Integrating hospitals into community emergency preparedness planning.

Science.gov (United States)

Braun, Barbara I; Wineman, Nicole V; Finn, Nicole L; Barbera, Joseph A; Schmaltz, Stephen P; Loeb, Jerod M

2006-06-06

Strong community linkages are essential to a health care organization's overall preparedness for emergencies. To assess community emergency preparedness linkages among hospitals, public health officials, and first responders and to investigate the influence of community hazards, previous preparation for an event requiring national security oversight, and experience responding to actual disasters. With expert advice from an advisory panel, a mailed questionnaire was used to assess linkage issues related to training and drills, equipment, surveillance, laboratory testing, surge capacity, incident management, and communication. A simple random sample of 1750 U.S. medical-surgical hospitals. Of 678 hospital representatives that agreed to participate, 575 (33%) completed the questionnaire in early 2004. Respondents were hospital personnel responsible for environmental safety, emergency management, infection control, administration, emergency services, and security. Prevalence and breadth of participation in community-wide planning; examination of 17 basic elements in a weighted analysis. In a weighted analysis, most hospitals (88.2% [95% CI, 84.1% to 92.3%]) engaged in community-wide drills and exercises, and most (82.2% [CI, 77.8% to 86.5%]) conducted a collaborative threat and vulnerability analysis with community responders. Of all respondents, 57.3% (CI, 52.1% to 62.5%) reported that their community plans addressed the hospital's need for additional supplies and equipment, and 73.0% (CI, 68.1% to 77.9%) reported that decontamination capacity needs were addressed. Fewer reported a direct link to the Health Alert Network (54.4% [CI, 49.3% to 59.5%]) and around-the-clock access to a live voice from a public health department (40.0% [CI, 35.0% to 45.0%]). Performance on many of 17 basic elements was better in large and urban hospitals and was associated with a high number of perceived hazards, previous national security event preparation, and experience in actual

The Fort McMurray Demonstration Project in Social Marketing: theory, design, and evaluation.

Science.gov (United States)

Guidotti, T L; Ford, L; Wheeler, M

2000-02-01

The Fort McMurray Demonstration Project in Social Marketing is a multifaceted program that applies the techniques of social marketing to health and safety. This paper describes the origins of the project and the principles on which it was based. VENUE: Fort McMurray, in the province of Alberta, Canada, was selected because the community had several community initiatives already underway and the project had the opportunity to demonstrate "value added." The project is distinguished from others by a model that attempts to achieve mutually reinforcing effects from social marketing in the community as a whole and from workplace safety promotion in particular. Specific interventions sponsored by the project include a media campaign on cable television, public activities in local schools, a community safety audit, and media appearance by a mascot that provides visual identity to the project, a dinosaur named "Safetysaurus." The project integrated its activities with other community initiatives. The evaluation component emphasizes outcome measures. A final evaluation based on injury rates and attitudinal surveys is underway. Baseline data from the first round of surveys have been compiled and published. In 1995, Fort McMurray became the first city in North America to be given membership in the World Health Organization's Safe Community Network.

Cancer incidence in Fort Chipewyan, Alberta : 1995-2006

Energy Technology Data Exchange (ETDEWEB)

Chen, Y. [Alberta Cancer Board, Edmonton, AB (Canada). Division of Population Health and Information Surveillance

2009-02-15

A high number of cases of cholangiocarcinoma, a rare form of bile duct cancer, as well as high rates of other cancers were reported by a physician working in Fort Chipewyan, Alberta in 2006. Concerns were raised by local residents, attributing cancers in their community to environmental contamination from a range of industrial development including the oil sands development, uranium mining and pulp mills. However, an initial review of the Alberta Cancer Registry did not confirm an increased incidence of cancer in Fort Chipewyan. In the summer/fall of 2007, a working group was formed to support the Alberta Cancer Board in doing a cluster investigation based on the guidelines of the United States Centre for Disease Control and Prevention. This report presented an investigation to determine if there was an elevated rate of cholangiocarcinoma in Fort Chipewyan and whether there was an elevated rate of cancers overall in Fort Chipewyan. The report provided background information on the Athabasca oil sands, uranium mining, and Fort Chipewyan as well as previous investigations of cancer incidence in Fort Chipewyan. Study methods were also presented with particular reference to study and comparison populations; cancer classification and inclusion criteria; active case ascertainment and verification; methods of analysis; and ethical approval. Results were also presented. The specific cancers that were discussed were cholangiocarcinoma, leukemia, colon cancer, and cancer in First Nations in Alberta. It was concluded that the observed number of cases of cholangiocarcinoma was within the expected range. 121 refs., 12 tabs., 3 figs., 5 appendices.

Collaboration between Hospital and Community Pharmacists to Improve Medication Management from Hospital to Home

Directory of Open Access Journals (Sweden)

Judith Kristeller

2017-05-01

Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days

Tourism, Tolerance, or Hospitality? An Assessment of a Native/Non-Native, Urban/Rural Youth Exchange Program between Fort Good Hope, NWT, and East Vancouver, BC

Science.gov (United States)

Hern, Matt

2009-01-01

This article considers and assesses a youth exchange project between two community-based youth centers: The Purple Thistle Centre in East Vancouver, British Columbia, and the K'asho Got'ine Youth Centre in Fort Good Hope, Northwest Territories. Both centers serve primarily low-income youth, but after that the similarities are very few. The…

Fort Collins Science Center-Fiscal year 2009 science accomplishments

Science.gov (United States)

Wilson, Juliette T.

2010-01-01

Public land and natural resource managers in the United States are confronted with increasingly complex decisions that have important ramifications for both ecological and human systems. The scientists and technical professionals at the U.S. Geological Survey Fort Collins Science Center?many of whom are at the forefront of their fields?possess a unique blend of ecological, socioeconomic, and technological expertise. Because of this diverse talent, Fort Collins Science Center staff are able to apply a systems approach to investigating complicated ecological problems in a way that helps answer critical management questions. In addition, the Fort Collins Science Center has a long record of working closely with the academic community through cooperative agreements and other collaborations. The Fort Collins Science Center is deeply engaged with other U.S. Geological Survey science centers and partners throughout the Department of the Interior. As a regular practice, we incorporate the expertise of these partners in providing a full complement of ?the right people? to effectively tackle the multifaceted research problems of today's resource-management world. In Fiscal Year 2009, the Fort Collins Science Center's scientific and technical professionals continued research vital to Department of the Interior's science and management needs. Fort Collins Science Center work also supported the science needs of other Federal and State agencies as well as non-government organizations. Specifically, Fort Collins Science Center research and technical assistance focused on client and partner needs and goals in the areas of biological information management and delivery, enterprise information, fisheries and aquatic systems, invasive species, status and trends of biological resources (including human dimensions), terrestrial ecosystems, and wildlife resources. In the process, Fort Collins Science Center science addressed natural-science information needs identified in the U

The mission of the well-managed community hospital.

Science.gov (United States)

Griffith, J R

1988-07-01

The well-managed community hospital as an organization is in dynamic equilibrium with its geographic community and with other communities providing finance, physicians, nurses, other professionals and resources necessary to meet local health care needs. The hospital is "well-managed" when it develops an equilibrium that permits all of its various constituencies to be satisfied. Growth in market share results from good management. The hospital's ability to attract and satisfy the needs of health care professionals while simultaneously meeting the needs of patients and their families at competitive prices allows it to flourish. Its financial success allows it to reward its medical staff and employees in ways that attract the best of each work group. A central problem in achieving good management is communication. Hospitals must communicate their goals convincingly to a large number of doctors and employees. "The Well-Managed Community Hospital," winner of the James A. Hamilton Hospital Administration Book Award, argues that a well-structured mission statement is the essential first step in the communications process. According to the book, final responsibility for the mission statement lies with the governing board and is one of five non-delegable functions of the board. The nature of the mission setting function as described in the book follows.

A visual progression of the Fort Valley Restoration Project treatments using remotely sensed imagery (P-53)

Science.gov (United States)

Joseph E. Crouse; Peter Z. Fule

2008-01-01

The landscape surrounding the Fort Valley Experimental Forest in northern Arizona has changed dramatically in the past decade due to the Fort Valley Restoration Project, a collaboration between the Greater Flagstaff Forest Partnership, Coconino National Forest, and Rocky Mountain Research Station. Severe wildfires in 1996 sparked community concern to start restoration...

Education in geriatric medicine for community hospital staff.

LENUS (Irish Health Repository)

O'Hanlon, Shane

2010-12-01

Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.

Hospital outreach to support faith community nursing.

Science.gov (United States)

Messerly, Sally; King, Michalene A; Hughes, Suzanne

2012-01-01

A Faith Community Nurse (FCN) Program was initiated by a Magnet hospital and developed through collaboration between hospital departments and a university nurse educator. This article describes the program's development and activities that offer FCNs networking, free continuing education, and are an extension of the hospital's mission and values.

What affects local community hospitals' survival in turbulent times?

Science.gov (United States)

Chiang, Hung-Che; Wang, Shiow-Ing

2015-06-01

Hospital closures became a prevalent phenomenon in Taiwan after the implementation of a national health insurance program. A wide range of causes contributes to the viability of hospitals, but little is known about the situation under universal coverage health systems. The purpose of present study is to recognize the factors that may contribute to hospital survival under the universal coverage health system. This is a retrospective case-control study. Local community hospitals that contracted with the Bureau of National Health Insurance in 1998 and remained open during the period 1998-2011 are the designated cases. Controls are local community hospitals that closed during the same period. Using longitudinal representative health claim data, 209 local community hospitals that closed during 1998-2011 were compared with 165 that remained open. Variables related to institutional characteristics, degree of competition, characteristics of patients and financial performance were analyzed by logistic regression models. Hospitals' survival was positively related to specialty hospital, the number of respiratory care beds, the physician to population ratio, the number of clinics in the same region, a highly competitive market and the occupancy rate of elderly patients in the hospital. Teaching hospitals, investor-owned hospitals, the provision of obstetrics services or home care, and the number of medical centers or other local community hospitals may jeopardize the chance of survival. Factors-enhanced local hospitals to survive under the universal coverage health system have been identified. Hospital managers could manipulate these findings and adapt strategies for subsistence. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Community benefits: how do for-profit and nonprofit hospitals measure up?

Science.gov (United States)

Nicholson, S; Pauly, M V

The rise of the for-profit hospital industry has opened a debate about the level of community benefits provided by non-profit hospitals. Do nonprofits provide enough community benefits to justify the community's commitment of resources to them, and the tax-exempt status they receive? If nonprofit hospitals convert to for-profit entities, would community benefits be lost in the transaction? This debate has highlighted the need to define and measure community benefits more clearly. In this Issue Brief, the authors develop a new method of identifying activities that qualify as community benefits, and propose a benchmark for the amount of benefit a nonprofit hospital should provide.

Hospitality: transformative service to children, families, and communities.

Science.gov (United States)

Melton, Gary B

2014-11-01

Hospitality is an ancient moral practice that was deeply embedded in early Judaism, Christianity, and Islam. Hospitality requires acceptance of, service to, and respect for people who lack a place in the community. The contemporary importance of this practice reflects the social disconnection and economic disadvantage of many young parents and the high frequency of separation of young people, including many young parents, from their communities. Such social deterioration substantially increases the risk of child maltreatment. Building on the proposals of the U.S. Advisory Board on Child Abuse and Neglect, Strong Communities for Children demonstrated the effectiveness of community building in reducing such risk. It further suggested the importance of both relying on and learning from hospitable people in strengthening support for children and their parents. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Community representation in hospital decision making: a literature review.

Science.gov (United States)

Murray, Zoë

2015-06-01

Advancing quality in health services requires structures and processes that are informed by consumer input. Although this agenda is well recognised, few researchers have focussed on the establishment and maintenance of customer input throughout the structures and processes used to produce high-quality, safe care. We present an analysis of literature outlining the barriers and enablers involved in community representation in hospital governance. The review aimed to explore how community representation in hospital governance is achieved. Studies spanning 1997-2012 were analysed using Donabedian' s model of quality systems as a guide for categories of interest: structure, in relation to administration of quality; process, which is particularly concerned with cooperation and culture; and outcome, considered, in this case, to be the achievement of effective community representation on quality of care. There are limited published studies on community representation in hospital governance in Australia. What can be gleaned from the literature is: 1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion. The analysis indicates that: quality subcommittees set up to assist boards are a key structure for involving community representation in decision making around quality of care. There are clearly a number of challenges to effectively developing the process of community representation in

Fortæller

DEFF Research Database (Denmark)

Larsen, Gorm

2012-01-01

Siden Gerard Genettes ”Discours du récit” (1972) er distinktionen mellem hvem, der taler, og hvem, der ser, blevet cementeret som et grundparadigme i narratologien og litteraturteorien. Genettes pointe var, at den etablerede narrative teori – som fx Wayne C. Booths The Rhetoric of Fiction (1961...... narratologi blevet forsøgt udfordret, enten fordi det hævdes, at en tekst ikke nødvendigvis er udstyret med en fortæller, eller fordi begrebet om fortæller antages at bero på en misvisende og reduktiv antropomorficering. Eller omvendt fordi der i Genettes begrebsdannelse ligger en forkastelse af...... forestillingen om en implicit forfatter (implied author) og dermed også en afvisning af en upålidelige fortæller. Kapitlet præsenterer begreberne fortæller og synsvinkel i narratologien med afsæt i Genettes bestemmelser og diskutere de problemer, der opstår i kølvandet herpå. Det være sig både de rent...

Community/hospital indicators in South African public sector mental health services.

Science.gov (United States)

Lund, Crick; Flisher, Alan J

2003-12-01

The need to balance resources between community and hospital-based mental health services in the post-deinstitutionalisation era has been well-documented. However, few indicators have been developed to monitor the relationship between community and hospital services, in either developed or developing countries. There is a particular need for such indicators in the South African context, with its history of inequitable services based in custodial institutions under apartheid, and a new policy that proposes the development of more equitable community-based care. Indicators are needed to measure the distribution of resources and the relative utilisation of community and hospital-based services during the reform process. These indicators are potentially useful for assessing the implementation of policy objectives over time. To develop and document community/hospital indicators in public sector mental health services in South Africa. A questionnaire was distributed to provincial mental health coordinators requesting numbers of full-time equivalent (FTE) staff who provide mental health care at all service levels, annual patient admissions to hospitals and annual patient attendances at ambulatory care facilities. The information was supplemented by consultations with mental health coordinators in each of the 9 provinces. Population data were obtained from preliminary findings of the 1996 census. The community/hospital indicator measuring staff distribution was defined as the ratio of staff employed in community settings to all staff, expressed as a percentage. The community/hospital indicator measuring patient service utilisation was defined as the ratio of the annual ambulatory care attendance rate per 100,000 population to the sum of this rate and the annual hospital admission rate per 100,000 population, expressed as a percentage. Of psychiatric public sector staff, 25% are located in community settings in South Africa (provincial range: 11-70%). If hospital outpatient

Product-market differentiation: a strategic planning model for community hospitals.

Science.gov (United States)

Milch, R A

1980-01-01

Community hospitals would seem to have every reason to identify and capitalize on their product-market strengths. The strategic marketing/planning model provides a framework for rational analysis of the community hospital dilemma and for developing sensible solutions to the complex problems of accelerating hospital price-inflation.

Voting pattern of mental patients in a community state hospital.

Science.gov (United States)

Klein, M M; Grossman, S A

1967-06-01

The voting pattern of mental patients in a community-based state hospital was studied. Patients were polled on the New York City mayoralty race. A comparison to the vote of the general population revealed that the hospital sample vote resembled most closely the election results of the hospital district. The results highlight the advantage of community-centered mental health facilities, which undertake the treatment and rehabilitation of mental patients under conditions that maintain ties with family and community.

Identifying key hospital service quality factors in online health communities.

Science.gov (United States)

Jung, Yuchul; Hur, Cinyoung; Jung, Dain; Kim, Minki

2015-04-07

The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. We defined social media-based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea's two biggest online portals were used to test the effectiveness of detection of social media-based key quality factors for hospitals. To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and

Joint Community Health Needs Assessments as a Path for Coordinating Community-Wide Health Improvement Efforts Between Hospitals and Local Health Departments.

Science.gov (United States)

Carlton, Erik L; Singh, Simone Rauscher

2018-05-01

To examine the association between hospital-local health department (LHD) collaboration around community health needs assessments (CHNAs) and hospital investment in community health. We combined 2015 National Association of County and City Health Officials (NACCHO) Forces of Change, 2013 NACCHO Profile, and 2014-2015 Area Health Resource File data to identify a sample of LHDs (n = 439) across the United States. We included data on hospitals' community benefit from their 2014 tax filings (Internal Revenue Service Form 990, Schedule H). We used bivariate and multivariate regression analyses to examine LHDs' involvement in hospitals' CHNAs and implementation strategies and the relationship with hospital investment in community health. The LHDs that collaborated with hospitals around CHNAs were significantly more likely to be involved in joint implementation planning activities than were those that did not. Importantly, LHD involvement in hospitals' implementation strategies was associated with greater hospital investment in community health improvement initiatives. Joint CHNAs may improve coordination of community-wide health improvement efforts between hospitals and LHDs and encourage hospital investment in community health improvement activities. Public Health Implications. Policies that strengthen LHD-hospital collaboration around the CHNA may enhance hospital investments in community health.

"Know your audience": A hospital community engagement programme in a non-profit paediatric hospital in Cambodia.

Directory of Open Access Journals (Sweden)

Sreymom Pol

Full Text Available The purpose of this evaluation is to explore the impact of the new hospital community engagement programme (comprised of a Young Persons Advisory Group and a Science Café on community members and other stakeholders, with regard to their attitudes, skills and degree of engagement in a paediatric hospital in Cambodia.Data collection included feedback questionnaires and reflections produced after each YPAG and Science Café event. Further questionnaires and reflective interviews were conducted to gather the views of key stakeholders. Data were analysed by thematic content analysis and numerical data were expressed using descriptive statistics.The vast majority of participants expressed their enjoyment and satisfaction of the hospital community engagement programme. Delivering the programme in the right manner for the target audiences, by prioritising their needs was key to this. Participants valued the programmes in terms of the knowledge delivered around good health practices, the skills developed such as confidence and responsibility for their health, and the provision of opportunities to voice their opinions. All stakeholders recognised the importance of the programme in improving the quality of the healthcare service provided at the hospital.In order to have a successful hospital community engagement programme, understanding the target audience is essential. The engagement programme must be delivered in the right way to meet the needs of community members, including right communication, right setting, right people and right timing. This will ultimately result in a meaningful programme that is able to empower community members, potentially resulting in lasting change in healthcare practices. In conclusion, the gap between hospitals and the community could narrow, allowing everyone to interact and learn from each other.

Archaeological Surveys and Evaluations of Four Construction Areas in the Vicinity of Fort Jackson, Plaquemines Parish, Louisiana

Science.gov (United States)

1992-04-01

the officers’ quarters, a hospital, and an inspector’s quarters (Greene 1982:128-129). The fort itself was a regular pentagon with bastions at each...Outside of the moat another brick wall was constructed, facing a second ditch. A bridge over the second ditch led southward to a water battery whose...Archaeological Swrveys and Evaluations at Fort Jackson du Pratz, Le Page 1975 The History of Louisiana. Louisiana American Revolution Bicentennial Commission

Parvovirus B19 infection in hospital workers: community or hospital acquisition?

Science.gov (United States)

Dowell, S F; Török, T J; Thorp, J A; Hedrick, J; Erdman, D D; Zaki, S R; Hinkle, C J; Bayer, W L; Anderson, L J

1995-10-01

A suspected nosocomial outbreak of parvovirus B19 infection in a maternity ward was investigated in February 1994. Questionnaires were administered and sera collected from maternity ward staff (n = 91), other ward staff in the same hospital (n = 101), and maternity ward staff at a nearby hospital (n = 81). Blood donors (n = 265) were used as community controls. Recent infection (parvovirus B19 IgM positivity) in susceptible persons (parvovirus B19 IgG-negative or IgM-positive) was common among all 4 groups (23%-30%). This high rate of recent infection occurred during a large community outbreak of fifth disease. Environmental samples collected from a room where a stillborn parvovirus B19-infected fetus was delivered were positive for parvovirus B19 DNA. Thus, this suspected nosocomial outbreak actually reflected transmission outside the hospital, but contaminated environmental surfaces were identified as one potential source for transmission of parvovirus B19.

Cultural keystone species in oil sands mine reclamation, Fort McKay, Alberta, Canada

Energy Technology Data Exchange (ETDEWEB)

Garibaldi, A.; Straker, J. [Stantec Ltd., Sidney, BC (Canada)

2009-07-01

Cultural keystone species (CKS) shape the cultural identify of people through the roles they have in diet, material and spiritual practices. The use of the CKS concept is regarded as a method of addressing linked social and ecological issues. This paper presented the results of using the CKS model in the indigenous community of Fort McKay, Alberta to address, social, ecological and spiritual values in regional mine-land reclamation. Fort McKay is at the epicenter of the existing mine developments. Its residents regard human and environmental health to be be linked and therefore experience the effects of development and subsequent reclamation on both cultural and ecological levels. The community is actively engaged in working with the local mining companies on issues of mine reclamation design. In order to hold meaning to the local people, oil sand operators used the CKS concept in their reclamation efforts to take into account ecological functionality and also address the linked social factors. Five CKS were identified through a literature review and extensive community interviews. The list includes moose, cranberry, blueberry, ratroot and beaver. These 5 CKS were used to focus discussions and make recommendations for relevant land reclamation within Fort McKay traditional territory. The project has influenced the way both the community and oil sands operators engage with reclamation. Lessons learned from this process will help direct reclamation activities on other portions of traditional territory, while offering guidance to other regional developers for addressing cultural values in reclamation on their leases. 15 refs., 1 fig.

Philanthropic Donor Perspectives on Supporting Nursing Excellence in a Community Hospital.

Science.gov (United States)

Fickley, Sharon K; Mishler, Ray R; Black, Amelia S; DeGuzman, Pam B

2016-11-01

The purpose of this research is to explore donors' perspectives on support of nursing excellence in a community hospital. Philanthropic support is rapidly becoming critical to support nursing excellence in hospitals, including continuing education, nursing research, and professional development. However, no research has examined the experience of private donors who support nursing programs in community hospitals. Structured interviews were conducted with individuals with a history of providing significant financial support (gifts >$50 000) targeted specifically for nursing in a 176- bed community hospital in the southeastern United States. Analysis was performed using descriptive content analysis. Four themes emerged that centered around making a difference, helping nurses meet new challenges, an existing foundation of service, and valuing excellent nursing care received. This research provides specific information that nursing administrators can use when seeking philanthropic gifts to support nursing excellence programs in US community hospitals.

Association Between Community Social Capital and Hospital Readmission Rates.

Science.gov (United States)

Brewster, Amanda L; Lee, Suhna; Curry, Leslie A; Bradley, Elizabeth H

2018-05-31

Hospital readmissions remain frequent, and are partly attributable to patients' social needs. The authors sought to examine whether local community levels of social capital are associated with hospital readmission rates. Social capital refers to the connections among members of a society that foster norms of reciprocity and trust, which may influence the availability of support for postdischarge recovery after hospitalization. Associations between hospital-wide, risk-stratified readmission rates for hospitals in the United States (n = 4298) and levels of social capital in the hospitals' service areas were examined. Social capital was measured by an index of participation in associational activities and civic affairs. A multivariate linear regression model was used to adjust for hospital and community factors such as hospital financial performance, race, income, and availability of heath care services. Results showed that higher social capital was significantly associated with lower readmission rates (P social capital in its region, but in areas of low social capital, it may be possible for public or philanthropic sectors to buttress the types of institutions that address nonmedical causes of readmission.

Evaluating Michigan's community hospital access: spatial methods for decision support

Directory of Open Access Journals (Sweden)

Varnakovida Pariwate

2006-09-01

Full Text Available Abstract Background Community hospital placement is dictated by a diverse set of geographical factors and historical contingency. In the summer of 2004, a multi-organizational committee headed by the State of Michigan's Department of Community Health approached the authors of this paper with questions about how spatial analyses might be employed to develop a revised community hospital approval procedure. Three objectives were set. First, the committee needed visualizations of both the spatial pattern of Michigan's population and its 139 community hospitals. Second, the committee required a clear, defensible assessment methodology to quantify access to existing hospitals statewide, taking into account factors such as distance to nearest hospital and road network density to estimate travel time. Third, the committee wanted to contrast the spatial distribution of existing community hospitals with a theoretical configuration that best met statewide demand. This paper presents our efforts to first describe the distribution of Michigan's current community hospital pattern and its people, and second, develop two models, access-based and demand-based, to identify areas with inadequate access to existing hospitals. Results Using the product from the access-based model and contiguity and population criteria, two areas were identified as being "under-served." The lower area, located north/northeast of Detroit, contained the greater total land area and population of the two areas. The upper area was centered north of Grand Rapids. A demand-based model was applied to evaluate the existing facility arrangement by allocating daily bed demand in each ZIP code to the closest facility. We found 1,887 beds per day were demanded by ZIP centroids more than 16.1 kilometers from the nearest existing hospital. This represented 12.7% of the average statewide daily bed demand. If a 32.3 kilometer radius was employed, unmet demand dropped to 160 beds per day (1

How confident is Fort McKay that industry can reclaim oil sand development

Energy Technology Data Exchange (ETDEWEB)

Fitzpatrick, C. [Fort McKay First Nations, AB (Canada)

2004-02-05

This presentation described how traditional environmental knowledge (TEK) can provide valuable information for both the reclamation design and assessment of oil sand development in Fort McKay. Conservation is valued by the Fort McKay First Nations communities who claim that current reclamation methods are too slow, and that the land is not being brought back to its original use with the uniqueness of the boreal landscape. Elders have noted that each year the water level in the Athabasca River is lower. The blowing tailings and coke dust are causing trees to dye and driving animals away. There is concern that the animals that remain may not be safe to eat. The Fort McKay First Nation community has stated that it will view reclamation as a success only when it functions with proof over many generations. The major concerns include: salt in the water draining from reclaimed areas; salt in the soils of reclaimed area; muskeg cannot be recreated; and, the issue of whether cranberry, blueberry and streambank forest areas can be recreated, along with traditional medicinal plants. Other concerns include the loss of rivers such as the Beaver Creek and Tar River, and that the water in reclaimed areas may not be suitable for animals to live in or to drink. tabs., figs.

How confident is Fort McKay that industry can reclaim oil sand development

International Nuclear Information System (INIS)

Fitzpatrick, C.

2004-01-01

This presentation described how traditional environmental knowledge (TEK) can provide valuable information for both the reclamation design and assessment of oil sand development in Fort McKay. Conservation is valued by the Fort McKay First Nations communities who claim that current reclamation methods are too slow, and that the land is not being brought back to its original use with the uniqueness of the boreal landscape. Elders have noted that each year the water level in the Athabasca River is lower. The blowing tailings and coke dust are causing trees to dye and driving animals away. There is concern that the animals that remain may not be safe to eat. The Fort McKay First Nation community has stated that it will view reclamation as a success only when it functions with proof over many generations. The major concerns include: salt in the water draining from reclaimed areas; salt in the soils of reclaimed area; muskeg cannot be recreated; and, the issue of whether cranberry, blueberry and streambank forest areas can be recreated, along with traditional medicinal plants. Other concerns include the loss of rivers such as the Beaver Creek and Tar River, and that the water in reclaimed areas may not be suitable for animals to live in or to drink. tabs., figs

Differences in microbiological profile between community-acquired, healthcare-associated and hospital-acquired infections.

Science.gov (United States)

Cardoso, Teresa; Ribeiro, Orquídea; Aragão, Irene; Costa-Pereira, Altamiro; Sarmento, António

2013-01-01

Microbiological profiles were analysed and compared for intra-abdominal, urinary, respiratory and bloodstream infections according to place of acquisition: community-acquired, with a separate analysis of healthcare-associated, and hospital-acquired. Prospective cohort study performed at a university tertiary care hospital over 1 year. Inclusion criteria were meeting the Centers for Disease Control definition of intra-abdominal, urinary, respiratory and bloodstream infections. A total of 1035 patients were included in the study. More than 25% of intra-abdominal infections were polymicrobial; multi-drug resistant gram-negatives were 38% in community-acquired, 50% in healthcare-associated and 57% in hospital-acquired. E. coli was the most prevalent among urinary infections: 69% in community-acquired, 56% in healthcare-associated and 26% in hospital-acquired; ESBL producers' pathogens were 10% in healthcare-associated and 3% in community-acquired and hospital-acquired. In respiratory infections Streptococcus pneumoniae was the most prevalent in community-acquired (54%) and MRSA in healthcare-associated (24%) and hospital-acquired (24%). A significant association was found between MRSA respiratory infection and hospitalization in the previous year (adjusted OR = 6.3), previous instrumentation (adjusted OR = 4.3) and previous antibiotic therapy (adjusted OR = 5.7); no cases were documented among patients without risk factors. Hospital mortality rate was 10% in community-acquired, 14% in healthcare-associated and 19% in hospital-acquired infection. This study shows that healthcare-associated has a different microbiologic profile than those from community or hospital acquired for the four main focus of infection. Knowledge of this fact is important because the existing guidelines for community-acquired are not entirely applicable for this group of patients.

Martin Luther King, Jr., General Hospital and community involvement.

Science.gov (United States)

Humphrey, M M

1973-07-01

Community involvement is not just one facet of the new Martin Luther King, Jr., General Hospital's existence. It is the mainstream from which all other activities flow. In addition to meeting the conventional needs of a conventional hospital staff with the core collection of texts and journals, this library goes one step further. It acts as a resource for its community health workers, dietitians, and nurses in their various outreach programs. It serves as a stimulus for the high school or community college student who may be curious about a health career. It also finds time to provide reading material for its patients.

Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

Directory of Open Access Journals (Sweden)

Gregory Jackson Tung

2017-09-01

Full Text Available Objective:  To explore the use of Health Impact Assessments (HIAs within non-profit hospital community benefit activities. Methods:  We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. Results:  HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas. Conclusion: HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities.

Not-for-profit hospitals' provision of community benefit: is there a trade-off between charity care and other benefits provided to the community?

Science.gov (United States)

Singh, Simone Rauscher

2013-01-01

For decades, not-for-profit hospitals have been required to provide community benefit in exchange for tax exemption. To fulfill this requirement, hospitals engage in a variety of activities ranging from free and reduced cost care provided to individual patients to services aimed at improving the health of the community at large. Limited financial resources may restrict hospitals' ability to provide the full range of community benefits and force them to engage in trade-offs. We analyzed the composition of not-for-profit hospitals' community benefit expenditures and explored whether hospitals traded off between charity care and spending on other community benefit activities. Data for this study came from Maryland hospitals' state-level community benefit reports for 2006-2010. Bivariate Spearman's rho correlation analysis was used to examine the relationships among various components of hospitals' community benefit activities. We found no evidence of trade-offs between charity care and activities targeted at the health and well-being of the community at large. Consistently, hospitals that provided more charity care did not offset these expenditures by reducing their spending on other community benefit activities, including mission-driven health services, community health services, and health professions education. Hospitals' decisions about how to allocate community benefit dollars are made in the context of broader community health needs and resources. Concerns that hospitals serving a disproportionate number of charity patients might provide fewer benefits to the community at large appear to be unfounded.

Home hospitalization in the spectrum of community geriatric care.

Science.gov (United States)

Stessman, J; Hammerman-Rozenberg, R; Cohen, A

1997-04-01

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

Directory of Open Access Journals (Sweden)

Eleanor M Winpenny

2016-11-01

Full Text Available Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs, nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

Defense.gov Special Report: Fort Hood Shooting

Science.gov (United States)

identify possible insider threats, Army Secretary John M. McHugh told lawmakers. Story Obama: Soldiers ," Army Secretary John M. McHugh told lawmakers. Story President Praises Swift Response to Fort Hood Remarks on Fort Hood Shooting at White House McHugh, Odierno Address Fort Hood Shooting Before Congress

Tax-Exempt Hospitals' Investments in Community Health and Local Public Health Spending: Patterns and Relationships.

Science.gov (United States)

Singh, Simone R; Young, Gary J

2017-12-01

To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs). We combined data on tax-exempt hospitals' community benefit spending with data on spending by the corresponding LHD that served the county in which a hospital was located. Data were available for 2 years, 2009 and 2013. Generalized linear regressions were estimated with indicators of hospital community benefit spending as the dependent variable and LHD spending as the key independent variable. Hospital community benefit spending was unrelated to how much local public health agencies spent, per capita, on public health in their communities. Patterns of local public health spending do not appear to impact the investments of tax-exempt hospitals in community health activities. Opportunities may, however, exist for a more active engagement between the public and private sector to ensure that the expenditures of all stakeholders involved in community health improvement efforts complement one another. © Health Research and Educational Trust.

The WIMS-E module W-FORTE

International Nuclear Information System (INIS)

Roth, M.J.

1983-09-01

There are three distinct versions of the WIMS lattice cell program. WIMS-E is the most general, WIMSD4 is restricted to clusters or to one dimensional slab or annular geometry, and LWRWIMS is designed principally for light water reactor geometries. W-FORTE is used to transfer data from WIMSD4 or LWRWIMS to WIMS-E. A description of the W-FORTE module is given, and includes the relevant data for WIMSD4, LWRWIMS and W-FORTE. (UK)

Frequency of Hospital Use Before and After Home-Delivery Meal by Meals On Wheels, of Tarrant County, Texas.

Science.gov (United States)

Cho, J; Thorud, J L; Marishak-Simon, S; Hammack, L; Stevens, A B

2018-01-01

Patients recently discharged from the hospital are vulnerable and are at high risk for readmission. Home-delivered meals may be beneficial in improving their health and facilitating independent living in the community. The purpose of this study was to identify the association between home-delivered meals and use of hospital services. This study includes 120 clients recently discharged from an inpatient hospital stay or from an emergency department (ED) visit who received meal services from Meals On Wheels, Inc., of Tarrant County. Healthcare utilization data was extracted from the Dallas-Fort Worth Hospital Council Foundation, a regional all claims database used by over 90% of hospitals in Dallas-Fort Worth area. Signed tests and generalized linear models (GLM) were performed. A total of 16,959 meals were delivered from March 2013 through March 2014. Each client received an average of 6.19 meals per week. The average number of ED visits decreased from 5.03 before receipt of meals to 1.45 after receipt of meals, z = -5.23, p meals were less likely to experience ED visits and hospitalizations after controlling for demographic characteristics and levels of physical functioning. The findings of this study indicate that home-delivered meals services may contribute to a reduction in hospital based care services among frail and vulnerable adults. Additional studies should consider the short and long-term effects of home-delivered meals services on healthcare utilization and the potential to decrease healthcare costs.

Communication between hospitals and isolated aboriginal community health clinics.

Science.gov (United States)

Mackenzie, G; Currie, B J

1999-04-01

This study described the communication dynamics, identified problems and recommended changes to improve patient follow-up and communication between Royal Darwin Hospital (RDH) and isolated Aboriginal community health clinics (CHC) in the Northern Territory (NT). In 1995, staff interviews were conducted and an audit of isolated Aboriginal patients' RDH discharge summaries (DS). Eighteen per cent of RDH DSs never arrived in CHCs. DSs were often prepared late and more likely to be in CHC records if written on time and if the referral source was specified. Interviews revealed discontent between CHCs and RDH regarding: communication, DS documentation, the supply of discharge medication, as well as different hospital and community perceptions of Aboriginies' reliability to carry a DS and CHC desire for patients to be given DSs at discharge. Aboriginal patients should be given a DS at discharge and resident medical officers should be educated as to the function and importance of the DS. In 18 months following this study, RDH appointed unit-based Aboriginal health workers and a policy was produced for written communication between hospital and CHCs, as well as a discharge planning manual for Aboriginal communities. Projects investigating communication between hospitals and isolated Aboriginal clinics and patient follow-up may result in significant policy changes concerning these processes.

Persisting high hospital and community childhood mortality in an urban setting in Guinea-Bissau

DEFF Research Database (Denmark)

Veirum, Jens Erik; Biai, Sidu; Jakobsen, Marianne

2007-01-01

AIM: To describe paediatric hospitalization in a West African capital in relation to overall childhood mortality in the community and to evaluate the potential impact of improved management at the hospital. METHODS: Hospital data on child admissions in a 6-year period were linked to information...... been hospitalized, and 24% of all deaths in the community occurred in-hospital. Community infant and under-three mortality rates were 110 and 207 per 1,000 person-years, respectively. In-hospital mortality remained persistently high from 1991 to 1996 and the overall in-hospital mortality was 12...... minor improvements in acute case management of sick children attending the hospital would be expected to result in substantial reduction in overall childhood mortality. Persistently high acute in-hospital mortality reflects the need of immediate and appropriate care at the hospital. Treatment should...

Radiation decontamination unit for the community hospital

International Nuclear Information System (INIS)

Waldron, R.L. II; Danielson, R.A.; Shultz, H.E.; Eckert, D.E.; Hendricks, K.O.

1981-01-01

Freestanding radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstrution. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Rige Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important

Comparing the Value of Nonprofit Hospitals' Tax Exemption to Their Community Benefits.

Science.gov (United States)

Herring, Bradley; Gaskin, Darrell; Zare, Hossein; Anderson, Gerard

2018-01-01

The tax-exempt status of nonprofit hospitals has received increased attention from policymakers interested in examining the value they provide instead of paying taxes. We use 2012 data from the Internal Revenue Service (IRS) Form 990, Centers for Medicare and Medicaid Services (CMS) Hospital Cost Reports, and American Hospital Association's (AHA) Annual Survey to compare the value of community benefits with the tax exemption. We contrast nonprofit's total community benefits to what for-profits provide and distinguish between charity and other community benefits. We find that the value of the tax exemption averages 5.9% of total expenses, while total community benefits average 7.6% of expenses, incremental nonprofit community benefits beyond those provided by for-profits average 5.7% of expenses, and incremental charity alone average 1.7% of expenses. The incremental community benefit exceeds the tax exemption for only 62% of nonprofits. Policymakers should be aware that the tax exemption is a rather blunt instrument, with many nonprofits benefiting greatly from it while providing relatively few community benefits.

Single-site community consultation for emergency research in a community hospital setting.

Science.gov (United States)

Galbraith, Kyle L; Keck, Anna-Sigrid; Little, Charletta

2014-01-01

The purpose of this study was to evaluate community member feedback from community consultation and public disclosure activities performed for a clinical investigation involving a device designed to treat traumatic brain injury in prehospital contexts. The clinical investigation of that device was to be performed under the federal regulations providing an exception from prospective informed consent requirements in emergency settings. Secondarily, we sought to assess the community consultation process by measuring the levels of outreach provided by the different communication methods used in these activities, with special attention to the effectiveness of social media for community outreach. The medical device investigation consists of a single-site pilot study based at a 345-bed community hospital in east central Illinois, which also serves as the area's only level I trauma center. Investigators, in collaboration with the local institutional review board, fulfilled community consultation and public disclosure requirements through four public town hall meetings, seven targeted focus groups, targeted mailings to 884 community leaders and researchers, a press conference and press release, internal and external websites, and multiple postings to the hospital's Facebook and Twitter accounts. Community members provided feedback by completing paper or electronic comment cards. A total of 428 community members attended the four town hall meetings and seven focus group sessions. Attendance at each meeting ranged from 4 to 20 attendees for the town hall meetings and 8 to 140 attendees for the focus groups. The investigation's external website received 626 unique visitors and the intranet website received 528 unique visits. Social media postings on Facebook and Twitter received six comments and eight "likes" to indicate that an individual read the posting. In total, attendees completed 175 comment cards to provide their feedback. Community member attitudes regarding the

Renewable Energy Opportunities at Fort Hood, Texas

Energy Technology Data Exchange (ETDEWEB)

Solana, Amy E.; Warwick, William M.; Orrell, Alice C.; Russo, Bryan J.; Parker, Kyle R.; Weimar, Mark R.; Horner, Jacob A.; Manning, Anathea

2011-11-14

This report presents the results of Pacific Northwest National Laboratory's (PNNL) follow-on renewable energy (RE) assessment of Fort Hood. Fort Hood receives many solicitations from renewable energy vendors who are interested in doing projects on site. Based on specific requests from Fort Hood staff so they can better understand these proposals, and the results of PNNL's 2008 RE assessment of Fort Hood, the following resources were examined in this assessment: (1) Municipal solid waste (MSW) for waste-to-energy (WTE); (2) Wind; (3) Landfill gas; (4) Solar photovoltaics (PV); and (5) Shale gas. This report also examines the regulatory issues, development options, and environmental impacts for the promising RE resources, and includes a review of the RE market in Texas.

Community-acquired Pneumonia in Hospitalized Urban Young ...

African Journals Online (AJOL)

As part of a comprehensive hospital-based study of acute lower respiratory infections (ALRI) in under-five urban Nigerian children, we sought to identify the possible clinical and investigative correlates of lobar versus bronchopneumonia, and the possible determinants of mortality in community-acquired pneumonia. Over a ...

Impacts of Mackenzie gas project on water supply systems of northern communities : Fort Simpson as a case study

International Nuclear Information System (INIS)

Mathrani, M.; Johnson, K.

2007-01-01

The proposed Mackenzie Gas Project (MGP) is a 1220-kilometre natural gas pipeline system along the Mackenzie Valley of Canada's Northwest Territories. The line will connect northern onshore gas fields with North American markets. Four major Canadian oil and gas companies and a group representing the Aboriginal peoples of Canada's Northwest Territories are partners in the proposed MGP. The MGP is currently in the project definition stage that involves examining the effect of the project on northern communities. Fort Simpson is located on an island, on the forks of the Mackenzie and Liard Rivers and is proposed as the major route for the MGP with the construction of barge handling areas, storage areas, camps/housing units and use of air and highway facilities. These activities are expected to result in burden on local civil infrastructure systems including water supply systems. Although the environmental impacts of the project on the community's infrastructure systems are projected by the MGP proponents, the local authority wanted to conduct its own assessment of the impacts on local water supply system. This paper presented the results of a study that examined the amount of water used by the community based upon available water use records and the current operational and maintenance costs based upon available financial documents. The study also estimated future water requirements based upon MGP activities and associated population growth. Current and future economic rates were also determined. 13 refs., 6 tabs

75 FR 36371 - Draft Environmental Impact Statement Addressing Campus Development at Fort Meade, MD

Science.gov (United States)

2010-06-25

...'s (NSA) continually evolving requirements and for Intelligence Community use. The purpose of the..., or e-mail [email protected]nsa.gov . SUPPLEMENTARY INFORMATION: Background: The NSA is a tenant DOD agency on Fort Meade. NSA is a high-technology organization that is on the frontier of communications and data...

Hospital and Community Pharmacists’ Perceptions of Which Competences Are Important for Their Practice

Directory of Open Access Journals (Sweden)

Jeffrey Atkinson

2016-06-01

Full Text Available The objective of the PHAR-QA (Quality assurance in European pharmacy education and training project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152 ranked 68 competences for pharmacy practice of two types (personal and patient care, arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258. Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation.

Hospital and Community Pharmacists’ Perceptions of Which Competences Are Important for Their Practice

Science.gov (United States)

Atkinson, Jeffrey; Sánchez Pozo, Antonio; Rekkas, Dimitrios; Volmer, Daisy; Hirvonen, Jouni; Bozic, Borut; Skowron, Agnieska; Mircioiu, Constantin; Sandulovici, Roxana; Marcincal, Annie; Koster, Andries; Wilson, Keith A.; van Schravendijk, Chris; Frontini, Roberto; Price, Richard; Bates, Ian; De Paepe, Kristien

2016-01-01

The objective of the PHAR-QA (Quality assurance in European pharmacy education and training) project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152) ranked 68 competences for pharmacy practice of two types (personal and patient care), arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258). Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation. PMID:28970394

Hospital management of community-acquired pneumonia in Malta

OpenAIRE

Callus, Roberta; Micallef, Josef; Mamo, Jonathan; Montefort, Stephen

2012-01-01

Community-acquired pneumonia (CAP) remains a common diagnosis requiring hospital admission and a leading cause of death worldwide. No local guideline is currently available for the management of CAP. Our aim was to evaluate current practices in the management of CAP at Mater Dei Hospital, Malta. In this prospective study we looked at all adult patients admitted with CAP in winter and summer (105 consecutive days for both seasons). Data collected and analysed included: basic patient demographi...

COORDINATING HOSPITAL AND COMMUNITY WORK ADJUSTMENT SERVICES. FINAL REPORT.

Science.gov (United States)

GOERTZEL, VICTOR; AND OTHERS

THE GOALS OF THIS STUDY WERE TO USE WORK TO HELP PATIENTS LEAVE THE CAMARILLO STATE HOSPITAL SOONER, BECOME A PART OF THE COMMUNITY, AND BECOME SELF-SUPPORTING. THE PROJECT SELECTED 146 SCHIZOPHRENIC MALES WHO HAD A HISTORY OF POOR WORK ADJUSTMENT. AS PART OF THE TREATMENT, THE MEN WERE PLACED IN THE HOSPITAL BAKERY. AFTER ADJUSTMENT TO THE WORK…

FOUR YEARS OF OPERATIONS AND RESULTS WITH FORTE

International Nuclear Information System (INIS)

D. ROUSSEL-DUPRE; P. KLINGNER; L. CARLSON; ET AL

2001-01-01

The FORTE (Fast Onboard Recording of Transient Events) satellite was launched on 29 August 1997 and has been in continuous operation since that time. FORTE was placed in a nearly circular, 825-km-altitude, 70 degrees inclination orbit by a Pegasus rocket funded by Air Force Space Test Program. The Department of Energy funded the FORTE satellite, which was designed and built at Los Alamos. FORTE's successful launch and engineered robustness were a result of several years of dedicated work by the joint Los Alamos National Laboratory/Sandia National Laboratory project team, led through mission definition, payload and satellite development, and launch by Dr. Stephen Knox. The project is now led by Dr. Abram Jacobson. FORTE carries a suite of instruments, an optical system and a rf system, for the study of lightning and anthropogenic signals. As a result of this effort, new understandings of lightning events have emerged as well as a more complete understanding of the relationship between optical and rf lightning events. This paper will provide an overview of the FORTE satellite and will discuss the on orbit performance of the subsystems

Urological Emergency Admissions to a Community Hospital: A Review

Science.gov (United States)

Atkins, Sam O.

1983-01-01

A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189

The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities.

Science.gov (United States)

Elder, W G; Amundson, B A

1991-01-01

The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.

Fort St. Vrain decommissioning project

International Nuclear Information System (INIS)

Fisher, M.

1998-01-01

Public Service Company of Colorado (PSCo), owner of the Fort St. Vrain nuclear generating station, achieved its final decommissioning goal on August 5, 1997 when the Nuclear Regulatory Commission terminated the Part 50 reactor license. PSCo pioneered and completed the world's first successful decommissioning of a commercial nuclear power plant after many years of operation. In August 1989, PSCo decided to permanently shutdown the reactor and proceed with its decommissioning. The decision to proceed with early dismantlement as the appropriate decommissioning method proved wise for all stake holders - present and future - by mitigating potential environmental impacts and reducing financial risks to company shareholders, customers, employees, neighboring communities and regulators. We believe that PSCo's decommissioning process set an exemplary standard for the world's nuclear industry and provided leadership, innovation, advancement and distinguished contributions to other decommissioning efforts throughout the world. (author)

First 101 Robotic General Surgery Cases in a Community Hospital

Science.gov (United States)

Robertson, Jarrod C.; Alrajhi, Sharifah

2016-01-01

Background and Objectives: The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Methods: Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Results: Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. Conclusion: A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy. PMID:27667913

78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

Science.gov (United States)

2013-08-20

... DEPARTMENT OF DEFENSE 32 CFR Part 199 [DoD-2010-HA-0072] RIN 0720-AB41 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction... TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access...

The Journey to Meet Emerging Community Benefit Requirements in a Rural Hospital: A Case Study

Science.gov (United States)

Sabin, Allison V; Levin, Pamela F

2015-10-22

The Affordable Care Act requires nonprofit hospitals to collaborate with public health agencies and community stakeholders to identify and address community health needs. As a rural organization, Wabash County (Indiana) Hospital pursued new approaches to achieve these revised requirements of the community benefit mandate. Using a case study approach, the authors provide a historical review of governmental relationships with nonprofit community hospitals, offer a case study application for implementing legislative mandates and community benefit requirements, share the insights they garnered on their journey to meet the mandates, and conclude that drawing upon the existing resources in the community and using current community assets in novel ways can help conserve time, and also financial, material, and human resources in meeting legislative mandates.

Vegetation inventory, mapping, and classification report, Fort Bowie National Historic Site

Science.gov (United States)

Studd, Sarah; Fallon, Elizabeth; Crumbacher, Laura; Drake, Sam; Villarreal, Miguel

2013-01-01

A vegetation mapping and characterization effort was conducted at Fort Bowie National Historic Site in 2008-10 by the Sonoran Desert Network office in collaboration with researchers from the Office of Arid lands studies, Remote Sensing Center at the University of Arizona. This vegetation mapping effort was completed under the National Park Service Vegetation Inventory program which aims to complete baseline mapping inventories at over 270 national park units. The vegetation map data was collected to provide park managers with a digital map product that met national standards of spatial and thematic accuracy, while also placing the vegetation into a regional and even national context. Work comprised of three major field phases 1) concurrent field-based classification data collection and mapping (map unit delineation), 2) development of vegetation community types at the National Vegetation Classification alliance or association level and 3) map accuracy assessment. Phase 1 was completed in late 2008 and early 2009. Community type descriptions were drafted to meet the then-current hierarchy (version 1) of the National Vegetation Classification System (NVCS) and these were applied to each of the mapped areas. This classification was developed from both plot level data and censused polygon data (map units) as this project was conducted as a concurrent mapping and classification effort. The third stage of accuracy assessment completed in the fall of 2010 consisted of a complete census of each map unit and was conducted almost entirely by park staff. Following accuracy assessment the map was amended where needed and final products were developed including this report, a digital map and full vegetation descriptions. Fort Bowie National Historic Site covers only 1000 acres yet has a relatively complex landscape, topography and geology. A total of 16 distinct communities were described and mapped at Fort Bowie NHS. These ranged from lush riparian woodlands lining the

Efficiency disparities among community hospitals in Tennessee: do size, location, ownership, and network matter?

Science.gov (United States)

Roh, Chul-Young; Moon, M Jae; Jung, Kwangho

2013-11-01

This study examined the impact of ownership, size, location, and network on the relative technical efficiency of community hospitals in Tennessee for the 2002-2006 period, by applying data envelopment analysis (DEA) to measure technical efficiency (decomposed into scale efficiency and pure technical efficiency). Data envelopment analysis results indicate that medium-size hospitals (126-250 beds) are more efficient than their counterparts. Interestingly, public hospitals are significantly more efficient than private and nonprofit hospitals in Tennessee, and rural hospitals are more efficient than urban hospitals. This is the first study to investigate whether hospital networks with other health care providers affect hospital efficiency. Results indicate that community hospitals with networks are more efficient than non-network hospitals. From a management and policy perspective, this study suggests that public policies should induce hospitals to downsize or upsize into optional size, and private hospitals and nonprofit hospitals should change their organizational objectives from profit-driven to quality-driven.

Getting more for your money: designing community needs assessments to build collaboration and capacity in hospital system community benefit work.

Science.gov (United States)

Ainsworth, Dale; Diaz, Heather; Schmidtlein, Mathew C

2013-11-01

Most community health needs assessments (CHNAs) are unilateral in nature and fail to include a community-based participatory research (CBPR) approach, limiting them in their scope. Nonprofit hospitals are required to conduct CHNAs every 3 years to determine where community prevention dollars should be spent. In 2010, a CBPR CHNA approach was conducted with four hospital systems in Northern California. Merging concepts from organization development, the approach included (a) goal determination, (b) use of a guiding framework, (c) creation of a container in which to interact, (d) established feedback loops, and (e) intentional trust-building exercises. The approach was to build lasting relationships between hospital systems that would extend beyond the CHNA. Results using this approach revealed that members representing all four hospital systems (a) began to meet regularly after the CHNA was completed, (b) increased collaboration with other community organizations, (c) expanded their level of intraorganization partnerships, (d) enjoyed the process, (e) felt that their professional knowledge expanded, and (f) felt connected professionally and personally with other hospital representatives. As a result, other joint projects are underway. The results of this study indicate that using CBPR to design a CHNA can build sustained collaborative relationships between study participants that continue.

Bent's Old Fort: Amphibians and Reptiles

Science.gov (United States)

Muths, E.

2008-01-01

Bent's Old Fort National Historic Site sits along the Arkansas River in the semi-desert prairie of southeastern Colorado. The USGS provided assistance in designing surveys to assess the variety of herpetofauna (amphibians and reptiles) resident at this site. This brochure is the results of those efforts and provides visitors with information on what frogs, toads, snakes and salamanders might be seen and heard at Bent's Old Fort.

Stillbirths in urban Guinea-Bissau: A hospital- and community-based study.

Directory of Open Access Journals (Sweden)

Morten Bjerregaard-Andersen

Full Text Available Stillbirth rates remain high in many low-income settings, with fresh (intrapartum stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau.The study was carried out by the Bandim Health Project (BHP, a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM, and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB if fetal movements were reported on the day of delivery.From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births. Excluding deliveries referred to the hospital from outside the capital (9.6%, the HNSM stillbirth rate was 2786/34490 births (81/1000. During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000. Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000 were stillbirths, and 609 (70.3% of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04. In the community cohort, antenatal care (ANC attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/1000 if she attended ≥7 consultations (P<0.001.In Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on

Repurposing Waste Streams: Lessons on Integrating Hospital Food Waste into a Community Garden.

Science.gov (United States)

Galvan, Adri M; Hanson, Ryan; George, Daniel R

2018-04-06

There have been increasing efforts in recent decades to divert institutional food waste into composting programs. As major producers of food waste who must increasingly demonstrate community benefit, hospitals have an incentive to develop such programs. In this article, we explain the emerging opportunity to link hospitals' food services to local community gardens in order to implement robust composting programs. We describe a partnership model at our hospital in central Pennsylvania, share preliminary outcomes establishing feasibility, and offer guidance for future efforts. We also demonstrate that the integration of medical students in such efforts can foster systems thinking in the development of programs to manage hospital waste streams in more ecologically-friendly ways.

Radiation decontamination unit for the community hospital.

Science.gov (United States)

Waldron, R L; Danielson, R A; Shultz, H E; Eckert, D E; Hendricks, K O

1981-05-01

"Freestanding" radiation decontamination units including surgical capability can be developed and made operational in small/medium sized community hospitals at relatively small cost and with minimal plant reconstruction. Because of the development of nuclear power plants in relatively remote areas and widespread transportation of radioactive materials it is important for hospitals and physicians to be prepared to handle radiation accident victims. The Radiological Assistance Program of the United States Department of Energy and the Radiation Emergency Assistance Center Training Site of Oak Ridge Associated Universities are ready to support individual hospitals and physicians in this endeavor. Adequate planning rather than luck, should be used in dealing with potential radiation accident victims. The radiation emergency team is headed by a physician on duty in the hospital. It is important that the team leader be knowledgeable in radiation accident management and have personnel trained in radiation accident management as members of this team. The senior administrative person on duty is responsible for intramural and extramural communications. Rapid mobilization of the radiation decontamination unit is important. Periodic drills are necessary for this mobilization and the smooth operation of the unit.

Organizational culture: an important context for addressing and improving hospital to community patient discharge.

Science.gov (United States)

Hesselink, Gijs; Vernooij-Dassen, Myrra; Pijnenborg, Loes; Barach, Paul; Gademan, Petra; Dudzik-Urbaniak, Ewa; Flink, Maria; Orrego, Carola; Toccafondi, Giulio; Johnson, Julie K; Schoonhoven, Lisette; Wollersheim, Hub

2013-01-01

Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. To explore aspects of organizational culture to develop a deeper understanding of the discharge process. A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data. In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses. Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices. On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.

Collection performance: an empirical analysis of not-for-profit community hospitals.

Science.gov (United States)

Prince, T R; Ramanan, R

1992-01-01

Many not-for-profit community hospitals had major shifts in their annual collection performance between 1986 and 1988. The collection performance is measured by excess collection time; this is computed as the difference between the actual average collection time for a hospital and the median for one of the six panels to which the hospital is assigned based on ownership, control code, and financial reporting practices. The sample for this study has 1,246 not-for-profit hospitals comprising over 50 percent of total revenue and expenses of all community hospitals (about 5,500). More than 16 percent of these hospitals had annual changes of ten-plus days in each of the years. Excess collection time within the six panels was examined by state, payer mix (Medicare, Medicaid, and Blue Cross), membership in the Council of Teaching Hospitals, medical school affiliation, case-mix index for Medicare, contractual allowance rate, debt-service coverage, return on assets, new investments, age of property, and urban location. Major findings were that collection patterns are different among some states. The proportions of Medicare, Medicaid, and Blue Cross are negatively associated with excess collection time in three of the panels. Contractual allowance is positively related, and return on assets is negatively associated with excess collection time in two of the panels. The other factors had virtually no effect on the collection performance.

Defining the value of community benefits. Analyzing the kinds of goods society produces clarifies hospitals' charity care contribution.

Science.gov (United States)

Sanders, S M

1992-01-01

Community benefits occur when a hospital bears all or part of the relatively unquantifiable costs of promoting, sponsoring, or engaging in religious, educational, scientific, or health-related activities designed to improve community health. By the very nature of their health-related activities, not-for-profit hospitals make extensive and varied contributions to community benefit. When a hospital free clinic inoculates a child for measles, the community as a whole benefits because the inoculation reduces the chance that measles will spread. Not-for-profit hospitals also provide many goods that are "undersupplied" by the for-profit private sector or the public sector, such as research, trauma centers used disproportionately by self-pay patients, and advocacy to rid the community of health hazards. Moreover, a number of factors impose a legal and normative obligation on not-for-profit hospitals to engage in activities that benefit the community. These include Internal Revenue Service rules governing tax exemption, hospitals' fiduciary responsibilities to philanthropic donors, their obligations as "institutional actors" in their communities, and their mission to reach out to the poor and underserved.

An ecological response model for the Cache la Poudre River through Fort Collins

Science.gov (United States)

Shanahan, Jennifer; Baker, Daniel; Bledsoe, Brian P.; Poff, LeRoy; Merritt, David M.; Bestgen, Kevin R.; Auble, Gregor T.; Kondratieff, Boris C.; Stokes, John; Lorie, Mark; Sanderson, John

2014-01-01

The Poudre River Ecological Response Model (ERM) is a collaborative effort initiated by the City of Fort Collins and a team of nine river scientists to provide the City with a tool to improve its understanding of the past, present, and likely future conditions of the Cache la Poudre River ecosystem. The overall ecosystem condition is described through the measurement of key ecological indicators such as shape and character of the stream channel and banks, streamside plant communities and floodplain wetlands, aquatic vegetation and insects, and fishes, both coolwater trout and warmwater native species. The 13- mile-long study area of the Poudre River flows through Fort Collins, Colorado, and is located in an ecological transition zone between the upstream, cold-water, steep-gradient system in the Front Range of the Southern Rocky Mountains and the downstream, warm-water, low-gradient reach in the Colorado high plains.

NSU Art Museum Fort Lauderdale | Art Museum in Fort Lauderdale

Science.gov (United States)

NSU Art Museum Fort Lauderdale Visit Admissions Hours & Admission Policies & Accessibility Airports Shop & Dine About the Café & Store Store Café Menu Art Exhibitions Currently on View Thursday 2-for-1 specials on wine and craft beer in the Museum Café, and hands-on art projects for all

FORTE spacecraft vibration mitigation. Final report

International Nuclear Information System (INIS)

Maly, J.R.

1996-02-01

This report documents work that was performed by CSA Engineering, Inc., for Los Alamos National Laboratory (LANL), to reduce vibrations of the FORTE spacecraft by retrofitting damped structural components into the spacecraft structure. The technical objective of the work was reduction of response at the location of payload components when the structure is subjected to the dynamic loading associated with launch and proto-qualification testing. FORTE is a small satellite that will be placed in orbit in 1996. The structure weighs approximately 425 lb, and is roughly 80 inches high and 40 inches in diameter. It was developed and built by LANL in conjunction with Sandia National Laboratories Albuquerque for the United States Department of Energy. The FORTE primary structure was fabricated primarily with graphite epoxy, using aluminum honeycomb core material for equipment decks and solar panel substrates. Equipment decks were bonded and bolted through aluminum mounting blocks to adjoining structure

Fortælling og fortolkning i Jyske Bank

DEFF Research Database (Denmark)

Albrechtsen, Charlotte

Afhandlingen præsenterer en undersøgelse af et konkret eksempel på storytelling brugt som strategisk ledelses- og kommunikationsredskab i en organisations interne kommunikation. Eksemplet er fortællingen "Slaget ved Vejle", som stammer fra Jyske Bank og udgør under afhandlingens case. De overordn......Afhandlingen præsenterer en undersøgelse af et konkret eksempel på storytelling brugt som strategisk ledelses- og kommunikationsredskab i en organisations interne kommunikation. Eksemplet er fortællingen "Slaget ved Vejle", som stammer fra Jyske Bank og udgør under afhandlingens case. De......, at medarbejderne forholder sig reflekteret, nuanceret og kritisk til den strategiske fortælling, og at der er stor diversitet i deres oplevelser, fortolkninger og vurderinger af fortællingen. Desuden ser afhandlingen nærmere på hvad begrebet "storytelling" dækker over, og hvordan der hidtil er forsket i...

77 FR 75891 - Suspension of Community Eligibility

Science.gov (United States)

2012-12-26

... identifying the current participation status of a community can be obtained from FEMA's Community Status Book..., 1989, Reg; January 2, 2013, Susp. Fort Gay, Town of, Wayne 540202 April 29, 1975, ......do Do. County...

Creating a "culture of research" in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program.

Science.gov (United States)

Dimond, Eileen P; St Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

2015-06-01

The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute's Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to

Sustainable Benefits of a Community Hospital-Based Paediatric Asthma Clinic.

Science.gov (United States)

Kuzik, Brian A; Chen, Chee P; Hansen, Miriam J; Montgomery, Paula L

2017-01-01

In 2011, we reported that our paediatric asthma clinic (PAC) appeared to significantly reduce the burden of paediatric asthma in our community. Supported by these results, the PAC underwent a gradual threefold expansion while maintaining the same model of care. We now report on the outcome of that expansion and demonstrate that our PAC continues to significantly reduce the burden of paediatric asthma in our community. As previously, newly enrolled PAC patients continue to show a 12-month reduction in asthma-related emergency department (ED) visits and admissions exceeding 60% and 80%, respectively. This consistent short-term benefit, coupled with clinic expansion, has contributed to a significant improvement in our rate of paediatric asthma-related ED visits or hospitalizations when compared to other Ontario hospitals.

Summary and abstracts from Sudden Aspen Decline (SAD) Meeting; Fort Collins, Colorado, February 12-13, 2008

Science.gov (United States)

Paul C. Rogers

2008-01-01

In recent years the aspen research and management community has witnessed increasing accounts of unexplained aspen die-offs across the Rocky Mountain region. In response, two meetings were held to address the issue; this paper summarizes the most recent gathering, a symposium held in Fort Collins at the USDA Forest Service, Rocky Mountain Research Station, on February...

Case nine. Two hospitals struggling to survive in a small rural community.

Science.gov (United States)

Gaidos, H A

1990-01-01

St. Luke's Hospital was the only hospital in town until 26 years before the time of the case. In the late 1950s St. Luke's Hospital was overcrowded and in dire need of renovation and expansion. Plans were devised and the hospital applied for Hill-Burton money to expand. At the same time, a group of local citizens decided to also apply for Hill-Burton money to build another hospital, County Memorial, in the community. The Hill-Burton money was divided and both received money. Both facilities opened within months of each other. For about 10 to 12 years, both hospitals prospered. At the time of the case, competition has heated up between the two facilities. Attempts at collaboration fail; the story is one of wasted resources and community pain because of the lack of ability of two competitors to put aside differences for mutual benefit. The case ends with there being only one hospital in town. Read alone, the case is instructive in terms of the difficulties created when organizations value survival in a known form above all else. Read and considered in concert with Case Eight, it encourages contemplation of the pros and cons of head-on competition versus collaboration.

Undervisning mellem fortælling og feedback

DEFF Research Database (Denmark)

Andersen, Kirsten Margrethe

2016-01-01

Feedback gør det muligt for den enkelte at forstå, hvordan jeg kan blive bedre til det, jeg er ved at lære. Fortællinger gør det muligt for den enkelte at udvide horisonten og derved komme til en forståelse af, hvilke mulige perspektiver der er for at forholde sig til den verden, som fortællingen...

Planning for strategic change? A participative planning approach for community hospitals.

Science.gov (United States)

MacDonald, S K; Beange, J E; Blachford, P C

1992-01-01

Strategic planning is becoming to hospitals what business case analysis is to private corporations. In fact, this type of planning is becoming essential for the professional management of Ontario hospitals. The participative strategic planning process at Toronto East General Hospital (TEGH) is an example of how a professionally structured and implemented strategic planning process can be successfully developed and implemented in a community hospital. In this article, the environmental factors driving planning are reviewed and the critical success factors for the development and implementation of a strategic plan are examined in the context of TEGH's experience.

Communicating with the business community. A hospital launches two outreach efforts to educate community leaders.

Science.gov (United States)

Lofgren, C; Schieffer, T

1994-10-01

Several years ago the management of Saint Francis Medical Center in Peoria, IL, decided that, with healthcare issues becoming increasingly complex, the hospital needed to find ways to share information with its community. Saint Francis's outreach effort began in 1991 with the launching of a Leadership Roundtable. Under its auspices, local leaders in business, finance, government, education, religion, and the media gather once a month to hear hospital staff members outline some aspect of healthcare or healthcare reform. A question-and-answer period follows. In 1993 James Moore, a Saint Francis administrator, began writing a monthly column on healthcare reform for a business publication that serves central Illinois. Moore's column explains to businesspeople how various healthcare reform proposals could affect them. With the column, as with the Leadership Roundtable, Saint Francis has strengthened its communication with the community.

Establishing a Baseline: Community Benefit Spending by Not-for-Profit Hospitals Prior to Implementation of the Affordable Care Act.

Science.gov (United States)

Leider, Jonathon P; Tung, Greg J; Lindrooth, Richard C; Johnson, Emily K; Hardy, Rose; Castrucci, Brian C

Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This has occurred mostly through charity care. This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending. Data were collected in 2015 and analyzed in 2015 and 2016. Data were matched at the facility level for a non-profit hospital's IRS tax filings (Form 990, Schedule H) and CMS Hospital Cost Report Information System and Provider of Service data sets. During 2009, hospitals spent about 8% of total operating expenses on Community Benefit. This increased to between 8.3% and 8.5% in 2012. The majority of spending (>80%) went toward charity care, unreimbursed Medicaid, and subsidized health services, with approximately 6% going toward both community health improvement and health professionals' education. By 2012, national spending on Community Benefit likely exceeded $60 billion. The largest hospital systems spent the vast majority of the nation's Community Benefit; the top 25% of systems spent more than 80 cents of every Community Benefit dollar. Community Benefit spending has remained relatively steady as a proportion of total operating expenses and so has increased over time-although charity care remains the major focus of Community Benefit spending overall. More than $60 billion was spent on Community Benefit prior to implementation of the ACA. New reporting and spending requirements from the IRS, alongside changes by the ACA, are changing incentives for hospitals in how they spend Community Benefit dollars. In the short term, and especially the long term, hospital systems would do well to partner with public health, other social services, and even

The community impact of consolidating long-term inpatient care at a single state hospital.

Science.gov (United States)

Wolff, N

2000-06-01

A community impact model was used to estimate how consolidation of all long-term inpatient care at one state mental hospital affected the town in which the hospital was located. Qualitative and quantitative methods were used to measure objective and subjective impacts of the hospital's expanded role. Objective impacts included employment, retail sales, and use of local services such as police, welfare, and education. Subjective impacts included residents' perceptions of safety. Data were obtained from hospital records, service providers, merchants, residents, and persons living on the streets or in shelters. Overall, the policy had a positive net impact on the community, estimated at roughly $4 million during the 18 months after implementation. Nearly $1 million was a direct payment from the state in lieu of taxes for the property occupied by the hospital. The hospital's payments to businesses in the town increased 10 percent. The number of hospital employees increased by 61 percent, to 1,336. The number of local residents working in the hospital grew from 200 to 320, and the proportion of the hospital's annual payroll paid to local residents increased from 14 to 24 percent. Local service use did not increase, and no change was noted in the crime rate. More patients were discharged to other towns than were admitted from the host town. Eighty percent of the residents surveyed said the town had either improved or had not changed. The benefits brought by the consolidation are likely to be sustained in the long run if the state continues the current rate of payments to the community and the hospital continues its policy of discharging patients to the town where they resided before hospitalization.

Prevalence of Methicillin Resistant Staphylococcus aureus in pyogenic community and hospital acquired skin and soft tissues infections

International Nuclear Information System (INIS)

Ahmad, M. K.; Asrar, A.

2014-01-01

Objective: To determine the percentage and frequency of Methicillin Resistant Staphylococcus aureus in community and hospital-acquired pyogenic skin and soft tissue infections. Methods: The descriptive cross-sectional study was conducted at the Dermatology Department of Combined Military Hospital, Abbottabad, from June 2009 to March 2010, and comprised 144 community-acquired and 54 hospital-acquired skin and soft tissue infections. Pus swabs from the infected lesions one from each individual were sent to laboratory for culture and sensitivity tests. Methicillin resistance was detected by 1 (mu) g oxacillin disk. Organisms were labelled methicillin-resistant once the inhibition zone for oxocillin was less than 10 mm. Data analysis was done by using SPSS 20. Results: Of the 198 patients in the study, 98(49.5%) were males and 100(50.5%) were females, with an overall mean age of 33.7+-14.8144 years. There were 144(72.72%) community-acquired infections and 54(27.27%) had hospital-acquired infections. Community-acquired Methicillin Resistant Staphylococcus aureus numbered 40(27.8%) and hospital-acquired ones numbered 26(48.1%). Conclusion: Prevalence of Methicillin Resistant Staphylococcus aureus in community and hospital-acquired pyogenic skin and soft tissue infections was high. (author)

Radiological incident preparedness for community hospitals: a demonstration project.

Science.gov (United States)

Jafari, Mary Ellen

2010-08-01

In November 2007, the Wisconsin Division of Public Health Hospital Disaster Preparedness Program State Expert Panel on Radiation Emergencies issued a report titled The Management of Patients in a Radiological Incident. Gundersen Lutheran Health System was selected to conduct a demonstration project to implement the recommendations in that report. A comprehensive radiological incident response plan was developed and implemented in the hospital's Trauma and Emergency Center, including the purchase and installation of radiation detection and identification equipment, staff education and training, a tabletop exercise, and three mock incident test exercises. The project demonstrated that the State Expert Panel report provides a flexible template that can be implemented at community hospitals using existing staff for an approximate cost of $25,000.

The clinical spectrum and antibiotic sensitivity patterns of staphylococcal pyodermas in the community and hospital

Directory of Open Access Journals (Sweden)

Shireen Furtado

2014-01-01

Full Text Available Context: The uncontrolled use of antibiotics has resulted in a relentless spread of multiresistant strains of Staphylococcus aureus. There are studies conducted in medical colleges in Chandigarh, Chennai, Mumbai and Vellore comparing pyodermas in the community and hospital setting based on clinical and bacteriological parameters. Aims: This study, conducted over 1½ years from March 2009 to August 2010, aimed at analyzing the clinical spectrum and antibiotic sensitivity pattern of community and hospital-associated (HA staphylococcal pyoderma. It also assessed the prevalence of methicillin-resistant S. aureus (MRSA in the community and hospital cohort settings. Subjects and Methods: The study comprised of 200 cases of staphylococcal pyodermas, derived from the community (150 cases and hospital (50 cases. Patients were evaluated based on their clinical presentation; antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method. Statistical Analysis Used: Statistical significance between individual attributes between the community and HA staphylococcal pyoderma groups was analyzed using Chi-square test and mean differences using student′s t-test. Results: Factors associated with community-associated (CA pyodermas were young age (P = 0.0021, primary pyodermas, and involvement of extremities, while those with HA pyodermas were middle age, secondary pyodermas, and significantly increased body surface involvement (P = 0.041. Incidence of CA-MRSA was 11.3%, while that of HA-MRSA was 18%. Conclusions: A high level of resistance to first-line drugs such as penicillin, ciprofloxacin and cotrimoxazole was observed, more so in the hospital strain than in the community strain. S. aureus demonstrated good susceptibility to cephalosporins. Though the two strains of MRSA differed clinically, they showed 100% sensitivity to vancomycin and linezolid.

Fort Cochin in Kerala 1750-1830 : the social condition of a Dutch community in an Indian milieu

NARCIS (Netherlands)

Singh, Anjana

2007-01-01

Focussing on individuals and institutions, the economic and social condition of the people of Fort Cochin between 1781 and 1830 has been studied. This study of the Dutch East India Company's (VOC) establishment on the south west coast of India provides a detailed research into the functioning of the

Structural remains at the early mediaeval fort at Raibania, Orissa

Directory of Open Access Journals (Sweden)

Bratati Sen

2013-11-01

Full Text Available The fortifications of mediaeval India occupy an eminent position in the history of military architecture. The present paper deals with the preliminary study of the structural remains at the early mediaeval fort at Raibania in the district of Balasore in Orissa. The fort was built of stone very loosely kept together. The three-walled fortification interspersed by two consecutive moats, a feature evidenced at Raibania, which is unparallel in the history of ancient and mediaeval forts and fortifications in India. Several other structures like the Jay-Chandi Temple Complex, a huge well, numerous tanks and remains of an ancient bridge add to the uniqueness of the Fort in the entire eastern region.

Statin Use and Hospital Length of Stay Among Adults Hospitalized With Community-acquired Pneumonia.

Science.gov (United States)

Havers, Fiona; Bramley, Anna M; Finelli, Lyn; Reed, Carrie; Self, Wesley H; Trabue, Christopher; Fakhran, Sherene; Balk, Robert; Courtney, D Mark; Girard, Timothy D; Anderson, Evan J; Grijalva, Carlos G; Edwards, Kathryn M; Wunderink, Richard G; Jain, Seema

2016-06-15

Prior retrospective studies suggest that statins may benefit patients with community-acquired pneumonia (CAP) due to antiinflammatory and immunomodulatory effects. However, prospective studies of the impact of statins on CAP outcomes are needed. We determined whether statin use was associated with improved outcomes in adults hospitalized with CAP. Adults aged ≥18 years hospitalized with CAP were prospectively enrolled at 3 hospitals in Chicago, Illinois, and 2 hospitals in Nashville, Tennessee, from January 2010-June 2012. Adults receiving statins before and throughout hospitalization (statin users) were compared with those who did not receive statins (nonusers). Proportional subdistribution hazards models were used to examine the association between statin use and hospital length of stay (LOS). In-hospital mortality was a secondary outcome. We also compared groups matched on propensity score. Of 2016 adults enrolled, 483 (24%) were statin users; 1533 (76%) were nonusers. Statin users were significantly older, had more comorbidities, had more years of education, and were more likely to have health insurance than nonusers. Multivariable regression demonstrated that statin users and nonusers had similar LOS (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], .88-1.12), as did those in the propensity-matched groups (HR, 1.03; 95% CI, .88-1.21). No significant associations were found between statin use and LOS or in-hospital mortality, even when stratified by pneumonia severity. In a large prospective study of adults hospitalized with CAP, we found no evidence to suggest that statin use before and during hospitalization improved LOS or in-hospital mortality. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Mycoplasma Pneumoniae among Children Hospitalized with Community-acquired Pneumonia.

Science.gov (United States)

Kutty, Preeta K; Jain, Seema; Taylor, Thomas H; Bramley, Anna M; Diaz, Maureen H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Edwards, Kathryn M; McCullers, Jonathan A; Pavia, Andrew T; Winchell, Jonas M; Schrag, Stephanie J; Hicks, Lauri A

2018-05-17

The burden and epidemiology of Mycoplasma pneumoniae (Mp) among U.S. children (<18 years) hospitalized with community-acquired pneumonia (CAP) are poorly understood. In the Etiology of Pneumonia in the Community (EPIC) study, we prospectively enrolled 2254 children hospitalized with radiographically-confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp-PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. In the EPIC study, 182(8%) children were Mp-PCR-positive (median age: 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 6/169(4%) isolates. Of 178(98%) Mp-PCR-positive children tested for co-pathogens, 50(28%) had ≥1 co-pathogen detected. Variables significantly associated with higher odds of Mp detection included age {10-17 years [adjusted odds ratio (aOR): 7.9 (95% confidence interval (CI): 4.5-13.6)] and 5-9 years [aOR: 4.8 (CI: 2.9-7.8)] vs. 2-4 years}, outpatient antibiotics ≤5 days pre-admission [aOR: 2.3 (CI: 1.5-3.4)], and co-pathogen detection [aOR: 2.1 (CI: 1.3-3.1)]. Clinical characteristics often seen included hilar lymphadenopathy, rales, headache, sore throat, and decreased breath sounds. Usually considered as a mild respiratory infection, M. pneumoniae was the most commonly detected bacteria among children ≥5 years hospitalized with CAP; one-quarter of whom had co-detections. Although associated with clinically non-specific symptoms, there was a need for intensive care support in some cases. M. pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.

Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia

Science.gov (United States)

Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.

2010-01-01

Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

Le Fort I Maxillary Advancement Using Distraction Osteogenesis

Science.gov (United States)

Combs, Patrick D.; Harshbarger, Raymond J.

2014-01-01

Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hypoplasia in cleft, syndromic, and noncleft patients. In this article, the authors provide a review of current data and recommendations concerning Le Fort I advancement with distraction osteogenesis. In addition, they outline their technique for treating severe maxillary hypoplasia with distraction osteogenesis using internal devices. PMID:25383054

Treatment of hyperthyroidism in community hospital

International Nuclear Information System (INIS)

Gossain, V.V.; Heath, R.C.; Rovner, D.R.

1989-01-01

The preferred treatment of hyperthyroidism remains controversial. Most of this data is derived from large, university-based medical centers. We report here our experience with treatment of hyperthyroidism in a community setting. This involves 144 patients with hyperthyroidism who were seen over a 10 year period at Michigan State University Clinical Center and were treated in the community hospitals and private physicians' offices, and by community surgeons. Follow-up data were available on 119 of these patients; 105 of them were hyperthyroid because of Graves' disease and multinodular goiter. Patients were encouraged to make their own decisions regarding choice of therapy, as independently as possible. Sixty-five percent of these patients were treated by 131I, 18% by antithyroid drugs, and 17% by surgery. The mean follow-up period was 2.5 years (range 2 months to 19 years). Hyperthyroidism was controlled in 84% of the patients treated by 131I and 83% of the patients treated by surgery. Forty percent of the patients treated by 131I and 33% treated by surgery became hypothyroid. Fifty percent of the patients achieved remission when treated by antithyroid drugs alone. Our results indicate that when patients are encouraged to make their own decisions regarding the treatment of hyperthyroidism, their choices are similar to those of the thyroidologists. Secondly, the results obtained with different modalities of treatment for hyperthyroidism in a community setting are similar to those obtained in university medical centers

Case Study: Fort Mill High School--A Culture of Continuous Improvement

Science.gov (United States)

Southern Regional Education Board (SREB), 2014

2014-01-01

This is the latest in a series of case studies highlighting best practices High Schools That Work (HSTW) network schools and districts are implementing to prepare students better for further studies and careers. Fort Mill High School is in Fort Mill, South Carolina, an outlying suburb of Charlotte, North Carolina. Fort Mill links high quality…

Hydrologic Analysis of Fort Leonard Wood, Missouri

Science.gov (United States)

2015-08-01

drainage areas are different, hydrological analysis will be conducted on the two basins individually. The results of the two analyses will be combined to...ER D C TR -1 5- 4 Environmental Quality and Installations Hydrologic Analysis of Fort Leonard Wood, Missouri En gi ne er R es ea rc h...Environmental Quality and Installations ERDC TR-15-4 August 2015 Hydrologic Analysis of Fort Leonard Wood, Missouri Michael L. Follum, Darla C. McVan

Fortællerfiktionen

DEFF Research Database (Denmark)

Reitan, Rolf

Bogen er en kritisk nærlæsning af Gérard Genettes Discours du récit og viser, hvorden den franske teoretiker løser og forenkler en række centrale problemer i traditionel fortælleteori, idet han uudtalt forudsætter et fiktionsbegreb, som han eksplicit afviser som narratologisk relevant. Det...

Fort Valley's early scientists: A legacy of distinction

Science.gov (United States)

Andrew J. Sanchez Meador; Susan D. Olberding

2008-01-01

When the Riordan brothers of Flagstaff, Arizona, asked Gifford Pinchot to determine why there was a deficit in ponderosa pine seedlings, neither party understood the historical significance of what they were setting in motion for the field of forest research. The direct result of that professional favor was the establishment of the Fort Valley Experiment Station (Fort...

The changing roles of pharmacists in hospital and community ...

African Journals Online (AJOL)

Dr Patrick O Erah

Available online at http://www.tjpr.freehosting.net. Editorial. The changing roles of pharmacists in hospital and community pharmacy practice in Nigeria. The profession and practice of pharmacy did not start in Nigeria as a well defined health care area of specialization as it is today. Rather, pharmaceutical training was borne.

Neutron flux distribution measurement in the Fort St. Vrain initial core (results of Fort St. Vrain start-up test A-7)

International Nuclear Information System (INIS)

Marshall, A.C.; Brown, J.R.

1975-01-01

A description is given of a test to measure the axial flux distribution at several radial locations in the Fort St. Vrain core representing unrodded, rodded, and partially rodded regions. The measurements were intended to verify the calculational accuracy of the three-dimensional calculational model used to compute axial power distributions for the Fort St. Vrain core. (U.S.)

Community Hospitals Indianapolis creates breast cancer awareness. The hospital joins a partnership with local ABC affiliate.

Science.gov (United States)

Herreria, J

1999-01-01

Community Hospitals Indianapolis raises the public's awareness of the importance of breast self-examination and mammography as the best tools for early detection of breast cancer. The health system has designed a program called Buddy Check 6 to partner with a local television station.

Severity and frequency of community-onset Clostridium difficile infection on an Australian tertiary referral hospital campus.

Science.gov (United States)

Clohessy, Penny; Merif, Juan; Post, Jeffrey John

2014-12-01

Clostridium difficile infection (CDI) is increasingly being found in populations without traditional risk factors. We compared the relative frequency, risk factors, severity, and outcomes of community-onset CDI with hospital-acquired infection. This was a retrospective, observational study of CDI at a tertiary hospital campus in Sydney, Australia. Patients aged 15 years and older with a first episode of CDI from January 1 to December 31, 2011 were included. CDI was defined as the presence of diarrhoea with a positive enzyme immunoassay in conjunction with a positive cell cytotoxicity assay, toxin culture, or organism culture. Main outcome measures were onset of infection (hospital or community), risk factors, markers of severity, and outcomes for the two groups. One hundred and twenty-nine cases of CDI infection were identified, of which 38 (29%) were community-onset. The community-onset infection group were less likely to have a recent history of antibiotic use (66% vs. 98%; pinfection group. Markers of severity and outcomes were similar in the two groups, with an overall mortality of 9%. Community-onset CDI accounts for a large proportion of C. difficile infections and has a similar potential for severe disease as hospital-acquired infection. Using a history of previous antibiotic use, proton pump inhibitor use, or recent hospitalization to predict cases is unreliable. We recommend that patients with diarrhoea being investigated in emergency departments and community practice are tested for Clostridium difficile infection. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults.

Science.gov (United States)

Salanitro, Amanda H; Hovater, Martha; Hearld, Kristine R; Roth, David L; Sawyer, Patricia; Locher, Julie L; Bodner, Eric; Brown, Cynthia J; Allman, Richard M; Ritchie, Christine S

2012-09-01

To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. Prospective, observational study with a baseline in-home assessment of symptom burden. Central Alabama. Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Molecular and phenotypic characteristics of healthcare- and community-associated methicillin-resistant Staphylococcus aureus at a rural hospital.

Directory of Open Access Journals (Sweden)

Amy E Peterson

Full Text Available BACKGROUND: While methicillin-resistant Staphylococcus aureus (MRSA originally was associated with healthcare, distinct strains later emerged in patients with no prior hospital contact. The epidemiology of MRSA continues to evolve. METHODS: To characterize the current epidemiology of MRSA-colonized patients entering a hospital serving both rural and urban communities, we interviewed patients with MRSA-positive admission nasal swabs between August 2009 and March 2010. We applied hospitalization risk factor, antimicrobial resistance phenotype, and multi-locus sequence genotype (MLST classification schemes to 94 case-patients. RESULTS: By MLST analysis, we identified 15 strains with two dominant clonal complexes (CCs-CC5 (51 isolates, historically associated with hospitals, and CC8 (27 isolates, historically of community origin. Among patients with CC5 isolates, 43% reported no history of hospitalization within the past six months; for CC8, 67% reported the same. Classification by hospitalization risk factor did not correlate strongly with genotypic classification. Sensitivity of isolates to ciprofloxacin, clindamycin, or amikacin was associated with the CC8 genotype; however, among CC8 strains, 59% were resistant to ciprofloxacin, 15% to clindamycin, and 15% to amikacin. CONCLUSIONS: Hospitalization history was not a strong surrogate for the CC5 genotype. Conversely, patients with a history of hospitalization were identified with the CC8 genotype. Although ciprofloxacin, clindamycin, and amikacin susceptibility distinguished CC8 strains, the high prevalence of ciprofloxacin resistance limited its predictive value. As CC8 strains become established in healthcare settings and CC5 strains disseminate into the community, community-associated MRSA definitions based on case-patient hospitalization history may prove less valuable in tracking community MRSA strains.

Anatomy of the Le Fort I segment: Are arterial variations a potential risk factor for avascular bone necrosis in Le Fort I osteotomies?

Science.gov (United States)

Bruneder, Simon; Wallner, Jürgen; Weiglein, Andreas; Kmečová, Ĺudmila; Egger, Jan; Pilsl, Ulrike; Zemann, Wolfgang

2018-05-02

Osteotomies of the Le Fort I segment are routine operations with low complication rates. Ischemic complications are rare, but can have severe consequences that may lead to avascular bone necrosis of the Le Fort I segment. Therefore the aim of this study was to investigate the blood supply and special arterial variants of the Le Fort I segment responsible for arterial hypoperfusion or ischemic avascular necrosis after surgery. The arterial anatomy of the Le Fort I segment's blood supply using 30 halved human cadaver head specimens was analyzed after complete dissection until the submicroscopic level. In all specimens the arterial variants of the Le Fort I segment and also the arterial diameters measured at two points were evaluated. The typical known vascularization pattern was apparent in 90% of all specimens, in which the ascending palatine (D1: 1,2 mm ± 0,34 mm; D2: 0,8 mm ± 0,34 mm) and ascending pharyngeal artery (D1: 1,3 mm ± 0,58 mm; D2: avascular segment necrosis after surgery. An individualized operation plan may prevent ischemic complications in at-risk patients. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

78 FR 17087 - Special Local Regulation; New River Raft Race, New River; Fort Lauderdale, FL

Science.gov (United States)

2013-03-20

...-AA08 Special Local Regulation; New River Raft Race, New River; Fort Lauderdale, FL AGENCY: Coast Guard... on the New River in Fort Lauderdale, Florida during the Rotary Club of Fort Lauderdale New River Raft... States during the Rotary Club of Fort Lauderdale New River Raft Race. On March 23, 2013, Fort Lauderdale...

Linking up with the community: a fertile strategy for a university hospital?

Directory of Open Access Journals (Sweden)

Thomas Plochg

2006-02-01

Full Text Available Purpose: To systematically identify, describe and characterise the collaborative initiatives, which have been established between the Academic Medical Centre/University of Amsterdam and local health care providers in the adjacent community. Background: The viability of university hospitals is jeopardised. Their narrowed orientation on delivering the most advanced services to the sickest patients challenges their missions in patient care, science and education. By linking up with local health care providers, university hospitals create synergistic relationships that should secure these three academic missions for the future. Methods: We conducted a multiple case study in two stages. Initially, division leaders and the director of integrated care were consulted to identify all existing collaborative initiatives of the Academic Medical Centre. Successively, face-to-face interviews were held with the leaders of these initiatives. During these interviews data were primarily collected through a questionnaire. Notes of the interviewer, and documents (if available were also collected. The analysis focused on systematically describing and characterising the initiatives using the concept of ‘community-based integrated care’. Results: Twenty-seven heterogeneous initiatives were identified. Half of these initiatives are targeted to the adjacent community of the Academic Medical Centre, but only four of them are initiated on the basis of community information and involve the community and/or patients. Furthermore, the extent of integration differed per dimension. Functional integration within the initiatives has been relatively low, clinical integration mixed, and professional integration quite advanced. Conclusions: The results indicate that a considerable number of collaborative initiatives have emerged. Still, these initiatives are loosely ‘community-based’ and hardly focus on the full integration of care services. This suggests that the community

40 CFR 81.63 - Metropolitan Fort Smith Interstate Air Quality Control Region.

Science.gov (United States)

2010-07-01

... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Metropolitan Fort Smith Interstate Air... Air Quality Control Regions § 81.63 Metropolitan Fort Smith Interstate Air Quality Control Region. The Metropolitan Fort Smith Interstate Air Quality Control Region (Arkansas-Oklahoma) has been revised to consist...

Hospital Resource Utilisation by Patients with Community-Acquired Pneumonia

LENUS (Irish Health Repository)

McCarthy, S

2017-09-01

Little data is available on the resource utilisation of patients admitted with Community-Acquired Pneumonia (CAP) in Ireland. A retrospective review of 50 randomly-selected patients admitted to Beaumont Hospital with CAP was undertaken. The mean length of stay of patients with CAP was 12 days (+\\/- 16 days). All patients were emergency admissions, all had a chest x-ray, a C-reactive protein blood test, and occupied a public bed at some point during admission. Common antimicrobial therapies were intravenous (IV) amoxicillin\\/clavulanic acid and oral clarithromycin; 60% received physiotherapy. The estimated mean cost of CAP per patient was €14,802.17. Costs arising from admission to hospital with CAP are substantial, but efforts can be undertaken to ensure that resources are used efficiently to improve patient care such as discharge planning and fewer in-hospital ward transfers

The Fort McMurray Demonstration Project in social marketing: health- and safety-related behaviour among oil sands workers.

Science.gov (United States)

Guidotti, T L; Watson, L; Wheeler, M; Jhangri, G S

1996-08-01

This is the first round in a series of surveys conducted in Fort McMurray as part of the Fort McMurray Demonstration Project in social marketing. This component of the survey was intended to focus on the most prominent group of employed workers in the community and to compare their patterns of response with the community as a whole. Respondents to the survey were overwhelmingly male (96%), married (72.9%) and living in households of two to five persons (87.9%). They were predominantly aged 30-44 (55%) and graduates of high school (53.5%). Younger male workers (below age 30) were more likely to have a high school diploma (78.3%) or some additional technical or vocational training (21.7% compared to 12.5% overall) and to be unmarried or separated. Attitudes toward safety-related behaviours were stronger than for respondents from the community as a whole. Approximately 70-100% of all age groups and both sexes showed strong agreement with attitudes involving child car seats and the unacceptability of drinking and driving. These attitudes include strong advocacy of vigorous enforcement of occupational health and safety standards. However, they showed a variability similar to the community as a whole in behaviour at home compared to work, generally reporting more consistent use of personal protection on the job than in their own homes, particularly hearing protection. Even so, they were much less likely to perform stretching and warm-up exercises prior to exertion than community residents in general. The potential may exist to transfer the technology and attitudes from workplace health and safety to community safety. One possible strategy to accomplish this is to involve workers in this industry directly in community initiatives. This strategy may be generalizable to any community in which there are major employers who place a heavy emphasis on risk control and occupational health and safety.

Enterobacteriaceae Antibiotic Resistance in Ready-to-Eat Foods Collected from Hospital and Community Canteens: Analysis of Prevalence.

Science.gov (United States)

Vincenti, Sara; Raponi, Matteo; Sezzatini, Romina; Giubbini, Gabriele; Laurenti, Patrizia

2018-03-01

Foodborne diseases and antibiotic resistance are serious widespread health problems in the contemporary world. In this study, we compared the microbiological quality of ready-to-eat (RTE) foods found in community canteens versus hospital canteens in Rome, Italy, focusing on detection and quantification of Enterobacteriaceae and the antibiotic resistance of these bacteria. Our findings show a remarkable difference in Enterobacteriaceae contamination between RTE foods distributed in community canteens (33.5% of samples) and those distributed in hospital canteens (5.3% of samples). This result highlights greater attention to good manufacturing practices and good hygiene practices by the food operators in hospitals compared with food operators in community canteens. As expected, a higher percentage of cold food samples (70.9%) than of hot food samples (10.8%) were positive for these bacteria. Excluding the intrinsic resistance of each bacterial strain, 92.3% of the isolated strains were resistant to at least one antibiotic, and about half of the isolated strains were classified as multidrug resistant. The prevalence of multidrug-resistant strains was 50% in the community samples and 33.3% in hospital canteens. Our results indicate that approximately 38% of RTE foods provided in community canteens is not compliant with microbiological food safety criteria and could be a special risk for consumers through spread of antibiotic-resistant strains. Hygienic processing and handling of foods is necessary for both hospital and community canteens.

Fort St. Vrain circulator operating experience

International Nuclear Information System (INIS)

Brey, H.L.

1988-01-01

Fort St. Vrain, on the system of Public Service Company of Colorado, is the only high-temperature gas-cooled power reactor in the United States. Four helium circulators are utilized in this plant to transfer heat from the reactor to the steam generators. These unique machines have a single stage axial flow helium compressor driven by a single stage steam turbine. A single stage water driven (pelton wheel) turbine is the back-up drive utilizing either feed water, condensate, or fire water as the driving fluid. Developmental testing of the circulators was accomplished prior to installation into Fort St. Vrain. A combined machine operating history of approximately 250,000 hours has shown these machines to be of conservative design and proven mechanical integrity. However, many problems have been encountered in operating the complex auxiliaries which are necessary for successful circulator and plant operation. It has been 15 years since initial installation of the circulators occurred at Fort St. Vrain. During this time, a number of significant issues had to be resolved dealing specifically with machine performance. These events include cavitation damage of the pelton wheels during the initial plant hot functional testing, cracks in the water turbine buckets and cervic coupling, static shutdown seal bellows failure, and, most recently, degradation of components within the steam drive assembly. Unreliable operation particularly with the circulator auxiliaries has been a focus of attention by Public Service Company of Colorado. Actions to replace or significantly modify the existing circulators and their auxiliaries are currently awaiting decisions concerning the long-term future of the Fort St. Vrain plant. (author). 10 refs, 7 figs, 2 tabs

Fort St. Vrain circulator operating experience

Energy Technology Data Exchange (ETDEWEB)

Brey, H. L.

1988-08-15

Fort St. Vrain, on the system of Public Service Company of Colorado, is the only high-temperature gas-cooled power reactor in the United States. Four helium circulators are utilized in this plant to transfer heat from the reactor to the steam generators. These unique machines have a single stage axial flow helium compressor driven by a single stage steam turbine. A single stage water driven (pelton wheel) turbine is the back-up drive utilizing either feed water, condensate, or fire water as the driving fluid. Developmental testing of the circulators was accomplished prior to installation into Fort St. Vrain. A combined machine operating history of approximately 250,000 hours has shown these machines to be of conservative design and proven mechanical integrity. However, many problems have been encountered in operating the complex auxiliaries which are necessary for successful circulator and plant operation. It has been 15 years since initial installation of the circulators occurred at Fort St. Vrain. During this time, a number of significant issues had to be resolved dealing specifically with machine performance. These events include cavitation damage of the pelton wheels during the initial plant hot functional testing, cracks in the water turbine buckets and cervic coupling, static shutdown seal bellows failure, and, most recently, degradation of components within the steam drive assembly. Unreliable operation particularly with the circulator auxiliaries has been a focus of attention by Public Service Company of Colorado. Actions to replace or significantly modify the existing circulators and their auxiliaries are currently awaiting decisions concerning the long-term future of the Fort St. Vrain plant. (author). 10 refs, 7 figs, 2 tabs.

Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.

Directory of Open Access Journals (Sweden)

Taro Takeshima

Full Text Available (1 To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER of community hospitals, and (2 to test the validity of that rule with a separate, independent set of data.Multicenter retrospective cohort study.To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation. We tested the rule using data from one other community hospital (validation, which was not among the three "derivation" hospitals.Adults (age ≥ 16 years old who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients, and for the validation data n = 467 (from 823 patients.We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score. Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC were computed.There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation and 0.74 (validation. For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively.The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.

[Integration of district psychiatric hospitals into the development of regional community psychiatry networks--the actual state. Results of a survey among medical directors of Bavarian district hospitals].

Science.gov (United States)

Welschehold, Michael; Kraus, Eva

2004-11-01

In this study, the medical directors of all Bavarian district psychiatric hospitals evaluated certain aspects of the integration of their hospitals into the development of regional community psychiatry networks ("Gemeindepsychiatrische Verbunde" - GPVs). They were asked to rate the actual quantity of cooperation between their hospitals and diverse community based services and to express their requests concerning the quality of cooperation. An estimation of possible advantages of the hospitals' integration in GPVs and expectations to future perspectives of GPV development were also investigated. The data were collected by a written questionnaire. The results of the survey indicate that a high relevance is attached to GPV: inspite of current heterogenous developments and inspite of existing skepticism concerning the feasibility of a complete GPV structure, medical directors strongly approve of seeing their hospitals actively engaged in the further development of community psychiatry networks.

How Do Le Fort-Type Fractures Present in a Pediatric Cohort?

Science.gov (United States)

Macmillan, Alexandra; Lopez, Joseph; Luck, J D; Faateh, Muhammad; Manson, Paul; Dorafshar, Amir H

2018-05-01

Le Fort-type fractures are very rare in children, and there is a paucity of literature presenting their frequency and characteristics. The purpose of this study was to determine the etiology, frequency, and fracture patterns of children with severe facial trauma associated with pterygoid plate fractures in a pediatric cohort. We performed a retrospective cohort study of all children aged younger than 16 years with pterygoid plate and facial fractures who presented to our institute between 1990 and 2010. Patient charts and radiologic records were reviewed for demographic and fracture characteristics. Patients were categorized into 2 groups as per facial fracture pattern: non-Le Fort-type fractures (group A) and Le Fort-type fractures (group B). Other variables including dentition age, frontal sinus development, mechanism of injury, injury severity, and concomitant injuries were recorded. Univariate methods were used to compare groups. We identified 24 children; 25% were girls, and 20.8% were of nonwhite race. Most presented with Le Fort-type fracture patterns (group B, 66.7%). Age was significantly different between group A and group B (mean, 5.9 years and 9.9 years, respectively; P = .009). No significant differences in Injury Severity Score, rate of operative repair, and length of stay were found between groups. Most children with severe facial fractures and pterygoid plate fractures presented with Le Fort-type fracture patterns in our cohort. The mean age of children with Le Fort-type fractures was greater than in those with non-Le Fort-type patterns. However, Le Fort-type fractures did occur in younger children with deciduous and mixed dentition. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Collective response to public health emergencies and large-scale disasters: putting hospitals at the core of community resilience.

Science.gov (United States)

Paturas, James L; Smith, Deborah; Smith, Stewart; Albanese, Joseph

2010-07-01

Healthcare organisations are a critical part of a community's resilience and play a prominent role as the backbone of medical response to natural and manmade disasters. The importance of healthcare organisations, in particular hospitals, to remain operational extends beyond the necessity to sustain uninterrupted medical services for the community, in the aftermath of a large-scale disaster. Hospitals are viewed as safe havens where affected individuals go for shelter, food, water and psychosocial assistance, as well as to obtain information about missing family members or learn of impending dangers related to the incident. The ability of hospitals to respond effectively to high-consequence incidents producing a massive arrival of patients that disrupt daily operations requires surge capacity and capability. The activation of hospital emergency support functions provides an approach by which hospitals manage a short-term shortfall of hospital personnel through the reallocation of hospital employees, thereby obviating the reliance on external qualified volunteers for surge capacity and capability. Recent revisions to the Joint Commission's hospital emergency preparedness standard have impelled healthcare facilities to participate actively in community-wide planning, rather than confining planning exclusively to a single healthcare facility, in order to harmonise disaster management strategies and effectively coordinate the allocation of community resources and expertise across all local response agencies.

Obstetric referrals from a rural clinic to a community hospital in Honduras.

Science.gov (United States)

Josyula, Srirama; Taylor, Kathryn K; Murphy, Blair M; Rodas, Dairamise; Kamath-Rayne, Beena D

2015-11-01

referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas. Copyright © 2015 Elsevier Ltd. All rights reserved.

Challenges in the delivery of nutrition services to hospital discharged older adults: the community connections demonstration project.

Science.gov (United States)

Sahyoun, Nadine R; Akobundu, Ucheoma; Coray, Kevin; Netterville, Linda

2009-04-01

The objective of this project was to explore the effort necessary to transform the Older Americans Act Nutrition Program (OAANP) into core programs within an integrated health care delivery system that serves hospital-discharged older adults in order to assist them in reintegrating into the community. Six OAANPs in six states were funded and provided technical assistance to develop coalitions with hospitals and community organizations. Each demonstration site was unique and faced many challenges in reaching out to a hospitalized vulnerable population. This project also provided opportunities to try out new initiatives and examine their sustainability within the community.

Developing leadership practices in hospital-based nurse educators in an online learning community.

Science.gov (United States)

Stutsky, Brenda J; Spence Laschinger, Heather K

2014-01-01

Hospital-based nurse educators are in a prime position to mentor future nurse leaders; however, they need to first develop their own leadership practices. The goal was to establish a learning community where hospital-based nurse educators could develop their own nursing leadership practices within an online environment that included teaching, cognitive, and social presence. Using a pretest/posttest-only nonexperimental design, 35 nurse educators from three Canadian provinces engaged in a 12-week online learning community via a wiki where they learned about exemplary leadership practices and then shared stories about their own leadership practices. Nurse educators significantly increased their own perceived leadership practices after participation in the online community, and teaching, cognitive, and social presence was determined to be present in the online community. It was concluded that leadership development can be enhanced in an online learning community using a structured curriculum, multimedia presentations, and the sharing and analysis of leadership stories. Educators who participated should now be better equipped to role model exemplary leadership practices and mentor our nurse leaders of the future.

Le Fort I Maxillary Advancement Using Distraction Osteogenesis

OpenAIRE

Combs, Patrick D.; Harshbarger, Raymond J.

2014-01-01

Treatment of maxillary hypoplasia has traditionally involved conventional Le Fort I osteotomies and advancement. Advancements of greater than 10 mm risk significant relapse. This risk is greater in the cleft lip and palate population, whose anatomy and soft tissue scarring from prior procedures contributes to instability of conventional maxillary advancement. Le Fort I advancement with distraction osteogenesis has emerged as viable, stable treatment modality correction of severe maxillary hyp...

An aerial radiological survey of the Fort Calhoun Nuclear Power Plant and surrounding area, Fort Calhoun, Nebraska

International Nuclear Information System (INIS)

1994-05-01

An aerial radiological survey was conducted over the Fort Calhoun Nuclear Power Plant in Fort Calhoun, Nebraska, during the period June 19 through June 28, 1993. The survey was conducted at an altitude of 150 feet (46 meters) over a 25-square-mile (65-square-kilometer) area centered on the power station. The purpose of the survey was to document the terrestrial gamma radiation environment of the Fort Calhoun Nuclear Power Plant and surrounding area. The results of the aerial survey are reported as inferred gamma radiation exposure rates at 1 meter above ground level in the form of a contour map. Outside the plant boundary, exposure rates were found to vary between 6 and 12 microroentgens per hour and were attributed to naturally-occurring uranium, thorium, and potassium. The aerial data were compared to ground-based benchmark exposure rate measurements and radionuclide assays of soil samples obtained within the survey boundary. The ground-based measurements were found to be in good agreement with those inferred from the aerial measuring system. A previous survey was conducted on August 9 and 10, 1972, before the plant began operation. Exposure rates measured in both surveys were consistent with normal terrestrial background

Ciprofloxacin : Use and resistance in Community, Nursing Home and Hospital

NARCIS (Netherlands)

van Hees, B.C.

2011-01-01

The aim of the studies described in this thesis was to analyze some aspects of ciprofloxacin use and clinical and (molecular) epidemiology of ciprofloxacin resistance in different settings, both within hospitals (chapter 3,4 and 6), community and nursing homes (chapter 2 and 5). With its broad

Fort Carson Wind Resource Assessment

Energy Technology Data Exchange (ETDEWEB)

Robichaud, R.

2012-10-01

This report focuses on the wind resource assessment, the estimated energy production of wind turbines, and economic potential of a wind turbine project on a ridge in the southeastern portion of the Fort Carson Army base.

A Measure of the Potential Impact of Hospital Community Health Activities on Population Health and Equity.

Science.gov (United States)

Begun, James W; Kahn, Linda M; Cunningham, Brooke A; Malcolm, Jan K; Potthoff, Sandra

2017-12-13

Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health. Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity. We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota metropolitan area in 2015. Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity. A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address structural causes of health equity (level 5 on the 5-point scale). Activities that score highest on potential impact fall into the topic categories of "community health and connectedness" and "healthy lifestyles and wellness." Lower-scoring activities focus on sick or at-risk individuals, such as the topic category of "chronic disease prevention, management, and screening." Health care organizations in the Minneapolis-St Paul metropolitan area vary substantially in the potential impact of their aggregated community health activities. Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.

Renewable Energy Opportunities at Fort Sill, Oklahoma

Energy Technology Data Exchange (ETDEWEB)

Boyd, Brian K.; Hand, James R.; Horner, Jacob A.; Orrell, Alice C.; Russo, Bryan J.; Weimar, Mark R.; Nesse, Ronald J.

2011-03-31

This document provides an overview of renewable resource potential at Fort Sill, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and on ground source heat pumps for heating and cooling buildings. The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment. The site visit to Fort Sill took place on June 10, 2010.

Renewable Energy Opportunities at Fort Polk, Louisiana

Energy Technology Data Exchange (ETDEWEB)

Solana, Amy E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Boyd, Brian K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Horner, Jacob A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Gorrissen, Willy J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Orrell, Alice C. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Weimar, Mark R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hand, James R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Russo, Bryan J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Williamson, Jennifer L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

2010-11-17

This document provides an overview of renewable resource potential at Fort Polk, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and also on ground source heat pumps for heating and cooling buildings. The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment. The site visit to Fort Polk took place on February 16, 2010.

Constipation in children: avoiding hospital admissions by the use of a specialist community nurse.

Science.gov (United States)

Bartle, David; Finlay, Fiona; Atherton, Fiona

2003-01-01

To review paediatric admissions with a primary diagnosis of constipation to see whether some could have been managed in the community instead. A review of the medical notes of all patients admitted with a primary diagnosis of constipation to the children's ward of a district general hospital over a 12-month period. Of 41 admissions (19 girls and 22 boys, age range 6 weeks to 12 years), the average length of stay was less than two nights. The short duration of hospital stay implies rapid improvement. It is likely that many of these children could have been managed in the community if suitable resources, such as a community nurse specialising in constipation, were available.

Fort Independence: An Eighteenth-Century Frontier Homesite and Militia Post in South Carolina.

Science.gov (United States)

1982-12-01

included in this instance as a condiment , but it could also indicate that the Fort Independence garrison was familiar with the strategy employed by the Fort...archeological investigation of Fort Charlotte, McCormick County, South Carolina. Notebook, Institute of Archeology and Anthropology, University of South

Independent radiographic prognostic factors in patients with hospital-treated community-acquired pneumonia

International Nuclear Information System (INIS)

Wilhelm, K.; Textor, J.; Schild, H.; Ewig, S.; Luederitz, B.; Krollmann, G.

1999-01-01

Purpose: To evaluate the independent prognostic impact of the chest radiograph for mortality from community-acquired pneumonia requiring hospitalization. Methods: Chest radiographs of 67 patients with hospital-treated community-acquired pneumonia were analyzed with regard to the prognostic implications of radiographic patterns, extent and density of infiltrates, and its evolution during treatment. Results: Non-survivors had a significantly higher extent of infiltrates (p=0.008), density of infiltrates (p=0.05), and radiographic spread during follow-up within 48-72 hours (p=0.0001). In multivariate analysis, persistent or progressive infiltrates were associated with a 47fold increase, and persistent or progressive density of infiltrates with an 18fold increase in risk of mortality. The presence of both parameters could correctly predict 96% of survivors and 90% of non-survivors. Conclusions: The chest radiograph is an independent predictor of the severity of pneumonia. Both persistent or progressive infiltrates and persistent or progressive density of infiltrates are independently associated with mortality from community-acquired pneumonia. (orig.) [de

Value congruence, control, sense of community and demands as determinants of burnout syndrome among hospitality workers.

Science.gov (United States)

Asensio-Martínez, Ángela; Leiter, Michael P; Gascón, Santiago; Gumuchian, Stephanie; Masluk, Bárbara; Herrera-Mercadal, Paola; Albesa, Agustín; García-Campayo, Javier

2017-09-07

Employees working in the hospitality industry are constantly exposed to occupational stressors that may lead employees into experiencing burnout syndrome. Research addressing the interactive effects of control, community and value congruence to alleviate the impact of workplace demands on experiencing burnout is relatively limited. The present study examined relationships among control, community and value congruence, workplace demands and the three components of burnout. A sample of 418 employees working in a variety of hospitality associations including restaurants and hotels in Spain were recruited. Moderation analyses and linear regressions analyzed the predictive power of control, community and value congruence as moderating variables. Results indicate that control, community and value congruence were successful buffers in the relationships between workplace demands and the burnout dimensions. The present findings offer suggestions for future research on potential moderating variables, as well as implications for reducing burnout among hospitality employees.

A community hospital's journey into Lean Six Sigma.

Science.gov (United States)

Stuenkel, Kurt; Faulkner, Taunya

2009-01-01

The implementation of Lean Six Sigma and 100-day workouts throughout the 304-bed Floyd Medical Center community hospital organization has led to sustainable results and a marked change in culture. The organization-wide learning of such an effort is deep and intehse, and to remain focused and successful it must be a priority of top management. The workout methodology can assist the organization to carry projects to completion and to achieve rapid implementation of desired improvements.

The role of the neonatal nurse practitioner in the community hospital level I nursery.

Science.gov (United States)

Hatch, Julie

2012-01-01

Neonatal nurse practitioners (NNPs) have played a significant role in providing medical coverage to many of the country's Level III neonatal intensive care units (NICUs). Extensive education and experience are required for a nurse practitioner (NP) to become competent in caring for these critically ill newborns. The NNP can take this competence and experience and expand her role out into the community Level I nurseries. Clinical care of the infants and close communication with parents, pediatricians, and the area tertiary center provide a community service with the goal of keeping parents and babies together in the community hospital without compromising the health of the baby. The NNP service, with 24-hour nursery and delivery coverage, supports an ongoing obstetric service to the community hospital. The NNP's experience enables her to provide a neonatal service that encompasses a multitude of advanced practice nursing roles.

A Community-Based Continuing Care Program for the Elderly Disabled. An Evaluation of Planned Intermittent Hospital Readmission

Science.gov (United States)

Robertson, Duncan; And Others

1977-01-01

Utilizing flexible community-supporting services integrated with a hospital-based program of planned intermittent relief of the patients' supporters, patients (N=50) were maintained in the community at an average cost of 79.5 hospital bed days per patient per annum. The Continuing Care Program is an alternative to institutionalization. (Author)

Drilling and Testing the DOI041A Coalbed Methane Well, Fort Yukon, Alaska

Science.gov (United States)

Clark, Arthur; Barker, Charles E.; Weeks, Edwin P.

2009-01-01

The need for affordable energy sources is acute in rural communities of Alaska where costly diesel fuel must be delivered by barge or plane for power generation. Additionally, the transport, transfer, and storage of fuel pose great difficulty in these regions. Although small-scale energy development in remote Arctic locations presents unique challenges, identifying and developing economic, local sources of energy remains a high priority for state and local government. Many areas in rural Alaska contain widespread coal resources that may contain significant amounts of coalbed methane (CBM) that, when extracted, could be used for power generation. However, in many of these areas, little is known concerning the properties that control CBM occurrence and production, including coal bed geometry, coalbed gas content and saturation, reservoir permeability and pressure, and water chemistry. Therefore, drilling and testing to collect these data are required to accurately assess the viability of CBM as a potential energy source in most locations. In 2004, the U.S. Geological Survey (USGS) and Bureau of Land Management (BLM), in cooperation with the U.S. Department of Energy (DOE), the Alaska Department of Geological and Geophysical Surveys (DGGS), the University of Alaska Fairbanks (UAF), the Doyon Native Corporation, and the village of Fort Yukon, organized and funded the drilling of a well at Fort Yukon, Alaska to test coal beds for CBM developmental potential. Fort Yukon is a town of about 600 people and is composed mostly of Gwich'in Athabascan Native Americans. It is located near the center of the Yukon Flats Basin, approximately 145 mi northeast of Fairbanks.

Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

Directory of Open Access Journals (Sweden)

Shantna Kumari

2014-01-01

Full Text Available Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP. Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalized. The study sample included 130 patients receiving outdoor treatment from a Psychiatric Hospital and a matched group of 140 patients receiving treatment from COP of the same hospital. Demographic and clinical details of the patients were recorded on a specially designed proforma. Modified felt stigma scale and Rosenberg self-esteem scale were used to assess stigma and self-esteem, respectively. Results: On the modified felt stigma scale, the mean (±standard deviation [SD] score of psychiatric hospital outpatients (31.89 ± 6.51 was significantly higher than the scores of patients attending COP (29.20 ± 6.80. On Rosenberg self-esteem scale, mean (±SD scores of patients with psychosis (17.98 ± 1.69 was significantly lower compared to scores of patients with epilepsy (21.83 ± 1.60. There was no significant correlation between stigma and self-esteem. Conclusion: As psychiatric hospital outpatients have significantly more self-stigma when compared to patients attending community outreach camps, the availability of more community outreach camps along with educating people about psychiatric illnesses may help in lowering stigma of psychiatric disorders.

Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals.

Science.gov (United States)

Bogart, Laura M; Howerton, Devery; Lange, James; Setodji, Claude Messan; Becker, Kirsten; Klein, David J; Asch, Steven M

2010-06-01

We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.

Net Income of Pharmacy Faculty Compared to Community and Hospital Pharmacists.

Science.gov (United States)

Chisholm-Burns, Marie A; Gatwood, Justin; Spivey, Christina A; Dickey, Susan E

2016-09-25

Objective. To compare the net cumulative income of community pharmacists, hospital pharmacists, and full-time pharmacy faculty members (residency-trained or with a PhD after obtaining a PharmD) in pharmacy practice, medicinal chemistry, pharmaceutics, pharmacology, and social and administrative sciences. Methods. Markov modeling was conducted to calculate net projected cumulative earnings of career paths by estimating the costs of education, including the costs of obtaining degrees and student loans. Results. The economic model spanned 49 years, from ages 18 to 67 years. Earning a PharmD and pursuing an academic career resulted in projected net cumulative lifetime earnings ranging from approximately $4.7 million to $6.3 million. A pharmacy practice faculty position following public pharmacy school and one year of residency resulted in higher net cumulative income than community pharmacy. Faculty members with postgraduate year 1 (PGY1) training also had higher net income than other faculty and hospital pharmacy career paths, given similar years of prepharmacy education and type of pharmacy school attended. Faculty members with either a PharmD or PhD in the pharmacology discipline may net as much as $5.9 million and outpace all other PhD graduates by at least $75 000 in lifetime earnings. Projected career earnings of postgraduate year 2 (PGY2) trained faculty and PharmD/PhD faculty members were lower than those of community pharmacists. Findings were more variable when comparing pharmacy faculty members and hospital pharmacists. Conclusion. With the exception of PGY1 trained academic pharmacists, faculty projected net cumulative incomes generally lagged behind community pharmacists, likely because of delayed entry into the job market as a result of advanced training/education. However, nonsalary benefits such as greater flexibility and autonomy may enhance the desirability of academic pharmacy as a career path.

En fascinerende fortælling om det 20. århundredes musik

DEFF Research Database (Denmark)

Bonde, Lars Ole

2011-01-01

Anmeldelse af Karl Aage Rasmussen: Musik i det tyvende århundrede: En fortælling. Gyldendal 2011.......Anmeldelse af Karl Aage Rasmussen: Musik i det tyvende århundrede: En fortælling. Gyldendal 2011....

Analysis of Delayed Sea Breeze Onset for Fort Ord Prescribed Burning Operations

Science.gov (United States)

2015-12-01

DELAYED SEA BREEZE ONSET FOR FORT ORD PRESCRIBED BURNING OPERATIONS by Dustin D. Hocking December 2015 Thesis Advisor: Wendell Nuss Second...AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE ANALYSIS OF DELAYED SEA BREEZE ONSET FOR FORT ORD PRESCRIBED BURNING OPERATIONS 5...release; distribution is unlimited 12b. DISTRIBUTION CODE 13. ABSTRACT (maximum 200 words) The U.S. Army conducts prescribed burns at Fort Ord

Whose forests, whose voices? Mining and community- based nature ...

African Journals Online (AJOL)

This paper explores local experiences of private - sector led community - based nature conservation near Fort Dauphin, southeastern Madagascar through the analysis of a conservation zone managed in partnership between the Rio Tinto mining corporation, local government and local communities. The article assesses ...

Fort Peck-Wolf Point transmission line project, Montana

International Nuclear Information System (INIS)

1992-01-01

The primary objective of the project is to replace the existing 36-mile Fort Peck-Wolf Point transmission line which has reached the end of its useful service life. Presently, the overall condition of this existing section of the 47-year-old line is poor. Frequent repairs have been required because of the absence of overhead ground wires. The continued maintenance of the line will become more expensive and customer interruptions will persist because of the damage due to lightning. The expense of replacing shell rotted poles, and the concern for the safety of the maintenance personnel because of hazards caused by severe shell rot are also of primary importance. The operational and maintenance problems coupled with power system simulation studies, demonstrate the need for improvements to the Wolf Point area to serve area loads. Western's Wolf Point Substation is an important point of interconnection for the power output from the Fort Peck Dam to area loads as far away as Williston, North Dakota. The proposed transmission line replacement would assure that there will continue to be reliable transmission capacity available to serve area electrical loads, as well as provide a reliable second high-voltage transmission path from the Fort Peck generation to back-up a loss of the Fort Peck-Wolf Point 115-kV Line No. 1

A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results.

Science.gov (United States)

Filardo, Giovanni; Nicewander, David; Herrin, Jeph; Edwards, Janine; Galimbertti, Percy; Tietze, Mari; McBride, Susan; Gunderson, Julie; Collinsworth, Ashley; Haydar, Ziad; Williams, Josie; Ballard, David J

2009-08-01

To investigate the effectiveness of a quality improvement educational program in rural hospitals. Hospital-randomized controlled trial. A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

Targeting Net Zero Energy at Fort Carson: Assessment and Recommendations

Energy Technology Data Exchange (ETDEWEB)

Anderson, K.; Markel, T.; Simpson, M.; Leahey, J.; Rockenbaugh, C.; Lisell, L.; Burman, K.; Singer, M.

2011-10-01

The U.S. Army's Fort Carson installation was selected to serve as a prototype for net zero energy assessment and planning. NREL performed the comprehensive assessment to appraise the potential of Fort Carson to achieve net zero energy status through energy efficiency, renewable energy, and electric vehicle integration. This report summarizes the results of the assessment and provides energy recommendations. This study is part of a larger cross-laboratory effort that also includes an assessment of renewable opportunities at seven other DoD Front Range installations, a microgrid design for Fort Carson critical loads and an assessment of regulatory and market-based barriers to a regional secure smart grid.

Morphological anomalies in two Lutzomyia (Psathyromyia) shannoni (Diptera: Psychodidae: Phlebotominae) specimens collected from Fort Rucker, Alabama, and Fort Campbell, Kentucky.

Science.gov (United States)

Florin, David A; Lawyer, Phillip; Rowton, Edgar; Schultz, George; Wilkerson, Richard; Davies, Stephen J; Lipnick, Robert; Keep, Lisa

2010-09-01

This report describes two male specimens of the sand fly species Lutzomyia shannoni (Dyar) (Diptera: Psychodidae: Phlebotominae) collected at Fort Rucker, AL, and Fort Campbell, KY, in dry ice-baited light traps during September 2005. The specimens were observed to have anomalies to the number of spines on the gonostyli. The taxonomic keys of Young and Perkins (Mosq. News 44: 263-285; 1984) use the number of spines on the gonostylus in the first couplet to differentiate two major groupings of North American sand flies. The two anomalous specimens were identified as L. shannoni based on the following criteria: (1) both specimens possess antennal ascoids with long, distinct proximal spurs (a near diagnostic character of L. shannoni in North America), (2) the sequences of the partial cytochrome c oxidase subunit 1 gene from both specimens indicated L. shannoni, and (3) the sequences of the internal transcribed spacer 2 molecular marker from both specimens indicated L. shannoni. The anomalous features are fundamentally different from each other as the Fort Rucker specimen possesses a fifth spine (basally located) on just one gonostylus, whereas the Fort Campbell specimen possesses five spines (extra spines subterminally located) on both gonostyli. Because the gonostyli are part of the external male genitalia, anomalies in the number of spines on the gonostyli may have serious biological consequences, such as reduced reproductive success, for the possessors. These anomalies are of taxonomic interest as the specimens could easily have been misidentified using available morphological keys.

76 FR 68625 - Establishment of the Fort Monroe National Monument

Science.gov (United States)

2011-11-07

... period of slavery in the colonies and, later, this Nation. Two hundred and forty-two years later, Fort... 1863. Thus, Old Point Comfort marks both the beginning and end of slavery in our Nation. The Fort... North Beach area lies the only undeveloped shoreline remaining on Old Point Comfort, providing modern...

[Awareness and attitude toward suicide in community mental health professionals and hospital workers].

Science.gov (United States)

Kim, Soung Nam; Lee, Kang Sook; Lee, Seon Young; Yu, Jae Hee; Hong, A Rum

2009-05-01

The purpose of this study was to evaluate community mental health professionals and hospital workers attitude and awareness towards suicide. This study investigated 264 community mental health professionals and 228 hospital workers. SOQs (Suicidal Opinion Questionnaires) were used from July 2007 to September 2007. After a factor analysis for the attitude towards suicide, the items on ethics, mental illness, religion, risk, and motivation were included in the subsequent analysis. There were significant differences in the attitude towards suicide according to religion, age, educational background, the marriage status, the economic position, and different professional licenses. Hospital workers' view was different from the community workers'. The hospital workers judged that suicide was due to mental illness, and suicide was high for the people in a special environment and who lacked motivation, which caused them to fall in a dangerous situation. For the lower educational group, they thought that suicide was attributable to mental illness. The awareness for suicide was significantly higher in the group with a postgraduate education, unmarried people, mental health professionals and the persons who had concern and experience with suicide. The factors that had an influence on the awareness of suicide were the items of mental illness, religion, risk and motivational factors. This study suggested that the factors to increase the awareness and attitude for suicide were the experience of increased education and case management of suicide. Therefore, education dealing with suicide and reinforcement of crisis management programs should be developed.

Inventory of Forts in Indonesia

Science.gov (United States)

Rinandi, N.; Suryaningsih, F.

2015-08-01

The great archipelago in Indonesia with its wealthy and various nature, the products and commodities of tropic agriculture and the rich soil, was through the centuries a region of interest for other countries all over the world. For several reasons some of these countries came to Indonesia to establish their existence and tried to monopolize the trading. These countries such as the Portuguese, the Spanish, the Dutch and the British built strengthened trade stations which later became forts all over Indonesia to defend their interest. The archipelago of Indonesia possesses a great number of fortification-works as legacies of native rulers and those which were built by European trading companies and later became colonial powers in the 16th to the 19th centuries. These legacies include those specific structures built as a defence system during pre and within the period of World War II. These fortresses are nowadaysvaluable subjects, because they might be considered as shared heritage among these countries and Indonesia. It's important to develop a vision to preserve these particular subjects of heritage, because they are an interesting part of the Indonesian history and its cultural treasures. The Government of the Republic of Indonesia has national program to compile a comprehensive documentation of the existing condition of these various types of forts as cultural heritage. The result of the 3 years project was a comprehensive 442 forts database in Indonesia, which will be very valuable to the implementation of legal protection, preservation matters and adaptive re-use in the future.

Cranial nerve injury after Le Fort I osteotomy.

Science.gov (United States)

Kim, J-W; Chin, B-R; Park, H-S; Lee, S-H; Kwon, T-G

2011-03-01

A Le Fort I osteotomy is widely used to correct dentofacial deformity because it is a safe and reliable surgical method. Although rare, various complications have been reported in relation to pterygomaxillary separation. Cranial nerve damage is one of the serious complications that can occur after Le Fort I osteotomy. In this report, a 19-year-old man with unilateral cleft lip and palate underwent surgery to correct maxillary hypoplasia, asymmetry and mandibular prognathism. After the Le Fort I maxillary osteotomy, the patient showed multiple cranial nerve damage; an impairment of outward movement of the eye (abducens nerve), decreased vision (optic nerve), and paraesthesia of the frontal and upper cheek area (ophthalmic and maxillary nerve). The damage to the cranial nerve was related to an unexpected sphenoid bone fracture and subsequent trauma in the cavernous sinus during the pterygomaxillary osteotomy. Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

The application of a biometric identification technique for linking community and hospital data in rural Ghana.

Science.gov (United States)

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

The application of a biometric identification technique for linking community and hospital data in rural Ghana

Science.gov (United States)

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

The application of a biometric identification technique for linking community and hospital data in rural Ghana

Directory of Open Access Journals (Sweden)

Eliezer Ofori Odei-Lartey

2016-03-01

Full Text Available Background: The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective: Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design: A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results: A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions: Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Association of Resident Coverage with Cost, Length of Stay, and Profitability at a Community Hospital

Science.gov (United States)

Shine, Daniel; Beg, Sumbul; Jaeger, Joseph; Pencak, Dorothy; Panush, Richard

2001-01-01

OBJECTIVE The effect of care by medical residents on hospital length of stay (LOS), indirect costs, and reimbursement was last examined across a range of illnesses in 1981; the issue has never been examined at a community hospital. We studied resource utilization and reimbursement at a community hospital in relation to the involvement of medical residents. DESIGN This nonrandomized observational study compared patients discharged from a general medicine teaching unit with those discharged from nonteaching general medical/surgical units. SETTING A 620-bed community teaching hospital with a general medicine teaching unit (resident care) and several general medicine nonteaching units (no resident care). PATIENTS All medical discharges between July 1998 and February 1999, excluding those from designated subspecialty and critical care units. MEASUREMENTS AND MAIN RESULTS Endpoints included mean LOS in excess of expected LOS, mean cost in excess of expected mean payments, and mean profitability (payments minus total costs). Observed values were obtained from the hospital's database and expected values from a proprietary risk–cost adjustment program. No significant difference in LOS between 917 teaching-unit patients and 697 nonteaching patients was demonstrated. Costs averaged $3,178 (95% confidencence interval (CI) ± $489) less than expected among teaching-unit patients and $4,153 (95% CI ± $422) less than expected among nonteaching-unit patients. Payments were significantly higher per patient on the teaching unit than on the nonteaching units, and as a result mean, profitability was higher: $848 (95% CI ± $307) per hospitalization for teaching-unit patients and $451 (95% CI ± $327) for patients on the nonteaching units. Teaching-unit patients of attendings who rarely admitted to the teaching unit (nonteaching attendings) generated an average profit of $1,299 (95% CI ± $613), while nonteaching patients of nonteaching attendings generated an average profit of $208

Conversations with the community: the Methodist Hospital System's experience with social media.

Science.gov (United States)

Angelle, Denny; Rose, Clare L

2011-01-01

The Methodist Hospital System has maintained a social media presence on Facebook, Twitter, and YouTube since 2009. After initial unofficial excursions into the world of social media, we discovered that social media can be a useful tool to extend a conversation with our patients and the community at large and share our hospital's culture with a larger base of like-minded people. But with this new power comes a heightened responsibility--platforms that can potentially reach millions of viewers and readers also provide a potential for misuse that can jeopardize patient privacy and place hospitals at risk. Because of their unique restrictions, even hospitals that use the tools regularly have much left to learn about social media. With constant monitoring and stewardship and a commitment to educating staff, hospitals can effectively use social media tools for marketing and education.

Transition from Hospital to Community Care: The Experience of Cancer Patients

Directory of Open Access Journals (Sweden)

Hanna Admi

2015-12-01

Full Text Available Purpose: This study examines care transition experiences of cancer patients and assesses barriers to effective transitions.Methods: Participants were adult Hebrew, Arabic, or Russian speaking oncology patients and health care providers from hospital and community settings. Qualitative (n=77 and quantitative (n=422 methods such as focus groups, interviews and self-administered questionnaires were used. Qualitative analysis showed that patients faced difficulties navigating a complex and fragmented healthcare system.Results: Mechanisms to overcome barriers included informal routes such as personal relationships, coordinating roles by nurse coordinators and the patients' general practitioners (GPs. The most significant variable was GPs involvement, which affected transition process quality as rated on the CTM (p<0.001. Our findings point to the important interpersonal role of oncology nurses to coordinate and facilitate the care transition process.Conclusion: Interventions targeted towards supporting the care transition process should emphasize ongoing counseling throughout a patient’s care, during and after hospitalization.-----------------------------------------Cite this article as:  Admi H, Muller E, Shadmi E. Transition from Hospital to Community Care: The Experience of Cancer Patients. Int J Cancer Ther Oncol 2015; 3(4:34011.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.

Fort Valley's early scientists: A legacy of distinction (P-53)

Science.gov (United States)

Andrew J. Sanchez Meador; Susan D. Olberding

2008-01-01

When the Riordan brothers of Flagstaff, Arizona asked Gifford Pinchot to determine why there was a deficit in ponderosa pine seedlings, neither party understood the historical significance of what they were setting in motion for the field of forest research. The direct result of that professional favor was the establishment of the Fort Valley Experiment Station (Fort...

Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

Science.gov (United States)

Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

2016-01-01

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

Science.gov (United States)

Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

2016-06-24

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

Renewable Energy Opportunities at Fort Campbell, Tennessee/Kentucky

Energy Technology Data Exchange (ETDEWEB)

Hand, James R.; Horner, Jacob A.; Kora, Angela R.; Orrell, Alice C.; Russo, Bryan J.; Weimar, Mark R.; Nesse, Ronald J.

2011-03-31

This document provides an overview of renewable resource potential at Fort Campbell, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and also on ground source heat pumps for heating and cooling buildings. The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment. The site visit to Fort Campbell took place on June 10, 2010.

Renewable Energy Opportunities at Fort Drum, New York

Energy Technology Data Exchange (ETDEWEB)

Brown, Scott A.; Orrell, Alice C.; Solana, Amy E.; Williamson, Jennifer L.; Hand, James R.; Russo, Bryan J.; Weimar, Mark R.; Rowley, Steven; Nesse, Ronald J.

2010-10-20

This document provides an overview of renewable resource potential at Fort Drum, based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. This effort focuses on grid-connected generation of electricity from renewable energy sources and also on ground source heat pumps for heating and cooling buildings. The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 Department of Defense (DoD) Renewables Assessment. The site visit to Fort Drum took place on May 4 and 5, 2010.

Hospitalization, Depression and Dementia in Community-Dwelling Older Americans: Findings from the National Health and Aging Trends Study

Science.gov (United States)

Davydow, Dimitry S.; Zivin, Kara; Langa, Kenneth M.

2014-01-01

Objective To estimate the prevalence of both dementia and depression among community-dwelling older Americans, and to determine if hospitalization is independently associated with dementia or depression in this population. Method This cross-sectional study utilized data from a nationally representative, population-based sample of 7,197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2. Results An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls, and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval[95%CI]: 1.16, 1.73) and substantial depressive symptoms (OR: 1.60, 95%CI: 1.29, 1.99). Conclusions Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bi-directional relationship between hospitalizations, dementia, and depression, along with targeted interventions to reduce hospitalizations, are needed. PMID:24388630

An audit of hospital based outpatient infusions and a pilot program of community-based monoclonal antibody infusions.

LENUS (Irish Health Repository)

Doran, J-P

2012-02-01

INTRODUCTION: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. METHODS: An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent\\'s University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. RESULTS: All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. CONCLUSION: This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.

Prevalence of Clostridium difficile infection and colonization in a tertiary hospital and elderly community of North-Eastern Peninsular Malaysia.

Science.gov (United States)

Zainul, N H; Ma, Z F; Besari, A; Siti Asma, H; Rahman, R A; Collins, D A; Hamid, N; Riley, T V; Lee, Y Y

2017-10-01

Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

Microgrid Enabled Distributed Energy Solutions (MEDES) Fort Bliss Military Reservation

Science.gov (United States)

2014-02-01

FINAL REPORT Microgrid Enabled Distributed Energy Solutions (MEDES) Fort Bliss Military Reservation ESTCP Project EW-201140 FEBRUARY...TITLE AND SUBTITLE Microgrid Enabled Distributed Energy Solutions (MEDES) 5a. CONTRACT NUMBER W912HQ-11-C-0082 Fort Bliss, Texas...Lockheed Martin’s Intelligent Microgrid Solution can provide more energy security while also lowering electric utility costs and greenhouse gas emissions

Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus in Danish Hospitals

NARCIS (Netherlands)

Hetem, D.J.; Westh, H.; Boye, K.; Jarlov, J.O.; Bonten, M.J.M.; Bootsma, M.C.J.

2012-01-01

Objectives The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has changed the epidemiology of MRSA infections worldwide. In contrast to hospital-associated MRSA (HA-MRSA), CA-MRSA more frequently affects healthy individuals, both with and without recent

Early Hospital Readmission is a Predictor of One-Year Mortality in Community-Dwelling Older Medicare Beneficiaries

NARCIS (Netherlands)

Lum, H.D.; Studenski, S.A.; Degenholtz, H.B.; Hardy, S.E.

2012-01-01

BACKGROUND: Hospital readmission within thirty days is common among Medicare beneficiaries, but the relationship between rehospitalization and subsequent mortality in older adults is not known. OBJECTIVE: To compare one-year mortality rates among community-dwelling elderly hospitalized Medicare

Impact of pre-hospital antibiotic use on community-acquired pneumonia.

Science.gov (United States)

Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

2014-09-01

Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Community Colleges Mobilize to Train Cybersecurity Workers

Science.gov (United States)

Parry, Marc

2009-01-01

If you work at a community college that teaches cybersecurity, it pays to be located in the backyard of a spy agency. Just don't ask Kelly A. Koermer, administrator of the Anne Arundel Community College, what's inside those dark towers at Fort Meade. She points out other highlights of the restricted region: an employees-only exit off the highway,…

Closing Italian Forensic Psychiatry Hospitals in Favor of Treating Insanity Acquittees in the Community.

Science.gov (United States)

Carabellese, Felice; Felthous, Alan R

2016-03-01

Originally a hedge against the death penalty, the insanity defense came to offer hospitalization as an alternative to imprisonment. In the late 19th century Italy opened inpatient services first for mentally ill prisoners and then for offenders found not guilty by reason of insanity. Within the past decade, a series of decrees has resulted in transferring the responsibility for treating NGRI acquittees and "dangerous" mentally ill prisoners from the Department of Justice to the Department of Health, and their treatment from Italy's high security forensic psychiatric hospitals (OPGs) to community regional facilities (REMSs, Residences for the Execution of Security Measures), community mental health facilities, one of which is located in each region of Italy. Today community REMSs provide the treatment and management of socially dangerous offenders. The dynamic evolution of Italy's progressive mental health system for insanity acquittees, to our knowledge the most libertarian, community oriented approach of any country, is retraced. Discussion includes cautionary concerns as well as potential opportunities for improvements in mental health services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Structural remains at the early mediaeval fort at Raibania, Orissa

OpenAIRE

Sen, Bratati

2013-01-01

The fortifications of mediaeval India occupy an eminent position in the history of military architecture. The present paper deals with the preliminary study of the structural remains at the early mediaeval fort at Raibania in the district of Balasore in Orissa. The fort was built of stone very loosely kept together. The three-walled fortification interspersed by two consecutive moats, a feature evidenced at Raibania, w...

Percutaneous cholecystostomy at the community hospital: value evaluation

International Nuclear Information System (INIS)

Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun; Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul

1997-01-01

To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20

Percutaneous cholecystostomy at the community hospital: value evaluation

Energy Technology Data Exchange (ETDEWEB)

Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

1997-10-01

To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

What do medical students learn when they follow patients from hospital to community? A longitudinal qualitative study

Directory of Open Access Journals (Sweden)

Rukshini Puvanendran

2012-07-01

Full Text Available Context: Although longitudinal community-based care of patients provides opportunities for teaching patient centredness and chronic disease management, there is a paucity of literature assessing learning outcomes of these clerkships. This study examines learning outcomes among students participating in longitudinal community based follow-up of patients discharged from the hospital. Methods: The authors conducted a thematic analysis of 253 student narratives written by 44 third-year medical students reflecting on their longitudinal interactions with patients with chronic medical illnesses. The narratives were written over three periods: after acute hospital encounter, after a home visit and at the end of the 10-month follow-up. Analysis involved coding of theme content and counting of aggregate themes. Results: The most frequent theme was ‘chronic disease management’ (25% followed by ‘patient-centred care’ (22%, ‘health care systems’ (20.9%, ‘biomedical issues’ (19.7%, ‘community services’ (9.5% and ‘student's role conflict’ (2.3%. There was a shift in the relative frequency of the different themes, as students moved from hospital to community with their patients. Biomedical (44.3% and health systems (18.2% were the dominant themes following the acute hospitalization encounter. Chronic disease management (35.1% and patient centredness (31.8% were the dominant themes after the 10-month longitudinal follow-up. Conclusion: Longitudinal community-based interaction with patients resulted in learning about chronic disease management, patient centredness and health care systems over time. Students shifted from learning biomedical knowledge during the acute hospitalization, to focus on better understanding of long-term care and patient centredness, at the end of the module.

Black Swan Event Assessment for Fort Leonard Wood, Missouri

Science.gov (United States)

2016-03-01

ER D C/ CE RL S R- 16 -1 Net Zero Planning for Fort Leonard Wood Black Swan Event Assessment for Fort Leonard Wood, Missouri Co ns...search for other technical reports published by ERDC, visit the ERDC online library at http://acwc.sdp.sirsi.net/client/default. Net Zero Planning for...1.8 degrees Celsius knots 0.5144444 meters per second miles (US statute) 1,609.347 meters miles per hour 0.44704 meters per second ERDC/CERL SR

75 FR 41922 - Notice of Intent To Rule on Request To Release Airport Property at Fort Smith Regional Airport...

Science.gov (United States)

2010-07-19

... To Release Airport Property at Fort Smith Regional Airport, Fort Smith, AR AGENCY: Federal Aviation... rule and invites public comment on the release of land at Fort Smith Regional Airport under the.... John Parker, Airport Director, Fort Smith Regional Airport, at the following address: Fort Smith...

Modeling the impacts of hospitality and tourism enterprises on community quality of life

OpenAIRE

Yi, Sangchoul

2015-01-01

The present research examined the impacts of hospitality and tourism businesses on community quality of life using existing public domain databases. In the tourism literature, various methodological approaches have been proposed to investigate the impacts of tourism on a host community and its residents. However, these approaches are limited because of innate methodological constraints such as the bias of the survey respondents' perceptions. To overcome such a limitation, alternative research...

Liquid radwaste processing history at Fort Calhoun Nuclear Station

International Nuclear Information System (INIS)

Bilau, A.; Rutar, F.

1989-01-01

This report presents a historical perspective of liquid radwaste processing at the Fort Calhoun Unit 1 Nuclear Power Station, located in east central Nebraska. Of particular interest is the textual and graphical comparison of the operational implications of the various waste processing methods employed in the last ten years at the Fort Calhoun Station. Fort Calhoun's waste collection and processing systems are described in detail. These process systems include evaporation and solidification employing an in-plant drum solidification system. This solidification system was later replaced with vendor solidification services which solidified wastes in large liners. Ultimately, the plant converted its processing operation to ion exchange cleanup using ion selective media. The operational and economic impact of each of these process systems is discussed including overall costs, personnel exposure, capital expenditure requirements, burial volumes generated, maintenance and reliability assessments. Operational goals and performance criteria employed in the decision-making process for selection of the optimal technology are discussed, including the impact of various influent and effluent requirements

End-use energy characterization and conservation potentials at DoD Facilities: An analysis of electricity use at Fort Hood, Texas

Energy Technology Data Exchange (ETDEWEB)

Akbari, H.; Konopacki, S.

1995-05-01

This report discusses the application of the LBL`s End-use Disaggregation Algorithm (EDA) to a DoD installation and presents hourly reconciled end-use data for all major building types and end uses. The project initially focused on achieving these objectives and pilot-testing the methodology at Fort Hood, Texas. Fort Hood, with over 5000 buildings was determined to have representative samples of nearly all of the major building types in use on DoD installations. These building types at Fort Hood include: office, administration, vehicle maintenance, shop, hospital, grocery store, retail store, car wash, church, restaurant, single-family detached housing, two and four-plex housings, and apartment building. Up to 11 end uses were developed for each prototype, consisting of 9 electric and 2 gas; however, only electric end uses were reconciled against known data and weather conditions. The electric end uses are space cooling, ventilation, cooking, miscellaneous/plugs, refrigeration, exterior lighting, interior lighting, process loads, and street lighting. The gas end uses are space heating and hot water heating. Space heating energy-use intensities were simulated only. The EDA was applied to 10 separate feeders from the three substations at Fort Hood. The results from the analyses of these ten feeders were extrapolated to estimate energy use by end use for the entire installation. The results show that administration, residential, and the bar-rack buildings are the largest consumers of electricity for a total of 250GWh per year (74% of annual consumption). By end use, cooling, ventilation, miscellaneous, and indoor lighting consume almost 84% of total electricity use. The contribution to the peak power demand is highest by residential sector (35%, 24 MW), followed by administration buildings (30%), and barrack (14%). For the entire Fort Hood installation, cooling is 54% of the peak demand (38 MW), followed by interior lighting at 18%, and miscellaneous end uses by 12%.

Sundhedsprofessionelles begejstring for fortællinger fra levet erfaring

DEFF Research Database (Denmark)

Liveng, Anne; Larsen, Christine; Lange, Mads

2018-01-01

I 2013 etablerede psykiatrien i Region Hovedstaden, Danmark, et undervisningsprogram om recovery for sundhedsprofessionelle. Evalueringer af programmet viste et udtalt engagement i fortællingen fra underviseren med levet erfaring. Artiklen diskuterer hvordan dette kan forstås. Evalueringsmaterialet...... analyseres ud fra et læringsteoretisk perspektiv og fokuserer på: 1) Betydningen af fortællingens emotionelle indhold, 2) Rolle-bytningen mellem personen med levet erfaring og sundhedsprofessionelle, og 3) Workshoppene som et læringsrum, der aktiverer refleksioner over strukturer og organisering af...

Fort Saint Vrain operational experience

International Nuclear Information System (INIS)

Fuller, C.H.

1989-01-01

Fort St. Vrain (FSV), on the system of the Public Service Company of Colorado, is the only high temperature gas-cooled (HTGR) power reactor in the United States. The plant features a helium-cooled reactor with a uranium-thorium fuel cycle. The paper describes the experience made during its operation. (author). 2 refs, 4 figs, 2 tabs

Den tabte fortælling

DEFF Research Database (Denmark)

Jørgensen, Kenneth Mølbjerg

2008-01-01

Ledelse er et af nøgleordene i fornyelsen af den offentlige sektor. Vi har imidlertid glemt et væsentligt aspekt af ledelse. Dette skyldes ikke mindst, at omgangsformen i dag er reguleret af information, mens den tidligere var reguleret af fortælleevnen. Evnen til dialog, indlevelse og nærvær er...

Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.

Science.gov (United States)

Kolls, Brad J; Mace, Brian E; Dombrowski, Keith E

2017-10-24

Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced

Cultural keystone species in oil sands reclamation, Fort McKay, Alberta, Canada

Energy Technology Data Exchange (ETDEWEB)

Garibaldi, A.; Straker, J. [Stantec Consulting Ltd., Surrey, BC (Canada)

2009-12-15

This presentation discussed a reclamation project conducted in Fort McKay, Alberta that was designed to address some of the social and cultural concerns related to oil sands mining in the region. Conventional reclamation practices in the region have demonstrated a lack of communication and participation from surrounding communities. The project was designed to address future land use plans and to include cultural values in the reclamation process. An integrative approach was used to address community landscapes issues and to explore methods of reclaiming the social and ecological components impacted by oil sands development. Traditional environmental knowledge was also incorporated into the program's design. Cultural keystone species (CKS) were used to provide a culturally relevant compass to guide people engaging in long-term reclamation and land use planning. Cultural keystone species were defined as salient species that significantly shape the cultural identity of a people. Keystone species in the region include the beaver; the moose; the ratroot; and cranberries and blueberries. Challenges to the program included the fact that the scale of oil sands disturbances are so immense that some community recommendations for reclaiming CKS may be impractical. tabs., figs.

Rumlige fortællinger fra mobilt og web-baseret GIS

DEFF Research Database (Denmark)

Møller-Jensen, Lasse

2009-01-01

Denne artikel handler om begrebet rumlige fortællinger med anvendelse af fortællingshenvisninger, og disses potentielle rolle ved implementation af fleksible og tematiske turistinformationssystemer. Artiklen fokuserer på brugen af mobile, positionsbekendte enheder, såsom visse PDA'er og smartphon......, samt på web-gis. Der præsenteres to anvendelseseksempler: et fra det centrale København og et fra et område nær Accra, Ghana....

Occupational burnout and work factors in community and hospital midwives: a survey analysis.

Science.gov (United States)

Yoshida, Yukiko; Sandall, Jane

2013-08-01

community-based midwifery practice has been promoted in the UK maternity policy over the last decade as a means of increasing continuity of care. However, there have been growing concerns to suggest that the community-based continuity model may not be sustainable due to the high levels of occupational burnout in midwives resulted by increased on-call work. this paper attempted to identify work factors associated with the levels of burnout in community midwives as compared to hospital midwives, aiming at contributing to the debate of organising sustainable midwifery care. a statistical analysis was conducted drawing on data from a survey of all midwives working at one Hospital Trust in England (n=238). Occupational burnout was measured using the Maslach Burnout Inventory (MBI). the sample midwives (n=128, 54%) had significantly higher levels of burnout compared to the reference groups. Multiple regression analysis identified as follows: (1) high levels of occupational autonomy were a key protective factor of burnout, and more prevalent in the community, (2) working hours were positively associated with burnout, and community midwives were more likely to have higher levels of stress recognition, and (3) support for work-life-balance from the Trust had a significant protective effect on the levels of burnout. the results should be taken into account in the maternity policy in order to incorporate continuity of care and sustainable organisation of midwifery care. Copyright © 2012 Elsevier Ltd. All rights reserved.

Computer-assisted instruction: a library service for the community teaching hospital.

Science.gov (United States)

McCorkel, J; Cook, V

1986-04-01

This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital.

Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region.

Science.gov (United States)

McTiernan, K; McDonald, N

2015-04-01

Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions

A brief geological history of Cockspur Island at Fort Pulaski National Monument, Chatham County, Georgia

Science.gov (United States)

Swezey, Christopher S.; Seefelt, Ellen L.; Parker, Mercer

2018-03-09

Fort Pulaski National Monument is located on Cockspur Island in Chatham County, Georgia, within the Atlantic Coastal Plain province. The island lies near the mouth of the Savannah River, and consists of small mounds (hummocks), salt marshes, and sediment dredged from the river. A 1,017-foot (ft) (310-meter [m])-deep core drilled at Cockspur Island in 2010 by the U.S. Geological Survey revealed several sedimentary units ranging in age from 43 million years old to present. Sand and mud are present at drilling depths from 0 to 182 ft (56 m), limestone is present at depths from 182 ft (56 m) to 965 ft (295 m), and glauconitic sand is present at depths from 965 ft (295 m) to 1,017 ft (310 m). The limestone and the water within the limestone are referred to collectively as the Floridan aquifer system, which is the primary source of drinking water for the City of Savannah and surrounding communities. In addition to details of the subsurface geology, this fact sheet identifies the following geologic materials used in the construction of Fort Pulaski: (1) granite, (2) bricks, (3) sandstone, and (4) lime mud with oyster shells.

Fort Mason Center: Pier 2 Project

Energy Technology Data Exchange (ETDEWEB)

Nester, Patrick [Fort Mason Center, San Francisco, CA (United States)

2014-08-30

The rooftop Photovoltaic (PV) panels and radiant piping project was constructed by Fort Mason Center as part of its $21 million comprehensive rehabilitation of the Pier 2 shed which include the shed’s electrical, natural gas and water systems. Fort Mason Center improved performance while reducing energy and water usage and costs to demonstrate the efficiencies and opportunities available to large multi-function facilities. The scalable demand of these facilities required a layered approach to conservation, control and production. The project employed a comprehensive retrofit of electrical natural gas, and plumbing systems to maximize efficiency and lower carbon footprint specifically to demonstrate the effectiveness of these strategies in a public setting with varied and diverse use. The project was completed in July 2014 and met the expected outcomes regarding increased comfort and operational efficiency throughout the Pier 2 shed as well as on site electrical generation of current consumption. The entire Pier 2 shed project won a 2015 California Preservation Foundation design award for historic rehabilitation.

Association of frailty in hospitalized and institutionalized elderly in the community-dwelling

Directory of Open Access Journals (Sweden)

Suzele Cristina Coelho Fabrício-Wehbe

2016-08-01

Full Text Available ABSTRACT Objective: to investigate the association between frailty with hospitalization and institutionalization in a follow-up study of elderly residents. Method: the follow-up study was performed in 2008 and 2013 with elderly of both genders, aged 65 years and older who were living in the community-dwelling. The sampling procedure performed was probabilistic, with dual-stage clustering. In 2008, 515 elderly people were interviewed and, in 2013, 262. We used the socioeconomic and demographic data, self-reported morbidity, specific data of hospitalization and institutionalization. Frailty was measured by the Edmonton Frail Scale (EFS, and functional capacity through the Functional Independence Measure. Results: we found the mean gross EFS score was higher among resident elderly who were hospitalized and institutionalized and was statistically significant in both investigated years. Conclusion: the confirmation of association between frailty and hospitalization and institutionalization reinforces the importance of the subject, and highlights frailty as an important tool for risk estimates for these adverse events.

Shifting contours of boundaries: an exploration of inter-agency integration between hospital and community interprofessional diabetes programs.

Science.gov (United States)

Wong, Rene; Breiner, Petra; Mylopoulos, Maria

2014-09-01

This article reports on research into the relationships that emerged between hospital-based and community-based interprofessional diabetes programs involved in inter-agency care. Using constructivist grounded theory methodology we interviewed a purposive theoretical sample of 21 clinicians and administrators from both types of programs. Emergent themes were identified through a process of constant comparative analysis. Initial boundaries were constructed based on contrasts in beliefs, practices and expertise. In response to bureaucratic and social pressures, boundaries were redefined in a way that created role uncertainty and disempowered community programs, ultimately preventing collaboration. We illustrate the dynamic and multi-dimensional nature of social and symbolic boundaries in inter-agency diabetes care and the tacit ways in which hospitals can maintain a power position at the expense of other actors in the field. As efforts continue in Canada and elsewhere to move knowledge and resources into community sectors, we highlight the importance of hospitals seeing beyond their own interests and adopting more altruistic models of inter-agency integration.

BRAND EQUITY OF LAHORE FORT AS A TOURISM DESTINATION BRAND

OpenAIRE

KASHIF, MUHAMMAD; SAMSI, SITI ZAKIAH MELATU; SARIFUDDIN, SYAMSULANG

2015-01-01

ABSTRACTStudies that measure the brand equity of destination brands by using the Customer-Based Brand Equity (CBBE) model in a developing country context are scarce. The present study investigates the destination brand equity of the Lahore Fort by employing the CBBE model in a developing country context of Pakistan. Following the positivist tradition, we adopted a survey-based approach to collect data from 237 tourists visiting the Lahore Fort. Data were collected through a questionnaire deve...

A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

Science.gov (United States)

Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B

2018-03-01

The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

Comprehensive Inventory and Determinations of Eligibility for Fort Riley Buildings: 1857-1963

Science.gov (United States)

2009-09-01

become fashionable . Stone residences built at Fort Riley after the 1850s all have rock-faced walls and most have contrasting smooth-faced lintels...507 is significant as a wood-framed Folk Victorian cottage. While Building 507 is one of four Folk Victorian buildings at Fort Riley, it possesses a

Topical Decolonization Does Not Eradicate the Skin Microbiota of Community-Dwelling or Hospitalized Adults

Science.gov (United States)

Hogan, Patrick G.; Wallace, Meghan A.; Deych, Elena; Shannon, William; Warren, David K.

2016-01-01

Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization–time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota. PMID:27671074

Florida hospital saves 5.3 M dollars by adopting principles of lean manufacturing.

Science.gov (United States)

2005-01-01

Florida hospital saves 5.3M dollars by adopting principles of lean manufacturing. Surgery cancellations have been slashed from 13% of cases to less than 3%, while emergency department admissions have increased by 20%. Those are just two of the results of a quality improvement project at Lee Memorial Health System in Fort Myers, FL, that focused on using the principles of lean manufacturing to improve patient flow in the five-hospital system

The geology and mechanics of formation of the Fort Rock Dome, Yavapai County, Arizona

Science.gov (United States)

Fuis, Gary S.

1996-01-01

The Fort Rock Dome, a craterlike structure in northern Arizona, is the erosional product of a circular domal uplift associated with a Precambrian shear zone exposed within the crater and with Tertiary volcanism. A section of Precambrian to Quaternary rocks is described, and two Tertiary units, the Crater Pasture Formation and the Fort Rock Creek Rhyodacite, are named. A mathematical model of the doming process is developed that is consistent with the history of the Fort Rock Dome.

Perceptions on hospitality when visiting secluded communities of guaranis, caiçaras e quilombolas in Paraty region

Directory of Open Access Journals (Sweden)

Luis Alberto Beares

2008-10-01

Full Text Available Tourism in secluded communities puts different cultures in contact with each other and must be handled carefully not to cause environmental damage as well as cultural loss which might jeopardize the local development and create hostile relationships. The proposal of in sito tourism, considering the local memory and patrimony as a hospitality potential, was observed during technical visitations to three communities located in the Paraty region and surroundings: Guarani, Caiçara (fishermen and Quilombola(African slaves descendants. Through field work involving visitations to communities and interviews with locals, information regarding cultural differences and the importance of the land occupation in the history of each of the communities was assessed. The common link in the history of these peoples is the struggle for the right of land possession. During visits when people shared their territory various forms of hospitality in each community were verified, issued from different cultures and cultural values.

Assessment of soil-gas, soil, and water contamination at the former hospital landfill, Fort Gordon, Georgia, 2009-2010

Science.gov (United States)

Falls, Fred W.; Caldwell, Andral W.; Guimaraes, Wladmir B.; Ratliff, W. Hagan; Wellborn, John B.; Landmeyer, James E.

2011-01-01

Soil gas, soil, and water were assessed for organic and inorganic constituents at the former hospital landfill located in a 75-acre study area near the Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia, from April to September 2010. Passive soil-gas samplers were analyzed to evaluate organic constituents in the hyporheic zone of a creek adjacent to the landfill and soil gas within the estimated boundaries of the former landfill. Soil and water samples were analyzed to evaluate inorganic constituents in soil samples, and organic and inorganic constituents in the surface water of a creek adjacent to the landfill, respectively. This assessment was conducted to provide environmental constituent data to Fort Gordon pursuant to requirements of the Resource Conservation and Recovery Act Part B Hazardous Waste Permit process. Results from the hyporheic-zone assessment in the unnamed tributary adjacent to the study area indicated that total petroleum hydrocarbons and octane were the most frequently detected organic compounds in groundwater beneath the creek bed. The highest concentrations for these compounds were detected in the upstream samplers of the hyporheic-zone study area. The effort to delineate landfill activity in the study area focused on the western 14 acres of the 75-acre study area where the hyporheic-zone study identified the highest concentrations of organic compounds. This also is the part of the study area where a debris field also was identified in the southern part of the 14 acres. The southern part of this 14-acre study area, including the debris field, is steeper and not as heavily wooded, compared to the central and northern parts. Fifty-two soil-gas samplers were used for the July 2010 soil-gas survey in the 14-acre study area and mostly detected total petroleum hydrocarbons, and gasoline and diesel compounds. The highest soil-gas masses for total petroleum hydrocarbons, diesel compounds, and the only valid detection of perchloroethene

Ecological Baseline, Fort Hood, Texas

Science.gov (United States)

1980-08-01

cedar eTm (Uiimus crassifolia), Texas ash (Fraxinus texansis), and Texas persimmon ( Diospyros texana). Conversely, the two predominant tree species...Ilex decidua), Mex- ican buckeye (Ungnadia spjeciosa), and Texas persimmon ( Diospyros texana). Vines included greenbrier (Smilax bona-nox) and white...Hedgehey Cactus (Echinocereus sp.) has been observed on Fort Hood. Due to the brief period of flowering for this genus , the individual species were not

Fort Davis National Historic Site : acoustical monitoring

Science.gov (United States)

2013-06-01

During the summer of 2010 (September - October 2010), the Volpe Center collected baseline acoustical data at Fort Davis National Historic Site (FODA)at two sites deployed for approximately 30 days each. The baseline data collected during this period ...

Project Octo-Pills - A practice model engaging community pharmacists in the care of patients from a tertiary hospital.

Science.gov (United States)

Ong, Kheng Yong; Chung, Wing Lam; Mamun, Kaysar; Chen, Li Li

2017-10-13

Even while pharmacy practice evolves to a more patient-centric mode of practice, local hospitals, due to high patient load as well as space and resource constraints, find it challenging to conduct thorough medication review and physical medication reconciliation for all patients. In light of this, optimizing the local current healthcare system to involve community pharmacists in the care of patients from public hospitals could potentially better cater to the healthcare needs of the older population. Due to easy accessibility, community pharmacies are often the first point of contact in the healthcare system. Project Octo-Pills aims to engage community pharmacists in the collaborative care of patients from a tertiary hospital, providing patients with quality medication reconciliation and review services from a more convenient location within their neighborhood. This paper describes the model for this pilot initiative. Copyright © 2017 Elsevier Inc. All rights reserved.

Electricity Generation from Geothermal Resources on the Fort Peck Reservation in Northeast Montana

Energy Technology Data Exchange (ETDEWEB)

Carlson, Garry J. [Gradient Geophysics Inc., Missoula, MT (United States); Birkby, Jeff [Birkby Consulting LLC, Missoula, MT (United States)

2015-05-12

Tribal lands owned by Assiniboine and Sioux Tribes on the Fort Peck Indian Reservation, located in Northeastern Montana, overlie large volumes of deep, hot, saline water. Our study area included all the Fort Peck Reservation occupying roughly 1,456 sq miles. The geothermal water present in the Fort Peck Reservation is located in the western part of the Williston Basin in the Madison Group complex ranging in depths of 5500 to 7500 feet. Although no surface hot springs exist on the Reservation, water temperatures within oil wells that intercept these geothermal resources in the Madison Formation range from 150 to 278 degrees F.

Technical evaluation report of the Fort St. Vrain final draft upgraded technical specifications

International Nuclear Information System (INIS)

Kimura, C.Y.

1989-01-01

This report is a technical evaluation of the final draft of the Fort St. Vrain (FSV) Upgraded Technical Specifications (UT/S) as issued by Public Service of Colorado (PSC) on May 27, 1988 with subsequent supplemental updates issued on June 15, 1988 and August 5, 1988. It has been compared for consistency, and safety conservatism with the Fort St. Vrain (FSV) Updated Final Safety Analysis Report (FSAR), the FSV Safety Evaluation Report (SER), the Facility Operating License, DPR-34, and all amendments to the Facility Operating License issued as of June 1, 1988, and Appendix A to the Operating License DPR-34, Technical Specifications. Because of the age of the plant, no supplements to the Fort St. Vrain SER have been issued since the original SER was not issued as a WASH or a NUREG report. This made it necessary to review all amendments to the Facility Operating License since they would contain the safety evaluations done to support changes to the Facility Operating License. The upgraded Fort St. Vrain Technical Specifications were also broadly compared with the latest Westinghouse Standard Technical Specifications (WSTS) to assure that what was proposed for Fort St. Vrain was consistent with the latest NRC staff practices for standard technical specifications

Fox Chase Network: Fox Chase Cancer Center's community hospital affiliation program.

Science.gov (United States)

Higman, S A; McKay, F J; Engstrom, P F; O'Grady, M A; Young, R C

2000-01-01

Fox Chase Cancer Center developed a format for affiliation with community providers in 1986. Fox Chase Network was formed to establish hospital-based community cancer centers to increase access to patients involved in clinical research. Under this program, the Fox Chase Network now contributes 500 patients per year to prevention and clinical research studies. As relationships with community providers form, patient referrals have increased at Fox Chase Cancer Center and for each Fox Chase Network member. A dedicated staff is required to operate the central office on a day-to-day basis as well as at each affiliate. We have found this to be a critical element in each program's success. New challenges in the cancer business-increasing volumes with declining revenue-have caused us to reconfigure the services offered to affiliates, while maintaining true to our mission: to reduce the burden of human cancer.

A Business Case Analysis of the Special Care Unit at Moncrief Army Community Hospital

National Research Council Canada - National Science Library

Unruh, Charles

2002-01-01

The goal of this project is to develop and evaluate four courses of action (COA) in order to determine the most efficient and effective method to care for Moncrief Army Community Hospitals Special Care Unit (SCU) inpatients...

Transitions from hospital to community care: the role of patient-provider language concordance.

Science.gov (United States)

Rayan, Nosaiba; Admi, Hanna; Shadmi, Efrat

2014-01-01

Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients' discharge from hospital to community care, specifically examining the relationship between patient-provider language concordance and the quality of transitional care. This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0-100 scale)) and on the primary-care post-discharge visit. Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient-provider language concordance was present in 49% of minority patients' discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

Fortælleværksteder

DEFF Research Database (Denmark)

Krøjer, Jo; Hutters, Camilla

2009-01-01

Unges valg af videregående uddannelse er omgærdet af forventninger. Forventninger til hvad man skal vælge. Forventninger til hvor lang tid, man skal være om at tage en uddannelse. Og forventninger til, hvad uddannelsen skal føre til. Artiklen præsenterer fortælleværkstedet, en metode til kollekti...... refleksioner over egne og adres forventninger til og tanker om uddannelsesvalg....

Microvascular free-flap reconstruction of a large defect of the scalp. Experience in a community hospital

International Nuclear Information System (INIS)

Singer, J.B.; Gulin, S.P.; Needham, C.W.

1990-01-01

The authors present a patient who had postradiation necrosis of the skull and scalp measuring over 300 cm square which was reconstructed with a free latissimus dorsi muscle flap with overlying skin grafts. The procedure was performed in a community hospital with a team comprising two plastic surgeons and a neurosurgeon, with backup from physicians assistants and nursing staff. The successful outcome of this procedure was a direct result of the concerted effort of the surgical team. We believe that microvascular free-flap reconstruction, although a complicated procedure, can be performed at the community hospital as long as appropriate measures for the care of the patient are planned and carried out

77 FR 58354 - Bend-Fort Rock Ranger District; Oregon; Withdrawal of Notice for Preparation of an Environmental...

Science.gov (United States)

2012-09-20

...-Fort Rock Ranger District; Oregon; Withdrawal of Notice for Preparation of an Environmental Impact... Administration, USDOT. ACTION: Notice of withdrawal. SUMMARY: The Bend-Fort Rock Ranger District and FHWA are..., Project Leader, Bend- Fort Rock Ranger District, 63095 Deschutes Market Road, Bend, OR 97701, phone 541...

Describing the continuum of collaboration among local health departments with hospitals around the community health assessments.

Science.gov (United States)

Wilson, Kristin D; Mohr, Lisa Buettner; Beatty, Kate E; Ciecior, Amanda

2014-01-01

Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through the Public Health Accreditation Board. Tax exempt hospitals must perform a community health needs assessment (CHNA), similar to the community health assessment (CHA) required for LHDs. These efforts have led to a renewed interest in hospitals and LHDs working together to achieve common goals. The purpose of this study is to gain a better understanding of levels of joint action leading toward collaboration between LHDs and hospitals and describe collaboration around CHAs. Local health departments were selected on the basis of reporting collaboration (n = 26) or unsure about collaboration (n = 29) with local hospitals. Local health departments were surveyed regarding their relationship with local hospitals. For LHDs currently collaborating with a hospital, a collaboration continuum scale was calculated. Appropriate nonparametric tests, chi-squares, and Spearman's rank correlations were conducted to determine differences between groups. A total of 44 LHDs responded to the survey (80.0%). Currently collaborating LHDs were more likely to be interested in accreditation and to refer to their CHA 5 or more times a year compared to the unsure LHDs. In the analysis, a collaboration continuum was created and is positively correlated with aspects of the CHA and CHA process. This study is the first attempt to quantify the level of collaboration between LHDs and hospitals around CHAs. Better understanding of the levels of joint action required may assist LHDs in making informed decisions regarding deployment of resources on the path to accreditation.

Cannon Fire Soon to Accompany Bugle Call at Fort Detrick | Poster

Science.gov (United States)

Beginning June 14, the familiar bugle calls at Fort Detrick will be joined by a special percussion instrument: a cannon. A single cannon shot will be fired on the first note of “Reveille,” which signals the start of each day and is accompanied by the raising of the American flag. “Reveille” sounds at 6:30 a.m. At 5 p.m., Fort Detrick plays “Retreat,” which alerts the post that

Site-Based Budgeting in Fort Worth, Texas.

Science.gov (United States)

Peternick, Lauri; Sherman, Joel

1998-01-01

Examines the Fort Worth Independent School District's decentralized decision-making system through three lenses: a review of site-based decision-making procedures at several schools; an examination of who participates; and stakeholders' perceptions. Some schools operated democratically, significantly including teachers, parents, and community…

Analyzing quality of colorectal cancer care through registry statistics: a small community hospital example.

Science.gov (United States)

Hopewood, Ian

2011-01-01

As the quantity of elderly Americans requiring oncologic care grows, and as cancer treatment and medicine become more advanced, assessing quality of cancer care becomes a necessary and advantageous practice for any facility.' Such analysis is especially practical in small community hospitals, which may not have the resources of their larger academic counterparts to ensure that the care being provided is current and competitive in terms of both technique and outcome. This study is a comparison of the colorectal cancer care at one such center, Falmouth Community Hospital (FCH)--located in Falmouth, Massachusetts, about an hour and a half away from the nearest metropolitan center--to the care provided at a major nearby Boston Tertiary Center (BTC) and at teaching and research facilities across New England and the United States. The metrics used to measure performance encompass both outcome (survival rate data) as well as technique, including quality of surgery (number of lymph nodes removed) and the administration of adjuvant treatments, chemotherapy, and radiation therapy, as per national guidelines. All data for comparison between FCH and BTC were culled from those hospitals' tumor registries. Data for the comparison between FCH and national tertiary/referral centers were taken from the American College of Surgeons' Commission on Cancer, namely National Cancer Data Base (NCDB) statistics, Hospital Benchmark Reports and Practice Profile Reports. The results showed that, while patients at FCH were diagnosed at both a higher age and at a more advanced stage of colorectal cancer than their BTC counterparts, FCH stands up favorably to BTC and other large centers in terms of the metrics referenced above. Quality assessment such as the analysis conducted here can be used at other community facilities to spotlight, and ultimately eliminate, deficiencies in cancer programs.

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

Science.gov (United States)

Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

2017-12-01

To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day

Construction experience on PCRV liners at Fort St. Vrain

International Nuclear Information System (INIS)

Cliff, J.O.; Wunderlich, R.G.

1976-01-01

The construction of the steel liners for the Fort St. Vrain prestressed concrete reactor vessel presented many unique problems for which techniques were developed to satisfy the rigid specification requirements. The PCRV cavity liner was fabricated from 1.9cm carbon steel plate. The liners were partially fabricated by Pittsburgh-Des Moines Steel Company at their Pittsburgh manufacturing facility. The liners were then shipped by rail to within approximately five miles of the jobsite and then trucked the remaining distance. The construction techniques, dimensional control, concrete support and testing utilized on the Fort St. Vrain project are presented in detail and demonstrate the flexibility of the PCRV for field construction. (author)

The Community Intervention Team as a means of Improving the transition from hospital to home for patients

OpenAIRE

Kearns, Michelle; Curran, Margaret; Collier, Dorcas; Burke, Mary; Lawler, Michelle

2017-01-01

Introduction: Too frequently patients are discharged from hospital to their home without local support from healthcare professionals. Without this support patients are often readmitted to hospital unnecessarily.Short description of practice change implemented: Networked Community intervention team (CIT) services make a unique contribution in facilitating the transition between hospital and home.Aim and theory of change: The aim is to facilitate early discharge from an acute setting, providing...

Development of an Orientation Program for Mid-level Managers at a Rural Civilian Community Hospital

National Research Council Canada - National Science Library

Mullarkey, David

1998-01-01

This study's focus was to identify perceived orientation and management development needs of department directors and middle managers at a mid-size, not-for-profit community hospital in Beaufort. south Carolina...

A mixed-methods approach to conducting Internal Revenue Service-compliant community health needs assessments: a case example for nonprofit hospital leaders

Directory of Open Access Journals (Sweden)

Oglesby WH

2014-10-01

Full Text Available Willie H Oglesby, Ken Slenkovich Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA Background: The Patient Protection and Affordable Care Act created new requirements for nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA at least once every 3 years, with a significant tax penalty for noncompliance. While some resources exist to help nonprofit hospital leaders conduct various aspects of a CHNA, few reflect the new Internal Revenue Service requirements. Methods: Many different models of CHNAs have emerged over the years. Although each has its unique features, the essential elements of a CHNA include engaging stakeholders, defining the community, gathering sufficient representative data, prioritizing information, and reporting results. In this paper, we expand upon this basic approach by offering a practical step-by-step guide to conducting CHNAs that meets new Internal Revenue Service regulations. Results: We developed and tested this methodology in partnership with several nonprofit hospital systems in Northeast Ohio, USA. In this paper, we discuss our use of the methodology and identify recommendations for other nonprofit hospital leaders. Conclusion: The methodology presented in this paper is a cost-effective approach to satisfying new CHNA requirements and nonprofit hospital leaders should consider using it or modifying it to fit their unique needs. Keywords: Affordable Care Act, CHNA, community benefit, community hospital

A comparison of hospital- and community-based mental health nurses: perceptions of their work environment and psychological health.

Science.gov (United States)

Fielding, J; Weaver, S M

1994-06-01

This study compares hospital- (n = 67) and community-based (n = 55) mental health nurses in relation to their perceptions of the work environment and also their psychological health. Measures include: the General Health Questionnaire, the Maslach Burnout Inventory and the Work Environment Scale. The data, obtained from self-returned questionnaires, show that community nurses rated their work environments higher for the dimensions of Involvement, Supervisor Support, Autonomy, Innovation and Work Pressure. Hospital nurses saw their environments as being higher in (managerial) Control. There were no differences between the groups for the dimensions of Peer Cohesion, Task Orientation, Clarity or (physical) Comfort. Furthermore, there were no overall differences between the two groups in relation to psychological health, although the pattern of factors associated with emotional well-being differed. Finally, analyses of the community data revealed that those nurses with 'flexitime' arrangements evaluated their work environments less positively and showed higher levels of psychological strain than did those working 'fixed-time' schedules. The findings suggest that the hospital and community environments make different demands on nursing staff, and that this should be considered when organizing nursing services if stress is to be avoided.

A Growing Opportunity: Community Gardens Affiliated with US Hospitals and Academic Health Centers.

Science.gov (United States)

George, Daniel R; Rovniak, Liza S; Kraschnewski, Jennifer L; Hanson, Ryan; Sciamanna, Christopher N

Community gardens can reduce public health disparities through promoting physical activity and healthy eating, growing food for underserved populations, and accelerating healing from injury or disease. Despite their potential to contribute to comprehensive patient care, no prior studies have investigated the prevalence of community gardens affiliated with US healthcare institutions, and the demographic characteristics of communities served by these gardens. In 2013, national community garden databases, scientific abstracts, and public search engines (e.g., Google Scholar) were used to identify gardens. Outcomes included the prevalence of hospital-based community gardens by US regions, and demographic characteristics (age, race/ethnicity, education, household income, and obesity rates) of communities served by gardens. There were 110 healthcare-based gardens, with 39 in the Midwest, 25 in the South, 24 in the Northeast, and 22 in the West. Compared to US population averages, communities served by healthcare-based gardens had similar demographic characteristics, but significantly lower rates of obesity (27% versus 34%, p gardens are located in regions that are demographically representative of the US population, and are associated with lower rates of obesity in communities they serve.

Detection of CTX-M-15 beta-lactamases in Enterobacteriaceae causing hospital- and community-acquired urinary tract infections as early as 2004, in Dar es Salaam, Tanzania.

Science.gov (United States)

Manyahi, Joel; Moyo, Sabrina J; Tellevik, Marit Gjerde; Ndugulile, Faustine; Urassa, Willy; Blomberg, Bjørn; Langeland, Nina

2017-04-17

The spread of Extended Spectrum β-lactamases (ESBLs) among Enterobacteriaceae and other Gram-Negative pathogens in the community and hospitals represents a major challenge to combat infections. We conducted a study to assess the prevalence and genetic makeup of ESBL-type resistance in bacterial isolates causing community- and hospital-acquired urinary tract infections. A total of 172 isolates of Enterobacteriaceae were collected in Dar es Salaam, Tanzania, from patients who met criteria of community and hospital-acquired urinary tract infections. We used E-test ESBL strips to test for ESBL-phenotype and PCR and sequencing for detection of ESBL genes. Overall 23.8% (41/172) of all isolates were ESBL-producers. ESBL-producers were more frequently isolated from hospital-acquired infections (32%, 27/84 than from community-acquired infections (16%, 14/88, p Enterobacteriaceae causing both hospital- and community-acquired infections in Tanzania.

Seasonal variation and trends in stroke hospitalizations and mortality in a South American community hospital.

Science.gov (United States)

Díaz, Alejandro; Gerschcovich, Eliana Roldan; Díaz, Adriana A; Antía, Fabiana; Gonorazky, Sergio

2013-10-01

Numerous studies have reported the presence of temporal variations in biological processes. Seasonal variation (SV) in stroke has been widely studied, but little data have been published on this phenomenon in the Southern Hemisphere, and there have been no studies reported from Argentina. The goals of the present study were to describe the SV of admissions and deaths for stroke and examine trends in stroke morbidity and mortality over a 3-year period in a community hospital in Argentina. Hospital discharge reports from the electronic database of vital statistics between 1999 and 2001 were examined retrospectively. Patients who had a main discharge diagnosis of stroke (ischemic or hemorrhagic) or cerebrovascular accident (International Classification of Diseases, Ninth Revision codes 431, 432, 434, and 436) were selected. The study sample included 1382 hospitalizations by stroke (3.5% of all admissions). In-hospital mortality demonstrated a winter peak (25.5% vs 17% in summer; P = .001). The crude seasonal stroke attack rate (ischemic and hemorrhagic) was highest in winter (164 per 100,000 population; 95% CI, 159-169 per 100,000) and lowest in summer (124 per 100,000; 95% CI, 120-127 per 100,000; P = .008). Stroke admissions followed a seasonal pattern, with a winter-spring predominance (P = .008). Our data indicate a clear SV in stroke deaths and admissions in this region of Argentina. The existence of SV in stroke raises a different hypothesis about the rationale of HF admissions and provides information for the organization of care and resource allocation. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China.

Science.gov (United States)

Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao

2018-03-22

Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

77 FR 9960 - Final Environmental Impact Statement for Extension of F-Line Streetcar Service to Fort Mason...

Science.gov (United States)

2012-02-21

... Environmental Impact Statement for Extension of F-Line Streetcar Service to Fort Mason Center, San Francisco, CA... Environmental Impact Statement for the Extension of F-Line Streetcar Service to Fort Mason Center, San Francisco... the extension of the historic streetcar F-line from Fisherman's Wharf to the Fort Mason Center, in San...

The Sewol Ferry Disaster: Experiences of a Community-Based Hospital in Ansan City.

Science.gov (United States)

Park, Jong-Hak; Cho, Hanjin; Kim, Joo Yeong; Song, Joo-Hyun; Moon, Sungwoo; Cha, Sang Hoon; Choi, Byung-Min; Han, Chang-Su; Ko, Young-Hoon; Lee, Hongjae

2017-06-01

The Sewol ferry disaster is one of the most tragic events in Korea's modern history. Among the 476 people on board, which included Danwon High School students (324) and teachers (14), 304 passengers died in the disaster (295 recovered corpses and 9 missing) and 172 survived. Of the rescued survivors, 72 were attending Danwon High School, located in Ansan City, and residing in a residence nearby. Because the students were young, emotionally susceptible adolescents, both the government and the parents requested the students be grouped together at a single hospital capable of appropriate psychiatric care. Korea University Ansan Hospital was the logical choice, as the only third-tier university-grade hospital with the necessary faculty and facilities within the residential area of the families of the students. We report the experiences and the lessons learned from the processes of preparing for and managing the surviving young students as a community-based hospital. (Disaster Med Public Health Preparedness. 2017;11:389-393).

BRAND EQUITY OF LAHORE FORT AS A TOURISM DESTINATION BRAND

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Muhammad Kashif

2015-06-01

Full Text Available Studies that measure the brand equity of destination brands by using the Customer-Based Brand Equity (CBBE model in a developing country context are scarce. The present study investigates the destination brand equity of the Lahore Fort by employing the CBBE model in a developing country context of Pakistan. Following the positivist tradition, we adopted a survey-based approach to collect data from 237 tourists visiting the Lahore Fort. Data were collected through a questionnaire developed to explain the relationship of brand awareness, brand image, brand association, and brand loyalty with Lahore Fort’s overall brand equity. We used various robust statistical techniques such as correlation, regression and confirmatory factor analysis (using PLS method to reach meaningful conclusions and found that brand image and brand associations positively contribute to brand loyalty. Furthermore, brand loyalty significantly contributes towards overall brand equity. Pragmatically, this study measures the customer based brand equity of the Lahore Fort, a destination brand. The results are useful as they suggest a few strategies that can help policy makers to enhance Lahore Fort’s brand performance.

National Training Center Fort Irwin expansion area aquatic resources survey

Energy Technology Data Exchange (ETDEWEB)

Cushing, C.E.; Mueller, R.P.

1996-02-01

Biologists from Pacific Northwest National Laboratory (PNNL) were requested by personnel from Fort Irwin to conduct a biological reconnaissance of the Avawatz Mountains northeast of Fort Irwin, an area for proposed expansion of the Fort. Surveys of vegetation, small mammals, birds, reptiles, amphibians, and aquatic resources were conducted during 1995 to characterize the populations and habitats present with emphasis on determining the presence of any species of special concern. This report presents a description of the sites sampled, a list of the organisms found and identified, and a discussion of relative abundance. Taxonomic identifications were done to the lowest level possible commensurate with determining the status of the taxa relative to its possible listing as a threatened, endangered, or candidate species. Consultation with taxonomic experts was undertaken for the Coleoptera ahd Hemiptera. In addition to listing the macroinvertebrates found, the authors also present a discussion related to the possible presence of any threatened or endangered species or species of concern found in Sheep Creek Springs, Tin Cabin Springs, and the Amargosa River.

Comparison of maxillary stability after Le Fort I osteotomy for occlusal cant correction surgery and maxillary advanced surgery.

Science.gov (United States)

Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Yoshida, Kan; Shimizu, Chika; Nakagawa, Kiyomasa; Yamamoto, Etsuhide

2007-07-01

To compare postoperative maxillary stability following Le Fort I osteotomy for the correction of occlusal cant as compared with conventional Le Fort I osteotomy for maxillary advancement. The subjects were 40 Japanese adults with jaw deformities. Of these, 20 underwent a Le Fort I osteotomy and intraoral vertical ramus osteotomy (IVRO) to correct asymmetric skeletal morphology and inclined occlusal cant. The other 20 patients underwent a Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO) to advance the maxilla. Lateral and posteroanterior cephalograms were taken postoperatively and assessed statistically. Thereafter, the 2 groups were followed for time-course changes. There was no significant difference between the 2 groups with regard to time-course changes during the immediate postoperative period. This suggests that maxillary stability after Le Fort I osteotomy for cant correction does not differ from that after Le Fort I osteotomy for maxillary advancement.

Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia

DEFF Research Database (Denmark)

Andersen, Stine Bang; Baunbæk Egelund, Gertrud Louise; Jensen, Andreas Vestergaard

2017-01-01

BACKGROUND: C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during hospitaliza......BACKGROUND: C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during...... hospitalization could improve management and ultimately reduce mortality levels. The aim of this study was to evaluate CRP on the 3rd day (CRP3) of hospitalization as a predictor for 30 days mortality. METHODS: A retrospective multicentre cohort study of adult patients admitted with CAP at three Danish hospitals....... Predictive associations of CRP3 (absolute levels and relative decline) and 30 days mortality were analysed using receiver operating characteristics and logistic regression. RESULTS: Eight hundred and fourteen patients were included and 90 (11%) died within 30 days. The area under the curve for CRP3 level...

Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

DEFF Research Database (Denmark)

Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

2010-01-01

is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... rebleeding were not statistically different. CONCLUSION: Our study shows that patients with BOV are more likely to receive therapy according to guidelines when hospitalized in a specialized unit compared with a community hospital. This however did not affect mortality.......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...

Feltarbejde i Thule. Sammenfiltringen af steder, folk og fortællinger

Directory of Open Access Journals (Sweden)

Kirsten Hastrup

2016-07-01

Full Text Available På baggrund af lang tids arbejde i Thuleregionen i det nordvestligste Grønland vil jeg diskutere, hvordan steder, folk og fortællinger gensidigt former hinanden. ’Felten’ er således formateret af mange forhold, historiske og nutidige, naturlige og kulturelle, og man må besinde sig på feltens flydende form, selv når den ser mest solid ud. Steder er i sig selv flygtige; de opstår i mødet med mennesker, som tillægger dem betydning. Folk kan se nok så traditionelle ud, men de lever i samme verden som antropologen, der kommer for at lære af dem. Endelig er fortællingerne ikke stivnede vidnesbyrd om tidligere tider; de er tværtimod et vigtigt redskab i håndteringen af højst nutidige udfordringer, som kommer til syne i det endnu ufortalte. Bag fortællingen om Thule ligger en større diskussion af enhver felts plasticitet.

Smithsonian Marine Station (SMS) at Fort Pierce

Science.gov (United States)

share current Smithsonian research on the plants and animals of the Indian River Lagoon and marine Smithsonian Marine Station at Fort Pierce Website Search Box Search Field: SMS Website Search Twitter SMS Home › Welcome to the Smithsonian Marine Station Homepage slideshow Who We Are... The

Organizational culture: an important context for addressing and improving hospital to community patient discharge

NARCIS (Netherlands)

Hesselink, G.J.; Vernooij-Dassen, M.J.F.J.; Pijnenborg, L.; Barach, P.; Gademan, P.; Dudzik-Urbaniak, E.; Flink, M.; Orrego, C.; Toccafondi, G.; Johnson, J.K.; Schoonhoven, L.; Wollersheim, H.C.H.; et al.,

2013-01-01

BACKGROUND: Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. OBJECTIVES: To explore aspects of organizational culture to develop a deeper understanding of the discharge

Barriers for nutritional care in the transition from hospital to the community among older patients.

Science.gov (United States)

Ginzburg, Yulia; Shmilovitz, Inbar; Monastyrsky, Nechama; Endevelt, Ronit; Shahar, Danit R

2018-06-01

Data on the continuity of nutritional care in the transition from the hospital to the community is scarce although its impact on medical complications is highly significant. The aim of the current study is to determine level of adherence to dietary recommendations after hospitalization and identify barriers for adherence. A prospective study among patients age ≥65 who were treated with oral nutritional supplements (ONS) during their hospitalization and discharged with dietary recommendations. Data was obtained in the hospital and at a 3-month home-visit. Adherence was assessed monthly and barriers for non-adherence were determined. Adherence levels were summed for 3 months and then divided into: 1. Full adherence: complete consumption as prescribed; 2. Partial adherence: partial consumption of the prescription [at least half]; or 3. No adherence: not consumed or less than half. Health-status was obtained from medical records; nutritional-status using anthropometric measurements, depressive symptoms using GDS [Geriatric Depression Scale], and functional abilities using FIM [Functional Independence Measure] were determined. Dietary intake was assessed by 24-h recall. Eighty-six patients were recruited (56 women) and followed for 3-months after discharge; 47.7% were advised in their discharge letter to consume at least one liquid ONS daily, 29% daily powder ONS, and 23.3% were advised to consume both. Adherence with liquid ONS was significantly higher among both groups, p nutritional supplements. In a regression model patients who were edentulous (OR = 9.13), with more depression symptoms (OR = 5.12), or lower BMI (OR = 1.13) were significantly more likely to adhere to ONS than patients with full dentition, fewer depression symptoms, and higher BMI. Providing a prescription for ONS by a primary care physician was a significant predictor [OR = 4.7] for adherence. Our results show low adherence to nutritional treatment in the community. Improving hospital-community

RadNet Air Data From Fort Smith, AR

Science.gov (United States)

This page presents radiation air monitoring and air filter analysis data for Fort Smith, AR from EPA's RadNet system. RadNet is a nationwide network of monitoring stations that measure radiation in air, drinking water and precipitation.

Inpatient Obstetric Care at Irwin Army Community Hospital: A Study to Determine the Most Efficient Organization

National Research Council Canada - National Science Library

Bergeron, Timothy

2001-01-01

This study attempts to compare, analyze, and recommend the most efficient model with which to deliver inpatient obstetrics and gynecological services to the served population of Irwin Army Community Hospital...

Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.

Science.gov (United States)

Simon, Steven R; Keohane, Carol A; Amato, Mary; Coffey, Michael; Cadet, Bismarck; Zimlichman, Eyal; Bates, David W

2013-06-24

Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions

COMPARISON OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS IN HEALTHY COMMUNITY HOSPITAL VISITORS[CA-MRSA] AND HOSPITAL STAFF [HA-MRSA

Directory of Open Access Journals (Sweden)

Nirmal A Pathare

2015-10-01

Full Text Available Background: The prevalence of community associated methicillin resistant Staphylococcus aureus [CA-MRSA] in unknown in Oman. Methods: Nasal and cell phones swabs were collected from hospital visitors and health-care workers on sterile polyester swabs and directly inoculated onto a mannitol salt agar containing oxacillin, allowing growth of methicillin-resistant microorganisms. Antibiotic susceptibility tests were performed using Kirby Bauer’s disc diffusion method on the isolates. A brief survey questionnaire was requested be filled to ascertain the exposure to known risk factors for CA-MRSA carriage. Results: Overall, nasal colonization with CA-MRSA was seen in 34 individuals (18%, 95% confidence interval [CI] =12.5%-23.5%, whereas, CA-MRSA was additionally isolated from the cell phone surface in 12 participants (6.3%, 95% CI =5.6%-6.98%. Nasal colonization prevalence with HA-MRSA was seen in 16 individuals (13.8%, 95% confidence interval [CI] =7.5%-20.06%, whereas, HA-MRSA was additionally isolated from the cell phone surface in 3 participants (2.6%, 95% CI =1.7-4.54.  Antibiotic sensitivity was 100% to linezolid and rifampicin in the CA-MRSA isolates. Antibiotic resistance to vancomycin and clindamycin varied between 9-11 % in the CA-MRSA isolates.  There was no statistically significant correlation between CA-MRSA nasal carriage and the risk factors (P>0.05, Chi-square test. Conclusions: The prevalence of CA-MRSA in the healthy community hospital visitors was 18 % (95% CI, 12.5% to 23.5% as compared to 13.8% [HA-MRSA] in the hospital health-care staff. In spite of a significant prevalence of CA-MRSA, these strains were mostly sensitive. Recommendation the universal techniques of hand washing, personal hygiene and sanitation are thus warranted.

Antiretroviral treatment for HIV in rural Uganda: two-year treatment outcomes of a prospective health centre/community-based and hospital-based cohort.

Directory of Open Access Journals (Sweden)

Walter Kipp

Full Text Available In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART. We tested the utility of a health centre (HC/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL after two years of treatment. Adherence was determined through weekly pill counts.Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospital-based cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p = 0.12, and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560. In multivariate analysis patients in the HC/community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04.Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a

Capital cost reimbursement to community hospitals under Federal health insurance programs.

Science.gov (United States)

Kinney, E D; Lefkowitz, B

1982-01-01

Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

Slaget ved Vejle og andre fortællinger fra Jyske Bank

DEFF Research Database (Denmark)

Albrechtsen, Charlotte

Storytelling som ledelsesværktøj er en form for retorik idet formålet med at bruge fortællinger i kommunikationen fra ledelse til medarbejdere er at påvirke modtagerne/medarbejderne. Imidlertid er refleksioner over modtagerinstansen så godt som fraværende både i den populære debat om storytelling...... og i den eksisterende forskning i emnet. Foruden at introducere til forskningen i storytelling præsenterer artiklens forfatter, som er ph.d.-studerende, en modtagerorienteret analyse af en fortælling fra Jyske Bank....

Diabetes and Prediabetes and Risk of Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study.

Science.gov (United States)

Schneider, Andrea L C; Kalyani, Rita R; Golden, Sherita; Stearns, Sally C; Wruck, Lisa; Yeh, Hsin Chieh; Coresh, Josef; Selvin, Elizabeth

2016-05-01

To examine the magnitude and types of hospitalizations among persons with prediabetes, undiagnosed diabetes, and diagnosed diabetes. This study included 13,522 participants in the Atherosclerosis Risk in Communities (ARIC) study (mean age 57 years, 56% female, 24% black, 18% with prediabetes, 4% with undiagnosed diabetes, 9% with diagnosed diabetes) with follow-up in 1990-2011 for hospitalizations. Participants were categorized by diabetes/HbA1c status: without diagnosed diabetes, HbA1c prediabetes, 5.7 to prediabetes had 1.3 times higher rates of hospitalization than those without diabetes and HbA1c prediabetes are at a significantly elevated risk of hospitalization compared with those without diabetes. Substantial excess rates of hospitalizations in persons with diagnosed diabetes were for endocrine, infection, and iatrogenic/injury causes, which may be preventable with improved diabetes care. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments.

Science.gov (United States)

Nirel, Nurit; Rosen, Bruce; Sharon, Assaf; Blondheim, Orna; Sherf, Michael; Samuel, Hadar; Cohen, Arnon D

2010-09-01

In 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEK's use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals. Examining the frequency of OFEK's use with its own track-log data; comparing, "before" and "after", quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients). OFEK's use increased by tens of percentages each year, Internal Medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests performed compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in General Surgery wards. The study helps evaluate the extent to which OFEK's targets were achieved and contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Low footwall accelerations and variable surface rupture behavior on the Fort Sage Mountains fault, northeast California

Science.gov (United States)

Briggs, Richard W.; Wesnousky, Steven G.; Brune, James N.; Purvance, Matthew D.; Mahan, Shannon

2013-01-01

The Fort Sage Mountains fault zone is a normal fault in the Walker Lane of the western Basin and Range that produced a small surface rupture (L 5.6 earthquake in 1950. We investigate the paleoseismic history of the Fort Sage fault and find evidence for two paleoearthquakes with surface displacements much larger than those observed in 1950. Rupture of the Fort Sage fault ∼5.6  ka resulted in surface displacements of at least 0.8–1.5 m, implying earthquake moment magnitudes (Mw) of 6.7–7.1. An older rupture at ∼20.5  ka displaced the ground at least 1.5 m, implying an earthquake of Mw 6.8–7.1. A field of precariously balanced rocks (PBRs) is located less than 1 km from the surface‐rupture trace of this Holocene‐active normal fault. Ground‐motion prediction equations (GMPEs) predict peak ground accelerations (PGAs) of 0.2–0.3g for the 1950 rupture and 0.3–0.5g for the ∼5.6  ka paleoearthquake one kilometer from the fault‐surface trace, yet field tests indicate that the Fort Sage PBRs will be toppled by PGAs between 0.1–0.3g. We discuss the paleoseismic history of the Fort Sage fault in the context of the nearby PBRs, GMPEs, and probabilistic seismic hazard maps for extensional regimes. If the Fort Sage PBRs are older than the mid‐Holocene rupture on the Fort Sage fault zone, this implies that current GMPEs may overestimate near‐fault footwall ground motions at this site.

Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study.

Science.gov (United States)

Girard, Timothy D; Self, Wesley H; Edwards, Kathryn M; Grijalva, Carlos G; Zhu, Yuwei; Williams, Derek J; Jain, Seema; Jackson, James C

2018-06-01

Recent studies suggest older patients hospitalized for community-acquired pneumonia are at risk for new-onset cognitive impairment. The characteristics of long-term cognitive impairment after pneumonia, however, have not been elucidated. To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia. Prospective cohort study. Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia. At enrollment, we estimated baseline cognitive function with the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). At 2- and 12-month follow-up, we assessed cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and tests of executive function, diagnosing cognitive impairment when results were ≥ 1.5 standard deviations below published age-adjusted means for the general population. We also identified subtypes of mild cognitive impairment using standard definitions. We assessed 58 (73%) of 80 patients who survived to 2-month follow-up and 57 (77%) of 74 who survived to 12-month follow-up. The median [range] age of survivors tested was 57 [19-97] years. Only 8 (12%) had evidence of mild cognitive impairment at baseline according to the Short IQCODE, but 21 (38%) at 2 months and 17 (30%) at 12 months had mild cognitive impairment per the RBANS. Moderate-to-severe cognitive impairment was common among adults ≥ 65 years [4/13 (31%) and 5/13 (38%) at 2 and 12 months, respectively] but also affected many of those cognitive domains affected one-third of patients ≥ 65 years old and 20% of younger patients, and another third of survivors had mild cognitive impairment.

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.

Hospital diversification strategy.

Science.gov (United States)

Eastaugh, Steven R

2014-01-01

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

FORT NAMUTONI: FROM MILITARY STRONGHOLD TO TOURIST ...

African Journals Online (AJOL)

STRONGHOLD TO TOURIST CAMP. Col Dr Jan Ploeger*. "... this fortress was not just a white elephant, it was actually occupied and played a major role in the settlement of Germans in the far North." (own translation) - D.W. Krynauw Die Verhaal van. Namutoni, p 3. Introduction. Fort Namutoni, the last White outpost east of ...

Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

Science.gov (United States)

Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W

2013-07-01

In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.

Determinants for hospitalization in " low-risk" community acquired pneumonia

Directory of Open Access Journals (Sweden)

Aliyu Muktar H

2003-06-01

Full Text Available Abstract Background A variable decision in managing community acquired pneumonia (CAP is the initial site of care; in-patient versus outpatient. These variations persist despite comprehensive practice guidelines. Patients with a Pneumonia Severity Index (PSI score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These patients are generally below the age of fifty years, non-nursing home residents, HIV negative and have no major cardiac, hepatic, renal or malignant diseases. Methods A retrospective analysis of 296 low-risk CAP patients evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All patients were assigned a PSI score. 208 (70% were evaluated and discharged from the emergency department (E.D. to complete outpatient antibiotic therapy, while 88 (30% were hospitalized. Patients were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. Results Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018, African Americans (CI: 0.31-0.73, p= 0.004, insurance coverage (CI: 0.19-0.63, p= 0.0034, temperature (CI: 0.04-0.09, p= 0.0001 and pulse rate (CI: 0.03-0.14, p= 0.0001. No statistically significant differences were observed between the two groups for altered mental status, hypotension, tachypnea, laboratory/radiological parameters and social indicators (p>0.05. The average length of stay for in-patients was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk CAP patients by admitting physicians was less than optimal. Conclusions High fever, tachycardia, female gender

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

Science.gov (United States)

Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

2017-08-01

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

78 FR 28622 - Notice of Approval of Record of Decision for Extending F-Line Streetcar Service to Fort Mason...

Science.gov (United States)

2013-05-15

...] Notice of Approval of Record of Decision for Extending F-Line Streetcar Service to Fort Mason Center... Environmental Impact Statement (Final EIS) for extending the F-Line historic streetcar service to Fort Mason... turnaround terminus at the Fort Mason Center; and installing appurtenant features such as signals, crossings...

Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

LENUS (Irish Health Repository)

Hannon, Niamh

2014-10-30

No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

Directory of Open Access Journals (Sweden)

Alibhai Arif

2011-11-01

Full Text Available Abstract Background Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs. The research This intervention study aimed to; 1 assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi of Uganda; and 2 compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda. Results and outcomes Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda’s Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated. Challenges and successes Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole’s health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the

77 FR 71636 - Huntington Foam LLC, Fort Smith, AR; Notice of Revised Determination on Reconsideration

Science.gov (United States)

2012-12-03

... Smith, AR; Notice of Revised Determination on Reconsideration On August 8, 2012, the Department of Labor... workers and former workers of Huntington Foam LLC, Fort Smith, Arkansas (subject firm). The workers are... reconsideration investigation, I determine that workers of Huntington Foam LLC, Fort Smith, Arkansas, who were...

Magnetic resonance imaging - guided vacuum-assisted breast biopsy: an initial experience in a community hospital

International Nuclear Information System (INIS)

Friedman, P.; Enis, S.; Pinyard, J.

2009-01-01

To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. (author)

Magnetic resonance imaging - guided vacuum-assisted breast biopsy: an initial experience in a community hospital

Energy Technology Data Exchange (ETDEWEB)

Friedman, P.; Enis, S.; Pinyard, J., E-mail: jpinyard@gmail.com [Morristown Memorial Hospital, The Carol W. and Julius A. Rippel Breast Center, The Carol G. Simon Cancer Centre, Morristown, New Jersey (United States)

2009-10-15

To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. (author)

Adherence to guidelines in bleeding oesophageal varices and effects on outcome: comparison between a specialized unit and a community hospital

DEFF Research Database (Denmark)

Hobolth, Lise; Krag, Aleksander; Malchow-Møller, Axel

2010-01-01

OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice is diffi......OBJECTIVES: Randomized controlled trials have shown beneficial effects of vasoactive drugs, endoscopic treatment and prophylactic antibiotics on the outcome of bleeding oesophageal varices (BOV). However, translating guidelines based on randomized controlled trials into clinical practice...... is difficult. Our aims were to compare adherence to evidence-based guidelines in BOV between a specialized unit and a community hospital, and to investigate whether differences in adherence affected the outcome. METHODS: Two cohorts hospitalized during 2000-2007 with a first episode of BOV were retrospectively...... enrolled, one in a community hospital comprising 66 patients and one in a specialized unit comprising 111 patients. Data on treatment, rebleeding and mortality were collected from medical records according to the Baveno III/IV Criteria. RESULTS: Treatments in the specialized unit versus the community...

Maxillary distraction osteogenesis at Le Fort-I level induces bone apposition at infraorbital rim.

Science.gov (United States)

Rattan, Vidya; Jena, Ashok Kumar; Singh, Satinder Pal; Utreja, Ashok Kumar

2014-09-01

The aim of this study is to evaluate whether there is any remodeling of bone at infraorbital rim following maxillary distraction osteogenesis (DO) at Le Fort-I level. Twelve adult subjects in the age range of 17-21 years with complete unilateral cleft lip and palate underwent advancement of the maxilla by DO. The effect of maxillary DO on the infraorbital rim remodeling was evaluated from lateral cephalograms recorded prior to the DO (T0), at the end of DO (T1), and at least 2-years after the DO (T2) by Walker's analysis. The ANOVA and two-tailed t test were used and probability value (P value) 0.05 was considered as statistically significant level. There was anterior movement of maxilla by 9.22 ± 3.27 mm and 7.67 ± 3.99 mm at the end of immediate (T1) and long-term (T2) follow-up of maxillary DO, respectively. The Walker's analysis showed 1.49 ± 1.22 mm and 2.31 ± 1.81 mm anterior movement of the infraorbital margin (Orbitale point) at the end of T1 and T2, respectively (P distraction osteogenesis at Le Fort-I level induced significant bone apposition at infraorbital rim. Patients with mild midface hypoplasia who would otherwise may be candidates for osteotomy at Le Fort-II or Le Fort-III level may benefit from maxillary distraction at Le Fort-I level.

Pentraxin-3 level at admission is a strong predictor of short-term mortality in a community-based hospital setting

DEFF Research Database (Denmark)

Bastrup-Birk, S; Munthe-Fog, L; Skjødt, Mikkel-Ole

2015-01-01

hospital setting is unknown. PATIENTS AND METHODS: The study cohort consisted of 1326 unselected, consecutive patients (age >40 years) admitted to a community hospital in Copenhagen, Denmark. Patients were followed until death or for a median of 11.5 years after admission. The main outcome measure was all...

Mucormycosis in two community hospitals and the role of infectious disease consultation: a case series

Directory of Open Access Journals (Sweden)

Dai Y

2013-10-01

Full Text Available Yue Dai,1 James W Walker,1 Ruba A Halloush,2 Faisal A Khasawneh3 1Department of Internal Medicine, Texas Tech University Health Sciences Center, 2Amarillo Pathology Group, 3Section of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA Background: Mucorales are ubiquitous filamentous fungi that can cause a devastating, invasive infection. This order has become an increasingly important pathogen during the last two decades, due to the dramatic increase in patients with predisposing factors. The aim of this retrospective study was to report the clinical characteristics, therapeutic options, and outcomes of patients diagnosed with mucormycosis in community hospitals in Amarillo, Texas, and to reflect on the role of infectious disease (ID physicians in managing this potentially life-threatening problem. Patients and methods: This was a retrospective chart review of patients hospitalized with mucormycosis in two community hospitals in Amarillo between January 1, 2001 and December 31, 2011. Results: Ten patients were diagnosed with mucormycosis during the study period, with a mean age of 58.8 years. There were five cases of pulmonary infection, two cases of cutaneous infection, two cases of rhinocerebral infection, and one case of gastrointestinal infection. Poorly controlled diabetes was the most common risk factor, identified in six patients, followed by hematological malignancy, immunosuppression, and trauma. ID physicians were consulted in all cases, albeit late in some cases. Nine patients received antifungal therapy, and five patients received surgical debridement. Lipid formulations of amphotericin B were prescribed for eight patients, used alone in two cases, and combined with caspofungin and posaconazole in one and five cases, respectively. One patient was treated with posaconazole alone. Eight patients were discharged from the hospital alive. The mortality rate at 6-month

Wood-Fired Boiler System Evaluation at Fort Stewart, GA

National Research Council Canada - National Science Library

Potts, Noel

2002-01-01

Part of the plan to modernize the central energy plant (CEP) at Fort Stewart, GA is focused on the installations wood-fired boiler, which provides steam for heating, cooling, and domestic hot water. The U.S...

Von Braun Rocket Team at Fort Bliss, Texas

Science.gov (United States)

1940-01-01

The German Rocket Team, also known as the Von Braun Rocket Team, poses for a group photograph at Fort Bliss, Texas. After World War II ended in 1945, Dr. Wernher von Braun led some 120 of his Peenemuende Colleagues, who developed the V-2 rocket for the German military during the War, to the United Sttes under a contract to the U.S. Army Corps as part of Operation Paperclip. During the following five years the team worked on high altitude firings of the captured V-2 rockets at the White Sands Missile Range in New Mexico, and a guided missile development unit at Fort Bliss, Texas. In April 1950, the group was transferred to the Army Ballistic Missile Agency (ABMA) at Redstone Arsenal in Huntsville, Alabama, and continued to work on the development of the guided missiles for the U.S. Army until transferring to a newly established field center of the National Aeronautic and Space Administration (NASA), George C. Marshall Space Flight Center (MSFC).

The evaluation of a 4000-home geothermal heat pump retrofit at Fort Polk, Louisiana: Final Report

Energy Technology Data Exchange (ETDEWEB)

Hughes, P.J.; Shonder, J.A.

1998-03-01

This report documents an independent evaluation of an energy retrofit of 4,003 family housing units at Fort Polk, Louisiana, under an energy savings performance contract (ESPC). Replacement of the heating, cooling, and water heating systems in these housing units with geothermal heat pumps (GHPs) anchored the retrofit; low-flow shower heads and compact fluorescent lighting were also installed, as well as attic insulation where needed. Statistically valid findings indicate that the project will save 25.8 million kWh, or 32.5% of the pre-retrofit whole-community electrical consumption, and 100% of the whole-community natural gas previously used for space conditioning and water heating (260,000 therms) in a typical meteorological year. At the end-use level, the GHPs were found to save about 42% of the pre-retrofit electrical consumption for heating, cooling, and water heating in housing units that were all-electric in the pre-retrofit period. This report also demonstrates an improved method of predicting energy savings. Using an engineering model calibrated to pre-retrofit energy use data collected in the field, the method predicted actual energy savings on one of the electric feeders at Fort Polk with a very high degree of accuracy. The accuracy of this model was in turn dependent on data-calibrated models of the geothermal heat pump and ground heat exchanger that are described in this report. In addition this report documents the status of vertical borehole ground heat exchanger (BHEx) design methods at the time this project was designed, and demonstrates methods of using data collected from operating GHP systems to benchmark BHEx design methods against a detailed engineering model calibrated to date. The authors also discuss the ESPC`s structure and implementation and how the experience gained here can contribute to the success of future ESPCs.

Impact of telemedicine on the practice of pediatric cardiology in community hospitals.

Science.gov (United States)

Sable, Craig A; Cummings, Susan D; Pearson, Gail D; Schratz, Lorraine M; Cross, Russell C; Quivers, Eric S; Rudra, Harish; Martin, Gerard R

2002-01-01

Tele-echocardiography has the potential to bring real-time diagnoses to neonatal facilities without in-house pediatric cardiologists. Many neonates in rural areas, smaller cities, and community hospitals do not have immediate access to pediatric sonographers or echocardiogram interpretation by pediatric cardiologists. This can result in suboptimal echocardiogram quality, delay in initiation of medical intervention, unnecessary patient transport, and increased medical expenditures. Telemedicine has been used with increased frequency to improve efficiency of pediatric cardiology care in hospitals that are not served by pediatric cardiologists. Initial reports suggest that telecardiology is accurate, improves patient care, is cost-effective, enhances echocardiogram quality, and prevents unnecessary transports of neonates in locations that are not served by pediatric cardiologists. We report the largest series to evaluate the impact of telemedicine on delivery of pediatric cardiac care in community hospitals. We hypothesized that live telemedicine guidance and interpretation of neonatal echocardiograms from community hospitals is accurate, improves patient care, enhances sonographer proficiency, allows for more efficient physician time management, increases patient referrals, and does not result in increased utilization of echocardiography. Using desktop videoconferencing computers, pediatric cardiologists guided and interpreted pediatric echocardiograms from 2 community hospital nurseries 15 miles from a tertiary care center. Studies were transmitted in real-time using the H.320 videoconferencing protocol over 3 integrated services digital network lines (384 kilobits per second). This resulted in a frame rate of 23 to 30 frames per second. Sonographers who primarily scanned adult patients but had received additional training in echocardiography of infants performed the echocardiograms. Additional views were suggested as deemed necessary by the interpreting physician

Epidemiology, species distribution, antifungal susceptibility and outcome of candidemia among Internal Medicine Wards of community hospitals of Udine province, Italy

Directory of Open Access Journals (Sweden)

Federico Silvestri

2014-09-01

Full Text Available Candidemia is an emerging problem among patients hospitalized in Internal Medicine Wards (IMW. We performed a retrospective study to assess the epidemiology, species distribution, antifungal susceptibility and outcome of candidaemia recorded over a 3-year period (2010-2012 among IMW of community hospitals of Udine province in Italy: forty-eight patients were identified, with an overall incidence of 1.44 cases/1000 hospital admissions/year. Candida albicans was the most frequent species, followed by Candida parapsilosis that accounted for 42.9% of Tolmezzo cases. All isolates were susceptible to amphotericin and caspofungin, while 11.4% of strains were not-susceptible to voriconazole and 14.3% to fluconazole. Crude mortality was 41.7%. In conclusion, in community hospitals overall incidence of candidemia is similar to tertiary care hospitals, but 80% of cases are detected in IMW. Candida species distribution is overlapping, but differences in local epidemiology were found and should be taken into consideration. No resistance to amphotericin and caspofungin was found while resistance to azoles was observed. Knowledge of this data might be useful when planning the best therapeutic strategy.

Wind resource assessment and wind energy system cost analysis: Fort Huachuca, Arizona

Energy Technology Data Exchange (ETDEWEB)

Olsen, T.L. [Tim Olsen Consulting, Denver, CO (United States); McKenna, E. [National Renewable Energy Lab., Golden, CO (United States)

1997-12-01

The objective of this joint DOE and National Renewable Energy Laboratory (NREL) Strategic Environmental Research and Development Program (SERDP) project is to determine whether wind turbines can reduce costs by providing power to US military facilities in high wind areas. In support of this objective, one year of data on the wind resources at several Fort Huachuca sites was collected. The wind resource data were analyzed and used as input to an economic study for a wind energy installation at Fort Huachuca. The results of this wind energy feasibility study are presented in the report.

Surgical risk factors and maxillary nerve function after le fort I osteotomy

DEFF Research Database (Denmark)

Thygesen, Torben Henrik; Jensen, Allan Bardow; Norholt, SE

2009-01-01

PURPOSE: Data on intraoperative risk factors for long-term postoperative complications after Le Fort I osteotomy (LFO) are limited. The aim of this study was to describe prospectively the overall postoperative changes in maxillary nerve function after LFO, and to correlate these changes with a nu......PURPOSE: Data on intraoperative risk factors for long-term postoperative complications after Le Fort I osteotomy (LFO) are limited. The aim of this study was to describe prospectively the overall postoperative changes in maxillary nerve function after LFO, and to correlate these changes...

Budget Impact Analysis of Oral Fisiogen Ferro Forte® versus Intravenous Iron for the Management of Iron Deficiency in Chronic Kidney Disease in Spain.

Science.gov (United States)

Darbà, Josep; Ascanio, Meritxell

2018-06-22

Iron deficiency is a frequent complication of chronic kidney disease (CKD) that is associated with a decrease in the quality of life of patients and an increase in the risk of other clinical complications. Iron therapy represents one of the fundamentals of patients with CKD. Sucrosomial ® oral iron allows Fisiogen Ferro Forte ® to be used in all patients who are intolerant to treatment by the oral route of administration, or who present with malabsorption of conventional oral iron preparations. The main objective of this study was to assess the economic impact of the oral iron Fisiogen Ferro Forte ® for the management of iron deficiency in CKD patients in Spain. A 4-year budget impact model was developed for the period 2017-2020 for CKD patients with iron deficiency who were candidates for intravenous iron due to a lack of response to oral iron, from the perspective of the Spanish healthcare system. Three subgroups of CKD patients were included in the analysis: predialysis, peritoneal dialysis, and post-transplant. The intravenous iron formulations Ferinject ® , Venofer ® , and Feriv ® were considered appropriate comparators to be used in the model. National data on the prevalence of CKD for the three subgroups of patients were obtained from the literature, and input data on drug utilization and outpatient hospitalizations associated with iron administration were obtained by consulting nephrologists. Nephrology experts were also asked about resources used during medical visits and monitoring tests. Based on the unit costs for each iron therapy and the resources used, the total treatment cost per patient associated with each product was obtained to estimate the global budget impact of increasing the use of Fisiogen Ferro Forte ® . The average annual budget savings due to an increase in Fisiogen Ferro Forte ® and a decrease in intravenous iron have been estimated at €398,685, €180,937, and €195,842 over 4 years for the predialysis, peritoneal dialysis

Status of the Fort St. Vrain decommissioning

International Nuclear Information System (INIS)

Fisher, M.J.

1990-01-01

Fort St. Vrain is a high temperature gas cooled reactor. It has been shut down as a result of financial and technical difficulties. Fort St. Vrain has been planning for defueling and decommissioning for at least three years. The preliminary decommissioning plan, in accordance with the NRC's final rule, has been submitted and is being reviewed by the NRC. The basis of the preliminary decommissioning plan has been SAFSTOR. Public Service Company, who is the owner and operator of FSV, is scheduled to submit a proposed decommissioning plan to the NRC in the fourth quarter of 1990. PSC has gone out for bid on the decontamination and dismantlement of FSV. This paper includes the defueling schedule, the independent spent fuel storage installation status, the probability of shipping fuel to DOE, the status of the preliminary decommissioning plan submittal, the issuance of a possession only license and what are the results of obtaining this license amendment, preliminary decommissioning activities allowed prior to the approval of a proposed decommissioning plan, the preparation of a proposed decommissioning plan and the status of our decision to proceed with SAFSTOR or DECON as identified in the NRC's final decommissioning rule

Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

Science.gov (United States)

Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

2017-07-07

The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

Strategic Analysis and Plan for Implementing Telemedicine at Fort Greely

National Research Council Canada - National Science Library

Bolton, Karl

2003-01-01

.... To best accomplish this, a strategic analysis and business case analysis was conducted. Introspective strategic analysis tools revealed an organization that is capable of supporting a telemedicine program at Fort Greely...

Emergence of community-acquired methicillin-resistant Staphylococcus aureus in an Iranian referral paediatric hospital.

Science.gov (United States)

Mamishi, S; Mahmoudi, S; Bahador, A; Matini, H; Movahedi, Z; Sadeghi, R H; Pourakbari, B

2015-01-01

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals has been changed in recent years due to the arrival of community-associated MRSA (CA-MRSA) strains into healthcare settings. The aim of this study is to investigate the distribution of staphylococcal cassette chromosome mec (SCCmec) type V as well as SCCmec IV subtypes, which have been associated with community-acquired infection among healthcare-associated MRSA (HA-MRSA) isolates. Antimicrobial susceptibility, SCCmec type, spa type and the presence of Panton-Valentine leukocidin (PVL) genes were determined for all HA-MRSA isolates in an Iranian referral hospital. In this study of 48 HA-MRSA isolates, 13 (27%), three (6.2%), five (10.4%) and one (2%) belonged to SCCmec subtypes IVa, IVb, IVc and IVd, respectively. Only two isolates (4.2%) belonged to SCCmec types V Notably, one isolate was found to harbour concurrent SCCmec subtypes IVb and IVd. MRSA containing SCCmec subtype IVb, IVc and IVd as well as type V isolates were all susceptible to chloramphenicol, clindamycin and rifampicin, while the sensitivity to these antibiotics was lower among MRSA containing SCCmec subtype IVa. The most frequently observed spa ttype was t037, accounting for 88% (22/25). Three other spa type was t002, t1816 and t4478. Large reservoirs of MRSA containing type IV subtypes and type V now exist in patients in this Iranian hospital. Therefore, effective infection control management in order to control the spread of CA-MRSA is highly recommended.

The Fort Smith radioactive belt, Northwest Territories

International Nuclear Information System (INIS)

Charbonneau, B.W.

1980-01-01

The Fort Smith Belt is an elongate zone, about 200 km x 50 km, extending from the East Arm of Great Slave Lake southerly into northeastern Alberta. The major feature of the belt is that it is one of the most radioactive regions so far recognized in the Canadian Shield. Potassium, uranium, and thorium are all enriched but the greatest increase is in thorium. The dominant rock type underlying the area is a foliated porphyritic granite. This rock contains an average of about 80 ppm thorium (with areas of tens of square kilometres containing up to 200 ppm) and approximately 11 ppm uranium. In places, dark elongate zones rich in biotite, apatite, and opaque minerals within the porphyritic granite may contain an order of magnitude more uranium and thorium than the porphyry. Radioactive minerals within both the porphyry and the dark zones are principally monazite (containing up to 16% ThO 2 ) and isolated grains of uraninite. This foliated porphyritic granite is interpreted as being pre- or syntectonic with respect to the Hudsonian event because its foliation parallels that of the surrounding rocks. There has been subsequent deformation. The second characteristic feature of the Fort Smith Belt is the development of a peripheral zone where eU is enriched relative to eTh correlating mainly with granitoid rocks which surround the thorium-rich area and wherein ratios of eU/eTh exceed 1:2 (compared to the crustal average of 1:4). Uranium may have moved laterally into this marginal area from the thorium-rich porphyry, possibly in a vapour phase. There is a possibility that concentrations of uranium as well as other metals such as Cu, Mo, Zn, Sn, and W could exist in the porphyry and its margin in appropriate chemical and/or structural traps. The radioactive granite rocks of the Fort Smith Belt are adjacent to uranium-thorium occurrences in the nearby Proterozoic Nonacho sediments but whether or not a genetic relationship exists between the two situations is uncertain. (auth)

Clinical Definitions of Sarcopenia and Risk of Hospitalization in Community-Dwelling Older Men: The Osteoporotic Fractures in Men Study.

Science.gov (United States)

Cawthon, Peggy M; Lui, Li-Yung; Taylor, Brent C; McCulloch, Charles E; Cauley, Jane A; Lapidus, Jodi; Orwoll, Eric; Ensrud, Kristine E

2017-10-01

The association between various definitions of sarcopenia and hospitalization has not been evaluated in community-dwelling older men. We used data from 1,516 participants at Visit 3 of the Osteoporotic Fractures in Men (MrOS) study who also had linked Medicare Fee-For-Service Claims data available. We examined the association between several sarcopenia definitions (International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman) and hospitalization, using two-part ("hurdle") models, adjusted for age, clinical center, functional limitations, self-reported health, comorbidity, and cognitive function. Predictors included sarcopenia status (the summary definitions and the components of slowness, weakness, and/or lean mass); outcomes included hospitalization and cumulative inpatient days/year in the 3 years following the Visit 3 exam. After accounting for confounding factors, none of the summary definitions or the definition components (slowness, weakness, or low lean mass) were associated with likelihood of hospitalization, the rate ratio of inpatient days among those hospitalized, or the mean rate of inpatient days amongst all participants. Sarcopenia was not associated hospitalization in community-dwelling older men. These results provide further evidence that current sarcopenia definitions are unlikely to identify those who are most likely to have greater hospitalization. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Fall of Fort Eben Emael: The Effects of Emerging Technologies on the Successful Completion of Military Objectives

Science.gov (United States)

2004-06-18

of Sickle,” World War II Magazine, November 2003, 59. 11Ibid., 60. 12Abbeville is 100 miles north of Paris near the English Channel. 13T. N. Mout... catacombs of Fort Eben Emael. A further understanding of the dynamics of the fort and her defenders can be gained by the knowledge that that fort was...Green Devils German Paratroopers 1939-45 ( Paris , France: Histories & Collections, 1997), 27. Helmut Wenzl (Left in photo) Born - 10 March

75 FR 39051 - Desoto Mills LLC, Fort Payne, AL; Notice of Negative Determination Regarding Application for...

Science.gov (United States)

2010-07-07

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,416] Desoto Mills LLC, Fort... applicable to workers and former workers at Desoto Mills, LLC, a Subsidiary of Fruit of the Loom, Fort Payne... * * * locations outside the Desoto Mills Plant.'' The petitioner compares the situation at this location with...

Implementing and evaluating e-communication to improve intersectoral cooperation between hospitals and local communities

DEFF Research Database (Denmark)

Nicolaisen, Anne; Qvist, Peter

2015-01-01

services for the patient. The Region of Southern Denmark has implemented e-communication to improve the cooperation across health care sectors. Communities and hospitals in the Region of Southern Denmark agreed to comply to specified quality standards for the content and timeliness of information exchange...... these will be presented at the conference. Keywords: e-communication, cooperation across health care sectors, audit, evaluation, practice...

FIND: Fort Calhoun Station, Unit 2

International Nuclear Information System (INIS)

Williams, W.H.

1976-07-01

This index is presented for the microfiche material of Docket 50548 which concerns the application of Omaha Public Power District to build and operate Fort Calhoun Station, Unit 2. The information includes both application and review material dated from September 1975 through March 1976. There are five amendments to the PSAR and one supplement to the ER which have been incorporated by reference into the respective reports. Docket RESAR-3 is used as a reference for portions of the PSAR

Etiology and characteristics of large symptomatic pericardial effusion in a community hospital in the contemporary era.

Science.gov (United States)

Abdallah, R; Atar, S

2014-05-01

The etiology and laboratory characteristics of large symptomatic pericardial effusion (LSPE) in the Western world have evolved over the years, and vary between regions, community and tertiary hospitals. We reviewed data of 86 consecutive patients who underwent pericardiocentesis or pericardial window due to LSPE in a community hospital from 2001 to 2010. The characteristics of the PE including chemistry, hematology, bacteriology, serology and cytology have been analyzed. We correlated the etiologies of PE with age, gender and clinical presentation. The most frequent etiology of LSPE was idiopathic [36% (77% with a clinical diagnosis of pericarditis)], followed by malignancy (31.4%), ischemic heart disease (16.3%), renal failure (4.6%), trauma (4.6%) and autoimmune disease (4.6%). The average age of all the etiological groups excluding trauma was over 50 years. Laboratory tests did not modify the pre-procedure diagnosis in any of the patients. The most frequent presenting symptom was dyspnea (76.6%). Chest pain was mostly common in patients with idiopathic etiology (58.06%). The most frequent medical condition associated with LSPE was the use of anticoagulant or antiplatelet drugs (31.40%), especially aspirin, and in those, the PE tended to be bloody (73%, P = 0.11). Most of the effusions were exudates (70.9%). PE due to renal failure was the largest (1467 ± 1387 ml). The spectrum of etiologies of LSPE in a community hospital in the Western world in the contemporary era is continuously evolving. The most frequent etiology is now idiopathic, followed by malignancy. Routine laboratory testing still rarely modifies the pre-procedure diagnosis.

Adherence with national guidelines in hospitalized patients with community-acquired pneumonia: results from the CAPO study in Venezuela.

Science.gov (United States)

Levy, Gur; Perez, Mario; Rodríguez, Benito; Hernández Voth, Ana; Perez, Jorge; Gnoni, Martin; Kelley, Robert; Wiemken, Timothy; Ramirez, Julio

2015-04-01

The Community-Acquired Pneumonia Organization (CAPO) is an international observational study in 130 hospitals, with a total of 31 countries, to assess the current management of hospitalized patients with community-acquired pneumonia (CAP). 2 Using the centralized database of CAPO was decided to conduct this study with the aim of evaluate the level of adherence with national guidelines in Venezuela, to define in which areas an intervention may be necessary to improve the quality of care of hospitalized patients with CAP. In this observational retrospective study quality indicators were used to evaluate the management of hospitalized patients with CAP in 8 Venezuelan's centers. The care of the patients was evaluated in the areas of: hospitalization, oxygen therapy, empiric antibiotic therapy, switch therapy, etiological studies, blood cultures indication, and prevention. The compliance was rated as good (>90%), intermediate (60% to 90%), or low (Venezuela that are not performed according to the national guidelines of SOVETHORAX.1 In any quality improvement process the first step is to evaluate the difference between what is recommended and what is done in clinical practice. While this study meets this first step, the challenge for the future is to implement the processes necessary to improve the management of CAP in Venezuela. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

ALARA and decommissioning: The Fort St. Vrain experience

Energy Technology Data Exchange (ETDEWEB)

Borst, T.; Niehoff, M. [Public Service Co. of Colorado, Platteville, CO (United States); Zachary, M. [Scientific Ecology Group, Platteville, CO (United States)

1995-03-01

The Fort St. Vrain Nuclear Generating Station, the first and only commercial High Temperature Gas Cooled Reactor to operate in the United States, completed initial fuel loading in late 1973 and initial startup in early 1974. Due to a series of non-nuclear technical problems, Fort St. Vrain never operated consistently, attaining a lifetime capacity factor of slightly less than 15%. In August of 1989, the decision was made to permanently shut down the plant due to control rod drive and steam generator ring header failures. Public Service Company of Colorado elected to proceed with early dismantlement (DECON) as opposed to SAFSTOR on the bases of perceived societal benefits, rad waste, and exposure considerations, regulatory uncertainties associated with SAFSTOR, and cost. The decommissioning of Fort St. Vrain began in August of 1992, and is scheduled to be completed in early 1996. Decommissioning is being conducted by a team consisting of Westinghouse, MK-Ferguson, and Scientific Ecology Group. Public Service Company of Colorado as the licensee provides contract management and oversight of contractor functions. An aggressive program to maintain project radiation exposures As Low As Reasonably Achievable (ALARA) has been established, with the following program elements: temporary and permanent shielding contamination control; mockup training; engineering controls; worker awareness; integrated work package reviews communication; special instrumentation; video camera usage; robotics application; and project committees. To date, worker exposures have been less than project estimates. from the start of the project through Februrary of 1994, total exposure has been 98.666 person-rem, compared to the project estimate of 433 person-rem and goal of 347 person-rem. The presentation will discuss the site characterization efforts, the radiological performance indicator program, and the final site release survey plans.

Methicillin-Resistant Staphylococcus aureus in the Community in Luanda, Angola: Blurred Boundaries with the Hospital Setting.

Science.gov (United States)

Conceição, Teresa; Coelho, Céline; Santos Silva, Isabel; de Lencastre, Hermínia; Aires-de-Sousa, Marta

2016-01-01

Although the nosocomial prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Angola is over 60% and one of the highest in Africa, the extent of MRSA in the community is unknown. To fill this gap, we conducted a hospital-based study in which 158 children attending the emergency ward and ambulatory services of a pediatric hospital in Luanda, the capital of Angola, were screened for S. aureus nasal colonization. Overall, 70 (44.3%) individuals were colonized with S. aureus, of which 20 (28.6%) carried MRSA, resulting in a prevalence of 12.7% (20/158) of MRSA in the population screened. Molecular characterization by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing, and SCCmec typing distributed the isolates into two major MRSA clones and one dominant methicillin-susceptible S. aureus (MSSA) lineage, corresponding to the main clones circulating in hospitals in Luanda. The MRSA isolates mainly belonged to clones A (PFGE type A, spa type t105, ST5-IVa-65%) and B (PFGE B, t3869, ST88-IVa-30%), while MSSA isolates mainly belonged to clone L (PFGE type L, t861, ST508-42%). S. aureus isolates showed resistance to penicillin (96%), rifampin (87%), and trimethoprim-sulfamethoxazole (21%). In conclusion, the prevalence of MRSA among children in the community in Luanda is high and seems to originate from hospitals, warranting continuous monitoring and implementation of additional infection control measures.

Opening remarks for the Fort Valley Centennial Celebration

Science.gov (United States)

G. Sam Foster

2008-01-01

The Rocky Mountain Research Station recognizes and values the contributions of our scientists and collaborators for their work over the past century at Fort Valley Experimental Forest. With the help of our partners and collaborators, Rocky Mountain Research Station is working to improve coordination across its research Program Areas and Experimental Forests and Ranges...

Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation.

Science.gov (United States)

Yang, Chris P; Hunt, Elizabeth A; Shilkofski, Nicole; Dudas, Robert; Egbuta, Chinyere; Schwartz, Jamie M

2017-07-01

Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial. In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia. The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07. This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at

Fortællinger om sorg og tab – når det personlige bliver socialt?

DEFF Research Database (Denmark)

Christensen, Dorthe Refslund; Sandvik, Kjetil

2016-01-01

Vi fortæller om døden, om det at miste og føle sorg. Kulturhistorisk er litteratur, teater og malerkunst scener for netop dette emne. Som socialt fænomen ser vi dog ikke i samme omfang fortællinger om død, tab og sorg, eftersom emnet typisk har været anskuet som et privat anliggende. Bestemte...

Department of Defense Agency Financial Report for FY 2011

Science.gov (United States)

2011-11-01

able to distribute resources across hospitals and clinics within a market to meet the needs of the entire population of eligible beneficiaries. In...WRAMC), Washington, DC. This entailed construction of a new community hospital and a dental clinic at Fort Belvoir and an expansion of the National...Department of Defense DSB Defense Science Board DSS Defense Security Service DTM Directive-type Memorandum DTS Defense Travel System EBF Education

The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

Directory of Open Access Journals (Sweden)

Robert Robinson

2017-03-01

overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 4.97 with a p value of 0.66. Discussion This single center retrospective study indicates that the HOSPITAL score has superior discriminatory ability when compared to the LACE index as a predictor of hospital readmission within 30 days at a medium-sized university-affiliated teaching hospital. Conclusions The internationally validated HOSPITAL score may be superior to the LACE index in moderate-sized community hospitals to identify patients at high risk of hospital readmission within 30 days.

Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders.

Science.gov (United States)

Millman, Alexander J; Finelli, Lyn; Bramley, Anna M; Peacock, Georgina; Williams, Derek J; Arnold, Sandra R; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Ampofo, Krow; Pavia, Andrew T; Edwards, Kathryn M; Jain, Seema

2016-06-01

To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Children children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. Published by Elsevier Inc.

The effect of contextual factors on unintentional injury hospitalization: from the Korea National Hospital Discharge Survey.

Science.gov (United States)

Lee, Hye Ah; Han, Hyejin; Lee, Seonhwa; Park, Bomi; Park, Bo Hyun; Lee, Won Kyung; Park, Ju Ok; Hong, Sungok; Kim, Young Taek; Park, Hyesook

2018-03-13

It has been suggested that health risks are affected by geographical area, but there are few studies on contextual effects using multilevel analysis, especially regarding unintentional injury. This study investigated trends in unintentional injury hospitalization rates over the past decade in Korea, and also examined community-level risk factors while controlling for individual-level factors. Using data from the 2004 to 2013 Korea National Hospital Discharge Survey (KNHDS), trends in age-adjusted injury hospitalization rate were conducted using the Joinpoint Regression Program. Based on the 2013 KNHDS, we collected community-level factors by linking various data sources and selected dominant factors related to injury hospitalization through a stepwise method. Multilevel analysis was performed to assess the community-level factors while controlling for individual-level factors. In 2004, the age-adjusted unintentional injury hospitalization rate was 1570.1 per 100,000 population and increased to 1887.1 per 100,000 population in 2013. The average annual percent change in rate of hospitalizations due to unintentional injury was 2.31% (95% confidence interval: 1.8-2.9). It was somewhat higher for females than for males (3.25% vs. 1.64%, respectively). Both community- and individual-level factors were found to significantly influence unintentional injury hospitalization risk. As community-level risk factors, finance utilization capacity of the local government and neighborhood socioeconomic status, were independently associated with unintentional injury hospitalization after controlling for individual-level factors, and accounted for 19.9% of community-level variation in unintentional injury hospitalization. Regional differences must be considered when creating policies and interventions. Further studies are required to evaluate specific factors related to injury mechanism.

From Long-Stay Hospitals to Community Care: Reconstructing the Narratives of People with Learning Disabilities

Science.gov (United States)

Leaning, Brian; Adderley, Hope

2016-01-01

Raymond, a 62 year old gentleman diagnosed with severe and profound learning disabilities, autistic spectrum disorder and severe challenging behaviour, who had lived in long stay campus-based hospital accommodation for 46 years was supported to move to a community project developed to support people to live in their own bespoke flat. This…

Analysis and evaluation of recent operational experience from the Fort St. Vrain HTGR

International Nuclear Information System (INIS)

Moses, D.L.; Lanning, W.D.

1985-05-01

The Fort St. Vrain operating experience to be discussed here includes notable safety-related events which have occurred since late 1981 when ORNL was first contracted to provide technical assistance to AEOD. Earlier Fort St. Vrain operating experience through the time of successful full-power testing in November 1981 has been summarized by the licensee and the reactor vendor, GA Technologies, Inc. (GA), in papers presented at several different forums during 1982. In addition, extensive and very useful detailed evaluations of preoperational and startup testing and of the rise-to-power operating experience through completion of the first refueling outage in August 1979 have been compiled into a series of reports under the sponsorship of the Electric Power Research Institute (EPRI). Finally, the US Department of Energy's Fort St. Vrain Improvement Plan provides a summary of the major operational limits which have affected the plant since start-up. The events discussed here are categorized based on the major systems affected, namely, (1) primary system and reactor vessel, (2) electrical systems, and (3) the reactor building. In all cases to be discussed, the lessons to be learned are vigilance and prevention. These lessons translate into the need for the recognition and control of unexpected situations and of their potential for branching effects. At Fort St. Vrain, these lessons are found in the effects of moisture ingress, in the challenges experienced to the supply of essential electrical power, and in controlling the environment of the reactor building. 13 refs

Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

Centers for Disease Control (CDC) Podcasts

In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.

Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans.

Science.gov (United States)

Amoah, Benjamin; Anto, Evelyn A; Osei, Prince K; Pieterson, Kojo; Crimi, Alessandro

2016-06-14

The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted. A sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed. The preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought. Our results show that the proposed

Operating Profitability of For-Profit and Not-for-Profit Florida Community Hospitals During Medicare Policy Changes, 2000 to 2010.

Science.gov (United States)

Langland-Orban, Barbara; Large, John T; Sear, Alan M; Zhang, Hanze; Zhang, Nanhua

2015-01-01

Medicare Advantage was implemented in 2004 and the Recovery Audit Contractor (RAC) program was implemented in Florida during 2005. Both increase surveillance of medical necessity and deny payments for improper admissions. The purpose of the present study was to determine their potential impact on for-profit (FP) and not-for-profit (NFP) hospital operating margins in Florida. FP hospitals were expected to be more adversely affected as admissions growth has been one strategy to improve stock performance, which is not a consideration at NFPs. This study analyzed Florida community hospitals from 2000 through 2010, assessing changes in pre-tax operating margin (PTOM). Florida Agency for Health Care Administration data were analyzed for 104 community hospitals (62 FPs and 42 NFPs). Academic, public, and small hospitals were excluded. A mixed-effects model was used to assess the association of RAC implementation, organizational and payer type variables, and ownership interaction effects on PTOM. FP hospitals began the period with a higher average PTOM, but converged with NFPs during the study period. The average Medicare Advantage effect was not significant for either ownership type. The magnitude of the RAC variable was significantly negative for average PTOM at FPs (-4.68) and positive at NFPs (0.08), meaning RAC was associated with decreasing PTOM at FP hospitals only. RAC complements other Medicare surveillance systems that detect medically unnecessary admissions, coding errors, fraud, and abuse. Since its implementation in Florida, average FP and NFP operating margins have been similar, such that the higher margins reported for FP hospitals in the 1990s are no longer evident. © The Author(s) 2015.

A mixed methods investigation into the use of non-technical skills by community and hospital pharmacists.

Science.gov (United States)

Irwin, A; Weidmann, A E

2015-01-01

Non-technical skills refer to the social and cognitive factors that may influence efficient and safe job performance. Non-technical skills are an important element of patient safety in a variety of health care disciplines, including surgery, anesthesia and nursing. However, the use of non-technical skills in pharmacy practice has not yet been fully assessed. To examine attitudes toward, and use of, non-technical skills by pharmacy personnel. A mixed methods approach was used: An attitude survey explored pharmacy personnel attitudes towards non-technical skills and inter-professional collaboration, with community and hospital pharmacy staff (n = 62). Qualitative interviews were then conducted using the critical incident technique, with community pharmacists (n = 11). The survey results demonstrated differences in the opinions of community and hospital pharmacists on three non-technical skill constructs: team structure, mutual support, and situation monitoring, with community pharmacists reporting significantly more positive attitudes about all three constructs. Both groups reported low levels of collaboration with primary care physicians. The interviews identified five non-technical skills as key elements of successful pharmacist performance from the interview transcripts: teamwork; leadership; task management; situation awareness; decision-making. The survey and interviews identified the non-technical skills that are important to pharmacists. This represents the first step towards the development of a behavioral rating system for training purposes that could potentially improve the non-technical skills of pharmacists and enhance patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.

Fort St. Vrain core performance

International Nuclear Information System (INIS)

McEachern, D.W.; Brown, J.R.; Heller, R.A.; Franek, W.J.

1977-07-01

The Fort St. Vrain High Temperature Gas Cooled Reactor core performance has been evaluated during the startup testing phase of the reactor operation. The reactor is graphite moderated, helium cooled, and uses coated particle fuel and on-line flow control to each of the 37 refueling regions. Principal objectives of startup testing were to determine: core and control system reactivity, radial power distribution, flow control capability, and initial fission product release. Information from the core demonstrates that Technical Specifications are being met, performance of the core and fuel is as expected, flow and reactivity control are predictable and simple for the operator to carry out

Third party testing : new pilot facility for mining processes opens in Fort McKay

International Nuclear Information System (INIS)

Jaremko, D.

2007-01-01

Fort McKay lies 65 kilometres north of Fort McMurray, Alberta and is the centre of operational oilsands mining activity. As such, it was chosen for a pilot testing facility created by the Geneva-based SGS Group. The reputable facility provides an opportunity for mining producers to advance their processes, including environmental performance, by allowing them to test different processes on their own oilsands. The Northern Lights partnership, led by Synenco Energy, was the first client at the facility. Due to outsourcing, clients are not obligated to make substantial capital investment into in-house research. The Northern Lights partnership will be using the facility to test extraction processes on bitumen from its leases. Although the Fort McKay facility is SGS's first venture into the oilsands industry, it operates in more than 140 companies globally, including the mineral industry, and specializes in inspection, verification, testing and certification. SGS took the experience from its minerals extraction business to identify what could be done to help the oilsands industry by using best practices developed from global operations. The facility lies on the Fort McKay industrial park owned by the Fort McKay First Nation. An existing testing facility called McMurray Resources Research and Testing was expanded by the SGS Group to include environmental analysis capabilities. The modular units that lie on 6 acres include refrigerated ore storage to maintain ore integrity; modular ore and materials handling systems; extraction equipment; and, zero discharge process water and waste disposal systems. Froth treatment will be added in the near future to cover the entire upstream side of the mining processing business. A micro-upgrader might be added in the future to manufacture synthetic crude. 3 figs

Third party testing : new pilot facility for mining processes opens in Fort McKay

Energy Technology Data Exchange (ETDEWEB)

Jaremko, D.

2007-12-15

Fort McKay lies 65 kilometres north of Fort McMurray, Alberta and is the centre of operational oilsands mining activity. As such, it was chosen for a pilot testing facility created by the Geneva-based SGS Group. The reputable facility provides an opportunity for mining producers to advance their processes, including environmental performance, by allowing them to test different processes on their own oilsands. The Northern Lights partnership, led by Synenco Energy, was the first client at the facility. Due to outsourcing, clients are not obligated to make substantial capital investment into in-house research. The Northern Lights partnership will be using the facility to test extraction processes on bitumen from its leases. Although the Fort McKay facility is SGS's first venture into the oilsands industry, it operates in more than 140 companies globally, including the mineral industry, and specializes in inspection, verification, testing and certification. SGS took the experience from its minerals extraction business to identify what could be done to help the oilsands industry by using best practices developed from global operations. The facility lies on the Fort McKay industrial park owned by the Fort McKay First Nation. An existing testing facility called McMurray Resources Research and Testing was expanded by the SGS Group to include environmental analysis capabilities. The modular units that lie on 6 acres include refrigerated ore storage to maintain ore integrity; modular ore and materials handling systems; extraction equipment; and, zero discharge process water and waste disposal systems. Froth treatment will be added in the near future to cover the entire upstream side of the mining processing business. A micro-upgrader might be added in the future to manufacture synthetic crude. 3 figs.

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan.

Science.gov (United States)

Lin, Chih-Yuan; Huang, Ai-Ling; Minas, Harry; Cohen, Alex

2009-01-02

Yuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a continuum of care for the patients. We reinterpret and

Integrating the hospital library with patient care, teaching and research: model and Web 2.0 tools to create a social and collaborative community of clinical research in a hospital setting.

Science.gov (United States)

Montano, Blanca San José; Garcia Carretero, Rafael; Varela Entrecanales, Manuel; Pozuelo, Paz Martin

2010-09-01

Research in hospital settings faces several difficulties. Information technologies and certain Web 2.0 tools may provide new models to tackle these problems, allowing for a collaborative approach and bridging the gap between clinical practice, teaching and research. We aim to gather a community of researchers involved in the development of a network of learning and investigation resources in a hospital setting. A multi-disciplinary work group analysed the needs of the research community. We studied the opportunities provided by Web 2.0 tools and finally we defined the spaces that would be developed, describing their elements, members and different access levels. WIKINVESTIGACION is a collaborative web space with the aim of integrating the management of all the hospital's teaching and research resources. It is composed of five spaces, with different access privileges. The spaces are: Research Group Space 'wiki for each individual research group', Learning Resources Centre devoted to the Library, News Space, Forum and Repositories. The Internet, and most notably the Web 2.0 movement, is introducing some overwhelming changes in our society. Research and teaching in the hospital setting will join this current and take advantage of these tools to socialise and improve knowledge management.

Community-acquired pneumonia requiring hospitalization: rational decision making and interpretation of guidelines.

Science.gov (United States)

Postma, Douwe F; van Werkhoven, Cornelis H; Oosterheert, Jan Jelrik

2017-05-01

This review focuses on the evidence base for guideline recommendations on the diagnosis, the optimal choice, timing and duration of empirical antibiotic therapy, and the use of microbiological tests for patients hospitalized with community-acquired pneumonia (CAP): issues for which guidelines are frequently used as a quick reference. Furthermore, we will discuss possibilities for future research in these topics. Many national and international guideline recommendations, even on critical elements of CAP management, are based on low-to-moderate quality evidence. The diagnosis and management of CAP has hardly changed for decades. The recommendation to cover atypical pathogens in all hospitalized CAP patients is based on observational studies only and is challenged by two recent trials. The following years, improved diagnostic testing, radiologically by low-dose Computed Tomography or ultrasound and/or microbiologically by point-of-care multiplex PCR, has the potential to largely influence the choice and start of antibiotic therapy in hospitalized CAP patients. Rapid microbiological testing will hopefully improve antibiotic de-escalation or early pathogen-directed therapy, both potent ways of reducing broad-spectrum antibiotic use. Current guideline recommendations on the timing and duration of antibiotic therapy are based on limited evidence, but will be hard to improve.

Rail Outloading Capability Study, Fort Polk, Louisiana,

Science.gov (United States)

1977-06-01

regardless of experience, to avoid wasted man -hours. The main problem at Fort Polk is that no blocking and bracing material stockpile exists and no...ti1 hottul only thtrough the 0111crinost hole; to defect within 20 days after it is determined to -tuit Owt ttrtk in tuse. III thle caste of classes 3...wheels, slipping, or similar trak (meh causes. 1 -------------------- (12) " Shelly spots" means a condition 2 ------------------------ % where a thin

Community-based management of multiple drug resistant tuberculosis in a tertiary hospital in Tanzania: a best practice implementation project.

Science.gov (United States)

Jelly, Isaya; Peters, Micah D J

2017-12-01

The World Health Organization (WHO) has prioritized collaboration with communities in its 2016 "End TB" implementation strategy. Acknowledging the difficulties that some communities face in gaining access to health facilities due to barriers such as stigma, discrimination, healthcare expenditure, transport and income loss, partnering with communities in the roll-out of community-based TB management activities is vital. The aim of this project was to make a contribution to promoting evidence-based practice with regards to the community-based management of multidrug-resistant tuberculosis (MDR-TB) at Kibong'oto National Infectious Disease Hospital, Tanzania, and thereby supporting improvements in patient outcomes and resource utilization. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) program to facilitate the collection of pre- and post-audit data. The Getting Research into Practice (GRiP) module was also used to analyze the potential barriers and for designing the final action plan. This project was conducted in three phases over a three-month period at the MDR-TB unit in a referral hospital in Northern Tanzania. The project showed that there were significant improvements in compliance rates in staff education and documentation of patients' suitability and preferences in receiving community-based care for MDR-TB. The compliance rate of criterion 2, which was already 100% at baseline, was slightly lower at follow-up. The project achieved significant improvements in the delivery of evidence-based practice with regards to community-based management of MDR-TB.

78 FR 78380 - Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort...

Science.gov (United States)

2013-12-26

... completion of an inventory of human remains under the control of Fort Bowie National Historic Site, Bowie, AZ....R50000] Notice of Inventory Completion: U.S. Department of the Interior, National Park Service, Fort... completed an inventory of human remains, in consultation with the appropriate Indian tribes or Native...

Medication Incidents Related to Automated Dose Dispensing in Community Pharmacies and Hospitals - A Reporting System Study

Science.gov (United States)

Cheung, Ka-Chun; van den Bemt, Patricia M. L. A.; Bouvy, Marcel L.; Wensing, Michel; De Smet, Peter A. G. M.

2014-01-01

Introduction Automated dose dispensing (ADD) is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. Methods The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR) reporting system were selected and characterized independently by two researchers. Main Outcome Measures Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. Results From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4%) incidents from community pharmacies and 11,428 (75.6%) incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8%) were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2%) were related to ADD than in hospitals (41/11,428 = 0.4%). The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. Conclusion A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an incident

Fra erfaringer til betydninger: Tolkning af fortællinger om eksamensgruppebegivenheder fra folkeskolelærerstuderende ved Aalborg Seminarium

DEFF Research Database (Denmark)

Silleborg, Ellen

2004-01-01

karakter. Denne situation giveruoverensstemmelser i de studerendes følelsesliv, og hovedparten af fortællingerne afspejler en i mange henseender konfliktfyldt eksamensgruppeproces. I fortællingernes betydninger ses en loyal men privatiseret etik, hvor ansvarlighed bliver til selvskyld. Alle implicerede...

La fouille du fort Saint-Georges à Chinon (Indre-et-Loire. Premiers résultats The excavation of fort Saint-Georges at Chinon (Indre-et-Loire. First results

Directory of Open Access Journals (Sweden)

Bruno Dufaÿ

2006-05-01

Full Text Available Cette note présente les premiers résultats des fouilles menées en 2003 et 2004 sur la quasi-totalité du fort Saint-Georges à Chinon (Indre-et-Loire. Celui-ci est l’un des trois éléments de la forteresse médiévale qui domine la ville. La fouille a permis de préciser la fonction du fort, construit dans la deuxième moitié du XIIe s., à l’époque où Chinon est le centre administratif des possessions continentales des Plantagenêt, rois d’Angleterre. Du point de vue militaire, il formait une fortification avancée, protégeant le château principal, selon une structure que Richard Cœur de Lion appliquera au Château Gaillard. À l’intérieur, de vastes bâtiments constituaient des logis, conçus peut-être au départ pour héberger la chancellerie royale.This article presents the first results of the excavations undertaken in 2003 and 2004 over almost all of the Fort Saint-Georges at Chinon (Indre-et-Loire, one of three elements of the medieval fortress which dominates the town. The excavation enabled us to clarify the function of the fort, built in the 2nd half of the 12th century at a time when Chinon was the administrative centre of the continental possesions of the Plantagenet King of England. From a military point of view, it formed an advanced fortification protecting the main castle, within a structure that Richard the Lionheart would apply to the Chayeau Gaillard. Inside, some vast buildings made up the dwellings, designed perhaps initially to house the royal chanceller.

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

Science.gov (United States)

Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital : The First 400 Procedures

NARCIS (Netherlands)

van den Bremer, J.; Joosten, P. Ph. A. Hedeman; Hamming, J. F.; Moll, F. L.

Endovenous Laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our

Airborne electromagnetic data and processing within Leach Lake Basin, Fort Irwin, California: Chapter G in Geology and geophysics applied to groundwater hydrology at Fort Irwin, California

Science.gov (United States)

Bedrosian, Paul A.; Ball, Lyndsay B.; Bloss, Benjamin R.; Buesch, David C.

2014-01-01

From December 2010 to January 2011, the U.S. Geological Survey conducted airborne electromagnetic and magnetic surveys of Leach Lake Basin within the National Training Center, Fort Irwin, California. These data were collected to characterize the subsurface and provide information needed to understand and manage groundwater resources within Fort Irwin. A resistivity stratigraphy was developed using ground-based time-domain electromagnetic soundings together with laboratory resistivity measurements on hand samples and borehole geophysical logs from nearby basins. This report releases data associated with the airborne surveys, as well as resistivity cross-sections and depth slices derived from inversion of the airborne electromagnetic data. The resulting resistivity models confirm and add to the geologic framework, constrain the hydrostratigraphy and the depth to basement, and reveal the distribution of faults and folds within the basin.

77 FR 37318 - Eighth Coast Guard District Annual Safety Zones; Sound of Independence; Santa Rosa Sound; Fort...

Science.gov (United States)

2012-06-21

...-AA00 Eighth Coast Guard District Annual Safety Zones; Sound of Independence; Santa Rosa Sound; Fort... Coast Guard will enforce a Safety Zone for the Sound of Independence event in the Santa Rosa Sound, Fort... during the Sound of Independence. During the enforcement period, entry into, transiting or anchoring in...

Forest pathology and entomology at Fort Valley Experimental Forest

Science.gov (United States)

Brian W. Geils

2008-01-01

Forest pathology and entomology have been researched at Fort Valley Experimental Forest throughout its history. The pathogens and insects of particular interest are mistletoes, decay and canker fungi, rusts, bark beetles, and various defoliators. Studies on life history, biotic interactions, impacts, and control have been published and incorporated into silvicultural...

Prognostic significance of platelet count changes during hospitalization for community-acquired pneumonia.

Science.gov (United States)

Gorelik, Oleg; Izhakian, Shimon; Barchel, Dana; Almoznino-Sarafian, Dorit; Tzur, Irma; Swarka, Muhareb; Beberashvili, Ilia; Feldman, Leonid; Cohen, Natan; Shteinshnaider, Miriam

2017-06-01

The prognostic significance of platelet count (PC) changes during hospitalization for community-acquired pneumonia (CAP) has not been investigated. For 976 adults, clinical data during hospitalization for CAP and all-cause mortality following discharge were compared according to ΔPC (PC on discharge minus PC on admission): groups A (declining PC, ΔPC 50 × 10 9 /l), and according to the presence of thrombocytopenia, normal PC, and thrombocytosis on admission/discharge. Groups A, B, and C comprised 7.9%, 46.5%, and 45.6% of patients, respectively. On hospital admission/discharge, thrombocytopenia, normal PC, and thrombocytosis were observed in 12.8%/6.4%, 84.1%/84.4%, and 3.1%/9.2% of patients, respectively. The respective 90-day, 3-year, and total (median follow-up of 54 months) mortality rates were significantly higher: in group A (40.3%, 63.6%, and 72.7%), compared to groups B (12.3%, 31.5%, and 39.0%) and C (4.9%, 17.3%, and 25.4%), p < 0.001; and in patients with thrombocytopenia at discharge (27.4%, 48.4%, and 51.6%), compared to those with normal PC (10.2%, 26.9%, and 35.4%) and thrombocytosis (8.9%, 17.8%, and 24.4%) at discharge (p < 0.001). Mortality rates were comparable among groups with thrombocytopenia, normal PC, and thrombocytosis at admission (p = 0.6). In the entire sample, each 100 × 10 9 /l increment of ΔPC strongly predicted lower mortality (p < 0.001, relative risk 0.73, 95% confidence interval 0.64-0.83). In conclusion, PC changes are common among CAP inpatients. Rising PC throughout hospitalization is a powerful predictor of better survival, while declining PC predicts poor outcome. Evaluation of PC changes during hospitalization for CAP may provide useful prognostic information.

Strategic Analysis and Associated Management Products Supporting the Reengineering of Bayne-Jones Army Community Hospital: Consultative Products and Findings

National Research Council Canada - National Science Library

Fulton, Larry

1998-01-01

.... ̂Product 2 - "Bayne-Jones Army Community Hospital Web Site," a strategic Internet web site for marketing health and wellness, the TRICARE medical network, the Joint Readiness Training Center Surgeon's...

Bioequivalence of fixed-dose combination Myrin®-P Forte and reference drugs in loose combination.

Science.gov (United States)

Wang, H F; Wang, R; O'Gorman, M; Crownover, P; Naqvi, A; Jafri, I

2013-12-01

Myrin®-P Forte is a fixed-dose combination (FDC) tablet containing rifampicin (RMP, 150 mg), isoniazid (INH, 75 mg), ethambutol (EMB) hydrochloride (275 mg) and pyrazinamide (PZA, 400 mg) developed for the treatment of tuberculosis (TB). This study was conducted at a single centre--the Pfizer Clinical Research Unit in Singapore. To demonstrate the bioequivalence of each drug component of the Myrin-P Forte FDC and the individual product in loose combination. In a randomized, open-label, single-dose, two-way, crossover study, subjects received single doses of Myrin-P Forte or four individual products under fasting conditions in a crossover fashion with at least 7 days washout between doses. The primary measures for comparison were peak plasma concentration (C(max)) and the area under plasma concentration-time curve (AUC). Of 36 subjects enrolled, 35 completed the study. The adjusted geometric mean ratios and 90% confidence intervals for C(max) and AUC values were completely contained within bioequivalence limits (80%, 125%) for all four drugs in both formulations. Both treatments were generally well tolerated in the study. The Myrin-P Forte FDC tablet formulation is bioequivalent to the four single-drug references for RMP, INH, EMB hydrochloride and PZA at equivalent doses.

Primary coolant chemistry of the Peach Bottom and Fort St. Vrain high-temperature gas-cooled reactors

International Nuclear Information System (INIS)

Burnette, R.D.; Baldwin, N.L.

1980-11-01

The chemical impurities in the primary coolants of the Peach Bottom and Fort St. Vrain reactors are discussed. The impurity mixtures in the two plants were quite different because the sources of the impurities were different. In the Peach Bottom reactor, the impurities were dominated by H 2 and CH 4 , which are decomposition products of oil. In the Fort St. Vrain reactor, there were high levels of CO, CO 2 , and H 2 O. Although oil ingress at Peach Bottom created carbon deposits on virtually all surfaces, its effect on reactor operation was negligible. Slow outgassing of water from the thermal insulation at Fort St. Vrain caused delays in reactor startup. The overall graphite oxidation in both plants was negligible

Primary coolant chemistry of the Peach Bottom and Fort St. Vrain high temperature gas-cooled reactors

International Nuclear Information System (INIS)

Burnette, R.D.; Baldwin, N.L.

1981-01-01

The chemical impurities in the primary coolants of the Peach Bottom and Fort St. Vrain reactors are discussed. The impurity mixtures in the two plants were quite different because the sources of the impurities were different. In the Peach Bottom reactor, the impurities were dominated by H 2 and CH 4 , which are decomposition products of oil. In the Fort St. Vrain reactor, there were high levels of CO, CO 2 , and H 2 O. Although oil ingress at Peach Bottom created carbon deposits on virtually all surfaces, its effect on reactor operation was negligible. Slow outgassing of water from the thermal insulation at Fort St. Vrain caused delays in reactor startup. The overall graphite oxidation in both plants was negligible. (author)

Separate treatment of hospital and urban wastewaters: A real scale comparison of effluents and their effect on microbial communities.

Science.gov (United States)

Chonova, Teofana; Keck, François; Labanowski, Jérôme; Montuelle, Bernard; Rimet, Frédéric; Bouchez, Agnès

2016-01-15

Hospital wastewaters (HWW) contain wider spectrum and higher quantity of pharmaceuticals than urban wastewaters (UWW), but they are generally discharged in sewers without pretreatment. Since traditional urban wastewater treatment plants (WWTP) are not designed to treat HWWs, treated effluents may still contain pollutants that could impair receiving aquatic environments. Hence, a better understanding of the effect of pharmaceuticals in the environment is required. Biofilms are effective "biological sensors" for assessing the environmental effects of pharmaceuticals due to their ability to respond rapidly to physical, chemical and biological fluctuations by changes in their structure and composition. This study evaluated the efficiency of biological treatment with conventional activated sludge system performed parallel on HWW and UWW. Furthermore, six successive monthly colonizations of biofilms were done on autoclaved stones, placed in grid-baskets in the hospital treated effluents (HTE) and urban treated effluents (UTE). The biomass of these biofilms as well as the structure and diversity of their bacterial communities were investigated. Results showed better treatment efficiency for phosphate and nitrite/nitrate during the treatment of UWW. Pharmaceuticals from all investigated therapeutic classes (beta-blockers, nonsteroidal anti-inflammatory drugs, antibiotics, analgesics and anticonvulsants) were efficiently removed, except for carbamazepine. The removal efficiency of the antibiotics, NSAIDs and beta-blockers was higher during the treatment of HWW. HTE and UTE shaped the bacterial communities in different ways. Higher concentrations of pharmaceuticals in the HTE caused adapted development of the microbial community, leading to less developed biomass and lower bacterial diversity. Seasonal changes in solar irradiance and temperature, caused changes in the community composition of biofilms in both effluents. According to the removal efficiency of pharmaceuticals

Renewable Energy Opportunities at Fort Hood, Texas

Energy Technology Data Exchange (ETDEWEB)

Chvala, William D.; Warwick, William M.; Dixon, Douglas R.; Solana, Amy E.; Weimar, Mark R.; States, Jennifer C.; Reilly, Raymond W.

2008-06-30

The document provides an overview of renewable resource potential at Fort Hood based primarily upon analysis of secondary data sources supplemented with limited on-site evaluations. The effort was funded by the U.S. Army Installation Management Command (IMCOM) as follow-on to the 2005 DoD Renewables Assessment. This effort focuses on grid-connected generation of electricity from renewable energy sources and also ground source heat pumps for heating and cooling buildings, as directed by IMCOM.

Heat-pump-centered integrated community energy systems

Energy Technology Data Exchange (ETDEWEB)

Schaetzle, W.J.; Brett, C.E.; Seppanen, M.S.

1979-12-01

The heat-pump-centered integrated community energy system (HP-ICES) supplies district heating and cooling using heat pumps and a thermal energy storage system which is provided by nature in underground porous formations filled with water, i.e., aquifers. The energy is transported by a two-pipe system, one for warm water and one for cool water, between the aquifers and the controlled environments. Each energy module contains the controlled environments, an aquifer, wells for access to the aquifer, the two pipe water distribution system and water source heat pumps. The heat pumps upgrade the energy in the distribution system for use in the controlled environments. Economically, the system shows improvement on both energy usage and capital costs. The system saves over 60% of the energy required for resistance heating; saves over 30% of the energy required for most air-source heat pumps and saves over 60% of the energy required for gas, coal, or oil heating, when comparing to energy input required at the power plant for heat pump usage. The proposed system has been analyzed as demonstration projects for a downtown portion of Louisville, Kentucky, and a section of Fort Rucker, Alabama. The downtown Louisville demonstration project is tied directly to major buildings while the Fort Rucker demonstration project is tied to a dispersed subdivision of homes. The Louisville project shows a payback of approximately 3 y, while Fort Rucker is approximately 30 y. The primary difference is that at Fort Rucker new heat pumps are charged to the system. In Louisville, either new construction requiring heating and cooling systems or existing chillers are utilized. (LCL)

Calculation of Void in the Fort Saint Vrain Material

Energy Technology Data Exchange (ETDEWEB)

Potter, David Charles [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Taylor, Craig Michael [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Coons, James Elmer [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-05-11

The percent void of the Fort Saint Vrain (FSV) material is estimated to be 21.1% based on the volume of the gap at the top of the drums, the volume of the coolant channels in the FSV fuel element, and the volume of the fuel handling channel in the FSV fuel element.

Hydrogeochemical cycling and chemical denudation in the Fort River Watershed, central Massachusetts: An appraisal of mass-balance studies

Science.gov (United States)

Yuretich, Richard F.; Batchelder, Gail L.

1988-01-01

The Fort River watershed in central Massachusetts receives precipitation with a composition similar to that in Hubbard Brook (New Hampshire), yet the average stream water chemistry is substantially different, showing higher pH and TDS. This is largely a function of bedrock and surficial geology, and chemical differences among small streams within the Fort River watershed are apparently controlled by the composition and thickness of the prevailing surficial cover. The surficial deposits determine groundwater and surface water flow paths, thereby affecting the resultant contact time with mineral matter and the chemistry of the runoff. Despite the rural setting, over 95% of the annual sodium and chloride in the streams comes from road salt; after correcting for this factor, cation denudation rates are about equal to those at Hubbard Brook. However, silica removal is occurring at a rate more than 30% greater in the Fort River. When climatic conditions in Hubbard Brook and Fort River are normalized, weathering rates appear consistently higher in the Fort River, reflecting differences in weathering processes (i.e., cation exchange and silicate breakdown) and hydrogeology. Because of uncertainties in mechanisms of cation removal from watersheds, the silica denudation rate may be a better index of weathering intensity.

Sustainability Analysis of the Water Resources and Supply of the Vieux Fort Region of Saint Lucia

Science.gov (United States)

Coles, D.; Johnson, B.; Morgan, F.

2005-05-01

In the Vieux Fort region of the Caribbean island of St. Lucia, water needs are becoming acute. The water supply shortfalls during the dry season will continue to grow as population and development increase, unless action is taken. Actions to address the problem should include measures to optimize the present water delivery system and the development of a new supply, through new intakes, groundwater, or reservoir construction. An investigation into the potential for groundwater resources using electrical resistivity soundings indicated a likely pervasive, shallow aquitard of clay materials below the water table; the shallowness of this aquitard virtually precludes the existence of productive perched aquifers. Consequently, a model of Grande Riviere du Vieux Fort (Big Vieux Fort River) seasonal surface-water flow was developed, based on a digital elevation model and rainfall data, allowing us to analyze the possible productivity of any new intakes placed along the river. A specific site downstream of the present intake was recommended for potential development. Recommendations were given for short, medium and long-term development of the resources and supply of the Vieux Fort region of southern St. Lucia.

Energy efficiency campaign for residential housing at the Fort Lewis army installation

Energy Technology Data Exchange (ETDEWEB)

AH McMakin; RE Lundgren; EL Malone

2000-02-23

In FY1999, Pacific Northwest National Laboratory conducted an energy efficiency campaign for residential housing at the Fort Lewis Army Installation near Tacoma, Washington. Preliminary weather-corrected calculations show energy savings of 10{percent} from FY98 for energy use in family housing. This exceeded the project's goal of 3{percent}. The work was funded by the U.S. DOEs Federal Energy Management Program (FEMP), Office of Energy Efficiency and Renewable Energy. The project adapted FEMP's national ``You Have the Power Campaign'' at the local level, tailoring it to the military culture. The applied research project was designed to demonstrate the feasibility of tailored, research-based strategies to promote energy conservation in military family housing. In contrast to many energy efficiency efforts, the campaign focused entirely on actions residents could take in their own homes, as opposed to technology or housing upgrades. Behavioral change was targeted because residents do not pay their own utility bills; thus other motivations must drive personal energy conservation. This campaign augments ongoing energy savings from housing upgrades carried out by Fort Lewis. The campaign ran from September 1998 through August 1999. The campaign strategy was developed based on findings from previous research and on input from residents and officials at Fort Lewis. Energy use, corrected to account for weather differences, was compared with the previous year's use. Survey responses from 377 of Fort Lewis residents of occupied housing showed that the campaign was moderately effective in promoting behavior change. Of those who were aware of the campaign, almost all said they were now doing one or more energy-efficient things that they had not done before. Most people were motivated by the desire to do the right thing and to set a good example for their children. They were less motivated by other factors.

Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland.

Science.gov (United States)

Meehan, Tom; Stedman, Terry; Parker, Stephen; Curtis, Bretine; Jones, Donna

2017-05-01

Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs. Methods An audit of consumers (n=240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning. Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems. Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options to move patients on were available. What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment. What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs. What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options were available. Future planning initiatives need to focus on developing a greater array of community

Comparison of clinical characteristics between healthcare-associated pneumonia and community-acquired pneumonia in patients admitted to secondary hospitals

Directory of Open Access Journals (Sweden)

Jong Hoo Lee

Full Text Available BACKGROUND: Since healthcare-associated pneumonia (HCAP is heterogeneous, clinical characteristics and outcomes are different from region to region. There can also be differences between HCAP patients hospitalized in secondary or tertiary hospitals. This study aimed to evaluate the clinical characteristics of HCAP patients admitted into secondary community hospitals. METHODS: This was a retrospective study conducted in patients with HCAP or community-acquired pneumonia (CAP hospitalized in two secondary hospitals between March 2009 and January 2011. RESULTS: Of a total of 303 patients, 96 (31.7% had HCAP. 42 patients (43.7% resided in a nursing home or long-term care facility, 36 (37.5% were hospitalized in an acute care hospital for > 2 days within 90 days, ten received outpatient intravenous therapy, and eight attended a hospital clinic or dialysis center. HCAP patients were older. The rates of patients with CURB65 scores of 3 or more (22.9% vs. 9.1%; p = 0.001 and PSI class IV or more (82.2% vs. 34.7%; p < 0.001 were higher in the HCAP group. Drug-resistant pathogens were more frequently detected in the HCAP group (23.9% vs. 0.4%; p < 0.001. However, Streptococcus pneumoniae was the most common pathogen in both groups. The rates of antibiotic change, use of inappropriate antibiotics, and failure of initial antibiotic therapy in the HCAP group were significantly higher. Although the overall survival rate of the HCAP group was significantly lower (82.3% vs. 96.8%; p < 0.001, multivariate analyses failed to show that HCAP itself was a prognostic factor for mortality (p = 0.826. Only PSI class IV or more was associated with increased mortality (p = 0.005. CONCLUSIONS: HCAP should be distinguished from CAP because of the different clinical features. However, the current definition of HCAP does not appear to be a prognostic for death. In addition, the use of broad-spectrum antibiotics for HCAP should be reassessed because S. pneumoniae was most

Master Environmental Plan: Fort Wingate Depot Activity, Gallup, New Mexico

Energy Technology Data Exchange (ETDEWEB)

Biang, C.A.; Yuen, C.R.; Biang, R.P.; Antonopoulos, A.A.; Ditmars, J.D.

1990-12-01

The master environmental plan is based on an environmental assessment of the areas requiring environmental evaluation (AREEs) at Fort Wingate Depot Activity near Gallup, New Mexico. The Fort Wingate Depot Activity is slated for closure under the Base Closure and Realignment Act, Public Law 100--526. The MEP assesses the current status, describes additional data requirements, recommends actions for the sites, and establishes a priority order for actions. The plan was developed so that actions comply with hazardous waste and water quality regulations of the State of New Mexico and applicable federal regulations. It contains a brief history of the site, relevant geological and hydrological information, and a description of the current status for each AREE along with a discussion of the available site-specific data that pertain to existing or potential contamination and the impact on the environment. 35 refs., 27 figs., 23 tabs.

Assessment of DOD Wounded Warrior Matters -- Fort Drum

Science.gov (United States)

2011-09-30

their relation to military duties. The six factors that are evaluated are: physical capacity or stamina , upper extremities, lower extremities...Health Net Federal Services contractor. The Fort Drum MEDDAC Referral Management Office created a “Reports Cell ” which was responsible for obtaining...Care Division had created a CLR/Reports Cell group that focused specifically on obtaining CLRs, inputting them into patients’ AHLTA records and

Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

Science.gov (United States)

Barnett, Paul G; Hong, Juliette S; Carey, Evan; Grunwald, Gary K; Joynt Maddox, Karen; Maddox, Thomas M

2018-02-01

The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Receipt of an elective coronary revascularization at a VA vs CC facility. Access to care as measured by travel distance, 30-day mortality, and costs. In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P publicly reported mortality data identified hospitals that provided higher-value care with the exception that CABG mortality was lower in small-volume CC hospitals. In this veteran cohort, PCIs performed in CC hospitals were associated with shorter travel distance but with higher mortality, higher costs, and minimal travel savings compared with VA hospitals. The CABG procedures performed in CC hospitals were associated with shorter travel distance

Thunderstorm and Lightning Studies using the FORTE Optical Lightning System (FORTE/OLS)

International Nuclear Information System (INIS)

Argo, P.; Franz, R.; Green, J.; Guillen, J.L.; Jacobson, A.R.; Kirkland, M.; Knox, S.; Spalding, R.; Suszcynsky, D.M.

1999-01-01

Preliminary observations of simultaneous RF and optical emissions from lightning as seen by the FORTE spacecraft are presented. RF/optical pairs of waveforms are routinely collected both as individual lightning events and as sequences of events associated with cloud-to-ground (CG) and intra-cloud (IC) flashes. CG pulses can be distinguished from IC pulses based on the properties of the RF and optical waveforms, but mostly based on the associated RF spectrograms. The RF spectrograms are very similar to previous ground-based VHF observations of lightning and show signatures associated with return strokes, stepped and dart leaders, and attachment processes,. RF emissions are observed to precede the arrival of optical emissions at the satellite by a mean value of 280 microseconds. The dual phenomenology nature of these observations are discussed in terms of their ability to contribute to a satellite-based lightning monitoring mission

Thunderstorm and Lightning Studies using the FORTE Optical Lightning System (FORTE/OLS)

Energy Technology Data Exchange (ETDEWEB)

Argo, P.; Franz, R.; Green, J.; Guillen, J.L.; Jacobson, A.R.; Kirkland, M.; Knox, S.; Spalding, R.; Suszcynsky, D.M.

1999-02-01

Preliminary observations of simultaneous RF and optical emissions from lightning as seen by the FORTE spacecraft are presented. RF/optical pairs of waveforms are routinely collected both as individual lightning events and as sequences of events associated with cloud-to-ground (CG) and intra-cloud (IC) flashes. CG pulses can be distinguished from IC pulses based on the properties of the RF and optical waveforms, but mostly based on the associated RF spectrograms. The RF spectrograms are very similar to previous ground-based VHF observations of lightning and show signatures associated with return strokes, stepped and dart leaders, and attachment processes,. RF emissions are observed to precede the arrival of optical emissions at the satellite by a mean value of 280 microseconds. The dual phenomenology nature of these observations are discussed in terms of their ability to contribute to a satellite-based lightning monitoring mission.

Final Sampling and Analysis Plan for Background Sampling, Fort Sheridan, Illinois

National Research Council Canada - National Science Library

1995-01-01

.... This Background Sampling and Analysis Plan (BSAP) is designed to address this issue through the collection of additional background samples at Fort Sheridan to support the statistical analysis and the Baseline Risk Assessment (BRA...

"To serve the community best": reconsidering Black politics in the struggle to save Homer G. Phillips Hospital in St. Louis, 1976-1984.

Science.gov (United States)

Kirouac-Fram, Jaclyn

2010-01-01

The move to consolidate, and eventually to close, Homer G. Phillips Hospital sparked a major uprising in St. Louis, Missouri, during the years 1976 through 1984. This article explores the struggle in St. Louis’s black community to keep open, and later to reopen, Homer G. Phillips Hospital from a vantage point that demonstrates the diversity of opinion surrounding the struggle. For many black St. Louis residents, the physical space of Homer G. Phillips Hospital was a metaphor for identity, a manifestation of citizenship rights, and a means of delineating a territory of shared histories, understandings, and values. For others, it was a relic of segregation and racism. In seeking to understand the diversity of public reaction, this article addresses class antagonism, examines the varied and divergent motivations for eliminating or maintaining services at the hospital, and reconsiders the discourse of "black politics." It is a decisive illustration of how the national twin crises of deindustrialization and privatization affected a heterogeneous black community.

Introducing a Third Timed Up & Go Test Trial Improves Performances of Hospitalized and Community-Dwelling Older Individuals

DEFF Research Database (Denmark)

Bloch, Mette Linding; R. Jønsson, Line R. Jønsson; T. Kristensen, Morten

2017-01-01

in hospitalized and community-dwelling older individuals. Methods: Eighty-two participants (50 from a geriatric hospital unit and 32 from an outpatient geriatric center; 52 women, 30 men) with a mean (SD) age of 83.6 (7.9) years were included in this cross-sectional study. All participants (except one from...... the hospital unit) performed 3 TUG trials, as fast as safely possible on the same day, and separated by up to 1-minute pauses. A rollator (4-wheeled rolling walker) was used as a standardized walking aid in the geriatric hospital unit, whereas participants used their normal walking aid (if any......) in the outpatient geriatric center. Results and Discussion: The fastest trial was trial 3 for 47 (57%), trial 2 for 25 (31%), and trial 1 for 10 (12%). Repeated-measures analyses of variance with Bonferroni corrections showed that TUG times improved from trial 1 to trial 3 (P

POLLUTION PREVENTION OPPORTUNITY ASSESSMENT HISTOLOGY LABORATORY XYLENE USE - FORT CARSON, COLORADO

Science.gov (United States)

Under the WREAFS program, RREL has performed a waste minimization opportunity assessment (WMOA) at the Evans Community Hospital Histopathology Laboratory on the Ft. Carson Army Base, Colorado, in the area of waste xylene and ethyl alcohol contaminated with human tissue. The waste...

Improving financial performance by modeling and analysis of radiology procedure scheduling at a large community hospital.

Science.gov (United States)

Lu, Lingbo; Li, Jingshan; Gisler, Paula

2011-06-01

Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, "what-if" analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital.

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

Directory of Open Access Journals (Sweden)

Minas Harry

2009-01-01

Full Text Available Abstract Background Yuli Veterans Hospital (YVH has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Methods Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. Results There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. Discussion There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. Conclusion This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition

Exchanging knowledge within a community of practice: toward an epistemology of practice in Occupational Therapy paediatric hospital care

Directory of Open Access Journals (Sweden)

Sandra Maria Galheigo

2017-09-01

Full Text Available Objective: This research proposed the creation of a community of practice (CoP with the objective of: (i analysing the feasibility of a CoP as a means of generating knowledge among occupational therapists and (ii investigating the practice of occupational therapy with hospitalized children and adolescents. This article privileges the results of one of the predominantly discussed themes - the use of assessments and strategies of evaluation in Occupational Therapy in the hospital context. Method: A participatory action research study was undertaken with nine occupational therapists in face-to-face meetings combined with virtual tasks on an on-line platform. A hermeneutic and dialectical method was used to interpret the results. Results: The CoP produced practical knowledge about the use of assessments with hospitalized children and adolescents and demonstrated to be a strategy of knowledge development through dialogue and collaborative reflection on practice. Conclusion: Research on the implementation of communities of practice offers a promising approach to the production of knowledge in occupational therapy. The generated knowledge is representative of occupational therapists’ experiences and demonstrates an example of an epistemology of practice.

Strategic Energy Management Plan For Fort Buchanan, Puerto Rico

Energy Technology Data Exchange (ETDEWEB)

Parker, Steven A.; Hunt, W. D.

2001-10-31

This document reports findings and recommendations as a result of a design assistance project with Fort Buchanan with the goals of developing a Strategic Energy Management Plan for the Site. A strategy has been developed with three major elements in mind: 1) development of a strong foundation from which to build, 2) understanding technologies that are available, and 3) exploring financing options to fund the implementation of improvements. The objective of this report is to outline a strategy that can be used by Fort Buchanan to further establish an effective energy management program. Once a strategy is accepted, the next step is to take action. Some of the strategies defined in this Plan may be implemented directly. Other strategies may require the development of a more sophisticated tactical, or operational, plan to detail a roadmap that will lead to successful realization of the goal. Similarly, some strategies are not single events. Rather, some strategies will require continuous efforts to maintain diligence or to change the culture of the Base occupants and their efforts to conserve energy resources.

Site Investigations with the Site Characterization and Analysis Penetrator System at Fort Dix, New Jersey

Science.gov (United States)

1993-07-01

rod system or through a tremie tube ; both procedures were used interchangeably at Fort Dix to demon- strate the efficiency and effectiveness of each...allows delivery through either a l/4-in.-diam grout tube or a 3/8-in.-diam rout tube . The grout used at Fort Dix consisted of a mixture of water and... microfine , blended Portland cement (Lehigh Geocem’, Leeds, Alabama). The grout is a suspension of a uniformly produced cement clinker interground with

Comparison of community and hospital pharmacists' attitudes and behaviors on medication error disclosure to the patient: A pilot study.

Science.gov (United States)

Kim, ChungYun; Mazan, Jennifer L; Quiñones-Boex, Ana C

To determine pharmacists' attitudes and behaviors on medication errors and their disclosure and to compare community and hospital pharmacists on such views. An online questionnaire was developed from previous studies on physicians' disclosure of errors. Questionnaire items included demographics, environment, personal experiences, and attitudes on medication errors and the disclosure process. An invitation to participate along with the link to the questionnaire was electronically distributed to members of two Illinois pharmacy associations. A follow-up reminder was sent 4 weeks after the original message. Data were collected for 3 months, and statistical analyses were performed with the use of IBM SPSS version 22.0. The overall response rate was 23.3% (n = 422). The average employed respondent was a 51-year-old white woman with a BS Pharmacy degree working in a hospital pharmacy as a clinical staff member. Regardless of practice settings, pharmacist respondents agreed that medication errors were inevitable and that a disclosure process is necessary. Respondents from community and hospital settings were further analyzed to assess any differences. Community pharmacist respondents were more likely to agree that medication errors were inevitable and that pharmacists should address the patient's emotions when disclosing an error. Community pharmacist respondents were also more likely to agree that the health care professional most closely involved with the error should disclose the error to the patient and thought that it was the pharmacists' responsibility to disclose the error. Hospital pharmacist respondents were more likely to agree that it was important to include all details in a disclosure process and more likely to disagree on putting a "positive spin" on the event. Regardless of practice setting, responding pharmacists generally agreed that errors should be disclosed to patients. There were, however, significant differences in their attitudes and behaviors

Molecular epidemiology of extended-spectrum β-lactamase-producing Escherichia coli in the community and hospital in Korea: emergence of ST131 producing CTX-M-15

Directory of Open Access Journals (Sweden)

Park Sun

2012-06-01

Full Text Available Abstract Background The prevalence of extended-spectrum β-lactamase (ESBL-producing Escherichia coli has been increased not only in the hospital but also in the community worldwide. This study was aimed to characterize ESBL- producing E. coli isolates and to investigate the molecular epidemiology of community isolates in comparison with hospital isolates at a single center in Korea. Methods A total of 142 ESBL-producing E. coli isolates were collected at Daejeon St Mary’s Hospital in Korea from January 2008 to September 2009. The ESBLs were characterized by PCR sequencing using specific primers. The genetic relatedness was determined by pulsed field gel electrophoresis (PFGE and multilocus sequence typing (MLST. Results Of 142 isolates, 139 were positive for CTX-M type ESBLs; CTX-M-14 (n = 69, 49.6 %, CTX-M-15 (n = 53, 38.1 % and both CTX-M-14 and -15 (n = 17, 12.2 %. CTX-M-14 and CTX-M-15 were detected in both community and hospital isolates whereas isolates producing both CTX-M14 and-15 were mainly identified in the hospital. CTX-M producing E. coli isolates were genetically heterogeneous, revealing 75 distinct PFGE types. By MLST, 21 distinctive STs including 5 major STs (ST131, ST405, ST38, ST10, and ST648 were identified. Major STs were distributed in both community and hospital isolates, and ST131 was the predominant clone regardless of the locations of acquisition. No specific major STs were confined to a single type of ESBLs. However, ST131 clones were significantly associated with CTX-M-15 and the majority of them were multidrug-resistant. Distinctively, we identified a hospital epidemic caused by the dissemination of an epidemic strain, ST131-PFGE type 10, characterized by multidrug resistance and co-producing both CTX-Ms with OXA-1 or TEM-1b. Conclusions The epidemiology of ESBL-producing E. coli is a complex and evolving phenomenon attributed to the horizontal transfer of genetic elements and clonal spread of

Population Screening Using Sewage Reveals Pan-Resistant Bacteria in Hospital and Community Samples.

Science.gov (United States)

Meir-Gruber, Lital; Manor, Yossi; Gefen-Halevi, Shiraz; Hindiyeh, Musa Y; Mileguir, Fernando; Azar, Roberto; Smollan, Gill; Belausov, Natasha; Rahav, Galia; Shamiss, Ari; Mendelson, Ella; Keller, Nathan

2016-01-01

The presence of pan-resistant bacteria worldwide possesses a threat to global health. It is difficult to evaluate the extent of carriage of resistant bacteria in the population. Sewage sampling is a possible way to monitor populations. We evaluated the presence of pan-resistant bacteria in Israeli sewage collected from all over Israel, by modifying the pour plate method for heterotrophic plate count technique using commercial selective agar plates. This method enables convenient and fast sewage sampling and detection. We found that sewage in Israel contains multiple pan-resistant bacteria including carbapenemase resistant Enterobacteriacae carrying blaKPC and blaNDM-1, MRSA and VRE. blaKPC carrying Klebsiella pneumonia and Enterobacter cloacae were the most common Enterobacteriacae drug resistant bacteria found in the sewage locations we sampled. Klebsiella pneumonia, Enterobacter spp., Escherichia coli and Citrobacter spp. were the 4 main CRE isolated from Israeli sewage and also from clinical samples in our clinical microbiology laboratory. Hospitals and Community sewage had similar percentage of positive samplings for blaKPC and blaNDM-1. VRE was found to be more abundant in sewage in Israel than MRSA but there were more locations positive for MRSA and VRE bacteria in Hospital sewage than in the Community. Therefore, our upgrade of the pour plate method for heterotrophic plate count technique using commercial selective agar plates can be a useful tool for routine screening and monitoring of the population for pan-resistant bacteria using sewage.

Practice comparisons between accelerated resolution therapy, eye movement desensitization and reprocessing and cognitive processing therapy with case examples.

Science.gov (United States)

Hernandez, Diego F; Waits, Wendi; Calvio, Lisseth; Byrne, Mary

2016-12-01

Recent outcomes for Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy indicate that as many as 60-72% of patients retain their PTSD diagnosis after treatment with CPT or PE. One emerging therapy with the potential to augment existing trauma focused therapies is Accelerated Resolution Therapy (ART). ART is currently being used along with evidence based approaches at Fort Belvoir Community Hospital and by report has been both positive for clients as well as less taxing on professionals trained in ART. The following is an in-practice theoretical comparison of CPT, EMDR and ART with case examples from Fort Belvoir Community Hospital. While all three approaches share common elements and interventions, ART distinguishes itself through emphasis on the rescripting of traumatic events and the brevity of the intervention. While these case reports are not part of a formal study, they suggest that ART has the potential to augment and enhance the current delivery methods of mental health care in military environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fort Lewis natural gas and fuel oil energy baseline and efficiency resource assessment

International Nuclear Information System (INIS)

Brodrick, J.R.; Daellenbach, K.K.; Parker, G.B.; Richman, E.E.; Secrest, T.J.; Shankle, S.A.

1993-02-01

The mission of the US Department of Energy (DOE) Federal Energy Management Program (FEMP) is to lead the improvement of energy efficiency and fuel flexibility within the federal sector. Through the Pacific Northwest Laboratory (PNL), FEMP is developing a fuel-neutral approach for identifying, evaluating, and acquiring all cost-effective energy projects at federal installations; this procedure is entitled the Federal Energy Decision Screening (FEDS) system. Through a cooperative program between FEMP and the Army Forces Command (FORSCOM) for providing technical assistance to FORSCOM installations, PNL has been working with the Fort Lewis Army installation to develop the FEDS procedure. The natural gas and fuel oil assessment contained in this report was preceded with an assessment of electric energy usage that was used to implement a cofunded program between Fort Lewis and Tacoma Public Utilities to improve the efficiency of the Fort's electric-energy-using systems. This report extends the assessment procedure to the systems using natural gas and fuel oil to provide a baseline of consumption and an estimate of the energy-efficiency potential that exists for these two fuel types at Fort Lewis. The baseline is essential to segment the end uses that are targets for broad-based efficiency improvement programs. The estimated fossil-fuel efficiency resources are estimates of the available quantities of conservation for natural gas, fuel oils number-sign 2 and number-sign 6, and fuel-switching opportunities by level of cost-effectiveness. The intent of the baseline and efficiency resource estimates is to identify the major efficiency resource opportunities and not to identify all possible opportunities; however, areas of additional opportunity are noted to encourage further effort

Etiology of community-acquired pneumonia in hospitalized patients in Jordan

International Nuclear Information System (INIS)

Al-Ali, Musa K.; Batchoun, R. G.; Al-Nour, Tariq M.

2006-01-01

To ascertain the causative organisms of community acquired pneumonia (Cap) in Jordanian patients requiring hospital admission. A prospective study of both adults and children admitted to Princess Basma and Princess Rahma Teaching Hospitals in Irbid, Jordan with a diagnosis of CAP over a 6-month period from April to October 2002. A total of 35 adult patients were admitted with a mean age of 47 years, and 63 children with a mean age of 3 years. A pathogen was isolated from 25 (71%) adults, and from 17 (27%) children, and sputum cultures gave the best diagnostic yield. In adults Streptococcus pneumoniae was the most common isolate (26%), followed by Chlamydia pneumoniae (23%), Haemophilus influenzae (17%), Mycoplasma pneumoniae (9%), and Legionella pneumophila and Klebsiella pneumoniae (6%) each. Seven of the 9 gram negative isolates were from patients with some co morbid illness. While in children, Chlamydia pneumoniae was the most common (14%), followed by Mycoplasma pneumoniae (6%), and Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa (3%) each. Streptococcus pneumoniae and atypical microorganisms are the most common cause of CAP in previously healthy adults; while in those with associated co morbid illness, gram negative organisms are the likely cause. In children, the overall detection rate of causative organisms was low with atypical microorganisms being the most common. (author)

Leaktightness in HTGRs - experience at Fort St. Vrain

International Nuclear Information System (INIS)

Neylan, A.J.; Barker, R.A.; Deardorff, A.F.

1976-01-01

The Fort St. Vrain Prestressed Concrete Reactor Vessel is the first utilized to contain the helium coolant of a High Temperature Gas-Cooled Reactor. Because the helium coolant contains fission products, leakage from the vessel is limited to 15 percent of vessel inventory per year. This paper describes the fabrication methods and development tests used to assure this leaktightness and the leakage test conducted to verify it. (author)

The health of loblolly pine stands at Fort Benning, GA

Science.gov (United States)

Soung-Ryoul Ryu; G. Geoff Wang; Joan L. Walker

2013-01-01

Approximately two-thirds of the red-cockaded woodpecker (Picoides borealis) (RCW) groups at Fort Benning, GA, depend on loblolly pine (Pinus taeda) stands for nesting or foraging. However, loblolly pine stands are suspected to decline. Forest managers want to replace loblolly pine with longleaf pine (P. palustris...

Characteristics of the Websites of the Community of Madrid Hospitals: Relationship between Web Quality and Corporate Social Responsibility

Directory of Open Access Journals (Sweden)

Herenia Gutiérrez-Ponce

2018-02-01

Full Text Available The aim of this research is to analyse the quality of websites of the public and private hospitals of the Community of Madrid; as well as to identify its relationship with the indicators of Corporate Social Responsibility (CSR. This study is in tune with the increasing demand of digital information about health institutions in follow-up of the Law of Transparency, Access to the Public Information and Good Government. The methodology used, supported by previous academic publications, consists on exploring the scores of hospitals by means of questionnaires and accessibility tools able to identify the quality of a web information, and its statistical relation with CSR indicators, especially in the case of public hospitals.

[Direct hospitalization costs associated with chronic Hepatitis C in the Valencian Community in 2013].

Science.gov (United States)

Barrachina Martínez, Isabel; Giner Durán, Remedios; Vivas-Consuelo, David; López Rodado, Antonio; Maldonado Segura, José Alberto

2018-04-23

Hospital costs associated with Chronic Hepatitis C (HCC) arise in the final stages of the disease. Its quantification is very helpful in order to estimate and check the burden of the disease and to make financial decisions for new antivirals. The highest costs are due to the decompensation of cirrosis. Cross-sectional observational study of hospital costs of HCC diagnoses in the Valencian Community in 2013 (n= 4,486 hospital discharges). Information source: Minimum basic set of data/ Basic Minimum Data Set. The costs were considered according to the rates established for the DRG (Diagnosis related group) associated with the episodes with diagnosis of hepatitis C. The average survival of patients since the onset of the decom- pensation of their cirrhosis was estimated by a Markov model, according to the probabilities of evolution of the disease existing in Literatura. There were 4,486 hospital episodes, 1,108 due to complications of HCC, which generated 6,713 stays, readmission rate of 28.2% and mortality of 10.2%. The hospital cost amounted to 8,788,593EUR: 3,306,333EUR corresponded to Cirrhosis (5,273EUR/patient); 1,060,521EUR to Carcinoma (6,350EUR/ patient) and 2,962,873EUR to transplantation (70,544EUR/paciente. Comorbidity was 1,458,866EUR. These costs are maintai- ned for an average of 4 years once the cirrhosis decompensation begins. Cirrhosis due to HCC generates a very high hospitalization's costs. The methodology used in the estimation of these costs from the DRG can be very useful to evaluate the trend and economic impact of this disease.

First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.

Science.gov (United States)

Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip

2017-03-01

There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

77 FR 57112 - Notice of Inventory Completion: U.S. Department of Defense, Army, Fort Sill Museum, Lawton, OK

Science.gov (United States)

2012-09-17

... Landmark and Museum, U.S. Army Fires Center of Excellence, Fort Sill, OK 73503, telephone (580) 442-6570... trapping, 3 metal rings, 2 metal rivets, 17 metal nails, 53 metal bracelets, 1 metal pail, 1,500 glass... A. Neel, Director, Fort Sill National Historic Landmark and Museum, U.S. Army Fires Center of...

Home health agency work environments and hospitalizations.

Science.gov (United States)

Jarrín, Olga; Flynn, Linda; Lake, Eileen T; Aiken, Linda H

2014-10-01

An important goal of home health care is to assist patients to remain in community living arrangements. Yet home care often fails to prevent hospitalizations and to facilitate discharges to community living, thus putting patients at risk of additional health challenges and increasing care costs. To determine the relationship between home health agency work environments and agency-level rates of acute hospitalization and discharges to community living. Analysis of linked Center for Medicare and Medicaid Services Home Health Compare data and nurse survey data from 118 home health agencies. Robust regression models were used to estimate the effect of work environment ratings on between-agency variation in rates of acute hospitalization and community discharge. Home health agencies with good work environments had lower rates of acute hospitalizations and higher rates of patient discharges to community living arrangements compared with home health agencies with poor work environments. Improved work environments in home health agencies hold promise for optimizing patient outcomes and reducing use of expensive hospital and institutional care.

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.

Qualitative insights into job satisfaction and dissatisfaction with management among community and hospital pharmacists.

Science.gov (United States)

Ferguson, Jane; Ashcroft, Darren; Hassell, Karen

2011-09-01

Job satisfaction research in pharmacy has predominantly been investigated using quantitative measures that have generally overlooked satisfaction with management. This article explores pharmacists' experiences and perceptions of management and examines the implications for job satisfaction. Semi-structured interviews were conducted with a convenience sample of 11 community and 15 hospital pharmacists in the North West of England (n=26). The interview schedule was composed of broad questions relating to job satisfaction and dissatisfaction, allowing for the exploration of original themes. Interviews were transcribed verbatim and entered into NVivo8. Template analysis was used to develop a hierarchical list of codes representing themes and the relationships between themes. Dissatisfaction with management emerged as a dominant aspect of pharmacists' job dissatisfaction. Of the 26 pharmacists interviewed, 24 commented on their dissatisfaction with management, whereas only 8 participants commented on positive experiences. Both hospital and community pharmacists expressed dissatisfaction with their line management, and how the organizations they worked for were managed. Findings suggest that satisfaction with management is an important and significant contributor to job satisfaction overall. It would appear that pharmacists' job satisfaction is compromised by poor line management, lack of recognition, and support from management, which may lead to an increase in turnover and a reduction in job satisfaction. Copyright © 2011 Elsevier Inc. All rights reserved.

Steps Toward Creating A Therapeutic Community for Inpatients Suffering from Chronic Ulcers: Lessons from Allada Buruli Ulcer Treatment Hospital in Benin.

Directory of Open Access Journals (Sweden)

Arnaud Setondji Amoussouhoui

2016-07-01

Full Text Available Reducing social distance between hospital staff and patients and establishing clear lines of communication is a major challenge when providing in-patient care for people afflicted by Buruli ulcer (BU and chronic ulcers. Research on hospitals as therapeutic communities is virtually non-existent in Africa and is currently being called for by medical anthropologists working in the field of health service and policy planning. This paper describes a pioneering attempt to establish a therapeutic community for patients suffering from BU and other chronic ulcers requiring long term hospital care in Benin.A six-month pilot project was undertaken with the objectives of establishing a therapeutic community and evaluating its impact on practitioner and patient relations. The project was designed and implemented by a team of social scientists working in concert with the current and previous director of a hospital serving patients suffering from advanced stage BU and other chronic ulcers. Qualitative research initially investigated patients' understanding of their illness and its treatment, identified questions patients had about their hospitalization, and ascertained their level of social support. Newly designed question-answer health education sessions were developed. Following these hospital wide education sessions, open forums were held each week to provide an opportunity for patients and hospital staff to express concerns and render sources of discontent transparent. Patient group representatives then met with hospital staff to problem solve issues in a non-confrontational manner. Psychosocial support for individual patients was provided in a second intervention which took the form of drop-in counseling sessions with social scientists trained to serve as therapy facilitators and culture brokers.Interviews with patients revealed that most patients had very little information about the identity of their illness and the duration of their treatment. This

Informal report on measurements of slant TEC by FORTE

International Nuclear Information System (INIS)

Massey, R.S.

1997-01-01

Los Alamos National Laboratory's Space and Atmospheric Sciences group is now operating the FORTE satellite, which has two sets of instruments: optical detectors and radio detectors. In this report the author describes work with one set of radio detectors that allow measurements of the total electron content (TEC) traversed by VHF radiation originating at an electromagnetic pulse (EMP) generator located at Los Alamos

Assessment of DoD Wounded Warrior Matters -- Fort Riley

Science.gov (United States)

2013-08-06

acceptable excuses included At Remote Care, Regular Leave, Maternity and Paternity Leave, Terminal Leave, Permanent Change of Station, and Transferred to...risk of negative medication interactions and reactions for Soldiers assigned to the Fort Riley WTB. B.2. Background The Joint Commission, an...reconciliation is to minimize medication errors such as omissions, duplications, dosing errors, and drug interactions . Medical reconciliation should

Antimicrobial Activity of Chlorhexidine, Peracetic acid/ Peroxide hydrogen and Alcohol based compound on Isolated Bacteria in Madani Heart Hospital, Tabriz, Azerbaijan, Iran

Science.gov (United States)

Ghotaslou, Reza; Bahrami, Nashmil

2012-01-01

Purpose: The aim of present study was to investigate the effect of chemical agents on the clinical isolates in Madani Heart Hospital, Tabriz, Iran. Methods: The minimum bactericide concentration (MBC) of disinfectants including chlorhexidine (Fort), peracetic acid (Micro) and an alcohol based compound (Deconex) on selected bacteria at various dilutions were determined by the standard suspension technique. Results: MBC of Micro, Fort and Deconex were 2-128 mg/L, 2-64 mg/L and 4 - 32 mg/L, respectively. The Gram negative bacteria were more resistance to disinfectant relation to Gram positive bacteria. Conclusion: The results showed that these agents are able to eradicate the bacteria and they can be used lonely. PMID:24312771

Antimicrobial Activity of Chlorhexidine, Peracetic acid/ Peroxide hydrogen and Alcohol based compound on Isolated Bacteria in Madani Heart Hospital, Tabriz, Azerbaijan, Iran

Directory of Open Access Journals (Sweden)

Reza Ghotaslou

2012-06-01

Full Text Available Purpose: The aim of present study was to investigate the effect of chemical agents on the clinical isolates in Madani Heart Hospital, Tabriz, Iran. Methods: The minimum bactericide concentration (MBC of disinfectants including chlorhexidine (Fort, peracetic acid (Micro and an alcohol based compound (Deconex on selected bacteria at various dilutions were determined by the standard suspension technique. Results: MBC of Micro, Fort and Deconex were 2-128 mg/L, 2-64 mg/L and 4 - 32 mg/L, respectively. The Gram negative bacteria were more resistance to disinfectant relation to Gram positive bacteria. Conclusion: The results showed that these agents are able to eradicate the bacteria and they can be used lonely.

Tile forts of the Liesbeeck Frontier | Sleigh | Scientia Militaria: South ...

African Journals Online (AJOL)

Scientia Militaria: South African Journal of Military Studies. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 27 (1997) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Tile forts of the Liesbeeck Frontier.

77 FR 24579 - Establishment of the Fort Ord National Monument

Science.gov (United States)

2012-04-25

... 1775-1776, Anza established the first overland route from ``New Spain,'' as Mexico was then known, to..., approximately 6 miles of which pass through the Fort Ord area. Although much of the historic route currently... tourists and recreationalists from near and far, and enhance its unique natural resources, for the...

The Forte Kreis : an Attempt to Spiritual Leadership over Europe

NARCIS (Netherlands)

Poorthuis, Marcel

2017-01-01

Just before the outbreak of World War 1, a group of writers, artists and philosophers decided to establish a spiritual rule over Europe, the Forte Kreis. The group aimed at a reconciliation in Europe, by establishing pacifism, but also between East and West by creating a new language. Their thoughts

Analysis of residents' willingness to pay to reduce air pollution to improve children's health in community and hospital settings in Shanghai, China.

Science.gov (United States)

Wang, Keran; Wu, Jinyi; Wang, Rui; Yang, Yingying; Chen, Renjie; Maddock, Jay E; Lu, Yuanan

2015-11-15

Shanghai, along with many major cities in China, faces deterioration of air quality and increases in air pollution-related respiratory diseases (RDs) in children due to rapid industrialization and urbanization. The Contingent Valuation Method (CVM) was used to qualitatively and quantitatively measure the willingness to pay (WTP) for reducing children's RDs through air quality improvement. Between April and May, 2014, 975 face-to-face interviews were collected from parents in a community-based and a hospital-setting in Shanghai. Multiple imputation and the Probit model were used to determine the relationship between the WTP and the related environmental factors, child health factors and the socio-economic status. Most respondents reported being willing to make a financial contribution to improve air quality in both the community (52.6%) and hospital (70.2%) samples. Those in the hospital setting were willing to pay significantly more ¥504 (USD$80.7) compared to the community sample ¥428 ($68.5) as expected. Reasons for those not being willing to pay included lack of disposable income and believing that responsibility of the air quality was a community issue. These did not differ by sample. Annual household income and education were related to WTP. This study indicated that parents in Shanghai would be willing to pay for improved air quality. Children's health can be the incentive for the citizens' participation and support in the air quality improvement, therefore, hospital settings may present unique places to improve education about air quality and enhance advocacy efforts. This study also suggested that future environmental policies be addressed more rigorously for targeted populations. Copyright © 2015 Elsevier B.V. All rights reserved.

The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities.

Science.gov (United States)

Suarez-Almazor, M E; Flowerdew, G; Saunders, L D; Soskolne, C L; Russell, A S

1993-05-01

The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture.

Prevalence of use of advance directives, health care proxy, legal guardian, and living will in 512 patients hospitalized in a cardiac care unit/intensive care unit in 2 community hospitals.

Science.gov (United States)

Kumar, Anil; Aronow, Wilbert S; Alexa, Margelusa; Gothwal, Ritu; Jesmajian, Stephen; Bhushan, Bharat; Gaba, Praveen; Catevenis, James

2010-04-30

The prevalence of use of any advance directives was 26% in 112 patients hospitalized in a cardiac care unit (CCU)/intensive care unit (ICU) in an academic medical center. We investigated in 2 community hospitals the prevalence of use of advance directives (AD), health care proxy (HCP), legal guardian (LG), and living will (LW) in 512 patients hospitalized in a CCU/ ICU approached for AD and HCP. The use of AD was 22%, of HCP was 19%, of LG was 16%, and of LW was 5%. The use of AD was 22%, of HCP was 19%, of LG was 16%, and of LW was 5% in patients hospitalized in a CCU/ICU. Educational programs on use of AD and of HCP need to be part of cardiovascular training programs and of cardiovascular continuing medical education.

Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery.

Science.gov (United States)

Salma, Ra'ed Ghaleb; Al-Shammari, Fahad Mohammed; Al-Garni, Bishi Abdullah; Al-Qarzaee, Mohammed Abdullah

2017-06-01

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery. A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included. The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night. In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

[Evaluation of a Two-day Hospital On-site Training Program for Community Pharmacists: Approach to Facilitate Collaboration among Community Healthcare Professionals].

Science.gov (United States)

Sumi, Masaki; Hasegawa, Chiaki; Morii, Hiroaki; Hoshino, Nobuo; Okunuki, Yumi; Kanemoto, Kashie; Horie, Miya; Okamoto, Haruka; Yabuta, Naoki; Matsuda, Masashi; Kamiya, Takaki; Sudo, Masatomo; Masuda, Kyouko; Iwashita, Yuri; Matsuda, Kaori; Motooka, Yoshiko; Hira, Daiki; Morita, Shin-Ya; Terada, Tomohiro

2018-01-01

　The importance of community-based care systems has increased due to the highly aging population and diversity of disease. To enhance the cooperation among healthcare professionals in community-based care systems, a two-day on-site training program for community pharmacists based on a multidisciplinary team approach was conducted at the Medical Science Hospital of Shiga University from April 2015 to March 2017. There were two professional courses in this training program: the palliative care course and nutrition support course. Both courses consisted of common pharmaceutical care training as follows: regional cooperation among healthcare professionals, pharmacist's clinical activities in the ward, pressure ulcer care, infection control, and aseptic technique for parenteral solutions. Each course was limited to 2 participants. A questionnaire was given to participants in the training program. Seventy-five pharmacists participated in the training and all of them answered the questionnaire. According to the questionnaire, 86% of participants felt that 2 days was an appropriate term for the training program. Positive answers regarding the content of each program and overall satisfaction were given by 100% and 99% of the participants, respectively. In the categorical classification of free comments regarding the expected change in pharmacy practice after the training, both "support for patients under nutritional treatment" and "cooperation with other medical staff" were answered by 24 participants. These results suggested that the 2-day on-site training for community pharmacists facilitated cooperation among healthcare professionals in the community.

Efficacy of Implementation of a Chest Pain Center at a Community Hospital.

Science.gov (United States)

Davis, Alexandra; Chiu, Jason; Lau, Stanley K; Kok, Yih Jen; Wu, Jonathan Y H

2017-12-01

Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption. The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge. A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day survival rates were 100% and 97%, respectively. The data showed a significant reduction in total length of stay for all chest pain patients. This retrospective program evaluation demonstrated some evidence in using HEART score to safely risk stratify chest pain patients to the appropriate level of care. As healthcare moves from a fee-for-service environment to value-based purchasing, hospitals need to devise and implement innovative strategies to provide efficient, beneficial, and safe care for the patients.

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.

Distinguishing community benefits: tax exemption versus organizational legitimacy.

Science.gov (United States)

Byrd, James D; Landry, Amy

2012-01-01

US policymakers continue to call into question the tax-exempt status of hospitals. As nonprofit tax-exempt entities, hospitals are required by the Internal Revenue Service (IRS) to report the type and cost of community benefits they provide. Institutional theory indicates that organizations derive organizational legitimacy from conforming to the expectations of their environment. Expectations from the state and federal regulators (the IRS, state and local taxing authorities in particular) and the community require hospitals to provide community benefits to achieve legitimacy. This article examines community benefit through an institutional theory framework, which includes regulative (laws and regulation), normative (certification and accreditation), and cultural-cognitive (relationship with the community including the provision of community benefits) pillars. Considering a review of the results of a 2006 IRS study of tax-exempt hospitals, the authors propose a model of hospital community benefit behaviors that distinguishes community benefits between cost-quantifiable activities appropriate for justifying tax exemption and unquantifiable activities that only contribute to hospitals' legitimacy.

22nd Spring Research Festival Showcases Fort Detrick Science | Poster

Science.gov (United States)

Rainy weather couldn’t dampen the spirits of visitors to the 2018 Spring Research Festival, which brought together scientists from the Frederick National Laboratory (FNL), NCI at Frederick, and the U.S. Army Medical Research and Materiel Command (USAMRMC) and showcased the important research that takes place every day at Fort Detrick.

Fort Valley studies: A natural laboratory for research and education

Science.gov (United States)

Brian W. Geils

2008-01-01

Drought, wildfire, extinction, and invasive species are considered serious threats to the health of our forests. Although these issues have global connections, we most readily see their consequences locally and attempt to respond with management based on science. For 100 years, the Fort Valley Experimental Forest (FVEF) has provided educational and experimental support...

Water quality and hydrology in the Fort Belvoir area, Virginia, 1954-55

Science.gov (United States)

Durfor, Charles N.

1961-01-01

This report summarizes the results of an investigation of water quality and hydrology in the Fort Belvoir, Va., area for the period August 1954 to September 1955. It summarizes and evaluates information about the water resources of this area that are pertinent to the choice of location and operation of an Army nuclear power reactor. The quantity, quality, nature, and use of the local water that might be affected by the location and operation of a reactor in the area were subjects of investigation. Variations in the quality of the water caused by variation in streamflow, tidal effects, and pollution were important facets of the investigation. During extended periods of low streamflow in the Potomac River (usually in the late summer months), salty water moves upstream from Chesapeake Bay and increases the dissolved solids content of the surface waters adjacent to Fort Belvoir. When the streamflow is low the concentration of dissolved solids in the water near the river bottom exceeds that near the surface. The waters in Gunston Cove usually contain more dissolved oxygen than those in the Potomac River. During the summer, the content of dissolved oxygen in the cove waters frequently exceeds 100 percent of saturation. Surface floats that were released on a flood tide in Gunston Cove moved toward the inner portion of the cove in the same direction as the wind and the tide. The maximum average velocity of these floats was 0.65 feet per second. On an ebb tide, many surface floats that were released in Gunston Cove moved toward the inner portion of the cove in the direction of the wind, in opposition to the direction of the tidal movement. Floats released near the mouth of the cove on the same tide, moved with the tide out of the cove through a narrow pass at the end of a submerged sandbar extending from the Fort Belvoir shoreline. The maximum average velocity of the floats in the pass on this ebb tide was 0.85 feet per second. Measurements of subsurface flow direction

2009 Federal Emergency Management Agency (FEMA) Topographic LiDAR: Fort Kent, Maine

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Camp Dresser McKee Inc. contracted with Sanborn Map Company to provide LiDAR mapping services for Fort Kent, Maine. Utilizing multi-return systems, Light Detection...

A Study to Develop a Case Mix Model for the Allocation of Impatient Workload for Silas B. Hays Army Community Hospital Fort Ord, California

Science.gov (United States)

1987-06-26

Development Research Department, World Bank, Washington, D.C. Evans, R.G. and H.D. Walker (1972). Information theory and the analysis of hospital cost...system. Medical Care 14: 185-201. Horn, S.D. and D.N. Schumacher (1979). An analysis of case mix complexity using information theory and diagnosis...REL UGT 459 HA 1 1.0 RETINAL PROCEDURES 0.7101 460 HA 3 1.0 OTHER DISORDERS OF JHE EYE AGE 0-17 0.4018 460 HB 7 2.4 T & A PROC EXCEPT TONSILLECTOMY

Financially fragile rural hospitals: mergers and closures.

Science.gov (United States)

Holmes, Mark

2015-01-01

Rural hospitals serve as major sources of health care and employment for their communities, but recently they have been under increased financial stress. What are the causes of this stress, and how have hospitals and their communities responded?

Bastion on the Border: Fort Bliss, 1854-1943

Science.gov (United States)

1993-01-01

Journals , Record Group (RG) 165, Records of the War Department General and Special Staffs, National Archives, Washington, D.C. "’Richard Estrada, Border...it was the Fort Bliss garrison and the other troops deployed by Steever in the El Paso Patrol District that would have to provide the figurative glue ...little military value. For example, on March 30 three carloads of oats, flour , corn, and hay were dispatched; on April 7 fourteen carloads of hay, gasoline

Anxiety and Depression during Transition from Hospital to Community in Older Adults: Concepts of a Study to Explain Late Age Onset Depression

Directory of Open Access Journals (Sweden)

Aislinn F. Lalor

2015-06-01

Full Text Available The transition between extended hospitalization and discharge home to community-living contexts for older adults is a critical time period. This transition can have an impact on the health outcomes of older adults such as increasing the risk for health outcomes like falls, functional decline and depression and anxiety. The aim of this work is to identify and understand why older adults experience symptoms of depression and anxiety post-discharge and what factors are associated with this. This is a mixed methods study of adults aged 65 years and over who experienced a period of hospitalization longer than two weeks and return to community-living post-discharge. Participants will complete a questionnaire at baseline and additional monthly follow-up questionnaires for six months. Anxiety and depression and their resulting behaviors are major public health concerns and are significant determinants of health and wellbeing among the ageing population. There is a critical need for research into the impact of an extended period of hospitalization on the health status of older adults post-discharge from hospital. This research will provide evidence that will inform interventions and services provided for older adults after they have been discharged home from hospital care.

76 FR 77684 - Establishment of the Fort Ross-Seaview Viticultural Area

Science.gov (United States)

2011-12-14

...; Treasury decision. SUMMARY: This Treasury decision establishes the 27,500-acre ``Fort Ross-Seaview... may purchase. DATES: Effective Date: January 13, 2012. FOR FURTHER INFORMATION CONTACT: Elisabeth C... may purchase. Establishment of a viticultural area is neither an approval nor an endorsement by TTB of...

Management of district hospitals--exploring success.

Science.gov (United States)

Couper, Ian D; Hugo, Jannie F M

2005-01-01

The aim of the study was to explore and document what assists a rural district hospital to function well. The lessons learned may be applicable to similar hospitals all over the world. A cross-sectional exploratory study was carried out using in-depth interviews with 21 managers of well-functioning district hospitals in two districts in South Africa. Thirteen themes were identified, integrated into three clusters, namely 'Teams working together for a purpose', 'Foundational framework and values' and 'Health Service and the community'. Teamwork and teams was a dominant theme. Teams working together are held together by the cement of good relationships and are enhanced by purposeful meetings. Unity is grown through solving difficult problems together and commitment to serving the community guides commitment towards each other, and towards patients and staff. Open communication and sharing lots of information between people and teams is the way in which these things happen. The structure and systems that have developed over years form the basis for teamwork. The different management structures and processes are developed with a view to supporting service and teamwork. A long history of committed people who hand over the baton when they leave creates a stable context. The health service and community theme cluster describes how integration in the community and community services is important for these managers. There is also a focus on involving community representatives in the hospital development and governance. Capacity building for staff is seen in the same spirit of serving people and thus serving staff, all aimed at reaching out to people in need in the community. The three clusters and thirteen themes and the relationships between them are described in detail through diagrams and narrative in the article. Much can be learned from the experience of these managers. The key issue is the development of a team in the hospital, a team with a unified vision of giving

Dimensions of Velopharyngeal Space following Maxillary Advancement with Le Fort I Osteotomy Compared to Zisser Segmental Osteotomy: A Cephalometric Study

Directory of Open Access Journals (Sweden)

Furkan Erol Karabekmez

2015-01-01

Full Text Available The objectives of this study are to assess the velopharyngeal dimensions using cephalometric variables of the nasopharynx and oropharynx as well as to compare the Le Fort I osteotomy technique to Zisser’s anterior maxillary osteotomy technique based on patients’ outcomes within early and late postoperative follow-ups. 15 patients with severe maxillary deficiency treated with Le Fort I osteotomy and maxillary segmental osteotomy were assessed. Preoperative, early postoperative, and late postoperative follow-up lateral cephalograms, patient histories, and operative reports are reviewed with a focus on defined cephalometric landmarks for assessing velopharyngeal space dimension and maxillary movement (measured for three different tracing points. A significant change was found between preoperative and postoperative lateral cephalometric measurements regarding the distance between the posterior nasal spine and the posterior pharyngeal wall in Le Fort I osteotomy cases. However, no significant difference was found between preoperative and postoperative measurements in maxillary segmental osteotomy cases regarding the same measurements. The velopharyngeal area calculated for the Le Fort I osteotomy group showed a significant difference between the preoperative and postoperative measurements. Le Fort I osteotomy for advancement of upper jaw increases velopharyngeal space. On the other hand, Zisser’s anterior maxillary segmental osteotomy does not alter the dimension of the velopharyngeal space significantly.

The safety of CRT with high-dose cisplatin for head and neck cancers in a community hospital and the renal protection effect with magnesium

International Nuclear Information System (INIS)

Ariizumi, Yosuke; Takahashi, Ryosuke; Tateishi, Yumiko; Yamada, Masato

2016-01-01

To confirm the safety of CRT with cisplatin 100mg/m"2 for head and neck cancers in a community hospital in Japan and the renal protection effect with magnesium (Mg) supplementation. A retrospective review of 13 head and neck cancers (oropharynx, hypopharynx, and larynx) was conducted. The patients of the 80mgMg - group received CDDP 80mg/m"2 without Mg supplementation, and 100mgMg + group received CDDP 100mg/m"2 with Mg supplementation. Our hospital is a community hospital, therefore second and third administrations of CDDP are discontinued with a lower level of adverse effects than clinical trials. The total dose of CDDP and adverse effects of the two groups were compared. The grade 3 adverse effects were 5 (38%) with stomatitis, 3 (23%) with decreased white blood cell count, 1 (8%) with decreased platelet count, and 1 (8%) with febrile neutropenia. There was no grade 4 adverse effect. The proportion of patients who could receive 200mg/m"2 or more was higher (p = 0.0097) in the 100mgMg + group (7/7) than the 80mgMg - group (1/6). CRT with CDDP 100mg/m"2 at a community hospital in Japan is feasible, with reduction of renal toxicity by Mg supplementation. (author)

Opening remarks for the Fort Valley Centennial Celebration (P-53)

Science.gov (United States)

G. Sam Foster

2008-01-01

The Rocky Mountain Research Station recognizes and values the contributions of our scientists and collaborators for their work over the past century at Fort Valley Experimental Forest. With the help of our partners and collaborators, Rocky Mountain Research Station is working to improve coordination across its research Program Areas and Experimental Forests and Ranges...

The impact of community-based palliative care on acute hospital use in the last year of life is modified by time to death, age and underlying cause of death. A population-based retrospective cohort study.

Science.gov (United States)

Spilsbury, Katrina; Rosenwax, Lorna; Arendts, Glenn; Semmens, James B

2017-01-01

Community-based palliative care is known to be associated with reduced acute care health service use. Our objective was to investigate how reduced acute care hospital use in the last year of life varied temporally and by patient factors. A retrospective cohort study of the last year of life of 12,763 Western Australians who died from cancer or one of seven non-cancer conditions. Outcome measures were rates of hospital admissions and mean length of hospital stays. Multivariate analyses involved time-to-event and population averaged log-link gamma models. There were 28,939 acute care overnight hospital admissions recorded in the last year of life, an average of 2.3 (SD 2.2) per decedent and a mean length of stay of 9.2 (SD 10.3) days. Overall, the rate of hospital admissions was reduced 34% (95%CI 1-66) and the mean length of stay reduced 6% (95%CI 2-10) during periods of time decedents received community-based palliative care compared to periods of time not receiving this care. Decedents aged community-based palliative care showed a reduced rate of hospital admission around five months before death, whereas for older decedents the reduction in hospital admissions was apparent a year before death. All decedents who were receiving community-based palliative care tended towards shorter hospital stays in the last month of life. Decedents with neoplasms had a mean length of stay three weeks prior to death while not receiving community-based palliative care of 9.6 (95%CI 9.3-9.9) days compared to 8.2 (95% CI 7.9-8.7) days when receiving community-based palliative care. Rates of hospital admission during periods of receiving community-based palliative care were reduced with benefits evident five months before death and even earlier for older decedents. The mean length of hospital stay was also reduced while receiving community-based palliative care, mostly in the last month of life.

Relationship of Work Therapy to Psychiatric Length of Stay and Readmission

Science.gov (United States)

Barbee, Margaret S.; and others

1969-01-01

Results indicated that participants in an in-hospital work-therapy program, randomly selected patients in Fort Logan Mental Health Center, had longer stays in both intensive treatment and total hospitalization and had more readmissions to Fort Logan than nonparticipants. Reprints available from authors at Fort Logan Mental Health Center, Denver,…

Field Demonstration of Aviation Turbine Fuel MIL-T-83133C, Grade JP-8 (NATO Code F-34), at Fort Bliss, TX

Science.gov (United States)

1992-09-01

APO NY 09052 CDR US ARMY NATICK RD&E CTR DOD PROJ MGR, MOBILE ELECTRIC POWER ATTN: SATNC-US US ARMY TROOP SUPPORT COMMAND NATICK MA 01760-5020 ATUN ...US ARMY QUARTERMASTER SCHOOL ATUN : LOEA-PL (MR LeVAN) I ATTN: ATSM-CDM 1 NEW CUMBERLAND PA 17070 ATSM-PWD I FORT LEE VA 23801 PETROLEUM FIELD OFFICE...ARTILLERY CENTER US ARMY INFANTRY SCHOOL & FORT BLISS ATTN: ATSH-CD-MIS-M I ATUN : ATZC-ISL-PP 3 ATSH-CD-TSM-T 1 ATZC-ISL-MM 3 FORT BENNING GA 31905-5400

ORNL's NRC-sponsored HTGR safety and licensing analysis activities for Fort St. Vrain and advanced reactors

International Nuclear Information System (INIS)

Ball, S.J.; Cleveland, J.C.; Harrington, R.M.

1985-01-01

The ORNL safety analysis program for the HTGR was established in 1974 to provide technical assistance to the USNRC on licensing questions for both Fort St. Vrain and advanced plant concepts. The emphasis has been on development of major component and system dynamic simulation codes, and use of these codes to analyze specific licensing-related scenarios. The program has also emphasized code verification, using Fort St. Vrain data where applicable, and comparing results with industry-generated codes. By the use of model and parameter adjustment routines, safety-significant uncertainties have been identified. A major part of the analysis work has been done for the Fort St. Vrain HTGR, and has included analyses of FSAR accident scenario re-evaluations, the core block oscillation problem, core support thermal stress questions, technical specification upgrade review, and TMI action plan applicability studies. The large, 2240-MW(t) cogeneration lead plant design was analyzed in a multi-laboratory cooperative effort to estimate fission product source terms from postulated severe accidents

Operational experience at Fort St. Vrain

International Nuclear Information System (INIS)

Bramblett, G.C.; Fisher, C.R.; Swart, F.E.

1981-01-01

The Fort St. Vrain (FSV) station, a 330-MW(e) single reheat steam cycle powered by a high-temperature gas-cooled reactor (HTGR), is the first HTGR to enter commercial operation. Designed and built by General Atomic Company (GA), the plant is owned and operated by Public Service Company of Colorado (PSC). Many unique design features have been incorporated into this reactor system, including high-pressure helium as the primary system coolant, a graphite-moderated prismatic block core design, fission-product-containing carbide coatings on both fissile and fertile fuel particles, steam-driven helium circulators turning on water bearings, and once-through steam generators. All of these systems are contained in a prestressed concrete reactor vessel (PCRV). Extensive testing has been conducted during the rise to power following first criticality early in 1974 to verify system design performance. During this period, the plant has operated at power levels up to 70% and produced over one billion kilowatt hours of electricity. In 1979, the first refueling was conducted in conjunction with an extensive in-core inspection, the addition of in-core instrumentation, and a planned removal of a circulator for inspection. Later in the year, a scheduled shutdown was undertaken for surveillance tests, insertion of core region constraint devices (RCDs), and other maintenance. Fort St. Vrain has encountered problems of the type that would be expected in a first-of-a-kind system. The plant is currently restricted to 70% of design power by the Nuclear Regulatory Commission (NRC) pending resolution of the core region gas outlet temperature fluctuation problem. Even so, the basic performance of the HTGR concept and all of the unique design features have been successfully demonstrated. The system has been characterized by low personnel radiation exposures, operational flexibility, and long time afforded for status evaluation and response. (author)

Automated Environmental Data Collection at Fort Benning, Georgia, from May 1999 to July 2001

National Research Council Canada - National Science Library

Hahn, Charles

2002-01-01

The Department of Defense, Strategic Environmental Research and Development Program, Ecosystem Management Project, Ecosystem Characterization and Monitoring initiative Program at Fort Benning, Georgia...

The changing nature of nursing work in rural and small community hospitals.

Science.gov (United States)

Montour, Amy; Baumann, Andrea; Blythe, Jennifer; Hunsberger, Mabel

2009-01-01

The nursing literature includes descriptions of rural nursing workforces in Canada, the United States of America and Australia. However, inconsistent definitions of rural demography, diverse employment conditions and health care system reorganization make comparisons of these data difficult. In 2007, the Ministry of Health and Long-term Care in Ontario, Canada, transferred responsibility for decision-making and funding to 14 regional governing bodies known as Local Health Integration Networks (LHINs). Little is known about rural-urban variations in the nursing workforces in the LHINs because existing data repositories do not describe them. This study investigated the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on nursing work in a geographically unique rural region. The purpose was to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. The study was conducted in 7 small rural and community hospitals in the Hamilton Niagara Haldimand Brant LHIN. Data collection occurred between August and November 2007. A qualitative descriptive study design was chosen to facilitate exploration of nursing in the rural setting. Study participants were identified through purposive snowball sampling. All nurses, nurse managers and nurse executives currently employed in the 7 study hospitals were eligible to participate. Data collection included the use of questionnaires and semi-structured interviews. Memos were also created to describe the relevance and applicability of concepts, categories and properties emerging from the data. Themes were compared across interviews to determine relevance and value. Twenty-one nurses from 7 different hospitals participated. The nurses reflect the aging trend in the provincial and regional workforces of Ontario. All study participants anticipate a substantial increase in retirements during the next decade, which will alter

Additional measures do not improve the diagnostic accuracy of the Hospital Admission Risk Profile for detecting downstream quality of life in community-dwelling older people presenting to a hospital emergency department.

Science.gov (United States)

Grimmer, K; Milanese, S; Beaton, K; Atlas, A

2014-01-01

The Hospital Admission Risk Profile (HARP) instrument is commonly used to assess risk of functional decline when older people are admitted to hospital. HARP has moderate diagnostic accuracy (65%) for downstream decreased scores in activities of daily living. This paper reports the diagnostic accuracy of HARP for downstream quality of life. It also tests whether adding other measures to HARP improves its diagnostic accuracy. One hundred and forty-eight independent community dwelling individuals aged 65 years or older were recruited in the emergency department of one large Australian hospital with a medical problem for which they were discharged without a hospital ward admission. Data, including age, sex, primary language, highest level of education, postcode, living status, requiring care for daily activities, using a gait aid, receiving formal community supports, instrumental activities of daily living in the last week, hospitalization and falls in the last 12 months, and mental state were collected at recruitment. HARP scores were derived from a formula that summed scores assigned to age, activities of daily living, and mental state categories. Physical and mental component scores of a quality of life measure were captured by telephone interview at 1 and 3 months after recruitment. HARP scores are moderately accurate at predicting downstream decline in physical quality of life, but did not predict downstream decline in mental quality of life. The addition of other variables to HARP did not improve its diagnostic accuracy for either measure of quality of life. HARP is a poor predictor of quality of life.

DIGITAL PRESERVATION OF THE QUON SANG LUNG LAUNDRY BUILDING, FORT MACLEOD, ALBERTA

Directory of Open Access Journals (Sweden)

P. Dawson

2017-08-01

Full Text Available This paper describes the results of an emergency recording and archiving of a historic structure in Southern Alberta and explores the lessons learned. Digital recording of the Quon Sang Lung Laundry building in Fort Macleod, Alberta, was a joint initiative between Alberta Culture and Tourism and the University of Calgary. The Quon Sang Lung Laundry was a boomtown-style wood structure situated in the Fort Macleod Provincial Historic Area, Alberta. Built in the mid-1800s, the structure was one of the four buildings comprising Fort Macleod’s Chinatown. Its association with Chinese immigration, settlement, and emergence of Chinese-owned businesses in early twentieth-century Alberta, made the Quon Sang Lung Laundry a unique and very significant historic resource. In recent years, a condition assessment of the structure indicated that the building was not safe and that the extent of the instability could lead to a sudden collapse. In response, Alberta Culture and Tourism engaged the Departments of Anthropology and Archaeology and Geomatics Engineering from the University of Calgary, to digitally preserve the laundry building. A complete survey including the laser scanning of all the remaining elements of the original structure, was undertaken. Through digital modeling, the work guarantees that a three-dimensional representation of the building is available for future use. This includes accurate 3D renders of the exterior and interior spaces and a collection of architectural drawings comprising floor plans, sections, and elevations.

Le Fort III Distraction With Internal vs External Distractors: A Cephalometric Analysis.

Science.gov (United States)

Robertson, Kevin J; Mendez, Bernardino M; Bruce, William J; McDonnell, Brendan D; Chiodo, Michael V; Patel, Parit A

2018-05-01

This study compares the change in midface position following Le Fort III advancement using either rigid external distraction (group 1) or internal distraction (group 2). We hypothesized that, with reference to right-facing cephalometry, internal distraction would result in increased clockwise rotation and inferior displacement of the midface. Le Fort III osteotomies and standardized distraction protocols were performed on 10 cadaveric specimens per group. Right-facing lateral cephalograms were traced and compared across time points to determine change in position at points orbitale, anterior nasal spine (ANS), A-point, and angle ANB. Institutional. Twenty cadaveric head specimens. Standard subcranial Le Fort III osteotomies were performed from a coronal approach and adequately mobilized. The specified distraction mechanism was applied and advanced by 15 mm. Changes of position were calculated at various skeletal landmarks: orbitale, ANS, A-point, and ANB. Group 1 demonstrated relatively uniform x-axis advancement with minimal inferior repositioning at the A-point, ANS, and orbitale. Group 2 demonstrated marked variation in x-axis advancement among the 3 points, along with a significant inferior repositioning and clockwise rotation of the midface ( P External distraction resulted in more uniform advancement of the midface, whereas internal distraction resulted in greater clockwise rotation and inferior displacement. External distraction appears to provide increased vector control of the midface, which is important in creating a customized distraction plan based on the patient's individual occlusal and skeletal needs.

Digital Preservation of the Quon Sang Lung Laundry Building, Fort Macleod, Alberta

Science.gov (United States)

Dawson, P.; Baradaran, F.; Jahraus, A.; Rubalcava, E.; Farrokhi, A.; Robinson, C.

2017-08-01

This paper describes the results of an emergency recording and archiving of a historic structure in Southern Alberta and explores the lessons learned. Digital recording of the Quon Sang Lung Laundry building in Fort Macleod, Alberta, was a joint initiative between Alberta Culture and Tourism and the University of Calgary. The Quon Sang Lung Laundry was a boomtown-style wood structure situated in the Fort Macleod Provincial Historic Area, Alberta. Built in the mid-1800s, the structure was one of the four buildings comprising Fort Macleod's Chinatown. Its association with Chinese immigration, settlement, and emergence of Chinese-owned businesses in early twentieth-century Alberta, made the Quon Sang Lung Laundry a unique and very significant historic resource. In recent years, a condition assessment of the structure indicated that the building was not safe and that the extent of the instability could lead to a sudden collapse. In response, Alberta Culture and Tourism engaged the Departments of Anthropology and Archaeology and Geomatics Engineering from the University of Calgary, to digitally preserve the laundry building. A complete survey including the laser scanning of all the remaining elements of the original structure, was undertaken. Through digital modeling, the work guarantees that a three-dimensional representation of the building is available for future use. This includes accurate 3D renders of the exterior and interior spaces and a collection of architectural drawings comprising floor plans, sections, and elevations.

Safety and licensing analyses for the Fort St. Vrain HTGR

International Nuclear Information System (INIS)

Ball, S.J.; Conklin, J.C.; Harrington, R.M.; Cleveland, J.C.; Clapp, N.E. Jr.

1982-01-01

The Oak Ridge National Laboratory (ORNL) safety analysis program for the HTGR includes development and verification of system response simulation codes, and applications of these codes to specific Fort St. Vrain reactor licensing problems. Licensing studies addressed the oscillation problems and the concerns about large thermal stresses in the core support blocks during a postulated accident

Early thinning experiments established by the Fort Valley Experimental Forest

Science.gov (United States)

Benjamin P. De Blois; Alex. J. Finkral; Andrew J. Sanchez Meador; Margaret M. Moore

2008-01-01

Between 1925 and 1936, the Fort Valley Experimental Forest (FVEF) scientists initiated a study to examine a series of forest thinning experiments in second growth ponderosa pine stands in Arizona and New Mexico. These early thinning plots furnished much of the early background for the development of methods used in forest management in the Southwest. The plots ranged...

78 FR 32699 - Notice of Intent To Rule on Request to Release Airport Property at the Fort Worth Spinks Airport...

Science.gov (United States)

2013-05-31

... to Release Airport Property at the Fort Worth Spinks Airport, Fort Worth, Texas AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of request to release airport property. SUMMARY: The FAA... the provisions of Section 125 of the Wendell H. Ford Aviation Investment Reform Act for the 21st...

Critical Access Hospitals (CAH)

Science.gov (United States)

... for Success Am I Rural? Evidence-based Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning ... hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, ...

78 FR 3479 - Notice of Public Meeting of Fort Scott Council

Science.gov (United States)

2013-01-16

... submitted on cards that will be provided at the meeting, via mail to Laurie Fox, Presidio Trust, 103... stated prominently at the beginning of the comments. The Trust will make available for public inspection... PRESIDIO TRUST Notice of Public Meeting of Fort Scott Council AGENCY: The Presidio Trust. ACTION...

Fort Hills Oil Sands Project No Net Loss Lake earthfill structure

Energy Technology Data Exchange (ETDEWEB)

Blakely, D.; Sawatsky, L. [Golder Associates Ltd., Calgary, AB (Canada); Wog, K.; Paz, S. [Alberta Environment, Edmonton, AB (Canada). Water Management Operations; Chernys, S. [Petro-Canada, Calgary, AB (Canada)

2007-07-01

The Fort Hills Oil Sands Project (FHOSP) is located north of Fort McMurray, Alberta. The Fort Hills Energy Corporation (FHEC) must compensate for fish habitat lost as a result of mine development that would disturb natural streams and lakes. FHEC planned to construct a fisheries compensation lake on the north end of its leased property, contained in part by an earthfill structure. Unlike most dam structures, the FHOSP No Net Loss Lake (NNLL) earthfill structure was planned solely for the creation of fisheries compensation habitat. Therefore, the NNLL earthfill structure must be designed with robust features that can handle any foreseeable environmental condition without failure, so that it may be accepted as a sustainable feature of the mine closure landscape. This paper discussed the design features of the NNLL earthfill structure. The paper presented information on the background of the project including regulatory criteria for the fisheries compensation habitat; fisheries compensation habitat location; and design criteria for the NNLL. The features of the NNLL earthfill structure were also discussed. In addition, the paper outlined the dam safety classification for earthfill structure and anticipated system performance. The proposed monitoring program and permanent closure plans were also discussed. It was concluded that the earthfill structure was designed with several features that would allow it to become a part of the closure landscape. These included a high width to height ratio, significant erosion protection, and an aggressive reclamation plan. These features will provide a sound basis for FHEC to apply for a reclamation certificate at the end of mine life. 3 refs., 3 tabs., 8 figs.

Fort Hood Building and Landscape Inventory with WWII and Cold War Context

Science.gov (United States)

2007-03-01

barracks, 1970s (NARA)........................................................... 112 Figure 37. Palmer Movie Theater (NARA...revised 1953) showing layout of Hood Village and trailer park (Fort Hood...arms ammunition storage building #92012 (ERDC-CERL, 2004). ......... 260 Figure 163: Radio reception building #92063 (ERDC-CERL, 2004

Nurses' health promoting lifestyle behaviors in a community hospital.

Science.gov (United States)

Kurnat-Thoma, Emma; El-Banna, Majeda; Oakcrum, Monica; Tyroler, Jill

2017-06-01

To examine nurses' health-promoting lifestyle behaviors, describe their self-reported engagement in employee wellness program benefit options, and explore relationships between nurse demographic factors, health characteristics and lifestyle behaviors. Nurses adopting unhealthy lifestyle behaviors are at significantly higher risk for developing a number of chronic diseases and are at increased susceptibility to exhaustion, job dissatisfaction and turnover. Strengthening professional nurses' abilities to engage in healthy lifestyle behaviors could serve as a valuable tool in combating negative workplace stress, promote improved work-life balance and personal well-being, and help retain qualified health-care providers. In a 187-bed community hospital in the Washington D.C. metropolitan area, we conducted an IRB-approved exploratory descriptive study. We examined 127 nurses' demographic characteristics, self-reported employer wellness program use, and measured their healthy lifestyle behaviors using the 52-item Health-Promoting Lifestyle Profile-II (HPLP-II) survey instrument. Nurse demographic and HPLP-II scores were analyzed in SPSS v20.0. Inferential univariate statistical testing examined relationships between nurse demographic factors, health and job characteristics, and HPLP-II score outcomes. Nurses over 40years old were more likely to report participation in hospital wellness program options. Statistically significant age differences were identified in total HPLP-II score (p=0.005), and two subscale scores-spiritual growth (p=0.002) and interpersonal relations (p=0.000). Post-hoc testing identified nurse participants 40-49years old and ≥50years old experienced slightly lower total HPLP-II score, subscale scores in comparison to younger colleagues. Nurses ≥40years old may benefit from additional employer support and guidance to promote and maintain healthy lifestyles, personal well-being, and positive interpersonal relationships. Copyright © 2017 Elsevier

Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

Science.gov (United States)

Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

2014-01-01

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

Vendor Payments-Operation Mongoose, Fort Belvoir Defense Accounting Office and Rome Operating Location

National Research Council Canada - National Science Library

Lane, F

1996-01-01

.... Due to the impending closure of the Defense Accounting Office at Fort Belvoir and the anticipated consolidation to the Rome Operating Location, New York, we did not perform a review of the management...

Revised Geologic Map of the Fort Garland Quadrangle, Costilla County, Colorado

Science.gov (United States)

Wallace, Alan R.; Machette, Michael N.

2008-01-01

The map area includes Fort Garland, Colo., and the surrounding area, which is primarily rural. Fort Garland was established in 1858 to protect settlers in the San Luis Valley, then part of the Territory of New Mexico. East of the town are the Garland mesas (basalt-covered tablelands), which are uplifted as horsts with the Central Sangre de Cristo fault zone. The map also includes the northern part of the Culebra graben, a deep structural basin that extends from south of San Luis (as the Sanchez graben) to near Blanca, about 8 km west of Fort Garland. The oldest rocks exposed in the map area are early Proterozic basement rocks (granites in Ikes Creek block) that occupy an intermediate structural position between the strongly uplifted Blanca Peak block and the Culebra graben. The basement rocks are overlain by Oligocene volcanic and volcaniclastic rocks of unknown origin. The volcanic rocks were buried by a thick sequence of basin-fill deposits of the Santa Fe Group as the Rio Grande rift formed about 25 million years ago. The Servilleta Basalt, a regional series of 3.7?4.8 Ma old flood basalts, was deposited within sediment, and locally provides a basis for dividing the group into upper and lower parts. Landslide deposits and colluvium that rest on sediments of the Santa Fe Group cover the steep margins of the mesas. Exposures of the sediment beneath the basalt and within the low foothills east of the Central Sangre de Cristo fault zone are comprised of siltstones, sandstones, and minor fluvial conglomerates. Most of the low ground surrounding the mesas and in the graben is covered by surficial deposits of Quaternary age. The alluvial deposits are subdivided into three Pleistocene-age units and three Holocene-age units. The oldest Pleistocene gravel (unit Qao) is preserved as isolated remnants that cap high surfaces north and east of Fort Garland. The primary geologic hazards in the map area are from earthquakes, landslides, and localized flooding. The Central

Alberta oil sands community exposure and health effects assessment : analysis of health records as a proxy for health outcomes

International Nuclear Information System (INIS)

Wang, F.; Mackenzie, A.; Schopflocher, D.; Shaw, S.; Robb, J.; Gabos, S.

2002-01-01

A large scale study was conducted to assess potential links between air quality and human health outcomes. Health records were used as a proxy measure for health outcomes. Residents of Fort McMurray and Lethbridge, Alberta, Canada were used in the comparison of risks of selected morbidity and mortality measures during a 3 year period between 1995 and 1998. Data on the socio-demography, morbidity, and mortality were linked by PI and geographic area from the Health Care Insurance Plan, physical and hospital billing systems, and vital statistics death registration. Age was the most important confounder. Asthma incidence for children 3 years or less was examined along with prevalence and mortality of selected diseases for each sex and age group. Results showed that the incidence of asthma varied by age and sex but not by study area. There was no major difference in death from lung cancer, cardiovascular disease, coronary heart disease, respiratory disorders and COPD between residents of the target and control communities. 6 figs

Fort Carson Building 1860 Biomass Heating Analysis Report

Energy Technology Data Exchange (ETDEWEB)

Hunsberger, Randolph [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tomberlin, Gregg [National Renewable Energy Lab. (NREL), Golden, CO (United States); Gaul, Chris [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2015-09-01

As part of the Army Net-Zero Energy Installation program, the Fort Carson Army Base requested that NREL evaluate the feasibility of adding a biomass boiler to the district heating system served by Building 1860. We have also developed an Excel-spreadsheet-based decision support tool--specific to the historic loads served by Building 1860--with which users can perform what-if analysis on gas costs, biomass costs, and other parameters. For economic reasons, we do not recommend adding a biomass system at this time.

Basewide Energy Study, Fort Wainwright Alaska: Volume 1-Executive Summary

Science.gov (United States)

1982-04-01

more accurate condensate wiett?Ing. 2.2 ENERGY OSAGE ANALISIS 4 top~down anay2ts was mad" of FY’•0 ener;’ uxage’ t Fort wrtsvrigFnt. The spporiIonments...vice, at each receptacle cluster . It should be thermally sensitlve. rtdtcing through-put from 600 watts at -SOOT to0soer power at 100? outside air

Flood-inundation maps for the St. Marys River at Fort Wayne, Indiana

Science.gov (United States)

Menke, Chad D.; Kim, Moon H.; Fowler, Kathleen K.

2012-01-01

Digital flood-inundation maps for a 9-mile reach of the St. Marys River that extends from South Anthony Boulevard to Main Street at Fort Wayne, Indiana, were created by the U.S. Geological Survey (USGS) in cooperation with the City of Fort Wayne. The inundation maps, which can be accessed through the USGS Flood Inundation Mapping Science Web site, depict estimates of the areal extent of flooding corresponding to selected water levels (stages) at the USGS streamgage 04182000 St. Marys River near Fort Wayne, Ind. Current conditions at the USGS streamgages in Indiana may be obtained from the National Water Information System: Web Interface. In addition, the information has been provided to the National Weather Service (NWS) for incorporation into their Advanced Hydrologic Prediction Service (AHPS) flood warning system. The NWS forecasts flood hydrographs at many places that are often collocated at USGS streamgages. That forecasted peak-stage information, also available on the Internet, may be used in conjunction with the maps developed in this study to show predicted areas of flood inundation. In this study, water-surface profiles were simulated for the stream reach by means of a hydraulic one-dimensional step-backwater model. The model was calibrated using the most current stage-discharge relation at the USGS streamgage 04182000 St. Marys River near Fort Wayne, Ind. The hydraulic model was then used to simulate 11 water-surface profiles for flood stages at 1-ft intervals referenced to the streamgage datum and ranging from bankfull to approximately the highest recorded water level at the streamgage. The simulated water-surface profiles were then combined with a geographic information system digital elevation model (derived from Light Detection and Ranging (LiDAR) data) in order to delineate the area flooded at each water level. A flood inundation map was generated for each water-surface profile stage (11 maps in all) so that for any given flood stage users will be

Using a SWOT analysis to inform healthy eating and physical activity strategies for a remote First Nations community in Canada.

Science.gov (United States)

Skinner, Kelly; Hanning, Rhona M; Sutherland, Celine; Edwards-Wheesk, Ruby; Tsuji, Leonard J S

2012-01-01

To plan community-driven health promotion strategies based on a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the healthy eating and physical activity patterns of First Nation (FN) youth. Cross-sectional qualitative and quantitative data used to develop SWOT themes and strategies. Remote, subarctic FN community of Fort Albany, Ontario, Canada. Adult (n  =  25) and youth (n  =  66, grades 6-11) community members. Qualitative data were collected using five focus groups with adults (two focus groups) and youth (three focus groups), seven individual interviews with adults, and an environmental scan of 13 direct observations of events/locations (e.g., the grocery store). Quantitative data on food/physical activity behaviors were collected using a validated Web-based survey with youth. Themes were identified from qualitative and quantitative data and were analyzed and interpreted within a SWOT matrix. Thirty-two SWOT themes were identified (e.g., accessibility of existing facilities, such as the gymnasium). The SWOT analysis showed how these themes could be combined and transformed into 12 strategies (e.g., expanding and enhancing the school snack/breakfast program) while integrating suggestions from the community. SWOT analysis was a beneficial tool that facilitated the combination of local data and community ideas in the development of targeted health promotion strategies for the FN community of Fort Albany.

Fort St. Vrain improvement program plan. Draft final report

International Nuclear Information System (INIS)

1980-03-01

The restraints are described which inhibit the Fort St. Vrain (FSV) Nuclear Power Station, a high temperature gas cooled reactor (HTGR) plant, from achieving full power operation with high availability. The actions necessary to overcome these restraints are outlined. The restraints originated from problems in both hardware related and institutional areas. The report summarizes what has been accomplished, what is currently being done, and what should be done to resolve the problems

[Crisis unit at the general hospital: Determinants of further hospitalization].

Science.gov (United States)

Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

2017-10-01

The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

No specific time window distinguishes between community-, healthcare-, and hospital-acquired bacteremia, but they are prognostically robust

DEFF Research Database (Denmark)

Gradel, Kim Oren; Nielsen, Stig Lønberg; Pedersen, Court

2014-01-01

), and hospital acquisition influenced the results of prognostic models. Design. Population-based cohort study. Setting. Hospitals in 3 areas of Denmark (2.3 million inhabitants) during 2000-2011. Methods. We computed graphs depicting proportions of males, absence of comorbidity, microorganisms, and 30-day......], 1.23-1.37) to 1.99 (95% CI, 1.48-2.67) for HCA and from 1.36 (95% CI, 1.24-1.50) to 2.53 (95% CI, 2.01-3.20) for hospital acquisition compared with community acquisition. Area under the ROC curve changed marginally from 0.684 (95% CI, 0.679-0.689) to 0.700 (95% CI, 0.695-0.705). Conclusions. No time......) curve for 30-day mortality, adjusting for sex, age, comorbidity, and microorganisms. Results. For 56,606 bacteremic episodes, no sharp transitions were detected on a specific day after admission. Among the 8 combined time windows, ORs for 30-day mortality varied from 1.30 (95% confidence interval [CI...

Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.

Directory of Open Access Journals (Sweden)

Cynthia Chen

Full Text Available OBJECTIVES: To (1 identify social and rehabilitation predictors of nursing home placement, (2 investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN: National data were retrospectively extracted from medical records of community hospital. DATA SOURCES: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3% patients were discharged home and 924 (9.7% patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37, other community hospital (n = 31, death in community hospital (n = 12, acute hospital (n = 1,182 and discharge against doctor's advice (n = 24 were excluded. OUTCOME MEASURE: Nursing home placement. RESULTS: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years, had lower mean Bathel Index scores (40 vs. 48, a longer median length of stay (40 vs. 33 days and a longer time to rehabilitation (19 vs. 15 days, had a higher proportion without a caregiver (28 vs. 7%, being single (21 vs. 7% and had dementia (23 vs. 10%. Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001 and 65% (p = 0.043 respectively compared to stroke patients. CONCLUSIONS: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such

"The family is the clinic, the community is the hospital": community mental health in Timor-Leste.

Science.gov (United States)

Hawkins, Zoe; Tilman, Teofilo

2011-07-01

This paper describes the history and recent development of mental health services in Timor-Leste, a small developing country recovering from conflict. Challenges to effective service delivery are discussed as well as plans for future development. Timor-Leste's mental health service began just over a decade ago. Unlike many other low and middle income countries where hospital-based services predominate, the mental health model in Timor-Leste is entirely community based. However, challenges to effective mental health care delivery are similar to most developing countries and include a lack of sufficient financial resources, human resources, and mental health infrastructure. Addressing these issues successfully requires political will, a greater prioritization of mental health services, close coordination between stakeholders, as well as developments in the area of education, training and infrastructure. Greater understanding and education about the links between mental and physical health would benefit the overall health of the population, and integration of these respective policies may prove a successful method of more equitably redistributing finances and resources.

Management of Groin Abcess with Flaminal Forte and KerraMax Care

Directory of Open Access Journals (Sweden)

Maggie Pugh

2016-04-01

Full Text Available The patient’s dressing plan using Flaminal Forte and KerraMax Care successfully managed the complexities of his wound, absorbing exudate, reducing pain on dressing, malodour and wound bioburden. Moreover, the plan encouraged patient concordance, reduced nursing consultation time and subsequently altered treatment plans for our patients with abscesses

Gynecologic Malignancies Post-LeFort Colpocleisis

Directory of Open Access Journals (Sweden)

Rayan Elkattah

2014-01-01

Full Text Available Introduction. LeFort colpocleisis (LFC is a safe and effective obliterative surgical option for older women with advanced pelvic organ prolapse who no longer desire coital activity. A major disadvantage is the limited ability to evaluate for post-LFC gynecologic malignancies. Methods. We present the first case of endometrioid ovarian cancer diagnosed after LFC and review all reported gynecologic malignancies post-LFC in the English medical literature. Results. This is the second reported ovarian cancer post-LFC and the first of the endometrioid subtype. A total of nine other gynecologic malignancies post-LFC have been reported in the English medical literature. Conclusions. Gynecologic malignancies post-LFC are rare. We propose a simple 3-step strategy in evaluating post-LFC malignancies.

A Case Analysis of Energy Savings Performance Contract Projects and Photovoltaic Energy at Fort Bliss, El Paso, Texas

Science.gov (United States)

2006-06-01

PHOTOVOLTAIC ENERGY AND FORT BLISS CASE BACKGROUND A. PHOTOVOLTAIC ENERGY The use of photovoltaic power systems is nothing new in the Department...against the Outback MPPT charge controller . This test will be done over a one month timeframe. The Arizona Power ISG test plan is contained in...cost-benefit analysis of conventional power versus emerging photovoltaic energy for the Army’s Fort Bliss in El Paso, TX. The project will also analyze