphysical principles and parameters, and suitable for implementation in the large scale design and assessment codes used in the nuclear weapons program.

  3. Stockpile Stewardship at Los Alamos(U)

    Energy Technology Data Exchange (ETDEWEB)

    Webster, Robert B. [Los Alamos National Laboratory

    2012-06-29

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

  4. FY 2015 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2014-04-01

    This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

  5. FY 2016 - Stockpile Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-03-01

    This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

  6. Final Programmatic Environmental Impact Statement for stockpile stewardship and management

    International Nuclear Information System (INIS)

    1996-09-01

    The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management Programmatic Environmental Impact Statement (PEIS) describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program. This document contains Volume II which consists of Appendices A through H

  7. Final programmatic environmental impact statement for stockpile stewardship and management

    International Nuclear Information System (INIS)

    1996-09-01

    In response to the end of the Cold War and changes in the world's political regimes, the United States is not producing new-design nuclear weapons. Instead, the emphasis of the U.S. nuclear weapons program is on reducing the size of the Nation's nuclear stockpile by dismantling existing nuclear weapons. The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management PEIS describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program

  8. FY 2014 - Stockpile and Stewardship and Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-06-01

    This Department of Energy’s (DOE) National Nuclear Security Administration (NNSA) Fiscal Year Stockpile Stewardship and Management Plan (SSMP) is a key planning document for the nuclear security enterprise.

  9. Without Testing: Stockpile Stewardship in the Second Nuclear Age

    Energy Technology Data Exchange (ETDEWEB)

    Martz, Joseph C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-01-07

    Stockpile stewardship is a topic dear to my heart. I’ve been fascinated by it, and I’ve lived it—mostly on the technical side but also on the policy side from 2009 to 2010 at Stanford University as a visiting scholar and the inaugural William J. Perry Fellow. At Stanford I worked with Perry, former secretary of defense, and Sig Hecker, former Los Alamos Lab director (1986–1997), looking at nuclear deterrence, nuclear policy, and stockpile stewardship and at where all this was headed.

  10. A system simulation to enhance stockpile stewardship (ASSESS)

    International Nuclear Information System (INIS)

    Yoshimura, A.S.; Plantenga, T.D.; Napolitano, L.M.; Johnson, M.M.

    1997-01-01

    This paper describes the ASSESS project, whose goal is to construct a policy driven enterprise simulation of the DOE nuclear weapons complex (DOE/NWC). ASSESS encompasses the full range of stockpile stewardship activities by incorporating simulation component models that are developed and managed by local experts. ASSESS runs on a heterogeneous distributed computing environment and implements multi-layered user access capabilities. ASSESS allows the user to create hypothetical policies governing stockpile stewardship, simulate the resulting operation of the DOE/NWC, and analyze the relative impact of each policy

  11. The Big Science of stockpile stewardship

    Energy Technology Data Exchange (ETDEWEB)

    Reis, Victor H.; Hanrahan, Robert J.; Levedahl, W. Kirk

    2016-08-15

    In the quarter century since the US last exploded a nuclear weapon, an extensive research enterprise has maintained the resources and know-how needed to preserve confidence in the country’s stockpile.

  12. FY 2017 Stockpile Stewardship and Management Plan - Biennial Plan Summary

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2016-03-01

    This year’s summary report updates the Fiscal Year 2016 Stockpile Stewardship and Management Plan (FY 2016 SSMP), the 25-year strategic program of record that captures the plans developed across numerous NNSA programs and organizations to maintain and modernize the scientific tools, capabilities, and infrastructure necessary to ensure the success of NNSA’s nuclear weapons mission. The SSMP is a companion to the Prevent, Counter, and Respond: A Strategic Plan to Reduce Global Nuclear Threats (FY 2017-2021) report, the planning document for NNSA’s nuclear threat reduction mission. New versions of both reports are published each year in response to new requirements and challenges. Much was accomplished in FY 2015 as part of the program of record described in this year’s SSMP. The science-based Stockpile Stewardship Program allowed the Secretaries of Energy and Defense to certify for the twentieth time that the stockpile remains safe, secure, and effective without the need for underground nuclear explosive testing. The talented scientists, engineers, and technicians at the three national security laboratories, the four nuclear weapons production plants, and the national security site are primarily responsible for this continued success. Research, development, test, and evaluation programs have advanced NNSA’s understanding of weapons physics, component aging, and material properties through first-of-a-kind shock physics experiments, along with numerous other critical experiments conducted throughout the nuclear security enterprise. The multiple life extension programs (LEPs) that are under way made progress toward their first production unit dates. The W76-1 LEP is past the halfway point in total production, and the B61-12 completed three development flight tests. Critical to this success is the budget. The Administration’s budget request for NNSA’s Weapons Activities has increased for all but one of the past seven years, resulting in a total increase of

  13. Final Programmatic Environmental Impact Statement for stockpile stewardship and management: Volume 1

    International Nuclear Information System (INIS)

    1996-09-01

    The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed Stockpile Stewardship and Maintenance Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management Program Programmatic Environmental Impact Statement (PEIS) describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program. This document contains Volume I of the PEIS

  14. Final programmatic environmental impact statement for stockpile stewardship and management. Comment response document. Volume 4

    International Nuclear Information System (INIS)

    1996-09-01

    In response to the end of the Cold War and changes in the world's political regimes, the United States is not producing new-design nuclear weapons. Instead, the emphasis on the U.S. nuclear weapons program is on reducing the size of the Nation's nuclear stockpile by dismantling existing nuclear weapons. The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management PEIS describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program

  15. Final Programmatic Environmental Impact Statement for stockpile stewardship and management: Volume 3

    International Nuclear Information System (INIS)

    1996-09-01

    The Department of Energy (DOE) has been directed by the President and Congress to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground nuclear testing. In order to fulfill that responsibility, DOE has developed a Stockpile Stewardship and Management Program to provide a single highly integrated technical program for maintaining the continued safety and reliability of the nuclear stockpile. The Stockpile Stewardship and Management Programmatic Environmental Impact Statement (PEIS) describes and analyzes alternative ways to implement the proposed actions for the Stockpile Stewardship and Management Program. This document consists of Volume III, Appendix I entitled ''National Ignition Facility Project-Specific Analysis,'' which investigates the environmental impacts resulting from constructing and operating the proposed National Ignition Facility

  16. Draft Programmatic Environmental Impact Statement for Stockpile Stewardship and Management: Volume 3, Appendix I, Appendix J, Appendix K

    International Nuclear Information System (INIS)

    1996-02-01

    In response to the end of the Cold War and changes in the world's political regimes, United States is no longer producing new nuclear weapons. Instead, the US nuclear weapons program is reducing the size of the nuclear stockpile by dismantling existing weapons. DOE has been directed to maintain the safety and reliability of the reduced nuclear weapons stockpile in the absence of underground testing. Therefore, DOE has developed a stewardship and management program to provide a single highly integrated technical program. The stockpile stewardship portion of the PEIS evaluates the potential impacts of three proposed facilities: the National Ignition Facility, the Contained Firing facility, and the Atlas Facility. This volume contains appendices for these 3 facilities; alternatives affecting LANL, LLNL, SNL, and NTS are addressed. Impacts on land resources, site infrastructure, air qualaity, water resources, geology and soils, biotic resources, cultural resources, etc., are evaluated. This PEIS presents unclassified information only

  17. China to Establish Strategic Oil Stockpile Bases

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    @@ Based on the reports from China's State Development and Reform Committee, a new department of the State Council recently put into operation, the relevant departments have located a number of places as the country's strategic oil stockpile bases, such as Zhoushan and Zhenghai in Zhejiang Province, Huangdao in Shandong Province and Daya Bay in Guangdong Province. However, the plan still needs to be examined and approved by the State Council.

  18. Stockpile stewardship and management programmatic environmental impact statement data for the no action and phase-out alternatives at the Oak Ridge Reservation

    International Nuclear Information System (INIS)

    1996-07-01

    Alternatives for the Oak Ridge Y-12 Plant are being considered under the Stockpile Stewardship and Management Program (SSM). The three alternatives under consideration include: continuing the secondary manufacturing operations in a down-sized footprint; no action; and phasing out the secondary manufacturing operations at Y-12. This report provides specific environmental data requested for the Y-12 Plant alternatives of no action and phase out

  19. 2015 Stewardship Science Academic Programs Annual

    Energy Technology Data Exchange (ETDEWEB)

    Stone, Terri [NNSA Office of Research, Development, Test, and Evaluation, Washington, DC (United States); Mischo, Millicent [NNSA Office of Research, Development, Test, and Evaluation, Washington, DC (United States)

    2015-02-01

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

  20. Collaborative Decision Model on Stockpile Material of a Traditional Market Infrastructure using Value-Based HBU

    Science.gov (United States)

    Utomo, C.; Rahmawati, Y.; Pararta, D. L.; Ariesta, A.

    2017-11-01

    Readiness of infrastructure establishment is needed in the early phase of real estate development. To meet the needs of retail property in the form of traditional markets, the Government prepares to build a new 1300 units. Traditional market development requires infrastructure development. One of it is the preparation of sand material embankment as much as ± 200,000 m3. With a distance of 30 km, sand material can be delivered to the project site by dump trucks that can only be operated by 2 trip per day. The material is managed by using stockpile method. Decision of stockpile location requires multi person and multi criteria in a collaborative environment. The highest and the best use (HBU) criteria was used to construct a value-based decision hierarchy. Decision makers from five stakeholders analyzed the best of three locations by giving their own preference of development cost and HBU function. Analytical Hierarchy Process (AHP) based on satisfying options and cooperative game was applied for agreement options and coalition formation on collaborative decision. The result indicates that not all solutions become a possible location for the stockpile material. It shows the ‘best fit’ options process for all decision makers.

  1. Urban ecological stewardship: understanding the structure, function and network of community-based urban land management

    Science.gov (United States)

    Erika s. Svendsen; Lindsay K. Campbell

    2008-01-01

    Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based...

  2. Nuclear Stockpile Management: A Technical and Political Assessment

    International Nuclear Information System (INIS)

    Sitt, Bernard; Grand, Camille

    2009-10-01

    Stewardship strategies. In fact, its effective implementation has resulted in the actual freezing of nuclear States' capacities, while allowing for somewhat different situations in Nuclear Weapon States and de facto nuclear States. The second structuring element of nuclear stockpile management is the ban on the production of fissile materials for nuclear weapons (FMCT), which has been on the agenda of the international community for fourteen years. But its negotiation at the Conference on Disarmament still has not managed to get started because the CD is still in a stalemate even today after the adoption of its program of work last May. The Stockpile Stewardship concept emerged rather belatedly in the history of nuclear arsenals, since it was introduced by the USA in 1992, as well as by other nuclear powers. The concept itself gradually evolved, until 1995 when the US Science Based Stockpile Stewardship policy and the French one in particular found their full expression: managing potential problems due to aging stockpiles, refurbishing weapons and components as required, maintaining the science and the engineering agencies supporting the national deterrent. As a matter of fact, the maintenance in operational condition of nuclear weapons presents, contrary to classical weapon systems, specific and increased challenges, owing to the sophistication of the technologies involved and because of the aging processes of nuclear and other materials in the weapons. We then try to review briefly in this paper the Stockpile Stewardship and Simulation context and policies in the Nuclear Weapon States and in three other de facto nuclear States considered as such, although very little is known in certain cases. (authors)

  3. An Introduction to Risk with a Focus on Design Diversity in the Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    Noone, Bailey C [Los Alamos National Laboratory

    2012-08-13

    The maintenance and security of nuclear weapons in the stockpile involves decisions based on risk analysis and quantitative measures of risk. Risk is a factor in all decisions, a particularly important factor in decisions of a large scale. One example of high-risk decisions we will discuss is the risk involved in design diversity within the stockpile of nuclear weapons arsenal. Risk is defined as 'possibility of loss or injury' and the 'degree of probability of such loss' (Kaplan and Garrick 12). To introduce the risk involved with maintaining the weapons stockpile we will draw a parallel to the design and maintenance of Southwest Airlines fleet of Boeing 737 planes. The clear benefits for cost savings in maintenance of having a uniform fleet are what historically drove Southwest to have only Boeing 737s in their fleet. Less money and resources are need for maintenance, training, and materials. Naturally, risk accompanies those benefits. A defect in a part of the plane indicates a potential defect in that same part in all the planes of the fleet. As a result, safety, business, and credibility are at risk. How much variety or diversity does the fleet need to mitigate that risk? With that question in mind, a balance is needed to accommodate the different risks and benefits of the situation. In a similar way, risk is analyzed for the design and maintenance of nuclear weapons in the stockpile. In conclusion, risk must be as low as possible when it comes to the nuclear weapons stockpile. Design and care to keep the stockpile healthy involves all aspects of risk management. Design diversity is a method that helps to mitigate risk, and to help balance options in stockpile stewardship.

  4. Thorium Nitrate Stockpile--From Here to Eternity

    International Nuclear Information System (INIS)

    Hermes, W. H.; Hylton, T. D.; Mattus, C.H.; Storch, S. N.; Singley, P.S.; Terry, J. W.; Pecullan, M.; Reilly, F. K.

    2003-01-01

    The Defense National Stockpile Center (DNSC), a field level activity of the Defense Logistics Agency (DLA) has stewardship of a stockpile of thorium nitrate that has been in storage for decades. The stockpile is made up of approximately 3.2 million kg (7 million lb) of thorium nitrate crystals (hydrate form) stored at two depot locations in the United States. DNSC sought technical assistance from Oak Ridge National Laboratory (ORNL) to define and quantify the management options for the thorium nitrate stockpile. This paper describes methodologies and results comprising the work in Phase 1 and Phase 2. The results allow the DNSC to structure and schedule needed tasks to ensure continued safe long-term storage and/or phased disposal of the stockpile

  5. Stockpiling Ventilators for Influenza Pandemics.

    Science.gov (United States)

    Huang, Hsin-Chan; Araz, Ozgur M; Morton, David P; Johnson, Gregory P; Damien, Paul; Clements, Bruce; Meyers, Lauren Ancel

    2017-06-01

    In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response.

  6. Promoting Environmental Stewardship through Project Based Learning (PBL)

    DEFF Research Database (Denmark)

    Borhan, Mohamad Termizi Bin; Ismail, Zurida

    2011-01-01

    of our fellow communities: human, plant or animal. It is grounded in an understanding of the importance of environmental quality and natural resources to the human race and the effects of human actions on the environment. Thus, it is important to provide relevant educational experiences that involve......Environmental stewardship is living responsibly as a caretaker of the environment for the benefit of present and future generations and is quickly becoming one of the most pressing public priorities for communities today. As stewards, we are personally responsible for the care and preservation......-service teachers enrolled in a chemistry teaching methods course participated in this study. The pre-service teachers were in their third year of the teacher education program. Data were collected through questionnaires containing Likert-type items designed to assess the degree of environmental concern...

  7. Urban Ecological Stewardship: Understanding the Structure, Function and Network of Community-based Urban Land Management

    Directory of Open Access Journals (Sweden)

    Lindsay K. Campbell

    2008-01-01

    Full Text Available Urban environmental stewardship activities are on the rise in cities throughout the Northeast. Groups participating in stewardship activities range in age, size, and geography and represent an increasingly complex and dynamic arrangement of civil society, government and business sectors. To better understand the structure, function and network of these community-based urban land managers, an assessment was conducted in 2004 by the research subcommittee of the Urban Ecology Collaborative. The goal of the assessment was to better understand the role of stewardship organizations engaged in urban ecology initiatives in selected major cities in the Northeastern U.S.: Boston, New Haven, New York City, Pittsburgh, Baltimore, and Washington, D.C. A total of 135 active organizations participated in this assessment. Findings include the discovery of a dynamic social network operating within cities, and a reserve of social capital and expertise that could be better utilized. Although often not the primary land owner, stewardship groups take an increasingly significant responsibility for a wide range of land use types including street and riparian corridors, vacant lots, public parks and gardens, green roofs, etc. Responsibilities include the delivery of public programs as well as daily maintenance and fundraising support. While most of the environmental stewardship organizations operate on staffs of zero or fewer than ten, with small cohorts of community volunteers, there is a significant difference in the total amount of program funding. Nearly all respondents agree that committed resources are scarce and insufficient with stewards relying upon and potentially competing for individual donations, local foundations, and municipal support. This makes it a challenge for the groups to grow beyond their current capacity and to develop long-term programs critical to resource management and education. It also fragments groups, making it difficult for planners and

  8. Is strategic stockpiling essential?

    International Nuclear Information System (INIS)

    Anon.

    2007-01-01

    As mentioned by the European Commission, a consultant has surveyed stakeholders on the concept of setting up strategic stockpiles of natural gas, namely to boost the security of Europe's supply, much like the strategic stockpiling for petroleum products the OECD member countries carried out after the petroleum crisis. If strategic stockpiling consists in blocking off a quantity of gas in addition to the usable stockpile, the AFG believes it is necessary to assess the implications of such a measure and to examine the security gain it would actually offer compared to the measures that have already been implemented to secure supplies. (author)

  9. Rural Community-Based Tourism and its Impact on Ecological Consciousness, Environmental Stewardship and Social Structures

    DEFF Research Database (Denmark)

    Raftopoulos, Malayna

    2018-01-01

    Since rural community-based tourism (RCBT) emerged, it has been widely considered to be an effective means of promoting development and conserving natural resources. Through a political ecology approach, this article explores the potential of RCBT to foster long-term stewardship and transformations...

  10. Place-Based Stewardship Education: Nurturing Aspirations to Protect the Rural Commons

    Science.gov (United States)

    Gallay, Erin; Marckini-Polk, Lisa; Schroeder, Brandon; Flanagan, Constance

    2016-01-01

    In this mixed-methods study, we examine the potential of place-based stewardship education (PBSE) for nurturing rural students' community attachment and aspirations to contribute to the preservation of the environmental "commons." Analyzing pre- and post-experience surveys (n = 240) and open-ended responses (n = 275) collected from…

  11. Applications of Nuclear Science for Stewardship Science

    International Nuclear Information System (INIS)

    Cizewski, Jolie A

    2013-01-01

    Stewardship science is research important to national security interests that include stockpile stewardship science, homeland security, nuclear forensics, and non-proliferation. To help address challenges in stewardship science and workforce development, the Stewardship Science Academic Alliances (SSAA) was inaugurated ten years ago by the National Nuclear Security Administration of the U. S. Department of Energy. The goal was to enhance connections between NNSA laboratories and the activities of university scientists and their students in research areas important to NNSA, including low-energy nuclear science. This paper presents an overview of recent research in low-energy nuclear science supported by the Stewardship Science Academic Alliances and the applications of this research to stewardship science.

  12. The Stockpile Monitor Program

    International Nuclear Information System (INIS)

    Buntain, G.A.; Fletcher, M.; Rabie, R.

    1994-07-01

    Recent political changes have led to drastic reductions in the number of nuclear warheads in stockpile, as well as increased expectations for warhead-service lives. In order to support and maintain a shrinking and aging nuclear stockpile, weapon scientists and engineers need detailed information describing the environments experienced by weapons in the field. Hence, the Stockpile Monitor Program was initiated in 1991 to develop a comprehensive and accurate database of temperature and humidity conditions experienced by nuclear warheads both in storage and on-alert

  13. IEA Shows Concerns Over China's Oil Stockpiling

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ Reportedly, China's oil imports accounted for nearly one third of the world's total oil supply in 2003. The country's oil imports are estimated at 110~120 million tons in 2004,equal to 2.2~2.4 million barrels per day, much higher than 91 million tons in 2003. International Energy Agency has helped the Chinese government with the country's strategic oil stockpiling plan by offering the training. The Paris-based IEA has urged China to take into consideration how to operate and maintain the national strategic oil stockpiling system and clarify the roles of the enterprises and the State in oil stockpiling.

  14. Chemical Stockpile Disposal Program

    Energy Technology Data Exchange (ETDEWEB)

    Krummel, J.R.; Policastro, A.J.; Olshansky, S.J.; McGinnis, L.D.

    1990-10-01

    As part of the Chemical Stockpile Disposal Program mandated by Public Law 99--145 (Department of Defense Authorization Act), an independent review is presented of the US Army Phase I environmental report for the disposal program at the Umatilla Depot Activity (UMDA) in Hermiston, Oregon. The Phase I report addressed new and additional concerns not incorporated in the final programmatic environmental impact statement (FPEIS). Those concerns were addressed by examining site-specific data for the Umatilla Depot Activity and by recommending the scope and content of a more detailed site-specific study. This independent review evaluates whether the new site-specific data presented in the Phase I report would alter the decision in favor of on-site disposal that was reached in the FPEIS, and whether the recommendations for the scope and content of the site-specific study are adequate. Based on the methods and assumptions presented in the FPEIS, the inclusion of more detailed site-specific data in the Phase I report does not change the decision reached in the FPEIS (which favored on-site disposal at UMDA). It is recommended that alternative assumptions about meteorological conditions be considered and that site-specific data on water, ecological, socioeconomic, and cultural resources; seismicity; and emergency planning and preparedness be considered explicitly in the site-specific EIS decision-making process. 7 refs., 1 fig.

  15. Facilitating Stewardship of scientific data through standards based workflows

    Science.gov (United States)

    Bastrakova, I.; Kemp, C.; Potter, A. K.

    2013-12-01

    scientific data acquisition and analysis requirements and effective interoperable data management and delivery. This includes participating in national and international dialogue on development of standards, embedding data management activities in business processes, and developing scientific staff as effective data stewards. Similar approach is applied to the geophysical data. By ensuring the geophysical datasets at GA strictly follow metadata and industry standards we are able to implement a provenance based workflow where the data is easily discoverable, geophysical processing can be applied to it and results can be stored. The provenance based workflow enables metadata records for the results to be produced automatically from the input dataset metadata.

  16. Analytical Characterization of the Thorium Nitrate Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    Mattus, CH

    2003-12-30

    For several years, Oak Ridge National Laboratory (ORNL) has been supporting the Defense Logistics Agency-Defense National Stockpile Center with stewardship of a thorium nitrate (ThN) stockpile. The effort for fiscal year 2002 was to prepare a sampling and analysis plan and to use the activities developed in the plan to characterize the ThN stockpile. The sampling was performed in June and July 2002 by RWE NUKEM with oversight by ORNL personnel. The analysis was performed by Southwest Research Institute of San Antonio, Texas, and data validation was performed by NFT, Inc., of Oak Ridge, Tennessee. Of the {approx} 21,000 drums in the stockpile, 99 were sampled and 53 were analyzed for total metals composition, radiological constituents (using alpha and gamma spectrometry), and oxidizing characteristics. Each lot at the Curtis Bay Depot was sampled. Several of the samples were also analyzed for density. The average density of the domestic ThN was found to be 1.89 {+-} 0.08 g/cm{sup 3}. The oxidizer test was performed following procedures issued by the United Nations in 1999. Test results indicated that none of the samples tested was a Division 5.1 oxidizer per Department of Transportation definition. The samples were analyzed for total metals following the U.S. Environmental Protection Agency methods SW-846-6010B and 6020 (EPA 2003) using a combination of inductively coupled plasma--atomic emission spectroscopy and inductively coupled plasma--mass spectroscopy techniques. The results were used to compare the composition of the eight Resource Conservation and Recovery Act metals present in the sample (arsenic, barium, cadmium, chromium, lead, mercury, selenium, and silver) to regulatory limits. None of the samples was found to be hazardous for toxicity characteristics. The radiological analyses confirmed, when possible, the results obtained by the inductively coupled plasma analyses. These results--combined with the historical process knowledge acquired on the material

  17. Validated sampling strategy for assessing contaminants in soil stockpiles

    International Nuclear Information System (INIS)

    Lame, Frank; Honders, Ton; Derksen, Giljam; Gadella, Michiel

    2005-01-01

    Dutch legislation on the reuse of soil requires a sampling strategy to determine the degree of contamination. This sampling strategy was developed in three stages. Its main aim is to obtain a single analytical result, representative of the true mean concentration of the soil stockpile. The development process started with an investigation into how sample pre-treatment could be used to obtain representative results from composite samples of heterogeneous soil stockpiles. Combining a large number of random increments allows stockpile heterogeneity to be fully represented in the sample. The resulting pre-treatment method was then combined with a theoretical approach to determine the necessary number of increments per composite sample. At the second stage, the sampling strategy was evaluated using computerised models of contaminant heterogeneity in soil stockpiles. The now theoretically based sampling strategy was implemented by the Netherlands Centre for Soil Treatment in 1995. It was applied to all types of soil stockpiles, ranging from clean to heavily contaminated, over a period of four years. This resulted in a database containing the analytical results of 2570 soil stockpiles. At the final stage these results were used for a thorough validation of the sampling strategy. It was concluded that the model approach has indeed resulted in a sampling strategy that achieves analytical results representative of the mean concentration of soil stockpiles. - A sampling strategy that ensures analytical results representative of the mean concentration in soil stockpiles is presented and validated

  18. Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship.

    Science.gov (United States)

    Oliver, Stefanie Jane; Cush, James; Ward, Jeanette E

    2017-01-01

    To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee. Prescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee. As AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

  19. Potassium iodide stockpiling

    International Nuclear Information System (INIS)

    Krimm, R.W.

    1983-01-01

    After examination by the Federal Emergency Management Agency (FEMA) and other federal agencies of federal policy on the use and distribution of potassium iodide (KI) as a thyroid-blocking agent for use in off-site preparedness around commercial nuclear powerplants, FEMA believes the present shelf life of KI is too short, that the minimum ordering quantities are an obstacle to efficient procurement, and that the packaging format offered by the drug industry does not meet the wishes of state and local government officials. FEMA has asked assistance from the Food and Drug Administration in making it possible for those states wishing to satisfy appropriate requirements to do so at the minimum cost to the public. Given an appropriate packaging and drug form, there appears to be no reason for the federal government to have further involvement in the stockpiling of KI

  20. Gaseous emissions from coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-01-15

    Stockpiled coal undergoes atmospheric oxidation and desorption processes during open air storage. These processes release gases to the environment which may effect health and safety by their toxicity and flammability. In extreme cases, this could lead to a fire. This report discusses gaseous emissions from coal stockpiles. It covers gas emission mechanisms, and gas sampling and testing methods, before examining in more detail the principal gases that have been emitted. It concludes that there is limited research in this area and more data are needed to evaluate the risks of gaseous emissions. Some methods used to prevent coal self-heating and spontaneous combustion can be applied to reduce emissions from coal stockpiles.

  1. Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship

    Directory of Open Access Journals (Sweden)

    Stefanie Jane Oliver

    2017-07-01

    Full Text Available BackgroundTo support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing.What we didFinding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee.What we learnedPrescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60% about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee.Strengthening AMS in remote settingsAs AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.

  2. Next Generation Cloud-based Science Data Systems and Their Implications on Data and Software Stewardship, Preservation, and Provenance

    Science.gov (United States)

    Hua, H.; Manipon, G.; Starch, M.

    2017-12-01

    NASA's upcoming missions are expected to be generating data volumes at least an order of magnitude larger than current missions. A significant increase in data processing, data rates, data volumes, and long-term data archive capabilities are needed. Consequently, new challenges are emerging that impact traditional data and software management approaches. At large-scales, next generation science data systems are exploring the move onto cloud computing paradigms to support these increased needs. New implications such as costs, data movement, collocation of data systems & archives, and moving processing closer to the data, may result in changes to the stewardship, preservation, and provenance of science data and software. With more science data systems being on-boarding onto cloud computing facilities, we can expect more Earth science data records to be both generated and kept in the cloud. But at large scales, the cost of processing and storing global data may impact architectural and system designs. Data systems will trade the cost of keeping data in the cloud with the data life-cycle approaches of moving "colder" data back to traditional on-premise facilities. How will this impact data citation and processing software stewardship? What are the impacts of cloud-based on-demand processing and its affect on reproducibility and provenance. Similarly, with more science processing software being moved onto cloud, virtual machines, and container based approaches, more opportunities arise for improved stewardship and preservation. But will the science community trust data reprocessed years or decades later? We will also explore emerging questions of the stewardship of the science data system software that is generating the science data records both during and after the life of mission.

  3. Temperature profiles of coal stockpiles

    Energy Technology Data Exchange (ETDEWEB)

    Sensogut, C.; Ozdeniz, A.H.; Gundogdu, I.B. [Dumlupinar University, Kutahya (Turkey). Mining Engineering Department

    2008-07-01

    Excess of produced coals should be kept in the stockyards of the collieries. The longer the duration time for these coals, the greater possibility for spontaneous combustion to take place. Spontaneously burnt coals result in economical and environmental problems. Therefore, taking the necessary precautions before an outburst of the spontaneous combustion phenomenon is too important in terms of its severe results. In this study, a stockpile having industrial dimensions was formed in coal stockyard. The effective parameters on the stockpiles of coal such as temperature and humidity of the weather, time, and atmospheric pressure values were measured. The interior temperature variations of these stockpiles caused by the atmospheric conditions were also measured. The interior temperature distribution maps of the stockpile together with maximum and minimum temperature values were expressed visually and numerically by the assistance of obtained data.

  4. Development of effective hospital-based antibiotic stewardship program. The role of infectious disease specialist

    Directory of Open Access Journals (Sweden)

    Georgios Chrysos

    2017-01-01

    Full Text Available Excessive antibiotic consumption and misuse is one of the main factors responsible for the emergence of antibiotic-resistant bacteria and has been associated with increased health care costs. Active intervention is necessary in changing antimicrobial prescribing practices. The Infection Control Committee and the administration of our hospital decided to implement an antibiotic stewardship program beginning in January 2016 in order to reduce inappropriate antibiotic use and to combat antibiotic resistance through improved prescribing practices. The antimicrobial stewardship team includes an ID specialist, physicians, infection control nurses, a microbiologist and a pharmacist who are responsible for the implementation of the program. Preauthorization by an ID specialist and prospective review is necessary for all pharmacy orders of antibiotics under restriction. Pre-intervention, we collected Pharmacy and hospital data regarding antibiotic consumption and numbers of patient-days for the years 2013-2015. We calculated antibiotic use in Defined Daily Doses (DDDs/100 patient-days. After one year, the antibiotic stewardship program was effective in reducing consumption of most antibiotics. The result of the implementation of the program in our hospital was a reduction about 17% of antibiotic DDDs/100 patient-days and about 21% of the antibiotic cost/100 patient-days. Education is an essential element of our program in order to influence prescribing behavior. Lectures and brochures are used to supplement strategies. Antibiotic stewardship programs have been shown from many studies to improve patient outcomes, reduce antibiotic resistance and save money.

  5. 20 Years of Success: Science, Technology, and the Nuclear Weapons Stockpile

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2015-10-22

    On Oct. 22, 2015, NNSA celebrated the proven success of the Stockpile Stewardship Program at a half-day public event featuring remarks by Secretary of Energy Ernest Moniz, Secretary of State John Kerry, and Under Secretary for Nuclear Security and NNSA Administrator Lt. Gen. (retired) Frank G. Klotz. The event also featured remarks by Deputy Secretary of Energy Elizabeth Sherwood-Randall and NNSA Principal Deputy Administrator Madelyn Creedon.

  6. Stewardship of climate

    International Nuclear Information System (INIS)

    Brown, P.G.

    1997-01-01

    A trustee is someone who cares for a resource on behalf of another. In the case of climate, one generation cares for the climate and the myriad things climate effects on behalf of subsequent generations. This article offers reasons for accepting trusteeship as a framework for thinking about climate change; discusses what trustee duties are: considers their implications for the construction of an economics of stewardship; shows how tradeoffs would be assessed within this framework, and points towards a reconceptualization of international relations based on these ideas. 1 ref

  7. Stockpile strategy for China's emergency oil reserve: A dynamic programming approach

    International Nuclear Information System (INIS)

    Bai, Y.; Dahl, C.A.; Zhou, D.Q.; Zhou, P.

    2014-01-01

    China is currently accelerating construction of its strategic petroleum reserves. How should China fill the SPR in a cost-effective manner in the short-run? How might this affect world oil prices? Using a dynamic programming model to answer these questions, the objective of this paper is to minimize the stockpiling costs, including consumer surplus as well as crude acquisition and holding costs. The crude oil acquisition price in the model is determined by global equilibrium between supply and demand. Demand, in turn, depends on world market conditions including China's stockpile filling rate. Our empirical study under different market conditions shows that China's optimal stockpile acquisition rate varies from 9 to 19 million barrels per month, and the optimal stockpiling drives up the world oil price by 3–7%. The endogenous price increase accounts for 52% of total stockpiling costs in the base case. When the market is tighter or the demand function is more inelastic, the stockpiling affects the market more significantly and pushes prices even higher. Alternatively, in a disruption, drawdown from the stockpile can effectively dampen soaring prices, though the shortage is likely to leave the price higher than before the disruption. - Highlights: • China's SPR policies are examined by dynamic programming. • The optimal stockpile acquisition rate varies from 9 to 19 million barrels per month. • The optimal stockpiling drives up world oil price by 3–7%

  8. Biosolid stockpiles are a significant point source for greenhouse gas emissions.

    Science.gov (United States)

    Majumder, Ramaprasad; Livesley, Stephen J; Gregory, David; Arndt, Stefan K

    2014-10-01

    The wastewater treatment process generates large amounts of sewage sludge that are dried and then often stored in biosolid stockpiles in treatment plants. Because the biosolids are rich in decomposable organic matter they could be a significant source for greenhouse gas (GHG) emissions, yet there are no direct measurements of GHG from stockpiles. We therefore measured the direct emissions of methane (CH4), nitrous oxide (N2O) and carbon dioxide (CO2) on a monthly basis from three different age classes of biosolid stockpiles at the Western Treatment Plant (WTP), Melbourne, Australia, from December 2009 to November 2011 using manual static chambers. All biosolid stockpiles were a significant point source for CH4 and N2O emissions. The youngest biosolids (nitrate and ammonium concentration. We also modeled CH4 emissions based on a first order decay model and the model based estimated annual CH4 emissions were higher as compared to the direct field based estimated annual CH4 emissions. Our results indicate that labile organic material in stockpiles is decomposed over time and that nitrogen decomposition processes lead to significant N2O emissions. Carbon decomposition favors CO2 over CH4 production probably because of aerobic stockpile conditions or CH4 oxidation in the outer stockpile layers. Although the GHG emission rate decreased with biosolid age, managers of biosolid stockpiles should assess alternate storage or uses for biosolids to avoid nutrient losses and GHG emissions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Stockpile tritium production from fusion

    International Nuclear Information System (INIS)

    Lokke, W.A.; Fowler, T.K.

    1986-01-01

    A fusion breeder holds the promise of a new capability - ''dialable'' reserve capacity at little additional cost - that offers stockpile planners a new way to deal with today's uncertainties in forecasting long range needs. Though still in the research stage, fusion can be developed in time to meet future military requirements. Much of the necessary technology will be developed by the ongoing magnetic fusion energy program. However, a specific program to develop the nuclear technology required for materials production is needed if fusion is to become a viable option for a new production complex around the turn of the century

  10. Microbiological surveillance and antimicrobial stewardship minimise ...

    African Journals Online (AJOL)

    Microbiological surveillance and antimicrobial stewardship minimise the need for ultrabroad-spectrum combination therapy for treatment of nosocomial infections in a trauma intensive care unit: An audit of an evidence-based empiric antimicrobial policy.

  11. Antimicrobial stewardship in long-term care facilities in Belgium: a questionnaire-based survey of nursing homes to evaluate initiatives and future developments

    Directory of Open Access Journals (Sweden)

    François Kidd

    2016-03-01

    Full Text Available Abstract Background The use of antimicrobials is intense and often inappropriate in long-term care facilities. Antimicrobial resistance has increased in acute and chronic care facilities, including those in Belgium. Evidence is lacking concerning antimicrobial stewardship programmes in chronic care settings. The medical coordinator practicing in Belgian nursing homes is a general practitioner designated to coordinate medical activity. He is likely to be the key position for effective implementation of such programmes. The aim of this study was to evaluate past, present, and future developments of antimicrobial stewardship programmes by surveying medical coordinators working in long-term care facilities in Belgium. Methods We conducted an online questionnaire-based survey of 327 Belgian medical coordinators. The questionnaire was composed of 33 questions divided into four sections: characteristics of the respondents, organisational frameworks for implementation of the antimicrobial stewardship programme, tools to promote appropriate antimicrobial use and priorities of action. Questions were multiple choice, rating scale, or free text. Results A total of 39 medical coordinators (12 % completed the questionnaire. Past or present antimicrobial stewardship initiatives were reported by 23 % of respondents. The possibility of future developments was rated 2.7/5. The proposed key role of medical coordinators was rated <3/5 by 36 % of respondents. General practitioners, nursing staff, and hospital specialists are accepted as important roles. The use of antimicrobial guidelines was reported by only 19 % of respondents. Education was considered the cornerstone for any future developments. Specific diagnostic recommendations were considered useful, but chest x-rays were judged difficult to undertake. The top priority identified was to reduce unnecessary treatment of asymptomatic urinary infections. Conclusions Our study shows that the implementation of

  12. Planning guidance for the Chemical Stockpile Emergency Preparedness Program

    Energy Technology Data Exchange (ETDEWEB)

    Shumpert, B.L.; Watson, A.P.; Sorensen, J.H. [and others

    1995-02-01

    This planning guide was developed under the direction of the U.S. Army and the Federal Emergency Management Agency (FEMA) which jointly coordinate and direct the development of the Chemical Stockpile Emergency Preparedness Program (CSEPP). It was produced to assist state, local, and Army installation planners in formulating and coordinating plans for chemical events that may occur at the chemical agent stockpile storage locations in the continental United States. This document provides broad planning guidance for use by both on-post and off-post agencies and organizations in the development of a coordinated plan for responding to chemical events. It contains checklists to assist in assuring that all important aspects are included in the plans and procedures developed at each Chemical Stockpile Disposal Program (CSDP) location. The checklists are supplemented by planning guidelines in the appendices which provide more detailed guidance regarding some issues. The planning guidance contained in this document will help ensure that adequate coordination between on-post and off-post planners occurs during the planning process. This planning guide broadly describes an adequate emergency planning base that assures that critical planning decisions will be made consistently at every chemical agent stockpile location. This planning guide includes material drawn from other documents developed by the FEMA, the Army, and other federal agencies with emergency preparedness program responsibilities. Some of this material has been developed specifically to meet the unique requirements of the CSEPP. In addition to this guidance, other location-specific documents, technical studies, and support studies should be used as needed to assist in the planning at each of the chemical agent stockpile locations to address the specific hazards and conditions at each location.

  13. 2008 stewardship report

    International Nuclear Information System (INIS)

    2009-03-01

    The Canadian Association of Petroleum Producers prepares an annual stewardship report as part of the industry's commitment to stewardship through the open and transparent reporting of progress on environmental, health and safety, and social issues. These reports also serve to provide annual benchmarking targets for the industry to surpass. This report presented the eighth annual stewardship report for 2008 and discussed indicators relating to several areas. The first involved air quality as it relates to climate change and greenhouse gases and technological solutions such as toe-to-heel air injection; geothermal energy; and carbon capture and sequestration. The issues of releasing greenhouse gases through flaring and venting were also examined along with other issues such as returning the land to a sustainable landscape; using water to produce oil and gas; ensuring the workplace is safe; and maintaining positive relationships. It was concluded that while greenhouse gas intensity has dropped, overall emissions have increase. Surface water use has also slightly increased. figs

  14. Stewardship and management challenges within a cloud-based open data ecosystem (Invited Paper 211863)

    Science.gov (United States)

    Kearns, E. J.

    2017-12-01

    NOAA's Big Data Project is conducting an experiment in the collaborative distribution of open government data to non-governmental cloud-based systems. Through Cooperative Research and Development Agreements signed in 2015 between NOAA and Amazon Web Services, Google Cloud Platform, IBM, Microsoft Azure, and the Open Commons Consortium, NOAA is distributing open government data to a wide community of potential users. There are a number of significant advantages related to the use of open data on commercial cloud platforms, but through this experiment NOAA is also discovering significant challenges for those stewarding and maintaining NOAA's data resources in support of users in the wider open data ecosystem. Among the challenges that will be discussed are: the need to provide effective interpretation of the data content to enable their use by data scientists from other expert communities; effective maintenance of Collaborators' open data stores through coordinated publication of new data and new versions of older data; the provenance and verification of open data as authentic NOAA-sourced data across multiple management boundaries and analytical tools; and keeping pace with the accelerating expectations of users with regard to improved quality control, data latency, availability, and discoverability. Suggested strategies to address these challenges will also be described.

  15. Environmental Management Welcomes a New Face and Reinforces Its Focus on Science-Based Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    Dale, Virginia H [ORNL

    2010-06-01

    ENVIRONMENTAL MANAGEMENT is pleased to announce that Rebecca Efroymson will join Virginia Dale as Co-Editors-in-Chief of the journal. Dr. Efroymson brings extensive expertise in risk assessment and environmental toxicology. Her work has focused on land management, natural resources, water quality, and rare species, with recent work on benefits and risks of energy alternatives. ENVIRONMENTAL MANAGEMENT has been publishing research on the management and conservation of natural resources and habitats since 1976. Articles discuss implications for an international audience and examine a scientific or management hypothesis. As a premier scientific journal in applied and cross-cutting areas, articles come from a variety of disciplines including biology, botany, climatology, earth sciences, ecology, ecological economics, environmental engineering, fisheries, forest sciences, geography, information science, law, management science, politics, public affairs, social sciences, and zoology, most often in combinations determined by the interdisciplinary topic of the study. The journal strives to improve cross-disciplinary communication by making ideas and results available to environmental practitioners from other backgrounds. The goal of ENVIRONMENTAL MANAGEMENT is to present a wide spectrum of viewpoints and approaches, and to this end the journal consists of four main sections. Forum contains addresses, editorials, comments, and opinions about environmental matters. Articles in the Profile section describe and evaluate particular case histories, events, policies, problems, or organizations and their work. Papers in the Research section present the methods and findings from empirical and model-based scientific studies. The section on Environmental Assessment is for articles that cover methods of appraisal, measurement, and comparison. Generally, the debates published in the journal's Forum help construct better environmental research or policies; Research and Assessment

  16. Experience With Rapid Microarray-Based Diagnostic Technology and Antimicrobial Stewardship for Patients With Gram-Positive Bacteremia.

    Science.gov (United States)

    Neuner, Elizabeth A; Pallotta, Andrea M; Lam, Simon W; Stowe, David; Gordon, Steven M; Procop, Gary W; Richter, Sandra S

    2016-11-01

    OBJECTIVE To describe the impact of rapid diagnostic microarray technology and antimicrobial stewardship for patients with Gram-positive blood cultures. DESIGN Retrospective pre-intervention/post-intervention study. SETTING A 1,200-bed academic medical center. PATIENTS Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention. METHODS Before the intervention, no rapid diagnostic technology was used or antimicrobial stewardship intervention was undertaken, except for the use of peptide nucleic acid fluorescent in situ hybridization and MRSA agar to identify staphylococcal isolates. After the intervention, all Gram-positive blood cultures underwent BC-GP microarray and the antimicrobial stewardship intervention consisting of real-time notification and pharmacist review. RESULTS In total, 513 patients with bacteremia were included in this study: 280 patients with S. aureus, 150 patients with enterococci, 82 patients with stretococci, and 1 patient with L. monocytogenes. The number of antimicrobial switches was similar in the pre-BC-GP (52%; 155 of 300) and post-BC-GP (50%; 107 of 213) periods. The time to antimicrobial switch was significantly shorter in the post-BC-GP group than in the pre-BC-GP group: 48±41 hours versus 75±46 hours, respectively (P<.001). The most common antimicrobial switch was de-escalation and time to de-escalation, was significantly shorter in the post-BC-GP group than in the pre-BC-GP group: 53±41 hours versus 82±48 hours, respectively (P<.001). There was no difference in mortality or hospital length of stay as a result of the intervention. CONCLUSIONS The combination of a rapid microarray diagnostic test with an antimicrobial

  17. Guide about petroleum strategic stockpiles in France

    International Nuclear Information System (INIS)

    2004-03-01

    The strategic character of petroleum products has been perceived since the first world war. It has led France to impose the petroleum operators to make stockpiles to provide against the consequences of a serious disruption of supplies. As a difference with some other industrialized countries like the USA or Japan, French stockpiles are made of finite products. A balanced geographical distribution of these stocks over the whole national territory increases their efficiency. Stockpiles of IEA member states must represent 90 days of net imports while those of European Union member states must represent 90 days of average domestic consumption. In France, each chartered operator contributes to the strategic storage and the stored volumes are defined by the law no 92-1443 from December 31, 1992. These stocks are permanently controlled and financial sanctions are applied in case of infraction. Particular dispositions are applied in overseas departments which are summarized in this paper. (J.S.)

  18. Fiber digestion kinetics and protein degradability characteristics of stockpiled Tifton 85 bermudagrass.

    Science.gov (United States)

    Sechler, S R; Mullenix, M K; Holland, C M; Muntifering, R B

    2017-09-01

    A 2-yr study was conducted to determine effects of N fertilization level on fiber digestion kinetics and protein degradability characteristics of stockpiled Tifton 85 bermudagrass (T85). Six 0.76-ha pastures of stockpiled T85 were cut to a 10-cm stubble height on August 1 of each yr and fertilized with 56 (56N), 112 (112N), or 168 (168N) kg N/ha (2 pastures/treatment). Fiber digestion kinetics included the 72-hr potential extent of NDF digestion (PED), rate of NDF digestion, and lag time. In yr 1 and 2, PED decreased over the stockpile season. Rates of NDF digestion did not differ ( > 0.05) among N fertilization treatments in either yr. In yr 1, rate of NDF digestion was greatest ( digestion decreased ( digestion rates were similar for November and January 21 sampling dates. Lag time was greater ( digestion ( = -0.60 and -0.25 in yr 1 and 2, respectively) was observed. There was a trend ( = 0.06) for lignin concentration to be positively correlated with lag time ( = 0.39) in yr 1, and a strong relationship was observed in yr 2 ( = 0.91; digestion in stockpiled T85 were influenced more by temporal changes over the stockpile season than by N fertilization level. Supplement formulations based on kinetic parameters of fiber digestion may require periodic adjustment to insure that energy-yielding components of NDF are sufficient to meet animal requirements throughout the stockpile season. The CP fraction in stockpiled T85 contains sufficient RDP to support fibrolytic activity and growth of ruminal microorganisms throughout the stockpile season. Toward the latter end of the season, supplementation with sources of digestible fiber and RDP could be expected to increase MP supply to the host animal.

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

    Science.gov (United States)

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

    2008-09-15

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

  20. Overview of the US Strategic National Stockpile

    International Nuclear Information System (INIS)

    Adams, S.

    2009-01-01

    The CBMTS community last received an overview of the United States Strategic National Stockpile in Dubrovnik during the Spring of 2001. The events that occurred later that year and the ensuing response have resulted in a dramatic expansion of both the scope and complexity of the Strategic National Stockpile. These changes are seen not only in the scope of the Materiel holdings which have grown by several orders of magnitude, but in the increasingly complex operational designs which can rapidly bring the materiel to bear in a clinically relevant time frame. Mr. Adams, Deputy Director of the program from the time of its 1999 inception, will provide a detailed overview of the current program highlighting many of the changes and evolutions which have occurred during the past 8 years.(author)

  1. Antibiotic losses from unprotected manure stockpiles.

    Science.gov (United States)

    Dolliver, Holly A S; Gupta, Satish C

    2008-01-01

    Manure management is a major concern in livestock production systems. Although historically the primary concerns have been nutrients and pathogens, manure is also a source of emerging contaminants, such as antibiotics, to the environment. There is a growing concern that antibiotics in manure are reaching surface and ground waters and contributing to the development and spread of antibiotic resistance in the environment. One such pathway is through leaching and runoff from manure stockpiles. In this study, we quantified chlortetracycline, monensin, and tylosin losses in runoff from beef manure stockpiles during two separate but consecutive experiments representing different weather conditions (i.e., temperature and precipitation amount and form). Concentrations of chlortetracycline, monensin, and tylosin in runoff were positively correlated with initial concentrations of antibiotics in manure. The highest concentrations of chlortetracycline, monensin, and tylosin in runoff were 210, 3175, and 2544 microg L(-1), respectively. Relative antibiotic losses were primarily a function of water losses. In the experiment that had higher runoff water losses, antibiotic losses ranged from 1.2 to 1.8% of total extractable antibiotics in manure. In the experiment with lower runoff water losses, antibiotic losses varied from 0.2 to 0.6% of the total extractable antibiotics in manure. Manure analysis over time suggests that in situ degradation is an important mechanism for antibiotic losses. Degradation losses during manure stockpiling may exceed cumulative losses from runoff events. Storing manure in protected (i.e., covered) facilities could reduce the risk of aquatic contamination associated with manure stockpiling and other outdoor manure management practices.

  2. Development of an Evidence-Based Antimicrobial Stewardship Smartphone App in a Tertiary Academic Pediatric and Women’s Health Centre in Canada

    OpenAIRE

    Slayter, Kathryn; Turple, Jennifer; Comeau, Jeannette L; Top, Karina A; Langley, Joanne M; Mailman, Tim; Halperin, Scott A

    2017-01-01

    Abstract Background Smart phone use by medical professionals is ubiquitous. In a recent survey, > 90% of health care providers were interested in locally developed antimicrobial stewardship (AMS) and infectious diseases applications (“apps”). We describe the process by which our antimicrobial stewardship program (ASP) developed an app to provide guidance regarding empiric antimicrobial choice, and education about antimicrobials and pathogens, integrating local laboratory data. We also describ...

  3. DEM Simulation of Particle Stratification and Segregation in Stockpile Formation

    Directory of Open Access Journals (Sweden)

    Zhang Dizhe

    2017-01-01

    Full Text Available Granular stockpiles are commonly observed in nature and industry, and their formation has been extensively investigated experimentally and mathematically in the literature. One of the striking features affecting properties of stockpiles are the internal patterns formed by the stratification and segregation processes. In this work, we conduct a numerical study based on DEM (discrete element method model to study the influencing factors and triggering mechanisms of these two phenomena. With the use of a previously developed mixing index, the effects of parameters including size ratio, injection height and mass ratio are investigated. We found that it is a void-filling mechanism that differentiates the motions of particles with different sizes. This mechanism drives the large particles to flow over the pile surface and segregate at the pile bottom, while it also pushes small particles to fill the voids between large particles, giving rise to separate layers. Consequently, this difference in motion will result in the observed stratification and segregation phenomena.

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

    Science.gov (United States)

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

    2014-02-01

    The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP. We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval. The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  5. Nuclear materials stewardship: Our enduring mission

    International Nuclear Information System (INIS)

    Isaacs, T.H.

    1998-01-01

    The US Department of Energy (DOE) and its predecessors have handled a remarkably wide variety of nuclear materials over the past 50 yr. Two fundamental changes have occurred that shape the current landscape regarding nuclear materials. If one recognizes the implications and opportunities, one sees that the stewardship of nuclear materials will be a fundamental and important job of the DOE for the foreseeable future. The first change--the breakup of the Soviet Union and the resulting end to the nuclear arms race--altered US objectives. Previously, the focus was on materials production, weapon design, nuclear testing, and stockpile enhancements. Now the attention is on dismantlement of weapons, excess special nuclear material inventories, accompanying increased concern over the protection afforded to such materials; new arms control measures; and importantly, maintenance of the safety and reliability of the remaining arsenal without testing. The second change was the raised consciousness and sense of responsibility for dealing with the environmental legacies of past nuclear arms programs. Recognition of the need to clean up radioactive contamination, manage the wastes, conduct current operations responsibly, and restore the environment have led to the establishment of what is now the largest program in the DOE. Two additional features add to the challenge and drive the need for recognition of nuclear materials stewardship as a fundamental, enduring, and compelling mission of the DOE. The first is the extraordinary time frames. No matter what the future of nuclear weapons and no matter what the future of nuclear power, the DOE will be responsible for most of the country's nuclear materials and wastes for generations. Even if the Yucca Mountain program is successful and on schedule, it will last more than 100 yr. Second, the use, management, and disposition of nuclear materials and wastes affect a variety of nationally important and diverse objectives, from national

  6. Antimicrobial stewardship: Limits for implementation

    NARCIS (Netherlands)

    Sinha, Bhanu

    2014-01-01

    Antibiotic stewardship programme (ASP) is a multifaceted approach to improve patients' clinical outcomes, prevent the emergence of antimicrobial resistance, and reduce hospital costs by prudent and focused antimicrobial use. Development of local treatment guidelines according to local ecology, rapid

  7. 30 CFR 702.16 - Stockpiling of minerals.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Stockpiling of minerals. 702.16 Section 702.16 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR GENERAL EXEMPTION FOR COAL EXTRACTION INCIDENTAL TO THE EXTRACTION OF OTHER MINERALS § 702.16 Stockpiling of...

  8. Fluorescent lamp recycling initiatives in the United States and a recycling proposal based on extended producer responsibility and product stewardship concepts.

    Science.gov (United States)

    Silveira, Geraldo Tr; Chang, Shoou-Yuh

    2011-06-01

    This paper presents an overview of mercury-containing lamp (MCL) recycling initiatives currently available in the world, especially in the United States. The majority of MCLs contain mercury which is a neurotoxin, a persistent pollutant in the environment, and can bioaccumulate in the food chain. Although there are some recycling options in the United States, collection rates are still at 23% of all potential used MCLs. This shows that citizens are either indifferent to or unaware of the recycling alternatives. On the other hand, MCL recycling seems not to be a cost-effective process and, for this reason, in the United States, take-back programmes are still sponsored only by consumers or municipalities. A few retailers have recently initiated limited take-back alternatives and manufacturers have not yet supported financially any consistent recycling alternative in the country. Considering successful experiences, this paper makes a suggestion for an MCL recycling system based on the concepts of extended producer responsibility and product stewardship. A manufacturer-importer advance recycling fee is proposed to finance the collection and recycling system while a MCL-energy recycling fee supported by the energy sector creates a lamp refund process. 'PRO Lamp', a producer responsibility organization, will manage the entire system through a widespread public-private agreement.

  9. Selective hedging strategies for oil stockpiling

    International Nuclear Information System (INIS)

    Yun, Won-Cheol

    2006-01-01

    As a feasible option for improving the economics and operational efficiency of stockpiling by public agency, this study suggests simple selective hedging strategies using forward contracts. The main advantage of these selective hedging strategies over the previous ones is not to predict future spot prices, but to utilize the sign and magnitude of basis easily available to the public. Using the weekly spot and forward prices of West Texas Intermediate for the period of October 1997-August 2002, this study adopts an ex ante out-of-sample analysis to examine selective hedging performances compared to no-hedge and minimum-variance routine hedging strategies. To some extent, selective hedging strategies dominate the traditional routine hedging strategy, but do not improve upon the expected returns of no-hedge case, which is mainly due to the data characteristics of out-of-sample period used in this analysis

  10. Place-Conscious Capacity-Building: A Systemic Model for the Revitalisation and Renewal of Rural Schools and Communities through University-Based Regional Stewardship

    Science.gov (United States)

    Johnson, Jerry; Thompson, Aaron; Naugle, Kim

    2009-01-01

    This paper sets forth a model of regional stewardship developed and implemented at a post-compulsory institution serving rural communities in central Appalachia, a region that is among the most impoverished in the United States. The model, termed place-conscious capacity-building, emphasises culturally-responsive methodologies and the strategic…

  11. Antimicrobial stewardship in small animal veterinary practice

    DEFF Research Database (Denmark)

    Guardabassi, Luca; Prescott, John F

    2015-01-01

    Despite the increasing recognition of the critical role for antimicrobial stewardship in preventing the spread of multidrug-resistant bacteria, examples of effective antimicrobial stewardship programs are rare in small animal veterinary practice. This article highlights the basic requirements...

  12. The organisational structure of urban environmental stewardship

    Science.gov (United States)

    Dana R. Fisher; Lindsay Campbell; Erika S. Svendsen

    2012-01-01

    How is the organisational structure of urban environmental stewardship groups related to the diverse ways that civic stewardship is taking place in urban settings? The findings of the limited number of studies that have explored the organisational structure of civic environmentalism are combined with the research on civic stewardship to answer this question. By...

  13. A broader view of stewardship to achieve conservation and sustainability goals in South Africa

    Directory of Open Access Journals (Sweden)

    Jaco Barendse

    2016-05-01

    Full Text Available Stewardship is a popular term for the principles and actions aimed at improving sustainability and resilience of social-ecological systems at various scales and in different contexts. Participation in stewardship is voluntary, and is based on values of altruism and long-term benefits. At a global scale, "earth stewardship" is viewed as a successor to earlier natural resource management systems. However, in South Africa, stewardship is narrowly applied to biodiversity conservation agreements on private land. Using a broader definition of stewardship, we identify all potentially related schemes that may contribute to sustainability and conservation outcomes. Stewardship schemes and actors are represented as a social network and placed in a simple typology based on objectives, mechanisms of action and operational scales. The predominant type was biodiversity stewardship programmes. The main actors were environmental non-governmental organisations participating in prominent bioregional landscape partnerships, together acting as important "bridging organisations" within local stewardship networks. This bridging enables a high degree of collaboration between non-governmental and governmental bodies, especially provincial conservation agencies via mutual projects and conservation objectives. An unintended consequence may be that management accountability is relinquished or neglected by government because of inadequate implementation capacity. Other stewardship types, such as market-based and landscape initiatives, complemented primarily biodiversity ones, as part of national spatial conservation priorities. Not all schemes related to biodiversity, especially those involving common pool resources, markets and supply chains. Despite an apparent narrow biodiversity focus, there is evidence of diversification of scope to include more civic and community-level stewardship activities, in line with the earth stewardship metaphor.

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

    Science.gov (United States)

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

    2012-01-01

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

  15. Fostering science literacy, environmental stewardship, and collaboration: Assessing a garden-based approach to teaching life science

    Science.gov (United States)

    Fisher-Maltese, Carley B.

    Recently, schools nationwide have expressed a renewed interest in school gardens (California School Garden Network, 2010), viewing them as innovative educational tools. Most of the scant studies on these settings investigate the health/nutritional impacts, environmental attitudes, or emotional dispositions of students. However, few studies examine the science learning potential of a school garden from an informal learning perspective. Those studies that do examine learning emphasize individual learning of traditional school content (math, science, etc.) (Blaire, 2009; Dirks & Orvis, 2005; Klemmer, Waliczek & Zajicek, 2005a & b; Smith & Mostenbocker, 2005). My study sought to demonstrate the value of school garden learning through a focus on measures of learning typically associated with traditional learning environments, as well as informal learning environments. Grounded in situated, experiential, and contextual model of learning theories, the purpose of this case study was to examine the impacts of a school garden program at a K-3 elementary school. Results from pre/post tests, pre/post surveys, interviews, recorded student conversations, and student work reveal a number of affordances, including science learning, cross-curricular lessons in an authentic setting, a sense of school community, and positive shifts in attitude toward nature and working collaboratively with other students. I also analyzed this garden-based unit as a type curriculum reform in one school in an effort to explore issues of implementing effective practices in schools. Facilitators and barriers to implementing a garden-based science curriculum at a K-3 elementary school are discussed. Participants reported a number of implementation processes necessary for success: leadership, vision, and material, human, and social resources. However, in spite of facilitators, teachers reported barriers to implementing the garden-based curriculum, specifically lack of time and content knowledge.

  16. DEVELOPMENT OF PASSIVE DETOXIFICATION TECHNOLOGY FOR GOLD HEAP LEACH STOCKPILED WASTES

    OpenAIRE

    M.P. Belykh; A.Yu. Chikin; S.V. Petrov; N.L. Belkova

    2017-01-01

    Purpose. The processes of biopassive detoxication are of special interest for the solution of environmental issues of detoxification of gold heap leach cyanide-bearing wastes whose detoxification period is unlimited. These processes are based on spontaneous degradation of cyanides under the influence of natural factors including the action of autochthonous bacterial community. The purpose of the work is to develop a biopassive detoxification technology of heap leach stockpiled wastes. Methods...

  17. National Certification Methodology for the Nuclear Weapons Stockpile

    International Nuclear Information System (INIS)

    Goodwin, B T; Juzaitis, R J

    2006-01-01

    and December of 2001 and continued in 2002 have proven useful in developing the methodology, and future workshops should prove useful in further refining this framework. Each laboratory developed an approach to certification with some differences in detailed implementation. The general methodology introduces specific quantitative indicators for assessing confidence in our nuclear weapon stockpile. The quantitative indicators are based upon performance margins for key operating characteristics and components of the system, and these are compared to uncertainties in these factors. These criteria can be summarized in a quantitative metric (for each such characteristic) expressed as: (i.e., confidence in warhead performance depends upon CR significantly exceeding unity for all these characteristics). These Confidence Ratios are proposed as a basis for guiding technical and programmatic decisions on stockpile actions. This methodology already has been deployed in certifying weapons undergoing current life extension programs or component remanufacture. The overall approach is an adaptation of standard engineering practice and lends itself to rigorous, quantitative, and explicit criteria for judging the robustness of weapon system and component performance at a detailed level. There are, of course, a number of approaches for assessing these Confidence Ratios. The general certification methodology was publicly presented for the first time to a meeting of Strategic Command SAG in January 2002 and met with general approval. At that meeting, the Laboratories committed to further refine and develop the methodology through the implementation process. This paper reflects the refinement and additional development to date. There will be even further refinement at a joint laboratory workshop later in FY03. A common certification methodology enables us to engage in peer reviews and evaluate nuclear weapon systems on the basis of explicit and objective metrics. The clarity provided by

  18. Piling Pills? Forward-Looking Behavior and Stockpiling of Prescription Drugs

    DEFF Research Database (Denmark)

    Simonsen, Marianne; Skipper, Lars; Skipper, Niels

    This paper provides evidence of forward-looking behavior in the demand for prescription drugs, while relying on registry-based, individual-level information about the universe of Danish prescription drug purchases from 1995–2014. We exploit a universal shift in policy in early 2000 from a flat......-rate to a non-linear insurance plan for prescription drugs that incentivizes stockpiling at the end of the coverage year. We extend the original framework of Keeler et al. (1977) and discuss how the institutional features of most health insurance contracts, at least theoretically, incentivize intertemporal...... immediately prior to the end-of-year reset in the non-linear plan using a difference-in-difference strategy. We provide evidence that consumers react to this reset by stockpiling toward the end of the coverage year: consumers buy what amounts to an additional 20%. We detect heterogeneity in the size...

  19. A Conceptual Framework for Allocation of Federally Stockpiled Ventilators During Large-Scale Public Health Emergencies.

    Science.gov (United States)

    Zaza, Stephanie; Koonin, Lisa M; Ajao, Adebola; Nystrom, Scott V; Branson, Richard; Patel, Anita; Bray, Bruce; Iademarco, Michael F

    2016-01-01

    Some types of public health emergencies could result in large numbers of patients with respiratory failure who need mechanical ventilation. Federal public health planning has included needs assessment and stockpiling of ventilators. However, additional federal guidance is needed to assist states in further allocating federally supplied ventilators to individual hospitals to ensure that ventilators are shipped to facilities where they can best be used during an emergency. A major consideration in planning is a hospital's ability to absorb additional ventilators, based on available space and staff expertise. A simple pro rata plan that does not take these factors into account might result in suboptimal use or unused scarce resources. This article proposes a conceptual framework that identifies the steps in planning and an important gap in federal guidance regarding the distribution of stockpiled mechanical ventilators during an emergency.

  20. Antimicrobial stewardship in wound care

    DEFF Research Database (Denmark)

    Lipsky, Benjamin A; Dryden, Matthew; Gottrup, Finn

    2016-01-01

    BACKGROUND: With the growing global problem of antibiotic resistance it is crucial that clinicians use antibiotics wisely, which largely means following the principles of antimicrobial stewardship (AMS). Treatment of various types of wounds is one of the more common reasons for prescribing...... of experts in infectious diseases/clinical microbiology (from the British Society for Antimicrobial Chemotherapy) and wound management (from the European Wound Management Association) who, after thoroughly reviewing the available literature and holding teleconferences, jointly produced this guidance document...

  1. Eco-Visualization: Promoting Environmental Stewardship in the Museum

    Science.gov (United States)

    Holmes, Tiffany

    2007-01-01

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

  2. Evaluation of environmental effect of coal stockpile in Muara Telang, Banyuasin, Indonesia

    Science.gov (United States)

    Rusdianasari; Arita, Susila; Ibrahim, Eddy; Ngudiantoro

    2013-04-01

    Stockpile commonly serves as a temporary dump before the coal is transported through the waterways. This study investigated the effects of coal stockpiles on the surrounding environment: air, water, and soil. The location of the study is in the estuary of Telang, South-Sumatra, Indonesia, which is located at the edge of the river of Telang and close to the residential community. The monitoring of the environmental impact from the stockpile is intended to conduct an environmental assessment owing the existence and operations of coal accumulation. Enviromental impact analysis was conducted based on the value of the effluent, air pollution (dust), soil and water by determining the parameters of the coal wastewater pH, total suspended solid, ferrous dan ferrous metals contents. The results indicate that the total suspended particulate, total suspended solids, noise level, ferrous metal and manganese metal were 10-14 μg/Nm3 249-355 mg/L, 41.3 to 50.3 dBA, 6.074 to7.579 mg/L, and 1.987 to 2.678 mg/L, respectively. Meanwhile the pH of water and soil were 3 to 4 and 2.83 to 4.02 respectively. It is concluded that the pH value are beyond the threshold standard.

  3. Evaluation of environmental effect of coal stockpile in Muara Telang, Banyuasin, Indonesia

    International Nuclear Information System (INIS)

    Rusdianasari; Arita, Susila; Ibrahim, Eddy; Ngudiantoro

    2013-01-01

    Stockpile commonly serves as a temporary dump before the coal is transported through the waterways. This study investigated the effects of coal stockpiles on the surrounding environment: air, water, and soil. The location of the study is in the estuary of Telang, South-Sumatra, Indonesia, which is located at the edge of the river of Telang and close to the residential community. The monitoring of the environmental impact from the stockpile is intended to conduct an environmental assessment owing the existence and operations of coal accumulation. Enviromental impact analysis was conducted based on the value of the effluent, air pollution (dust), soil and water by determining the parameters of the coal wastewater pH, total suspended solid, ferrous dan ferrous metals contents. The results indicate that the total suspended particulate, total suspended solids, noise level, ferrous metal and manganese metal were 10-14 μg/Nm 3 249-355 mg/L, 41.3 to 50.3 dBA, 6.074 to7.579 mg/L, and 1.987 to 2.678 mg/L, respectively. Meanwhile the pH of water and soil were 3 to 4 and 2.83 to 4.02 respectively. It is concluded that the pH value are beyond the threshold standard.

  4. Influence of Stockpile Angle in Natural Drying of Laterite Ore

    Directory of Open Access Journals (Sweden)

    Yoalbys Retirado-Mediaceja

    2016-10-01

    Full Text Available Natural drying is performed at Cuban nickel plants by depositing bulk ore in the open. The ore is currently being stockpiled without much consideration for the impact of the drying surface angle on the process power behavior. Simulations were carried out in this investigation, which prove that an increased triangular stockpile angle considerably reduces natural drying efficiency. A 45 sexagesimal degree angle to the horizontal plane results in exposure of a large volume of ore to natural drying and guarantees adequate energy performance.

  5. NOAA's Scientific Data Stewardship Program

    Science.gov (United States)

    Bates, J. J.

    2004-12-01

    The NOAA mission is to understand and predict changes in the Earth's environment and conserve and manage coastal and marine resources to meet the Nation's economic, social and environmental needs. NOAA has responsibility for long-term archiving of the United States environmental data and has recently integrated several data management functions into a concept called Scientific Data Stewardship. Scientific Data Stewardship a new paradigm in data management consisting of an integrated suite of functions to preserve and exploit the full scientific value of NOAA's, and the world's, environmental data These functions include careful monitoring of observing system performance for long-term applications, the generation of authoritative long-term climate records from multiple observing platforms, and the proper archival of and timely access to data and metadata. NOAA has developed a conceptual framework to implement the functions of scientific data stewardship. This framework has five objectives: 1) develop real-time monitoring of all satellite observing systems for climate applications, 2) process large volumes of satellite data extending up to decades in length to account for systematic errors and to eliminate artifacts in the raw data (referred to as fundamental climate data records, FCDRs), 3) generate retrieved geophysical parameters from the FCDRs (referred to as thematic climate data records TCDRs) including combining observations from all sources, 4) conduct monitoring and research by analyzing data sets to uncover climate trends and to provide evaluation and feedback for steps 2) and 3), and 5) provide archives of metadata, FCDRs, and TCDRs, and facilitate distribution of these data to the user community. The term `climate data record' and related terms, such as climate data set, have been used for some time, but the climate community has yet to settle on a concensus definition. A recent United States National Academy of Sciences report recommends using the

  6. 30 CFR 823.12 - Soil removal and stockpiling.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Soil removal and stockpiling. 823.12 Section 823.12 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR PERMANENT PROGRAM PERFORMANCE STANDARDS SPECIAL PERMANENT PROGRAM PERFORMANCE STANDARDS-OPERATIONS ON PRIME FARMLAND § 823.12 Soil removal and...

  7. Stockpiling and Comprehensive Utilization of Red Mud Research Progress

    Science.gov (United States)

    Liu, Dong-Yan; Wu, Chuan-Sheng

    2012-01-01

    With increasing production of red mud, the environmental problems caused by it are increasingly serious, and thus the integrated treatment of red mud is imminent. This article provides an overview of the composition and the basic characteristics of red mud. The research progress of safe stockpiling and comprehensive utilization of red mud is summarized. The safe stockpiling of red mud can be divided into two aspects: the design and safe operation of the stocking yard. The comprehensive utilization of red mud can be further divided into three aspects: the effective recycling of components, resource utilization and application in the field of environmental protection. This paper points out that the main focus of previous studies on red mud stockpiling is cost reproduction and land tenure. The recovery of resources from red mud has a high value-added, but low level industrialization. The use of red mud as a building material and filler material is the most effective way to reduce the stockpiling of red mud. Red mud used for environmental remediation materials is a new hotspot and worth promoting for its simple processing and low cost.

  8. The Six Principles of Facilities Stewardship

    Science.gov (United States)

    Kaiser, Harvey H.; Klein, Eva

    2010-01-01

    Facilities stewardship means high-level and pervasive commitment to optimize capital investments, in order to achieve a high-functioning and attractive campus. It includes a major commitment to capital asset preservation and quality. Stewardship is about the long view of an institution's past and future. It ultimately forms the backdrop for…

  9. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R; van Gemert-Pijnen, Julia Ewc

    2014-01-01

    BACKGROUND: Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital.

  10. Investigating the ways in which health information technology can promote antimicrobial stewardship: a conceptual overview.

    Science.gov (United States)

    King, Abby; Cresswell, Kathrin M; Coleman, Jamie J; Pontefract, Sarah K; Slee, Ann; Williams, Robin; Sheikh, Aziz

    2017-08-01

    Antimicrobial resistance is now recognised as a threat to health worldwide. Antimicrobial stewardship aims to promote the responsible use of antibiotics and is high on international and national policy agendas. Health information technology has the potential to support antimicrobial stewardship in a number of ways, but this field is still poorly characterised and understood. Building on a recent systematic review and expert roundtable discussions, we take a lifecycle perspective of antibiotic use in hospitals and identify potential targets for health information technology-based interventions to support antimicrobial stewardship. We aim for this work to help chart a future research agenda in this critically important area.

  11. Reliability Impact of Stockpile Aging: Stress Voiding; TOPICAL

    International Nuclear Information System (INIS)

    ROBINSON, DAVID G.

    1999-01-01

    The objective of this research is to statistically characterize the aging of integrated circuit interconnects. This report supersedes the stress void aging characterization presented in SAND99-0975, ''Reliability Degradation Due to Stockpile Aging,'' by the same author. The physics of the stress voiding, before and after wafer processing have been recently characterized by F. G. Yost in SAND99-0601, ''Stress Voiding during Wafer Processing''. The current effort extends this research to account for uncertainties in grain size, storage temperature, void spacing and initial residual stress and their impact on interconnect failure after wafer processing. The sensitivity of the life estimates to these uncertainties is also investigated. Various methods for characterizing the probability of failure of a conductor line were investigated including: Latin hypercube sampling (LHS), quasi-Monte Carlo sampling (qMC), as well as various analytical methods such as the advanced mean value (Ah/IV) method. The comparison was aided by the use of the Cassandra uncertainty analysis library. It was found that the only viable uncertainty analysis methods were those based on either LHS or quasi-Monte Carlo sampling. Analytical methods such as AMV could not be applied due to the nature of the stress voiding problem. The qMC method was chosen since it provided smaller estimation error for a given number of samples. The preliminary results indicate that the reliability of integrated circuits due to stress voiding is very sensitive to the underlying uncertainties associated with grain size and void spacing. In particular, accurate characterization of IC reliability depends heavily on not only the frost and second moments of the uncertainty distribution, but more specifically the unique form of the underlying distribution

  12. Uranium purchasing and stockpiling policies of European utilities

    International Nuclear Information System (INIS)

    Messer, K.P.

    1984-01-01

    Most European utilities almost entirely depend on uranium imports. Around 1970 there was a worldwide oversupply of uranium, and utilities concluded short and medium term supply contracts for initial power plant programs. A few years later the situation had changed, with uranium becoming scarce and expensive. Many European utilities decided to participate, directly or indirectly, in the exploration and development of uranium resources. In 1984 most utilities believed that long term contracts from each of the big producer regions should supply 20-25% of their demand. Some remaining demand was reserved for the spot market and reprocessed fuel. This buying policy has t be supplemented by uranium stockpiles corresponding to the demand for the coming two years. However, with the declining worldwide economy power demand has not grown as predicted, and supply contracts have obliged utilities to take delivery of more uranium than needed. Stockpiles have grown larger than planned. (L.L.) (7 figs.)

  13. Uranium purchasing and stockpiling policies of European utilities

    International Nuclear Information System (INIS)

    Messer, K.P.

    1984-01-01

    When preparing my little presentation I was wondering whether a title like 'Policies of European utilities to minimise the inflow of uranium not needed and to reduce excessive stockpiles' would not be more appropriate. But I hop that I shall be able to convince you that we European utilities are not that short-sighted and that we do have a more far-sighted policy regarding uranium supplies

  14. Responsible stewardship of nuclear materials

    International Nuclear Information System (INIS)

    Hannum, W.H.

    1994-01-01

    The ability to tap the massive energy potential of nuclear fission was first developed as a weapon to end a terrible world war. Nuclear fission is also a virtually inexhaustible energy resource, and is the only energy supply in certain areas in Russia, Kazakhstan and elsewhere. The potential link between civilian and military applications has been and continues to be a source of concern. With the end of the Cold War, this issue has taken a dramatic turn. The U.S. and Russia have agreed to reduce their nuclear weapons stockpiles by as much as two-thirds. This will make some 100 tonnes of separated plutonium and 500 tonnes of highly enriched uranium available, in a form that is obviously directly usable for weapons. The total world inventory of plutonium is now around 1000 tonnes and is increasing at 60-70 tonnes per year. There is even more highly enriched uranium. Fortunately the correct answer to what to do with excess weapons material is also the most attractive. It should be used and reused as fuel for fast reactors. Material in use (particularly nuclear material) is very easy to monitor and control, and is quite unattractive for diversion. Active management of fissile materials not only makes a major contribution to economic stability and well-being, but also simplifies accountability, inspection and other safeguards processes; provides a revenue stream to pay for the necessary safeguards; and, most importantly, limits the prospective world inventory of plutonium to only that which is used and useful

  15. STEWARDSHIP: A Conceptual Imperative For Managerial ...

    African Journals Online (AJOL)

    resources for the management of the health sector. (Stewardship of ... of health sector development and performance. Examples of ... attempt at health sector decentralization and improving ... organizations could create inherent limitations on.

  16. Measuring the impact of antimicrobial stewardship programs

    NARCIS (Netherlands)

    Dik, Jan-Willem H.; Hendrix, Ron; Poelman, Randy; Niesters, Hubert G.; Postma, Maarten J.; Sinha, Bhanu; Friedrich, Alexander W.

    Antimicrobial Stewardship Programs (ASPs) are being implemented worldwide to optimize antimicrobial therapy, and thereby improve patient safety and quality of care. Additionally, this should counteract resistance development. It is, however, vital that correct and timely diagnostics are performed in

  17. Volunteer Environmental Stewardship and Affective Labour in Philadelphia

    Directory of Open Access Journals (Sweden)

    Alec Foster

    2018-01-01

    Full Text Available Recent research has critically evaluated the rapid growth of volunteer urban environmental stewardship. Framings of this phenomenon have largely focused upon environmentality and/or neoliberal environments, unfortunately often presenting a totalising picture of the state and/or market utilising power from above to create environmental subjects with limited agency available to local citizens. Based upon qualitative research with volunteer urban environmental stewards in Philadelphia, affective labour is proposed as an alternative explanation for participation. Stewards volunteered their time and labour due to the intense emotional attachments they formed with their neighbourhoods, neighbours, and nonhuman others in relationships of affective labour. Volunteer urban environmental stewardship as affective labour provides room for agency on the part of individuals and groups involved in volunteer urban environmental reproduction and opens up new ways of relating to and being with human and nonhuman others.

  18. Leveraging best practices to promote health, safety, sustainability, and stewardship.

    Science.gov (United States)

    Weiss, Marjorie D

    2013-08-01

    Strategically leveraging health and safety initiatives with sustainability and stewardship helps organizations improve profitability and positively impact team member and customer attachment to the organization. Collective efficacy enhances the triple bottom line: healthy people, healthy planet, and healthy profits. The HS(3)™ Best Practice Exchanges group demonstrated that collective efficacy can leverage the social cohesion, communication channels, and activities within workplaces to promote a healthy, sustainable work culture. This in turn (1) protects the health and safety of workers, (2) preserves the natural environment, and (3) increases attachment to the organization. Community-based participatory research using the Attach21 survey assessed the progress of these companies in their efforts to integrate health, safety, sustainability, and stewardship. Monthly Best Practice Exchanges promoted collective efficacy by providing support, encouragement, and motivation to share and adopt new ideas. Copyright 2013, SLACK Incorporated.

  19. NASA'S Earth Science Data Stewardship Activities

    Science.gov (United States)

    Lowe, Dawn R.; Murphy, Kevin J.; Ramapriyan, Hampapuram

    2015-01-01

    NASA has been collecting Earth observation data for over 50 years using instruments on board satellites, aircraft and ground-based systems. With the inception of the Earth Observing System (EOS) Program in 1990, NASA established the Earth Science Data and Information System (ESDIS) Project and initiated development of the Earth Observing System Data and Information System (EOSDIS). A set of Distributed Active Archive Centers (DAACs) was established at locations based on science discipline expertise. Today, EOSDIS consists of 12 DAACs and 12 Science Investigator-led Processing Systems (SIPS), processing data from the EOS missions, as well as the Suomi National Polar Orbiting Partnership mission, and other satellite and airborne missions. The DAACs archive and distribute the vast majority of data from NASA’s Earth science missions, with data holdings exceeding 12 petabytes The data held by EOSDIS are available to all users consistent with NASA’s free and open data policy, which has been in effect since 1990. The EOSDIS archives consist of raw instrument data counts (level 0 data), as well as higher level standard products (e.g., geophysical parameters, products mapped to standard spatio-temporal grids, results of Earth system models using multi-instrument observations, and long time series of Earth System Data Records resulting from multiple satellite observations of a given type of phenomenon). EOSDIS data stewardship responsibilities include ensuring that the data and information content are reliable, of high quality, easily accessible, and usable for as long as they are considered to be of value.

  20. Joint stockpiling and emergency sharing of oil: Arrangements for regional cooperation in East Asia

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Eui-soon, E-mail: shine@yonsei.ac.k [School of Economics, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749 (Korea, Republic of); Savage, Tim, E-mail: seoul@nautilus.or [Nautilus Institute, 58-14 Shinmun-ro 1-ga, Hangeul Hall Room 503, Jongro-gu, Seoul 110-061 (Korea, Republic of)

    2011-05-15

    The East Asia region includes three of the world's top five oil-importing nations-China, Japan, and the Republic of Korea. As a consequence, international oil supply disruptions and oil price spikes, and their effects on the economies of the region, have historically been of significant concern. Each of these three nations, as well as other nations in East Asia, has developed or is developing their own strategic oil stockpiles, but regional coordination in stockpiling arrangements and sharing of oil stocks in an emergency could provide significant benefits. This article describes the overall oil supply security situation in East Asia, reviews the attributes of different stockpiling arrangements to address energy supply security concerns, summarizes ongoing national approaches to stockpiling in East Asia, describes the development of joint oil stockpile initiatives in the region, and suggests the most attractive options for regional cooperation on oil stockpiling issues. - Highlights: {yields} Rising oil consumption will make East Asia more vulnerable to energy insecurity. {yields} There have been various dialogs on the need for a joint regional oil stockpile. {yields} No serious joint oil stockpiling efforts have been made in East Asia to date. {yields} Despite various impediments, diverse benefits justify oil stockpile cooperation.

  1. Medical Managment of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group

    National Research Council Canada - National Science Library

    Waselenka, Jamie K; MacVittie, Thomas J; Blakely, William F; Pesik, Nicki; Wiley, Albert L; Dickerson, William E; Tsu, Horace; Confer, Dennis L; Coleman, Norman; Seed, Thomas

    2004-01-01

    .... This consensus document was developed by the Strategic National Stockpile Radiation Working Group to provide a framework for physicians in internal medicine and the medical subspecialties to evaluate...

  2. Joint stockpiling and emergency sharing of oil: Arrangements for regional cooperation in East Asia

    International Nuclear Information System (INIS)

    Shin, Eui-soon; Savage, Tim

    2011-01-01

    The East Asia region includes three of the world's top five oil-importing nations-China, Japan, and the Republic of Korea. As a consequence, international oil supply disruptions and oil price spikes, and their effects on the economies of the region, have historically been of significant concern. Each of these three nations, as well as other nations in East Asia, has developed or is developing their own strategic oil stockpiles, but regional coordination in stockpiling arrangements and sharing of oil stocks in an emergency could provide significant benefits. This article describes the overall oil supply security situation in East Asia, reviews the attributes of different stockpiling arrangements to address energy supply security concerns, summarizes ongoing national approaches to stockpiling in East Asia, describes the development of joint oil stockpile initiatives in the region, and suggests the most attractive options for regional cooperation on oil stockpiling issues. - Highlights: → Rising oil consumption will make East Asia more vulnerable to energy insecurity. → There have been various dialogs on the need for a joint regional oil stockpile. → No serious joint oil stockpiling efforts have been made in East Asia to date. → Despite various impediments, diverse benefits justify oil stockpile cooperation.

  3. Embedding Data Stewardship in Geoscience Australia

    Science.gov (United States)

    Bastrakova, I.; Fyfe, S.

    2013-12-01

    Ten years of technological innovation now enable vast amounts of data to be collected, managed, processed and shared. At the same time, organisations have witnessed government legislative and policy requirements for open access to public sector data, and a demand for flexibility in access to data by both machine-to-machine and human consumption. Geoscience Australia (GA) has adopted Data Stewardship as an organisation-wide initiative to improve the way we manage and share our data. The benefits to GA including: - Consolidated understanding of GA's data assets and their value to the Agency; - Recognition of the significant role of data custodianship and data management; - Well-defined governance, policies, standards, practices and accountabilities that promote the accessibility, quality and interoperability of GA's data; - Integration of disparate data sets into cohesive information products available online in real time and equally accessible to researchers, government, industry and the public. Although the theory behind data stewardship is well-defined and accepted and the benefits are generally well-understood, practical implementation requires an organisation to prepare for a long-term commitment of resources, both financial and human. Fundamentally this involves: 1. Raising awareness in the organisation of the need for data stewardship and the challenges this entails; 2. Establishing a data stewardship framework including a data governance office to set policy and drive organisational change; and 3. Embedding the functions and a culture of data stewardship into business as usual operations. GA holds a vast amount of data ranging from petabytes of Big Data to significant quantities of relatively small ';long tail' geoscientific observations and measurements. Over the past four years, GA has undertaken strategic activities that prepare us for Data Stewardship: - Organisation-wide audits of GA's data holdings and identification of custodians for each dataset

  4. Antibiotic stewardship in community-acquired pneumonia.

    Science.gov (United States)

    Viasus, Diego; Vecino-Moreno, Milly; De La Hoz, Juan M; Carratalà, Jordi

    2017-04-01

    Community-acquired pneumonia (CAP) continues to be associated with significant mortality and morbidity. As with other infectious diseases, in recent years there has been a marked increase in resistance to the antibiotics commonly used against the pathogens that cause CAP. Antimicrobial stewardship denotes coordinated interventions to improve and measure the appropriate use of antibiotics by encouraging the selection of optimal drug regimens. Areas covered: Several elements can be applied to antibiotic stewardship strategies for CAP in order to maintain or improve patient outcomes. In this regard, antibiotic de-escalation, duration of antibiotic treatment, adherence to CAP guidelines recommendations about empirical treatment, and switching from intravenous to oral antibiotic therapy may each be relevant in this context. Antimicrobial stewardship strategies, such as prospective audit with intervention and feedback, clinical pathways, and dedicated multidisciplinary teams, that have included some of these elements have demonstrated improvements in antimicrobial use for CAP without negatively affecting clinical outcomes. Expert commentary: Although there are a limited number of randomized clinical studies addressing antimicrobial stewardship strategies in CAP, there is evidence that antibiotic stewardship initiatives can be securely applied, providing benefits to both healthcare systems and patients.

  5. Sustainable Stewardship of the Landrace Diversity

    Directory of Open Access Journals (Sweden)

    Ioannis Tokatlidis

    2016-12-01

    Full Text Available Landraces are heterogeneous populations and their variability goes through continuous alterations because of physical, genetic, and epigenetic procedures exacerbated by the ongoing climatic changes. Appropriate stewardship of landrace diversity is pivotal to promote its longevity in a manner that is sustainable from the farming perspective. A seed multiplication procedure is presented based on the assumption that in order to improve effectiveness in resource use and increase seed productivity, landraces should comprise genotypes which minimize intra-species competition. These aforementioned genotypes should be of the “weak competitor” ideotype, which are selected so as to alleviate the interplant competition and reach as high as possible crop stand uniformity. Stand uniformity is essential to ensure the same growing conditions for each plant. Reduced intra-crop inequality and equal use of inputs by individual plants will optimize crop performance. Precisely, the “weak competitor” is most often of high yield potential due to a negative association between yielding and competitive ability. Therefore, the suggested procedure involves initial reproduction at nil-competition (widely spaced plants to preclude any plant-to-plant interference for inputs where “off-type” and low yielding plants are omitted, followed by subsequent multiplication at dense stands. This may represent an effective cultural practice to improve also the landrace health status concerning seed-borne diseases in the absence of certification systems.

  6. Risk communications and the Chemical Stockpile Emergency-Planning Program

    Energy Technology Data Exchange (ETDEWEB)

    Vogt, B.M.; Sorensen, J.H.

    1994-09-01

    The CSEPP (Chemical Stockpile Emergency Preparedness Program) was created to improve emergency planning and response capabilities at the eight sites around the country that store chemical weapons. These weapons are scheduled to be destroyed in the near future. In preparation of the Draft Programmatic Environmental Impact Statement (DPEIS) for the Chemical Stockpile Disposal Program (CSDP), it was proposed that the Army mitigate accidents through an enhanced community emergency preparedness program at the eight storage sites. In 1986, the Army initiated the development of an Emergency Response Concept Plan (ERCP) for the CSDP, one of 12 technical support studies conducted during preparation of the Final Programmatic Environmental Impact Statement (FPEIS). The purpose of this document is to provide a fairly comprehensive source book on risk, risk management, risk communication research and recommended risk communication practices. It does not merely summarize each publication in the risk communication literature, but attempts to synthesize them along the lines of a set of organizing principles. Furthermore, it is not intended to duplicate other guidance manuals (such as Covello et al.`s manual on risk comparison). The source book was developed for the CSEPP in support of the training module on risk communications. Although the examples provided are specific to CSEPP, its use goes beyond that of CSEPP as the findings apply to a broad spectrum of risk communication topics. While the emphasis is on communication in emergency preparedness and response specific to the CSEPP, the materials cover other non-emergency communication settings. 329 refs.

  7. Modeling the filtration ability of stockpiled filtering facepiece

    Science.gov (United States)

    Rottach, Dana R.

    2016-03-01

    Filtering facepiece respirators (FFR) are often stockpiled for use during public health emergencies such as an infectious disease outbreak or pandemic. While many stockpile administrators are aware of shelf life limitations, environmental conditions can lead to premature degradation. Filtration performance of a set of FFR retrieved from a storage room with failed environmental controls was measured. Though within the expected shelf life, the filtration ability of several respirators was degraded, allowing twice the penetration of fresh samples. The traditional picture of small particle capture by fibrous filter media qualitatively separates the effect of inertial impaction, interception from the streamline, diffusion, settling, and electrostatic attraction. Most of these mechanisms depend upon stable conformational properties. However, common FFR rely on electrets to achieve their high performance, and over time heat and humidity can cause the electrostatic media to degrade. An extension of the Langevin model with correlations to classical filtration concepts will be presented. The new computational model will be used to predict the change in filter effectiveness as the filter media changes with time.

  8. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail.

    Science.gov (United States)

    Goff, Debra A; Kullar, Ravina; Goldstein, Ellie J C; Gilchrist, Mark; Nathwani, Dilip; Cheng, Allen C; Cairns, Kelly A; Escandón-Vargas, Kevin; Villegas, Maria Virginia; Brink, Adrian; van den Bergh, Dena; Mendelson, Marc

    2017-02-01

    In February, 2016, WHO released a report for the development of national action plans to address the threat of antibiotic resistance, the catastrophic consequences of inaction, and the need for antibiotic stewardship. Antibiotic stewardship combined with infection prevention comprises a collaborative, multidisciplinary approach to optimise use of antibiotics. Efforts to mitigate overuse will be unsustainable without learning and coordinating activities globally. In this Personal View, we provide examples of international collaborations to address optimal prescribing, focusing on five countries that have developed different approaches to antibiotic stewardship-the USA, South Africa, Colombia, Australia, and the UK. Although each country's approach differed, when nurtured, individual efforts can positively affect local and national antimicrobial stewardship programmes. Government advocacy, national guidelines, collaborative research, online training programmes, mentoring programmes, and social media in stewardship all played a role. Personal relationships and willingness to learn from each other's successes and failures continues to foster collaboration. We recommend that antibiotic stewardship models need to evolve from infection specialist-based teams to develop and use cadres of health-care professionals, including pharmacists, nurses, and community health workers, to meet the needs of the global population. We also recommend that all health-care providers who prescribe antibiotics take ownership and understand the societal burden of suboptimal antibiotic use, providing examples of how countries can learn, act globally, and share best antibiotic stewardship practices. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. 76 FR 45548 - Draft Site-Wide Environmental Impact Statement for the Continued Operation of the Department of...

    Science.gov (United States)

    2011-07-29

    .... The Facility includes office buildings, a high bay, machine shop, laboratories, experimental... moratorium. These activities would include science-based stockpile stewardship tests, experiments, and...

  10. 77 FR 16205 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2012-03-20

    .... The Committee is seeking public comments on the potential market impact of the material research and... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... National Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is...

  11. 77 FR 42271 - National Defense Stockpile Market Impact Committee Request for Public Comments on the Potential...

    Science.gov (United States)

    2012-07-18

    ... comments on the potential market impact associated with the two material research and development projects... Defense Stockpile Market Impact Committee Request for Public Comments on the Potential Market Impact of... National Defense Stockpile Market Impact Committee, co-chaired by the Departments of Commerce and State, is...

  12. 30 CFR 77.211 - Draw-off tunnels; stockpiling and reclaiming operations; general.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Draw-off tunnels; stockpiling and reclaiming operations; general. 77.211 Section 77.211 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... WORK AREAS OF UNDERGROUND COAL MINES Surface Installations § 77.211 Draw-off tunnels; stockpiling and...

  13. Methane, nitrous oxide and ammonia emissions from pigs housed on litter and from stockpiling of spent litter

    KAUST Repository

    Phillips, F. A.; Wiedemann, S. G.; Naylor, T. A.; McGahan, E. J.; Warren, B. R.; Murphy, C. M.; Parkes, Stephen; Wilson, J.

    2016-01-01

    Mitigation of agricultural greenhouse gas emissions is a target area for the Australian Government and the pork industry. The present study measured methane (CH4), nitrous oxide (N2O) and ammonia (NH3) from a deep-litter piggery and litter stockpile over two trials in southern New South Wales, to compare emissions from housing pigs on deep litter with those of pigs from conventional housing with uncovered anaerobic effluent-treatment ponds. Emissions were measured using open-path Fourier transform infrared spectrometry, in conjunction with a backward Lagrangian stochastic model. Manure excretion was determined by mass balance and emission factors (EFs) were developed to report emissions relative to volatile solids and nitrogen (N) input. Nitrous oxide emissions per animal unit (1 AU ≤ 500 kg liveweight) from deep-litter sheds were negligible in winter, and 8.4 g/AU.day in summer. Ammonia emissions were 39.1 in winter and 52.2 g/AU.day in summer, while CH4 emissions were 16.1 and 21.6 g/AU.day in winter and summer respectively. Emission factors averaged from summer and winter emissions showed a CH4 conversion factor of 3.6%, an NH3-N EF of 10% and a N2O-N EF of 0.01 kg N2O-N/kg N excreted. For the litter stockpile, the simple average of summer and winter showed an EF for NH3-N of 14%, and a N2O-N EF of 0.02 kg N2O-N/kg-N of spent litter added to the stockpile. We observed a 66% and 80% decrease in emissions from the manure excreted in litter-based housing with litter stockpiling or without litter stockpiling, compared with conventional housing with an uncovered anaerobic effluent-treatment pond. This provides a sound basis for mitigation strategies that utilise litter-based housing as an alternative to conventional housing with uncovered anaerobic effluent-treatment ponds. © CSIRO 2016.

  14. Methane, nitrous oxide and ammonia emissions from pigs housed on litter and from stockpiling of spent litter

    KAUST Repository

    Phillips, F. A.

    2016-05-05

    Mitigation of agricultural greenhouse gas emissions is a target area for the Australian Government and the pork industry. The present study measured methane (CH4), nitrous oxide (N2O) and ammonia (NH3) from a deep-litter piggery and litter stockpile over two trials in southern New South Wales, to compare emissions from housing pigs on deep litter with those of pigs from conventional housing with uncovered anaerobic effluent-treatment ponds. Emissions were measured using open-path Fourier transform infrared spectrometry, in conjunction with a backward Lagrangian stochastic model. Manure excretion was determined by mass balance and emission factors (EFs) were developed to report emissions relative to volatile solids and nitrogen (N) input. Nitrous oxide emissions per animal unit (1 AU ≤ 500 kg liveweight) from deep-litter sheds were negligible in winter, and 8.4 g/AU.day in summer. Ammonia emissions were 39.1 in winter and 52.2 g/AU.day in summer, while CH4 emissions were 16.1 and 21.6 g/AU.day in winter and summer respectively. Emission factors averaged from summer and winter emissions showed a CH4 conversion factor of 3.6%, an NH3-N EF of 10% and a N2O-N EF of 0.01 kg N2O-N/kg N excreted. For the litter stockpile, the simple average of summer and winter showed an EF for NH3-N of 14%, and a N2O-N EF of 0.02 kg N2O-N/kg-N of spent litter added to the stockpile. We observed a 66% and 80% decrease in emissions from the manure excreted in litter-based housing with litter stockpiling or without litter stockpiling, compared with conventional housing with an uncovered anaerobic effluent-treatment pond. This provides a sound basis for mitigation strategies that utilise litter-based housing as an alternative to conventional housing with uncovered anaerobic effluent-treatment ponds. © CSIRO 2016.

  15. Towards Materials Sustainability through Materials Stewardship

    Directory of Open Access Journals (Sweden)

    Christopher D. Taylor

    2016-10-01

    Full Text Available Materials sustainability requires a concerted change in philosophy across the entire materials lifecycle, orienting around the theme of materials stewardship. In this paper, we address the opportunities for improved materials conservation through dematerialization, durability, design for second life, and diversion of waste streams through industrial symbiosis.

  16. Stewardship, Learning, and Memory in Disaster Resilience

    Science.gov (United States)

    Tidball, Keith G.; Krasny, Marianne E.; Svendsen, Erika; Campbell, Lindsay; Helphand, Kenneth

    2010-01-01

    In this contribution, we propose and explore the following hypothesis: civic ecology practices, including urban community forestry, community gardening, and other self-organized forms of stewardship of green spaces in cities, are manifestations of how memories of the role of greening in healing can be instrumentalized through social learning to…

  17. Stewardship, learning, and memory in disaster resilience

    Science.gov (United States)

    Keith G. Tidball; Marianne E. Krasny; Erika Svendsen; Lindsay Campbell; Kenneth. Helphand

    2010-01-01

    In this contribution, we propose and explore the following hypothesis: civic ecology practices, including urban community forestry, community gardening, and other self-organized forms of stewardship of green spaces in cities, are manifestations of how memories of the role of greening in healing can be instrumentalized through social learning to foster social-ecological...

  18. Predicting volunteer commitment in environmental stewardship programmes

    Science.gov (United States)

    Robert L. Ryan; Rachel Kaplan; Robert E. Grese

    2001-01-01

    The natural environment benefits greatly from the work of volunteers in environmental stewardship programmes. However, little is known about volunteers' motivations for continued participation in these programmes. This study looked at the relationship between volunteer commitment and motivation, as well as the effect that volunteering has on participants'...

  19. Should remaining stockpiles of smallpox virus (variola) be destroyed?

    Science.gov (United States)

    Weinstein, Raymond S

    2011-04-01

    In 2011, the World Health Organization will recommend the fate of existing smallpox stockpiles, but circumstances have changed since the complete destruction of these cultures was first proposed. Recent studies suggest that variola and its experimental surrogate, vaccinia, have a remarkable ability to modify the human immune response through complex mechanisms that scientists are only just beginning to unravel. Further study that might require intact virus is essential. Moreover, modern science now has the capability to recreate smallpox or a smallpox-like organism in the laboratory in addition to the risk of nature re-creating it as it did once before. These factors strongly suggest that relegating smallpox to the autoclave of extinction would be ill advised.

  20. Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.

    Science.gov (United States)

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

    2016-01-01

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

  1. Biologics industry challenges for developing diagnostic tests for the National Veterinary Stockpile.

    Science.gov (United States)

    Hardham, J M; Lamichhane, C M

    2013-01-01

    Veterinary diagnostic products generated ~$3 billion US dollars in global sales in 2010. This industry is poised to undergo tremendous changes in the next decade as technological advances move diagnostic products from the traditional laboratory-based and handheld immunologic assays towards highly technical, point of care devices with increased sensitivity, specificity, and complexity. Despite these opportunities for advancing diagnostic products, the industry continues to face numerous challenges in developing diagnostic products for emerging and foreign animal diseases. Because of the need to deliver a return on the investment, research and development dollars continue to be focused on infectious diseases that have a negative impact on current domestic herd health, production systems, or companion animal health. Overcoming the administrative, legal, fiscal, and technological barriers to provide veterinary diagnostic products for the National Veterinary Stockpile will reduce the threat of natural or intentional spread of foreign diseases and increase the security of the food supply in the US.

  2. Integrating Information Networks for Collective Planetary Stewardship

    Science.gov (United States)

    Tiwari, A.

    2016-12-01

    Responsible behaviour resulting from climate literacy in global environmental movement is limited to policy and planning institutions in the Global South, while remaining absent for ends-user. Thus, planetary stewardship exists only at earth system boundaries where pressures sink to the local scale while ethics remains afloat. Existing citizen participation is restricted within policy spheres, appearing synonymous to enforcements in social psychology. Much, accounted reason is that existing information mechanisms operate mostly through linear exchanges between institutions and users, therefore reinforcing only hierarchical relationships. This study discloses such relationships that contribute to broad networking gaps through information demand assessment of stakeholders in a dozen development projects based in South Asia. Two parameters widely used for this purpose are: a. Feedback: Ends-user feedback to improve consumption literacy of climate sensitive resources (through consumption displays, billing, advisory services ecolabelling, sensors) and, b. Institutional Policy: Rewarding punishing to enforce desired behaviour (subsidies, taxation). Research answered: 1. Who gets the information (Equity in Information Distribution)? As existing information publishing mechanisms are designed by and for analysts, 2. How information translates to climate action Transparency of Execution)? Findings suggested that climate goals manifested in economic policy, than environmental policy, have potential clear short-term benefits and costs, and coincide with people's economic goals Also grassroots roles for responsible behaviour are empowered with presence of end user information. Barier free climate communication process and decision making is ensured among multiplicity of stakeholders with often conflicting perspectives. Research finds significance where collaboration among information networks can better translate regional policies into local action for climate adaptation and

  3. Relational responsibility, and not only stewardship, a Roman Catholic view on voluntary euthanasia for dying and non-dying patients.

    Science.gov (United States)

    Schotsmans, Paul T

    2003-01-01

    The Roman Catholic theological approach to euthanasia is radically prohibitive. The main theological argument for this prohibition is the so-called "stewardship argument": Christians cannot escape accounting to God for stewardship of the bodies given them on earth. This contribution presents an alternative approach based on European existentialist and philosophical traditions. The suggestion is that exploring the fullness of our relational responsibility is more apt for a pluralist--and even secular--debate on the legitimacy of euthanasia.

  4. Optimal vaccine stockpile design for an eradicated disease: application to polio.

    Science.gov (United States)

    Tebbens, Radboud J Duintjer; Pallansch, Mark A; Alexander, James P; Thompson, Kimberly M

    2010-06-11

    Eradication of a disease promises significant health and financial benefits. Preserving those benefits, hopefully in perpetuity, requires preparing for the possibility that the causal agent could re-emerge (unintentionally or intentionally). In the case of a vaccine-preventable disease, creation and planning for the use of a vaccine stockpile becomes a primary concern. Doing so requires consideration of the dynamics at different levels, including the stockpile supply chain and transmission of the causal agent. This paper develops a mathematical framework for determining the optimal management of a vaccine stockpile over time. We apply the framework to the polio vaccine stockpile for the post-eradication era and present examples of solutions to one possible framing of the optimization problem. We use the framework to discuss issues relevant to the development and use of the polio vaccine stockpile, including capacity constraints, production and filling delays, risks associated with the stockpile, dynamics and uncertainty of vaccine needs, issues of funding, location, and serotype dependent behavior, and the implications of likely changes over time that might occur. This framework serves as a helpful context for discussions and analyses related to the process of designing and maintaining a stockpile for an eradicated disease. (c) 2010 Elsevier Ltd. All rights reserved.

  5. Exploiting the plutonium stockpiles in PWRs by using inert matrix fuel

    International Nuclear Information System (INIS)

    Lombardi, C.; Mazzola, A.

    1996-01-01

    The plutonium coming from dismantled warheads and that already stockpiled coming from spent fuel reprocessing have raised many concerns related to proliferation resistance, environmental safety and economy. The option of disposing of plutonium by fission is one of the most widely discussed and many proposals for plutonium burning in a safe and economical manner have been put forward. Due to their diffusion, PWRs appear to be the main candidates for the reduction of the plutonium stockpiles. In order to achieve a high plutonium consumption rate, a uranium-free fuel may be conceived, based on the dilution of PuO 2 within a carrier matrix made of inert oxide. In this paper, a partial loading of inert matrix fuel in a current technology PWR was investigated with 3-D calculations. The results indicated that this solution has good plutonium elimination capabilities: commercial PWRs operating in a once-through cycle scheme can transmute more than 98% of the loaded Pu-239 and 73 or 81% of the overall initially loaded reactor grade or weapons grade plutonium, respectively. The plutonium still let in the spent fuel was of poor quality and then offered a better proliferation resistance. Power peaking problems could be faced with the adoption of burnable absorbers: IFBA seemed to be particularly suitable. In spite of a reduction of the overall plutonium loaded mass by a factor 3.7 or 5.4 depending on its quality, there was no evidence of an increase of the minor actinides radiotoxicity after a time period of about 25 years. (author)

  6. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Mathematical Modeling.

    Science.gov (United States)

    Barnes, Sean L; Kasaie, Parastu; Anderson, Deverick J; Rubin, Michael

    2016-11-01

    Mathematical modeling is a valuable methodology used to study healthcare epidemiology and antimicrobial stewardship, particularly when more traditional study approaches are infeasible, unethical, costly, or time consuming. We focus on 2 of the most common types of mathematical modeling, namely compartmental modeling and agent-based modeling, which provide important advantages-such as shorter developmental timelines and opportunities for extensive experimentation-over observational and experimental approaches. We summarize these advantages and disadvantages via specific examples and highlight recent advances in the methodology. A checklist is provided to serve as a guideline in the development of mathematical models in healthcare epidemiology and antimicrobial stewardship. Infect Control Hosp Epidemiol 2016;1-7.

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

    Science.gov (United States)

    Magill, G

    2001-04-01

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

  8. Environmental Stewardship: A Conceptual Review and Analytical Framework

    Science.gov (United States)

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

    2018-04-01

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

  9. Environmental Stewardship: A Conceptual Review and Analytical Framework.

    Science.gov (United States)

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

    2018-04-01

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

  10. Antifungal stewardship considerations for adults and pediatrics.

    Science.gov (United States)

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

    2017-08-18

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

  11. Multi-generational stewardship of plutonium

    International Nuclear Information System (INIS)

    Pillay, K.K.S.

    1997-01-01

    The post-cold war era has greatly enhanced the interest in the long-term stewardship of plutonium. The management of excess plutonium from proposed nuclear weapons dismantlement has been the subject of numerous intellectual discussions during the past several years. In this context, issues relevant to long-term management of all plutonium as a valuable energy resource are also being examined. While there are differing views about the future role of plutonium in the economy, there is a recognition of the environmental and health related problems and proliferation potentials of weapons-grade plutonium. The long-term management of plutonium as an energy resource will require a new strategy to maintain stewardship for many generations to come

  12. Antimicrobial stewardship: Strategies for a global response

    Directory of Open Access Journals (Sweden)

    Jenny Grunwald

    2014-01-01

    Full Text Available The increasing antimicrobial resistance worldwide, combined with dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health and safety of patients. To combat this hazard, antimicrobial stewardship programs (ASPs have emerged. Antimicrobial stewardship programs prevent or slow the emergence of antimicrobial resistance by coordinated interventions designed to optimize antimicrobial use to achieve the best clinical outcomes and limiting selective pressures that drive the emergence of resistance. This also reduces excessive costs attributable to suboptimal antimicrobial use. Even though an ideal effective ASP should incorporate more than one element simultaneously, it also requires a multidisciplinary team, which should include an infectious diseases physician, a clinical pharmacist with infectious diseases training, infection control professionals, hospital epidemiologist, a clinical microbiologist and an information specialist. However, for antimicrobial stewardship (AMS programs to be successful, they must address the specific needs of individual institutions, must be built on available resources, the limitations and advantages of each institution, and the available staffing and technological infrastructure.

  13. The impact of the quality of coal mine stockpile soils on sustainable vegetation growth and productivity

    CSIR Research Space (South Africa)

    Mushia, NM

    2016-06-01

    Full Text Available , chemical, and biological properties, limiting their capability for sustainable vegetation growth. The aim of the study was to evaluate the impact of stockpile soils of differing depth and quality on vegetation growth and productivity. Soils were collected...

  14. Wilderness stewardship in America today and what we can do to improve it

    Science.gov (United States)

    Ken Cordell; Chris Barns; David Brownlie; Tom Carlson; Chad Dawson; William Koch; Garry Oye; Chris Ryan

    2016-01-01

    The authors of this article are recently retired wilderness professionals from universities or federal agencies. We were asked to share our observations about how wilderness stewardship is being managed in America today. We based our observations on our many years of combined professional wilderness career experience as managers, trainers, scientists, educators, and...

  15. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, A.H.M.; Sinha, Bhanu; Lo-Ten-Foe, Jerome R.; van Gemert-Pijnen, Julia E.W.C.

    2014-01-01

    Background Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlier

  16. Innovative Concepts and Operational Techniques for the Strategic National Stockpile

    International Nuclear Information System (INIS)

    Adams, S. A.

    2007-01-01

    This presentation is to discuss the innovative concepts and operational techniques developed by the Center for Disease Control and Prevention's Division of Strategic National Stockpile (DSNS). The primary response model for the SNS is to move from secure strategic storage locations to an area of need within 12 hours to augment local resources. While this 12 hour response is appropriate for most threat scenarios, it clearly cannot meet the needs of first line responders who need to rapidly administer initial dosing of nerve agent antidote. To address the threat of nerve agent poisoning the DSNS developed the CHEMPACK Project which allows centralized SNS management forward placement within hundreds of local jurisdictions. Another variation from the primary mission of the DSNS is addressing the nation's potential shortfall in non-acute care bed capacity. To address this mission, the Federal Medical Station (FMS) program was created to build surge capability to meet a range of non-acute medical needs following a disaster. The FMS model is a pre-configured 250 bed unit that is deployable throughout the Nation and configured to respond rapidly. Operational techniques used to maximize product lifespan and efficacy will also be discussed.(author)

  17. The Impact of the Quality of Coal Mine Stockpile Soils on Sustainable Vegetation Growth and Productivity

    Directory of Open Access Journals (Sweden)

    Nicky M Mushia

    2016-06-01

    Full Text Available Stockpiled soils are excavated from the ground during mining activities, and piled on the surface of the soil for rehabilitation purposes. These soils are often characterized by low organic matter (SOM content, low fertility, and poor physical, chemical, and biological properties, limiting their capability for sustainable vegetation growth. The aim of the study was to evaluate the impact of stockpile soils of differing depth and quality on vegetation growth and productivity. Soils were collected at three different depths (surface, mid, and deep as well as mixed (equal proportion of surface, mid and deep from two stockpiles (named Stockpile 1: aged 10 and Stockpile 2: 20 years at the coal mine near Witbank in the Mpumalanga province of South Africa. Soils were amended with different organic and inorganic fertilizer. A 2 × 4 × 5 factorial experiment in a completely randomized blocked design with four replications was established under greenhouse conditions. A grass species (Digiteria eriantha was planted in the pots with unamended and amended soils under greenhouse conditions at 26–28 °C during the day and 16.5–18.5 °C at night. Mean values of plant height, plant cover, total fresh biomass (roots, stems and leaves, and total dry biomass were found to be higher in Stockpile 1 than in Stockpile 2 soils. Plants grown on soils with no amendments had lower mean values for major plant parameters studied. Soil amended with poultry manure and lime was found to have higher growth rate compared with soils with other soil amendments. Mixed soils had better vegetation growth than soil from other depths. Stockpiled soils in the study area cannot support vegetation growth without being amended, as evidenced by low grass growth and productivity in this study.

  18. E-commerce as a Stockpiling Technology - Implications for Consumer Savings

    OpenAIRE

    Andrea Pozzi

    2013-01-01

    Shopping on the Internet spares customers the discomfort of carrying around heavy and bulky baskets of goods, since the service usually includes home de- livery. This makes e-commerce a technology well suited to helping consumers to buy in bulk or to stockpile items on discount. I use grocery scanner data provided by a supermarket chain selling both online and through traditional stores to show that the introduction of e-commerce leads to an increase in bulk purchase and stockpiling behavior ...

  19. Stockpiling anti-viral drugs for a pandemic: the role of Manufacturer Reserve Programs.

    Science.gov (United States)

    Harrington, Joseph E; Hsu, Edbert B

    2010-05-01

    To promote stockpiling of anti-viral drugs by non-government organizations such as hospitals, drug manufacturers have introduced Manufacturer Reserve Programs which, for an annual fee, provide the right to buy in the event of a severe outbreak of influenza. We show that these programs enhance drug manufacturer profits but could either increase or decrease the amount of pre-pandemic stockpiling of anti-viral drugs.

  20. Hedge math: Theoretical limits on minimum stockpile size across nuclear hedging strategies

    Energy Technology Data Exchange (ETDEWEB)

    Lafleur, Jarret Marshall [Sandia National Lab. (SNL-CA), Livermore, CA (United States); Roesler, Alexander W. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-09-01

    In June 2013, the Department of Defense published a congressionally mandated, unclassified update on the U.S. Nuclear Employment Strategy. Among the many updates in this document are three key ground rules for guiding the sizing of the non-deployed U.S. nuclear stockpile. Furthermore, these ground rules form an important and objective set of criteria against which potential future stockpile hedging strategies can be evaluated.

  1. Integrating Science-Based Co-management, Partnerships, Participatory Processes and Stewardship Incentives to Improve the Performance of Small-Scale Fisheries

    Directory of Open Access Journals (Sweden)

    Kendra A. Karr

    2017-10-01

    Full Text Available Small scale fisheries are critically important for the provision of food security, livelihoods, and economic development for billions of people. Yet, most of these fisheries appear to not be achieving either fisheries or conservation goals, with respect to creating healthier oceans that support more fish, feed more people and improve livelihoods. Research and practical experience have elucidated many insights into how to improve the performance of small-scale fisheries. Here, we present lessons learned from five case studies of small-scale fisheries in Cuba, Mexico, the Philippines, and Belize. The major lessons that arise from these cases are: (1 participatory processes empower fishers, increase compliance, and support integration of local and scientific knowledge; (2 partnership across sectors improves communication and community buy-in; (3 scientific analysis can lead fishery reform and be directly applicable to co-management structures. These case studies suggest that a fully integrated approach that implements a participatory process to generate a scientific basis for fishery management (e.g., data collection, analysis, design and to design management measures among stakeholders will increase the probability that small-scale fisheries will implement science-based management and improve their performance.

  2. Strategies for antiviral stockpiling for future influenza pandemics: a global epidemic-economic perspective.

    Science.gov (United States)

    Carrasco, Luis R; Lee, Vernon J; Chen, Mark I; Matchar, David B; Thompson, James P; Cook, Alex R

    2011-09-07

    Influenza pandemics present a global threat owing to their potential mortality and substantial economic impacts. Stockpiling antiviral drugs to manage a pandemic is an effective strategy to offset their negative impacts; however, little is known about the long-term optimal size of the stockpile under uncertainty and the characteristics of different countries. Using an epidemic-economic model we studied the effect on total mortality and costs of antiviral stockpile sizes for Brazil, China, Guatemala, India, Indonesia, New Zealand, Singapore, the UK, the USA and Zimbabwe. In the model, antivirals stockpiling considerably reduced mortality. There was greater potential avoidance of expected costs in the higher resourced countries (e.g. from $55 billion to $27 billion over a 30 year time horizon for the USA) and large avoidance of fatalities in those less resourced (e.g. from 11.4 to 2.3 million in Indonesia). Under perfect allocation, higher resourced countries should aim to store antiviral stockpiles able to cover at least 15 per cent of their population, rising to 25 per cent with 30 per cent misallocation, to minimize fatalities and economic costs. Stockpiling is estimated not to be cost-effective for two-thirds of the world's population under current antivirals pricing. Lower prices and international cooperation are necessary to make the life-saving potential of antivirals cost-effective in resource-limited countries.

  3. 76 FR 11243 - Solicitation of Input From Stakeholders To Inform the National Framework for Electronics Stewardship

    Science.gov (United States)

    2011-03-01

    ... Stakeholders To Inform the National Framework for Electronics Stewardship AGENCY: Environmental Protection... inform the national framework for electronics stewardship that is being developed by the Interagency Task Force on Electronics Stewardship. On November 15, 2010, President Obama signed a presidential...

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

    Science.gov (United States)

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

  5. Stewardship Reporting in the DOD Agency-Wide Financial Statements for FY 1998

    National Research Council Canada - National Science Library

    1999-01-01

    ...; heritage assets, stewardship land, and stewardship investments were presented on the financial statements accurately and in accordance with generally accepted accounting standards for Federal agencies...

  6. Stewardship challenges abortion: A proposed means to mitigate abortion's social divisiveness.

    Science.gov (United States)

    Tardiff, Robert G

    2015-08-01

    Since 1973 the legislated constitutional right to abortion has produced a political dichotomy (anti-abortion versus pro-abortion) within the United States, even while witnessing a gradual decline in the rate of abortions. A third paradigm, moral stewardship, is advanced as an effective means to ameliorate this social divisiveness. Incorporating the concept of stewardship into deliberations of pregnancy termination would require recognition, through fact-based education programs, of the life circumstances that prompt the consideration to terminate a pregnancy. Based on collective responsibility, policies, and programs are needed to foster social justice for parents and for the offspring brought to term, without creating excessive burdens on women faced with an unwanted pregnancy. Moral stewardship is perceived as humanitarian to family and community and advantageous to society overall. It also offers a serious opportunity to reshape our society from divisiveness to inclusiveness, and to guide science policy judgment that enhances and strengthens social justice. Lay summary: Differing opinions over the ethics of human abortion have been legion since Roe v. Wade (1973). The disputes between pro- and anti-abortion factions have segregated society with few improvements in social justice. This study offers an alternative approach, one capable of social assimilation and justice for unwanted offspring and pregnant mothers bearing them. It promotes moral stewardship toward the unborn whose humanity and personhood are recognized genetically and supported philosophically by long-standing ethical principles. Stewardship incorporates all people at all levels of society based on collective responsibility, supported by government policies, yet not restricting a mother's choices for the future of her unborn offspring.

  7. US antibiotic stewardship and penicillin allergy.

    Science.gov (United States)

    Wada, Kara J; Calhoun, Karen H

    2017-06-01

    The purpose of this review is to improve otolaryngologists' antibiotic stewardship by detailing current approaches to penicillin allergy. Although up to 15% of hospitalized patients in the United States have a penicillin allergy recorded on their charts, fewer than 10% of these have a true penicillin allergy. Using a combination of a detailed allergy history, skin testing and graded-dose administration, many patients whose charts say 'penicillin-allergic' can safely be treated with penicillin and cross-reacting antibiotics. This permits use of narrower-spectrum antibiotics and saves money.

  8. A Unified Framework for Measuring Stewardship Practices Applied to Digital Environmental Datasets

    Directory of Open Access Journals (Sweden)

    Ge Peng

    2015-01-01

    Full Text Available This paper presents a stewardship maturity assessment model in the form of a matrix for digital environmental datasets. Nine key components are identified based on requirements imposed on digital environmental data and information that are cared for and disseminated by U.S. Federal agencies by U.S. law, i.e., Information Quality Act of 2001, agencies’ guidance, expert bodies’ recommendations, and users. These components include: preservability, accessibility, usability, production sustainability, data quality assurance, data quality control/monitoring, data quality assessment, transparency/traceability, and data integrity. A five-level progressive maturity scale is then defined for each component associated with measurable practices applied to individual datasets, representing Ad Hoc, Minimal, Intermediate, Advanced, and Optimal stages. The rationale for each key component and its maturity levels is described. This maturity model, leveraging community best practices and standards, provides a unified framework for assessing scientific data stewardship. It can be used to create a stewardship maturity scoreboard of dataset(s and a roadmap for scientific data stewardship improvement or to provide data quality and usability information to users, stakeholders, and decision makers.

  9. Intergenerational equity and long-term stewardship plans

    International Nuclear Information System (INIS)

    Hocking, E. K.

    2002-01-01

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

  10. Considerations for Future Climate Data Stewardship

    Science.gov (United States)

    Halem, M.; Nguyen, P. T.; Chapman, D. R.

    2009-12-01

    In this talk, we will describe the lessons learned based on processing and generating a decade of gridded AIRS and MODIS IR sounding data. We describe the challenges faced in accessing and sharing very large data sets, maintaining data provenance under evolving technologies, obtaining access to legacy calibration data and the permanent preservation of Earth science data records for on demand services. These lessons suggest a new approach to data stewardship will be required for the next decade of hyper spectral instruments combined with cloud resolving models. It will not be sufficient for stewards of future data centers to just provide the public with access to archived data but our experience indicates that data needs to reside close to computers with ultra large disc farms and tens of thousands of processors to deliver complex services on demand over very high speed networks much like the offerings of search engines today. Over the first decade of the 21st century, petabyte data records were acquired from the AIRS instrument on Aqua and the MODIS instrument on Aqua and Terra. NOAA data centers also maintain petabytes of operational IR sounders collected over the past four decades. The UMBC Multicore Computational Center (MC2) developed a Service Oriented Atmospheric Radiance gridding system (SOAR) to allow users to select IR sounding instruments from multiple archives and choose space-time- spectral periods of Level 1B data to download, grid, visualize and analyze on demand. Providing this service requires high data rate bandwidth access to the on line disks at Goddard. After 10 years, cost effective disk storage technology finally caught up with the MODIS data volume making it possible for Level 1B MODIS data to be available on line. However, 10Ge fiber optic networks to access large volumes of data are still not available from CSFC to serve the broader community. Data transfer rates are well below 10MB/s limiting their usefulness for climate studies. During

  11. Antimicrobial Stewardship and Urinary Tract Infections

    Directory of Open Access Journals (Sweden)

    Lilian M. Abbo

    2014-05-01

    Full Text Available Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections.

  12. Medical table: A major tool for antimicrobial stewardship policy.

    Science.gov (United States)

    Roger, P-M; Demonchy, E; Risso, K; Courjon, J; Leroux, S; Leroux, E; Cua, É

    2017-09-01

    Infectious diseases are unpredictable, with heterogeneous clinical presentations, diverse pathogens, and various susceptibility rates to anti-infective agents. These features lead to a wide variety of clinical practices, which in turn strongly limits their evaluation. We have been using a medical table since 2005 to monitor the medical activity in our department. The observation of heterogeneous therapeutic practices led to drafting up our own antibiotic guidelines and to implementing a continuous evaluation of their observance and impact on morbidity and mortality associated with infectious diseases, including adverse effects of antibiotics, duration of hospital stay, use of intensive care, and deaths. The 10-year analysis of medical practices using the medical table is based on more than 10,000 hospitalizations. It shows simplified antibiotic therapies and a reduction in infection-related morbidity and mortality. The medical table is a major tool for antimicrobial stewardship, leading to constant benefits for patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. The PRISM reactor as a possible option to deal with the british civilian plutonium stockpile

    Energy Technology Data Exchange (ETDEWEB)

    Fichtlscherer, Christopher [IANUS, TU Darmstadt (Germany); Friess, Friederike [IANUS, TU Darmstadt (Germany); ISR, Universitaet fuer Bodenkultur Wien (Boku) (Austria)

    2017-07-01

    Dealing with stocks of separated weapon-usable plutonium is a big challenge for our modern society. This work focuses on the British civil plutonium stockpiles, which amount to 103.3 tons. One option is seen in irradiating the plutonium in a fast reactor under development, namely the GE PRISM reactor. The PRISM reactor is a small modular, fast reactor which has a thermal power of 840 MW and an electrical output of 311 MW. It is intended to use MOX fuel and proponents claim, that it thus would be possible to produce clean energy, while making the plutonium proliferation resistant. A MCNP model of the reactor is built and depletion calculations with different target burnups of the fuel were conducted to check whether the burned material would fulfil the Spent-Fuel Standard. Particularly it was checked whether the spent fuel is self protecting, meaning that the dose rate does not fall below a limit of 1 Sv/h in 1 meter distance after a cooling period of 30 years. Based on the reactor model calculations the irradiation time to fulfill this limit for the spent fuel is calculated. Based on the needed target burnup, it can be verified, whether it is possible for the PRISM reactor to render the civil plutonium proliferation resistant in only 20 years as is is claimed by its proponents.

  14. Ontario tire recycling and economic development (OnTRED) plan : a market approach to eliminating tire stockpiles and promoting recycled rubber product manufacturing in Ontario

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-05-15

    Details of the Ontario Tire Recycling and Economic Development (OnTRED) plan were presented. The plan was developed to address deficiencies in the Ontario Tire Stewardship's (OTS) Scrap Tire Diversion Program plan. The OTS promotes the burning of scrap tires contrary to the Waste Diversion Act, and transfers the financial responsibility for scrap tire management from manufacturers to retailers. The OnTRED plan will attempt to improve the current 87 per cent recovery rate for passenger scrap tires in Ontario, and prevent the formation of any new tire stockpiles. The aim of the OnTRED plan is to ensure reuse and recycling consistent with provisions in the Waste Diversion Act and enhance the existing workings of the tire and scrap tire market through the promotion of reuse and recycling. In addition, the plan aims to minimize administration and compliance costs. A program summary of the OnTRED plan was presented, as well as details of market development plans and buy-recycled rebates. Issues concerning collector registration and transaction tracking were presented, as well as details of brand-owner and first importer pay-in models. Stakeholder roles and responsibilities were reviewed. A budget scenario was presented, as well as a rebate and diversion scenario. It was concluded that Ontario's 87 per cent scrap tire diversion rate can be improved through a focus on patterns of reuse and recycling. 3 tabs., 7 figs.

  15. Using Direct Sub-Level Entity Access to Improve Nuclear Stockpile Simulation Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Parker, Robert Y. [Brigham Young Univ., Provo, UT (United States)

    1999-08-01

    Direct sub-level entity access is a seldom-used technique in discrete-event simulation modeling that addresses the accessibility of sub-level entity information. The technique has significant advantages over more common, alternative modeling methods--especially where hierarchical entity structures are modeled. As such, direct sub-level entity access is often preferable in modeling nuclear stockpile, life-extension issues, an area to which it has not been previously applied. Current nuclear stockpile, life-extension models were demonstrated to benefit greatly from the advantages of direct sub-level entity access. In specific cases, the application of the technique resulted in models that were up to 10 times faster than functionally equivalent models where alternative techniques were applied. Furthermore, specific implementations of direct sub-level entity access were observed to be more flexible, efficient, functional, and scalable than corresponding implementations using common modeling techniques. Common modeling techniques (''unbatch/batch'' and ''attribute-copying'') proved inefficient and cumbersome in handling many nuclear stockpile modeling complexities, including multiple weapon sites, true defect analysis, and large numbers of weapon and subsystem types. While significant effort was required to enable direct sub-level entity access in the nuclear stockpile simulation models, the enhancements were worth the effort--resulting in more efficient, more capable, and more informative models that effectively addressed the complexities of the nuclear stockpile.

  16. Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

    Science.gov (United States)

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

    2016-06-01

    BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

  17. Guide about petroleum strategic stockpiles in France; Repere sur les stocks strategiques petroliers en France

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2004-03-01

    The strategic character of petroleum products has been perceived since the first world war. It has led France to impose the petroleum operators to make stockpiles to provide against the consequences of a serious disruption of supplies. As a difference with some other industrialized countries like the USA or Japan, French stockpiles are made of finite products. A balanced geographical distribution of these stocks over the whole national territory increases their efficiency. Stockpiles of IEA member states must represent 90 days of net imports while those of European Union member states must represent 90 days of average domestic consumption. In France, each chartered operator contributes to the strategic storage and the stored volumes are defined by the law no 92-1443 from December 31, 1992. These stocks are permanently controlled and financial sanctions are applied in case of infraction. Particular dispositions are applied in overseas departments which are summarized in this paper. (J.S.)

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

    Science.gov (United States)

    Siemer, William F.

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

  19. University Research Program in Robotics - "Technologies for Micro-Electrical-Mechanical Systems in directed Stockpile Work (DSW) Radiation and Campaigns", Final Technical Annual Report, Project Period 9/1/06 - 8/31/07

    Energy Technology Data Exchange (ETDEWEB)

    James S. Tulenko; Carl D. Crane

    2007-12-13

    The University Research Program in Robotics (URPR) is an integrated group of universities performing fundamental research that addresses broad-based robotics and automation needs of the NNSA Directed Stockpile Work (DSW) and Campaigns. The URPR mission is to provide improved capabilities in robotics science and engineering to meet the future needs of all weapon systems and other associated NNSA/DOE activities.

  20. From nuclides to nerve gas: The development of the Chemical Stockpile Emergency Preparedness Exercise Program

    International Nuclear Information System (INIS)

    Gant, K.S.; Adler, M.V.

    1991-01-01

    The Army and the Federal Emergency Management Agency established the Chemical Stockpile Emergency Preparedness Program (CSEPP), to improve emergency preparedness around each location storing the nation's aging stockpile of unitary chemical weapons. The CSEPP requires that a series of exercises be conducted at each location on a regular schedule. The CSEPP exercise program drew upon the existing Army and civilian exercises. Merging the exercise traditions of both the communities and installations into a joint exercise program acceptable to both sides and the particular nature of the hazard required a number of adjustments in the usual approaches. 14 refs., 1 fig

  1. Covering of milled peat stockpile with wood chips; Jyrsinturveauman peittaeminen hakkeella

    Energy Technology Data Exchange (ETDEWEB)

    Franssila, T.; Leinonen, A.

    1996-12-31

    The aim of this project is to research the applicability of wooden materials for protection of milled peat stockpile against losses during storaging. Water transmission features of sawdust, wastewood chip and whole tree chip were investigated in laboratory with raining experiments. The plan for raining experiments was made with experiment planning program and results were analysed with multivariate analysis. Freezing features were investigated thorough breaking tests with hydraulic piston vice. Laboratory experiments were completed with field tests in Laakasuo near Sotkamo. On the basis of results covering peat stockpiles with sawdust is fully competitive comparing to present covering methods. Chip materials are technically not as good covering materials as sawdust

  2. The Stewardship Role of Analyst Forecasts, and Discretionary Versus Non-Discretionary Accruals

    DEFF Research Database (Denmark)

    Christensen, Peter Ove; Frimor, Hans; Sabac, Florin

    We examine the interaction between discretionary and non-discretionary accruals in a stewardship setting. Contracting includes multiple rounds of renegotiation based on contractible accounting information and non-contractible but more timely non-accounting information. We show that accounting...... timely non-accounting information (analyst earnings forecasts) increases the ex ante value of the firm and reduces costly earnings management. There is an optimal level of reversible non-discretionary accrual noise introduced through revenue recognition policies. Tight rules-based accounting regulation...... regulation aimed at increasing earnings quality from a valuation perspective (earnings persistence) may have a significant impact on how firms rationally respond in terms of allowing accrual discretion in order to alleviate the impact on the stewardship role of earnings. Increasing the precision of more...

  3. The Stewardship Role of Analyst Forecasts, and Discretionary Versus Non-Discretionary Accruals

    DEFF Research Database (Denmark)

    Christensen, Peter Ove; Frimor, Hans; Sabac, Florin

    2013-01-01

    We examine the interaction between discretionary and non-discretionary accruals in a stewardship setting. Contracting includes multiple rounds of renegotiation based on contractible accounting information and non-contractible but more timely non-accounting information. We show that accounting...... timely non-accounting information (analyst earnings forecasts) increases the ex ante value of the firm and reduces costly earnings management. There is an optimal level of reversible non-discretionary accrual noise introduced through revenue recognition policies. Tight rules-based accounting regulation...... regulation aimed at increasing earnings quality from a valuation perspective (earnings persistence) may have a significant impact on how firms rationally respond in terms of allowing accrual discretion in order to alleviate the impact on the stewardship role of earnings. Increasing the precision of more...

  4. The Roles of the Accountant and Auditor in Stewardship and ...

    African Journals Online (AJOL)

    While much attention has been given to accountability in public sector which has not even yielded the desired result, the same can not be said of organised private sector. ... Keywords: Stewardship, corporate governance, accountability,

  5. Long-Term Stewardship Science and Technology Requirements

    International Nuclear Information System (INIS)

    McDonald, J.K.; Nickelson, R.A.

    2002-01-01

    To ensure technology developed for long-term stewardship will meet existing requirements, a review of requirements was performed. In addition to identifying existing science and technology related requirements, gaps and conflicts of requirements were identified

  6. Airport Capital Improvement Planning: Stewardship for Airport Development

    Science.gov (United States)

    1997-09-01

    "Airport Capital Improvement Planning: Stewardship for Airport Development", was : originally written in October, 1995. It documented an effort to implement the : concept of capital improvement planning with the airport development industry. : Airpor...

  7. An integrated stewardship model : Antimicrobial, infection prevention and diagnostic (AID)

    NARCIS (Netherlands)

    Dik, Jan-Willem H.; Poelman, Randy; Friedrich, Alexander W.; Panday, Prashant Nannan; Lo-Ten-Foe, Jerome R.; van Assen, Sander; van Gemert-Pijnen, Julia E. W. C.; Niesters, Hubert G. M.; Hendrix, Ron; Sinha, Bhanu

    2016-01-01

    Considering the threat of antimicrobial resistance and the difficulties it entails in treating infections, it is necessary to cross borders and approach infection management in an integrated, multidisciplinary manner. We propose the antimicrobial, infection prevention and diagnostic stewardship

  8. An integrated stewardship model: antimicrobial, infection prevention and diagnostic (AID)

    NARCIS (Netherlands)

    Dik, Jan-Willem H.; Poelman, Randy; Friedrich, Alexander W.; Panday, Prashant N.; Lo-Ten-Foe, Jerome R.; van Assen, Sander; van Gemert-Pijnen, Julia E.W.C.; Niesters, Hubert G.M.; Hendrix, Ron; Sinha, Bhanu

    2015-01-01

    Considering the threat of antimicrobial resistance and the difficulties it entails in treating infections, it is necessary to cross borders and approach infection management in an integrated, multidisciplinary manner. We propose the antimicrobial, infection prevention and diagnostic stewardship

  9. Long-Term Stewardship Baseline Report and Transition Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Kristofferson, Keith

    2001-11-01

    Long-term stewardship consists of those actions necessary to maintain and demonstrate continued protection of human health and the environment after facility cleanup is complete. As the Department of Energy’s (DOE) lead laboratory for environmental management programs, the Idaho National Engineering and Environmental Laboratory (INEEL) administers DOE’s long-term stewardship science and technology efforts. The INEEL provides DOE with technical, and scientific expertise needed to oversee its long-term environmental management obligations complexwide. Long-term stewardship is administered and overseen by the Environmental Management Office of Science and Technology. The INEEL Long-Term Stewardship Program is currently developing the management structures and plans to complete INEEL-specific, long-term stewardship obligations. This guidance document (1) assists in ensuring that the program leads transition planning for the INEEL with respect to facility and site areas and (2) describes the classes and types of criteria and data required to initiate transition for areas and sites where the facility mission has ended and cleanup is complete. Additionally, this document summarizes current information on INEEL facilities, structures, and release sites likely to enter long-term stewardship at the completion of DOE’s cleanup mission. This document is not intended to function as a discrete checklist or local procedure to determine readiness to transition. It is an overarching document meant as guidance in implementing specific transition procedures. Several documents formed the foundation upon which this guidance was developed. Principal among these documents was the Long-Term Stewardship Draft Technical Baseline; A Report to Congress on Long-Term Stewardship, Volumes I and II; Infrastructure Long-Range Plan; Comprehensive Facility Land Use Plan; INEEL End-State Plan; and INEEL Institutional Plan.

  10. The chemical stockpile intergovernmental consultation program: Lessons for HLW public involvement

    International Nuclear Information System (INIS)

    Feldman, D.L.

    1991-01-01

    This paper assesses the appropriateness of the US Army's Chemical Stockpile Disposal Program's (CSDP) Intergovernmental Consultation and Coordination Boards (ICCBs) as models for incorporating public concerns in the future siting of HLW repositories by DOE. ICCB structure, function, and implementation are examined, along with other issues relevant to the HLW context. 27 refs

  11. Prevention of spontaneous combustion in coal stockpiles : Experimental results in coal storage yard

    NARCIS (Netherlands)

    Fierro, V.; Miranda, J.L.; Romero, C.; Andrés, J.M.; Arriaga, A.; Schmal, D.; Visser, G.H.

    1999-01-01

    The spontaneous ignition of coal stockpiles is a serious economic and safety problem. This paper deals with oxidation and spontaneous combustion of coal piles laid in coal storage yard and the measures to avoid the heat losses produced. Investigations on self heating were carried out with five test

  12. Faith community nursing demonstrates good stewardship of community benefit dollars through cost savings and cost avoidance.

    Science.gov (United States)

    Brown, Ameldia R; Coppola, Patricia; Giacona, Marian; Petriches, Anne; Stockwell, Mary Ann

    2009-01-01

    Health systems seeking responsible stewardship of community benefit dollars supporting Faith Community Nursing Networks require demonstration of positive measurable health outcomes. Faith Community Nurses (FCNs) answer the call for measurable outcomes by documenting cost savings and cost avoidances to families, communities, and health systems associated with their interventions. Using a spreadsheet tool based on Medicare reimbursements and diagnostic-related groupings, 3 networks of FCNs have together shown more than 600 000 (for calendar year 2008) healthcare dollars saved by avoidance of unnecessary acute care visits and extended care placements. The cost-benefit ratio of support dollars to cost savings and cost avoidance demonstrates that support of FCNs is good stewardship of community benefit dollars.

  13. Usage of solar aggregate stockpiles in the production of hot mix asphalt

    International Nuclear Information System (INIS)

    Androjić, Ivica; Kaluđer, Gordana

    2016-01-01

    Highlights: • Low energy storage mineral mixtures. • The impact of models thermal insulation on the temperature of aggregate. • Effect of periods with no solar radiation on the aggregate accumulated heat. • Low energy storage saves energy for preheating mineral mixtures. - Abstract: The production process of hot mix asphalt (HMA) requires a considerable demand for thermal energy which is fed into the process of drying and heating of mineral mixture. An overview of solar aggregate stockpiles designed in order to reduce energy consumption is given. Solar stockpiles were designed with the primary goal of achieving as much accumulation of thermal energy obtained from solar radiation as possible during the exposure period. Models of solar stockpiles were made with a constant volume capacity, variable thermal insulation thickness in the range of 2, 5 and 10 cm, and a glass ceiling surface to allow the realisation of high solar transmission into the interior of a stockpile. Temperature measurement of the mineral mixture deposited in the solar models and of those exposed to external environmental conditions was conducted during the period from May to November, 2015. The results achieved indicate to the facts that there comes to the constant growth in warmth of mineral mixtures in insulated stockpiles for the duration of their exposure to solar radiation, that an increase in thermal insulation thickness leads to the quadratic functional dependence between the referred thickness and mixture temperature and, ultimately, that there comes to the exponential loss of an accumulated thermal energy in insulated models in the period with no effect of solar radiation.

  14. Unmaking the bomb: Verifying limits on the stockpiles of nuclear weapons

    Science.gov (United States)

    Glaser, Alexander

    2017-11-01

    Verifying limits on the stockpiles of nuclear weapons may require the ability for international in-spectors to account for individual warheads, even when non-deployed, and to confirm the authenticity of nuclear warheads prior to dismantlement. These are fundamentally new challenges for nuclear verification, and they have been known for some time; unfortunately, due to a lack of sense of urgency, research in this area has not made substantial progress over the past 20 years. This chapter explores the central outstanding issues and offers a number of possible paths forward. In the case of confirming numerical limits, these in-clude innovative tagging techniques and approaches solely based on declarations using modern crypto-graphic escrow schemes; with regard to warhead confirmation, there has recently been increasing interest in developing fundamentally new measurement approaches where, in one form or another, sensitive infor-mation is not acquired in the first place. Overall, new international R&D efforts could more usefully focus on non-intrusive technologies and approaches, which may show more promise for early demonstration and adoption. In the meantime, while warhead dismantlements remain unverified, nuclear weapon states ought to begin to document warhead assembly, refurbishment, and dismantlement activities and movements of warheads and warhead components through the weapons complex in ways that international inspectors will find credible at a later time. Again, such a process could be enabled by modern cryptographic techniques such as blockchaining. Finally, and perhaps most importantly, it is important to recognize that the main reason for the complexity of technologies and approaches needed for nuclear disarmament verification is the requirement to protect information that nuclear weapon states consider sensitive. Ultimately, if information security concerns cannot be resolved to the satisfaction of all stakeholders, an alternative would be to "reveal the

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

    Science.gov (United States)

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

    2017-03-01

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

  16. Identifying and Predicting Profiles of Medical Noncompliance: Pediatric Caregivers' Antibiotic Stewardship.

    Science.gov (United States)

    Smith, Rachel A; Kim, Youllee; M'Ikanatha, Nkuchia M

    2018-05-14

    Sometimes compliance with medical recommendations is problematic. We investigated pediatric caregivers' (N = 606) patterns of noncompliance with antibiotic stewardship based on the obstacle hypothesis. We tested predictors of noncompliance framed by the obstacle hypothesis, dissonance theory, and psychological reactance. The results revealed four profiles of caregivers' stewardship: one marked by compliance (Stewards) and three marked by types of noncompliance (Stockers, Persuaders, and Dissenters). The covariate analysis showed that, although psychological reactance predicted being noncompliant, it was types of obstacles and discrepant experiences that predicted caregivers' patterns of noncompliance with antibiotic stewardship. Campaign planning often focuses on identifying the belief most associated with the targeted outcome, such as compliance. Noncompliance research, however, points out that persuaders may be successful to the extent to which they anticipate obstacles to compliance and address them in their influence attempts. A shift from medical noncompliance to patient engagement also affords an opportunity to consider how some recommendations create obstacles for others and to find positive ways to embrace conflicting needs, tensions, and reasons for refusal in order to promote collective goals.

  17. A boundary-spanning organization for transdisciplinary science on land stewardship: The Stewardship Network

    Directory of Open Access Journals (Sweden)

    A. Paige. Fischer

    2015-12-01

    Full Text Available Although people and organizations in the Great Lakes region, USA take seriously their role as stewards of natural resources, many lack capacity to fulfill that role in a meaningful way. Stepping into that gap, The Stewardship Network (TSN envisions "a world of empowered, connected communities caring for land and water, now and forever," and fulfills that vision through its mission to "connect, equip, and mobilize people and organizations to care for land and water in their communities." TSN uses a scalable model of linked local and regional capacity building, science communication, civic engagement, and on-the-ground stewardship activities to achieve these goals. The model engages local and regional groups in an ongoing process of learning around conservation and restoration that improves social and ecological knowledge. I share the story of TSN to demonstrate how transdisciplinary science can take hold locally and expand regionally to bring people from diverse disciplines and functional roles together to solve common problems. I demonstrate how researchers and practitioners can collaborate to create enduring mechanisms of social and ecological change.

  18. Designing behaviourally informed policies for land stewardship: A new paradigm

    Directory of Open Access Journals (Sweden)

    Don W Hine

    2015-06-01

    Full Text Available This paper argues the case for a new approach to the stewardship of land resources that uses behavioural science theory to support the design and application of policies that facilitate changes in behaviour by those who develop policy and the farmers who implement it. Current approaches have: focused on legally-based expert system; and have been devised by national and international bureaucracies with little or no knowledge of how land owners and managers are motivated, and how they think, behave and operate as stewards of their natural resources. A review of current approaches from the social scientific literature is provided, with a particular focus on principles from social psychology. This is followed by an examination of how these principles can be applied to influence behaviour related to land restoration and soil conservation. Examples of the problems with traditional approaches and the evolution of new approaches with full engagement of farmers as the delivery agents are provided from within the European Union, Iceland and Scotland. In the light of these examples and emerging thinking in other parts of the world, the paper sets out the basis for a new approach based on behavioural science theory and application, reinforcing the arguments already made in the literature for a social license for farming.

  19. Evaluation of pharmacy generalists performing antimicrobial stewardship services.

    Science.gov (United States)

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

    2015-08-01

    Improvements in medication use achieved by pharmacy generalists using a care bundle approach to antimicrobial stewardship are reported. A six-month prospective, repeated-treatment, quasi-experimental study involving three month-long intervention periods and three month-long control periods was conducted in the setting of an existing antimicrobial stewardship program at a large hospital. The intervention involved prospective audit and feedback conducted by pharmacy generalists who were trained in an antimicrobial stewardship care bundle approach. During control months, a pharmacy generalist who was not trained in antimicrobial stewardship rounded with the multidisciplinary team and provided standard-of-care pharmacy services. The primary endpoint was compliance with a care bundle of four antimicrobial stewardship metrics: documentation of indication for therapy in the medical record, selection of empirical therapy according to institutional guidelines, documented performance of indicated culture testing, and deescalation of therapy when indicated. Two-hundred eighty-six patients were enrolled in the study: 124 in the intervention group and 162 in the control group. The cumulative rate of full compliance with all care bundle components during the six-month study was significantly greater during intervention months than during control months (68.5% versus 45.7%, p management. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  20. Antimicrobial Stewardship in Daily Practice: Managing an Important Resource

    Directory of Open Access Journals (Sweden)

    Nicole Le Saux

    2014-01-01

    Full Text Available Antimicrobial stewardship is a recent concept that embodies the practical, judicious use of antimicrobials to decrease adverse outcomes from antimicrobials while optimizing the treatment of bacterial infections to reduce the emergence of resistant pathogens. The objectives of the present statement are to illustrate the principles of antimicrobial stewardship and to offer practical examples of how to make antimicrobial stewardship part of everyday hospital and outpatient practice. Vital components of antimicrobial stewardship include appropriate testing to diagnose whether infections are viral or bacterial, and using clinical follow-up rather than antibiotics in cases in which the child is not very ill and uncertainty exists. Other specific, important actions include questioning whether positive urine cultures are contaminated when there is no evidence of pyuria or inflammatory changes, and obtaining a chest radiograph to support a diagnosis of bacterial pneumonia. Optimizing the choice and dosage of antimicrobials also reduces the probability of clinical failures and subsequent courses of antimicrobials. A list of common clinical scenarios to promote stewardship is included.

  1. Long-Term Stewardship Program Science and Technology Requirements

    Energy Technology Data Exchange (ETDEWEB)

    Joan McDonald

    2002-09-01

    Many of the United States’ hazardous and radioactively contaminated waste sites will not be sufficiently remediated to allow unrestricted land use because funding and technology limitations preclude cleanup to pristine conditions. This means that after cleanup is completed, the Department of Energy will have long-term stewardship responsibilities to monitor and safeguard more than 100 sites that still contain residual contamination. Long-term stewardship encompasses all physical and institutional controls, institutions, information, and other mechanisms required to protect human health and the environment from the hazards remaining. The Department of Energy Long-Term Stewardship National Program is in the early stages of development, so considerable planning is still required to identify all the specific roles and responsibilities, policies, and activities needed over the next few years to support the program’s mission. The Idaho National Engineering and Environmental Laboratory was tasked with leading the development of Science and Technology within the Long-Term Stewardship National Program. As part of that role, a task was undertaken to identify the existing science and technology related requirements, identify gaps and conflicts that exist, and make recommendations to the Department of Energy for future requirements related to science and technology requirements for long-term stewardship. This work is summarized in this document.

  2. Defense Nuclear Material Stewardship Integrated Inventory Information Management System (IIIMS).

    Energy Technology Data Exchange (ETDEWEB)

    Aas, Christopher A.; Lenhart, James E.; Bray, Olin H.; Witcher, Christina Jenkin

    2004-11-01

    Sandia National Laboratories was tasked with developing the Defense Nuclear Material Stewardship Integrated Inventory Information Management System (IIIMS) with the sponsorship of NA-125.3 and the concurrence of DOE/NNSA field and area offices. The purpose of IIIMS was to modernize nuclear materials management information systems at the enterprise level. Projects over the course of several years attempted to spearhead this modernization. The scope of IIIMS was broken into broad enterprise-oriented materials management and materials forecasting. The IIIMS prototype was developed to allow multiple participating user groups to explore nuclear material requirements and needs in detail. The purpose of material forecasting was to determine nuclear material availability over a 10 to 15 year period in light of the dynamic nature of nuclear materials management. Formal DOE Directives (requirements) were needed to direct IIIMS efforts but were never issued and the project has been halted. When restarted, duplicating or re-engineering the activities from 1999 to 2003 is unnecessary, and in fact future initiatives can build on previous work. IIIMS requirements should be structured to provide high confidence that discrepancies are detected, and classified information is not divulged. Enterprise-wide materials management systems maintained by the military can be used as overall models to base IIIMS implementation concepts upon.

  3. Application of Electrocoagulation Process for Continuous Coal Stockpile Wastewater Treatment System

    Directory of Open Access Journals (Sweden)

    Rusdianasari Rusdianasari

    2017-02-01

    Full Text Available Coal wastewater is characterized by high total suspended solid (TSS, heavy metals, and low acidity (pH. The purpose of this study was to research the effects of the operating parameters such as applied voltage, the number of electrodes, and reaction time on a real coal stockpile wastewater in the continuous electrocoagulation process. For this purpose, aluminum electrodes were used in the presence of potassium chloride as an electrolyte. It has been shown that the removal efficiency of TSS and heavy metals content increased with increasing the applied voltage and reaction time. The results indicate that the electrocoagulation process is efficient and able to achieve 88.67% TSS removal, 95.65% ferrous removal, 99.11% manganesse removal, and pH increased until 7.1 at 24 volts during 120 min, respectively. The experiments demonstrated the effectiveness of electrocoagulation methods for the treatment of coal stockpile wastewater.

  4. Internal Controls and Compliance with Laws and Regulations for the National Defense Stockpile Transaction Fund Financial Statements for FY 1996

    National Research Council Canada - National Science Library

    Lane, F

    1997-01-01

    The Chief Financial Officers Act of 1990, as amended by the Federal Financial Management Act of 1994, requires an annual audit of revolving funds such as the National Defense Stockpile Transaction Fund...

  5. CFD simulations of the effect of wind on the spontaneous heating of coal stockpiles

    Czech Academy of Sciences Publication Activity Database

    Taraba, B.; Michalec, Zdeněk; Michalcová, V.; Blejchař, T.; Bojko, M.; Kozubková, M.

    2014-01-01

    Roč. 118, č. 1 (2014), s. 107-112 ISSN 0016-2361 Grant - others:GA ČR GA105/08/1414; TA ČR(CZ) TA01020351; GA MŠk(CZ) ED2.1.00/03.0100 Institutional support: RVO:68145535 Keywords : coal oxidation * spontaneous heating * CFD modelling * coal stockpile Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 3.520, year: 2014 http://www.sciencedirect.com/science/article/pii/S0016236113010053#

  6. Certainty in Stockpile Computing: Recommending a Verification and Validation Program for Scientific Software

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J.R.

    1998-11-01

    As computing assumes a more central role in managing the nuclear stockpile, the consequences of an erroneous computer simulation could be severe. Computational failures are common in other endeavors and have caused project failures, significant economic loss, and loss of life. This report examines the causes of software failure and proposes steps to mitigate them. A formal verification and validation program for scientific software is recommended and described.

  7. China's optimal stockpiling policies in the context of new oil price trend

    International Nuclear Information System (INIS)

    Xie, Nan; Yan, Zhijun; Zhou, Yi; Huang, Wenjun

    2017-01-01

    Optimizing the size of oil stockpiling plays a fundamental role in the process of making national strategic petroleum reserve (SPR) policies. There have been extensive studies on the operating strategies of SPR. However, previous literatures have paid more attention to a booming or stable international oil market, while few studies analyzed the impact of a long-term low oil price on SPR policy. As a supplement, this paper extends a static model to study China's optimal stockpiling policy under different oil price trends, and in response to different current oil prices. A new variable “FC”, which demonstrates the appreciation and depreciation of the reserved oil economic value, has been taken into account to assess the optimal size of SPR. In this paper, a more multi-perspective of view is provided to consider the policies of China's SPR, especially under the different trend of international oil price fluctuations. - Highlights: • We extended a static model to study optimal stockpiling size of China's SPR. • A new variable “FC” was applied to illustrate the shifting financial value of SPR. • We analyzed how current oil price and varied prediction influence optimal size. • Operational measures could be adjusted at the end of each decision-making period. • A more multifaceted of view might be provided for China's SPR policy-making.

  8. An empirical analysis of the dynamic programming model of stockpile acquisition strategies for China's strategic petroleum reserve

    International Nuclear Information System (INIS)

    Wu, Gang; Fan, Ying; Wei, Yi-Ming; Liu, Lan-Cui

    2008-01-01

    The world's future oil price is affected by many factors. The challenge, therefore, is how to select optimal stockpile acquisition strategies to minimize the cost of maintaining a reserve. This paper provides a new method for analyzing this problem using an uncertain dynamic programming model to analyze stockpile acquisition strategies for strategic petroleum reserve. Using this model, we quantify the impact of uncertain world oil price on optimal stockpile acquisition strategies of China's strategic petroleum reserve for the period 2007-2010 and 2011-2020. Our results show that the future stockpile acquisition is related to oil prices and their probability and, if not considering the occurrence of oil supply shortage, China should at least purchase 25 million barrels when world oil price is at an optimal level. The optimal price of stockpile acquisition of every year has a stronger relationship with the probability of high price; and the optimal expected price and size of stockpile acquisition is different in each year. (author)

  9. Improving Wellbeing and Environmental Stewardship Through Volunteering in Nature.

    Science.gov (United States)

    Molsher, Robyn; Townsend, Mardie

    2016-03-01

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

  10. The cause and effect of exclusionary zoning within a jurisdiction, and, The stockpile of petroleum needed to contain OPEC's price shocks

    Science.gov (United States)

    Vatter, Marc H.

    In Part I, I model a jurisdiction where residents differ by income, and housing confers benefits on neighbors. By majority vote, residents choose minima on consumption of housing that differ by neighborhood, and they separate into neighborhoods by income. In practice, such laws take the form of minimum lot sizes, bans on multi-family units, building codes, and other restrictions. This policy maximizes a benefit-cost welfare criterion. Alternative policies include no minima and a uniform minimum citywide, based on libertarian and utilitarian welfare criteria, respectively. I compare the policies in terms of efficiency, implementability, and distributional consequences, and give numerical examples based on U.S. data. Willingness to pay for the benefit-cost optimum is convex in income. This helps to explain why neighborhood stratification by income has outpaced stratification of income itself in U.S metropolitan areas since 1970. In the examples, gains to a rich household are in the thousands and losses to the poor in the hundreds of dollars annually. In Part II, I estimate the stockpile of petroleum sufficient to contain a price shock perpetrated by the OPEC. I estimate world demand for petroleum such that the long run price elasticity exceeds that in the short run, and supply from non-OPEC producers with a similar kind of lagged response. Given this structure for elasticities, OPEC profits from sudden increases in price. I simulate interaction among consumers, non-OPEC producers, OPEC, and an International Energy Agency (IEA) that punishes OPEC by releasing oil onto the market. I endow the IEA with increasingly large stockpiles until they suffice to limit price shocks to specified levels. Every 5 reduction in the shock raises present-valued world GDP by about 650 billion. The IEA now has 1.4 billion barrels of petroleum, including 700 million in the U.S. Strategic Petroleum Reserve. A 3 billion barrel stockpile would suffice to reduce a 35 price shock to 20, raising

  11. Organizing urban ecosystem services through environmental stewardship governance in New York City

    Science.gov (United States)

    James J. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

    2013-01-01

    How do stewardship groups contribute to the management of urban ecosystem services? In this paper, we integrate the research on environmental stewardship with the social-ecological systems literature to explain how stewardship groups serve as bridge organizations between public agencies and civic organizations, working across scales and sectors to build the flexible...

  12. ESIP's Emerging Provenance and Context Content Standard Use Cases: Developing Examples and Models for Data Stewardship

    Science.gov (United States)

    Ramdeen, S.; Hills, D. J.

    2013-12-01

    Earth science data collections range from individual researchers' private collections to large-scale data warehouses, from computer-generated data to field or lab based observations. These collections require stewardship. Fundamentally, stewardship ensures long term preservation and the provision of access to the user community. In particular, stewardship includes capturing appropriate metadata and documentation--and thus the context of the data's creation and any changes they underwent over time --to enable data reuse. But scientists and science data managers must translate these ideas into practice. How does one balance the needs of current and (projected) future stakeholders? In 2011, the Data Stewardship Committee (DSC) of the Federation of Earth Science Information Partners (ESIP) began developing the Provenance and Context Content Standard (PCCS). As an emerging standard, PCCS provides a framework for 'what' must be captured or preserved as opposed to describing only 'how' it should be done. Originally based on the experiences of NASA and NOAA researchers within ESIP, the standard currently provides data managers with content items aligned to eight key categories. While the categories and content items are based on data life cycles of remote sensing missions, they can be generalized to cover a broader set of activities, for example, preservation of physical objects. These categories will include the information needed to ensure the long-term understandability and usability of earth science data products. In addition to the PCCS, the DSC is developing a series of use cases based on the perspectives of the data archiver, data user, and the data consumer that will connect theory and practice. These cases will act as specifications for developing PCCS-based systems. They will also provide for examination of the categories and content items covered in the PCCS to determine if any additions are needed to cover the various use cases, and also provide rationale and

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

    Science.gov (United States)

    Nicolle, Lindsay E

    2014-02-12

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

  14. Stewardship - De nieuwe facilitaire werkelijkheid, Facto Magazine, nr. 12

    NARCIS (Netherlands)

    Kok, H.B.

    2011-01-01

    Voor het succesvol besturen van organisaties bestaan in de managementliteratuur diverse modellen en theorieën. Het lijkt er op dat de stewardship-theorie, die uitgaat van wederzijds vertrouwen, beter past bij de ontwikkeling die FM op dit moment doormaakt dan de agencytheorie

  15. Ecosystem stewardship: sustainability strategies for a rapidly changing planet

    Science.gov (United States)

    F. Stuart Chapin; Stephen R. Carpenter; Gary P. Kofinas; Carl Folke; Nick Abel; William C. Clark; Per Olsson; D. Mark Stafford Smith; Brian Walker; Oran R. Young; Fikret Berkes; Reinette Biggs; J. Morgan Grove; Rosamond L. Naylor; Evelyn Pinkerton; Will Steffen; Frederick J. Swanson

    2010-01-01

    Ecosystem stewardship is an action-oriented framework intended to foster the social-ecological sustainability of a rapidly changing planet. Recent developments identify three strategies that make optimal use of current understanding in an environment of inevitable uncertainty and abrupt change: reducing the magnitude of, and exposure and sensitivity to, known stresses...

  16. A state-stewardship view on executive compensation

    NARCIS (Netherlands)

    Liang, Hao; Renneboog, Luc; Li Sun, Sunny; Choi, J.; Powers, M.; Zhang, X.

    2016-01-01

    We take a state-stewardship view on the corporate governance model and executive compensation policies in economies with strong political involvement. In such a highly politically-oriented institutional environment, the business elites are not just professional managers but are also de facto

  17. 76 FR 17180 - Meeting of the Regional Resource Stewardship Council

    Science.gov (United States)

    2011-03-28

    ... area components of the draft NRP and the benefits and challenges stemming from such programs. 5. Public... and will be called on during the public comment period. Handout materials should be limited to one printed page. Written comments are also invited and may be mailed to the Regional Resource Stewardship...

  18. United States Department of Energy Nuclear Materials Stewardship

    International Nuclear Information System (INIS)

    Newton, J. W.

    2002-01-01

    The Department of Energy launched the Nuclear Materials Stewardship Initiative in January 2000 to accelerate the work of achieving integration and cutting long-term costs associated with the management of the Department's nuclear materials, with the principal focus on excess materials. Management of nuclear materials is a fundamental and enduring responsibility that is essential to meeting the Department's national security, nonproliferation, energy, science, and environmental missions into the distant future. The effective management of nuclear materials is important for a set of reasons: (1) some materials are vital to our national defense; (2) the materials pose physical and security risks; (3) managing them is costly; and (4) costs are likely to extend well into the future. The Department currently manages nuclear materials under eight programs, with offices in 36 different locations. Through the Nuclear Materials Stewardship Initiative, progress was during calendar year 20 00 in achieving better coordination and integration of nuclear materials management responsibilities and in evaluating opportunities to further coordinate and integrate cross-program responsibilities for the treatment, storage, and disposition of excess nuclear materials. During CY 2001 the Departmental approach to nuclear materials stewardship changed consistent with the business processes followed by the new administration. This paper reports on the progress of the Nuclear Materials Stewardship Initiative in evaluating and implementing these opportunities, and the remaining challenges in integrating the long-term management of nuclear materials

  19. ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC).

    Science.gov (United States)

    Chandy, Sujith J; Michael, Joy Sarojini; Veeraraghavan, Balaji; Abraham, O C; Bachhav, Sagar S; Kshirsagar, Nilima A

    2014-02-01

    Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance.

  20. Antimicrobial Stewardship Initiatives Throughout Europe: Proven Value for Money

    NARCIS (Netherlands)

    Oberje, E.J.M.; Tanke, M.A.C.; Jeurissen, P.P.T.

    2017-01-01

    Antimicrobial stewardship is recognized as a key component to stop the current European spread of antimicrobial resistance. It has also become evident that antimicrobial resistance is a problem that cannot be tackled by single institutions or physicians. Prevention of antimicrobial resistance needs

  1. Antimicrobial stewardship: attempting to preserve a strategic resource

    Directory of Open Access Journals (Sweden)

    Trevor Van Schooneveld, Md

    2011-07-01

    Full Text Available Antimicrobials hold a unique place in our drug armamentarium. Unfortunately the increase in resistance among both gram-positive and gram-negative pathogens coupled with a lack of new antimicrobial agents is threatening our ability to treat infections. Antimicrobial use is the driving force behind this rise in resistance and much of this use is suboptimal. Antimicrobial stewardship programs (ASP have been advocated as a strategy to improve antimicrobial use. The goals of ASP are to improve patient outcomes while minimizing toxicity and selection for resistant strains by assisting in the selection of the correct agent, right dose, and best duration. Two major strategies for ASP exist: restriction/pre-authorization that controls use at the time of ordering and audit and feedback that reviews ordered antimicrobials and makes suggestions for improvement. Both strategies have some limitations, but have been effective at achieving stewardship goals. Other supplemental strategies such as education, clinical prediction rules, biomarkers, clinical decision support software, and institutional guidelines have been effective at improving antimicrobial use. The most effective antimicrobial stewardship programs have employed multiple strategies to impact antimicrobial use. Using these strategies stewardship programs have been able to decrease antimicrobial use, the spread of resistant pathogens, the incidence of C. difficile infection, pharmacy costs, and improved patient outcomes.

  2. 36 CFR 230.6 - Landowner forest stewardship plan.

    Science.gov (United States)

    2010-07-01

    ... manage soil, water, aesthetic qualities, recreation, timber, and fish and wildlife resources in a manner... sells or otherwise conveys land covered by a landowner forest stewardship plan, such plan shall remain... plan. 230.6 Section 230.6 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE...

  3. Importance of antimicrobial stewardship to the English National Health Service

    Directory of Open Access Journals (Sweden)

    Dixon J

    2014-05-01

    Full Text Available Jill Dixon, Christopher JA Duncan Department of Infectious Diseases and Tropical Medicine, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK Abstract: Antimicrobials are an extremely valuable resource across the spectrum of modern medicine. Their development has been associated with dramatic reductions in communicable disease mortality and has facilitated technological advances in cancer therapy, transplantation, and surgery. However, this resource is threatened by the dwindling supply of new antimicrobials and the global increase in antimicrobial resistance. There is an urgent need for antimicrobial stewardship (AMS to protect our remaining antimicrobials for future generations. AMS emphasizes sensible, appropriate antimicrobial management for the benefit of the individual and society as a whole. Within the English National Health Service (NHS, a series of recent policy initiatives have focused on all aspects of AMS, including best practice guidelines for antimicrobial prescribing, enhanced surveillance mechanisms for monitoring antimicrobial use across primary and secondary care, and new prescribing competencies for doctors in training. Here we provide a concise summary to clarify the current position and importance of AMS within the NHS and review the evidence base for AMS recommendations. The evidence supports the impact of AMS strategies on modifying prescribing practice in hospitals, with beneficial effects on both antimicrobial resistance and the incidence of Clostridium difficile, and no evidence of increased sepsis-related mortality. There is also a promising role for novel diagnostic technologies in AMS, both in enhancing microbiological diagnosis and improving the specificity of sepsis diagnosis. More work is needed to establish an evidence base for interventions to improve public and patient education regarding the role of antibiotics in common clinical syndromes, such as respiratory tract infection. Future

  4. Using stockpile delegation to improve China's strategic oil policy: A multi-dimension stochastic dynamic programming approach

    International Nuclear Information System (INIS)

    Chen, Xin; Mu, Hailin; Li, Huanan; Gui, Shusen

    2014-01-01

    There has been much attention paid to oil security in China in recent years. Although China has begun to establish its own strategic petroleum reserve (SPR) to prevent potential losses caused by oil supply interruptions, the system aiming to ensure China's oil security is still incomplete. This paper describes and provides evidence for the benefits of an auxiliary strategic oil policy choice, which aims to strengthen China's oil supply security and offer a solution for strategic oil operations with different holding costs. In this paper, we develop a multi-dimension stochastic dynamic programming model to analyze the oil stockpile delegation policy, which is an intermediate policy between public and private oil stockpiles and is appropriate for the Chinese immature private oil stockpile sector. The model examines the effects of the oil stockpile delegation policy in the context of several distinct situations, including normal world oil market conditions, slight oil supply interruption, and serious oil supply interruption. Operating strategies that respond to different oil supply situations for both the SPR and the delegated oil stockpile were obtained. Different time horizons, interruption times and holding costs of delegated oil stockpiles were examined. The construction process of China's SPR was also taken into account. - Highlights: • We provided an auxiliary strategic oil policy rooted in Chinese local conditions. • The policy strengthen China's capability for preventing oil supply interruption. • We model to obtain the managing strategies for China's strategic petroleum reserve. • Both of the public and delegated oil stockpile were taken into consideration. • The three phase's construction process of China's SPR was taken into account

  5. Sharing Responsibility for Data Stewardship Between Scientists and Curators

    Science.gov (United States)

    Hedstrom, M. L.

    2012-12-01

    Data stewardship is becoming increasingly important to support accurate conclusions from new forms of data, integration of and computation across heterogeneous data types, interactions between models and data, replication of results, data governance and long-term archiving. In addition to increasing recognition of the importance of data management, data science, and data curation by US and international scientific agencies, the National Academies of Science Board on Research Data and Information is sponsoring a study on Data Curation Education and Workforce Issues. Effective data stewardship requires a distributed effort among scientists who produce data, IT staff and/or vendors who provide data storage and computational facilities and services, and curators who enhance data quality, manage data governance, provide access to third parties, and assume responsibility for long-term archiving of data. The expertise necessary for scientific data management includes a mix of knowledge of the scientific domain; an understanding of domain data requirements, standards, ontologies and analytical methods; facility with leading edge information technology; and knowledge of data governance, standards, and best practices for long-term preservation and access that rarely are found in a single individual. Rather than developing data science and data curation as new and distinct occupations, this paper examines the set of tasks required for data stewardship. The paper proposes an alternative model that embeds data stewardship in scientific workflows and coordinates hand-offs between instruments, repositories, analytical processing, publishers, distributors, and archives. This model forms the basis for defining knowledge and skill requirements for specific actors in the processes required for data stewardship and the corresponding educational and training needs.

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

    Science.gov (United States)

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

    2013-02-15

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

  7. Antimicrobial stewardship education in US colleges and schools of pharmacy.

    Science.gov (United States)

    Kufel, Wesley D; Jeffres, Meghan N; MacDougall, Conan; Cho, Jonathan C; Marx, Ashley H; Williams, Dennis M

    2018-05-28

    Pharmacists are key members of antimicrobial stewardship (AS) teams. It is unknown if and how US colleges and schools of pharmacy incorporate AS into their Doctor of Pharmacy (PharmD) curricula. This study was a cross-sectional, multicentre, electronic survey distributed to infectious diseases faculty or department chairs of 137 accredited and candidate-status PharmD programmes. One hundred and sixteen programmes participated, representing an 84.7% response rate. AS education was integrated into the required didactic, elective didactic and experiential education components of the curricula in 79 (68.1%), 43 (37.1%) and 97 (83.6%) PharmD programmes, respectively. The most common AS topics in required and elective didactic curricula were AS definitions, principles and purpose (98.7% and 86.0%) and the pharmacist's role in AS (93.7% and 83.7%). In the required and elective didactic curricula, lecture (93.7% and 86.0%) and case-based instruction (57.0% and 83.7%) were the most common instructional methods. For experiential education, the pharmacist's role in AS (96.9%), de-escalation of antimicrobials (96.9%) and antimicrobial dose optimization (95.9%) were the most common AS topics. PharmD programmes employing a faculty member who specializes in AS were more likely to offer AS experiential education than programmes without AS faculty (88.1% versus 71.9%, P = 0.049). Integration of AS education in US PharmD curricula is variable and there are considerable differences in the AS activities and topics delivered. PharmD programmes should attempt to expose students to AS education to prepare future pharmacists for AS practice. Efforts should be made to incorporate interprofessional collaboration into AS education.

  8. Hedging against antiviral resistance during the next influenza pandemic using small stockpiles of an alternative chemotherapy.

    Directory of Open Access Journals (Sweden)

    Joseph T Wu

    2009-05-01

    Full Text Available The effectiveness of single-drug antiviral interventions to reduce morbidity and mortality during the next influenza pandemic will be substantially weakened if transmissible strains emerge which are resistant to the stockpiled antiviral drugs. We developed a mathematical model to test the hypothesis that a small stockpile of a secondary antiviral drug could be used to mitigate the adverse consequences of the emergence of resistant strains.We used a multistrain stochastic transmission model of influenza to show that the spread of antiviral resistance can be significantly reduced by deploying a small stockpile (1% population coverage of a secondary drug during the early phase of local epidemics. We considered two strategies for the use of the secondary stockpile: early combination chemotherapy (ECC; individuals are treated with both drugs in combination while both are available; and sequential multidrug chemotherapy (SMC; individuals are treated only with the secondary drug until it is exhausted, then treated with the primary drug. We investigated all potentially important regions of unknown parameter space and found that both ECC and SMC reduced the cumulative attack rate (AR and the resistant attack rate (RAR unless the probability of emergence of resistance to the primary drug p(A was so low (less than 1 in 10,000 that resistance was unlikely to be a problem or so high (more than 1 in 20 that resistance emerged as soon as primary drug monotherapy began. For example, when the basic reproductive number was 1.8 and 40% of symptomatic individuals were treated with antivirals, AR and RAR were 67% and 38% under monotherapy if p(A = 0.01. If the probability of resistance emergence for the secondary drug was also 0.01, then SMC reduced AR and RAR to 57% and 2%. The effectiveness of ECC was similar if combination chemotherapy reduced the probabilities of resistance emergence by at least ten times. We extended our model using travel data between 105

  9. Algal biochar enhances the re-vegetation of stockpiled mine soils with native grass.

    Science.gov (United States)

    Roberts, David A; Cole, Andrew J; Paul, Nicholas A; de Nys, Rocky

    2015-09-15

    In most countries the mining industry is required to rehabilitate disturbed land with native vegetation. A typical approach is to stockpile soils during mining and then use this soil to recreate landforms after mining. Soil that has been stockpiled for an extended period typically contains little or no organic matter and nutrient, making soil rehabilitation a slow and difficult process. Here, we take freshwater macroalgae (Oedogonium) cultivated in waste water at a coal-fired power station and use it as a feedstock for the production of biochar, then use this biochar to enhance the rehabilitation of two types of stockpiled soil - a ferrosol and a sodosol - from the adjacent coal mine. While the biomass had relatively high concentrations of some metals, due to its cultivation in waste water, the resulting biochar did not leach metals into the pore water of soil-biochar mixtures. The biochar did, however, contribute essential trace elements (particularly K) to soil pore water. The biochar had very strong positive effects on the establishment and growth of a native plant (Kangaroo grass, Themeda australis) in both of the soils. The addition of the algal biochar to both soils at 10 t ha(-1) reduced the time to germination by the grass and increased the growth and production of plant biomass. Somewhat surprisingly, there was no beneficial effect of a higher application rate (25 t ha(-1)) of the biochar in the ferrosol, which highlights the importance of matching biochar application rates to the requirements of different types of soil. Nevertheless, we demonstrate that algal biochar can be produced from biomass cultivated in waste water and used at low application rates to improve the rehabilitation of a variety of soils typical of coal mines. This novel process links biomass production in waste water to end use of the biomass in land rehabilitation, simultaneously addressing two environmental issues associated with coal-mining and processing. Copyright © 2015

  10. CHARACTERIZATION OF METAL GRADES IN A STOCKPILE OF AN IRON MINE (CASE STUDY- CHOGHART IRON MINE, IRAN

    Directory of Open Access Journals (Sweden)

    Francesco Tinti

    2018-01-01

    Full Text Available In any mining operation due to the cut-off grade (economic criteria, materials classify into the ore and waste. The material with grade equal to or higher than the cut-off grade is considered as ore and the material with grade less than the cut-off grade is transported as wastes to the waste dumps. However, because of increasing metal demand, depleting of in situ ore reserves and so the reduction of cut-off grades for many metals, the mentioned waste dumps were considered as valuable ore reserves named stockpiles. In this paper, multivariate geostatistics was used to estimate the iron grades of two stockpiles following the sequential of piling procedures from the main source - the ore deposit - to the piling field. One stockpile is characterized by phosphorous concentration ((P % > 0.6 %, while the other by iron concentration ((Fe %< 50%. Since economic and physical constraints made sampling physically and economically problematic, the grade distribution and variability were estimated on the basis of primary blast-hole data from the main ore body and the mine’s long-term planning policy. A geostatistical model was applied to the excavated part of the iron deposit and the stockpile, by reconstructing ore selection, haulage and piling method. Results were validated through spatial variability of iron and phosphorous concentrations by comparing grade variability (Fe and P with mining and pilling units. This methodology allows characterizing the iron grades within stockpiles without any extra sampling.

  11. Applying a Data Stewardship Maturity Matrix to the NOAA Observing System Portfolio Integrated Assessment Process

    Science.gov (United States)

    Peng, G.; Austin, M.

    2017-12-01

    Identification and prioritization of targeted user community needs are not always considered until after data has been created and archived. Gaps in data curation and documentation in the data production and delivery phases limit data's broad utility specifically for decision makers. Expert understanding and knowledge of a particular dataset is often required as a part of the data and metadata curation process to establish the credibility of the data and support informed decision-making. To enhance curation practices, content from NOAA's Observing System Integrated Assessment (NOSIA) Value Tree, NOAA's Data Catalog/Digital Object Identifier (DOI) projects (collection-level metadata) have been integrated with Data/Stewardship Maturity Matrices (data and stewardship quality information) focused on assessment of user community needs. This results in user focused evidence based decision making tools created by NOAA's National Environmental Satellite, Data, and Information Service (NESDIS) through identification and assessment of data content gaps related to scientific knowledge and application to key areas of societal benefit. Through enabling user need feedback from the beginning of data creation through archive allows users to determine the quality and value of data that is fit for purpose. Data gap assessment and prioritization are presented in a user-friendly way using the data stewardship maturity matrices as measurement of data management quality. These decision maker tools encourages data producers and data providers/stewards to consider users' needs prior to data creation and dissemination resulting in user driven data requirements increasing return on investment. A use case focused on need for NOAA observations linked societal benefit will be used to demonstrate the value of these tools.

  12. Impact of an antimicrobial stewardship intervention on appropriateness of prescribing for community-acquired pneumonia in an Australian regional hospital.

    Science.gov (United States)

    Bond, Stuart E; Boutlis, Craig S; Yeo, Wilfred W; Miyakis, Spiros

    2017-05-01

    Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP. © 2017 Royal Australasian College of Physicians.

  13. Evidence synthesis and decision modelling to support complex decisions: stockpiling neuraminidase inhibitors for pandemic influenza usage [version 2; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Samuel I. Watson

    2017-03-01

    Full Text Available Objectives: The stockpiling of neuraminidase inhibitor (NAI antivirals as a defence against pandemic influenza is a significant public health policy decision that must be made despite a lack of conclusive evidence from randomised controlled trials regarding the effectiveness of NAIs on important clinical end points such as mortality. The objective of this study was to determine whether NAIs should be stockpiled for treatment of pandemic influenza on the basis of current evidence. Methods: A decision model for stockpiling was designed. Data on previous pandemic influenza epidemiology was combined with data on the effectiveness of NAIs in reducing mortality obtained from a recent individual participant meta-analysis using observational data. Evidence synthesis techniques and a bias modelling method for observational data were used to incorporate the evidence into the model. The stockpiling decision was modelled for adults (≥16 years old and the United Kingdom was used as an example. The main outcome was the expected net benefits of stockpiling in monetary terms. Health benefits were estimated from deaths averted through stockpiling. Results: After adjusting for biases in the estimated effectiveness of NAIs, the expected net benefit of stockpiling in the baseline analysis was £444 million, assuming a willingness to pay of £20,000/QALY ($31,000/QALY. The decision would therefore be to stockpile NAIs. There was a greater probability that the stockpile would not be utilised than utilised. However, the rare but catastrophic losses from a severe pandemic justified the decision to stockpile. Conclusions: Taking into account the available epidemiological data and evidence of effectiveness of NAIs in reducing mortality, including potential biases, a decision maker should stockpile anti-influenza medication in keeping with the postulated decision rule.

  14. Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics.

    Science.gov (United States)

    Vilhelmsson, Andreas; Mulinari, Shai

    2017-08-09

    Little is known about how pharmaceutical companies lobby authorities or experts regarding procurement or the use of vaccines and antivirals. This paper investigates how members of Denmark's pandemic planning committee experienced lobbying efforts by Roche, manufacturer of Tamiflu, the antiviral that was stockpiled before the 2009 A(H1N1) pandemic. Analysis of interviews with six of seven members of the Danish core pandemic committee, supplemented with documentary analysis. We sought to identify (1) arguments and (2) tactics used in lobbying, and to characterize interviewees' views on the impact of (3) lobbying and (4) scientific evidence on the decision to stockpile Tamiflu. Roche lobbied directly (in its own name) and through a seemingly independent third party. Roche used two arguments: (1) the procurement agreement had to be signed quickly because the drug would be delivered on a first-come, first-served basis and (2) Denmark was especially vulnerable to an influenza crisis because it had smaller Tamiflu stocks than other countries. Most interviewees suspected that lobbying had an impact on Tamiflu procurement. Our study highlights risks posed by pharmaceutical lobbying. Arguments and tactics deployed by Roche are likely to be repeated whenever many countries are negotiating drug procurements in a monopolistic market. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health.

  15. Stewardship to tackle global phosphorus inefficiency: The case of Europe.

    Science.gov (United States)

    Withers, Paul J A; van Dijk, Kimo C; Neset, Tina-Simone S; Nesme, Thomas; Oenema, Oene; Rubæk, Gitte H; Schoumans, Oscar F; Smit, Bert; Pellerin, Sylvain

    2015-03-01

    The inefficient use of phosphorus (P) in the food chain is a threat to the global aquatic environment and the health and well-being of citizens, and it is depleting an essential finite natural resource critical for future food security and ecosystem function. We outline a strategic framework of 5R stewardship (Re-align P inputs, Reduce P losses, Recycle P in bioresources, Recover P in wastes, and Redefine P in food systems) to help identify and deliver a range of integrated, cost-effective, and feasible technological innovations to improve P use efficiency in society and reduce Europe's dependence on P imports. Their combined adoption facilitated by interactive policies, co-operation between upstream and downstream stakeholders (researchers, investors, producers, distributors, and consumers), and more harmonized approaches to P accounting would maximize the resource and environmental benefits and help deliver a more competitive, circular, and sustainable European economy. The case of Europe provides a blueprint for global P stewardship.

  16. Spatially explicit data: stewardship and ethical challenges in science.

    Science.gov (United States)

    Hartter, Joel; Ryan, Sadie J; Mackenzie, Catrina A; Parker, John N; Strasser, Carly A

    2013-09-01

    Scholarly communication is at an unprecedented turning point created in part by the increasing saliency of data stewardship and data sharing. Formal data management plans represent a new emphasis in research, enabling access to data at higher volumes and more quickly, and the potential for replication and augmentation of existing research. Data sharing has recently transformed the practice, scope, content, and applicability of research in several disciplines, in particular in relation to spatially specific data. This lends exciting potentiality, but the most effective ways in which to implement such changes, particularly for disciplines involving human subjects and other sensitive information, demand consideration. Data management plans, stewardship, and sharing, impart distinctive technical, sociological, and ethical challenges that remain to be adequately identified and remedied. Here, we consider these and propose potential solutions for their amelioration.

  17. Water appropriation and ecosystem stewardship in the Baja desert

    OpenAIRE

    de las Heras Alejandro; Rodriguez Mario A.; Islas-Espinoza Marina

    2014-01-01

    The UNESCO San Francisco Rock Paintings polygon within El Vizcaino Biosphere Reserve in the Baja California Peninsula derives its moisture from the North American monsoon. There, ranchers have depended on the desert since the 18th century. More recently, the desert has depended on the environmental stewardship of the ranchers who have allayed mining exploitation and archaeological looting. Using a Rapid Assessment Procedure (RAP), climate data, and geographical informa...

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

    OpenAIRE

    Nicolle, Lindsay E

    2014-01-01

    Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicro...

  19. Antibiotic stewardship er etableret på Herlev Hospital

    DEFF Research Database (Denmark)

    Arpi, Magnus; Gjørup, Ida; Boel, Jonas Bredtoft

    2014-01-01

    A high incidence of Clostridium difficile and multiresistant organisms and increasing consumption of cephalosporins and quinolones have required an antibiotic stewardship programme, and antibiotic audits with feedback, revised guidelines and stringent prescription rules have been successful....... The hospital intervention was managed by an antibiotic team combined with contact persons in all departments, a pocket edition of the guideline was available, and monthly commented reports about antibiotic consumption in each department were presented on the intranet. Declining use of restricted antibiotics...

  20. Enzymes for Degradation of Energetic Materials and Demilitarization of Explosives Stockpiles - SERDP Annual (Interim) Report, 12/98

    Energy Technology Data Exchange (ETDEWEB)

    Shah, M.M.

    1999-01-18

    The current stockpile of energetic materials requiring disposal contains about half a million tons. Through 2001, over 2.1 million tons are expected to pass through the stockpile for disposal. Safe and environmentally acceptable methods for disposing of these materials are needed. This project is developing safe, economical, and environmentally sound processes using biocatalyst (enzymes) to degrade energetic materials and to convert them into economically valuable products. Alternative methods for destroying these materials are hazardous, environmentally unacceptable, and expensive. These methods include burning, detonation, land and sea burial, treatment at high temperature and pressure, and treatment with harsh chemicals. Enzyme treatment operates at room temperature and atmospheric pressure in a water solution.

  1. Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis.

    Science.gov (United States)

    Pfaller, Michael A; Castanheira, Mariana

    2016-01-01

    Candidemia and other forms of candidiasis are associated with considerable excess mortality and costs. Despite the addition of several new antifungal agents with improved spectrum and potency, the frequency of Candida infection and associated mortality have not decreased in the past two decades. The lack of rapid and sensitive diagnostic tests has led to considerable overuse of antifungal agents resulting in increased costs, selection pressure for resistance, unnecessary drug toxicity, and adverse drug interactions. Both the lack of timely diagnostic tests and emergence of antifungal resistance pose considerable problems for antifungal stewardship. Whereas antifungal stewardship with a focus on nosocomial candidiasis should be able to improve the administration of antifungal therapy in terms of drug selection, proper dose and duration, source control and de-escalation therapy, an important parameter, timeliness of antifungal therapy, remains a victim of slow and insensitive diagnostic tests. Fortunately, new proteomic and molecular diagnostic tools are improving the time to species identification and detection. In this review we will describe the potential impact that rapid diagnostic testing and antifungal stewardship can have on the management of nosocomial candidiasis. © The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. 2003 Stewardship progress report : committed to continuous improvement

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-12-01

    The stewardship initiative is a mandatory requirement for members of the Canadian Association of Petroleum Producers (CAPP). It involves performance management and benchmarking, voluntary audits and verification, as well as training and improved communication inside and outside the industry. This fourth annual progress report describes the environment, health, safety and socio-economic stewardship initiative. This report presents an aggregate of industry performance. Stewardship of Excellence awards were presented in 2003, celebrating outstanding performance by members who demonstrated their commitment to responsible development and continuous improvement within a business framework. The awards were presented in three categories, namely environment, health and safety, and socio-economic. Northrock Resources was presented with the award in the environment category for its voluntary waste gas reduction. The health and safety recognition went to Burlington Resources Canada Ltd. for superior office ergonomics, while the award in the socio-economic category was presented to Suncor Energy Inc. for Aboriginal business development. A brief overview of the achievements of each of these three companies was presented. tabs., figs.

  3. Resilience design: toward a synthesis of cognition, learning, and collaboration for adaptive problem solving in conservation and natural resource stewardship

    Directory of Open Access Journals (Sweden)

    Charles G. Curtin

    2014-06-01

    Full Text Available Through the resilience design approach, I propose to extend the resilience paradigm by re-examining the components of adaptive decision-making and governance processes. The approach can be divided into three core components: (1 equity design, i.e., the integration of collaborative approaches to conservation and adaptive governance that generates effective self-organization and emergence in conservation and natural resource stewardship; (2 process design, i.e., the generation of more effective knowledge through strategic development of information inputs; and (3 outcome design, i.e., the pragmatic synthesis of the previous two approaches, generating a framework for developing durable and dynamic conservation and stewardship. The design of processes that incorporate perception and learning is critical to generating durable solutions, especially in developing linkages between wicked social and ecological challenges. Starting from first principles based on human cognition, learning, and collaboration, coupled with nearly two decades of practical experience designing and implementing ecosystem-level conservation and restoration programs, I present how design-based approaches to conservation and stewardship can be achieved. This context is critical in helping practitioners and resources managers undertake more effective policy and practice.

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

    NARCIS (Netherlands)

    Sartelli, M.; Labricciosa, F.M.; Barbadoro, P.; Pagani, L.; Ansaloni, L.; Brink, A.J.; Carlet, J.; Khanna, A.; Chichom-Mefire, A.; Coccolini, F.; Saverio, S. Di; May, A.K.; Viale, P.; Watkins, R.R.; Scudeller, L.; Abbo, L.M.; Abu-Zidan, F.M.; Adesunkanmi, A.K.; Al-Dahir, S.; Al-Hasan, M.N.; Alis, H.; Alves, C.; Araujo da Silva, A.R.; Augustin, G.; Bala, M.; Barie, P.S.; Beltran, M.A.; Bhangu, A.; Bouchra, B.; Brecher, S.M.; Cainzos, M.A.; Camacho-Ortiz, A.; Catani, M.; Chandy, S.J.; Jusoh, A.C.; Cherry-Bukowiec, J.R.; Chiara, O.; Colak, E.; Cornely, O.A.; Cui, Y.; Demetrashvili, Z.; Simone, B. De; Waele, J.J. De; Dhingra, S.; Marzo, F. Di; Dogjani, A.; Dorj, G.; Dortet, L.; Duane, T.M.; Elmangory, M.M.; Enani, M.A.; Ferrada, P.; Esteban Foianini, J.; Gachabayov, M.; Gandhi, C.; Ghnnam, W.M.; Giamarellou, H.; Gkiokas, G.; Gomi, H.; Goranovic, T.; Griffiths, E.A.; Guerra Gronerth, R.I.; Haidamus Monteiro, J.C.; Hardcastle, T.C.; Hecker, A.; Hodonou, A.M.; Ioannidis, O.; Isik, A.; Iskandar, K.A.; Kafil, H.S.; Kanj, S.S.; Kaplan, L.J.; Kapoor, G.; Karamarkovic, A.R.; Kenig, J.; Kerschaever, I.; Khamis, F.; Khokha, V.; Kiguba, R.; Kim, H.B.; Ko, W.C.; Koike, K.; Kozlovska, I.; Kumar, A.; Lagunes, L.; Latifi, R.; Lee, J.G.; Lee, Y.R.; Leppaniemi, A.; Li, Y.; Liang, S.Y.; Lowman, W.; Machain, G.M.; Maegele, M.; Major, P.; Malama, S.; Manzano-Nunez, R.; Marinis, A.; Casas, I.; Goor, H. van; Zuidema, W.P.; Catena, F.

    2017-01-01

    BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on

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

    OpenAIRE

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

    2016-01-01

    Abstract There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial s...

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

    OpenAIRE

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

    2016-01-01

    There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardshi...

  7. Estimating landholders' probability of participating in a stewardship program, and the implications for spatial conservation priorities.

    Directory of Open Access Journals (Sweden)

    Vanessa M Adams

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

  8. Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative.

    Science.gov (United States)

    McPherson, Christopher; Lee, Brian R; Terrill, Cindy; Hersh, Adam L; Gerber, Jeffrey S; Kronman, Matthew P; Newland, Jason G

    2018-01-25

    In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention's (CDC) seven core elements of a successful ASP within a large subset of US Children's Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources.

  9. Characteristics of Pediatric Antimicrobial Stewardship Programs: Current Status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS Collaborative

    Directory of Open Access Journals (Sweden)

    Christopher McPherson

    2018-01-01

    Full Text Available In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP have been rapidly implemented in the United States (US. This study examines the prevalence of the Centers for Disease Control and Prevention’s (CDC seven core elements of a successful ASP within a large subset of US Children’s Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94% had established ASPs and 41 hospitals (79% included all seven core elements. Physician accountability (87% and a dedicated ASP pharmacist or drug expert (88% were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources.

  10. Environmental stewardship practices of veterinary professionals and educators related to use and disposal of pharmaceuticals and personal care products.

    Science.gov (United States)

    Lam, Jennifer; Chan, Samuel S; Conway, Flaxen D L; Stone, David

    2018-03-01

    OBJECTIVE To document the environmental stewardship practices (decisions and actions regarding use and disposal) of pet and human pharmaceuticals and personal care products (PPCPs) among pet-owning veterinary-care professionals (practicing veterinarians, veterinary students, and veterinary technicians and trainees) and environmental educators. DESIGN Internet-based cross-sectional survey. SAMPLE 191 pet owners (103 veterinary-care professionals and 88 environmental educators). PROCEDURES Study participants were recruited by means of a 2-part internet survey distributed to veterinary-care professional and environmental educator networks of individuals residing in Washington state, Oregon, and southern California. Survey questions addressed motivators for environmental stewardship practices (ie, decisions and actions regarding use and disposal of pet and human PPCPs). RESULTS Data were collected from 191 respondents; the response rate for individuals who self-selected to opt in was 78% (191/246). Of the 191 respondents, 42 (22%) stored pet pharmaceuticals indefinitely. The most common disposal method was the garbage (88/191 [46%]). Veterinary-care professionals counseled clients infrequently regarding environmental stewardship practices for PPCPs. Fifty-five percent (105/191) of all respondents preferred more environmentally friendly and clinically effective PPCPs. CONCLUSIONS AND CLINICAL RELEVANCE Results of the present survey emphasized the urgent need for improved educational resources to minimize environmental contamination from improper disposal of PPCPs. Environmental and economic motivations among pet owners in the veterinary-care and education professions indicate further opportunities for outreach and institutional support.

  11. Open-pit coal mine production sequencing incorporating grade blending and stockpiling options: An application from an Indian mine

    Science.gov (United States)

    Kumar, Ashish; Chatterjee, Snehamoy

    2017-05-01

    Production scheduling is a crucial aspect of the mining industry. An optimal and efficient production schedule can increase the profits manifold and reduce the amount of waste to be handled. Production scheduling for coal mines is necessary to maintain consistency in the quality and quantity parameters of coal supplied to power plants. Irregularity in the quality parameters of the coal can lead to heavy losses in coal-fired power plants. Moreover, the stockpiling of coal poses environmental and fire problems owing to low incubation periods. This article proposes a production scheduling formulation for open-pit coal mines including stockpiling and blending opportunities, which play a major role in maintaining the quality and quantity of supplied coal. The proposed formulation was applied to a large open-pit coal mine in India. This contribution provides an efficient production scheduling formulation for coal mines after utilizing the stockpile coal within the incubation periods with the maximization of discounted cash flows. At the same time, consistency is maintained in the quality and quantity of coal to power plants through blending and stockpiling options to ensure smooth functioning.

  12. When are stockpiled products consumed faster? A convenience-salience framework of postpurchase consumption incidence and quantity

    NARCIS (Netherlands)

    Chandon, P.; Wansink, B.

    2002-01-01

    When people stockpile products, how do they decide when and how much they will consume? To answer this question, the authors develop a framework that shows how the salience and convenience of products influence postpurchase consumption incidence and quantity. Multiple research methods¿including

  13. On Utilization and Stockpiling of Prescription Drugs when Co-payments Increase: Heterogeneity across Types of Drugs

    DEFF Research Database (Denmark)

    Skipper, Niels

    by stockpiling on their medications. This has implications for other papers in the literature that use variation in subsidy rates over time to estimate the price elasticity of demand. This is not the case for penicillin however, where price elasticities are estimated to be in the -.18 – -.35 range. Further, I...

  14. Public Health, Law, and Local Control: Destruction of the US Chemical Weapons Stockpile

    Science.gov (United States)

    Greenberg, Michael R.

    2003-01-01

    Destruction of US chemical weapons has begun at one of the 8 sites in the continental United States, was completed on Johnston Island in the Pacific Ocean, and is scheduled to begin in at least 3 other locations during the upcoming year. About 25% of the stockpile and 38% of the munitions had been destroyed as of December 31, 2002. However, the program has become controversial with regard to choice of technology, emergency management, and cost. This controversy is in large part due to efforts by some state and local governments and activist groups to play a more central role in a decisionmaking process that was once fully controlled by the US Army. PMID:12893599

  15. Evaluation of models of particulate suspension for a thorium ore stockpile

    International Nuclear Information System (INIS)

    Smith, W.J.

    1983-01-01

    Fifteen mathematical models of particle saltation, suspension, and resuspension were reviewed and categorized. Appropriate models were applied to the estimation of particulate releases from a hypothetical thorium ore storage pile. An assumed location (near Lemhi Pass, Montana) was used to permit the development of site specific information on ore characteristics and environmental influences. The available models were characterized in terms of suitability for representing aspects of the ore pile, such as rough surface features, wide particle size range, and site specific climate. Five models were selected for detailed study. A computer code for each of these is given. Site specific data for the assumed ore stockpile location were prepared. These data were manipulated to provide the input values required for each of the five models. Representative values and ranges for model variables are tabulated. The response of each model to input data for selected variables was determined. Each model was evaluated in terms of the physical realism of its response of each model to input data for selected variables was determined. Each model was evaluated in terms of the physical realism of its responses and its overall ability to represent the features of an ore stockpile. The two models providing the best representation were a modified version of the dust suspension subroutine TAILPS from the computer code MILDOS, and the dust suspension formulation from the computer code REDIST. Their responses are physically reasonable, although different from each other for two parameters: ore moisture and surface roughness. With the input values judged most representative of an ore pile near Lemhi Pass, the estimate of the release of suspended particulates is on the order of 1 g/m 2 -yr

  16. Economic framework for integrating environmental stewardship into ...

    African Journals Online (AJOL)

    A number of agricultural production technologies (based on natural resource management principles) exist that offer opportunities for achieving the two seemingly divergent goals because they have the characteristics to produce joint multiple outputs, i.e, they produce food and provide environmental services. However ...

  17. Idaho National Laboratory Comprehensive Land Use and Environmental Stewardship Report

    Energy Technology Data Exchange (ETDEWEB)

    No name listed on publication

    2011-08-01

    Land and facility use planning and decisions at the Idaho National Laboratory (INL) Site are guided by a comprehensive site planning process in accordance with Department of Energy Policy 430.1, 'Land and Facility Use Policy,' that integrates mission, economic, ecologic, social, and cultural factors. The INL Ten-Year Site Plan, prepared in accordance with Department of Energy Order 430.1B, 'Real Property Asset Management,' outlines the vision and strategy to transform INL to deliver world-leading capabilities that will enable the Department of Energy to accomplish its mission. Land use planning is the overarching function within real property asset management that integrates the other functions of acquisition, recapitalization, maintenance, disposition, real property utilization, and long-term stewardship into a coordinated effort to ensure current and future mission needs are met. All land and facility use projects planned at the INL Site are considered through a formal planning process that supports the Ten-Year Site Plan. This Comprehensive Land Use and Environmental Stewardship Report describes that process. The land use planning process identifies the current condition of existing land and facility assets and the scope of constraints across INL and in the surrounding region. Current land use conditions are included in the Comprehensive Land Use and Environmental Stewardship Report and facility assets and scope of constraints are discussed in the Ten-Year Site Plan. This report also presents the past, present, and future uses of land at the INL Site that are considered during the planning process, as well as outlining the future of the INL Site for the 10, 30, and 100-year timeframes.

  18. Remanufacture

    Energy Technology Data Exchange (ETDEWEB)

    Cornwall, J. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Dimotakis, P. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Dyson, F. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Garwin, R. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Katz, J. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Koonin, S. [The MITRE Corporation, McLean, VA (US). JASON Program Office; LeLevier, R. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Panofsky, W. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Peurifoy, B. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Schwitters, R. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Treiman, S. [The MITRE Corporation, McLean, VA (US). JASON Program Office; Williams, E. [The MITRE Corporation, McLean, VA (US). JASON Program Office

    1999-10-18

    The reconstitution of DOE remanufacturing takes place within the commitment to Science-Based Stockpile Stewardship (SBSS), and in an environment of the CTBT. The purpose of remanufacture is to maintain a safe and reliable stockpile of nuclear devices, together with their non-nuclear components that constitute a nuclear warhead.

  19. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, Emelie C.; Hulscher, Marlies E. J. L.; Mouton, Johan W.; Verduin, Cees M.; Stuart, James W. T. Cohen; Overdiek, Hans W. P. M.; van der Linden, Paul D.; Natsch, Stephanie; Hertogh, Cees M. P. M.; Wolfs, Tom F. W.; Schouten, Jeroen A.; Kullberg, Bart Jan; Prins, Jan M.

    2016-01-01

    Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes: clinical outcomes,

  20. Current evidence on hospital antimicrobial stewardship objectives : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, Emelie C.; Hulscher, Marlies E J L; Mouton, Johan W.; Verduin, Cees M.; Stuart, James W T Cohen; Overdiek, Hans W P M; van der Linden, Paul D.; Natsch, Stephanie; Hertogh, Cees M P M; Wolfs, Tom F W; Schouten, Jeroen A.; Kullberg, Bart Jan; Prins, Jan M.

    2016-01-01

    BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:

  1. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Schuts, E.C.; Hulscher, M.E.J.L.; Mouton, J.W.; Verduin, C.M.; Stuart, J.W.; Overdiek, H.W.; Linden, P.D. van der; Natsch, S.S.; Hertogh, C.M.; Wolfs, T.F.; Schouten, J.A.; Kullberg, B.J.; Prins, J.M.

    2016-01-01

    BACKGROUND: Antimicrobial stewardship is advocated to improve the quality of antimicrobial use. We did a systematic review and meta-analysis to assess whether antimicrobial stewardship objectives had any effects in hospitals and long-term care facilities on four predefined patients' outcomes:

  2. Antecedents and consequences of environmental stewardship in boundary-spanning B2B teams

    NARCIS (Netherlands)

    Ruyter, de J.C.; Jong, de A.; Wetzels, M.G.M.

    2009-01-01

    The authors examine antecedents and consequences of environmental stewardship in frontline business-to-business teams. On the basis of data from members of 34 teams organized into regional networks, they demonstrate the differential impact of team environmental stewardship on customer satisfaction

  3. Communicating the value and benefits of silviculture through partnerships and collaborative stewardship

    Science.gov (United States)

    1997-01-01

    Opening comments to this session share observations on the current management climate within the USDA Forest Service. Partnerships and collaborative stewardship as agency philosophy are discussed. Silviculturists roles, as scientists and managers are compared, and the need for internal and external cooperation stressed as we strive to meet forest stewardship goals....

  4. Gasoline toxicology: overview of regulatory and product stewardship programs.

    Science.gov (United States)

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

    2014-11-01

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

  5. Antimicrobial stewardship initiatives throughout Europe: proven value for money

    Directory of Open Access Journals (Sweden)

    Edwin J.M. Oberjé

    2017-03-01

    Full Text Available Antimicrobial stewardship is recognized as a key component to stop the current European spread of antimicrobial resistance. It has also become evident that antimicrobial resistance is a problem that cannot be tackled by single institutions or physicians. Prevention of antimicrobial resistance needs rigorous actions at ward level, institution level, national level and at supra-national levels. Countries can learn from each other and possibly transplant best practices across borders to prevent antimicrobial resistance. The aim of this study is to highlight some of the success stories of proven cost-effective interventions, and to describe the actions that have been taken, the outcomes that have been found, and the difficulties that have been met. In some cases we came across substantial scope for real-life cost savings. Although the best approach to effectively hinder the spread of antimicrobial resistance remains unclear and may vary significantly among settings, several EU-wide examples demonstrate that cost-effective antimicrobial stewardship is possible. Such examples can encourage others to implement (the most cost-effective elements in their system.

  6. Antimicrobial Stewardship: A Call to Action for Surgeons

    Science.gov (United States)

    Duane, Therese M.; Catena, Fausto; Tessier, Jeffrey M.; Coccolini, Federico; Kao, Lillian S.; De Simone, Belinda; Labricciosa, Francesco M.; May, Addison K.; Ansaloni, Luca; Mazuski, John E.

    2016-01-01

    Abstract Despite current antimicrobial stewardship programs (ASPs) being advocated by infectious disease specialists and discussed by national and international policy makers, ASPs coverage remains limited to only certain hospitals as well as specific service lines within hospitals. The ASPs incorporate a variety of strategies to optimize antimicrobial agent use in the hospital, yet the exact set of interventions essential to ASP success remains unknown. Promotion of ASPs across clinical practice is crucial to their success to ensure standardization of antimicrobial agent use within an institution. To effectively accomplish this standardization, providers who actively engage in antimicrobial agent prescribing should participate in the establishment and support of these programs. Hence, surgeons need to play a major role in these collaborations. Surgeons must be aware that judicious antibiotic utilization is an integral part of any stewardship program and necessary to maximize clinical cure and minimize emergence of antimicrobial resistance. The battle against antibiotic resistance should be fought by all healthcare professionals. If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders. If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients. PMID:27828764

  7. Improving Stewardship of Marine Resources: Linking Strategy to Opportunity

    Directory of Open Access Journals (Sweden)

    Franciska von Heland

    2014-07-01

    Full Text Available The need for improved stewardship of coastal and marine resources is evident worldwide. However, complex ecosystem dynamics, institutional inertia, and budgetary constraints impede such action. This study explores how networks of change-oriented individuals or “institutional entrepreneurs” can introduce new types of human-environment interaction. The focus is on investigating the interplay between the strategies of institutional entrepreneurs and broader system dynamics that shape the context in which they are working, and possible impacts of institutional entrepreneurship on marine governance. We explore these issues in the context of Wakatobi National Park in eastern Indonesia. We suggest that creating links between different social spheres, such as between marine resource management and spirituality or between marine resource management and education, may accelerate the development of a new ecosystem stewardship. We further suggest that the use of media has significant power to show alternative futures, but that media may also serve to objectify certain resource users and increase the complexity of marine resource management. In general, institutional entrepreneurs play an important role in capturing and managing opportunity to open up space for experimentation and novel ideas, for example by linking their ideas to broader political priorities. Yet, such strategies bear the risk of institutional capture. Finally, institutional entrepreneurs sometimes have vested interests in certain solutions that may forsake experimentation toward a sustainable future.

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

    Science.gov (United States)

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

    2017-11-01

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

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

    Science.gov (United States)

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

    2016-07-27

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

  10. Prediction of temperature and thermal inertia effect in the maturation stage and stockpiling of a large composting mass

    OpenAIRE

    Barrena Gómez, Raquel

    2006-01-01

    A macroscopic non-steady state energy balance was developed and solved for a composting pile of source-selected organic fraction of municipal solid waste during the maturation stage (13,500 kg of compost). Simulated temperature profiles correlated well with temperature experimental data (ranging from 50 to 70 °C) obtained during the maturation process for more than 50 days at full scale. Thermal inertia effect usually found in composting plants and associated to the stockpiling of large compo...

  11. Engineering of Soil Biological Quality from Nickel Mining Stockpile Using Two Earthworm Ecological Groups

    Directory of Open Access Journals (Sweden)

    L M H Kilowasid

    2015-04-01

    Full Text Available Earthworms have the ability in modifying soil biological quality for plant growth. Their ability is mostly depending on its ecological groups. The objectives of the research were to study the influence of two ecological groups of earthworms on soil microbial activity and soil micro-fauna abundance, and to know the potential of soil modified by earthworms as plant growth medium. Eight combination of individual earthworm from epigeic and endogeic groups was applied into pot that was filled by soil from two years of nickel stockpile and each treatment was repeated by five times. The experiment was following complete randomize design procedure. After sixteen days of research, the soil sample from each pot was analyzed for soil FDA activity, number of flagellate and nematodes. Furthermore, one kg of the soil from each pot was taken and every pot was grown by Paraserianthes falcataria seedling with the age of five days and continued its growth for two months. The results indicated that the soil FDA activity, number of flagellate and nematodes among treatments were significantly differences. In addition, it indicated the significant differences in dry weight of shoot, root, total plant, and root to shoot ratio of P. falcataria seedlings. It concluded that the combination of an individual number of epigeic and endogeic earthworms improved soil biological quality of stock pile, amd most suitable for seedlings growth in nickel mining area.

  12. The pharmaceuticalisation of security: Molecular biomedicine, antiviral stockpiles, and global health security.

    Science.gov (United States)

    Elbe, Stefan

    2014-12-01

    Pharmaceuticals are now critical to the security of populations. Antivirals, antibiotics, next-generation vaccines, and antitoxins are just some of the new 'medical countermeasures' that governments are stockpiling in order to defend their populations against the threat of pandemics and bioterrorism. How has security policy come to be so deeply imbricated with pharmaceutical logics and solutions? This article captures, maps, and analyses the 'pharmaceuticalisation' of security. Through an in-depth analysis of the prominent antiviral medication Tamiflu , it shows that this pharmaceutical turn in security policy is intimately bound up with the rise of a molecular vision of life promulgated by the biomedical sciences. Caught in the crosshairs of powerful commercial, political, and regulatory pressures, governments are embracing a molecular biomedicine promising to secure populations pharmaceutically in the twenty-first century. If that is true, then the established disciplinary view of health as a predominantly secondary matter of 'low' international politics is mistaken. On the contrary, the social forces of health and biomedicine are powerful enough to influence the core practices of international politics - even those of security. For a discipline long accustomed to studying macrolevel processes and systemic structures, it is in the end also our knowledge of the minute morass of molecules that shapes international relations.

  13. Hydroxocobalamin as a Cyanide Antidote: Empirical use , Safety, Efficacy, and Considerations for Stockpiling

    International Nuclear Information System (INIS)

    Hall, A. H.

    2007-01-01

    Cyanide is a well-known toxic terrorism agent and is a major cause of mortality and morbidity in smoke inhalation victims. Terrorist attacks could start enclosed-space fires with cyanide-poisoned victims, even if cyanide itself was not utilized. Cyanide poisoning cannot be emergent confirmed by laboratory analysis and treatment with safe and efficacious antidotes must be administered empirically. Hydroxocobalamin has been recently approved by the US FDA and is a safe and efficacious antidote. Its efficacy is comparable to that of other, more toxic, cyanide antidotes. Its mechanism of action involves both direct cyanide chelation (forming non-toxic cyanocobalamin which is excreted in the urine) and nitric oxide scavenging. Adverse effects are usually limited to transient dark red-brown discoloration of urine, skin, sclera, and mucous membranes. Antidotal doses have not caused allergic reactions in cyanide-poisoned patients and only minor and easily-treated allergic reactions occurred in 2 of 136 normal volunteers. Transient, asymptomatic hypertension and reflex bradycardia have occurred in some normal volunteers, but not in seriously ill smoke inhalation victims not having significant cyanide poisoning. Hydroxocobalamin is a safe and efficacious antidote and can be empirically administered in pre-hospital or emergency department settings. It is therefore suitable for inclusion in national or multinational medication stockpiles and is already included in some national programs in the European Union.(author)

  14. Training should be the first step toward an antifungal stewardship program.

    Science.gov (United States)

    Valerio, Maricela; Muñoz, Patricia; Rodríguez-González, Carmen; Sanjurjo, María; Guinea, Jesús; Bouza, Emilio

    2015-04-01

    The frequency of use of systemic antifungal agents has increased significantly in most tertiary centers. However, antifungal stewardship has received very little attention. The objective of this article was to assess the knowledge of prescribing physicians in our institution as a first step in the development of an antifungal stewardship program. Attending physicians from the departments that prescribe most antifungals were invited to complete a questionnaire based on current guidelines on diagnosis and therapy of invasive candidiasis and invasive aspergillosis (IA). The survey was completed by 60.8% (200/329) of the physicians who were invited to participate. The physicians belonged to the following departments: medical (60%), pediatric (19%), intensive care (15.5%), and surgical (5.5%). The mean (±SD) score of correct responses was 5.16±1.73. In the case of candidiasis, only 55% of the physicians clearly distinguished between colonization and infection, and 17.5% knew the local rate of fluconazole resistance. Thirty-three percent knew the accepted indications for antifungal prophylaxis, and 23% the indications for empirical therapy. However, most physicians knew which antifungals to choose when starting empirical therapy (73.5%). As for aspergillosis, most physicians (67%) could differentiate between colonization and infection, and 34.5% knew the diagnostic value of galactomannan. The radiological features of IA were well recognized by 64%, but only 31.5% were aware of the first line of treatment for IA, and 36% of the recommended duration of therapy. The usefulness of antifungal levels was known by 67%. This simple, easily completed questionnaire enabled us to identify which areas of our training strategy could be improved. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  15. OPTIMIZING ANTIMICROBIAL PHARMACODYNAMICS: A GUIDE FOR YOUR STEWARDSHIP PROGRAM

    Directory of Open Access Journals (Sweden)

    Joseph L. Kuti, PharmD

    2016-09-01

    Full Text Available Pharmacodynamic concepts should be applied to optimize antibiotic dosing regimens, particularly in the face of some multidrug resistant bacterial infections. Although the pharmacodynamics of most antibiotic classes used in the hospital setting are well described, guidance on how to select regimens and implement them into an antimicrobial stewardship program in one's institution are more limited. The role of the antibiotic MIC is paramount in understanding which regimens might benefit from implementation as a protocol or use in individual patients. This review article outlines the pharmacodynamics of aminoglycosides, beta-lactams, fluoroquinolones, tigecycline, vancomycin, and polymyxins with the goal of providing a basis for strategy to select an optimized antibiotic regimen in your hospital setting.

  16. Product Stewardship in Uranium: A Way for the Industry to Demonstrate its High Performance

    International Nuclear Information System (INIS)

    Harris, Frank

    2014-01-01

    Conclusions: • Product stewardship is an means for communicating the high performance on health, safety and environment of the nuclear fuel cycle including uranium mining. • It has been effective with other products and is appropriate for uranium. • Can be a vehicle for addressing public concerns across the industry. • Due to uranium’s unique characteristics it has the potential to be a best practice example of product stewardship. • Work is underway in the international arena to progress uranium product stewardship and it represent a unique opportunity to provide whole of industry benefits

  17. ACAM2000™: The new smallpox vaccine for United States Strategic National Stockpile

    Directory of Open Access Journals (Sweden)

    Aysegul Nalca

    2010-05-01

    Full Text Available Aysegul Nalca, Elizabeth E ZumbrunCenter for Aerobiological Sciences, US Army Medical Research Institute of Infectious Diseases (USAMRIID, Fort Detrick, MD, USAAbstract: Smallpox was eradicated more than 30 years ago, but heightened concerns over bioterrorism have brought smallpox and smallpox vaccination back to the forefront. The previously licensed smallpox vaccine in the United States, Dryvax® (Wyeth Laboratories, Inc., was highly effective, but the supply was insufficient to vaccinate the entire current US population. Additionally, Dryvax® had a questionable safety profile since it consisted of a pool of vaccinia virus strains with varying degrees of virulence, and was grown on the skin of calves, an outdated technique that poses an unnecessary risk of contamination. The US government has therefore recently supported development of an improved live vaccinia virus smallpox vaccine. This initiative has resulted in the development of ACAM2000™ (Acambis, Inc.™, a single plaque-purified vaccinia virus derivative of Dryvax®, aseptically propagated in cell culture. Preclinical and clinical trials reported in 2008 demonstrated that ACAM2000™ has comparable immunogenicity to that of Dryvax®, and causes a similar frequency of adverse events. Furthermore, like Dryvax®, ACAM2000™ vaccination has been shown by careful cardiac screening to result in an unexpectedly high rate of myocarditis and pericarditis. ACAM2000™ received US Food and Drug Administration (FDA approval in August 2007, and replaced Dryvax® for all smallpox vaccinations in February 2008. Currently, over 200 million doses of ACAM2000™ have been produced for the US Strategic National Stockpile. This review of ACAM2000™ addresses the production, characterization, clinical trials, and adverse events associated with this new smallpox vaccine.Keywords: smallpox, vaccinia, variola, vaccine, efficacy, safety

  18. NCDC International Best Track Archive for Climate Stewardship (IBTrACS) Project, Version 3

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The International Best Track Archive for Climate Stewardship (IBTrACS) dataset was developed by the NOAA National Climatic Data Center, which took the initial step...

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

    Science.gov (United States)

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

    2013-02-15

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

  20. 77 FR 6820 - Proposed Information Collection; Comment Request: Creating Stewardship Through Biodiversity...

    Science.gov (United States)

    2012-02-09

    ... Information Collection; Comment Request: Creating Stewardship Through Biodiversity Discovery in National Parks... collection (IC) described below. This collection will survey participants of Biodiversity Discovery efforts... Biodiversity Discovery refers to a variety of efforts to discover living organisms through public involvement...

  1. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

    Wentzel, Jobke; van Velsen, Lex; van Limburg, Maarten; de Jong, Nienke; Karreman, Joyce; Hendrix, Ron; van Gemert-Pi, Julia Elisabeth Wilhelmina Cornelia

    2014-01-01

    Background: Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put

  2. Participatory eHealth development to support nurses in antimicrobial stewardship

    NARCIS (Netherlands)

    Wentzel, M.J.; van Velsen, Lex Stefan; van Limburg, A.H.M.; Beerlage-de Jong, Nienke; Karreman, Joyce; Hendrix, Ron; van Gemert-Pijnen, Julia E.W.C.

    2014-01-01

    Background Antimicrobial resistance poses a threat to patient safety worldwide. To stop antimicrobial resistance, Antimicrobial Stewardship Programs (ASPs; programs for optimizing antimicrobial use), need to be implemented. Within these programs, nurses are important actors, as they put

  3. Strategic Plan for Sustainable Energy Management and Environmental Stewardship for Los Angeles Unified School District

    Energy Technology Data Exchange (ETDEWEB)

    Walker, A.; Beattie, D.; Thomas, K.; Davis, K.; Sim, M.; Jhaveri, A.

    2007-11-01

    This Strategic Plan for Sustainable Energy Management and Environmental Stewardship states goals, measures progress toward goals and how actions are monitored to achieve continuous improvement for the Los Angeles Unified School District.

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

    OpenAIRE

    Sartelli, M.; Labricciosa, F.M.; Barbadoro, P.; Pagani, L.; Ansaloni, L.; Brink, A.J.; Carlet, J.; Khanna, A.; Chichom-Mefire, A.; Coccolini, F.; Saverio, S. Di; May, A.K.; Viale, P.; Watkins, R.R.; Scudeller, L.

    2017-01-01

    BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial steward...

  5. Saint Joseph's University Institute for Environmental Stewardship

    Energy Technology Data Exchange (ETDEWEB)

    McCann, Micahel P. [Saint Joseph' s Univ., Philadelphia, PA (United States); Springer, Clint J. [Saint Joseph' s Univ., Philadelphia, PA (United States)

    2014-06-03

    Task A: Examination of the physiological, morphological, and reproductive responses of Panicum virgatum (switchgrass) cultivars identified as potential biofuel producing cultivars as well as naturally-occurring varieties of switchgrass to projected changes in climate for the central portion of the United States. This project was a multi-year project set in a field site located at the Konza Prairie Biological Station near Manhattan, KS USA. The major objective of the study was to understand the physiological and growth responses of the important biofuel grass species, Panicum virgatum (switch grass) to simulated changes in precipitation expected for the Central Plains region of the United States. Population level adaptation to broad-scale regional climates or within-population variation in genome size of this genetically and phenotypically diverse C4 grass species may influence the responses to future precipitation variability associated with climate change. Therefore, we investigated switchgrass responses to water variability between natural populations collected across latitudinal gradient and populations. P. virgatum plants from natural populations originating from Kansas, Oklahoma, and Texas received frequent, small precipitation events (“ambient’) or infrequent, large precipitation events (‘altered”) to simulate contrasting rainfall variability expected from this region. We measured leaf-level physiology, aboveground biomass varied significantly by population origin but did not differ by genome size. Our results suggest that trait variation in P. virgatum is primarily attributed to population-level adaptation across latitudinal gradient, not genome size, and that neither population-level adaptation nor genome size may be important predictors of P. virgatum responses to future climatic conditions. Based solely on the data presented here, the most important consideration when deciding what varieties of switchgrass to cultivate for biofuel feedstocks under

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

    Science.gov (United States)

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

    2018-01-11

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Lucas Miyake Okumura

    2016-05-01

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

  9. Defining antimicrobial stewardship competencies for undergraduate health professional education in the United Kingdom: A study protocol.

    Science.gov (United States)

    Courtenay, Molly; Castro-Sánchez, Enrique; Deslandes, Rhian; Hodson, Karen; Lim, Rosemary; Morris, Gary; Reeves, Scott; Weiss, Marjorie

    2018-04-16

    Multi-drug resistant infections have been identified as one of the greatest threats to human health. Healthcare professionals are involved in an array of patient care activities for which an understanding of antimicrobial stewardship is important. Although antimicrobial prescribing and stewardship competencies have been developed for healthcare professionals who adopt the role of a prescriber, competencies do not exist for other medicine-related stewardship activities. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. This report presents a protocol for a study designed to provide national consensus on antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. A modified Delphi process will be used in which a panel of Experts, comprising members from across the United Kingdom, with expertise in prescribing and medicines management with regard to the education and practice of healthcare professionals, and antimicrobial prescribing and stewardship, will be invited to take part in two survey rounds. The competencies developed will be applicable to all undergraduate healthcare professional education programmes. They will help to standardise curricula content and enhance the impact of antimicrobial stewardship education.

  10. Collaboration in long-term stewardship at DOE Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Moren, R. J.; Zeisloft, J. H.; Feist, E. T.; Brown, D.; Grindstaff, K. D.

    2013-01-10

    The U.S. Department of Energy's (DOE) Hanford Site comprises approximately 1,517 km{sup 2} (586 mi{sup 2}) of land in southeastern Washington. The site was established in 1943 as part of the Manhattan Project to produce plutonium for the nation's nuclear weapons program. As the Cold War era came to an end, the mission of the site transitioned from weapons production to environmental cleanup. As the River Corridor area of the site cleanup is completed, the mission for that portion of the site will transition from active cleanup to continued protection of environment through the Long-Term Stewardship (LTS) Program. The key to successful transition from cleanup to LTS is the unique collaboration among three (3) different DOE Programs and three (3) different prime contractors with each contractor having different contracts. The LTS Program at the site is a successful model of collaboration resulting in efficient resolution of issues and accelerated progress that supports DOE's Richland Office 2015 Vision for the Hanford Site. The 2015 Vision for the Hanford Site involves shrinking the active cleanup footprint of the surface area of the site to approximately 20 mi{sup 2} on the Central Plateau. Hanford's LTS Program is defined in DOE's planning document, Hanford Long-Term Stewardship Program Plan, DOE/RL-2010-35 Rev 1. The Plan defines the relationship and respective responsibilities between the federal cleanup projects and the LTS Program along with their respective contractors. The LTS Program involves these different parties (cleanup program and contractors) who must work together to achieve the objective for transition of land parcels. Through the collaborative efforts with the prime contractors on site over the past two years, 253.8 km{sup 2} (98 mi{sup 2}) of property has been successfully transitioned from the cleanup program to the LTS Program upon completion of active surface cleanup. Upcoming efforts in the near term will include transitioning another large

  11. Long-Term Stewardship At DOE's Hanford Site - 12575

    International Nuclear Information System (INIS)

    Moren, R.J.; Grindstaff, K.D.

    2012-01-01

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

  12. Building the strategic national stockpile through the NIAID Radiation Nuclear Countermeasures Program.

    Science.gov (United States)

    Rios, Carmen I; Cassatt, David R; Dicarlo, Andrea L; Macchiarini, Francesca; Ramakrishnan, Narayani; Norman, Mai-Kim; Maidment, Bert W

    2014-02-01

    The possibility of a public health radiological or nuclear emergency in the United States remains a concern. Media attention focused on lost radioactive sources and international nuclear threats, as well as the potential for accidents in nuclear power facilities (e.g., Windscale, Three Mile Island, Chernobyl, and Fukushima) highlight the need to address this critical national security issue. To date, no drugs have been licensed to mitigate/treat the acute and long-term radiation injuries that would result in the event of large-scale, radiation, or nuclear public health emergency. However, recent evaluation of several candidate radiation medical countermeasures (MCMs) has provided initial proof-of-concept of efficacy. The goal of the Radiation Nuclear Countermeasures Program (RNCP) of the National Institute of Allergy and Infectious Diseases (National Institutes of Health) is to help ensure the government stockpiling of safe and efficacious MCMs to treat radiation injuries, including, but not limited to, hematopoietic, gastrointestinal, pulmonary, cutaneous, renal, cardiovascular, and central nervous systems. In addition to supporting research in these areas, the RNCP continues to fund research and development of decorporation agents targeting internal radionuclide contamination, and biodosimetry platforms (e.g., biomarkers and devices) to assess the levels of an individual's radiation exposure, capabilities that would be critical in a mass casualty scenario. New areas of research within the program include a focus on special populations, especially pediatric and geriatric civilians, as well as combination studies, in which drugs are tested within the context of expected medical care management (e.g., antibiotics and growth factors). Moving forward, challenges facing the RNCP, as well as the entire radiation research field, include further advancement and qualification of animal models, dose conversion from animal models to humans, biomarker identification, and

  13. Critical evaluation of emergency stockpile ventilators in an in vitro model of pediatric lung injury.

    Science.gov (United States)

    Custer, Jason W; Watson, Christopher M; Dwyer, Joe; Kaczka, David W; Simon, Brett A; Easley, R Blaine

    2011-11-01

    Modern health care systems may be inadequately prepared for mass casualty respiratory failure requiring mechanical ventilation. Current health policy has focused on the "stockpiling" of emergency ventilators, though little is known about the performance of these ventilators under conditions of respiratory failure in adults and children. In this study, we seek to compare emergency ventilator performance characteristics using a test lung simulating pediatric lung injury. Evaluation of ventilator performance using a test lung. Laboratory. None. Six transport/emergency ventilators capable of adult/child application were chosen on the basis of manufacturer specifications, Autovent 3000, Eagle Univent 754, EPV 100, LP-10, LTV 1200, and Parapac 200D. Manufacturer specifications for each ventilator were reviewed and compared with known standards for alarms and functionality for surge capacity ventilators. The delivered tidal volume, gas flow characteristics, and airway pressure waveforms were evaluated in vitro using a mechanical test lung to model pediatric lung injury and integrated software. Test lung and flow meter recordings were analyzed over a range of ventilator settings. Of the six ventilators assessed, only two had the minimum recommended alarm capability. Four of the six ventilators tested were capable of being set to deliver a tidal volume of less than 200 mL. The delivered tidal volume for all ventilators was within 8% of the nominal setting at a positive end expiratory pressure of zero but was reduced significantly with the addition of positive end expiratory pressure (range, ±10% to 30%; p ventilators tested performed comparably at higher set tidal volumes; however, only three of the ventilators tested delivered a tidal volume across the range of ventilator settings that was comparable to that of a standard intensive care unit ventilator. Multiple ventilators are available for the provision of ventilation to children with respiratory failure in a mass

  14. Antibiotic stewardship programs and the internist’s role

    Directory of Open Access Journals (Sweden)

    Massimo Giusti

    2016-12-01

    Full Text Available Antimicrobial resistance (AMR is a worldwide issue, but with significant epidemiological diversity in different countries. A recently observed phenomenon is represented by the diffusion of AMR, initially confined to intensive-care units, to medical wards. This was predictable, since patients hospitalized in medical units are made up of more than 70% of elderly people (over 75 years of age in 1 case out of 2. They are fragile patients, with significant comorbidity (over a half with at least 3 diseases, weakened immune systems, and consequently a higher risk of infection. Given such a scenario, it becomes therefore both necessary and urgent to adopt a multifaceted approach of antimicrobial stewardship programs in order to prevent, detect and control the emergence of antimicrobial resistant organisms. The ideal antimicrobial program is led by an infectious diseases (ID physician and clinical pharmacist with ID training, together with a list of other important staff: clinical microbiologist, information systems specialist, infection control professional, and hospital epidemiologist. In real life, not all the Italian hospitals have got an ID physician and therefore the best canditates for antimicrobial management practices are internists if provided with a specific expertise in ID and antibiotic therapy. Adhering to the principles of optimal antimicrobial therapy in their clinical practice, the internist is able to improve the care and help to reduce the resistance of a patient at his bedside. At the same time, he can achieve other key goals reducing the length of stay and reducing the cost and utilization of health care resources.

  15. Nuclear Materials Stewardship Within the DOE Environmental Management Program

    International Nuclear Information System (INIS)

    Bilyeu, J. D.; Kiess, T. E.; Gates, M. L.

    2002-01-01

    The Department of Energy (DOE) Environmental Management (EM) Program has made significant progress in planning disposition of its excess nuclear materials and has recently completed several noteworthy studies. Since establishment in 1997, the EM Nuclear Material Stewardship Program has developed disposition plans for excess nuclear materials to support facility deactivation. All nuclear materials have been removed from the Miamisburg Environmental Management Project (Mound), and disposition planning is nearing completion for the Fernald Environmental Management Project and the Rocky Flats Environmental Technology Site. Only a few issues remain for materials at the Hanford and Idaho sites. Recent trade studies include the Savannah River Site Canyons Nuclear Materials Identification Study, a Cesium/Strontium Management Alternatives Trade Study, a Liquid Technical Standards Trade Study, an Irradiated Beryllium Reflectors with Tritium study, a Special Performance Assessment Required Trade Study, a Neutron Source Trade Study, and development of discard criteria for uranium. A Small Sites Workshop was also held. Potential and planned future activities include updating the Plutonium-239 storage study, developing additional packaging standards, developing a Nuclear Material Disposition Handbook, determining how to recover or dispose of Pu-244 and U-233, and working with additional sites to define disposition plans for their nuclear materials

  16. Environmental stewardship for gold mining in tropical regions

    Directory of Open Access Journals (Sweden)

    A Isahak

    2013-10-01

    Full Text Available Mining has gained strong popularity in recent years due to the increase in global demand for metals and other industrial raw material derived from the ground. However, information and good governance regarding activities related to mining is still very much lacking especially in underdeveloped and developing countries in the tropics. In Malaysia, the importance of environmental stewardship in mining is a new phenomenon. The new National Mineral Policy 2 calls for compliance with existing standards and guidelines, stresses on progressive and post mining rehabilitation as well as promotes the gathering and dissemination of information, best mining practices, public disclosure and corporate social responsibility. Our preliminary studies however have shown that its implementation may have been hampered by inadequate legal and administrative structures, lack of freedom of information, physical inaccessibility, lack of information and public participation. In this presentation, the above issues and measures to reduce the impact of mining, particularly that of gold on the environment with a special focus on Malaysia is discussed. These measures include alternative gold extraction methods, appropriate tailing dam construction and management, health risk assessment and risk management, compliance with the Cyanide Code and liberalization of access to information, facilitation of access to justice, the strengthening of legal and administrative structures as well as corporate accountability to the public as part of corporate social responsibility.

  17. Financial evaluations of antibiotic stewardship programs - a systematic review

    Directory of Open Access Journals (Sweden)

    Jan-Willem Hendrik Dik

    2015-04-01

    Full Text Available IntroductionThere is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs. Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. MethodsA systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list.Results1233 studies were found, of which 149 were read completely. 99 were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n=23, costs for hospital stay (n=18 and/or other costs (n=19. 9 studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19.ConclusionsThis review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.

  18. Antimicrobial Stewardship for a Geriatric Behavioral Health Population

    Directory of Open Access Journals (Sweden)

    Kristen Ellis

    2016-01-01

    Full Text Available Antimicrobial resistance is a growing public health concern. Antimicrobial stewardship and multi-disciplinary intervention can prevent inappropriate antimicrobial use and improve patient care. Special populations, especially older adults and patients with mental health disorders, can be particularly in need of such intervention. The purpose of this project was to assess the impact of pharmacist intervention on appropriateness of antimicrobial prescribing on a geriatric psychiatric unit (GPU. Patients ≥18 years old prescribed oral antibiotics during GPU admission were included. Antimicrobial appropriateness was assessed pre- and post-pharmacist intervention. During the six-month pre- and post-intervention phase, 63 and 70 patients prescribed antibiotics were identified, respectively. Subjects in the post-intervention group had significantly less inappropriate doses for indication compared to the pre-intervention group (10.6% vs. 23.9%, p = 0.02, and significantly less antibiotics prescribed for an inappropriate duration (15.8% vs. 32.4%, p < 0.01. There were no significant differences for use of appropriate drug for indication or appropriate dose for renal function between groups. Significantly more patients in the post intervention group had medications prescribed with appropriate dose, duration, and indication (51% vs. 66%, p = 0.04. Pharmacist intervention was associated with decreased rates of inappropriate antimicrobial prescribing on a geriatric psychiatric unit.

  19. Extended Producer Responsibility and Product Stewardship for Tobacco Product Waste.

    Science.gov (United States)

    Curtis, Clifton; Collins, Susan; Cunningham, Shea; Stigler, Paula; Novotny, Thomas E

    2014-09-01

    This paper reviews several environmental principles, including Extended Producer Responsibility (EPR), Product Stewardship (PS), the Polluter Pays Principle (PPP), and the Precautionary Principle, as they may apply to tobacco product waste (TPW). The review addresses specific criteria that apply in deciding whether a particular toxic product should adhere to these principles; presents three case studies of similar approaches to other toxic and/or environmentally harmful products; and describes 10 possible interventions or policy actions that may help prevent, reduce, and mitigate the effects of TPW. EPR promotes total lifecycle environmental improvements, placing economic, physical, and informational responsibilities onto the tobacco industry, while PS complements EPR, but with responsibility shared by all parties involved in the tobacco product lifecycle. Both principles focus on toxic source reduction, post-consumer take-back, and final disposal of consumer products. These principles when applied to TPW have the potential to substantially decrease the environmental and public health harms of cigarette butts and other TPW throughout the world. TPW is the most commonly littered item picked up during environmental, urban, and coastal cleanups globally.

  20. Transformative leadership: an ethical stewardship model for healthcare.

    Science.gov (United States)

    Caldwell, Cam; Voelker, Carolyn; Dixon, Rolf D; LeJeune, Adena

    2008-01-01

    The need for effective leadership is a compelling priority for those who would choose to govern in public, private, and nonprofit organizations, and applies as much to the healthcare profession as it does to other sectors of the economy (Moody, Horton-Deutsch, & Pesut, 2007). Transformative Leadership, an approach to leadership and governance that incorporates the best characteristics of six other highly respected leadership models, is an integrative theory of ethical stewardship that can help healthcare professionals to more effectively achieve organizational efficiencies, build stakeholder commitment and trust, and create valuable synergies to transform and enrich today's healthcare systems (cf. Caldwell, LeJeune, & Dixon, 2007). The purpose of this article is to introduce the concept of Transformative Leadership and to explain how this model applies within a healthcare context. We define Transformative Leadership and identify its relationship to Transformational, Charismatic, Level 5, Principle-Centered, Servant, and Covenantal Leadership--providing examples of each of these elements of Transformative Leadership within a healthcare leadership context. We conclude by identifying contributions of this article to the healthcare leadership literature.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Muhammad Umair Khan

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

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

    Science.gov (United States)

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

    2015-12-01

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

  4. The challenge of measuring emergency preparedness: integrating component metrics to build system-level measures for strategic national stockpile operations.

    Science.gov (United States)

    Jackson, Brian A; Faith, Kay Sullivan

    2013-02-01

    Although significant progress has been made in measuring public health emergency preparedness, system-level performance measures are lacking. This report examines a potential approach to such measures for Strategic National Stockpile (SNS) operations. We adapted an engineering analytic technique used to assess the reliability of technological systems-failure mode and effects analysis-to assess preparedness. That technique, which includes systematic mapping of the response system and identification of possible breakdowns that affect performance, provides a path to use data from existing SNS assessment tools to estimate likely future performance of the system overall. Systems models of SNS operations were constructed and failure mode analyses were performed for each component. Linking data from existing assessments, including the technical assistance review and functional drills, to reliability assessment was demonstrated using publicly available information. The use of failure mode and effects estimates to assess overall response system reliability was demonstrated with a simple simulation example. Reliability analysis appears an attractive way to integrate information from the substantial investment in detailed assessments for stockpile delivery and dispensing to provide a view of likely future response performance.

  5. Integrating human and natural systems in community psychology: an ecological model of stewardship behavior.

    Science.gov (United States)

    Moskell, Christine; Allred, Shorna Broussard

    2013-03-01

    Community psychology (CP) research on the natural environment lacks a theoretical framework for analyzing the complex relationship between human systems and the natural world. We introduce other academic fields concerned with the interactions between humans and the natural environment, including environmental sociology and coupled human and natural systems. To demonstrate how the natural environment can be included within CP's ecological framework, we propose an ecological model of urban forest stewardship action. Although ecological models of behavior in CP have previously modeled health behaviors, we argue that these frameworks are also applicable to actions that positively influence the natural environment. We chose the environmental action of urban forest stewardship because cities across the United States are planting millions of trees and increased citizen participation in urban tree planting and stewardship will be needed to sustain the benefits provided by urban trees. We used the framework of an ecological model of behavior to illustrate multiple levels of factors that may promote or hinder involvement in urban forest stewardship actions. The implications of our model for the development of multi-level ecological interventions to foster stewardship actions are discussed, as well as directions for future research to further test and refine the model.

  6. A study on possible use of Urtica dioica (common nettle) plants as uranium (234U, 238U) contamination bioindicator near phosphogypsum stockpile.

    Science.gov (United States)

    Olszewski, Grzegorz; Boryło, Alicja; Skwarzec, Bogdan

    The aim of this study was to determine uranium concentrations in common nettle ( Urtica dioica ) plants and corresponding soils samples which were collected from the area of phosphogypsum stockpile in Wiślinka (northern Poland). The uranium concentrations in roots depended on its concentrations in soils. Calculated BCF and TF values showed that soils characteristics and air deposition affect uranium absorption and that different uranium species have different affinities to U . dioica plants. The values of 234 U/ 238 U activity ratio indicate natural origin of these radioisotopes in analyzed plants. Uranium concentration in plants roots is negatively weakly correlated with distance from phosphogypsum stockpile.

  7. A study on possible use of Urtica dioica (common nettle) plants as uranium (234U, 238U) contamination bioindicator near phosphogypsum stockpile

    International Nuclear Information System (INIS)

    Olszewski, Grzegorz; Borylo, Alicja; Skwarzec, Bogdan

    2016-01-01

    The aim of this study was to determine uranium concentrations in common nettle (Urtica dioica) plants and corresponding soils samples which were collected from the area of phosphogypsum stockpile in Wislinka (northern Poland). The uranium concentrations in roots depended on its concentrations in soils. Calculated BCF and TF values showed that soils characteristics and air deposition affect uranium absorption and that different uranium species have different affinities to U. dioica plants. The values of 234 U/ 238 U activity ratio indicate natural origin of these radioisotopes in analyzed plants. Uranium concentration in plants roots is negatively weakly correlated with distance from phosphogypsum stockpile. (author)

  8. Integrated Stewardship of NASA Satellite and Field Campaign Data

    Science.gov (United States)

    Hausman, J.; Tsontos, V. M.; Hardman, S. H.

    2016-02-01

    The Physical Oceanography Distributed Active Archive Center (PO.DAAC) is NASA's archive, steward and distributor for physical oceanographic satellite data. Those data are typically organized along the lines of single parameters, such as Sea Surface Temperature, Ocean Winds, Salinity, etc. However there is a need supplement satellite data with in situ and various other remote sensing data to provide higher spatial and temporal sampling and information on physical processes that the satellites are not capable of measuring. This presentation will discuss how PO.DAAC is creating a stewardship and distribution plan that will accommodate satellite, in situ and other remote sensing data that can be used to solve a more integrated approach to data access and utilization along thematic lines in support of science and applications, specifically those posed by Salinity Processes in the Upper Ocean Regional Study (SPURS) and Oceans Melting Greenland (OMG) projects. SPURS used shipboard data, moorings and in situ instruments to investigate changes in salinity and how that information can be used in explaining the water cycle. OMG is studying ice melt in Greenland and how it contributes to changes in sea level through shipboard measurements, airborne and a variety of in situ instruments. PO.DAAC plans on adapting to stewarding and distributing these varieties of data through applications of file format and metadata standards (so data are discoverable and interoperable), extend the internal data system (to allow for better archiving, collection generation and querying of in situ and airborne data) and integration into tools (visualization and data access). We are also working on Virtual Collections with ESDWG, which could provide access to relevant data across DAACs/Agencies along thematic lines. These improvements will improve long-term data management and make it easier for users of various background, regardless if remote sensing or in situ, to discover and use the data.

  9. DOE's Stewardship of Government-Owned Uranium Materials

    International Nuclear Information System (INIS)

    Jackson, J. Dale; Donaldson, Dale E.

    2002-01-01

    Beginning in the 1980's, a significant number of Department of Energy facilities have been shut down and are in the decommissioning process. The shutdown of additional facilities is planned. In addition, during the past several decades, the Department of Energy has loaned nuclear material to a wide variety of private and governmental institutions for research and educational purposes. Subsequent changes in the Department's priorities have reduced the need for nuclear materials to support the Department's programs. Similarly, there has been a reduction in the need for borrowed nuclear materials by organizations and institutions using nuclear materials 'on loan' from the Department. As a result, inventories of uranium material from the Department's facilities and 'on loan' must be removed and returned to the Department. This material is in the form of low enriched uranium (LEU), normal uranium (NU), and depleted uranium (DU) in various forms. This uranium material is located at over one hundred sites within the United States and overseas, including universities and laboratories. Much of this uranium is not needed to support national priorities and programs. The Department of Energy has assumed a stewardship role in managing nuclear materials throughout their life cycle, from acquisition to storage. Surplus uranium has created challenges for DOE in managing and storing the material as well as identifying opportunities for its further use. On behalf of the Department, the Oak Ridge Operations Office has been given the responsibility to implement the Department responsibilities in meeting these challenges and managing the Department's uranium materials. To support this effort, the Office of Nuclear Fuel Security and Uranium Technology within the ORO complex coordinates uranium management functions across the Department of Energy. This coordination provides DOE with a number of important benefits, among which are: consolidated management and storage of uranium; improved

  10. Planning for quality stewardship: The sitewide environmental impact statement

    International Nuclear Information System (INIS)

    Webb, D.

    1995-01-01

    The U.S Department of Energy is responsible for managing many large tracts of Federal land throughout this country. These sites host the nation's nuclear weapons complex, national laboratories, environmental restoration facilities, and serve other uses. The Department faces unique problems in administering this land. Many have multiple activities taking place at the same time; for example, a site may simultaneously be used for energy research, technology development, waste disposal and wildlife habitat. The sites often use radioactive and other hazardous materials and many are contaminated as a result of past management practices. In 1992 the Department institutes a policy, as stated in its National Environmental Policy Act regulations [10 CFR 1021], to prepare sitewide environmental impact statements for its large, multipurpose sites. For the first time, through the sitewide environmental impact statement process, the Department has an effective tool to plan for quality stewardship of the lands and resources entrusted to its care. The sitewide environmental impact statement is a specialized type of programmatic environmental impact statement which allows the Department to look at the geographically connected actions taking place at a given site. The sitewide statement allows a comprehensive look at the operational baseline for the entire site to determine the total cumulative impact of ongoing operations at the site. The Department can identify areas where a change in management practices would mitigate undesirable impacts; areas not at issue could continue under existing practices. As a result, an environmentally-sound operating envelope can be established. This, in turn, can serve in the future as a threshold to decide if new proposals would result in significant impacts to the site as a whole, to simplify future National Environmental Policy Act reviews

  11. Developing a mixture design specification for flexible base construction.

    Science.gov (United States)

    2012-06-01

    In the Texas Department of Transportation (TxDOT), flexible base producers typically generate large stockpiles of material exclusively for TxDOT projects. This large state-only inventory often maintained by producers, along with time requiremen...

  12. Examining the concept of convenient collection: an application to extended producer responsibility and product stewardship frameworks.

    Science.gov (United States)

    Wagner, Travis P

    2013-03-01

    Increasingly, Extended Producer Responsibility (EPR) and Product Stewardship (PS) frameworks are being adopted as a preferred policy approach to promote cost-effective diversion and recovery of post-consumer solid waste. Because the application of EPR/PS generally requires the creation of a separate and often parallel collection and/or management system, key to increasing the amount of waste recovered is to maximize the convenience of the collection system to maximize consumer participation. Convenient collection is often mandated in EPR/PS laws, however it is not defined. Convenience is a subjective construct rendering it extremely difficult to define. However, based on a dissection of post-consumer collection efforts under a generic EPR/PS system, this paper identifies and examines five categories of convenience - knowledge requirements, proximity to a collection site, opportunity to drop-off materials, the draw of the collection site, and the ease of the process-and the various factors of convenience within each of these categories. By using a simplified multiple criteria decision analysis, this paper proposes a performance matrix of criteria of convenience. Stakeholders can use this matrix to assist in the design, assessment, and/or implementation of a convenient post-consumer collection system under an EPR/PS framework. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Lessons from White Lake - Connecting Students to their Community through Environmental Stewardship

    Science.gov (United States)

    Tate, Susan

    2014-05-01

    White Lake and its surrounding community have been negatively affected by shoreline degradation and wildlife habitat loss caused primarily by historical logging practices, and reduced water quality from industrial pollution and storm water runoff. This led to the lake being identified as a Great Lakes Area of Concern by the United States Environmental Protection Agency three decades ago. Local community partners have worked diligently in recent years to reverse habitat loss, and repair damaged ecosystems. The "H2O White Lake" (Healthy Habitats On White Lake) project has involved over seven hundred middle school students in grades six through eight over the course of the last five years. Students begin by researching the environmental history of the watershed and then they monitor six tributaries of the lake for nutrient pollution and habitat degradation. Students use the field experience as a community inventory to identify stewardship needs, for which they then identify solutions that take into account land usage and community behaviors. Class projects have focused on stream bank restoration, storm water management, eradication of invasive species, shoreline clean-up, and community outreach and education. This year, the project culminated in the first ever White Lake Environmental Film Festival, for which students had the opportunity to create their own short documentary. This multiple year place based education project allows students to apply their classroom studies of surface water and groundwater dynamics to an authentic, real-world situation, conduct themselves as scientists, and feel valuable through connections with community partners.

  14. [Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

    Science.gov (United States)

    Roth-Deubel, André N; Molina-Marín, Gloria

    2013-01-01

    Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

  15. Expert consensus regarding drivers of antimicrobial stewardship in companion animal veterinary practice: a Delphi study.

    Science.gov (United States)

    Currie, Kay; King, Caroline; Nuttall, Tim; Smith, Matt; Flowers, Paul

    2018-03-23

    Antimicrobial resistance (AMR) is a global challenge facing both human and animal healthcare professionals; an effective response to this threat requires a 'One-Health' approach to antimicrobial stewardship (AMS) to preserve important antibiotics for urgent clinical need. However, understanding of barriers and enablers to effective AMS behaviour in companion animal veterinary practice is currently limited. We conducted a Delphi study of 16 nationally recognised experts from UK-based veterinary policymakers, university academics and leaders of professional bodies. This Delphi study sought to identify veterinary behaviours which experts believe contribute to AMR and form vital aspects of AMS. Analysis of Delphi findings indicated a perceived hierarchy of behaviours, the most influential being antibiotic prescribing behaviours and interactions with clients. Other veterinary behaviours perceived as being important related to interactions with veterinary colleagues; infection control practices; and the use of diagnostic tests to confirm infection. Key barriers and enablers to AMS within each of these behavioural domains were identified. Specific interventions to address important barriers and enablers are recommended. To the authors' knowledge, this is the first study to establish expert consensus at a national level about which 'behaviours' (aspects of veterinarian practice) should be targeted in relation to AMR and AMS in companion animal veterinary practice. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Strategic Program Planning Lessons Learned In Developing The Long-Term Stewardship Science and Technology Roadmap

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, B.W.; Hanson, D.J.; Matthern, G.E.

    2003-04-24

    Technology roadmapping is a strategic planning method used by companies to identify and plan the development of technologies necessary for new products. The U.S. Department of Energy's Office of Environmental Management has used this same method to refine requirements and identify knowledge and tools needed for completion of defined missions. This paper describes the process of applying roadmapping to clarify mission requirements and identify enhancing technologies for the Long-Term Stewardship (LTS) of polluted sites after site cleanup has been completed. The nature of some contamination problems is such that full cleanup is not achievable with current technologies and some residual hazards remain. LTS maintains engineered contaminant barriers and land use restriction controls, and monitors residual contaminants until they no longer pose a risk to the public or the environment. Roadmapping was used to clarify the breadth of the LTS mission, to identify capability enhancements needed to improve mission effectiveness and efficiency, and to chart out the research and development efforts to provide those enhancements. This paper is a case study of the application of roadmapping for program planning and technical risk management. Differences between the planned and actual application of the roadmapping process are presented along with lessons learned. Both the process used and lessons learned should be of interest for anyone contemplating a similar technology based planning effort.

  17. Integrating different understandings of landscape stewardship into the design of agri-environmental schemes

    DEFF Research Database (Denmark)

    Raymond, Christopher Mark; Reed, Mark; Bieling, Claudia

    2016-01-01

    While multiple studies have identified land managers’ preferences for agri-environmental schemes (AES), few approaches exist for integrating different understandings of landscape stewardship into the design of these measures. We compared and contrasted rural land managers’ attitudes toward AES...... to the reduced amount of funding available for entry-level and higher-level stewardship schemes in the UK since 2008, changing funding priorities, perceived overstrict compliance and lack of support for farm succession and new entrants into farming. However, there were differences in concerns across...... understandings of landscape stewardship, with production respondents citing that AES do not encourage food production, whereas environmental and holistic farmers citing that AES do not support the development of a local green food culture and associated social infrastructure. These differences also emerged...

  18. Optimizing adherence to advice from antimicrobial stewardship audit and feedback rounds.

    Science.gov (United States)

    Rawlins, Matthew D M; Sanfilippo, Frank M; Ingram, Paul R; McLellan, Duncan G J; Crawford, Colin; D'Orsogna, Luca; Dyer, John

    2018-02-01

    We examined adherence to antimicrobial stewardship prospective audit and feedback rounds in a rehabilitation service compared with the remainder of the acute hospital, and explored the reasons for this. Between October 2014 and December 2015, we retrospectively assessed the rate of non-adherence to advice from antimicrobial stewardship prospective audit and feedback rounds between the rehabilitation service and the acute hospital, along with the source of the patient referral. Compared with the rehabilitation service, acute hospital medical staff were almost twice as likely to not adhere to advice provided on antimicrobial stewardship prospective audit and feedback rounds (13.8% vs. 7.6%, p risk 1.8 [95% confidence interval 1.3, 2.5]). In the rehabilitation service, referrals were more likely to come from medical staff (61.9% vs. 16.3%, p model potentially applicable to other settings.

  19. [The absence of stewardship in the Chilean health authority after the 2004 health reform].

    Science.gov (United States)

    Herrera, Tania; Sánchez, Sergio

    2014-11-26

    Stewardship is the most important political function of a health system. It is a government responsibility carried out by the health authority. Among other dimensions, it is also a meta-function that includes conduction and regulation. The Health Authority and Management Act, which came about from the health reform of 2004, separated the functions of service provision and stewardship with the aim of strengthening the role of the health authority. However, the current structure of the health system contains overlapping functions between the different entities that leads to lack of coordination and inconsistencies, and a greater weight on individual health actions at the expense of collective ones. Consequently, a properly funded national health strategy to improve the health of the population is missing. Additionally, the components of citizen participation and governance are weak. It is necessary, therefore, to revisit the Chilean health structure in order to develop one that truly enables the exercise of the health authority’s stewardship role.

  20. Principles and principals : do customer stewardship and agency control compete or complement when shaping frontline employee behavior?

    NARCIS (Netherlands)

    Schepers, J.J.L.; Falk, T.; Ruyter, de J.C.; Jong, de A.; Hammerschmidt, M.

    2012-01-01

    This article introduces customer stewardship control to the marketing field. This concept represents a frontline employee’s felt ownership of and moral responsibility for customers’ overall welfare. In two studies, the authors show that customer stewardship control is a more encompassing construct

  1. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention.

    Science.gov (United States)

    Pollack, Loria A; Srinivasan, Arjun

    2014-10-15

    The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  2. Treatment Modalities and Antimicrobial Stewardship Initiatives in the Management of Intra-Abdominal Infections

    Directory of Open Access Journals (Sweden)

    Charles Hoffmann

    2016-02-01

    Full Text Available Antimicrobial stewardship programs (ASPs focus on improving the utilization of broad spectrum antibiotics to decrease the incidence of multidrug-resistant Gram positive and Gram negative pathogens. Hospital admission for both medical and surgical intra-abdominal infections (IAIs commonly results in the empiric use of broad spectrum antibiotics such as fluoroquinolones, beta-lactam beta-lactamase inhibitors, and carbapenems that can select for resistant organisms. This review will discuss the management of uncomplicated and complicated IAIs as well as highlight stewardship initiatives focusing on the proper use of broad spectrum antibiotics.

  3. Government stewardship of the for-profit private health sector in Afghanistan.

    Science.gov (United States)

    Cross, Harry E; Sayedi, Omarzaman; Irani, Laili; Archer, Lauren C; Sears, Kathleen; Sharma, Suneeta

    2017-04-01

    Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a

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

    Energy Technology Data Exchange (ETDEWEB)

    Nikkel, Daniel J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Meisner, Robert [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2010-09-10

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

  5. The impact of an automated dose-dispensing scheme on user compliance, medication understanding, and medication stockpiles

    DEFF Research Database (Denmark)

    Larsen, Anna Bira; Haugbølle, Lotte Stig

    2007-01-01

    the assumed user benefits. Neither Danish nor international studies dealt with users' perspective on ADD in general or with respect to the pinpointed benefits, and thus exploration was needed. OBJECTIVES: The objective of this article is to respond to the following research question: How does ADD affect users......' handling and consumption of medication in terms of compliance behavior, and how does the assumption of user benefits made by health professionals and legislators measure up to users' experiences with ADD? METHODS: The results built on a secondary analysis of 9 qualitative interviews with a varied selection...... understanding, nor does it automatically eliminate stockpiles of old medication in users' homes. The gap between the perspectives of users and health professionals makes a compelling case for considering users' voices in the development and implementation of future health technologies....

  6. Technology to support integrated Antimicrobial Stewardship Programs : a user centered and stakeholder driven development approach

    NARCIS (Netherlands)

    Beerlage-de Jong, Nienke; van Gemert-Pijnen, Julia E.W.C.; Wentzel, M.J.; Hendrix, Ron; Tjin-Kam-Jet-Siemons, Liseth

    2017-01-01

    The rise of antimicrobial resistance (AMR) is a severe global health problem. Tackling this problem requires the prudent prescribing of antimicrobials. This is promoted through Antimicrobial Stewardship Programs (ASPs). In this position paper we describe i) how a socio-technical multidisciplinary

  7. Science and society: the role of long-term studies in environmental stewardship

    Science.gov (United States)

    Charles T. Driscoll; Kathleen F. Lambert; F. Stuart Chapin; David J. Nowak; Thomas A. Spies; Frederick J. Swanson; David B. Kittredge; Clarisse M. Hart

    2012-01-01

    Long-term research should play a crucial role in addressing grand challenges in environmental stewardship. We examine the efforts of five Long Term Ecological Research Network sites to enhance policy, management, and conservation decisions for forest ecosystems. In these case studies, we explore the approaches used to inform policy on atmospheric deposition, public...

  8. Stewardship as a Means to Create Organizational Reform: A View into Minnesota 4-H Youth Development

    Science.gov (United States)

    Skuza, Jennifer A.; Freeman, Dorothy M.; Bremseth, Tamara J.; Doering, Shirley A.; Quinlan, Robert B.; Morreim, Patricia A.; Deidrick, James C.

    2010-01-01

    Minnesota 4-H Youth Development (MN 4-H) used stewardship as a means to create organizational reform to address the public use of the 4-H name and emblem in terms of risk management, real estate and equipment, and finances. A task force implemented a participatory process with colleagues and stakeholders to build and implement the reform effort.…

  9. The global wilderness seminar for government agencies: a meeting at the crossroads of wildlands stewardship

    Science.gov (United States)

    Nancy Roeper; Peter Landres; Don Fisher

    2006-01-01

    Two days before the 8th World Wilderness Congress began in Alaska, nearly 200 government wildlands managers from 17 countries met to share ideas about common challenges and to explore ways to improve wildland stewardship globally. The goal for this Global Wilderness Seminar for Government Agencies was to lay the foundation for an operating peer network of government...

  10. Enhancing Ecosystem Stewardship in Small-Scale Fisheries: Prospects for Latin America and the Caribbean

    Directory of Open Access Journals (Sweden)

    Rodrigo Pereira Medeiros

    2014-12-01

    Full Text Available Despite recognition of small-scale fisheries (SSF contribution to livelihood diversity and food security worldwide, a better understanding of their social and ecological dynamics is required. This paper is a synthesis of the main findings from the special issue “Enhancing ecosystem stewardship in small-scale fisheries” published in this journal. Contributors explored ecosystem stewardship in three dimensions: impacts, monitoring and stewardship. Results suggested that ecosystem stewardship encompasses collaborative action to foster: i new perspectives on SSF management; ii a broader perspective on managers and stakeholders – as stewards for implementing these new perspectives; and iii enabling environments through partnership, networking, communication and collective action. This special issue is an output from the Too Big to Ignore (TBTI Working Group 4 - “Enhancing the Stewardship”. TBTI is a global research network and knowledge mobilization partnership intended to better comprehend SSF contributions on issues such as food security and poverty alleviation, as well as the associated impacts of global changes, through the efforts of diverse partners around the world.

  11. A special issue of the Journal of Forestry - Wilderness science and its role in wilderness stewardship

    Science.gov (United States)

    Susan F. Fox

    2016-01-01

    This special issue of the Journal of Forestry provides an overview of America’s National Wilderness Preservation System and highlights the important role that science serves in informing wilderness stewardship. The lead authors of the articles in this volume selected the Journal because it is highly respected and widely circulated among foresters and federal...

  12. Recognizing Stewardship Practices as Indicators of Social Resilience: In Living Memorials and in a Community Garden

    Science.gov (United States)

    Heather McMillen; Lindsay Campbell; Erika Svendsen; Renae Reynolds

    2016-01-01

    Resilience theory has received increased attention from researchers across a range of disciplines who have developed frameworks and articulated categories of indicators; however, there has been less discussion of how to recognize, and therefore support, social resilience at the community level, especially in urban areas. The value of urban environmental stewardship for...

  13. Integration of environmental stewardship and local economic development to enhance community health.

    Science.gov (United States)

    Levine, Jay F

    2011-01-01

    Environmental groups working to preserve natural ecosystems and groups working to enhance local economic development often find themselves on philosophically opposite sides of the negotiation table. Case histories of cooperative engagement are provided that serve as examples of how environmental stewardship is compatible with local economic development and community health.

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

    Science.gov (United States)

    Aspen Institute, 2009

    2009-01-01

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

  15. The Critical Role of Stewardship in Fund Raising: The Coaches vs. Cancer Campaign.

    Science.gov (United States)

    Worley, Debra A.; Little, Jennifer K.

    2002-01-01

    Examines the critical role of stewardship in the process of fund raising. Uses the Coaches vs. Cancer campaign to illustrate the limitations of the public relations ROPE (research, objectives, planning, and evaluation) model in explaining fund raising success, and supports K.S. Kelly's contention that addition of a fifth step to the model, the…

  16. Integration of Cloud Technologies for Data Stewardship at the NOAA National Centers for Environmental Information (NCEI)

    Science.gov (United States)

    Casey, K. S.; Hausman, S. A.

    2016-02-01

    In the last year, the NOAA National Oceanographic Data Center (NODC) and its siblings, the National Climatic Data Center and National Geophysical Data Center, were merged into one organization, the NOAA National Centers for Environmental Information (NCEI). Combining its expertise under one management has helped NCEI accelerate its efforts to embrace and integrate private, public, and hybrid cloud environments into its range of data stewardship services. These services span a range of tiers, from basic, long-term preservation and access, through enhanced access and scientific quality control, to authoritative product development and international-level services. Throughout these tiers of stewardship, partnerships and pilot projects have been launched to identify technological and policy-oriented challenges, to establish solutions to these problems, and to highlight success stories for emulation during operational integration of the cloud into NCEI's data stewardship activities. Some of these pilot activities including data storage, access, and reprocessing in Amazon Web Services, the OneStop data discovery and access framework project, and a set of Cooperative Research and Development Agreements under the Big Data Project with Amazon, Google, IBM, Microsoft, and the Open Cloud Consortium. Progress in these efforts will be highlighted along with a future vision of how NCEI could leverage hybrid cloud deployments and federated systems across NOAA to enable effective data stewardship for its oceanographic, atmospheric, climatic, and geophysical Big Data.

  17. Little Book, Big Waves: The Epistle of James and Global Stewardship in Bioethics

    Directory of Open Access Journals (Sweden)

    Lora Jean Brake

    2016-03-01

    Full Text Available At first glance the twenty-first century arena of biotechnology and bioethics seems worlds away from the practical concerns of the first century outlook of the New Testament book of James. A closer look, however, reveals that the issues that James addresses have applications to challenges in bioethics. This article will give an overview of James and examine James’ teaching on wealth, poverty, and generosity and its import for the issue of global stewardship in bioethics.  Stewardship concerns both a Christian’s care and management of time, talents, and treasures.  Faithful use of the resources God has given demonstrates the fruitful faith that James writes of in his epistle. The idea of global stewardship, though “stewardship” is grounded in a distinctly Christian ethic, reflects an emerging discussion in bioethics regarding the need to address the inequities present between the money and time spent on biotechnology in some of the world in proportion to the money spent on meeting the basic healthcare needs of the poor of the entire world.  This New Testament epistle gives clear indications of how the Christian is to view wealth and how the Christian is to respond to poverty.  James, though a comparatively small book, sends a crucial message across the years that should greatly impact how Christians view stewardship in terms of global healthcare needs. 

  18. Strategies and challenges of antimicrobial stewardship in long-term care facilities.

    Science.gov (United States)

    Dyar, O J; Pagani, L; Pulcini, C

    2015-01-01

    As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes. Copyright © 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  19. Enhancing stewardship in Latin America and Caribbean small-scale fisheries : challenges and opportunities

    NARCIS (Netherlands)

    Gasalla, M.A.; de Castro, F.

    2016-01-01

    This thematic series, entitled “Enhancing Stewardship in Latin America and Caribbean Small-Scale Fisheries”, emerged as part of a joint effort to bridge Latin-American scholars interested in networking on small-scale fisheries in the region. Built on results presented at two meetings (‘Too Big to

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

    NARCIS (Netherlands)

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

    2017-01-01

    Background: Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily

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

    NARCIS (Netherlands)

    Beerlage-de Jong, Nienke; Wentzel, M.J.; Hendrix, Ron; van Gemert-Pijnen, Julia E.W.C.

    Background Current clinical decision support systems (CDSSs) for antimicrobial stewardship programs (ASPs) are guideline- or expert-driven. They are focused on (clinical) content, not on supporting real-time workflow. Thus, CDSSs fail to optimally support prudent antimicrobial prescribing in daily

  2. Understanding micro-processes of institutionalization: stewardship contracting and national forest management

    Science.gov (United States)

    Cassandra Moseley; Susan Charnley

    2014-01-01

    This paper examines micro-processes of institutionalization, using the case of stewardship contracting within the US Forest Service. Our basic premise is that, until a new policy becomes an everyday practice among local actors, it will not become institutionalized at the macro-scale. We find that micro-processes of institutionalization are driven by a mixture of large-...

  3. Wilderness stewardship challenges in the uKhahlamba Drakensberg Park World Heritage Site

    Science.gov (United States)

    Sonja Krüger

    2007-01-01

    The location of the uKhahlamba Drakensberg Park wilderness areas along an international border and within a World Heritage Site and Transfrontier Conservation Area, provides unique opportunities and challenges for the stewardship of these areas. Although the wilderness areas were proclaimed more than 30 years ago, wilderness-specific planning, management and monitoring...

  4. The National Map hydrography data stewardship: what is it and why is it important?

    Science.gov (United States)

    Arnold, Dave

    2014-01-01

    The National Hydrography Dataset (NHD) and Watershed Boundary Dataset (WBD) were designed and populated by a large consortium of agencies involved in hydrography across the United States. The effort was led by the U.S. Geological Survey (USGS), the U.S. Environmental Protection Agency (EPA), and the Natural Resources Conservation Service (NRCS). The high-resolution NHD dataset, completed in 2007, is based on the USGS 7.5-minute series topographic maps at a scale of 1:24,000. There are now 26 million features in the NHD representing a 7.5 million mile stream network with over 6.5 million waterbodies. The six-level WBD, completed in 2010, is based on 1:24,000 scale data and contains over 23,000 watershed polygons. The NHD’s flow network, attribution, and linear referencing are used to conduct extensive scientific analyses. The NHD is ideal for cartographic applications such as the US Topo topographic map series, and also is available on the Geospatial Platform, which provides shared and trusted geospatial data, services, and applications for use by government agencies, their partners, and the public. The WBD watersheds are used by scientists and managers to identify discrete drainage areas. The ongoing maintenance of the NHD and WBD is essential for improving these datasets to meet the ever increasing demand for currency, additional detail, and more significant attribution. The best source of information about changes in local hydrography are users closest to the data, such as State and local governments, as well as Federal land management agencies, and other users of the data. The need for local knowledge has led to the creation of a collaborative data stewardship process to revise and maintain the NHD.

  5. Antimicrobial stewardship activities: a survey of Queensland hospitals.

    Science.gov (United States)

    Avent, Minyon L; Hall, Lisa; Davis, Louise; Allen, Michelle; Roberts, Jason A; Unwin, Sean; McIntosh, Kylie A; Thursky, Karin; Buising, Kirsty; Paterson, David L

    2014-11-01

    In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. WHAT IS KNOWN ABOUT THE TOPIC?: The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare

  6. Role of the hospitalist in antimicrobial stewardship: a review of work completed and description of a multisite collaborative.

    Science.gov (United States)

    Rohde, Jeffrey M; Jacobsen, Diane; Rosenberg, David J

    2013-06-01

    Historically, antimicrobial stewardship programs have been led by infectious-disease physicians and pharmacists. With the growing presence of hospitalists in health and hospital systems, combined with their focus on quality improvement and patient safety, this emerging medical specialty has the potential to fill essential roles in antimicrobial stewardship programs. The goal of this article was to present the reasons hospitalists are ideally positioned to fill antimicrobial-stewardship roles, a narrative review of previously reported hospitalist-led antibiotic-stewardship projects, and a description of an ongoing multisite collaborative by the Institute for Healthcare Improvement (IHI) and the Centers for Disease Control and Prevention (CDC). A review of the published literature was performed, including an extensive review of the abstracts submitted to the Society of Hospital Medicine annual meetings. A number of examples of hospitalists developing and leading antimicrobial-stewardship programs are described. The details of a current multisite IHI/CDC hospitalist-focused initiative are discussed in detail. Hospitalists are actively involved with, and even lead, a variety of antimicrobial-stewardship programs in several different hospital systems. A large, multisite collaborative focused on hospitalist-led antimicrobial stewardship is currently in progress. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-12-19

    Resource stewardship is being increasingly recognized as an essential competency for physicians, but medical schools are just beginning to integrate this into education. We describe the evaluation of Choosing Wisely Canada's Students and Trainees Advocating for Resource Stewardship (STARS) campaign, a student-led campaign to advance resource stewardship education in medical schools across Canada. We evaluated the campaign 6 months after its launch, in November 2015. STARS students were administered a telephone survey eliciting a description of the initiatives that they had implemented or planned to implement at their schools to promote resource stewardship, and exploring their perceptions of facilitators of and barriers to successful implementation of their initiatives. We used a mixed-methods approach to analyze and summarize the data. Twenty-seven (82%) of the 33 eligible students representing all 17 medical schools responded. In 14 schools (82%), students led various local activities (e.g., interest groups, campaign weeks) to raise awareness about resource stewardship among medical students and faculty. Students contributed to curriculum change (both planned and implemented) at 10 schools (59%). Thematic analysis revealed key program characteristics that facilitated success (e.g., pan-Canadian student network, local faculty champion) as well as barriers to implementing change (e.g., complex processes to change curriculum, hierarchical nature of medical school). This student-led campaign, with support from local faculty and Choosing Wisely Canada staff, led to awareness-building activities and early curricula change at medical schools across Canada. Future plans will build on the initial momentum created by the STARS campaign to sustain and spread local initiatives. Copyright 2017, Joule Inc. or its licensors.

  8. Evolution of data stewardship over two decades at a NASA data center

    Science.gov (United States)

    Armstrong, E. M.; Moroni, D. F.; Hausman, J.; Tsontos, V. M.

    2013-12-01

    physical domain was still critical, especially relevant to assessments of data quality, additional skills in computer science, statistics and system engineering also became necessary. Furthermore, the level of effort to implement data curation has not expanded linearly either. Management of ongoing data operations demands increased productivity on a continual basis and larger volumes of data, with constraints on funding, must be managed with proportionately less human resources. The role of data curation has also changed within the perspective of satellite missions. In many early missions, data management and curation was an afterthought (since there were no explicit data management plans written into the proposals), while current NASA mission proposals must have explicit data management plans to identify resources and funds for archiving, distribution and implementing overall data stewardship. In conclusion, the role of the data scientist/engineer at the PO.DAAC has shifted from supporting singular missions and primarily representing a point of contact for the science community to complete end-to-end stewardship through the implementation of a robust set of dataset lifecycle policies from ingest, to archiving, including data quality assessment for a broad swath of parameter based datasets that can number in the hundreds.

  9. Campus sustainability and natural area stewardship: student involvement in adaptive comanagement

    Directory of Open Access Journals (Sweden)

    Marianne E. Krasny

    2014-09-01

    Full Text Available University campus sustainability initiatives have proliferated over the last decade. We contend that such initiatives benefit from applying conceptual frameworks to help understand and guide their activities and from a focus on campus open space and natural areas management. Informed by an adaptive comanagement framework encompassing social learning, social capital, and shared action, we used semistructured interviews to examine student participation in the immediate response and longer-term policy formulation following a crisis that occurred in a campus natural area. Students exhibited social learning as demonstrated by reflection and the integration of new ideas through discussions with administrators and peers, as well as social capital through increased social trust, which led to a shift in perspective regarding norms of student-administrator interactions. Further, students participated in shared action, such as posting warning signs in dangerous areas, and importantly, through their contributions to longer-term campus natural area safety and recreational access policy. Three conditions explain student engagement in the adaptive comanagement process: the presence of a pre-existing student organization that had built bonding social capital and was committed to campus natural area stewardship, openness to multiple stakeholder viewpoints and commitment to action on the part of the university administration, and the presence of a crisis that spurred emotions and action. Based on these findings, we assert that student organizations can contribute to an adaptive comanagement process and that such a process is consistent with university and campus sustainability values related to the importance of student engagement, mental health, and learning.

  10. Automatic day-2 intervention by a multidisciplinary Antimicrobial Stewardship-Team leads to multiple positive effects

    Directory of Open Access Journals (Sweden)

    Jan-Willem H Dik

    2015-06-01

    Full Text Available Background: Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary Antimicrobial Stewardship-Team (A-Team was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS and antimicrobial use.Methods: Automatic e-mail alerts were sent after 48 hours of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient’s therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort. Results: A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59-6.81 compared to the historic cohort (7.57 days; 95% CI: 6.92-8.21 (p=0.012. Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10-9.24 to 5.93 DDD/patient (95% CI: 5.02-6.83 (p=0.008. For patients with severe underlying diseases (e.g. cancer these outcome measures remained unchanged.Conclusions: The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.

  11. Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units.

    Science.gov (United States)

    Ruiz-Ramos, Jesus; Frasquet, Juan; Romá, Eva; Poveda-Andres, Jose Luis; Salavert-Leti, Miguel; Castellanos, Alvaro; Ramirez, Paula

    2017-06-01

    To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting. A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG. Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided. Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

  12. Ocean Acidification Scientific Data Stewardship: An approach for end-to-end data management and integration

    Science.gov (United States)

    Arzayus, K. M.; Garcia, H. E.; Jiang, L.; Michael, P.

    2012-12-01

    As the designated Federal permanent oceanographic data center in the United States, NOAA's National Oceanographic Data Center (NODC) has been providing scientific stewardship for national and international marine environmental and ecosystem data for over 50 years. NODC is supporting NOAA's Ocean Acidification Program and the science community by providing end-to-end scientific data management of ocean acidification (OA) data, dedicated online data discovery, and user-friendly access to a diverse range of historical and modern OA and other chemical, physical, and biological oceanographic data. This effort is being catalyzed by the NOAA Ocean Acidification Program, but the intended reach is for the broader scientific ocean acidification community. The first three years of the project will be focused on infrastructure building. A complete ocean acidification data content standard is being developed to ensure that a full spectrum of ocean acidification data and metadata can be stored and utilized for optimal data discovery and access in usable data formats. We plan to develop a data access interface capable of allowing users to constrain their search based on real-time and delayed mode measured variables, scientific data quality, their observation types, the temporal coverage, methods, instruments, standards, collecting institutions, and the spatial coverage. In addition, NODC seeks to utilize the existing suite of international standards (including ISO 19115-2 and CF-compliant netCDF) to help our data producers use those standards for their data, and help our data consumers make use of the well-standardized metadata-rich data sets. These tools will be available through our NODC Ocean Acidification Scientific Data Stewardship (OADS) web page at http://www.nodc.noaa.gov/oceanacidification. NODC also has a goal to provide each archived dataset with a unique ID, to ensure a means of providing credit to the data provider. Working with partner institutions, such as the

  13. Behavioral approach to appropriate antimicrobial prescribing in hospitals: the Dutch Unique Method for Antimicrobial Stewardship (DUMAS) participatory intervention study.

    NARCIS (Netherlands)

    Sikkens, J.J.; Agtmael, M.A. van; Peters, E.J.G.; Lettinga, K.D.; Kuip, M. van der; Vandenbroucke-Grauls, C.M.J.E.; Wagner, C.; Kramer, M.H.H.

    2017-01-01

    Importance: Inappropriate antimicrobial prescribing leads to antimicrobial resistance and suboptimal clinical outcomes. Changing antimicrobial prescribing is a complex behavioral process that is not often taken into account in antimicrobial stewardship programs. Objective: To examine whether an

  14. Prediction of temperature and thermal inertia effect in the maturation stage and stockpiling of a large composting mass

    International Nuclear Information System (INIS)

    Barrena, R.; Canovas, C.; Sanchez, A.

    2006-01-01

    A macroscopic non-steady state energy balance was developed and solved for a composting pile of source-selected organic fraction of municipal solid waste during the maturation stage (13,500 kg of compost). Simulated temperature profiles correlated well with temperature experimental data (ranging from 50 to 70 deg. C) obtained during the maturation process for more than 50 days at full scale. Thermal inertia effect usually found in composting plants and associated to the stockpiling of large composting masses could be predicted by means of this simplified energy balance, which takes into account terms of convective, conductive and radiation heat dissipation. Heat losses in a large composting mass are not significant due to the similar temperatures found at the surroundings and at the surface of the pile (ranging from 15 to 40 deg. C). In contrast, thermophilic temperature in the core of the pile was maintained during the whole maturation process. Heat generation was estimated with the static respiration index, a parameter that is typically used to monitor the biological activity and stability of composting processes. In this study, the static respiration index is presented as a parameter to estimate the metabolic heat that can be generated according to the biodegradable organic matter content of a compost sample, which can be useful in predicting the temperature of the composting process

  15. Microbial Diversity in Sulfate-Reducing Marine Sediment Enrichment Cultures Associated with Anaerobic Biotransformation of Coastal Stockpiled Phosphogypsum (Sfax, Tunisia

    Directory of Open Access Journals (Sweden)

    Hana Zouch

    2017-08-01

    Full Text Available Anaerobic biotechnology using sulfate-reducing bacteria (SRB is a promising alternative for reducing long-term stockpiling of phosphogypsum (PG, an acidic (pH ~3 by-product of the phosphate fertilizer industries containing high amounts of sulfate. The main objective of this study was to evaluate, for the first time, the diversity and ability of anaerobic marine microorganisms to convert sulfate from PG into sulfide, in order to look for marine SRB of biotechnological interest. A series of sulfate-reducing enrichment cultures were performed using different electron donors (i.e., acetate, formate, or lactate and sulfate sources (i.e., sodium sulfate or PG as electron acceptors. Significant sulfide production was observed from enrichment cultures inoculated with marine sediments, collected near the effluent discharge point of a Tunisian fertilizer industry (Sfax, Tunisia. Sulfate sources impacted sulfide production rates from marine sediments as well as the diversity of SRB species belonging to Deltaproteobacteria. When PG was used as sulfate source, Desulfovibrio species dominated microbial communities of marine sediments, while Desulfobacter species were mainly detected using sodium sulfate. Sulfide production was also affected depending on the electron donor used, with the highest production obtained using formate. In contrast, low sulfide production (acetate-containing cultures was associated with an increase in the population of Firmicutes. These results suggested that marine Desulfovibrio species, to be further isolated, are potential candidates for bioremediation of PG by immobilizing metals and metalloids thanks to sulfide production by these SRB.

  16. Earth Stewardship: An initiative by the Ecological Society of America to foster engagement to sustain Planet Earth

    Science.gov (United States)

    Chapin, F. Stuart; Pickett, S.T.A.; Power, Mary E.; Collins, Scott L.; Baron, Jill S.; Inouye, David W.; Turner, Monica G.

    2017-01-01

    The Ecological Society of America (ESA) has responded to the growing commitment among ecologists to make their science relevant to society through a series of concerted efforts, including the Sustainable Biosphere Initiative (1991), scientific assessment of ecosystem management (1996), ESA’s vision for the future (2003), Rapid Response Teams that respond to environmental crises (2005), and the Earth Stewardship Initiative (2009). During the past 25 years, ESA launched five new journals, largely reflecting the expansion of scholarship linking ecology with broader societal issues. The goal of the Earth Stewardship Initiative is to raise awareness and to explore ways for ecologists and other scientists to contribute more effectively to the sustainability of our planet. This has occurred through four approaches: (1) articulation of the stewardship concept in ESA publications and Website, (2) selection of meeting themes and symposia, (3) engagement of ESA sections in implementing the initiative, and (4) outreach beyond ecology through collaborations and demonstration projects. Collaborations include societies and groups of Earth and social scientists, practitioners and policy makers, religious and business leaders, federal agencies, and artists and writers. The Earth Stewardship Initiative is a work in progress, so next steps likely include continued nurturing of these emerging collaborations, advancing the development of sustainability and stewardship theory, improving communication of stewardship science, and identifying opportunities for scientists and civil society to take actions that move the Earth toward a more sustainable trajectory.

  17. Antibiotic stewardship and empirical antibiotic treatment: How can they get along?

    Science.gov (United States)

    Zuccaro, Valentina; Columpsi, Paola; Sacchi, Paolo; Lucà, Maria Grazia; Fagiuoli, Stefano; Bruno, Raffaele

    2017-06-01

    The aim of this review is to focus on the recent knowledge on antibiotic stewardship and empiric antibiotic treatment in cirrhotic patients. The application of antimicrobial stewardship (AMS) rules appears to be the most appropriate strategy to globally manage cirrhotic patients with infectious complications: indeed they represent a unique way to provide both early diagnosis and appropriate therapy in order to avoid not only antibiotic over-prescription but, more importantly, selection and spread of antimicrobial resistance. Moreover, cirrhotic patients must be considered "frail" and susceptible to healthcare associated infections: applying AMS policies would assure a cost reduction and thus contribute to the improvement of public health strategies. Copyright © 2017. Published by Elsevier Ltd.

  18. Evaluation of Penicillin Allergy in the Hospitalized Patient: Opportunities for Antimicrobial Stewardship.

    Science.gov (United States)

    Chen, Justin R; Khan, David A

    2017-06-01

    Penicillin allergy is often misdiagnosed and is associated with adverse consequences, but testing is infrequently done in the hospital setting. This article reviews historical and contemporary innovations in inpatient penicillin allergy testing and its impact on antimicrobial stewardship. Adoption of the electronic medical record allows rapid identification of admitted patients carrying a penicillin allergy diagnosis. Collaboration with clinical pharmacists and the development of computerized clinical guidelines facilitates increased testing and appropriate use of penicillin and related β-lactams. Education of patients and their outpatient providers is the key to retaining the benefits of penicillin allergy de-labeling. Penicillin allergy testing is feasible in the hospital and offers tangible benefits towards antimicrobial stewardship. Allergists should take the lead in this endeavor and work towards overcoming personnel limitations by partnering with other health care providers and incorporating technology that improves the efficiency of allergy evaluation.

  19. Minnesota anglers' fisheries-related value orientations and their stewardship of fish resources

    Science.gov (United States)

    Bruskotter, J.T.; Fulton, D.C.

    2008-01-01

    Research on natural resource-related values and value orientations has grown substantially over the past decade. However, existing studies have focused almost exclusively on value orientations related to wildlife and forests. This article reports data from two mail surveys of Minnesota anglers used to develop scales for measuring fisheries-related value orientations. We report results of regression analyses examining the relationship between anglers' value orientations and norms concerning fisheries stewardship and the use of technological aids to angling. Results indicate 10 items reliably measure three value orientations we termed utilitarianism, dominance, and protectionism. Regression analyses suggest anglers' stewardship norms are influenced by all three value orientation types, while support for the use of technological aids was related with protectionism and utilitarianism, but not dominance. Results suggest anglers' fisheries-related value orientations cannot be adequately captured using single domain scales. Implications for the study of natural resources-related value orientations are discussed. Copyright ?? Taylor & Francis Group, LLC.

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

    Science.gov (United States)

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

    2017-11-01

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

  1. Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme.

    Science.gov (United States)

    Nathwani, Dilip; Sneddon, Jacqueline; Malcolm, William; Wiuff, Camilla; Patton, Andrea; Hurding, Simon; Eastaway, Anne; Seaton, R Andrew; Watson, Emma; Gillies, Elizabeth; Davey, Peter; Bennie, Marion

    2011-07-01

    In 2008, the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was published by the Scottish Government. One of the key actions was initiation of the Scottish Antimicrobial Prescribing Group (SAPG), hosted within the Scottish Medicines Consortium, to take forward national implementation of the key recommendations of this action plan. The primary objective of SAPG is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. This programme, led by SAPG, is delivered by NHS National Services Scotland (Health Protection Scotland and Information Services Division), NHS Quality Improvement Scotland, and NHS National Education Scotland as well as NHS board Antimicrobial Management Teams. Between 2008 and 2010, SAPG has achieved a number of early successes, which are the subject of this review: (i) through measures to optimise prescribing in hospital and primary care, combined with infection prevention measures, SAPG has contributed significantly to reducing Clostridium difficile infection rates in Scotland; (ii) there has been engagement of all key stakeholders at local and national levels to ensure an integrated approach to antimicrobial stewardship within the wider healthcare-associated infection agenda; (iii) development and implementation of data management systems to support quality improvement; (iv) development of training materials on antimicrobial stewardship for healthcare professionals; and (v) improving clinical management of infections (e.g. community-acquired pneumonia) through quality improvement methodology. The early successes achieved by SAPG demonstrate that this delivery model is effective and provides the leadership and focus required to implement antimicrobial stewardship to improve antimicrobial prescribing and infection management across NHS Scotland. Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  2. Antimicrobial Stewardship in Acute Care Centres: A Survey of 68 Hospitals in Quebec

    Directory of Open Access Journals (Sweden)

    Vincent Nault

    2008-01-01

    Full Text Available BACKGROUND: Antimicrobial stewardship programs (ASPs and quantitative monitoring of antimicrobial use are required to ensure that antimicrobials are used appropriately in the acute care setting, and have the potential to reduce costs and limit the spread of antimicrobial-resistant organisms and Clostridium difficile. Currently, it is not known what proportion of Quebec hospitals have an ASP and/or monitor antimicrobial use.

  3. Mapping Antimicrobial Stewardship in Undergraduate Medical, Dental, Pharmacy, Nursing and Veterinary Education in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Enrique Castro-Sánchez

    Full Text Available To investigate the teaching of antimicrobial stewardship (AS in undergraduate healthcare educational degree programmes in the United Kingdom (UK.Cross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning.80% (112/140 of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%. 'Adopting necessary infection prevention and control precautions' was the most frequently taught principle (83/88, 94.3%, followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity' (73/88, 82.9% and 'minimisation of unnecessary antimicrobial prescribing' (72/88, 81.8%. The 'use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment' was reported in ~50% of courses. Only 32/88 (36.3% programmes included all recommended principles.Antimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles.

  4. The absence of stewardship in the Chilean health authority after the 2004 health reform

    Directory of Open Access Journals (Sweden)

    Tania Herrera

    2014-11-01

    Full Text Available Stewardship is the most important political function of a health system. It is a government responsibility carried out by the health authority. Among other dimensions, it is also a meta-function that includes conduction and regulation. The Health Authority and Management Act, which came about from the health reform of 2004, separated the functions of service provision and stewardship with the aim of strengthening the role of the health authority. However, the current structure of the health system contains overlapping functions between the different entities that leads to lack of coordination and inconsistencies, and a greater weight on individual health actions at the expense of collective ones. Consequently, a properly funded national health strategy to improve the health of the population is missing. Additionally, the components of citizen participation and governance are weak. It is necessary, therefore, to revisit the Chilean health structure in order to develop one that truly enables the exercise of the health authority’s stewardship role

  5. Local Government Implementation of Long-Term Stewardship at Two DOE Facilities

    Energy Technology Data Exchange (ETDEWEB)

    John Pendergrass; Roman Czebiniak; Kelly Mott; Seth Kirshenberg; Audrey Eidelman; Zachary Lamb; Erica Pencak; Wendy Sandoz

    2003-08-13

    The Department of Energy (DOE) is responsible for cleaning up the radioactive and chemical contamination that resulted from the production of nuclear weapons. At more than one hundred sites throughout the country DOE will leave some contamination in place after the cleanup is complete. In order to protect human health and the environment from the remaining contamination DOE, U.S. Environmental Protection Agency (EPA), state environmental regulatory agencies, local governments, citizens and other entities will need to undertake long-term stewardship of such sites. Long-term stewardship includes a wide range of actions needed to protect human health in the environment for as long as the risk from the contamination remains above acceptable levels, such as barriers, caps, and other engineering controls and land use controls, signs, notices, records, and other institutional controls. In this report the Environmental Law Institute (ELI) and the Energy Communities Alliance (ECA) examine how local governments, state environmental agencies, and real property professionals implement long-term stewardship at two DOE facilities, Losa Alamos National Laboratory and Oak Ridge Reservation.

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

    Science.gov (United States)

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

    2017-09-01

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

  7. Interoperability Across the Stewardship Spectrum in the DataONE Repository Federation

    Science.gov (United States)

    Jones, M. B.; Vieglais, D.; Wilson, B. E.

    2016-12-01

    Thousands of earth and environmental science repositories serve many researchers and communities, each with their own community and legal mandates, sustainability models, and historical infrastructure. These repositories span the stewardship spectrum from highly curated collections that employ large numbers of staff members to review and improve data, to small, minimal budget repositories that accept data caveat emptor and where all responsibility for quality lies with the submitter. Each repository fills a niche, providing services that meet the stewardship tradeoffs of one or more communities. We have reviewed these stewardship tradeoffs for several DataONE member repositories ranging from minimally (KNB) to highly curated (Arctic Data Center), as well as general purpose (Dryad) to highly discipline or project specific (NEON). The rationale behind different levels of stewardship reflect resolution of these tradeoffs. Some repositories aim to encourage extensive uptake by keeping processes simple and minimizing the amount of information collected, but this limits the long-term utility of the data and the search, discovery, and integration systems that are possible. Other repositories require extensive metadata input, review, and assessment, allowing for excellent preservation, discovery, and integration but at the cost of significant time for submitters and expense for curatorial staff. DataONE recognizes these different levels of curation, and attempts to embrace them to create a federation that is useful across the stewardship spectrum. DataONE provides a tiered model for repositories with growing utility of DataONE services at higher tiers of curation. The lowest tier supports read-only access to data and requires little more than title and contact metadata. Repositories can gradually phase in support for higher levels of metadata and services as needed. These tiered capabilities are possible through flexible support for multiple metadata standards and services

  8. Chemical Stockpile Disposal Program: Review and comment on the Phase 1 environmental report for the Pueblo Depot Activity, Pueblo, Colorado

    International Nuclear Information System (INIS)

    Olshansky, S.J.; Krummel, J.R.; Policastro, A.J.; McGinnis, L.D.

    1994-03-01

    As part of the Chemical Stockpile Disposal Program, an independent review is presented of the US Army Phase I environmental report for the disposal of chemical agents and munitions stored at the Pueblo Depot Activity (PUDA) in Pueblo, Colorado. The Phase I report addresses new and additional concerns not incorporated in the final programmatic environmental impact statement (FPEIS). These concerns are addressed by examining site-specific data for the PUDA. On the basis of our review of the Phase I report, we concluded that on-site meteorological data from December 1988 to June 1992 appear to be of insufficient quality to have been used instead of the off-site Pueblo airport data. No additional meteorological data have been collected since June 1992. The Phase I report briefly mentions problems with the air pollution control system. These problems will likely require the systems to be upgraded at the Johnston Atoll site and at each of the other depots in the continental United States. Without such improvements, the probability of accidents during start-up and shutdown would likely increase. The Army has a lessons-learned program to incorporate improvements into the design of future facilities. The Phase I report does not make any design change commitments. These issues need to be fully evaluated and resolved before any final conclusion concerning the adequacy of the decision in the FPEIS can be made with respect to the PUDA. With the exception of this issue, the inclusion of other more detailed site-specific data in the Phase I report does not change the decision reached in the FPEIS (which favored on-site disposal at the PUDA). We recommend that site-specific data on water, ecological, socioeconomic, and cultural resources and emergency planning and preparedness be considered explicitly in the site-specific EIS decision-making process

  9. The Capacity-Building Stewardship Model: assessment of an agricultural network as a mechanism for improving regional agroecosystem sustainability

    Directory of Open Access Journals (Sweden)

    Alison J. Duff

    2017-03-01

    Full Text Available Working lands have potential to meet agricultural production targets while serving as reservoirs of biological diversity and as sources of ecological services. Yet agricultural policy creates disincentives for this integration of conservation and production goals. While necessary, the development of a policy context that promotes agroecosystem sustainability will take time, and successful implementation will depend on a receptive agricultural audience. As the demands placed on working lands grow, there is a need for regional support networks that build agricultural producers' capacity for land stewardship. We used a social-ecological system framework to illustrate the Healthy Grown Potato Program as an agricultural network case study. Our Capacity-Building Stewardship Model reflects a 20-year experience working in collaboration with potato growers certified under an ecolabel in Wisconsin, USA. The model applies an evolving, modular farm stewardship standard to the entire farm - croplands and noncroplands. The model demonstrates an effective process for facilitating communication and shared learning among program participants, including agricultural producers, university extension specialists, nonprofit conservation partners, and industry representatives. The limitation of the model in practice has been securing funding to support expansion of the program and to ensure that the ecolabel standard is responsive to changes in the social-ecological system. Despite this constraint, the Capacity-Building Stewardship Model reveals an important mechanism for building regional commitment to conservation, with agricultural producers in a leadership role as architects, adopters, and advocates for stewardship behavior. Our experience provides important insight for the application of agri-environment schemes on private lands. The durability of a conservation ethic on working farms is likely to be enhanced when networks engage and support producers in an

  10. Canada ordered to implement WTO ruling against "stockpiling" of generic drugs.

    Science.gov (United States)

    Elliott, R

    2000-01-01

    In the last issue, we reported on a mixed World Trade Organization (WTO) ruling regarding Canada's patent laws, based on a complaint by the member states of the European Communities (joined by the United States). In March 2000, a WTO Panel accepted the provision in Canada's Patent Act that creates an "early working exception" to patent rights--in other words, that allows a third party to use a patented invention during the term of patent protection, as long as the use is for obtaining regulatory approval of an equivalent product to be sold once the patent expires. This was an important victory from the perspective of allowing earlier access to generic versions of patented drugs.

  11. Antiviral stockpiles for influenza pandemics from the household perspective: treatment alone versus treatment with prophylaxis.

    Science.gov (United States)

    Kwok, Kin On; Leung, Gabriel M; Mak, Peter; Riley, Steven

    2013-06-01

    Model-based studies of antiviral use to mitigate the impact of moderate and severe influenza pandemics implicitly take the viewpoint of a central public health authority. However, it seems likely that the key decision of when to use antivirals will be made at the household level. We used a stochastic compartmental model of the transmission of influenza within and between households to evaluate the expected mortality under two strategies: households saving available antivirals for treatment only and households implementing prophylaxis as well as treatment. Given that every individual in the population was allocated a single course of antivirals, we investigated the impact of these two strategies for a wide range of AVED, the efficacy of antivirals in preventing death in severe cases (AVED=1 for complete protection). We found a cross-over point for our baseline parameter values in a regime where antivirals were still highly effective in reducing the chance of death: below AVED=0.9 the optimal strategy was for households to use both treatment and prophylaxis. We also considered the possibility that a small number of households might "cheat" by choosing to follow the treatment-only strategy when other households were following treatment with prophylaxis. The cross-over point for cheating households was considerably lower, at AVED=0.6, but substantially above 0. These results suggest that unless antivirals are almost completely effective in reducing the chance of death in serious cases, households will likely be better served implementing prophylaxis as well as treatment. More generally, our study illustrates the potential value of considering viewpoints other than a central authority when conducting model-based analysis of interventions against infectious disease. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. Airport Capital Improvement Plan : stewardship for airport development

    Science.gov (United States)

    1997-09-01

    This document summarizes efforts of the Federal Aviation Administration (FAA) Office : of the Associate Administrator for Airports to implement the concept of Airport Capital : Improvement Planning (ACIP). It is based on the experiences of the FAA's ...

  13. Update Direct-Strike Lightning Environment for Stockpile-to-Target Sequence

    International Nuclear Information System (INIS)

    Uman, M.A.; Rakov, V.A.; Elisme, J.O.; Jordan, D.M.; Biagi, C.J.; Hill, J.D.

    2008-01-01

    The University of Florida has surveyed all relevant publications reporting lightning characteristics and presents here an up-to-date version of the direct-strike lightning environment specifications for nuclear weapons published in 1989 by R. J. Fisher and M. A. Uman. Further, we present functional expressions for current vs. time, current derivative vs. time, second current derivative vs. time, charge transfer vs. time, and action integral (specific energy) vs. time for first return strokes, for subsequent return strokes, and for continuing currents; and we give sets of constants for these expressions so that they yield approximately the median and extreme negative lightning parameters presented in this report. Expressions for the median negative lightning waveforms are plotted. Finally, we provide information on direct-strike lightning damage to metals such as stainless steel, which could be used as components of storage containers for nuclear waste materials; and we describe UF's new experimental research program to add to the sparse data base on the properties of positive lightning. Our literature survey, referred to above, is included in four Appendices. The following four sections (II, III, IV, and V) of this final report deal with related aspects of the research: Section II. Recommended Direct-Strike Median and Extreme Parameters; Section III. Time-Domain Waveforms for First Strokes, Subsequent Strokes, and Continuing Currents; Section IV. Damage to Metal Surfaces by Lightning Currents; and Section V. Measurement of the Characteristics of Positive Lightning. Results of the literature search used to derive the material in Section II and Section IV are found in the Appendices: Appendix 1. Return Stroke Current, Appendix 2. Continuing Current, Appendix 3. Positive Lightning, and Appendix 4. Lightning Damage to Metal Surfaces

  14. Strategic Petroleum Reserve Program stewardship report No. 1

    Energy Technology Data Exchange (ETDEWEB)

    None

    1978-11-03

    This report is a managerial evaluation of the Strategic Petroleum Reserve (SPR) Program conducted by the SPR program director and project manager. Current capabilities and goals of the program have been assessed resulting in an achievable SPR baseline for performance and measurement of this program. Projections and recommendations are based on available technical, schedule, and cost information, taking into account known influencing factors. The SPR Baseline incorporates current critical factors and deviations from the FY 1980 budget data bases. Data on existing sites, expansion sites, turnkey sites, program cost, and withdrawal are included.

  15. Changes in antimicrobial prescribing behavior after the introduction of the antimicrobial stewardship program: A pre- and post-intervention survey

    Directory of Open Access Journals (Sweden)

    Ruchir Chavada

    2017-10-01

    Full Text Available The introduction of an antimicrobial stewardship (AMS program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs.

  16. Angling into the Future: Ten Commandments for Recreational Fisheries Science, Management, and Stewardship in a Good Anthropocene

    Science.gov (United States)

    Elmer, Laura K.; Kelly, Lisa A.; Rivest, Stephanie; Steell, S. Clay; Twardek, William M.; Danylchuk, Andy J.; Arlinghaus, Robert; Bennett, Joseph R.; Cooke, Steven J.

    2017-08-01

    A new geological epoch, the "Anthropocene", has been defined as the period in which humans have had substantial geological and ecological influence on the planet. A positive future for this epoch can be referred to as the "good Anthropocene" and would involve effective management strategies and changes in human behavior that promote the sustainability and restoration of ecosystems. Recreational fisheries hold significant social, cultural, and economic value and can generate many benefits when managed sustainably and thus be an integral part of a "good Anthropocene". Here, we list ten commandments to facilitate persistence and long-term sustainability of recreational fisheries in the "good Anthropocene". This list includes fostering aquatic stewardship, promoting education, using appropriate capture gear, adopting evidence-based management approaches, promoting the concept of resilience, obtaining and using effort data in management, embracing the ecosystem approach, engaging in multilevel collaboration, enhancing accessibility, and embracing optimism. When used singly, or simultaneously, these ten commandments will contribute to the harmonization of sustainable fish populations and angling practices, to create recreational fisheries' "bright spots".

  17. Returning to Netukulimk: Mi’kmaq cultural and spiritual connections with resource stewardship and self-governance

    Directory of Open Access Journals (Sweden)

    Morgan Moffitt

    2011-10-01

    Full Text Available Recent global initiatives such as the United Nations Declaration on the Rights of Indigenous Peoples have brought the issues facing and needs of indigenous peoples to the forefront of international attention. While underscoring respect for traditional practices, these initiatives have yet to appreciate fully the extent to whichindigenous peoples’ practices engage ways of being, living and believing that encompass a holistic understanding of the relations between humans and all facets of their ecosystem. The Mi’kmaq, theindigenous people of Maritime Canada, capture and express their holistic understanding through the concept of Netukulimk. In this essay we review core attributes of Netukulimk. We also review key moments in the colonialization assault on Netukulimk as a primary means for subordinating and marginalizing the Mi’kmaq.We close the essay with an overview and discussion of recent developments wherein the Mi’kmaq are working to revitalize the place of Netukulimk in treaty-based rights and Mi’kmaq law-ways, particularly within selfgovernance and resource stewardship initiatives. The Mi’kmaq experiences provide insights regarding thechallenges and requirements for achieving respect for traditional practices as key to affirming the rights of indigenous peoples.

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

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

    2018-02-05

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

  20. Development and impact of a massive open online course (MOOC) for antimicrobial stewardship.

    Science.gov (United States)

    Sneddon, Jacqueline; Barlow, Gavin; Bradley, Sally; Brink, Adrian; Chandy, Sujith J; Nathwani, Dilip

    2018-04-01

    The University of Dundee and the BSAC developed a massive open online course (MOOC) to address the global need for education to support antimicrobial stewardship in low- and middle-income countries. An interactive course, Antimicrobial Stewardship: Managing Antibiotic Resistance, was developed and delivered via the FutureLearn© platform. The course ran over four 6 week periods during 2015 and 2016 supported by educators and was evaluated via data on uptake and feedback from learners on impact on clinical practice. In total, 32 944 people, 70% of them healthcare professionals, from 163 countries joined the course from Europe (49%), Asia (16%), Africa (13%), North America (9%), Australia (8%) and South America (5%). Between 33% and 37% of joiners in each run completed at least one step in any week of the course and 219 participants responded to a post-course survey. The course was rated good or excellent by 208 (95%) of the participants, and 83 (38%) intended to implement stewardship interventions in their own setting. A follow-up survey 6 months later suggested that 49% had implemented such interventions. The MOOC has addressed a global learning need by providing education free at the point of access, and learning from its development will help others embarking upon similar educational solutions. Initial quantitative and qualitative feedback suggests it has engaged participants and complements traditional educational methods. Measuring its real impact on clinical practice remains a challenge. The FutureLearn© platform offers flexibility for MOOCs to be sustainable through modification to remove educator facilitation but maintain active participant discussion.

  1. Integrating societal perspectives and values for improved stewardship of a coastal ecosystem engineer

    Directory of Open Access Journals (Sweden)

    Steven B. Scyphers

    2014-09-01

    Full Text Available Oyster reefs provide coastal societies with a vast array of ecosystem services, but are also destructively harvested as an economically and culturally important fishery resource, exemplifying a complex social-ecological system (SES. Historically, societal demand for oysters has led to destructive and unsustainable levels of harvest, which coupled with multiple other stressors has placed oyster reefs among the most globally imperiled coastal habitats. However, more recent studies have demonstrated that large-scale restoration is possible and that healthy oyster populations can be sustained with effective governance and stewardship. However, both of these require significant societal support or financial investment. In our study, we explored relationships among how coastal societies (1 perceive and value oyster ecosystem services, (2 recognize and define problems associated with oyster decline, and (3 perceive or support stewardship initiatives. We specifically focused on the SES of eastern oysters (Crassostrea virginica and coastal societies in the northern Gulf of Mexico, a region identified as offering among the last and best opportunities to sustainably balance conservation objectives with a wild fishery. We found that, in addition to harvest-related benefits, oysters were highly valued for providing habitat, mitigating shoreline erosion, and improving water quality or clarity. Our results also showed that although most respondents recognized that oyster populations have declined, many respondents characterized the problem differently than most scientific literature does. Among a variety of initiatives for enhancing sustainability, spawning sanctuaries and reef restoration were well supported in all states, but support for harvest reductions was less consistent. Our study suggests that public support for maintaining both harvest and ecosystem services exists at societal levels and that enhancing public awareness regarding the extent and causes

  2. Planning for Site Transition to Long-Term Stewardship: Identification of Requirements and Issues

    International Nuclear Information System (INIS)

    Banaee, J.

    2002-01-01

    A systematic methodology is presented and applied for the identification of requirements and issues pertaining to the planning for, and transition to, long term stewardship (LTS). The method has been applied to three of the twelve identified LTS functions. The results of the application of the methodology to contaminated and uncontaminated federal real property in those three functions are presented. The issues that could be seen as impediments to the implementation of LTS are also identified for the three areas under consideration. The identified requirements are significant and in some cases complex to implement. It is clear that early and careful planning is required in all circumstances

  3. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship – Quasi-Experimental Designs

    Science.gov (United States)

    Schweizer, Marin L.; Braun, Barbara I.; Milstone, Aaron M.

    2016-01-01

    Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt non-randomized interventions. Quasi-experimental studies can be categorized into three major types: interrupted time series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies. PMID:27267457

  4. Integrated Weed Control for Land Stewardship at Legacy Management's Rocky Flats Site in Colorado - 13086

    International Nuclear Information System (INIS)

    Nelson, Jody K.

    2013-01-01

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

  5. Planning for Site Transition to Long-Term Stewardship: Identification of Requirements and Issues

    Energy Technology Data Exchange (ETDEWEB)

    Banaee, J.

    2002-05-16

    A systematic methodology is presented and applied for the identification of requirements and issues pertaining to the planning for, and transition to, long term stewardship (LTS). The method has been applied to three of the twelve identified LTS functions. The results of the application of the methodology to contaminated and uncontaminated federal real property in those three functions are presented. The issues that could be seen as impediments to the implementation of LTS are also identified for the three areas under consideration. The identified requirements are significant and in some cases complex to implement. It is clear that early and careful planning is required in all circumstances.

  6. Planning for Site Transition to Long-Term Stewardship: Identification of Requirements and Issues

    Energy Technology Data Exchange (ETDEWEB)

    Banaee, Jila

    2002-08-01

    A systematic methodology is presented and applied for the identification of requirements and issues pertaining to the planning for, and transition to, long term stewardship (LTS). The method has been applied to three of the twelve identified LTS functions. The results of the application of the methodology to contaminated and uncontaminated federal real property in those three functions are presented. The issues that could be seen as impediments to the implementation of LTS are also identified for the three areas under consideration. The identified requirements are significant and in some cases complex to implement. It is clear that early and careful planning is required in all circumstances.

  7. Indigenous Values and Health Systems Stewardship in Circumpolar Countries

    Directory of Open Access Journals (Sweden)

    Susan Chatwood

    2017-11-01

    Full Text Available Circumpolar regions, and the nations within which they reside, have recently gained international attention because of shared and pressing public policy issues such as climate change, resource development, endangered wildlife and sovereignty disputes. In a call for national and circumpolar action on shared areas of concern, the Arctic states health ministers recently met and signed a declaration that identified shared priorities for international cooperation. Among the areas for collaboration raised, the declaration highlighted the importance of enhancing intercultural understanding, promoting culturally appropriate health care delivery and strengthening circumpolar collaboration in culturally appropriate health care delivery. This paper responds to the opportunity for further study to fully understand indigenous values and contexts, and presents these as they may apply to a framework that will support international comparisons and systems improvements within circumpolar regions. We explored the value base of indigenous peoples and provide considerations on how these values might interface with national values, health systems values and value bases between indigenous nations particularly in the context of health system policy-making that is inevitably shared between indigenous communities and jurisdictional or federal governments. Through a mixed methods nominal consensus process, nine values were identified and described: humanity, cultural responsiveness, teaching, nourishment, community voice, kinship, respect, holism and empowerment.

  8. Nuclear stockpiles globalization

    International Nuclear Information System (INIS)

    Jouffray, Fabien

    2016-01-01

    For technological reasons, but more importantly political ones, the spread of nuclear weapons is foreseen as inevitable especially with the multiplication of so-called 'threshold states'. On the one hand, technological barriers will gradually disappear with globalization and information sharing in our societies. Furthermore, becoming a threshold power appears today as key to get freedom of action, a tool of counter-deterrence or blackmail according to the camp you belong to, like in the Iranian and north Korean cases. For proliferant countries, it will now consist in an enforcement of an embryonic, even though rather deterrent or even threatening, nuclear program thanks to new technologies, reducing completion times and even allowing to skip the final nuclear test

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

    NARCIS (Netherlands)

    Berrevoets, M.A.H.; Oever, J. ten; Sprong, T.; Hest, R.M. van; Groothuis, I.; Heijl, I. van; Schouten, J.A.; Hulscher, M.E.J.L.; Kullberg, B.J.

    2017-01-01

    BACKGROUND: The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the

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

    NARCIS (Netherlands)

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

    2017-01-01

    The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of

  11. Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital

    Directory of Open Access Journals (Sweden)

    Storey Donald F

    2012-10-01

    Full Text Available Abstract Background Antimicrobial stewardship has been promoted as a key strategy for coping with the problems of antimicrobial resistance and Clostridium difficile. Despite the current call for stewardship in community hospitals, including smaller community hospitals, practical examples of stewardship programs are scarce in the reported literature. The purpose of the current report is to describe the implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital employing a core strategy of post-prescriptive audit with intervention and feedback. Methods For one hour twice weekly, an infectious diseases physician and a clinical pharmacist audited medical records of inpatients receiving systemic antimicrobial therapy and made non-binding, written recommendations that were subsequently scored for implementation. Defined daily doses (DDDs; World Health Organization Center for Drug Statistics Methodology and acquisition costs per admission and per patient-day were calculated monthly for all administered antimicrobial agents. Results The antimicrobial stewardship team (AST made one or more recommendations for 313 of 367 audits during a 16-month intervention period (September 2009 – December 2010. Physicians implemented recommendation(s from each of 234 (75% audits, including from 85 of 115 for which discontinuation of all antimicrobial therapy was recommended. In comparison to an 8-month baseline period (January 2009 – August 2009, there was a 22% decrease in defined daily doses per 100 admissions (P = .006 and a 16% reduction per 1000 patient-days (P = .013. There was a 32% reduction in antimicrobial acquisition cost per admission (P = .013 and a 25% acquisition cost reduction per patient-day (P = .022. Conclusions An effective antimicrobial stewardship program was implemented with limited resources on the medical-surgical service of a 100-bed community hospital.

  12. Roadmap to MaRIE January 2015

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, Cris William [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-01-15

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

  13. Implementing an intensified antibiotic stewardship programme targeting daptomycin use in orthopaedic surgery: a cost-benefit analysis from the hospital perspective.

    Science.gov (United States)

    Borde, Johannes P; Nussbaum, Sarah; Hauser, Stefanie; Hehn, Philip; Hübner, Johannes; Sitaru, Gabriela; Köller, Sebastian; Schweigert, Bruno; deWith, Katja; Kern, Winfried V; Kaier, Klaus

    2016-06-01

    Hospital antibiotic stewardship (ABS) programmes offer several evidence-based tools to control prescription rates of antibiotics in different settings, influence the incidence of nosocomial infections and to contain the development of multi-drug-resistant bacteria. In the context of endoprosthetic surgery, however, knowledge of core antibiotic stewardship strategies, comparisons of costs and benefits of hospital ABS programmes are still lacking. We identified a high daptomycin use for the treatment of methicillin-sensitive staphylococcal infections as a potential target for our ABS intervention. In addition, we endorsed periprosthetic tissue cultures for the diagnosis of PJI. Monthly antibiotic use data were obtained from the hospital pharmacy and were expressed as WHO-ATC defined daily doses (DDD) and dose definitions adapted to local guidelines (recommended daily doses, RDD), normalized per 1000 patient days. The pre-intervention period was defined from February 2012 through January 2014 (24 months). The post-intervention period included monthly time points from February 2014 to April 2015 (15 months). For a basic cost-benefit analysis from the hospital perspective, three cost drivers were taken into account: (1) the cost savings due to changes in antimicrobial prescribing; (2) costs associated with the increase in the number of cultured tissue samples, and (3) the appointment of an infectious disease consultant. Interrupted time-series analysis (ITS) was applied. Descriptive analysis of the usage data showed a decline in overall use of anti-infective substances in the post-intervention period (334.9 vs. 221.4 RDDs/1000 patient days). The drug use density of daptomycin dropped by -75 % (51.7 vs. 12.9 RDD/1000 patient days), whereas the utilization of narrow-spectrum penicillins, in particular flucloxacillin, increased from 13.8 to 33.6 RDDs/1000 patient days. ITS analysis of the consumption dataset showed significant level changes for overall prescriptions, as

  14. Sewage pollution: mitigation is key for coral reef stewardship.

    Science.gov (United States)

    Wear, Stephanie L; Thurber, Rebecca Vega

    2015-10-01

    Coral reefs are in decline worldwide, and land-derived sources of pollution, including sewage, are a major force driving that deterioration. This review presents evidence that sewage discharge occurs in waters surrounding at least 104 of 112 reef geographies. Studies often refer to sewage as a single stressor. However, we show that it is more accurately characterized as a multiple stressor. Many of the individual agents found within sewage, specifically freshwater, inorganic nutrients, pathogens, endocrine disrupters, suspended solids, sediments, and heavy metals, can severely impair coral growth and/or reproduction. These components of sewage may interact with each other to create as-yet poorly understood synergisms (e.g., nutrients facilitate pathogen growth), and escalate impacts of other, non-sewage-based stressors. Surprisingly few published studies have examined impacts of sewage in the field, but those that have suggest negative effects on coral reefs. Because sewage discharge proximal to sensitive coral reefs is widespread across the tropics, it is imperative for coral reef-focused institutions to increase investment in threat-abatement strategies for mitigating sewage pollution. © 2015 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

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

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    1999-10-01

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

  16. Increasing Capacity for Stewardship of Oceans and Coasts: Findings of the National Research Council Report

    Science.gov (United States)

    Roberts, S. J.; Feeley, M. H.

    2008-05-01

    inappropriate evaluation procedures; and, lack of a coordinated and strategic approach among donors. A New Framework Improving ocean stewardship and ending the fragmentation of current capacity building programs will require a new, broadly adopted framework for capacity building that emphasizes cooperation, sustainability, and knowledge transfer within and among communities. The report identifies four specific features of capacity building that would increase the effectiveness and efficiency of future programs: 1. Regional action plans based on periodic program assessments to guide investments in capacity and set realistic milestones and performance measures. 2. Long-term support to establish self-sustaining programs. Sustained capacity building programs require a diversity of sources and coordinated investments from local, regional, and international donors. 3. Development of leadership and political will. One of the most commonly cited reasons for failure and lack of progress in ocean and coastal governance initiatives is lack of political will. One strategy for strengthening support is to identify, develop, mentor, and reward leaders. 4. Establishment of networks and mechanisms for regional collaboration. Networks bring together those working in the same or similar ecosystems with comparable management or governance challenges to share information, pool resources, and learn from one another. The report also recommends the establishment of regional centers to encourage and support collaboration among neighboring countries.

  17. Data Stewardship: Environmental Data Curation and a Web-of-Repositories

    Directory of Open Access Journals (Sweden)

    Karen S. Baker

    2009-10-01

    Full Text Available Scientific researchers today frequently package measurements and associated metadata as digital datasets in anticipation of storage in data repositories. Through the lens of environmental data stewardship, we consider the data repository as an organizational element central to data curation. One aspect of non-commercial repositories, their distance-from-origin of the data, is explored in terms of near and remote categories. Three idealized repository types are distinguished – local, center, and archive - paralleling research, resource, and reference collection categories respectively. Repository type characteristics such as scope, structure, and goals are discussed. Repository similarities in terms of roles, activities and responsibilities are also examined. Data stewardship is related to care of research data and responsible scientific communication supported by an infrastructure that coordinates curation activities; data curation is defined as a set of repeated and repeatable activities focusing on tending data and creating data products within a particular arena. The concept of “sphere-of-context” is introduced as an aid to distinguishing repository types. Conceptualizing a “web-of-repositories” accommodates a variety of repository types and represents an ecologically inclusive approach to data curation.

  18. Revising Payment for Ecosystem Services in the Light of Stewardship: The Need for a Legal Framework

    Directory of Open Access Journals (Sweden)

    Alessandra Solazzo

    2015-11-01

    Full Text Available Since the Millennium Ecosystem Assessment (MEA highlighted the importance of ecosystem services for human well-being, the payments for such services have increasingly been drawing the attention of governments, the private sector and academia. Nonetheless, there is not yet a specific legal framework which is able to capture the complexity of managing natural resources and, at the same time, deal with the numerous drawbacks that have been identified by critics, who are opposed to using financialisation of the environment as a tool. This paper, after briefly summarizing some of the main features and criticisms of the Payment for Ecosystem Services (PES, will critically assess the understanding of property rights over natural resources as stewardship, rather than as entitlement, because this interpretation is more coherent with the inherent characteristics of natural resources and, consequently, of ecosystem services. The novel usage of a stewardship dimension to property rights underlines the necessity for a legal framework for PES, constituted by “property-liability rules”.

  19. Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach.

    Science.gov (United States)

    Pulcini, C; Binda, F; Lamkang, A S; Trett, A; Charani, E; Goff, D A; Harbarth, S; Hinrichsen, S L; Levy-Hara, G; Mendelson, M; Nathwani, D; Gunturu, R; Singh, S; Srinivasan, A; Thamlikitkul, V; Thursky, K; Vlieghe, E; Wertheim, H; Zeng, M; Gandra, S; Laxminarayan, R

    2018-04-03

    With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability. A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires. The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased. This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide. Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. All rights reserved.

  20. Implementation of a Mobile Clinical Decision Support Application to Augment Local Antimicrobial Stewardship.

    Science.gov (United States)

    Hoff, Brian M; Ford, Diana C; Ince, Dilek; Ernst, Erika J; Livorsi, Daniel J; Heintz, Brett H; Masse, Vincent; Brownlee, Michael J; Ford, Bradley A

    2018-01-01

    Medical applications for mobile devices allow clinicians to leverage microbiological data and standardized guidelines to treat patients with infectious diseases. We report the implementation of a mobile clinical decision support (CDS) application to augment local antimicrobial stewardship. We detail the implementation of our mobile CDS application over 20 months. Application utilization data were collected and evaluated using descriptive statistics to quantify the impact of our implementation. Project initiation focused on engaging key stakeholders, developing a business case, and selecting a mobile platform. The preimplementation phase included content development, creation of a pathway for content approval within the hospital committee structure, engaging clinical leaders, and formatting the first version of the guide. Implementation involved a media campaign, staff education, and integration within the electronic medical record and hospital mobile devices. The postimplementation phase required ongoing quality improvement, revision of outdated content, and repeated staff education. The evaluation phase included a guide utilization analysis, reporting to hospital leadership, and sustainability and innovation planning. The mobile application was downloaded 3056 times and accessed 9259 times during the study period. The companion web viewer was accessed 8214 times. Successful implementation of a customizable mobile CDS tool enabled our team to expand beyond microbiological data to clinical diagnosis, treatment, and antimicrobial stewardship, broadening our influence on antimicrobial prescribing and incorporating utilization data to inspire new quality and safety initiatives. Further studies are needed to assess the impact on antimicrobial utilization, infection control measures, and patient care outcomes.

  1. Carbon stewardship: land management decisions and the potential for carbon sequestration in Colorado, USA

    International Nuclear Information System (INIS)

    Failey, Elisabeth L; Dilling, Lisa

    2010-01-01

    Land use and its role in reducing greenhouse gases is a key element of policy negotiations to address climate change. Calculations of the potential for enhanced terrestrial sequestration have largely focused on the technical characteristics of carbon stocks, such as vegetation type and management regime, and to some degree, on economic incentives. However, the actual potential for carbon sequestration critically depends on who owns the land and additional land management decision drivers. US land ownership patterns are complex, and consequently land use decision making is driven by a variety of economic, social and policy incentives. These patterns and incentives make up the 'carbon stewardship landscape'-that is, the decision making context for carbon sequestration. We examine the carbon stewardship landscape in the US state of Colorado across several public and private ownership categories. Achieving the full potential for land use management to help mitigate carbon emissions requires not only technical feasibility and financial incentives, but also effective implementing mechanisms within a suite of often conflicting and hard to quantify factors such as multiple-use mandates, historical precedents, and non-monetary decision drivers.

  2. A study on possible use of Urtica dioica (common nettle) plant as polonium (210)Po and lead (210)Pb contamination biomonitor in the area of phosphogypsum stockpile.

    Science.gov (United States)

    Olszewski, Grzegorz; Boryło, Alicja; Skwarzec, Bogdan

    2016-04-01

    The aim of this study was to test a possible use of Urtica dioica (common nettle) plant as a biomonitor of polonium (210)Po and lead (210)Pb contamination near phosphogypsum stacks by determining concentrations of these radionuclides in samples collected from the area of phosphogypsum stockpile in Wiślinka (northern Poland). The (210)Po and (210)Pb contents in roots depended on their concentrations in soils. Bioconcentration factor values from soil to root of the plant did not depend on (210)Po and (210)Pb contents in soils that leads to the conclusion that different polonium and lead species have different affinities to U. dioica plants. The main sources of both analyzed radionuclides in green parts of plants are wet and dry air deposition and transportation from soil. The values of (210)Po/(210)Pb activity ratio indicate natural origin of these radioisotopes in analyzed plants. (210)Po and (210)Pb concentration in U. dioica roots is negatively weakly correlated with distance from phosphogypsum stockpile.

  3. THE BNL ASTD FIELD LAB - NEAR - REAL - TIME CHARACTERIZATION OF BNL STOCKPILED SOILS TO ACCELERATE COMPLETION OF THE EM CHEMICAL HOLES PROJECT

    International Nuclear Information System (INIS)

    BOWERMAN, B.S.; ADAMS, J.W.; HEISER, J.; KALB, P.D.; LOCKWOOD, A.

    2003-01-01

    As of October 2001, approximately 7,000 yd 3 of stockpiled soil remained at Brookhaven National Laboratory (BNL) after the remediation of the BNL Chemical/Animal/Glass Pits disposal area. The soils were originally contaminated with radioactive materials and heavy metals, depending on what materials had been interred in the pits, and how the pits were excavated. During the 1997 removal action, the more hazardous/radioactive materials were segregated, along with, chemical liquids and solids, animal carcasses, intact gas cylinders, and a large quantity of metal and glass debris. Nearly all of these materials have been disposed of. In order to ensure that all debris was removed and to characterize the large quantity of heterogeneous soil, BNL initiated an extended sorting, segregation, and characterization project directed at the remaining soil stockpiles. The project was co-funded by the Department of Energy Environmental Management Office (DOE EM) through the BNL Environmental Restoration program and through the DOE EM Office of Science and Technology Accelerated Site Technology Deployment (ASTD) program. The focus was to remove any non-conforming items, and to assure that mercury and radioactive contaminant levels were within acceptable limits for disposal as low-level radioactive waste. Soils with mercury concentrations above allowable levels would be separated for disposal as mixed waste. Sorting and segregation were conducted simultaneously. Large stockpiles (ranging from 150 to 1,200 yd 3 ) were subdivided into manageable 20 yd 3 units after powered vibratory screening. The 1/2-inch screen removed almost all non-conforming items (plus some gravel). Non-conforming items were separated for further characterization. Soil that passed through the screen was also visually inspected before being moved to a 20 yd 3 ''subpile.'' Eight samples from each subpile were collected after establishing a grid of four quadrants: north, east, south and west, and two layers: top and

  4. Advanced Simulation and Computing Co-Design Strategy

    Energy Technology Data Exchange (ETDEWEB)

    Ang, James A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hoang, Thuc T. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Kelly, Suzanne M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); McPherson, Allen [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Neely, Rob [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-11-01

    This ASC Co-design Strategy lays out the full continuum and components of the co-design process, based on what we have experienced thus far and what we wish to do more in the future to meet the program’s mission of providing high performance computing (HPC) and simulation capabilities for NNSA to carry out its stockpile stewardship responsibility.

  5. Neutron metrology for SBSS

    International Nuclear Information System (INIS)

    Morris, C.L.; Anaya, J.M.; Armijo, V.

    1998-01-01

    This is the final report of a two-year, Laboratory Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). The goal of this work is to develop new detector technologies for Science-Based Stockpile Stewardship (SBSS) at the Los Alamos Neutron Scattering Center (LANSCE) using existing expertise and infrastructure from the nuclear and particle physics programs at LANL

  6. "Nuestra Tierra Dinamica" Global Climate Change STEM Education Fostering Environmental Stewardship

    Science.gov (United States)

    La Grave, M.; de Valenzuela, M.; Russell, R.

    2012-12-01

    CLUB ECO LÓGICO is a democratic and participatory program that provides active citizenship in schools and community, placing climate change into context for the Latino Community. The program's objectives focus on: 1. The Environment. Reducing the school and community impact on the environment through environmental footprint through stewardship actions. 2. Empowerment. Engaging participants through project and service learning and make decisions about how to improve their schools, their homes and their community's environment. 3. Community and Research Partnerships. Fostering collaborations with local community, stakeholders, government, universities, research organizations, and businesses that have expertise in environmental research, management, education and climate change. 4. Awareness. Increasing environmental and climate science knowledge of participants through STEM activities and hands-on access to technology. 5. Research and evaluation. Assessing the relevance of program activities through the engagement of the Latino community in planning and the effectiveness and impact of STEM activities through formative and summative evaluation. To address these objectives, the program has several inter related components in an after school setting: SUN EARTH Connections: Elementary (grades K to 2) students learn the basic climate change concepts through inquiry and hands on STEM activities. Bilingual 8 facilitators adapt relevant NASA educational resources for use in inquiry based, hands on activities. Drama and the arts provide unique experiences as well as play a key role in learning, participation and facilitation. GREEN LABS: Elementary students (grades 3 to 5) participate in stations where each Lab is staffed by at least two professionals: a College level fully bilingual Latin American Professional and a stakeholder representing either a research organization or other relevant environmental organization. Our current Green Lab themes include: Air, Soils, Water

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

    Science.gov (United States)

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

    2017-01-01

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

  8. Application of the “4R” nutrient stewardship concept to horticultural crops: getting nutrients in the “right” place

    Science.gov (United States)

    The 4R nutrient stewardship concept was introduced in 2009 by International Plant Nutrition Institute to define the right source, rate, time, and place to apply fertilizers to produce not only the most economical outcome in any given crop but to also to provide desirable social and environmental ben...

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

    Science.gov (United States)

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

    2014-01-01

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

  10. Assessing the distribution of environmental stewardship organizations and their relationship to the demographics of Los Angeles County

    Science.gov (United States)

    Krystle M. Golly

    2017-01-01

    An equal distribution of environmental stewardship organizations across the urban landscape provides an environment that facilitates community empowerment. The systemic issues found in Los Angeles County play an important role in the social development of the area. Through the utilization of modern technology and geographical mapping software, spatial distribution of...

  11. Networked governance and the management of ecosystem services: The case of urban environmental stewardship in New York City

    Science.gov (United States)

    James J.T. Connolly; Erika S. Svendsen; Dana R. Fisher; Lindsay K. Campbell

    2014-01-01

    Urban environmental stewardship groups have become an essential component of the governance structure that regulates ecosystem services in cities. New York City is one example where these groups have grown rapidly in number, size, and visibility since the 1970s. In this article, we combine quantitative survey data with qualitative interview data to examine the...

  12. The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program.

    Science.gov (United States)

    Slayton, Rachel B; Scott, R Douglas; Baggs, James; Lessa, Fernanda C; McDonald, L Clifford; Jernigan, John A

    2015-06-01

    To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals Markov model with a 5-year time horizon Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old. CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012. Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials. RESULTS In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion). The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.

  13. Reconnecting cities to the biosphere: stewardship of green infrastructure and urban ecosystem services.

    Science.gov (United States)

    Andersson, Erik; Barthel, Stephan; Borgström, Sara; Colding, Johan; Elmqvist, Thomas; Folke, Carl; Gren, Åsa

    2014-05-01

    Within-city green infrastructure can offer opportunities and new contexts for people to become stewards of ecosystem services. We analyze cities as social-ecological systems, synthesize the literature, and provide examples from more than 15 years of research in the Stockholm urban region, Sweden. The social-ecological approach spans from investigating ecosystem properties to the social frameworks and personal values that drive and shape human interactions with nature. Key findings demonstrate that urban ecosystem services are generated by social-ecological systems and that local stewards are critically important. However, land-use planning and management seldom account for their role in the generation of urban ecosystem services. While the small scale patchwork of land uses in cities stimulates intense interactions across borders much focus is still on individual patches. The results highlight the importance and complexity of stewardship of urban biodiversity and ecosystem services and of the planning and governance of urban green infrastructure.

  14. Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines

    Directory of Open Access Journals (Sweden)

    Yeo Chay Leng

    2012-11-01

    Full Text Available Abstract Our prospective-audit-and-feedback antimicrobial stewardship (AS program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation. However, process indicators including the number of recommendations and recommendation acceptance rates fell significantly during the year, with accompanying increases in broad-spectrum antibiotic prescription. The trends were reversed only upon reverting to the original setup. Dedicated clinicians play a crucial role in AS programs involving immunocompromised patients. Structured training and adequate succession/contingency planning is critical for sustainability.

  15. Biogeochemical Cycling and Environmental Stability of Pu Relevant to Long-Term Stewardship of DOE Sites

    Energy Technology Data Exchange (ETDEWEB)

    Honeyman, Bruce D.

    2006-06-01

    The overall objective of this proposed research is to understand the biogeochemical cycling of Pu in environments of interest to long-term DOE stewardship issues. Central to Pu cycling (transport initiation to immobilization) is the role of microorganisms. The hypothesis underlying this proposal is that microbial activity is the causative agent in initiating the mobilization of Pu in near-surface environments: through the transformation of Pu associated with solid phases, production of extracellular polymeric substances (EPS) carrier phases, and the creation of microenvironments. Also, microbial processes are central to the immobilization of Pu species, through the metabolism of organically complexed Pu species and Pu associated with extracellular carrier phases and the creation of environments favorable for Pu transport retardation.

  16. Biogeochemical Cycling and Environmental Stability of Pu Relevant to Long-Term Stewardship of DOE Sites

    Energy Technology Data Exchange (ETDEWEB)

    Francis, Arokiasamy J.; Santschi, Peter H.; Honeyman, Bruce D.

    2005-06-01

    The overall objective of this proposed research is to understand the biogeochemical cycling of Pu in environments of interest to long-term DOE stewardship issues. Central to Pu cycling (transport initiation to immobilization) is the role of microorganisms. The hypothesis underlying this proposal is that microbial activity is the causative agent in initiating the mobilization of Pu in near-surface environments: through the transformation of Pu associated with solid phases, production of extracellular polymeric substances (EPS) carrier phases, and the creation of microenvironments. Also, microbial processes are central to the immobilization of Pu species, through the metabolism of organically complexed Pu species and Pu associated with extracellular carrier phases and the creation of environments favorable for Pu transport retardation.

  17. Carbapenem stewardship: does ertapenem affect Pseudomonas susceptibility to other carbapenems? A review of the evidence.

    Science.gov (United States)

    Nicolau, David P; Carmeli, Yehuda; Crank, Christopher W; Goff, Debra A; Graber, Christopher J; Lima, Ana Lucia L; Goldstein, Ellie J C

    2012-01-01

    The group 2 carbapenems (imipenem, meropenem and, more recently, doripenem) have been a mainstay of treatment for patients with serious hospital infections caused by Pseudomonas aeruginosa, Enterobacteriaceae and other difficult-to-treat Gram-negative pathogens as well as mixed aerobic/anaerobic infections. When ertapenem, a group 1 carbapenem, was introduced, questions were raised about the potential for ertapenem to select for imipenem- and meropenem-resistant Pseudomonas. Results from ten clinical studies evaluating the effect of ertapenem use on the susceptibility of Pseudomonas to carbapenems have uniformly shown that ertapenem use does not result in decreased Pseudomonas susceptibility to these antipseudomonal carbapenems. Here we review these studies evaluating the evidence of how ertapenem use affects P. aeruginosa as well as provide considerations for ertapenem use in the context of institutional stewardship initiatives. Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  18. Bedside resource stewardship in disasters: a provider's dilemma practicing in an ethical gap.

    Science.gov (United States)

    Daniel, Michelle

    2012-01-01

    During disasters, clinicians may be forced to play dual roles, as both a provider and an allocator of scarce resources. At present, a clear framework to govern resource stewardship at the bedside is lacking. Clinicians who find themselves practicing in this ethical gap between clinical and public health ethics can experience significant moral distress. One provider describes her experience allocating an oxygen tank in the intensive care unit at a hospital in Port-au-Prince, Haiti, immediately following the 2010 earthquake. Using a clinical vignette and reflective narrative she attempts to identify the factors that influenced her allocation decision, opening up the factors for commentary and debate by an ethicist. A better paradigm for the ethical care of patients during disasters is needed to better guide provider choices in the future.

  19. Energy Systems Integration Facility (ESIF) Facility Stewardship Plan: Revision 2.1

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Juan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Anderson, Art [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-01-02

    The U.S. Department of Energy (DOE), Office of Energy Efficiency and Renewable Energy (EERE), has established the Energy Systems Integration Facility (ESIF) on the campus of the National Renewable Energy Laboratory (NREL) and has designated it as a DOE user facility. This 182,500-ft2 research facility provides state-of-the-art laboratory and support infrastructure to optimize the design and performance of electrical, thermal, fuel, and information technologies and systems at scale. This Facility Stewardship Plan provides DOE and other decision makers with information about the existing and expected capabilities of the ESIF and the expected performance metrics to be applied to ESIF operations. This plan is a living document that will be updated and refined throughout the lifetime of the facility.

  20. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases.

    Science.gov (United States)

    Drees, Marci; Gerber, Jeffrey S; Morgan, Daniel J; Lee, Grace M

    2016-11-01

    Administrative and surveillance data are used frequently in healthcare epidemiology and antimicrobial stewardship (HE&AS) research because of their wide availability and efficiency. However, data quality issues exist, requiring careful consideration and potential validation of data. This methods paper presents key considerations for using administrative and surveillance data in HE&AS, including types of data available and potential use, data limitations, and the importance of validation. After discussing these issues, we review examples of HE&AS research using administrative data with a focus on scenarios when their use may be advantageous. A checklist is provided to help aid study development in HE&AS using administrative data. Infect Control Hosp Epidemiol 2016;1-10.

  1. Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship-Quasi-Experimental Designs.

    Science.gov (United States)

    Schweizer, Marin L; Braun, Barbara I; Milstone, Aaron M

    2016-10-01

    Quasi-experimental studies evaluate the association between an intervention and an outcome using experiments in which the intervention is not randomly assigned. Quasi-experimental studies are often used to evaluate rapid responses to outbreaks or other patient safety problems requiring prompt, nonrandomized interventions. Quasi-experimental studies can be categorized into 3 major types: interrupted time-series designs, designs with control groups, and designs without control groups. This methods paper highlights key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies. Infect Control Hosp Epidemiol 2016;1-6.

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

    Science.gov (United States)

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

    2018-04-01

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

  3. Urine culture guided antibiotic interventions: A pharmacist driven antimicrobial stewardship effort in the ED.

    Science.gov (United States)

    Zhang, Xi; Rowan, Nicole; Pflugeisen, Bethann Mangel; Alajbegovic, Sanjin

    2017-04-01

    Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED. This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015. Analyses were conducted using Chi-squared and Fisher Exact tests and stepwise multiple logistic regression. Urine cultures from 457 encounters were reviewed, of which 136 met the inclusion criteria as non-pregnant and asymptomatic for urinary tract infection (UTI). 43% of 136 patients were treated with antibiotics, for a total of 426 antibiotic days. Pharmacist interventions for these patients resulted in 122/426 (29%) of potential antibiotic days saved. Factors found to significantly increase the odds of antibiotic prescribing in asymptomatic patients included presence of leukocyte esterase (OR=4.5, 95% CI: 1.2-17.2; p=0.03) or nitrites (OR=10.8, 95% CI: 1.7-68.1; p=0.01) in the urine and age≥75 (OR=3.5, 95% CI: 1.2-9.6, p=0.02). Pharmacist intervention in discontinuing or modifying antibiotics for asymptomatic patients with urine cultures reduced unnecessary antibiotic exposure and was a first step in antimicrobial stewardship efforts in the ED. Future work includes limiting urine tests and subsequent antibiotic therapy for non-pregnant asymptomatic patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. The resistance tsunami, antimicrobial stewardship, and the golden age of microbiology.

    Science.gov (United States)

    Prescott, John F

    2014-07-16

    Modern medicine is built on antibiotics. Antibiotics are something that we take for granted. We have however spent over 60 years educating bacteria to become resistant, and the global resistance tsunami has caught everyone unawares. Since bacteria have changed, we also have to change, and to change most of the practices of how we use antibiotics. Because the development of new antibiotics is so expensive, a stewardship approach may help to preserve those that we have now while we work to develop new antibiotics and to develop other approaches to controlling and treating infections. We need to adopt the ethic of Good Stewardship Practice (GSP) as an active and dynamic process of continuous improvement in antibiotic use, a process with many steps of different sizes involving everyone involved in antibiotic use. All antibiotic users have an important role to play in GSP. Although the resistance situation is pessimistic, and the future of antibiotics looks uncertain, we are fortunately entering what may be seen as the golden age of microbiology. This encompasses an astonishing array of technologies for rapid pathogen and resistance gene detection, for clone identification by genome sequencing, for identification of novel bacterial genes and for identification of the Achilles' heels of different pathogens. Future antibiotics may have to be far more targeted to the individual pathogen and the site of infection. A global tax on antibiotics might reduce their use while funding the cost of developing new antibiotics and new approaches to control of infectious diseases. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Clinical Outcomes of a Pharmacy-Led Blood Factor Stewardship Program.

    Science.gov (United States)

    Trueg, Anne O; Lowe, Christopher; Kiel, Patrick J

    To report the results of a pharmacist-directed blood factor stewardship program targeting off-label utilization designed to limit use to established organizational guidelines in high-risk populations. Prospective evaluation of recombinant factor VIIa and prothrombin complex concentrate orders beginning June 2013 through May 2014 and a matched retrospective cohort from June 2012 to May 2013. Matched cohorts were evaluated for 28-day mortality, change in international normalized ratio (INR), adverse events, concurrent blood product use, and cost savings. Forty-two orders for blood factor were ordered between June 2013 and May 2014, 70 orders in the year before (N = 112). Twenty eight-day mortality was not different between the cohorts: 53.9% versus 50% (P = 0.77). Blood factor use with underlying liver failure and active bleeding was strongly associated with 28-day mortality: odds ratio (95% confidence interval), 2.9 (1.5-7.14) and 2.91 (0.01-2.91), respectively. Blood products dispensed increased over the year with plasma products the most significant (1 vs. 4 P = 0.004). All other clinical outcomes were nonsignificant. An annual cost savings of $375,539 was achieved, primarily through a significant reduction in recombinant factor VIIa and avoidance in high-risk patients. Use of off-label blood factors can be controlled through a pharmacist-led stewardship program. Twenty eight-day mortality was not different between the 2 cohorts; however, identification of risk factors for death associated with blood factor use allows for restriction in high-risk populations, creates a discussion of futile care, and yields cost savings.

  6. Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance.

    Science.gov (United States)

    Dos Santos, Rodrigo P; Dalmora, Camila H; Lukasewicz, Stephani A; Carvalho, Otávio; Deutschendorf, Caroline; Lima, Raquel; Leitzke, Tiago; Correa, Nilson C; Gambetta, Marcelo V

    2018-01-01

    Introduction Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. Methods We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. Results After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = -0.80; P change, β = -0.01; P = 0.98), first-generation cephalosporins (level change, β = -0.91; P change, β = +0.01; P = 0.96), vancomycin (level change, β = -0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = -0.15; P = 0.56; trend change, β = -1.75; P change, β = +0.84; P change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = -1.26; P resistance.

  7. The Nature of Scatter at the DARHT Facility and Suggestions for Improved Modeling of DARHT Facility

    Energy Technology Data Exchange (ETDEWEB)

    Morneau, Rachel Anne [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-11-09

    This report describes the US Stockpile Stewardship Program which is meant to sustain and evaluate nuclear weapon stockpile with no underground nuclear tests. This research will focus on DARHT, the Dual Axis Radiographic Hydrodynamic Test facility.

  8. Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy

    NARCIS (Netherlands)

    Hara, G. Levy; Kanj, S.S.; Pagani, L.; Abbo, L.; Endimiani, A.; Wertheim, H.F.L.; Amabile-Cuevas, C.; Tattevin, P.; Mehtar, S.; Cardoso, F.; Unal, S.; Gould, I.

    2016-01-01

    The Antibiotic Stewardship and Resistance Working Groups of the International Society for Chemotherapy propose ten key points for the appropriate use of antibiotics in hospital settings. (i) Get appropriate microbiological samples before antibiotic administration and carefully interpret the results:

  9. Dose Estimates from Irrigation with Tritiated Water at the Savannah River Site

    International Nuclear Information System (INIS)

    Lee, P.L.

    2000-01-01

    The Savannah River Site (SRS) is part of the U.S. Department of Energy (DOE) complex. It was constructed in the early 1950's to produce special nuclear materials (such as plutonium-239 and tritium) used in the production of nuclear weapons. The 310-square-mile site is located in South Carolina, about 15 miles southeast of Augusta, Georgia. The production of nuclear materials at SRS continued for more than 40 years. However, the end of the Cold War caused a downsizing of this original national defense mission. Current missions are focused on: (1) nuclear weapons stockpile stewardship which emphasizes science-based maintenance of the country's nuclear weapons stockpile; (2) nuclear materials stewardship for management of excess nuclear materials, including transportation, stabilization, storage, and safe and secure disposition; and (3) environmental stewardship involving management, treatment, and disposal of radioactive and nonradioactive wastes resulting from past, present, and future operations

  10. Impact of an antimicrobial stewardship programme on antibiotic usage and resistance in a tertiary hospital in China.

    Science.gov (United States)

    Zhang, Z-G; Chen, F; Ou, Y

    2017-10-01

    Antimicrobial misuse has been commonly observed in China. This phenomenon can cause antibiotic resistance. This study was designed to evaluate the impact of an antimicrobial stewardship programme implemented in a tertiary hospital in China from 2011 to 2014. The antimicrobial stewardship programme began in 2011. Data on the consumption of antibiotics and antimicrobial resistance between 2011 and 2014 were collected. Comparison of the 2011 data with those of 2014 showed that antibiotic defined daily doses/per 100 patient-days decreased from 92.5±2.8 to 35.8±1.2 (Padministrative management, especially information management, was effective in reducing antibiotic consumption and lessening antibiotic resistance. © 2017 John Wiley & Sons Ltd.

  11. Designing Program Roadmaps to Catalyze Community Formation: A Case Study of the Long-Term Stewardship Science and Technology Roadmapword

    International Nuclear Information System (INIS)

    Dixon, Brent; Hanson, Duane; Matthern, Gretchen

    2003-01-01

    A number of broad perspective technology roadmaps have been developed in the last few years as tools for coordinating nation-wide research in targeted areas. These roadmaps share a common characteristic of coalescing the associated stakeholder groups into a special-interest community that is willing to work cooperatively in achieving the roadmap goals. These communities are key to roadmap implementation as they provide the collaborative energy necessary to obtain the political support and funding required for identified science and technology development efforts. This paper discusses the relationship between roadmaps and special-interest communities, using the recently drafted Department of Energy's Long-Term Stewardship Science and Technology Roadmap as a case study. Specific aspects this roadmap's design facilitated the development of a long-term stewardship community while specific realities during roadmap development impacted the realization of the design

  12. The effectiveness of agricultural stewardship for improving water quality at the catchment scale: Experiences from an NVZ and ECSFDI watershed

    Science.gov (United States)

    Kay, Paul; Grayson, Richard; Phillips, Martin; Stanley, Karen; Dodsworth, Alan; Hanson, Ann; Walker, Andrew; Foulger, Miles; McDonnell, Iain; Taylor, Simon

    2012-02-01

    SummaryAgriculture is estimated to be responsible for 70% of nitrate and 30-50% of phosphorus pollution, contributing to ecological and water treatment problems. Despite the fact that significant gaps remain in our understanding, it is known that agricultural stewardship can be highly effective in controlling water pollution at the plot and field scales. Knowledge at the catchment scale is, to a large extent, entirely lacking though and this is of paramount concern given that the catchment is the management unit used by regulatory authorities. The few studies that have examined the impact of agricultural stewardship at the catchment scale have found that Nitrate Vulnerable Zones (NVZs) in the UK have resulted in little improvement in water quality which concurs with the current catchment study. In addition to NVZs, there was little evidence to suggest that the England Catchment Sensitive Farming Delivery Initiative had impacted water quality and suggestions have been made for improvements, such as ensuring that stewardship measures are used in key pollution source areas and their implementation and impacts are monitored more closely. This will be essential if agricultural catchment management schemes are going to provide the benefits expected of them. Nevertheless, more intensive monitoring than that carried out by regulators showed a significant trend in decreasing winter nitrate peaks in some streams which is hypothesised to be due to recent reduced inorganic fertiliser application as a result of increasing prices. It was concluded that, collectively, these findings indicate that agricultural stewardship measures have the potential to improve water quality at the catchment scale but that voluntary schemes with insufficient financial reward or regulatory pressure are unlikely to be successful.

  13. Fish stakes: the pros and cons of the Marine Stewardship Council initiative: a debate from the pages of SAMUDRA Report

    OpenAIRE

    1998-01-01

    The recent effort by two global organizations, the World Wide Fund for Nature (WWF) and the Anglo-Dutch multinational, Unilever, to establish an independent Marine Stewardship Council (MSC) as a conservation partnership to create market incentives for sustainable fishing has attracted a great deal of attention-as well as controversy. In this dossier, the pros and cons of the SC initiative are argued out in a series of articles that first appeared in SAMUDRA Report, the triannual publication o...

  14. Patient and public understanding and knowledge of antimicrobial resistance and stewardship in a UK hospital: should public campaigns change focus?

    Science.gov (United States)

    Micallef, Christianne; Kildonaviciute, Kornelija; Castro-Sánchez, Enrique; Scibor-Stepien, Aleksandra; Santos, Reem; Aliyu, Sani H; Cooke, Fiona J; Pacey, Sarah; Holmes, Alison H; Enoch, David A

    2017-01-01

    The rising global tide of antimicrobial resistance is a well-described phenomenon. Employing effective and innovative antimicrobial stewardship strategies is an essential approach to combat this public health threat. Education of the public and patients is paramount to enable the success of such strategies. A panel of hospital multidisciplinary healthcare professionals was set up and a short quiz containing true/false statements around antimicrobial stewardship and resistance was designed and piloted. An educational leaflet with the correct replies and supporting information was also produced and disseminated. Participants were recruited on a single day (18 November 2015) from the hospital outpatient clinics and the hospital outpatient pharmacy waiting room. One hundred and forty-five completed quizzes were returned, providing a total of 1450 answers. Overall, 934 of 1450 (64%) statements were scored correctly whilst 481 (33%) were scored incorrectly; 35 (3%) statements were left unscored. We speculate that these results may demonstrate that respondents understood the statements, as only a small proportion of statements were left unanswered. The question dealing with the definition of antimicrobial resistance and the question dealing with the definition of antimicrobial stewardship obtained the most incorrect replies (85% and 72%, respectively). However, a specific factual recall question regarding only one microorganism (MRSA) received the most correct responses (99%). We describe a simple, innovative method of engagement with patients and the general public to help educate and disseminate important public health messages around antimicrobial resistance and stewardship. We also identified the need for public health campaigns to address the knowledge gaps found around this topic. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  15. Collaboration in Long-Term Stewardship at DOE's Hanford Site - 13019

    International Nuclear Information System (INIS)

    Moren, Rick; Brown, David; Feist, Ella; Grindstaff, Keith; Zeisloft, Jamie

    2013-01-01

    The U.S. Department of Energy's (DOE) Hanford Site comprises approximately 1,517 km 2 (586 mi 2 ) of land in southeastern Washington. The site was established in 1943 as part of the Manhattan Project to produce plutonium for the nation's nuclear weapons program. As the Cold War era came to an end, the mission of the site transitioned from weapons production to environmental cleanup. As the River Corridor area of the site cleanup is completed, the mission for that portion of the site will transition from active cleanup to continued protection of environment through the Long-Term Stewardship (LTS) Program. The key to successful transition from cleanup to LTS is the unique collaboration among three (3) different DOE Programs and three (3) different prime contractors with each contractor having different contracts. The LTS Program at the site is a successful model of collaboration resulting in efficient resolution of issues and accelerated progress that supports DOE's Richland Office 2015 Vision for the Hanford Site. The 2015 Vision for the Hanford Site involves shrinking the active cleanup footprint of the surface area of the site to approximately 20 mi 2 on the Central Plateau. Hanford's LTS Program is defined in DOE's planning document, Hanford Long-Term Stewardship Program Plan [1]. The Plan defines the relationship and respective responsibilities between the federal cleanup projects and the LTS Program along with their respective contractors. The LTS Program involves these different parties (cleanup program and contractors) who must work together to achieve the objective for transition of land parcels. Through the collaborative efforts with the prime contractors on site over the past two years,, 253.8 km 2 (98 mi 2 ) of property has been successfully transitioned from the cleanup program to the LTS Program upon completion of active surface cleanup. Upcoming efforts in the near term will include transitioning another large parcel that includes one of the six (6

  16. Collaboration in Long-Term Stewardship at DOE's Hanford Site - 13019

    Energy Technology Data Exchange (ETDEWEB)

    Moren, Rick; Brown, David [Mission Support Alliance, LLC, Richland, WA (United States); Feist, Ella [Washington Closure Hanford, LLC, Richland WA (United States); Grindstaff, Keith; Zeisloft, Jamie [US Department of Energy, Richland Operations, Richland WA (United States)

    2013-07-01

    The U.S. Department of Energy's (DOE) Hanford Site comprises approximately 1,517 km{sup 2} (586 mi{sup 2}) of land in southeastern Washington. The site was established in 1943 as part of the Manhattan Project to produce plutonium for the nation's nuclear weapons program. As the Cold War era came to an end, the mission of the site transitioned from weapons production to environmental cleanup. As the River Corridor area of the site cleanup is completed, the mission for that portion of the site will transition from active cleanup to continued protection of environment through the Long-Term Stewardship (LTS) Program. The key to successful transition from cleanup to LTS is the unique collaboration among three (3) different DOE Programs and three (3) different prime contractors with each contractor having different contracts. The LTS Program at the site is a successful model of collaboration resulting in efficient resolution of issues and accelerated progress that supports DOE's Richland Office 2015 Vision for the Hanford Site. The 2015 Vision for the Hanford Site involves shrinking the active cleanup footprint of the surface area of the site to approximately 20 mi{sup 2} on the Central Plateau. Hanford's LTS Program is defined in DOE's planning document, Hanford Long-Term Stewardship Program Plan [1]. The Plan defines the relationship and respective responsibilities between the federal cleanup projects and the LTS Program along with their respective contractors. The LTS Program involves these different parties (cleanup program and contractors) who must work together to achieve the objective for transition of land parcels. Through the collaborative efforts with the prime contractors on site over the past two years,, 253.8 km{sup 2} (98 mi{sup 2}) of property has been successfully transitioned from the cleanup program to the LTS Program upon completion of active surface cleanup. Upcoming efforts in the near term will include transitioning another

  17. Collaboration in long-term stewardship at DOE Hanford Site-13019

    International Nuclear Information System (INIS)

    Moren, R. J.; Zeisloft, J. H.; Feist, E. T.; Brown, D.; Grindstaff, K. D.

    2013-01-01

    The U.S. Department of Energy's (DOE) Hanford Site comprises approximately 1,517 km 2 (586 mi 2 ) of land in southeastern Washington. The site was established in 1943 as part of the Manhattan Project to produce plutonium for the nation's nuclear weapons program. As the Cold War era came to an end, the mission of the site transitioned from weapons production to environmental cleanup. As the River Corridor area of the site cleanup is completed, the mission for that portion of the site will transition from active cleanup to continued protection of environment through the Long-Term Stewardship (LTS) Program. The key to successful transition from cleanup to LTS is the unique collaboration among three (3) different DOE Programs and three (3) different prime contractors with each contractor having different contracts. The LTS Program at the site is a successful model of collaboration resulting in efficient resolution of issues and accelerated progress that supports DOE's Richland Office 2015 Vision for the Hanford Site. The 2015 Vision for the Hanford Site involves shrinking the active cleanup footprint of the surface area of the site to approximately 20 mi 2 on the Central Plateau. Hanford's LTS Program is defined in DOE's planning document, Hanford Long-Term Stewardship Program Plan, DOE/RL-2010-35 Rev 1. The Plan defines the relationship and respective responsibilities between the federal cleanup projects and the LTS Program along with their respective contractors. The LTS Program involves these different parties (cleanup program and contractors) who must work together to achieve the objective for transition of land parcels. Through the collaborative efforts with the prime contractors on site over the past two years, 253.8 km 2 (98 mi 2 ) of property has been successfully transitioned from the cleanup program to the LTS Program upon completion of active surface cleanup. Upcoming efforts in the near term will include transitioning another large parcel that includes one

  18. Antimicrobial Stewardship: A Cross-Sectional Survey Assessing the Perceptions and Practices of Community Pharmacists in Ethiopia

    Directory of Open Access Journals (Sweden)

    Daniel Asfaw Erku

    2016-01-01

    Full Text Available Background. Community pharmacists are key healthcare professionals for antimicrobial stewardship programs owing to their role in dispensing of antimicrobials. The aim of the present study was to assess the perception and practices of community pharmacists towards antimicrobial stewardship (AMS in Ethiopia. Methods. A cross-sectional survey was conducted by selecting pharmacy sites through stratified simple random sampling technique. Descriptive and inferential statistics were used to analyze the data. Results. Majority of respondents strongly agreed or agreed that AMS program is vital for the improvement of patient care. Almost all of respondents agreed that pharmacists can play a prominent role in AMS and infection prevention (93.2%, median = 5; IQR = 2–5. However, only 26.5% of respondents strongly agreed or agreed that AMS should be practiced at community pharmacy level (median = 4, IQR = 1–3 and more than half of community pharmacists (59.9% often/always dispense antimicrobial without a prescription. Conclusion. The present study revealed positive perceptions and practices of community pharmacists towards antimicrobial stewardship. Yet, some weak areas like integration of AMS program in community pharmacies, the significance of interprofessional involvement, and dispensing of antimicrobials without a valid prescription still need improvement.

  19. Campaign Preparation for Complex Initiatives: A Person-Centered Approach to Audience Segmentation of Parents' Antibiotic Stewardship.

    Science.gov (United States)

    Smith, Rachel A; MacGeorge, Erina L; Hackman, Nicole M; M'ikanatha, Nkuchia M

    2017-10-25

    The evolution of antibiotic resistance is outpacing the speed at which new antibiotics will reach the marketplace. To slow the rate of resistance, people need to engage in antibiotic stewardship, which includes acts to prevent the spread of bacteria and judicious use of antibiotics to treat infections. This study identified the patterns and predictors of antibiotic stewardship behaviors of parents (N = 516) related to their children. The latent class analysis revealed three profiles of parental stewardship, labeled Stewards, Requesters, and Non-Stewards. The findings implied different campaign goals: to encourage Stewards to follow through on their intentions, to encourage Requesters to stop asking providers for antibiotics when their children have ear infections, and to influence Non-Stewards to accept medical advice when an antibiotic is not indicated and to dispose of leftover antibiotics. The covariate analysis provided theoretical insight into the strategies to pursue in campaigns targeting these three groups. For example, parents who perceived antibiotic-resistant infections as less serious health conditions, felt less worry when thinking about their child getting an antibiotic-resistant infection, and had stronger misattributions of antibiotics' efficacy to treat multiple symptoms were more likely to be Requesters and Non-Stewards, instead of Stewards.

  20. Community-based memorials to September 11, 2001: environmental stewardship as memory work

    Science.gov (United States)

    Erika S. Svendsen; Lindsay K. Campbell

    2014-01-01

    This chapter investigates how people use trees, parks, gardens, and other natural resources as raw materials in and settings for memorials to September 11, 2001. In particular, we focus on 'found space living memorials', which we define as sites that are community-managed, re-appropriated from their prior use, often carved out of the public right-of-way, and...

  1. Controversies in Antimicrobial Stewardship: Focus on New Rapid Diagnostic Technologies and Antimicrobials

    Directory of Open Access Journals (Sweden)

    Eric Wenzler

    2016-01-01

    Full Text Available Antimicrobial stewardship programs (ASPs are challenged with ensuring appropriate antimicrobial use while minimizing expenditures. ASPs have consistently demonstrated improved patient outcomes and significant cost reductions but are continually required to justify the costs of their existence and interventions due to the silo mentality often adopted by hospital administrators. As new technologies and antimicrobials emerge, ASPs are in a constant tug-of-war between providing optimal clinical outcomes and ensuring cost containment. Additionally, robust data on cost-effectiveness of new rapid diagnostic technologies and antimicrobials with subsequent ASP interventions to provide justification are lacking. As the implementation of an ASP will soon be mandatory for acute care hospitals in the United States, ASPs must find ways to justify novel interventions to align themselves with healthcare administrators. This review provides a framework for the justification of implementing a rapid diagnostic test or adding a new antimicrobial to formulary with ASP intervention, reviews approaches to demonstrating cost-effectiveness, and proposes methods for which ASPs may reduce healthcare expenditures via alternative tactics.

  2. Emergence of a global science–business initiative for ocean stewardship

    Science.gov (United States)

    Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-01-01

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science–business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well. PMID:28784792

  3. Implementation of the long term stewardship model of decommissioning power reactors. Update on the Zion project

    Energy Technology Data Exchange (ETDEWEB)

    Christian, J.; Hess, J.; Moloney, B.P. [EnergySolutions EU, Swindon (United Kingdom)

    2012-11-01

    Several countries have announced programmes to phase out nuclear power. Many NPPs built in the 1960s-80s are in any case reaching the end of their planned operating lives. Over the next decade, approximately 60-80 reactors worldwide will reach end of useful life and become candidates for decontamination and dismantling (D and D). Utilities will therefore commission over the coming decade a much larger number of decommissioning programmes to discharge their license responsibilities for reactor dismantling and site remediation. One major strategic question for the utilities is whether they regard decommissioning reactors as part of their core business or whether they wish to transfer this burden and risk in part or in whole to a specialised contractor. This paper reviews progress at the first programme in the US where a non-utility company has taken on the full license responsibility from the utility to undertake site remediation and license termination. We call this model ''Long Term Stewardship'' and it is now fully underway at the Zion NPP near Chicago, Illinois. (orig.)

  4. Enabling sustainable pastoralism: policies and investments that optimise livestock production and rangeland stewardship.

    Science.gov (United States)

    Ouedraogo, R; Davies, J

    2016-11-01

    Pastoralism is a system of dynamically managing livestock and land for economic, social and environmental benefit. To a large extent, pastoralism is an adaptation to ecological and climatic variability and is not simply a livestock production system but provides significant environmental services to humanity. Evidence from a range of national contexts shows that sustainable pastoralist development requires an understanding of the dual environmental and economic roles of pastoralism and an adaptation of policies and investments to support both. The current paper examines three cornerstones that have proven to be crucial for sustainable pastoralist development and for maximising the links between livestock production and environmental stewardship: strengthening pastoral capabilities and institutions, securing land tenure and natural resource governance, and ensuring equitable markets for pastoral diversity. To effectively support the dual economic-environmental roles of pastoralism requires not only optimisation of the production of ecosystem services through extensive livestock production, but also a major overhaul of the way we approach pastoralist development, and major investment in the people who are central to the system. As long as pastoralists remain marginalised, with weak rights and little access to services, their future will remain uncertain.

  5. New Developments in NOAA's Comprehensive Large Array-Data Stewardship System

    Science.gov (United States)

    Ritchey, N. A.; Morris, J. S.; Carter, D. J.

    2012-12-01

    The Comprehensive Large Array-data Stewardship System (CLASS) is part of the NOAA strategic goal of Climate Adaptation and Mitigation that gives focus to the building and sustaining of key observational assets and data archives critical to maintaining the global climate record. Since 2002, CLASS has been NOAA's enterprise solution for ingesting, storing and providing access to a host of near real-time remote sensing streams such as the Polar and Geostationary Operational Environmental Satellites (POES and GOES) and the Defense Meteorological Satellite Program (DMSP). Since October, 2011 CLASS has also been the dedicated Archive Data Segment (ADS) of the Suomi National Polar-orbiting Partnership (S-NPP). As the ADS, CLASS receives raw and processed S-NPP records for archival and distribution to the broad user community. Moving beyond just remote sensing and model data, NOAA has endorsed a plan to migrate all archive holdings from NOAA's National Data Centers into CLASS while retiring various disparate legacy data storage systems residing at the National Climatic Data Center (NCDC), National Geophysical Data Center (NGDC) and the National Oceanographic Data Center (NODC). In parallel to this data migration, CLASS is evolving to a service-oriented architecture utilizing cloud technologies for dissemination in addition to clearly defined interfaces that allow better collaboration with partners. This evolution will require implementation of standard access protocols and metadata which will lead to cost effective data and information preservation.

  6. Vertically Differentiating Environmental Standards: The Case of the Marine Stewardship Council

    Directory of Open Access Journals (Sweden)

    Simon R. Bush

    2015-02-01

    Full Text Available This paper explores the externally-led vertical differentiation of third-party certification standards using the case of the Marine Stewardship Council (MSC. We analyze this process in two dimensions. First, fisheries employ strategies to capture further market value from fishing practices that go beyond their initial conditions for certification and seek additional recognition for these activities through co-labelling with, amongst others, international NGOs. Second, fisheries not yet able to meet the requirements of MSC standards are being enrolled in NGO and private sector sponsored Fisheries Improvement Projects (FIPs, providing an alternative route to global markets. In both cases the credibility and authority of the MSC is challenged by new coalitions of market actors opening up new strategies for capturing market value and/or improving the conditions of international market access. Through the lens of global value chains, the results offer new insights on how such standards not only influence trade and markets, but are also starting to change their internal governance in response to threats to their credibility by actors and modes of coordination in global value chains.

  7. Emergence of Global Adaptive Governance for Stewardship of Regional Marine Resources

    Directory of Open Access Journals (Sweden)

    Henrik Österblom

    2013-06-01

    Full Text Available Overfishing has historically caused widespread stock collapses in the Southern Ocean. Until recently, illegal, unreported, and unregulated (IUU fishing threatened to result in the collapse of some of the few remaining valuable fish stocks in the region and vulnerable seabird populations. Currently, this unsustainable fishing has been reduced to less than 10% of former levels. We describe and analyze the emergence of the social-ecological governance system that made it possible to curb the fisheries crisis. For this purpose, we investigated the interplay between actors, social networks, organizations, and institutions in relation to environmental outcomes. We drew on a diversity of methods, including qualitative interviews, quantitative social network and survey data, and literature reviews. We found that the crisis triggered action of an informal group of actors over time, which led to a new organization (ISOFISH that connected two independent networks (nongovermental organizations and the fishing industry, and later (COLTO linked to an international body and convention (CCAMLR. The emergence of the global adaptive governance systems for stewardship of a regional marine resource took place over a 15-year period. We describe in detail the emergence process and illustrate the usefulness of analyzing four features of governance and understanding social-ecological processes, thereby describing structures and functions, and their link to tangible environmental outcomes.

  8. Emergence of a global science-business initiative for ocean stewardship.

    Science.gov (United States)

    Österblom, Henrik; Jouffray, Jean-Baptiste; Folke, Carl; Rockström, Johan

    2017-08-22

    The ocean represents a fundamental source of micronutrients and protein for a growing world population. Seafood is a highly traded and sought after commodity on international markets, and is critically dependent on healthy marine ecosystems. A global trend of wild stocks being overfished and in decline, as well as multiple sustainability challenges associated with a rapid growth of aquaculture, represent key concerns in relation to the United Nations Sustainable Development Goals. Existing efforts aimed to improve the sustainability of seafood production have generated important progress, primarily at the local and national levels, but have yet to effectively address the global challenges associated with the ocean. This study highlights the importance of transnational corporations in enabling transformative change, and thereby contributes to advancing the limited understanding of large-scale private actors within the sustainability science literature. We describe how we engaged with large seafood producers to coproduce a global science-business initiative for ocean stewardship. We suggest that this initiative is improving the prospects for transformative change by providing novel links between science and business, between wild-capture fisheries and aquaculture, and across geographical space. We argue that scientists can play an important role in facilitating change by connecting knowledge to action among global actors, while recognizing risks associated with such engagement. The methods developed through this case study contribute to identifying key competences in sustainability science and hold promises for other sectors as well.

  9. Next step in antibiotic stewardship: Pharmacist-provided penicillin allergy testing.

    Science.gov (United States)

    Gugkaeva, Z; Crago, J S; Yasnogorodsky, M

    2017-08-01

    Penicillin allergy limits therapeutic options for patients but often disappears over time, leaving patients erroneously labelled allergic and leading to the utilization of broad-spectrum and more expensive antibiotics. Penicillin allergy can be effectively assessed via skin testing. To improve patient access to penicillin allergy testing by implementing a pharmacist-provided service in a hospital setting. Beta-lactams remain a mainstream therapy for many infections due to their effectiveness, low side effects and affordability. Typically, patient access to penicillin allergy testing is limited by the availability of allergy specialists, who traditionally perform such testing. A pharmacist-provided penicillin allergy testing service was implemented at our hospital in 2015 and became a powerful antibiotic stewardship tool. Removing penicillin allergy from patient profiles significantly expanded therapeutic options, expedited discharges and reduced costs of care. Pharmacists can expand patient access to penicillin allergy testing. Pharmacist-provided penicillin allergy testing permitted optimized antibiotic treatment and expedited discharges. © 2017 John Wiley & Sons Ltd.

  10. A Report to Congress on Long-Term Stewardship. Volume II, Site Summaries

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    2001-01-01

    During World War II and the Cold War, the Federal government developed and operated a vast network of industrial facilities for the research, production, and testing of nuclear weapons, as well as for other scientific and engineering research. These processes left a legacy of radioactive and chemical waste, environmental contamination, and hazardous facilities and materials at well over a 100 sites in 30 States and one U.S. Territory. Hundreds of thousand of acres of residually contaminated soils, contaminated groundwater, surface water and sediment contamination, and contaminated buildings are present at many sites across the country. These sites range in size from less than one acre, containing only a single facility, to large sites spanning over 100,000 acres with huge uranium enrichment plants and plutonium processing canyons. Since 1989, the U.S. Department of Energy’s (DOE) Environmental Management (EM) program has made significant progress in addressing this environmental legacy. Millions of cubic meters of waste have been removed, stabilized, or disposed of, resulting in significant risk and cost reduction. In addition, DOE began disposing of transuranic (i.e., plutonium-contaminated) waste in the nation’s first deep geologic repository – the Waste Isolation Pilot Plant in New Mexico. DOE is now carrying out its long-term stewardship obligations at dozens of sites, including smaller sites where DOE has completed cleanup work for the entire site and many larger sites where DOE has remediated portions of the site.

  11. Metronidazole stewardship initiative at Christchurch hospitals-achievable with immediate benefits.

    Science.gov (United States)

    Gardiner, Sharon J; Metcalf, Sarah Cl; Chin, Paul Kl; Doogue, Matthew P; Dalton, Simon C; Chambers, Stephen T

    2018-04-13

    To evaluate an antimicrobial stewardship (AMS) initiative to change hospital prescribing practice for metronidazole. In October 2015, the Canterbury District Health Board (CDHB) AMS committee changed advice for metronidazole to promote two times daily dosing for most indications, prioritisation of the oral route and avoidance of double anaerobic cover. Adoption of the initiative was facilitated via change in prescribing guidelines, education and ongoing pharmacy support. Usage and expenditure on metronidazole for adult inpatients were compared for the five years pre- and two years post-change. Other district health boards (DHBs) were surveyed to determine their dosing recommendation for metronidazole IV. Mean annual metronidazole IV use, as defined daily doses per 1,000 occupied bed days, decreased by 43% post-initiative. Use of non-IV (oral or rectal) formulations increased by 104%. Total savings associated with the initiative were approximately $33,400 in drug costs plus $78,200 per annum in IV giving sets and post-dose flushes. Twelve of 20 (60%) DHBs (including CDHB) endorse twice daily IV dosing. In addition to financial savings, reduction in IV doses has potential benefits, including avoidance of IV catheter-associated complications such as bloodstream infections. Approaches to metronidazole dosing vary across DHBs and could benefit from national coordination.

  12. Using Private Rights to Manage Natural Resources: Is Stewardship Linked to Ownership?

    Directory of Open Access Journals (Sweden)

    Patrick W. Gilmour

    2012-09-01

    Full Text Available There is increasing interest in privatizing natural resource systems to promote sustainability and conservation goals. Though economic theory suggests owners of private property rights have an incentive to act as resource stewards, few studies have tested this empirically. This paper asks whether private rights-owners were more conservative with respect to their management opinions than nonrights-owners in five Australian abalone (Haliotis spp. fisheries. Multiple regression analyses were used to link opinions to demographic, economic, and attitudinal variables. In contrast to standard economic assumptions, nonrights-owners suggested more conservative catch limits than did rights-owners, confirming qualitative observations of behavior in management workshops. Differing views about the condition of the resource and differing levels of experience contributed to these results. The first of its kind, this study directly demonstrates that private rights do not necessarily promote the greatest level of stewardship. This has substantial implications for how natural resources are governed globally, but also warns against applying simplistic behavioral assumptions to complex social-ecological systems.

  13. Adaptation of a hospital electronic referral system for antimicrobial stewardship prospective audit and feedback rounds.

    Science.gov (United States)

    Rawlins, Matthew D M; Raby, Edward; Sanfilippo, Frank M; Douglass, Rae; Chambers, Jonathan; McLellan, Duncan; Dyer, John R

    2018-05-04

    To evaluate the impact of the adaptation of an existing electronic referral application for use in antimicrobial stewardship prospective audit and feedback rounds (antimicrobial rounds). Retrospective, single-centre observational study between March 2015 and February 2016. A new quaternary referral centre. Adults referred for antimicrobial rounds outside of the intensive care and haematology units. Adaptation of an electronic referral application used by medical and allied health staff. A questionnaire-style referral form was designed to capture patient clinical details using a combination of free text and dropdown menus. Clinical pharmacists were educated and granted access to the system. The proportion of completed electronic referrals of total round reviews by month for the 12 months after implementation. The time from request to completion of reviews. The impact on adherence to advice provided on rounds. The impact on the institutional usage of broad-spectrum antibiotics: glycopeptides, carbapenems, third and fourth generation cephalosporins, fluoroquinolones and piperacillin/tazobactam. Over the study period, the proportion of electronic referrals of completed antimicrobial round reviews increased from 59% to 88% (P < 0.001); 75.7% of accepted electronic referrals were seen within 48 h of request. The proportion of advice ignored fell from 18% to 8.5% (P < 0.001). Piperacillin/tazobactam, fluoroquinolone and glycopeptide usage decreased. The adaptation of an electronic referral application for antimicrobial rounds was associated with increased adherence to advice and reduction in use in target antibiotics. Our model is now used at other institutions.

  14. Long-Term Stewardship at a Former Uranium Mill Tailings Site in Riverton, Wyoming WM2017-17090

    Energy Technology Data Exchange (ETDEWEB)

    Dam, William [USDOE Office of Legacy Management, Washington, DC (United States); Gil, Dr. April [USDOE Office of Legacy Management, Washington, DC (United States); Johnson, Raymond H. [Navarro Research and Engineering, Oak Ridge, TN (United States); Campbell, Sam [Navarro Research and Engineering, Oak Ridge, TN (United States)

    2017-03-01

    The US Department of Energy Office of Legacy Management (LM) is responsible for maintaining protective public health and environmental conditions at former uranium mill tailings sites nationwide via long-term stewardship. One of these sites, a former uranium mill near Riverton, Wyoming, is within the boundary of the Wind River Indian Reservation and operated from 1958 to 1963. Tailings and contaminated material associated with mill operations were removed and transported to an offsite disposal cell in 1989. The remedial action was completed under Title I of the Uranium Mill Tailings Radiation Control Act of 1978. Milling operations, which included an unlined tailings impoundment and an unlined evaporation pond, contaminated the shallow groundwater, resulting in a downgradient groundwater plume that discharges to the Little Wind River. A natural flushing compliance strategy was implemented in 1998. This strategy allows contaminants of concern to naturally flush from the groundwater, provided that contaminants flush below US Environmental Protection Agency maximum concentration limits within 100 years. As part of the compliance strategy, LM has implemented a groundwater monitoring program along with institutional controls that include the installation of an alternate water supply, continued sampling of private wells, and restrictions on well drilling and gravel pit construction. LM works closely with local stakeholders and community members to ensure that these institutional controls are in place and maintained. The Riverton site provides an interesting case study where contaminant remobilization due to river flooding prompted a reevaluation of the conceptual site model to verify if the current compliance strategy would remain protective of human health and the environment. Concentrations of groundwater contaminants, which include sulfate, molybdenum, and uranium, were transiently elevated following flooding of the Little Wind River in 2010 and 2016. These flood

  15. Effect of a wildlife conservation camp experience in China on student knowledge of animals, care, propensity for environmental stewardship, and compassionate behavior toward animals

    Science.gov (United States)

    Bexell, Sarah M.

    The goal of conservation education is positive behavior change toward animals and the environment. This study was conducted to determine whether participation in a wildlife conservation education camp was effective in positively changing 8-12 year old students': (a) knowledge of animals, (b) care about animals, (c) propensity for environmental and wildlife stewardship, and (d) compassionate behavior toward animals. During the summer of 2005, 2 five-day camps were conducted at 2 zoological institutions in Chengdu, China. The camp curriculum was influenced by theory and research on the following: conservation psychology, social learning theory, empathy and moral development theory, socio-biological theory, constructivist theory, and conservation science. Camp activities were sensitive to Chinese culture and included Chinese conservation issues. Activities were designed to help children form bonds with animals and care enough about them to positively change their behavior toward animals and the environment. This mixed methods study triangulated quantitative and qualitative data from six sources to answer the following: (1) Did camp increase student knowledge of animals? (2) Did camp increase student caring about animals? (3) Did camp increase student propensity for environmental and wildlife stewardship? (4) Did camp affect student compassionate behavior toward animals? A conservation stewards survey revealed significant increases on pre-post, self-report of knowledge, care, and propensity. Pre-post, rubric-scored responses to human-animal interaction vignettes indicated a significant increase in knowledge, and stable scores on care and propensity. Qualitative data from student journals, vignettes, and end-of-camp questionnaires demonstrated knowledge, caring, and propensity, and revealed the emergent theme empathy. To address question 4, instructors tallied campers' behavior toward animals using a student behavior ethogram. Occurrence of positive behaviors was

  16. Successful control of resistance in Pseudomonas aeruginosa using antibiotic stewardship and infection control programs at a Chinese university hospital: a 6-year prospective study

    Directory of Open Access Journals (Sweden)

    Liu L

    2018-05-01

    Full Text Available Lei Liu,1 Bin Liu,1 Yu Li,2 Wei Zhang1 1Department of Respiratory Medicine, The First Affiliated Hospital of Harbin Medical University, 2Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China Objective: Pseudomonas aeruginosa is emerging as a highly multidrug-resistant (MDR nosocomial pathogen. Data on the efficacy of infection control measures in endemic situations are lacking. We investigated the effect of antimicrobial stewardship (AMS and infection control programs (ICPs in controlling the resistance of P. aeruginosa at a tertiary hospital center.Methods: Susceptibility and resistance were investigated using broth microdilution, as per the guidelines of the Clinical and Laboratory Standards Institute. Antibiotic use was restricted through AMS, which included a classification management system for antibiotic use. The ICPs included environmental cleaning and disinfection, hand hygiene, active surveillance of P. aeruginosa, and education about infection control.Results: A total of 2,241 P. aeruginosa isolates were evaluated between 2012 and 2017. Sensitivity and resistance of the isolates to the antipseudomonal antimicrobials colistin and tigecycline were stable. The sensitivity and resistance to other antipseudomonal antimicrobials improved after 2014, after the AMS and ICPs were implemented in 2013. The use of alcohol-based hand gel significantly increased from 0.6 to 10.9 L per 1,000 patient-days (PD during the study period (P=0.005. The incidence rates of extensively drug-resistant (XDR and MDR P. aeruginosa showed a sustained decrease from 2013 (4.9 and 22% to 2017 (1 and 15%, respectively. The yearly consumption of antimicrobial agents also showed a sustained and significant decrease from 45 defined daily doses (DDDs per 1,000 PD to 38.15 DDDs per 1,000 PD (P=0.04. A significant correlation was found between the incidence rate of MDR P. aeruginosa and the

  17. Benefits of a Biological Monitoring Program for Assessing Remediation Performance and Long-Term Stewardship - 12272

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Mark [Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831 (United States)

    2012-07-01

    The Biological Monitoring and Abatement Program (BMAP) is a long-running program that was designed to evaluate biological conditions and trends in waters downstream of Department of Energy (DOE) facilities in Oak Ridge, Tennessee. BMAP monitoring has focused on aquatic pathways from sources to biota, which is consistent with the sites' clean water regulatory focus and the overall cleanup strategy which divided remediation areas into watershed administrative units. Specific programmatic goals include evaluating operational and legacy impacts to nearby streams and the effectiveness of implemented remediation strategies at the sites. The program is characterized by consistent, long-term sampling and analysis methods in a multidisciplinary and quantitative framework. Quantitative sampling has shown conclusively that at most Oak Ridge stream sites, fish and aquatic macro-invertebrate communities have improved considerably since the 1980s. Monitoring of mercury and PCBs in fish has shown that remedial and abatement actions have also improved stream conditions, although in some cases biological monitoring suggests further actions are needed. Follow-up investigations have been implemented by BMAP to identify sources or causes, consistent with an adaptive management approach. Biological monitoring results to date have not only been used to assess regulatory compliance, but have provided additional benefits in helping address other components of the DOE's mission, including facility operations, natural resource, and scientific goals. As a result the program has become a key measure of long-term trends in environmental conditions and of high value to the Oak Ridge environmental management community, regulators, and the public. Some of the BMAP lessons learned may be of value in the design, implementation, and application of other long-term monitoring and stewardship programs, and assist environmental managers in the assessment and prediction of the effectiveness of

  18. Practical implications of understanding the influence of motivations on commitment to voluntary urban conservation stewardship.

    Science.gov (United States)

    Asah, Stanley T; Blahna, Dale J

    2013-08-01

    -building motivations may help enhance volunteers' commitment to conservation stewardship and address the pressing challenge of retaining urban conservation volunteers. © 2013 Society for Conservation Biology.

  19. [REDUCTION OF ANTIBIOTIC CONSUMPTION IN RAMBAM HEALTH CARE CAMPUS - THE ROLE OF AN ANTIBIOTIC STEWARDSHIP PROGRAM].

    Science.gov (United States)

    Bitterman, Roni; Raz-Pasteur, Ayelet; Azzam, Zaher S; Karban, Amir; Levy, Yishai; Hayek, Tony; Braun, Eyal; Oren, Ilana; Bar-Lavi, Yaron; Kassis, Imad; Hussein, Khetam; Paul, Mical

    2017-09-01

    Antibiotic stewardship programs (ASP) are designed to optimize antibiotic use in hospitals. Antibiotic consumption is one of the measures assessing the effects of ASPs. To evaluate the effect of an ASP on antibiotic consumption in our hospital and compare it to hospitals in Israel and worldwide. Between October 2012 and March 2013 an ASP was implemented in Rambam Hospital. The program included educational activities, publication of local guidelines for empirical antibiotic treatment, structured infectious diseases consultations, pre-authorization antibiotic restrictions and stop orders. We compared antibacterial antibiotic consumption in defined daily doses (DDD)/100 hospital days (HD) between the periods before (1/2010-3/2013) and after (4/2013-9/2014) implementing the ASP. The study was conducted in the medical departments, hematology, the intensive care unit (ICU) and all pediatric wards. Total antibiotic consumption before implementing the ASP was 96±11.2 DDD/100 HD in medical departments, 186.4±42.8 in the ICU and 185.5±59 in hematology; all values were higher than the worldwide-reported averages for these departments. Following the ASP, total antibiotic consumption decreased by 12% (p=0.008) in the medical departments and by 26% (p=0.002) in hematology, mostly due to reductions in non-restricted antibiotics. No significant changes were observed overall in the ICU and in pediatric wards. There was a significant reduction in consumption of vancomycin and carbapenems in all settings, the latter was reduced to nearly half. Amikacin use quadrupled in the medical departments. Implementation of an ASP lead to a reduction in non-restricted and restricted antibiotic consumption, especially carbapenems.

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

    Science.gov (United States)

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

    2016-10-01

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

  1. Barriers to and enablers of implementing antimicrobial stewardship programs in veterinary practices.

    Science.gov (United States)

    Hardefeldt, Laura Y; Gilkerson, J R; Billman-Jacobe, H; Stevenson, M A; Thursky, K; Bailey, K E; Browning, G F

    2018-03-23

    Antimicrobial stewardship (AMS) programs are yet to be widely implemented in veterinary practice and medical programs are unlikely to be directly applicable to veterinary settings. To gain an in-depth understanding of the factors that influence effective AMS in veterinary practices in Australia. A concurrent explanatory mixed methods design was used. The quantitative phase of the study consisted of an online questionnaire to assess veterinarians' attitudes to antimicrobial resistance (AMR) and antimicrobial use in animals, and the extent to which AMS currently is implemented (knowingly or unknowingly). The qualitative phase used semi-structured interviews to gain an understanding of the barriers to and enablers of AMS in veterinary practices. Data were collected and entered into NVivo v.11, openly coded and analyzed according to mixed methods data analysis principles. Companion animal, equine, and bovine veterinarians participated in the study. Veterinary practices rarely had antimicrobial prescribing policies. The key barriers were a lack of AMS governance structures, client expectations and competition between practices, cost of microbiological testing, and lack of access to education, training and AMS resources. The enablers were concern for the role of veterinary antimicrobial use in development of AMR in humans, a sense of pride in the service provided, and preparedness to change prescribing practices. Our study can guide development and establishment of AMS programs in veterinary practices by defining the major issues that influence the prescribing behavior of veterinarians. © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  2. Pharmacy-Driven Dexmedetomidine Stewardship and Appropriate Use Guidelines in a Community Hospital Setting.

    Science.gov (United States)

    Schickli, M Alexandra; Eberwein, Kip A; Short, Marintha R; Ratliff, Patrick D

    2017-01-01

    Dexmedetomidine is a widely utilized agent in the intensive care unit (ICU) because it does not suppress respiratory drive and may be associated with less delirium than midazolam or propofol. Cost of dexmedetomidine therapy and debate as to the proper duration of use has brought its use to the forefront of discussion. To validate the efficacy and cost savings associated with pharmacy-driven dexmedetomidine appropriate use guidelines and stewardship in mechanically ventilated patients. This was a retrospective cohort study of adult patients who received dexmedetomidine for ICU sedation while on mechanical ventilation at a 433-bed not-for-profit community hospital. Included patients were divided into pre-enactment (PRE) and postenactment (POST) of dexmedetomidine guideline groups. A total of 100 patients (50 PRE and 50 POST) were included in the analysis. A significant difference in duration of mechanical ventilation (11.1 vs 6.2 days, P = 0.006) and incidence of reintubation (36% vs 18% of patients, P = 0.043) was seen in the POST group. Aggregate use of dexmedetomidine 200-µg vials (37.1 vs 18.4 vials, P = 0.010) and infusion days (5.4 vs 2.5 days, P = 0.006) were significantly lower in the POST group. Dexmedetomidine acquisition cost savings were calculated at $374 456.15 in the POST group. There was no difference between the PRE and POST groups with regard to ICU length of stay, expected mortality, and observed mortality. Pharmacy-driven dexmedetomidine appropriate use guidelines decreased the use of dexmedetomidine and increased cost savings at a community hospital without adversely affecting clinical outcomes.

  3. Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.

    Science.gov (United States)

    Keller, Sara C; Tamma, Pranita D; Cosgrove, Sara E; Miller, Melissa A; Sateia, Heather; Szymczak, Julie; Gurses, Ayse P; Linder, Jeffrey A

    2018-01-01

    In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS. © Copyright 2018 by the American Board of Family Medicine.

  4. A framework for ensuring a balanced accounting of the impact of antimicrobial stewardship interventions.

    Science.gov (United States)

    Toma, Madalina; Davey, Peter G; Marwick, Charis A; Guthrie, Bruce

    2017-12-01

    Drawing on a Cochrane systematic review, this paper examines the relatively limited range of outcomes measured in published evaluations of antimicrobial stewardship interventions (ASIs) in hospitals. We describe a structured framework for considering the range of consequences that ASIs can have, in terms of their desirability and the extent to which they were expected when planning an ASI: expected, desirable consequences (intervention goals); expected, undesirable consequences (intervention trade-offs); unexpected, undesirable consequences (unpleasant surprises); and unexpected, desirable consequences (pleasant surprises). Of 49 randomized controlled trials identified by the Cochrane review, 28 (57%) pre-specified increased length of stay and/or mortality as potential trade-offs of ASI, with measurement intended to provide reassurance about safety. In actuality, some studies found unexpected decreases in length of stay (a pleasant surprise). In contrast, only 11 (10%) of 110 interrupted time series studies included any information about unintended consequences, with 10 examining unexpected, undesirable outcomes (unpleasant surprises) using case-control, qualitative or cohort designs. Overall, a large proportion of the ASIs reported in the literature only assess impact on their targeted process goals-antimicrobial prescribing-with limited examination of other potential outcomes, including microbial and clinical outcomes. Achieving a balanced accounting of the impact of an ASI requires careful consideration of expected undesirable effects (potential trade-offs) from the outset, and more consideration of unexpected effects after implementation (both pleasant and unpleasant surprises, although the latter will often be more important). The proposed framework supports the systematic consideration of all types of consequences of improvement before and after implementation. © The Author 2017. Published by Oxford University Press on behalf of the British Society for

  5. Deep-sea genetic resources: New frontiers for science and stewardship in areas beyond national jurisdiction

    Science.gov (United States)

    Harden-Davies, Harriet

    2017-03-01

    The deep-sea is a large source of marine genetic resources (MGR), which have many potential uses and are a growing area of research. Much of the deep-sea lies in areas beyond national jurisdiction (ABNJ), including 65% of the global ocean. MGR in ABNJ occupy a significant gap in the international legal framework. Access and benefit sharing of MGR is a key issue in the development of a new international legally-binding instrument under the United Nations Convention on the Law of the Sea (UNCLOS) for the conservation and sustainable use of marine biological diversity in ABNJ. This paper examines how this is relevant to deep-sea scientific research and identifies emerging challenges and opportunities. There is no internationally agreed definition of MGR, however, deep-sea genetic resources could incorporate any biological material including genes, proteins and natural products. Deep-sea scientific research is the key actor accessing MGR in ABNJ and sharing benefits such as data, samples and knowledge. UNCLOS provides the international legal framework for marine scientific research, international science cooperation, capacity building and marine technology transfer. Enhanced implementation could support access and benefit sharing of MGR in ABNJ. Deep-sea scientific researchers could play an important role in informing practical new governance solutions for access and benefit sharing of MGR that promote scientific research in ABNJ and support deep-sea stewardship. Advancing knowledge of deep-sea biodiversity in ABNJ, enhancing open-access to data and samples, standardisation and international marine science cooperation are significant potential opportunity areas.

  6. Skin Infections and Antibiotic Stewardship: Analysis of Emergency Department Prescribing Practices, 2007-2010

    Directory of Open Access Journals (Sweden)

    Daniel J. Pallin

    2014-05-01

    Full Text Available Introduction: National guidelines suggest that most skin abscesses do not require antibiotics, and that cellulitis antibiotics should target streptococci, not community-associated MRSA (CA-MRSA. The objective of this study is to describe antimicrobial treatment of skin infections in U.S. emergency departments (EDs and analyze potential quality measures. Methods: The National Hospital Ambulatory Medical Care Survey (NHAMCS is a 4-stage probability sample of all non-federal U.S. ED visits. In 2007 NHAMCS started recording whether incision and drainage was performed at ED visits. We conducted a retrospective analysis, pooling 2007-2010 data, identified skin infections using diagnostic codes, and identified abscesses by performance of incision and drainage. We generated national estimates and 95% confidence intervals using weighted analyses; quantified frequencies and proportions; and evaluated antibiotic prescribing practices. We evaluated 4 parameters that might serve as quality measures of antibiotic stewardship, and present 2 of them as potentially robust enough for implementation. Results: Of all ED visits, 3.2% (95% confidence interval 3.1-3.4% were for skin infection, and 2.7% (2.6-2.9% were first visits for skin infection, with no increase over time (p=0.80. However, anti-CA-MRSA antibiotic use increased, from 61% (56-66% to 74% (71-78% of antibiotic regimens (p<0.001. Twenty-two percent of visits were for abscess, with a non-significant increase (p=0.06. Potential quality measures: Among discharged abscess patients, 87% were prescribed antibiotics (84-90%, overuse. Among antibiotic regimens for abscess patients, 84% included anti-CA-MRSA agents (81-89%, underuse. Conclusion: From 2007-2010, use of anti-CA-MRSA agents for skin infections increased significantly, despite stable visit frequencies. Antibiotics were over-used for discharged abscess cases, and CA-MRSA-active antibiotics were underused among regimens when antibiotics were used for

  7. Antimicrobial stewardship: a qualitative study of the development of national guidelines for antibiotic use in hospitals

    Directory of Open Access Journals (Sweden)

    Eli Feiring

    2017-11-01

    Full Text Available Abstract Background As effective antibiotics are becoming a scarce resource, governmental regulation is needed to promote responsible use. Implementation of antibiotic stewardship and practice guidelines in health care facilities seems to be crucial to this effort. Empirical studies suggest, however, that guidelines have limited influence on health professionals’ behavior and practice. Barriers and facilitators to guideline implementability are much studied, but little attention has been given to health professionals’ perceptions of normative acceptability of guidelines as a condition for compliance. The aim of the present study was first, to examine if and how aspects potentially promoting acceptability and compliance among clinical target users were addressed during development of Norwegian national guidelines for antibiotic use in hospitals and second, to identify procedural characteristics of the development process that were perceived by target users to yield legitimate guidelines. Methods Qualitative deductive thematic analysis was used. A theoretical framework inspired by the AGREE II Instrument and the Accountability for reasonableness framework assisted data gathering and interpretation. Archival data was collected and used to detail the guideline development process. Semi-structured, in-depth interviews with eight clinicians with extensive knowledge of the guidelines were carried out. Results Guideline development was characterized by i broad agreement about scope and purpose, ii broad involvement of stakeholders in the development process, iii use of systematic methods to search for and apply evidence, iv easily identifiable and specific recommendations, v provision of tools on how to put recommendations into practice, and vi editorial independence. Several procedural characteristics were perceived by the interviewees as promoting guideline legitimacy; i diverse perspectives systematically involved in the process, ii accessibility

  8. Antimicrobial stewardship: a qualitative study of the development of national guidelines for antibiotic use in hospitals.

    Science.gov (United States)

    Feiring, Eli; Walter, Anne Berit

    2017-11-21

    As effective antibiotics are becoming a scarce resource, governmental regulation is needed to promote responsible use. Implementation of antibiotic stewardship and practice guidelines in health care facilities seems to be crucial to this effort. Empirical studies suggest, however, that guidelines have limited influence on health professionals' behavior and practice. Barriers and facilitators to guideline implementability are much studied, but little attention has been given to health professionals' perceptions of normative acceptability of guidelines as a condition for compliance. The aim of the present study was first, to examine if and how aspects potentially promoting acceptability and compliance among clinical target users were addressed during development of Norwegian national guidelines for antibiotic use in hospitals and second, to identify procedural characteristics of the development process that were perceived by target users to yield legitimate guidelines. Qualitative deductive thematic analysis was used. A theoretical framework inspired by the AGREE II Instrument and the Accountability for reasonableness framework assisted data gathering and interpretation. Archival data was collected and used to detail the guideline development process. Semi-structured, in-depth interviews with eight clinicians with extensive knowledge of the guidelines were carried out. Guideline development was characterized by i) broad agreement about scope and purpose, ii) broad involvement of stakeholders in the development process, iii) use of systematic methods to search for and apply evidence, iv) easily identifiable and specific recommendations, v) provision of tools on how to put recommendations into practice, and vi) editorial independence. Several procedural characteristics were perceived by the interviewees as promoting guideline legitimacy; i) diverse perspectives systematically involved in the process, ii) accessibility and transparency of the rationales for decision

  9. Environmental Stewardship at the Savannah River Site: Generations of Success - 13212

    Energy Technology Data Exchange (ETDEWEB)

    Looney, Brian B.; Bergren, Christopher L.; Gaughan, Thomas F.; Aylward, Robert S.; Guevara, Karen C.; Whitaker, Wade C.; Hennessey, Brian T.; Mills, Gary L.; Blake, John I. [Savannah River Site, Aiken SC 29808, 773-42A (United States)

    2013-07-01

    Approximately sixty years ago, the Savannah River Site (SRS) was built to produce nuclear materials. SRS production operations impacted air, soil, groundwater, ecology, and the local environment. Throughout its history, SRS has addressed these contamination issues directly and has maintained a commitment to environmental stewardship. The Site boasts many environmental firsts. Notably, SRS was the first major Department of Energy (DOE) facility to perform a baseline ecological assessment. This pioneering effort, by Ruth Patrick and the Philadelphia Academy of Sciences, was performed during SRS planning and construction in the early 1950's. This unique early generation of work set the stage for subsequent efforts. Since that time, the scientists and engineers at SRS pro-actively identified environmental problems and developed and implemented effective and efficient environmental management and remediation solutions. This second generation, spanning the 1980's through the 2000's, is exemplified by numerous large and small cleanup actions to address metals and radionuclides, solvents and hydrocarbons, facility and area decommissioning, and ecological restoration. Recently, a third generation of environmental management was initiated as part of Enterprise SRS. This initiative to 'Develop and Deploy Next Generation Cleanup Technologies' formalizes and organizes the major technology matching, development, and implementation processes associated with historical SRS cleanup success as a resource to support future environmental management missions throughout DOE. The four elements of the current, third generation, effort relate to: 1) transition from active to passive cleanup, 2) in situ decommissioning of large nuclear facilities, 3) new long term monitoring paradigms, and 4) a major case study related to support for recovery and restoration of the Japanese Fukushima-Daiichi nuclear power plant and surrounding environment. (authors)

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

    Science.gov (United States)

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

    2017-09-01

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

  11. The Changing Role of Data Stewardship in Creating Trustworthy, Interdisciplinary High Performance Data Platforms for the Future.

    Science.gov (United States)

    Richards, C. J.; Evans, B. J. K.; Wyborn, L. A.; Wang, J.; Trenham, C. E.; Druken, K. A.

    2016-12-01

    The Australian National Computational Infrastructure (NCI) has ingested over 10PB of national and international environmental, Earth systems science and geophysics reference data onto a single platform to advance high performance data (HPD) techniques that enable interdisciplinary Data-intensive Science. Improved Data Stewardship is critical to evolve both data and data services that support the increasing need for programmatic usability and that prioritises interoperability rather than just traditional data download or portal access. A data platform designed for programmatic access requires quality checked collections that better utilise interoperable data formats and standards. Achieving this involves strategies to meet both the technical and `social' challenges. Aggregating datasets used by different communities and organisations requires satisfying multiple use cases for the broader research community, whilst addressing existing BAU requirements. For NCI, this requires working with data stewards to manage the process of replicating data to the common platform, community representatives and developers to confirm their requirements, and with international peers to better enable globally integrated data communities. It is particularly important to engage with representatives from each community who can work collaboratively to a common goal, as well as capture their community needs, apply quality assurance, determine any barriers to change and to understand priorities. This is critical when managing the aggregation of data collections from multiple producers with different levels of stewardship maturity, technologies and standards, and where organisational barriers can impact the transformation to interoperable and performant data access. To facilitate the management, development and operation of the HPD platform, NCI coordinates technical and domain committees made up of user representatives, data stewards and informatics experts to provide a forum to discuss

  12. Impact of the Antibiotic Stewardship Program on Prevention and Control of Surgical Site Infection during Peri-Operative Clean Surgery.

    Science.gov (United States)

    Liu, Juyuan; Li, Na; Hao, Jinjuan; Li, Yanming; Liu, Anlei; Wu, Yinghong; Cai, Meng

    2018-04-01

    Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial healthcare costs, with increased morbidity and mortality. To investigate the effects of the antibiotic stewardship program on prevention and control of SSI during clean surgery, we investigated this situation in our institution. We performed a quasi-experimental study to compare the effect before and after the antibiotic stewardship program intervention. During the pre-intervention stage (January 1, 2010 through December 31, 2011), comprehensive surveillance was performed to determine the SSI baseline data. In the second stage (January 1, 2012 through December 31, 2016), an infectious diseases physician and an infection control practitioner identified the surgical patients daily and followed up on the duration of antimicrobial prophylaxis. From January 1, 2010 to December 31, 2016, 41,426 patients underwent clean surgeries in a grade III, class A hospital. The rate of prophylactic antibiotic use in the 41,426 clean surgeries was reduced from 82.9% to 28.0% after the interventions. The rate of antibiotic agents administered within 120 minutes of the first incision increased from 20.8% to 85.1%. The rate at which prophylactic antimicrobial agents were discontinued in the first 24 hours after surgery increased from 22.1% to 60.4%. Appropriate antibiotic selection increased from 37.0% to 93.6%. Prophylactic antibiotic re-dosing increased from 3.8% to 64.8%. The SSI rate decreased from 0.7% to 0.5% (p < 0.05). The pathogen detection rate increased from 16.7% up to 41.8% after intervention. The intensity of antibiotic consumption reduced from 74.9 defined daily doses (DDDs) per 100 bed-days to 34.2 DDDs per 100 bed-days after the interventions. Long-term and continuous antibiotic stewardship programs have important effects on the prevention and control of SSI during clean surgery.

  13. The Stewardship Science Academic Alliance: A Model of Education for Fundamental and Applied Low-energy Nuclear Science

    Energy Technology Data Exchange (ETDEWEB)

    Cizewski, J.A., E-mail: cizewski@rutgers.edu

    2014-06-15

    The Stewardship Science Academic Alliances (SSAA) were inaugurated in 2002 by the National Nuclear Security Administration of the U. S. Department of Energy. The purpose is to enhance connections between NNSA laboratories and the activities of university scientists and their students in research areas important to NNSA, including low-energy nuclear science. This paper highlights some of the ways that the SSAA fosters education and training of graduate students and postdoctoral scholars in low-energy nuclear science, preparing them for careers in fundamental and applied research and development.

  14. Integrated Weed Control for Land Stewardship at Legacy Management's Rocky Flats Site in Colorado - 13086

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Jody K. [Stoller LMS Team, Contractor to the U.S. Department of Energy Office of Legacy Management, 11025 Dover Street, Suite 1000, Westminster, Colorado 80021 (United States)

    2013-07-01

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

  15. Differentiation of volatile profiles of stockpiled almonds at varying relative humidity levels using benchtop and portable GC-MS

    Science.gov (United States)

    Contamination by aflatoxin, a toxic metabolite produced by Aspergillus fungi ubiquitous in California almond and pistachio orchards, results in millions of dollars of lost product annually. Current detection of aflatoxin relies on destructive, expensive and time-intensive laboratory-based methods. T...

  16. GLAS Long-Term Archive: Preservation and Stewardship for a Vital Earth Observing Mission

    Science.gov (United States)

    Fowler, D. K.; Moses, J. F.; Zwally, J.; Schutz, B. E.; Hancock, D.; McAllister, M.; Webster, D.; Bond, C.

    2012-12-01

    Data Stewardship, preservation, and reproducibility are fast becoming principal parts of a data manager's work. In an era of distributed data and information systems, it is of vital importance that organizations make a commitment to both current and long-term goals of data management and the preservation of scientific data. Satellite missions and instruments go through a lifecycle that involves pre-launch calibration, on-orbit data acquisition and product generation, and final reprocessing. Data products and descriptions flow to the archives for distribution on a regular basis during the active part of the mission. However there is additional information from the product generation and science teams needed to ensure the observations will be useful for long term climate studies. Examples include ancillary input datasets, product generation software, and production history as developed by the team during the course of product generation. These data and information will need to be archived after product data processing is completed. NASA has developed a set of Earth science data and information content requirements for long term preservation that is being used for all the EOS missions as they come to completion. Since the ICESat/GLAS mission was one of the first to end, NASA and NSIDC, in collaboration with the science team, are collecting data, software, and documentation, preparing for long-term support of the ICESat mission. For a long-term archive, it is imperative to preserve sufficient information about how products were prepared in order to ensure future researchers that the scientific results are accurate, understandable, and useable. Our experience suggests data centers know what to preserve in most cases. That is, the processing algorithms along with the Level 0 or Level 1a input and ancillary products used to create the higher-level products will be archived and made available to users. In other cases, such as pre-launch, calibration/validation, and test

  17. Veterinarians’ Perception, Knowledge and Practices of Antibiotic Stewardship in Enugu State Southeast, Nigeria

    Directory of Open Access Journals (Sweden)

    Madubuike Umunna ANYANWU

    2017-09-01

    Full Text Available A cross-sectional survey utilizing structured questionnaires was used to study the veterinarians’ perception, knowledge and practices of antibiotic stewardship (ABS in Enugu State, Southeastern Nigeria. Data obtained were analyzed using chi-square on SPSS (Version 15.0 at a significance level of P < 0.05 to determine possible associations between variables and perceptions/knowledge about ABS. Out of 280 respondents, 41 (17.1% had heard about ABS. Minority of the respondents perceived/knew that using antibiotics only when necessary (6.4%, 18, administering antibiotics at the appropriate dose (6.4%, 18 and administering antibiotics for appropriate duration in every case (4.3%, 12 were among the principles of ABS. The study also showed that age, gender, qualification, years of practice and locations did not exert any influence (P > 0.05 on the awareness of respondents about ABS. More than one-third of the respondents wrongly perceived that increasing the use of broad-spectrum antibiotics (35.4%, 99 is one of the goals of ABS, whereas the minority of the respondents rightly perceived/knew that minimizing toxicity and other adverse effects (16.8%, 47 and reducing antibiotic resistance (ABR (43.2%, 121 are also goals of ABS. Only 21.4% (60 had overall knowledge of ABS. Prescribing antibiotics without seeing/examining the patient, prescribing antibiotics for any case suspected to be infectious, prescribing broad-spectrum antibiotics despite availability of narrow-spectrum antibiotics, prescribing different classes/types of antibiotics concurrently to ensure therapeutic efficacy, prescribing overdose of antibiotics to ensure efficacy and non-consultation of the veterinary formulary/other resources when in doubt during prescription, are some of inappropriate/untoward ABS practices/behaviors/attitudes amongst the respondents. No significant association (P > 0.05 was found between practices of ABS and age, gender, qualification, years of practice and

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

    Directory of Open Access Journals (Sweden)

    Mary Richard Akpan

    2016-01-01

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

  19. Differentiation of Volatile Profiles from Stockpiled Almonds at Varying Relative Humidity Levels Using Benchtop and Portable GC-MS.

    Science.gov (United States)

    Beck, John J; Willett, Denis S; Gee, Wai S; Mahoney, Noreen E; Higbee, Bradley S

    2016-12-14

    Contamination by aflatoxin, a toxic metabolite produced by Aspergillus fungi ubiquitous in California almond and pistachio orchards, results in millions of dollars of lost product annually. Current detection of aflatoxin relies on destructive, expensive, and time-intensive laboratory-based methods. To explore an alternative method for the detection of general fungal growth, volatile emission profiles of almonds at varying humidities were sampled using both static SPME and dynamic needle-trap SPE followed by benchtop and portable GC-MS analysis. Despite the portable SPE/GC-MS system detecting fewer volatiles than the benchtop system, both systems resolved humidity treatments and identified potential fungal biomarkers at extremely low water activity levels. This ability to resolve humidity levels suggests that volatile profiles from germinating fungal spores could be used to create an early warning, nondestructive, portable detection system of fungal growth.

  20. Toward an Understanding of Citywide Urban Environmental Governance: An Examination of Stewardship Networks in Baltimore and Seattle.

    Science.gov (United States)

    Romolini, Michele; Morgan Grove, J; Ventriss, Curtis L; Koliba, Christopher J; Krymkowski, Daniel H

    2016-08-01

    Efforts to create more sustainable cities are evident in the proliferation of sustainability policies in cities worldwide. It has become widely proposed that the success of these urban sustainability initiatives will require city agencies to partner with, and even cede authority to, organizations from other sectors and levels of government. Yet the resulting collaborative networks are often poorly understood, and the study of large whole networks has been a challenge for researchers. We believe that a better understanding of citywide environmental governance networks can inform evaluations of their effectiveness, thus contributing to improved environmental management. Through two citywide surveys in Baltimore and Seattle, we collected data on the attributes of environmental stewardship organizations and their network relationships. We applied missing data treatment approaches and conducted social network and comparative analyses to examine (a) the organizational composition of the network, and (b) how information and knowledge are shared throughout the network. Findings revealed similarities in the number of actors and their distribution across sectors, but considerable variation in the types and locations of environmental stewardship activities, and in the number and distribution of network ties in the networks of each city. We discuss the results and potential implications of network research for urban sustainability governance.

  1. Controlling endemic multidrug-resistant Acinetobacter baumannii in Intensive Care Units using antimicrobial stewardship and infection control.

    Science.gov (United States)

    Cheon, Shinhye; Kim, Mi-Ja; Yun, Seon-Jin; Moon, Jae Young; Kim, Yeon-Sook

    2016-03-01

    Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have become public-health problem. However, few studies have evaluated the control of endemic MDR A. baumannii in Intensive Care Units (ICUs). Therefore, we investigated the effectiveness of antimicrobial stewardship and comprehensive intensified infection control measures for controlling endemic MDR A. baumannii in ICUs at a tertiary care center. Carbapenem use was strictly restricted through antimicrobial stewardship. Environmental cleaning and disinfection was performed at least 3 times per day in addition to basic infection control measures. Isolation using plastic curtains and contact precautions were applied to patients who were colonized or infected with MDR A. baumannii. The outcome was measured as the incidence density rate of hospital-onset MDR A. baumannii among patients in the ICUs. The incidence density rate of hospital-onset MDR A. baumannii decreased from 22.82 cases per 1,000 patient-days to 2.68 cases per 1,000 patient-days after the interventions were implemented (odds ratio, 0.12; 95% confidence interval, 0.03 to 0.4; p baumannii in our ICUs within 1 year.

  2. Integrating rapid diagnostics and antimicrobial stewardship improves outcomes in patients with antibiotic-resistant Gram-negative bacteremia.

    Science.gov (United States)

    Perez, Katherine K; Olsen, Randall J; Musick, William L; Cernoch, Patricia L; Davis, James R; Peterson, Leif E; Musser, James M

    2014-09-01

    An intervention for Gram-negative bloodstream infections that integrated mass spectrometry technology for rapid diagnosis with antimicrobial stewardship oversight significantly improved patient outcomes and reduced hospital costs. As antibiotic resistance rates continue to grow at an alarming speed, the current study was undertaken to assess the impact of this intervention in a challenging patient population with bloodstream infections caused by antibiotic-resistant Gram-negative bacteria. A total of 153 patients with antibiotic-resistant Gram-negative bacteremia hospitalized prior to the study intervention were compared to 112 patients treated post-implementation. Outcomes assessed included time to optimal antibiotic therapy, time to active treatment when inactive, hospital and intensive care unit length of stay, all-cause 30-day mortality, and total hospital expenditures. Integrating rapid diagnostics with antimicrobial stewardship improved time to optimal antibiotic therapy (80.9 h in the pre-intervention period versus 23.2 h in the intervention period, P Gram-negatives. The intervention decreased hospital and intensive care unit length of stay, total hospital costs, and reduced all-cause 30-day mortality. Copyright © 2014. Published by Elsevier Ltd.

  3. Policy options to reduce consumer waste to zero: comparing product stewardship and extended producer responsibility for refrigerator waste.

    Science.gov (United States)

    Nicol, Scott; Thompson, Shirley

    2007-06-01

    Today, over-consumption, pollution and resource depletion threaten sustainability. Waste management policies frequently fail to reduce consumption, prevent pollution, conserve resources and foster sustainable products. However, waste policies are changing to focus on lifecycle impacts of products from the cradle to the grave by extending the responsibilities of stakeholders to post-consumer management. Product stewardship and extended producer responsibility are two policies in use, with radically different results when compared for one consumer product, refrigerators. North America has enacted product stewardship policies that fail to require producers to take physical or financial responsibility for recycling or for environmentally sound disposal, so that releases of ozone depleting substances routinely occur, which contribute to the expanding the ozone hole. Conversely, Europe's Waste Electrical and Electronic Equipment (WEEE) Directive requires extended producer responsibility, whereby producers collect and manage their own post-consumer waste products. WEEE has resulted in high recycling rates of greater than 85%, reduced emissions of ozone-depleting substances and other toxins, greener production methods, such as replacing greenhouse gas refrigerants with environmentally friendly hydrocarbons and more reuse of refrigerators in the EU in comparison with North America.

  4. Science and stewardship to protect and sustain wilderness values: Seventh World Wilderness Congress symposium; 2001 November 2-8; Port Elizabeth, South Africa

    Science.gov (United States)

    Alan Watson; Janet Sproull

    2003-01-01

    The Seventh World Wilderness Congress met in Port Elizabeth, South Africa, in 2001. The symposium on science and stewardship to protect and sustain wilderness values was one of several symposia held in conjunction with the Congress. The papers contained in this proceedings were presented at this symposium and cover seven topics: state-of-knowledge on protected areas...

  5. Participatory action research in antimicrobial stewardship: a novel approach to improving antimicrobial prescribing in hospitals and long-term care facilities

    NARCIS (Netherlands)

    van Buul, L.W.; Sikkens, J.J.; van Agtmael, M.A.; Kramer, M.H.H.; van der Steen, J.T.; Hertogh, C.M.P.M.

    2014-01-01

    It is challenging to change physicians' antimicrobial prescribing behaviour. Although antimicrobial prescribing is determined by contextual (e.g. a lack of guidelines), cultural (e.g. peer practice) and behavioural (e.g. perceived decision making autonomy) factors, most antimicrobial stewardship

  6. Science and stewardship to protect and sustain wilderness values: Tenth World Wilderness Congress symposium; 2013, 4-10 October, Salamanca, Spain

    Science.gov (United States)

    Alan Watson; Stephen Carver; Zdenka Krenova; Brooke McBride

    2015-01-01

    The Tenth World Wilderness Congress (WILD10) met in Salamanca, Spain in 2013. The symposium on science and stewardship to protect and sustain wilderness values was the largest of multiple symposia held in conjunction with the Congress. This symposium was organized and sponsored by the Aldo Leopold Wilderness Research Institute, the Wildland Research Institute of the...

  7. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.

    Science.gov (United States)

    Baur, David; Gladstone, Beryl Primrose; Burkert, Francesco; Carrara, Elena; Foschi, Federico; Döbele, Stefanie; Tacconelli, Evelina

    2017-09-01

    Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria. For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I 2 method. We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; pdifficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; pinfections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria. German Center for Infection Research

  8. Cost Analysis of Implementing Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Plus Real-Time Antimicrobial Stewardship Intervention for Bloodstream Infections.

    Science.gov (United States)

    Patel, Twisha S; Kaakeh, Rola; Nagel, Jerod L; Newton, Duane W; Stevenson, James G

    2017-01-01

    Studies evaluating rapid diagnostic testing plus stewardship intervention have consistently demonstrated improved clinical outcomes for patients with bloodstream infections. However, the cost of implementing new rapid diagnostic testing can be significant, and such testing usually does not generate additional revenue. There are minimal data evaluating the impact of adding matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for rapid organism identification and dedicating pharmacy stewardship personnel time on the total hospital costs. A cost analysis was performed utilizing patient data generated from the hospital cost accounting system and included additional costs of MALDI-TOF equipment, supplies and personnel, and dedicated pharmacist time for blood culture review and of making interventions to antimicrobial therapy. The cost analysis was performed from a hospital perspective for 3-month blocks before and after implementation of MALDI-TOF plus stewardship intervention. A total of 480 patients with bloodstream infections were included in the analysis: 247 in the preintervention group and 233 in the intervention group. Thirty-day mortality was significantly improved in the intervention group (12% versus 21%, P cost per bloodstream infection was lower in the intervention group ($42,580 versus $45,019). Intensive care unit cost per bloodstream infection accounted for the largest share of the total costs in each group and was also lower in the intervention group ($10,833 versus $13,727). Implementing MALDI-TOF plus stewardship review and intervention decreased mortality for patients with bloodstream infections. Despite the additional costs of implementing MALDI-TOF and of dedicating pharmacy stewardship personnel time to interventions, the total hospital costs decreased by $2,439 per bloodstream infection, for an approximate annual cost savings of $2.34 million. Copyright © 2016 American Society for Microbiology.

  9. Material Stream Strategy for Lithium and Inorganics (U)

    Energy Technology Data Exchange (ETDEWEB)

    Safarik, Douglas Joseph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Dunn, Paul Stanton [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Korzekwa, Deniece Rochelle [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2018-01-24

    Design Agency Responsibilities: Manufacturing Support to meet Stockpile Stewardship goals for maintaining the nuclear stockpile through experimental and predictive modeling capability. Development and maintenance of Manufacturing Science expertise to assess material specifications and performance boundaries, and their relationship to processing parameters. Production Engineering Evaluations with competence in design requirements, material specifications, and manufacturing controls. Maintenance and enhancement of Aging Science expertise to support Stockpile Stewardship predictive science capability.

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

    Science.gov (United States)

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

    2017-07-01

    Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl AUC due to MDR GNB uropathogens, these results have important ASP implications. Currently, nitfurantoin is not recommended if CrCl < 60 ml/min. In our experience, used appropriately against susceptible uropathogens, nitrofurantoin was highly effective in nearly all patients with CrCl = 30-60 ml/min., and only failed in two patients due to renal insufficiency (CrCl < 30 ml/ml).

  11. Impact of Stewardship Interventions on Antiretroviral Medication Errors in an Urban Medical Center: A 3-Year, Multiphase Study.

    Science.gov (United States)

    Zucker, Jason; Mittal, Jaimie; Jen, Shin-Pung; Cheng, Lucy; Cennimo, David

    2016-03-01

    There is a high prevalence of HIV infection in Newark, New Jersey, with University Hospital admitting approximately 600 HIV-infected patients per year. Medication errors involving antiretroviral therapy (ART) could significantly affect treatment outcomes. The goal of this study was to evaluate the effectiveness of various stewardship interventions in reducing the prevalence of prescribing errors involving ART. This was a retrospective review of all inpatients receiving ART for HIV treatment during three distinct 6-month intervals over a 3-year period. During the first year, the baseline prevalence of medication errors was determined. During the second year, physician and pharmacist education was provided, and a computerized order entry system with drug information resources and prescribing recommendations was implemented. Prospective audit of ART orders with feedback was conducted in the third year. Analyses and comparisons were made across the three phases of this study. Of the 334 patients with HIV admitted in the first year, 45% had at least one antiretroviral medication error and 38% had uncorrected errors at the time of discharge. After education and computerized order entry, significant reductions in medication error rates were observed compared to baseline rates; 36% of 315 admissions had at least one error and 31% had uncorrected errors at discharge. While the prevalence of antiretroviral errors in year 3 was similar to that of year 2 (37% of 276 admissions), there was a significant decrease in the prevalence of uncorrected errors at discharge (12%) with the use of prospective review and intervention. Interventions, such as education and guideline development, can aid in reducing ART medication errors, but a committed stewardship program is necessary to elicit the greatest impact. © 2016 Pharmacotherapy Publications, Inc.

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

    Science.gov (United States)

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

    2017-05-15

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

  13. Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting.

    Directory of Open Access Journals (Sweden)

    Michelle T Hecker

    Full Text Available To evaluate adherence to uncomplicated urinary tract infections (UTI guidelines and UTI diagnostic accuracy in an emergency department (ED setting before and after implementation of an antimicrobial stewardship intervention.The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18-65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1, and after audit and feedback (period 2.Adherence to UTI guidelines increased from 44% (baseline to 68% (period 1 to 82% (period 2 (P≤.015 for each successive period. Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline to 14% (period 1 to 13% (period 2 (P<.001 and P = .7 for each successive period. Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period. For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods.A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.

  14. The role of civil organizations in monitoring the convention on the prohibition of the use, stockpiling, production and transfer of anti-personnel mines and on their destruction: a proposal for a cooperative compliance mechanism

    International Nuclear Information System (INIS)

    Wiseberg, LS.

    1998-01-01

    On December 2, 1997, approximately 100 government representatives will gather in Ottawa, Canada to sign a treaty banning the production, use or stockpiling of landmines. Both the speed with which this treaty was negotiated, and the extent to which it is a product of genuine cooperation between like-minded governments and non-governmental organizations (especially the International Campaign to Ban Landmines) make it a landmark document. Nonetheless, when the Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of Anti-personnel Mines and on their Destruction (hereinafter, the APM Treaty) is reviewed in the context of other arms control agreements, it is clear that the 'compliance mechanism' is extremely soft. There are no sanctions against states who do not live up to the obligations they assume on signing the APM Treaty, although (under Article 8), States Parties may authorize a fact-finding mission to clarify a question regarding alleged non-compliance. This notwithstanding, the primary compliance mechanism is the provision that states voluntarily report once a year on measures they have taken to implement the treaty. (author)

  15. Public stewardship of private for-profit healthcare providers in low- and middle-income countries

    Science.gov (United States)

    Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

    2016-01-01

    Background Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. Objectives To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. Search methods For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant

  16. Public stewardship of private for-profit healthcare providers in low- and middle-income countries.

    Science.gov (United States)

    Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

    2016-08-11

    Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant articles, WHO International Clinical

  17. Impact of the PROVAUR stewardship programme on linezolid resistance in a tertiary university hospital: a before-and-after interventional study.

    Science.gov (United States)

    García-Martínez, Lucrecia; Gracia-Ahulfinger, Irene; Machuca, Isabel; Cantisán, Sara; De La Fuente, Soraya; Natera, Clara; Pérez-Nadales, Elena; Vidal, Elisa; Rivero, Antonio; Rodríguez-Lopez, Fernando; Del Prado, José Ramón; Torre-Cisneros, Julián

    2016-09-01

    There is little evidence of the impact of antimicrobial stewardship programmes on antimicrobial resistance. To study the efficacy and safety of a package of educational and interventional measures to optimize linezolid use and its impact on bacterial resistance. A quasi-experimental study was designed and carried out before and after implementation of a stewardship programme in hospitalized patients with Gram-positive infections treated with linezolid. The intervention reduced linezolid consumption by 76%. The risk of linezolid-resistant CoNS isolates (OR = 0.37; 95% CI = 0.27-0.49; P linezolid use can contribute to reducing the resistance rate of CoNS and E. faecalis to this antibiotic. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. Advances in rapid identification and susceptibility testing of bacteria in the clinical microbiology laboratory: implications for patient care and antimicrobial stewardship programs

    Directory of Open Access Journals (Sweden)

    Florian P. Maurer

    2017-03-01

    Full Text Available Early availability of information on bacterial pathogens and their antimicrobial susceptibility is of key importance for the management of infectious diseases patients. Currently, using traditional approaches, it usually takes at least 48 hours for identification and susceptibility testing of bacterial pathogens. Therefore, the slowness of diagnostic procedures drives prolongation of empiric, potentially inappropriate, antibacterial therapies. Over the last couple of years, the improvement of available techniques (e.g. for susceptibility testing, DNA amplification assays, and introduction of novel technologies (e.g. MALDI-TOF has fundamentally changed approaches towards pathogen identification and characterization. Importantly, these techniques offer increased diagnostic resolution while at the same time shorten the time-to-result, and are thus of obvious importance for antimicrobial stewardship. In this review, we will discuss recent advances in medical microbiology with special emphasis on the impact of novel techniques on antimicrobial stewardship programs.

  19. Correction to: Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy.

    Science.gov (United States)

    Giacobbe, Daniele Roberto; Del Bono, Valerio; Mikulska, Malgorzata; Gustinetti, Giulia; Marchese, Anna; Mina, Federica; Signori, Alessio; Orsi, Andrea; Rudello, Fulvio; Alicino, Cristiano; Bonalumi, Beatrice; Morando, Alessandra; Icardi, Giancarlo; Beltramini, Sabrina; Viscoli, Claudio

    2017-12-01

    A technical error led to incorrect rendering of the author group in this article. The correct authorship is as follows: Daniele Roberto Giacobbe 1 , Valerio Del Bono 1 , Malgorzata Mikulska 1 , Giulia Gustinetti 1 , Anna Marchese 2 , Federica Mina 3 , Alessio Signori 4 , Andrea Orsi 5 , Fulvio Rudello 6 , Cristiano Alicino 5 , Beatrice Bonalumi 3 , Alessandra Morando 7 , Giancarlo Icardi 5 , Sabrina Beltramini 3 , Claudio Viscoli 1 ; On behalf of the San Martino Antimicrobial Stewardship Group.

  20. Evaluation of the short-term effects of antimicrobial stewardship in the intensive care unit at a tertiary hospital in China.

    Directory of Open Access Journals (Sweden)

    Dapeng Hou

    Full Text Available Antibiotic abuse can lead to antibiotic resistance, which is a severe problem in China. The purpose of this study is to evaluate the short-term effects of antimicrobial stewardship strategies, including formulary restriction, preauthorization, perioperative quinolone restriction, and control of total antibiotic consumption in the ICU at a tertiary hospital in China. After implementation of antimicrobial stewardship, the total antibiotic consumption in the ICU significantly decreased. The defined daily doses (DDDs per 100 patient-days decreased from 197.65 to 143.41; however, the consumption of cephalosporins increased from 53.65 to 63.17 DDDs. Significant improvements in resistance to amikacin, gentamicin, ciprofloxacin, ofloxacin, ceftriaxone, ceftazidime, and piperacillin in Enterobacteriaceae and resistance to ceftazidime, imipenem, and meropenem in non-fermenting Gram-negative rods were observed. In addition, the initial use of no antibiotics or of a single antibiotic significantly increased (P<0.001 and the use of two antibiotics in combination significantly decreased (P<0.001. Our results demonstrate that implementation of antimicrobial stewardship in a short period in the ICU dramatically reduced antibiotic consumption and significantly improved antibiotic resistance, which leads to more reasonable antibiotic selections by ICU physicians.

  1. Advanced Simulation and Computing FY17 Implementation Plan, Version 0

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, Michel [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Archer, Bill [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hendrickson, Bruce [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Wade, Doug [National Nuclear Security Administration (NNSA), Washington, DC (United States). Office of Advanced Simulation and Computing and Institutional Research and Development; Hoang, Thuc [National Nuclear Security Administration (NNSA), Washington, DC (United States). Computational Systems and Software Environment

    2016-08-29

    The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resource, including technical staff, hardware, simulation software, and computer science solutions. ASC is now focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), and quantifying critical margins and uncertainties. Resolving each issue requires increasingly difficult analyses because the aging process has progressively moved the stockpile further away from the original test base. Where possible, the program also enables the use of high performance computing (HPC) and simulation tools to address broader national security needs, such as foreign nuclear weapon assessments and counter nuclear terrorism.

  2. Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality.

    Science.gov (United States)

    Horikoshi, Yuho; Suwa, Junichi; Higuchi, Hiroshi; Kaneko, Tetsuji; Furuichi, Mihoko; Aizawa, Yuta; Fukuoka, Kahoru; Okazaki, Kaoru; Ito, Kenta; Shoji, Takayo

    2017-11-01

    The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP. This quasi-experimental study was conducted at Tokyo Metropolitan Children's Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality. A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p=0.04). The carbapenem resistance rate in P. aeruginosa (pcarbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  3. Law for Country: the Structure of Warlpiri Ecological Knowledge and Its Application to Natural Resource Management and Ecosystem Stewardship

    Directory of Open Access Journals (Sweden)

    Miles C. C. Holmes

    2013-09-01

    Full Text Available Indigenous Ecological Knowledge (IEK is deeply encoded in social processes. Our research shows that from an Indigenous perspective, IEK is a way of living whose core aim is to sustain the healthy functioning of people and country through relationships of reciprocity. However, IEK is often portrayed more prosaically as a body of knowledge about the environment. We introduce a framework, called ngurra-kurlu, that enables appreciation of indigenous perspectives on IEK. The framework was identified from the collaborative work of the authors with Warlpiri aboriginal elders in the Tanami Desert region of central Australia. Ngurra-kurlu facilitates cross-cultural understanding by distilling, from a complex cultural system, the five distinct conceptual categories that comprise IEK: law, skin, ceremony, language, and country. The framework enables engagement with nuanced environmental knowledge because it synthesizes, for cross-cultural audiences, all the key areas of knowledge and practice in which IEK is located. In particular, the framework highlights how social systems mediate the transmission, deployment, and regulation of environmental knowledge in on-ground situations, including collaborative natural resource management. Although the framework was generated in relation to one indigenous group, the epistemological structure of Warlpiri IEK is relevant throughout Australia, and the framework can be applied internationally to the emerging interest in fostering ecosystem stewardship in which the cultural connections between people and place are an integral part of ecosystems management.

  4. Economic Pasture-Based Cow-Calf Systems for Appalachia

    OpenAIRE

    Emenheiser, Joseph Carl

    2014-01-01

    Pasture-based beef production is well-suited for the Appalachian region of the United States. This research investigated pasture, beef cattle, and economics components within the cow-calf sector of pasture beef production, and presents implications of their interplay for the vitality of the whole system. Samples of forage DM mass and CP, ADF, NDF, and ash contents in each paddock of a rotational stocking system were collected monthly for 4 grazing seasons. Effects of month, stockpiling, hay f...

  5. Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship.

    Science.gov (United States)

    Huang, Po-Yen; Shie, Shian-Sen; Ye, Jung-Jr; Lin, Shih-Pin; Liu, Tsui-Ping; Wu, Ting-Shu; Wu, Tsu-Lan; Chuang, Shiow-Shuh; Cheng, Ming-Huei; Hsieh, Yu-Chia; Huang, Ching-Tai

    2017-08-30

    Information is limited about the effect of restricted carbapenem use on clearance of multi-drug resistant Acinetobacter baumannii (MDRAB). We sought to determine the time effect of antibiotic exposure on multi-drug resistant Acinetobacter baumannii (MDRAB) acquisition and clearance. We conducted a retrospective observational study at the intensive care units of a tertiary medical center. Forty-two of a cohort of previously healthy young adults who were concurrently burned by a dust explosion was included. Cases consisted of those from whom MDRAB was isolated during hospitalization. Controls consisted of patients from whom MDRAB was not isolated in the same period. Use of antimicrobial agents was compared based on days of therapy per 1,000 patient-days (DOT/1,000PD). A 2-state Markov multi-state model was used to estimate the risk of acquisition and clearance of MDRAB. MDRAB was discovered in 9/42 (21.4%) individuals. The cases had significantly higher use of carbapenem (652 DOT/1,000PD vs. 385 DOT/1,000PD, P < 0.001) before MDRAB isolation. For the cases, clearance of MDRAB was associated with lower use of carbapenem (469 DOT/1,000PD vs. 708 DOT/1,000PD, P = 0.003) and higher use of non-carbapenem beta-lactam (612 DOT/1,000PD vs. 246 DOT/1,000PD, P <0.001). In multi-state model, each additional DOT of carbapenem increased the hazard of acquiring MDRAB (hazard ratio (HR), 1.08; 95% confidence interval (CI) 1.01-1.16) and each additional DOT of non-carbapenem beta-lactam increased the protection of clearing MDRAB (HR, 1.25; 95% CI 1.07-1.46). Both acquisition and clearance of MDRAB were related to antibiotic exposure in a homogeneous population. Our findings suggest that early discontinuation of carbapenem could be an effective measure in antibiotic stewardship for the control of MDRAB spreading.

  6. Quality Assessment of Process Measures in Antimicrobial Stewardship: Concordance of Valacyclovir Indication and Automatic Prospective Approval in Computerized Provider Order Entry

    Science.gov (United States)

    Lee, Tiffany; McCoy, Christopher; Mahoney, Monica V

    2017-01-01

    Abstract Background The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend computerized decision support at the time of prescribing as an antimicrobial stewardship (AST) tool. Providing antimicrobial indications during prescribing can optimize infection-specific therapy through appropriate antimicrobial selection, dosing, and frequency. The Leapfrog group identifies this as a quality measure for their report card system. At Beth Israel Deaconess Medical Center (BIDMC), indication-based dosing has been incorporated in the computerized provider order entry (CPOE) system since 2006. At BIDMC, valacyclovir is only approved for the treatment of varicella zoster (VZV) infection or prophylaxis of solid organ transplant (SOT) patients at low risk for cytomegalovirus. These indications bypass the need for AST approval. Accuracy validation of the selected indications has not been formally performed. Methods A retrospective chart review was performed in patients prescribed valacyclovir during an 8-month period in 2016. Electronic medical records, laboratory reports, and pharmacy records were reviewed to identify the suspected/confirmed infection. The primary outcome was the concordance rate of selected CPOE valacyclovir indication compared with suspected/confirmed infection at the time of ordering. The secondary outcome was the proportion of valacyclovir use per institutional protocol. Results Overall, 117 patients were included, with a median age of 57.9 years, 51 (43.6%) were male, and 4 (3.4%) were located in an intensive care unit. Fifty-nine orders (50.4%) selected VZV as the indication, followed by 21 orders (17.9%) for SOT prophylaxis. Of orders with any CPOE indication, only 59/101 (58.4%) were concordant with suspected/confirmed infection. Of the valacyclovir orders with a VZV indication, 37 (62.7%) were concordant. Of the orders with SOT prophylaxis indications, 5 (23.8%) were concordant

  7. The outcome of non-carbapenem-based empirical antibacterial ...

    African Journals Online (AJOL)

    Background: Febrile neutropenia (FN) is generally a complication of cancer chemotherapy. Objective: ... Furthermore, non-carbapenem-based empirical therapy provides benefit in regard to cost-effectiveness and antimicrobial stewardship when local antibiotic resistance patterns of gram-negative bacteria are considered.

  8. Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

    Directory of Open Access Journals (Sweden)

    Stefanie Setiawan

    2018-03-01

    Full Text Available Antibiotic Stewardship Program (ASP is mandatory to all Indonesian hospitals, in accordance to the 2015 Minister of Health Decree No. 8. Dr. Ramelan Naval Hospital Surabaya is one among the many hospitals in Indonesia that has implemented the ASP. The study objective was to describe quantitative-qualitatively the use of antibiotics, along with clinical and microbiological outcomes observed in an Intensive Care Unit (ICU after ASP implementation in dr. Ramelan Naval Hospital Surabaya. The design was a 3-month (February–May 2016 cross-sectional observational study. Quantitative description was reported using Days of Therapy (DOT/100 patient-days, the qualitative description was reviewed using Gyssens’ flowchart. Clinical outcomes observed include nosocomial infection, infection-related mortality, and average length of stay (LOS. Microbiological outcome was observed through the occurences of multi-drug resistant organism. The results showed overall antibiotic use was 151.63 DOT/100 patient-days. Quality of antibiotic use were 52.73% definitely appropriate; 8.18% inappropriate regarding dose, intervals, durations, and timing; 7.27% no indication; and no mutual agreement in 31.82% (κ=0.59; p<0.05. Hospital Acquired Pneumonias (HAPs/Ventilator Associated Pneumonias (VAPs were the most observed nosocomial infection, infection-related mortality rate was 44.68%; and average LOS were 7.17±1.9 days (p<0.05. No incidents of Methicillin-resistant Staphylococcus aureus (MRSA or Extended Spectrum Beta-Lactamase (ESBL have been found, but there were two cases of Multi Drug Resistant (MDR Acinetobacter baumannii.

  9. Data Stewardship and Long-Term Archive of ICESat Data at the National Snow and Ice Data Center (NSIDC)

    Science.gov (United States)

    Fowler, D. K.; Moses, J. F.; Duerr, R. E.; Webster, D.; Korn, D.

    2010-12-01

    Data Stewardship is becoming a principal part of a data manager’s work at NSIDC. It is vitally important that our organization makes a commitment to both current and long-term goals of data management and the preservation of our scientific data. Data must be available to researchers not only during active missions, but long after missions end. This includes maintaining accurate documentation, data tools, and a knowledgeable user support staff. NSIDC is preparing for long-term support of the ICESat mission data. Though ICESat has seen its last operational day, the data is still being improved and NSIDC is scheduled to archive the final release, Release 33, starting late in 2010. This release will include the final adjustments to the processing algorithms and will produce the best possible products to date. Along with the higher-level data sets, all supporting documentation will be archived at NSIDC. For the long-term archive, it is imperative that there is sufficient information about how products were prepared in order to convince future researchers that the scientific results are reproducible. The processing algorithms along with the Level 0 and ancillary products used to create the higher-level products will be archived and made available to users. This can enable users to examine production history, to derive revised products and to create their own products. Also contained in the long-term archive will be pre-launch, calibration/validation, and test data. These data are an important part of the provenance which must be preserved. For longevity, we’ll need to archive the data and documentation in formats that will be supported in the years to come.

  10. Optimizing Data Center Services to Foster Stewardship and Use of Geospatial Data by Heterogeneous Populations of Users

    Science.gov (United States)

    Downs, R. R.; Chen, R. S.; de Sherbinin, A. M.

    2017-12-01

    Growing recognition of the importance of sharing scientific data more widely and openly has refocused attention on the state of data repositories, including both discipline- or topic-oriented data centers and institutional repositories. Data creators often have several alternatives for depositing and disseminating their natural, social, health, or engineering science data. In selecting a repository for their data, data creators and other stakeholders such as their funding agencies may wish to consider the user community or communities served, the type and quality of data products already offered, and the degree of data stewardship and associated services provided. Some data repositories serve general communities, e.g., those in their host institution or region, whereas others tailor their services to particular scientific disciplines or topical areas. Some repositories are selective when acquiring data and conduct extensive curation and reviews to ensure that data products meet quality standards. Many repositories have secured credentials and established a track record for providing trustworthy, high quality data and services. The NASA Socioeconomic Data and Applications Center (SEDAC) serves users interested in human-environment interactions, including researchers, students, and applied users from diverse sectors. SEDAC is selective when choosing data for dissemination, conducting several reviews of data products and services prior to release. SEDAC works with data producers to continually improve the quality of its open data products and services. As a Distributed Active Archive Center (DAAC) of the NASA Earth Observing System Data and Information System, SEDAC is committed to improving the accessibility, interoperability, and usability of its data in conjunction with data available from other DAACs, as well as other relevant data sources. SEDAC is certified as a Regular Member of the International Council for Science World Data System (ICSU-WDS).

  11. Coral reefs and residents of the U.S. Virgin Islands: A relationship of knowledge, outdoor activities and stewardship

    Directory of Open Access Journals (Sweden)

    Christine Settar

    2010-10-01

    Full Text Available To test the hypotheses that U.S. Virgin Islanders’ knowledge about local coral reefs is correlated with behavior, and that different sociological groups of residents have different patterns of knowledge and behavior, a mixed approach to surveying residents was used: (1 personal interviews were held in public locations and (2 an online version of the survey was administered to residents of the U.S. Virgin Islands. From July-October 2008, 462 residents over 18 years old were surveyed. Results indicate that people who engaged in outdoor activities knew significantly more about coral reefs (Spearman p<0.01, r2=0.128. Those more knowledgeable about coral reefs engaged in more positive stewardship activities (e.g. beach clean-ups (Spearman p<0.01, r2=0.127. Negative behaviors (e.g. anchoring on reef were not significantly correlated with increased knowledge of coral reefs (Spearman p=0.911, r2=-0.000025. Fishers did not have greater ability in identifying Acropora palmate coral than non-fishers (χ2=4.138, p=0.126; however, swimmers, snorkelers and divers (as a class were moreable to identify A. palmata than non-swimmers (χ2 =9.764, p=0.002. Most residents identified sea turtle species as endangered (hawksbill turtle, 78.9% but only 48.2% of the responses included Acropora spp. as threatened. Resident attitudes towards conservation of local resources were overwhelmingly positive. Rev. Biol. Trop. 58 (Suppl. 3: 197-212. Epub 2010 October 01.

  12. Environmental management: Integrating ecological evaluation, remediation, restoration, natural resource damage assessment and long-term stewardship on contaminated lands

    International Nuclear Information System (INIS)

    Burger, Joanna

    2008-01-01

    Ecological evaluation is essential for remediation, restoration, and Natural Resource Damage Assessment (NRDA), and forms the basis for many management practices. These include determining status and trends of biological, physical, or chemical/radiological conditions, conducting environmental impact assessments, performing remedial actions should remediation fail, managing ecosystems and wildlife, and assessing the efficacy of remediation, restoration, and long-term stewardship. The objective of this paper is to explore the meanings of these assessments, examine the relationships among them, and suggest methods of integration that will move environmental management forward. While remediation, restoration, and NRDA, among others, are often conducted separately, it is important to integrate them for contaminated land where the risks to ecoreceptors (including humans) can be high, and the potential damage to functioning ecosystems great. Ecological evaluations can range from inventories of local plants and animals, determinations of reproductive success of particular species, levels of contaminants in organisms, kinds and levels of effects, and environmental impact assessments, to very formal ecological risk assessments for a chemical or other stressor. Such evaluations can range from the individual species to populations, communities, ecosystems or the landscape scale. Ecological evaluations serve as the basis for making decisions about the levels and kinds of remediation, the levels and kinds of restoration possible, and the degree and kinds of natural resource injuries that have occurred because of contamination. Many different disciplines are involved in ecological evaluation, including biologists, conservationists, foresters, restoration ecologists, ecological engineers, economists, hydrologist, and geologists. Since ecological evaluation forms the basis for so many different types of environmental management, it seems reasonable to integrate management options

  13. Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: a before and after intervention study of carbapenem-use stewardship.

    Science.gov (United States)

    Yoon, Young Kyung; Yang, Kyung Sook; Lee, Seung Eun; Kim, Hyun Jeong; Sohn, Jang Wook; Kim, Min Ja

    2014-01-01

    Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18); Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36); and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54). During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD): 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028) and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; Pcarbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB) (P = 0.031). Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

  14. Effects of Group 1 versus Group 2 carbapenems on the susceptibility of Acinetobacter baumannii to carbapenems: a before and after intervention study of carbapenem-use stewardship.

    Directory of Open Access Journals (Sweden)

    Young Kyung Yoon

    Full Text Available OBJECTIVE: Antimicrobial stewardship programs have been proposed for reducing bacterial resistance in the hospital environment. The purpose of this study was to investigate the impact of a carbapenem-use stewardship program on the susceptibility of Acinetobacter baumannii to Group 2 carbapenems. METHODS: A before and after intervention study was conducted at a university hospital from September 2008 to February 2013. Three study periods were defined: Phase I, pre-intervention (months 1-18; Phase II, a postintervention period during which ertapenem use was mandated but carbapenem use was not restricted (months 19-36; and Phase III, a postintervention period during which Group 2 carbapenem use was restricted (months 37-54. RESULTS: During the study period, intervention resulted in diminished consumption of Group 2 carbapenems (antimicrobial use density (AUD: 21.3±6.0 in Phase I, 18.8±6.0 in Phase II, 16.1±4.4 in Phase III; P = 0.028 and increased consumption of ertapenem (AUD: 2.7±1.7 in Phase I, 7.2±4.5 in Phase II, 9.1±5.3 in Phase III; P<0.001. The use of autoregressive-error models showed that in contrast with ertapenem use, the use of Group 2 carbapenem during the previous one month was positively and significantly associated with a subsequent increase in the proportion of carbapenem-resistant A. baumannii (CRAB (P = 0.031. CONCLUSIONS: Implementing a carbapenem-use stewardship program featuring the preferential use of ertapenem for treating appropriate indications of infection resulted in reduced use of Group 2 carbapenems and had a positive impact on the susceptibility of A. baumannii to carbapenems. This approach could be integrated into CRAB-control strategies in hospitals.

  15. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use.

    Science.gov (United States)

    Jump, Robin L P; Olds, Danielle M; Seifi, Nasim; Kypriotakis, Georgios; Jury, Lucy A; Peron, Emily P; Hirsch, Amy A; Drawz, Paul E; Watts, Brook; Bonomo, Robert A; Donskey, Curtis J

    2012-12-01

    We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF. A 160-bed VA LTCF. Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series. Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (Peffective means to achieve antimicrobial stewardship.

  16. Implementing an Antibiotic Stewardship Information System to Improve Hospital Infection Control: A Co-Design Process.

    Science.gov (United States)

    Maia, Mélanie R; Simões, Alexandra; Lapão, Luís V

    2018-01-01

    HAITooL information system design and implementation was based on Design Science Research Methodology, ensuring full participation, in close collaboration, of researchers and a multidisciplinary team of healthcare professionals. HAITooL enables effective monitoring of antibiotic resistance, antibiotic use and provides an antibiotic prescription decision-supporting system by clinicians, strengthening the patient safety procedures. The design, development and implementation process reveals benefits in organizational and behavior change with significant success. Leadership commitment multidisciplinary team and mainly informaticians engagement was crucial to the implementation process. Participants' motivation and the final product delivery and evolution depends on that.

  17. Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention.

    Science.gov (United States)

    Saliba-Gustafsson, Erika A; Borg, Michael A; Rosales-Klintz, Senia; Nyberg, Anna; StålsbyLundborg, Cecilia

    2017-09-24

    Antibiotic misuse is a key driver of antibiotic resistance. In 2015/2016, Maltese respondents reported the highest proportions of antibiotic consumption in Europe. Since antibiotics are prescription-only medicines in Malta, research on effective strategies targeting general practitioners' (GPs) knowledge and behaviour is needed. Multifaceted behaviour change (BC) interventions are likely to be effective. Social marketing (SM) can provide the tools to promote sustained BC; however, its utilisation in Europe is limited. This paper aims to describe the design and methods of a multifaceted SM intervention aimed at changing Maltese GPs' antibiotic prescribing behaviour for patients with acute respiratory tract infections (aRTIs). This 4-year quasiexperimental intervention study will be carried out in Malta and includes three phases: preintervention, intervention and postintervention. The preintervention phase intends to gain insight into the practices and attitudes of GPs, pharmacists and parents through interviews, focus group discussions and antibiotic prescribing surveillance. A 6-month intervention targeting GPs will be implemented following assessment of their prescribing intention and readiness for BC. The intervention will likely comprise: prescribing guidelines, patient educational materials, delayed antibiotic prescriptions and GP education. Outcomes will be evaluated in the postintervention phase through questionnaires based on the theory of planned behaviour and stages-of-change theory, as well as postintervention surveillance. The primary outcome will be the antibiotic prescribing rate for all patients with aRTIs. Secondary outcomes will include the proportion of diagnosis-specific antibiotic prescription and symptomatic relief medication prescribed, and the change in GPs stage-of-change and their intention to prescribe antibiotics. The project received ethical approval from the University of Malta's Research Ethics Committee. Should this intervention

  18. Core Certification of Data Repositories: Trustworthiness and Long-Term Stewardship

    Science.gov (United States)

    de Sherbinin, A. M.; Mokrane, M.; Hugo, W.; Sorvari, S.; Harrison, S.

    2017-12-01

    Scientific integrity and norms dictate that data created and used by scientists should be managed, curated, and archived in trustworthy data repositories thus ensuring that science is verifiable and reproducible while preserving the initial investment in collecting data. Research stakeholders including researchers, science funders, librarians, and publishers must also be able to establish the trustworthiness of data repositories they use to confirm that the data they submit and use remain useful and meaningful in the long term. Data repositories are increasingly recognized as a key element of the global research infrastructure and the importance of establishing their trustworthiness is recognised as a prerequisite for efficient scientific research and data sharing. The Core Trustworthy Data Repository Requirements are a set of universal requirements for certification of data repositories at the core level (see: https://goo.gl/PYsygW). They were developed by the ICSU World Data System (WDS: www.icsu-wds.org) and the Data Seal of Approval (DSA: www.datasealofapproval.org)—the two authoritative organizations responsible for the development and implementation of this standard to be further developed under the CoreTrustSeal branding . CoreTrustSeal certification of data repositories involves a minimally intensive process whereby repositories supply evidence that they are sustainable and trustworthy. Repositories conduct a self-assessment which is then reviewed by community peers. Based on this review CoreTrustSeal certification is granted by the CoreTrustSeal Standards and Certification Board. Certification helps data communities—producers, repositories, and consumers—to improve the quality and transparency of their processes, and to increase awareness of and compliance with established standards. This presentation will introduce the CoreTrustSeal certification requirements for repositories and offer an opportunity to discuss ways to improve the contribution of

  19. Acquired resistance to chlorhexidine - is it time to establish an 'antiseptic stewardship' initiative?

    Science.gov (United States)

    Kampf, G

    2016-11-01

    Chlorhexidine digluconate (CHG) is an antimicrobial agent used for different types of applications in hand hygiene, skin antisepsis, oral care, and patient washing. Increasing use raises concern regarding development of acquired bacterial resistance. Published data from clinical isolates with CHG minimum inhibitory concentrations (MICs) were reviewed and compared to epidemiological cut-off values to determine resistance. CHG resistance is rarely found in Escherichia coli, Salmonella spp., Staphylococcus aureus or coagulase-negative staphylococci. In Enterobacter spp., Pseudomonas spp., Proteus spp., Providencia spp. and Enterococcus spp., however, isolates are more often CHG resistant. CHG resistance may be detected in multi-resistant isolates such as extremely drug-resistant Klebsiella pneumoniae. Isolates with a higher MIC are often less susceptible to CHG for disinfection. Although cross-resistance to antibiotics remains controversial, some studies indicate that the overall exposure to CHG increases the risk for resistance to some antibiotic agents. Resistance to CHG has resulted in numerous outbreaks and healthcare-associated infections. On an average intensive care unit, most of the CHG exposure would be explained by hand hygiene agents when liquid soaps or alcohol-based hand rubs contain CHG. Exposure to sub-lethal CHG concentration may enhance resistance in Acinetobacter spp., K. pneumoniae, and Pseudomonas spp., all species well known for emerging antibiotic resistance. In order to reduce additional selection pressure in nosocomial pathogens it seems to make sense to restrict the valuable agent CHG to those indications with a clear patient benefit and to eliminate it from applications without any benefit or with a doubtful benefit. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  20. Maltese Antibiotic Stewardship Programme in the Community (MASPIC): protocol of a prospective quasiexperimental social marketing intervention

    Science.gov (United States)

    Saliba-Gustafsson, Erika A; Borg, Michael A; Rosales-Klintz, Senia; Nyberg, Anna; StålsbyLundborg, Cecilia

    2017-01-01

    Introduction Antibiotic misuse is a key driver of antibiotic resistance. In 2015/2016, Maltese respondents reported the highest proportions of antibiotic consumption in Europe. Since antibiotics are prescription-only medicines in Malta, research on effective strategies targeting general practitioners’ (GPs) knowledge and behaviour is needed. Multifaceted behaviour change (BC) interventions are likely to be effective. Social marketing (SM) can provide the tools to promote sustained BC; however, its utilisation in Europe is limited. This paper aims to describe the design and methods of a multifaceted SM intervention aimed at changing Maltese GPs’ antibiotic prescribing behaviour for patients with acute respiratory tract infections (aRTIs). Methods and analysis This 4-year quasiexperimental intervention study will be carried out in Malta and includes three phases: preintervention, intervention and postintervention. The preintervention phase intends to gain insight into the practices and attitudes of GPs, pharmacists and parents through interviews, focus group discussions and antibiotic prescribing surveillance. A 6-month intervention targeting GPs will be implemented following assessment of their prescribing intention and readiness for BC. The intervention will likely comprise: prescribing guidelines, patient educational materials, delayed antibiotic prescriptions and GP education. Outcomes will be evaluated in the postintervention phase through questionnaires based on the theory of planned behaviour and stages-of-change theory, as well as postintervention surveillance. The primary outcome will be the antibiotic prescribing rate for all patients with aRTIs. Secondary outcomes will include the proportion of diagnosis-specific antibiotic prescription and symptomatic relief medication prescribed, and the change in GPs stage-of-change and their intention to prescribe antibiotics. Ethics and dissemination The project received ethical approval from the University of